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Home > Education > Diagnosis > TCM Urinalysis

A Basic Primer of TCM Urinalysis

By Victoria Dragon

Normal urine is pale yellow or straw-colored.

One of the most basic considerations is that scanty dark-colored urine is associated with Heat. This may be Excess Heat or Yin Deficiency (aka Deficiency Heat). Cloudy urine points to Damp Heat. (Note: If the person is taking a multi-B vitamin, this will cause the urine to be a bright yellow. This is not Heat.)

Large amounts of clear urine often is associated with Cold. If Kidney Yang Deficiency is present, everything the person drinks may go right through him/her.

Large amounts of urine also can be associated with diabetes. Diabetes usually is associated primarily with Yin Deficiency. If the person producing great amounts of urine also complains of feeling thirsty all the time and wanting cold liquids and complains of cravings for sweets, suspect Yin Deficiency and diabetes. Refer clients with possible diabetes to a MD or DO for confirmation. Diabetes is something which is best treated by using both allopathic medicine and TCM as in some cases insulin will be required even if TCM imbalances are identified and corrected.

The fluid intake is going to match the increased urination in most cases of diabetes. The person usually is drinking a lot of water and other liquids. Not so in copious urination with a Root of Yang Deficiency. Yang Deficient (aka Deficiency Cold) people usually do not feel thirsty, drink little, may have to force themselves to drink, and prefer hot liquids, especially soups when they do drink. Also, in Yang Deficiency the tongue and complexion usually are pale; in Yin Deficiency the tongue and complexion usually are red.

Note: It's normal for urine to be more concentrated in the summer as people tend to sweat and have less fluid in their bodies. It's normal for people to urinate more in the winter and for urine to be clearer at this time because fluid is not being lost through perspiration.

Note: Attack by either Exterior Wind Cold or Exterior Wind Heat can trigger increased urination. Once the Wind Heat penetrates to the Interior, the urine will be dark. But as long as the Wind Heat Evil is in the Exterior, the urine will be clear. (Maciocia, The Foundations of Chinese Medicine, p. 158)

Summation: Scanty and dark, think Heat. Copious (great amounts) and clear, think Cold. Cloudy, think Damp Heat. Rule in or rule out.

A strong, foul odor is associated with Dampness. This usually is Damp Heat . This is true not only of urine but feces, semen, and vaginal discharge. If it smells really strong and foul, it's usually Damp Heat. There are exceptions. If there is a fishy odor, suspect Damp Cold. In any event, if it smells foul and strong, suspect Dampness.

Frequent and large amounts of clear urine usually indicates Kidney Yang Deficiency. BUT, frequent trips to the bathroom with little urine each time points to Kidney Qi Deficiency. Remember, one of the functions of Qi is to transport and transform.

Urinary incontinence also points to Kidney and/or Bladder Qi Deficiency. Incontinence in general points to Qi Deficiency. One of the functions of the Kidneys is to "govern opening and closing." (Bob Flaws, Curing Hay Fever Naturally With Chinese Medicine, p.22.) When the Kidneys are Deficient, this not only can affect urination with problems like copious amounts of urine (Kidney Yang Deficiency), incontinence of urine and "dribbling" (Kidney Qi Deficiency), it also can play a role in some cases of diarrhea, some cases of chronic nasal drip, leaking seminal fluid, and vaginal discharge. (Note: The opening and closing of skin pores is a Lung function.) If there is incontinence of any kind - urine or feces - suspect Kidney Deficiency and Qi Deficiency as possible Roots and rule in or rule out.

Retention of urine points to Damp Heat. The person has the urge to go to the bathroom but nothing comes out.

Difficulty in urination - the person has to push to get the urine out instead of it flowing easily - points to Damp Heat or Kidney Deficiency. (Maciocia says Kidney Deficiency is the more likely cause in older people. (Foundations, p. 158) Swelling of tissues often is associated with Damp Heat, and swelling can be a factor in urination being difficult.

Warner J.W. Fan, M.D., says that Wind Invasion and Heat also can be associated with incontinence (A Manual of Chinese Herbal Medicine, p. 143.)

Maciocia has some words on pain associated with urinating: "Pain before urination indicates stagnation of Qi in the Lower Burner, pain during urination indicates Heat in the Bladder and pain after urination indicates a deficiency of Qi." (Foundations, p. 158)

When there is pain in the pubic area, and/or physical changes in the area, and/or problems with urination, one also should consider the Liver meridian. The Liver meridian runs right through this area on either side of the front midline of the body. Cold or Heat can lodge in this meridian in this area. There also can be Qi Stagnation problems. In males either Cold or Heat invasion in this area can result in the penis being shrunken. In females Cold or Heat in the Liver meridian can result in some very severe, constant pain associated with the menstrual periods. This pain often will be very localized to the right or left or both of the front midline of the body in the area of the pubic bone.

If urine is reddish yellow or red, suspect and rule in or rule out Liver meridian involvement in the former case and Heat in the Blood in the latter. (Fan, p. 144.)

Pregnancy sometimes can trigger Qi Stagnation problems in the lower abdomen.

In TCM, sexual desire is associated with the Kidneys. In general, loss of sexual desire or inconstant sexual desire (fades quickly) point to Kidney Yang Deficiency. Some of the Yang tonic herbs, like Epimedium, will increase sexual desire. (WARNING: Herbs like Epimedium are to be used ONLY when Kidney Yang Deficiency is present. This are not herbs to be taken just because a man or a woman wants more sex. Taking Yang tonic herbs (or any other herb) when they are not indicated will result in other problems developing. In the case of Yang tonic herbs, problems like Dryness, agitation, nervousness, Heat, etc.)

Excessive sexual desire and/or wet dreams point to Kidney and Liver Yin Deficiency and/or Liver involvement. The Liver also plays a role in TCM in sexual desire and performance as well as in the health of the urogenital system.

Too much sexual activity can damage the Kidneys, including Kidney Jing. So little also can be injurous.

Victoria Dragon

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