Chapter contents

INTRODUCTION

Generally, the term ‘observation of the excretions’ would include observation of urine, stools, vaginal discharge and menstrual blood, as well as of sputum, nasal discharge and sweat. As the doctor normally finds out about the first group of excretions through interrogation rather than observation, the reader should refer also to the Interrogation section, Part 2, Chapters 31 and 46.

SPUTUM

Interrogation, Chapter 38; Hearing and smelling, Chapter 54; Symptoms and Signs, Chapter 63

Sputum is always, by definition, a manifestation of Phlegm retained in the Lungs. The colour and consistency of the sputum give us an indication of the nature of the condition: Hot or Cold, or Deficient or Excess.

White and dilute sputum indicates Cold-Phlegm, which is usually associated with a Yang deficiency of the Spleen or Kidneys, or both.

White and sticky sputum indicates Damp-Phlegm in the Lungs, while yellow and sticky sputum indicates Phlegm-Heat in the Lungs. If yellow and sticky sputum is also purulent, this indicates Toxic Heat in the Lungs. Very dark sputum the colour of coffee grounds indicates Phlegm-Heat in the Lungs with a predominance of Heat injuring the blood vessels.

Blood-streaked sputum indicates either Phlegm-Heat in the Lungs or, if it is scanty, Lung-Yin deficiency with Empty-Heat.

Box 20.1 summarizes sputum signs.

NASAL DISCHARGE

Interrogation, Chapter 35; Symptoms and Signs, Chapter 58

Nasal discharge may indicate either Phlegm or Dampness: for example, a sticky-yellow nasal discharge in a person suffering from acute bronchitis indicates Phlegm-Heat, while the nasal discharge of a person suffering from sinusitis indicates Damp-Heat. In some cases, it may not fall into either category but is due simply to an impairment of the Lungs’ diffusing and descending of fluids; examples of this are the chronic nasal discharge of allergic rhinitis or the acute nasal discharge seen in the common cold.

Generally, a white, watery and dilute nasal discharge indicates Cold Phlegm. Such a nasal discharge is frequently seen either in allergic rhinitis or in the common cold: in the former case it is due to deficient Lung-Qi failing in the diffusing and descending of the fluids; in the latter it is due to external Wind impairing the Lungs’ diffusing and descending of fluids.

A white and sticky nasal discharge may indicate either an external invasion of Wind-Heat or chronic retention of Dampness in the nose and sinuses. A sticky-yellow nasal discharge indicates chronic retention of Damp-Heat in the nose and sinuses.

A blood-streaked nasal discharge may indicate either Phlegm-Heat in the Lungs or Damp-heat in the nose or sinuses.

Box 20.2 summarizes patterns underlying nasal discharges.

SWEAT

Interrogation, Chapter 41; Hearing and smelling, Chapter 54; Symptoms and Signs, Chapter 76

Sweating is generally due either to Heat or to a deficiency (of Qi, Yang or Yin).

Sweat that looks like drops of oil, especially on the forehead, indicates collapse of Yang. Yellow sweat indicates Damp-Heat in the Stomach and Spleen, while profuse, incessant sweating all over the body indicates either Stomach-Heat in acute conditions or severe deficiency of Yang in chronic conditions.

Sweating on the head indicates Heat or Damp-Heat in the Stomach or Empty-Heat deriving from Kidney-Yin deficiency. In children, sweating on the head is usually due to retention of food.

Sweating on the nose indicates Damp-Heat in the Lungs or Stomach, or both. Sweating on the hands indicates deficiency of Qi or Yin of the Lungs or Heart, or Heat in the Lungs or Heart. Sweating of the palms and soles indicates Kidney-Yin deficiency.

Box 20.3 summarizes patterns underlying sweating.

STOOLS

Interrogation, Chapter 31; Hearing and smelling, Chapter 54; Symptoms and Signs, Chapter 72

URINE

Interrogation, Chapter 31; Hearing and smelling, Chapter 54; Symptoms and Signs, Chapter 73

The colour of the urine gives a good indication of the Hot and Cold condition of the patient. Normal urine is pale yellow. Pale urine indicates Cold in the Bladder or Kidney-Yang deficiency; dark urine indicates Heat in the Bladder or Kidney-Yin deficiency. It should be remembered that the colour of the urine is affected when the person drinks a lot of water (becoming paler than it would otherwise be) and also when the person takes Vitamin B, which makes the urine bright yellow.

Blood in the urine indicates either Qi deficiency (of the Spleen and Kidneys), Heat in the Bladder or Kidney-Yin deficiency.

Very dark urine, like soya sauce, indicates a kidney disease such as kidney failure or glomerulonephritis.

Turbid urine indicates Dampness in the urinary passages. Urine with small flakes of mucus indicates Damp-Heat in the Bladder.

Box 20.5 summarizes urine signs.

MENSTRUAL BLOOD

Interrogation, Chapter 46; Hearing and smelling, Chapter 54; Symptoms and Signs, Chapter 84

VAGINAL DISCHARGE

Interrogation, Chapter 46; Hearing and smelling, Chapter 54; Symptoms and Signs, Chapter 89