Internal Medicine (g): Jaundice

One record of jaundice is found in the Chapter on Medicine, in the Theravāda Bhesajjakkhandhaka. The information is as below:

Theravāda:—“At that time a certain monk had an illness of jaundice. ‘I allow, monks, to cause [him] to drink yellow myrobalan [treated] with urine.’”^[1]

The Pāli term paṇḍuroga (Sanskrit: pāṇḍuroga), which literally means yellow disease, are rendered as jaundice (Pali-English Dictionary, s.v. “paṇḍu: -roga”; A Sanskrit-English Dictionary, s.v. “pāṇḍu: roga”).^[2] In Āyurveda, there are five types of this disease: three caused by each humour, one by the combination of three humours, and one by habitual mud-eating (Caraka Saṃhitā Cikitsāsthāna 16. 3; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 13. 9-15). By various causative factors and mud-eating (which aggravates one of the humours by different tastes of mud), the humours are aggravated, with bile humour being the predominant one. Then the aggravated bile humour at the heart is forced by wind humour to enter the ten vessels connected to the heart, and it circulates throughout the body. It afflicts the body tissues, resides in them, and causes various forms of yellow colour of the skin and muscles (Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 13. 1-3). If such a patient indulges in diet or activity which aggravates bile humour, it results in excessive bile humour. The increased bile humour then burns the blood and muscles, gets localised in the alimentary tract and the peripheral tissues, and causes the eyes, skin, nails, and urine to become deep yellow in colour (Caraka Saṃhitā Cikitsāsthāna 16. 34-36; Aṣṭāṅga Hṛdaya Saṃhitā Nidānasthāna 13. 15-17). Treatment for jaundice generally includes consumption of medicated ghee at first for the purpose of lubrication, ^[3] then emesis and purgation by means of medicinal decoction (often including yellow myrobalan, cow’s urine, and iron powder as ingredients) for elimination of aggravated humours,^[4] and then suitable diets such as vegetable or meat soups. For mud-eating patients, mud has to be expelled out of the body by strong elimination therapies (emesis and purgation); after the alimentary tract is cleansed, different types of medicated ghee are consumed for promoting strength. Moreover, such patients should be given mud impregnated with certain drugs so as to create aversion to mud in them (Caraka Saṃhitā Cikitsāsthāna 16. 39 ff.; Suśruta Saṃhitā Uttarasthāna 44. 14 ff.; Aṣṭāṅga Hṛdaya Saṃhitā Cikitsāsthāna 16. 1 ff.).

In modern medicine, jaundice is a clinical feature but not a disease. It is the yellow discoloration of the skin and of the sclerae (Talley and O’Connor 2010, 25). It is the result of accumulation of bilirubin (a product of haem metabolism) in the body tissues, when the serum bilirubin level exceeds 50µmol/L (Burroughs and Westaby 2012, 312; Friedman 2012, 644). Jaundice is usually divided into three groups: haemolytic jaundice, when there is enhanced bilirubin production usually due to increased destruction of red blood cells; hyperbilirubinaemia, when there is high concentration of bilirubin in the blood due to impaired uptake of bilirubin by the liver cells; and cholestatic jaundice, when there is an obstruction to the flow of bilirubin-containing bile from the liver to the intestine due to liver disease or bile duct obstruction (Burroughs and Westaby 2012, 307, 312). Numerous congenital and acquired disorders can cause jaundice, such as haemolytic anaemia, Gilbert’s syndrome, hepatitis, cirrhosis, drug reactions, bile duct stones, bile duct cancer, pancreatic tumours, and so on (Friedman 2012, 645, table 16. 1). Treatment of jaundice depends on the diagnosis of the underlying cause.

A case of jaundice is found in the Chapter on Medicine. Such disease was treated by consuming yellow myrobalan treated with cow’s urine in the Buddhist source. This treatment should be an eliminative therapy amongst the variety of remedies employed in Āyurveda. In modern medicine, jaundice is merely a clinical feature occurring when there is excessive bilirubin in plasma and body tissues. It can occur in many disorders where the production of bilirubin is increased, its uptake by liver cells is reduced, and its secretion in bile is obstructed. Treatment nowadays is directed at the cause, and the Buddhist or Āyurvedic remedies are not utilised in modern medicine.

Footnotes and references:

[1]:

Theravāda Vinaya Piṭaka I. 206: “tena kho pana samayena aññatarassa bhikkhuno paṇḍurogābādho hot. anujānāmi bhikkhave muttaharītakaṃ pāyetun ti.” The Samantapāsādikā (V. 1092) provides a brief annotation on the remedy:

“‘Yellow myrobalan [treated] with urine’ is the yellow myrobalan treated with cow’s urine” (muttaharīṭakan ti gomuttaparibhāvitaṃ harītakaṃ).

[2]:

Modern Āyurvedic scholars tend to render this disease as anaemia. But we will see, in the following discussion of jaundice in modern medicine, that a type of anaemia–viz. haemolytic anaemia–is associated with jaundice.

[3]:

In Āyurveda, before a patient receives the emesis and/or purgation therapies for elimination of aggravated humours, he/she usually has preliminary therapies of lubrication (by intake of oil/ghee and/or external application of oil/ghee) and perspiration, for the purpose of loosening the aggravated humours (Suśruta Saṃhitā Cikitsāsthāna 33. 5).

[4]:

In the above Buddhist record, yellow myrobalan treated with cow’s urine is mentioned, which seems to be used as a medicine for eliminating the aggravated humours.