Symptoms 11, stool and urine

Below is a brief description of the major stool and urine symptoms, with links to entries that provide more detail.

Stool

Sloppy stool (便溏 biàn táng): Semiliquid stool that is traditionally described as being like duck’s droppings. This results when the yáng qì of the spleen fails to remove excess water from the digestive tract by its warming and transforming action. In some cases, of spleen qì vacuity, the stool is first dry and then sloppy. Sloppy stool with ungratifying defecation (a feeling after the passing of stool that defecation is not complete) is usually a sign of damp-heat.

Diarrhea (泻泄 xiè xiè): Increased fluidity of stool and frequency of defecation. It differs from sloppy stool, which is slightly increased fluidity without a marked increase in frequency of defecation. Diarrhea is essentially related to dysfunction of the large intestine and/or the spleen and stomach. In large intestine disease, diarrhea occurs in large intestine damp-heat (which may stem from spleen dysfunction) and in large intestine vacuity cold. In intestinal heat bowel repletion patterns, it may take the form of heat bind with circumfluence (see below). In spleen-stomach disease, it can occur in spleen vacuity qì fall, spleen-kidney yáng vacuity, liver qì invading the spleen, and food stagnating in the stomach and intestines. Spleen qì vacuity is associated with sloppy stool rather than diarrhea. Severe diarrhea may be associated with other signs such as tenesmus, pus and blood in the stool, or prolapse of the rectum, all of which are large intestine signs.

Clear-grain diarrhea (下利清谷 xià lì qīng gǔ): Diarrhea with grain failing to transform (完谷不化 wán gǔ bù huà), that is, the presence of only partially digested food in the stool. It is usually attributed to spleen yáng vacuity. Being a sign of vacuity, it is usually persistent.

Throughflux diarrhea (洞泄 dòng xiè): A term found in older texts, denoting diarrhea after eating, with nontransformation of food (undigested food in the stool).

Food diarrhea (飧泄 sūn xiè): A term found in older texts, denoting diarrhea with clear thin stool containing undigested food and accompanied by rumbling intestines. It indicates clear qì failing to bear upward (that is, spleen qì failing to extract the essence of grain and water and carry it upward to be utilized by the body). It is usually ascribed to liver depression and spleen vacuity.

Constipation (便秘 biàn bì): Failure to defecate for longer than normal (4–7 days or more). It occurs in intestinal heat bowel pattern; blood vacuity and liquid depletion; large intestine liquid depletion; kidney yáng vacuity; and stomach cold. Constipation in heat patterns is often called heat bind and in cold patterns, cold bind.

Difficult defecation (便难 biàn nán): Difficulty passing stool is naturally associated with constipation. However, the term difficult defecation may refer to a distinct condition of difficulty in passing stool in which bowel movements occur every day (rather than once in several days, as in constipation), with soft rather than hard and bound stool, or without the abdominal discomfort associated with constipation. Difficult defecation may occur in large intestinal heat bind, damp-heat brewing in the spleen, spleen-lung qì vacuity, liver-spleen qì stagnation, spleen-kidney yáng vacuity, and yīn vacuity with blood depletion. Note that difficult defecation (or constipation) stemming from spleen vacuity depriving the intestines of moisture is traditionally often referred to as straitened spleen (脾约 pí yuē).

Heat bind with circumfluence (热结旁流 rè jié páng liú): The passing of green-blackish foul-smelling water in the stool in patients suffering from heat bind, which is constipation caused by exuberant heat in the intestines (intestinal heat bowel repletion patterns). It is so called because the thin stool passes around the impacted stool.

Fifth-watch diarrhea (五更泄 wǔ jīng xiè): Also called early morning diarrhea and daybreak diarrhea. Diarrhea during the 5th watch (4–6 a. m.), heralded by pain. It is a sign of spleen-kidney yáng vacuity and accumulation and stagnation of cold-damp.

Fecal incontinence (大便失禁 dà biàn shī jìn): Loss of voluntary control over bowel movements. It occurs in large intestine vacuity cold, spleen vacuity qì fall, spleen-kidney yáng vacuity. It can also occur in damp-heat or intense heat toxin patterns with clouded spirit.

Efflux diarrhea (滑泄 huá xiè): Persistent diarrhea with fecal incontinence. It occurs in large intestine vacuity cold or spleen vacuity qì fall.

