Elevated total bile acids are mainly caused by damage to hepatocytes or bile duct obstruction. Clinically, different treatment options need to be chosen depending on the specific cause. For example, in patients with hepatitis B, nucleoside analogs are chosen for antiviral treatment, while in patients with hepatitis C, interferon is mostly chosen for treatment; in patients with alcoholic liver disease, total bile acids may gradually return to normal after abstinence from alcohol. For patients with biliary obstruction, medication is only an adjunct, and the most important thing is to release the obstruction and unblock the drainage through surgery or interventional treatment. Depending on the cause, surgical procedures mainly include stone removal and tumor excision. Patients who are unable to undergo surgery can also be temporarily treated by placing a stent or by external drainage. In pregnant women with intrahepatic cholestasis during pregnancy, the application of relevant medications such as ursodeoxycholic acid, adenosylmethionine, and dexamethasone should also be promptly considered. Pregnancy itself, however, can cause a mild elevation of total bile acids. If there are no clinical symptoms, no special treatment is required.