Comments for:

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response to McDonagh

Submitter: David M. Moore | moore@bcm.tmc.edu

Baylor College of Medicine

Published February 4, 2004

It is certainly correct that our studies were with mice, not pigs or people, and should not be taken to provide any direct evidence for effects of Yin Zhi Huang in human jaundice. Despite some positive reports (1-3), it remains unclear whether this widely used herbal treatment is beneficial, ineffective, or possibly even harmful. We were not surprised by the lack of effect of the short term yin zhi huang treatments in piglets (4), however, since the mechanism that we outlined involves new gene expression over a substantially longer time course.
We also agree with Dr. McDonagh that visible light phototherapy provides an effective and natural treatment for neonatal jaundice that must be on the list of pharmaceutical manufacturers’ worst nightmares. Nonetheless, limitations with this approach have prompted continuing efforts to identify pharmacologic therapies (5). Phenobarbital is clearly effective and is sometimes used, but is undesirable because sedating doses are required (6). Thus, we also agree with Dr. Lazar (7) that “It will be very exciting if a pure compound emerges from the tea leaves as a pharmacological therapy for neonatal jaundice that is complementary or alternative to the current Western practice of phototherapy.” Such a compound could be either a natural product, such as 6,7-dimethylesculetin or a related coumarin, or an unrelated human CAR agonist (8).
1.Yang, S.H., and Lu, C.F. 1984. Effects of decoction of Artemisia, Rheum, Gardenia, Coptidis and Rhizoma on neonatal jaundice in Chinese newborn infants. J. Chin. Child Med. 25:144-148.
2.Chen, Z.L., and Guan, W.H. 1985. Approach to the effect and indication of Yin Zhi Huang to treat neonatal jaundice. J. Clin. Pediatr. 3:302-303.
3.Dong, Y.S., Huang, Z.H., and Wu, L.F. 1992. [Treatment of infantile hepatitis syndrome with injection of yin zhi huang]. Zhongguo Zhong Xi Yi Jie He Za Zhi 12:26-27, 25-26.
4.Kuo, C.Y., Chang, P.C., and Wei, J.S. 1996. The effect of decoction of Artemisia, Rheum, and Gardeniae in a piglet model of hyperbilirubinemia. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi 37:253-256.
5.Cooke, R.W. 1999. New approach to prevention of kernicterus. Lancet 353:1814-1815.
6.Wallin, A., and Boreus, L.O. 1984. Phenobarbital prophylaxis for hyperbilirubinemia in preterm infants. A controlled study of bilirubin disappearance and infant behavior. Acta Paediatr Scand 73:488-497.
7.Lazar, M.A. 2004. East meets West: an herbal tea finds a receptor. J Clin Invest 113:23-25.
8.Maglich, J.M., Parks, D.J., Moore, L.B., Collins, J.L., Goodwin, B., Billin, A.N., Stoltz, C.A., Kliewer, S.A., Lambert, M.H., Willson, T.M., et al. 2003. Identification of a novel human CAR agonist and its use in the identification of CAR target genes. J Biol Chem.

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Herbal treatment of jaundice — risks.

Submitter: Antony F. McDonagh | tonymcd@itsa.ucsf.edu

University of California, San Francisco

Published February 4, 2004

“David Moore and colleagues” (1) did not show “the improvement of jaundice by a Chinese herbal tea called Yin Zhi Huang” (2). What they showed was that the decoction increased the plasma clearance of exogenously administered bilirubin in a mouse model, which is rather different. Improvement of jaundice has yet to be demonstrated. The discovery is also unlikely “to improve upon the standard Western treatment for fetal jaundice” (2). Fetal jaundice is rare, compared to neonatal jaundice, and generally reflects very different, more serious, pathology. And, as noted in a preceding letter, visible light with wavelengths in the ~400–500 nm region of the spectrum is used to treat neonatal jaundice, not ultraviolet light. Exposing newborn infants to ultraviolet light could cause skin damage and burns.
More importantly, both the original paper (1) and the commentary (2) overlooked previous studies (3) that found no effect of decoctions of Artemisia Rheum Gardeniae, given orally or intravenously, on hyperbilirubinemia in newborn piglets infused with bilirubin.
Most important of all, neither publication noted evidence that constituents of Yin Chen (Yin Chin), which is thought to be the active ingredient in Yin Zhi Huang (1), are highly effective in displacing bilirubin from its binding sites on serum proteins (4). Therefore, while lowering the concentration of bilirubin in blood, the medication could potentially increase the risk of bilirubin encephalopathy and kernicterus. The goal of treatments for neonatal jaundice is to enhance elimination of bilirubin, not merely its plasma disappearance. Some sulphonamides lower circulating levels of bilirubin very effectively but are not given to jaundiced babies because, by displacing bilirubin from protein binding, they can also cause neurotoxic brain damage. So, despite enhancing clearance and even elimination of bilirubin, these traditional herbal remedies could put the jaundiced infant at still greater risk. To quote Tai Fai Fok (5): “although herbal treatment of neonatal jaundice has been practiced for a long time in China, its effectiveness remains doubtful and no convincing evidence, either pharmacological or epidemiological, has demonstrated its usefulness.” As stressed by Yeung and colleagues (4), for the present “herbal usage in the perinatal period should be discouraged.”
Fortunately, there is a safe, drugless and natural alternative that works well—phototherapy. With visible light, of course.
References
1. Huang, W., Zhang, J.Z., and Moore, D.D. 2004. A traditional herbal medicine enhances bilirubin clearance by activating the nuclear receptor CAR. J. Clin. Invest. 113, 137–143.
2.Lazar, M.A. 2004. East meets West: an herbal tea finds a receptor. J. Clin. Invest. 113, 23–25.
3.Kuo, C.Y., Chang, P.C., and Wei, J.S. 1996. The effect of decoction of Artemisia, Rheum, and Gardeniae in a piglet model of hyperbilirubinemia [In English]. Zhonghua Min Guo Xiao Er Ke Yi Xue Hue Za Zhi, 37, 253–256. (PubMed ID 8854345 AN 97007070).
4.Yeung, C.Y., Leung, C.S., and Chen, Y.Z. 1993. An old traditional herbal remedy for neonatal jaundice with a newly identified risk. J. Paed. Child Health. 29, 292–294.
5.Fok, T.F. 2001. Neonatal jaundice — traditional Chinese medicine approach. J. Perinatol. 21 Suppl 1:S98–S100.

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Jaundice treatment

Submitter: Howard W Chilton | hchilton@nascor.com.au

Royal Hospital for Women

Published January 5, 2004

The conventional treatment for neonatal jaundice is blue visible light not ultraviolet.