The clinical experience about treatment of refractory neonatal jaundice
                                                                Written by Sunshufen   Translated by Hu Xiaohua
 

Case 2
Child patient 2, female, three-month-old, first visit on Jul. 02, 2005
Yellow skin 3 days after birth, disappeared after 2 weeks and recurrence at the fourth week, severer day by day, brown urine and white stool. Anti-infection, protecting liver and transfusion were used, no effect. Abdominal ultrasound reported increased density of liver, gallbladder and common bile duct image was invisible. Isotope scanning, 6h after intravenous injection of developer, “invisible development of intestinal, bile duct and gallbladder ”, reported “congenital atresia of biliary tract ”.
By exploratory laparotomy, 20ml bile was seen in abdominen, hepatomegaly reached 10cm subcostally, hard texture and brown color, yellowish green section, gallbladder was 1.0 cm×5.0 cm, common bile duct atresia showed fibrous bands, with 0.6~0.8 cm diameter, and then Roux en Y hepaticoportojejunostomy. Yellow sclera and skin disappeared slightly after 3 days of the operation, dull complexion, weakness with weight of 4.3 kg, 0.6 kg increasing every month averagely. Fatigue and sleepiness, deep yellow urine, pottery color and diluted stool, 5-6 times stool per day. abdominal distention, obvious venulae, hepatomegaly reached 4.5 cm right subcostally, 2.cm xiphoid process.
Lab test: Serum total bilirubin was 250μmol/L, direct bilirubin was 132μmol/L, alanine aminotransferase was 93 U/L, alkaline phosphatase was 988 U/L. pale red tongue, white and thick tongue fur, purplish and dull index finger veins.
Syndrome differentiation: stagnation of dampness due to splenic asthenia, dysfunction of hepatobiliary conducting and dispersing.
Treatment: invigorating spleen to re solve dampness, dispersing stagnation and dredging the collaterals
Prescriptions: fresh Malt12g, seeding of virgate wermwood 10g, jinqiancao herba 10g, Rice Paperiant Pith 4g, poria cocos 9g, atractylodes 4g, prepared hyacinth bean 9g, prepared chinese yam 9g, pangolin processed with vinegar 4g. Decocted 15 min, extracted juice 90ml, added Alum 0.3g, Indigo pulverata levis 0.3g, Resina Draconis 0.3g and Amber 0.3g were made into powder and added into juice, 1 decoction per day (oral take 3 times separately per day, 30ml per time). After 15-day treatment, stool showed yellow. The same prescription was taken 1 month more, the yellow sclera and skin disappeared, and face was soft, smooth and had natural facial color. Weight increased to 5 kg, Reexamination of liver function showed normal.
Comment:
This case is congenital atresia of biliary tract from the western medicine angle, which pertains to obstructive jaundice the same as Case 1. This patient was dull yellow color, water stool, pertains to “Yin jaundice”. The patient was weak constitution, longer course, severe jaundice, so strengthening spleen-stomach and preventing Vital qi were used. Fresh Malt was used for strengthen spleen-stomach, Seeding of virgate wermwood, Jinqiancao herba, Paperiant Pith and Phellodendron were capable of clearing heat and removing dampness, Poria cocos and atractylodes can invigorate spleen to remove dampness, prepared Hyacinth bean and prepared Chinese yam had the actions of strengthening spleen to checkdiarrhea, Pangolin processed with vinegar had effect of promoting menstruational flow, added the powder of the above four kinds of herbs to prevent Vital qi and clear damp-heat, in order to cure jaundice.
Experiences:
The location of refractory neonatal jaundice is liver and gallbladder, but this disease has the close relations with five Zang-organs, especially spleen and stomach. Refractory neonatal is due to “damp-heat ”, and pathogenesis lies in blood stasis, so treatment focuses on dredging collaterals. Jaundice is divided into 2 types in TCM, “Yang jaundice and Yin jaundice”. Yang jaundice is caused by damp-heat transmission from mother to infant, qi stagnation and blood stasis; Yin jaundice is caused by insufficient natural endowment due to various reasons of parents, spleen yang deficiency and cold-damp stagnation. Both of the 2 types can cause qi stagnation and blood stasis, damp and blood stasis mix together, not liver and gallbladder freely distributing can induce yellow sclera and skin, yellow urine, pottery clay color stool, abdominal mass and liver enlargement which are all caused by blood stasis. Modern research reported that hepatobiliary inflammation, biliary stone and biliary infection all can induce ropiness of bile, biliary stricture and atresia. TCM reports that smooth collaterals can eliminate blood stasis to clear damp-heat, so as to cure jaundice. So dredging collaterals and removing blood stasis, clearing damp and eliminating jaundice, strengthening spleen-stomach is important in treatment. The patients are all infants, Zang-fu do not develop well, transportation and transformation of spleen and stomach are weak, so bitter cold herbs are avoided.