Jaundice with external contraction

Patient Information
Su, a 66-year-old woman from Tianjin, developed jaundice during mid-spring.

Etiology
Emotional distress caused liver fire to flare up, followed by mild external contraction, leading to generalized jaundice.

Clinical Manifestations
Yellow-orange discoloration of the entire body, particularly the sclera; dark yellow urine that stains clothing; dry, white stools; feverish sensation with thirst; loss of appetite. Pulse: strong, taut, and hard on the left, slightly floating but forceful on the right. Tongue: thin, white coating with no moisture.

Diagnosis
Pre-existing liver heat exacerbated by external contraction caused bile duct swelling, obstructing bile flow into the small intestine. Bile overflowed into the bloodstream, spreading systemically and causing jaundice. Bile pigments excreted through urine led to dark urine, while absence of bile in the intestines resulted in pale stools. Niter and Alum Powder (from Synopsis of the Golden Chamber), originally for "female consumptive jaundice," was adapted here. The formula was modified with liver-draining herbs due to excessive liver-gallbladder pulse signs.

Prescription

​Pills:
Niter (1 liang, powdered)
Alum (1 liang, powdered)
Roasted barley flour (2 liang; wheat flour as substitute)
Mixed with water to form wutong seed-sized pills. Dosage: 2 qian (6g) twice daily.

​Decoction:
Dioscorea opposita (1 liang)
Paeonia lactiflora (8 qian)
Forsythia suspensa (3 qian)
Talcum (3 qian)
Gardenia jasminoides (2 qian)
Artemisia capillaris (2 qian)
Glycyrrhiza uralensis (2 qian)
Boiled into a large bowl of decoction, taken with pills. Reuse the dregs for the second dose.

​Additional: Aspirin (1g) taken 1 hour after initial dose to induce mild sweating and resolve residual external contraction.

Follow-up
After 4 doses, sweating occurred, fever and thirst diminished, appetite improved, stools turned black, urine lightened, and jaundice receded. Pulse softened. Adjusted dosage: pills reduced to 1.5 qian (4.5g) twice daily; modified decoction:

Dioscorea opposita (1 liang)

Paeonia lactiflora (6 qian)

Hordeum vulgare sprouts (3 qian)

Artemisia capillaris (2 qian)

Fresh Imperata cylindrica root (3 qian; Phragmites root substitute)

Gentiana scabra (2 qian)

Glycyrrhiza uralensis (1.5 qian)

Outcome
After 5 doses, jaundice reduced by two-thirds, urine normalized, and pulse stabilized. Treatment ceased. Daily regimen: Dioscorea opposita and Coix lacryma-jobi flour cooked into tea, mixed with fresh pear and water chestnut juice. Full recovery in 20 days.

Q&A
Q: Traditional Chinese medicine (TCM) attributes jaundice to the spleen, while Western medicine links it to the gallbladder. Does this case disprove TCM theory?
A: Jaundice arises from diverse etiologies. Zhongjing’s Niter and Alum Powder targets gallbladder-origin jaundice. Alum regulates liver-gallbladder, while niter (potassium nitrate) synergizes with its metallic pungency. Modern parallels include dissolving gallstones (validated by Western science) and treating hookworm-induced jaundice. Zhongjing’s frequent use of Artemisia capillaris—a gallbladder-specific herb—and Yu Chang’s Ming-era case analysis confirm gallbladder involvement. TCM and Western theories coexist, addressing different pathological pathways.