High direct bilirubin is considered to be possibly related to physiologic factors, or pathologic factors such as viral hepatitis, gallbladder stones, and bile duct cancer. Drugs, surgery and other treatments can be given according to the cause. 1. Physiological factors: Usually, staying up late and drinking alcohol may lead to a transient mild increase in direct bilirubin, which is not accompanied by clinical symptoms, and will usually decrease to normal after resting and stopping drinking alcohol. 2. Pathologic factors: (1) Viral hepatitis: such as hepatitis B, due to bile excretion disorder caused by hepatocyte inflammation, causing elevated direct bilirubin, usually given oseltamivir antiviral as well as glycyrrhizic acid preparation for liver protection treatment. (2) Gallbladder stones: The elevation of direct bilirubin is caused by the obstruction of bile ducts and poor bile excretion due to the blockage of bile ducts by stones, and can usually be treated by surgical removal of stones. (3) Cholangiocarcinoma: Bile ducts are narrowed due to bile duct tumors, which leads to poor bile excretion, thus causing elevated direct bilirubin, accompanied by abdominal pain, loss of appetite, and emaciation. Surgery is usually the mainstay of treatment. There may be other reasons for elevated direct bilirubin, so it is recommended to go to the hospital as soon as possible and take relevant measures under the doctor’s guidance.