A Basic Primer of TCM Urinalysis

Normal urine is pale yellow or straw-colored.

One of the most basic considerations is that scanty darkcolored 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 multiB 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.