Bloody stool (便血 biàn xuè): Also called blood in the stool, and in traditional literature as descent of blood (下血 xià xuè, a term that may also denote bleeding via the vagina), and as hematochezia in biomedicine. Note that the term hemafecia is sometimes used in English-language Chinese medical texts, but it is not recognized by standard English dictionaries. Bloody stool is loss of blood through the anus, with varying amounts of stool. It is attributable either to the spleen failing to control blood or to damp-heat pouring down into the large intestine and damaging the network vessels. Bright-red blood indicates heat, whereas dark-red blood indicates qì vacuity or damp toxin. Bloody stool may be attributable to distal or proximal bleeding (i.e., distant from or close to the anus). Compare the next item.

Pus and blood in the stool (大便脓血 dà biàn nóng xuè): The presence of blood and pus-like matter in the stool, usually accompanied by abdominal pain, frequent defecation, and tenesmus. It is a major sign of dysentery.

Ungratifying defecation (大便不爽 dà biàn bù shuǎng): Absence of the normal feeling of satisfactory completion after defecation. It occurs in dysentery resulting from large intestine damp-heat and in food stagnating in the stomach duct.

Tenesmus (里急后重 lǐ jí hòu zhòng): Also called abdominal urgency and rectal heaviness. Urgent desire to defecate with a feeling of pressure in the rectum and difficulty expelling stool. It most commonly occurs in dysentery caused by large intestine damp-heat but may also occur in qì stagnation, qì vacuity, and damage to liquid with blood vacuity.

Passing of flatus (矢气 shǐ qì): Literally, fecal qì. Expulsion of intestinal gas from the anus. This is not usually a sign of illness, although it may increase in frequency in stomach and intestinal disorders. Passing of flatus that relieves discomfort may indicate liver qì stagnation or gastrointestinal qì stagnation.

Urine

Inhibited urination (小便不利 xiǎo biàn bù lì): Inability to achieve a full stream of urine. It is caused by disturbances in the movement of fluids or urine productionowing to insufficiency of yáng qì of the kidney, lung, and/or spleen. It may also result from damp-heat or to qì stagnation with damp obstruction.

Profuse urination at night (夜间多尿 yè jiān duō niào): Called nocturia in biomedicine. Getting up frequently in the night to urinate. It is usually a sign of kidney yáng vacuity.

Frequent urination (小便频数 xiǎo biàn pín shuò): Urination more frequent than normal. It mostly occurs in kidney yáng vacuity and in bladder damp-heat.

Dribble after voiding (尿后余沥 niào hòu yú lì): Failure of voluntary urination to terminate cleanly. It is attributed to insecurity of kidney qì.

Enuresis (遗尿 yí niào): Involuntary loss of urine during sleep; bed-wetting. It is usually attributable to insecurity of kidney qì.

Urinary incontinence (小便失禁 xiǎo biàn shī jìn): Involuntary loss of urine during the day. Like enuresis, it is a sign of insecurity of kidney qì but indicates a more severe condition.

Short voidings of reddish urine (小便短赤 xiǎo biàn duǎn chì); short voidings of yellow urine (小便短黄 xiǎo biàn duǎn huáng): Scant urine darker in color than normal. It is attributable to heat causing reduction of the fluids. Mild heat (e.g., vacuity heat) causes the urine to become yellower than normal, while severe heat (repletion heat) causes the urine to assume a deep tea-colored appearance, which is traditionally called reddish. Note that we say reddish rather than red, to avoid confusion with the bright-red coloration observed in bloody urine (see below).

Long voidings of clear urine (小便清长 xiǎo biàn qīng cháng): Urination longer than normal with copious colorless urine. It results from yáng vacuity. This conforms with the maxim that all disease with watery humors that are clear, pure, and cold is ascribed to cold (诸病水液澄澈清冷, 皆属于寒 zhū bìng shuǐ yè chéng chè qīng lěng, jiē shǔ yú hán).

Scorching pain in the urethra (尿道灼痛 niào dào zhuó tòng): Burning pain in the urethra on urination. It is usually associated with damp-heat and is a major sign of strangury.

Stones in the urine (尿有砂石 niào yǒu shā shí): Passing of small particles of calculus in the urine, usually associated with acute pain, and most commonly attributable to damp-heat is a sign of stone strangury (or sand strangury).

Bloody urine (尿血 niào xuè): Called hematuria in biomedicine. Urine colored by fresh blood or blood clots in the urine, without any pronounced discomfort. It is distinct from reddish urine, which is urine darker in color than normal. The term is often used in distinction to blood strangury, in which urination is painful, to mark a condition in which pain is absent. Bloody urine is usually attributed to insufficiency of kidney yīn with effulgent heart-liver fire spreading to the small intestine or to dual depletion of the spleen and kidney preventing the blood from being contained.