Urine

Surplus body fluid discharged from the anterior yīn. The urine productioninvolves the spleen’s action of moving and transforming water-damp, the triple burner’s regulation of the waterways, and the small intestine’s separation of the clear and turbid, and in the final stage by kidney qì transformation. It is passed to the bladder by whose opening and closing action it can be stored and discharged at convenient times. The normal, healthy individual voids from four to six times a day, mostly during the daytime.

Appearance Urine is usually a pale yellow in color. Changes in color are usually associated with changes in volume (discussed below). Yellow urine or reddish urine, referring to urine darker than normal in color, is associated short scant voidings and indicates heat. Colorlessness of urine is associated with long copious voidings. Bloody urine without heat or pronounced pain may be due to spleen and kidney vacuity, vacuity fire, or damp-heat. Other signs must be correlated for accurate diagnosis. Murkiness of the urine is called urinary turbidity, a distinction being made between red turbidity and white turbidity.

Volume

• Urinary voidings marked by a long-lasting stream of clear urine are called long voidings of clear urineand are a vacuity cold sign.
• Profuse urination (frequent copious voidings) is a sign of dispersion-thirst when accompanied by thirst, high fluid intake, and weight loss.
• Short scant voidings are normal in hot weather if fluids lost in sweating are not replaced by adequate fluid intake. Pathologically, short voidings of reddish urine indicate heat.
• A gradual reduction of the amount of urine, leading to inhibited urination (scant urine with difficult urination) or dribbling urinary block with generalized puffy swelling is usually yáng vacuity water flood arising when kidney yáng is debilitated and fails to perform qì transformation and move water.
• Sudden urinary block (urine retention) together with foul-smelling urine, pain in the bladder, and heat effusion indicates repletion.

Frequency Frequent urination with clear urine or even incontinence indicates qì vacuity.

• Profuse urination at night, frequent urination at night, indicates vacuous kidney yáng failing to secure and contain urine.
• Frequent short voidings of scant urine occurring in pregnancy indicates shifted bladder and is attributable to qì vacuity.
• Frequent urination, urgency, and painful urination, often with blood or stones in the urine, constitute strangury, which may result from qì vacuity, repletion heat, or damp-heat.

Lack of control

• Enuresis (bed-wetting) is usually attributable to insecurity of vacuous kidney qì.
• Dribble after voiding is a continuing dribble after urination has terminated (patients in such cases being unable to achieve a full stream of urine), and arises most commonly when debilitation of kidney qì leads to failure of the opening and closing action of the bladder.
• Urinary incontinence is usually due to vacuity and may be seen, for example, in wind stroke desertion patterns.

NB: Western medicine establishes that the adult voids between 700 to 2000 ml per day. A daily volume in excess of 2500 ml is termed polyuria (excessive secretion of urine), and less than 500 ml is termed oliguria (diminished secretion of urine). Anuria (absence of urine) refers to a daily volume of less than 100 ml.