Section 3　Inspection of Excreta

The excreta include secretion, discharge and pathological output. In observation of excreta one should pay attention to the colour, quality, volume and other associated pathological products of the excreta.

Usually whitish, clear and thin excreta indicate deficiency or cold patterns; and yellowish, thick excreta indicate excess or heat patterns.

1. Inspection of Phlegm, Drool, Nasal Discharge and Saliva

(1) Inspection of phlegm or sputum

Phlegm or sputum is a kind of sticky fluid, excreted from the lung and trachea. Thick and turbid matter is phlegm (tán), thin and clear matter is rheum (yĭn) and both can often be seen. Phlegm and rheum are produced by disturbance of the fluid metabolism. Fluid metabolism is closely related to the lung, spleen and kidneys, so it is easy to realise why it is said 'the spleen is the source of phlegm; the lung is the container of phlegm and the kidney is the root of phlegm'. Thus, inspection of the phlegm may help one understand the pathological changes of the lung, spleen and kidneys and then distinguish the characteristics of disease.

Abnormal manifestations and clinical significance of phlegm:

A. Cold phlegm: whitish, clear and thin.

B. Heat phlegm: yellowish, sticky and coagulated.

C. Dry phlegm: scanty, sticky and difficult to expectorate.

D. Damp phlegm: whitish, slippery and easily expectorated.

E. Lung abscess: coughing, spitting up phlegm with a fishy smell or with pus or blood.

F. Hemoptysis: phlegm mingled with fresh blood, mostly belongs to lung heat.

(2) Inspection of drool

Drool is related to the spleen. It is excreted in the mouth and helps to moisten the oral cavity, lubricate and digest chewed food. Therefore, inspection of the drool can help one examine the pathological changes of the spleen and stomach.

Abnormal manifestations and clinical significance of drool:

A. Clear and abundant drool: deficiency-cold of the spleen and stomach.

B. Sticky drool: damp-heat of the spleen and stomach.

C. Salivation from the corners of the mouth and infant's slobbering: deficiency of the spleen, stomach heat and worm accumulation.

D. Salivation in sleeping: stomach heat or food retention, phlegm-heat brewing internally.

(3) Inspection of nasal discharge

Nasal discharge refers to sticky fluid discharged from the nose. Nasal discharge relates to the lung. Thus, inspection of nasal discharge is helpful for understanding the pathological changes of the lung.

Abnormal manifestations and clinical significance of nasal discharge:

A. Stuffy nose with clear nasal discharge of recent onset: externally-contracted wind-cold.

B. Stuffy nose with turbid nasal discharge of recent onset: externally-contracted windheat.

C. Paroxysmal (convulsive) and continual sneezing with lots of nasal discharge: allergic rhinitis, wind-cold harassing the lung.

D. Persistent discharge of turbid yellowish pus-like nasal discharges with foul smell: sinusitis, damp-heat accumulating and blocking the lung.

(4) Inspection of saliva

Saliva refers to sticky and foamy fluid discharged from the mouth. Saliva is related to the kidney but also related to the stomach. Thus, inspection of saliva is helpful for understanding the pathological changes of the kidney and stomach.

Abnormal manifestations and clinical significance of saliva:

A. Abundant saliva escaping from the mouth: cold or accumulated cold, damp-heat or accumulated food in the stomach.

B. Abundant saliva in the mouth: kidney cold or kidney deficiency.

2. Inspection of Vomit

Vomiting is caused by counter flow rising of stomach qi. Inspection of vomit is helpful for understanding the pathological changes of the stomach and the nature of the disease.

Abnormal manifestations and clinical significance of vomit:

A. Thin, clear and without foul smell, or water-like vomit: cold vomit.

B. Turbid vomit with sour odour: heat vomit.

C. Vomiting of fresh or purplish blood with clots or food dregs: liver fire invading the stomach, accumulation of heat in the stomach, blood stasis in the stomach.

D. Vomiting of undigested or sour food: food damage/retention.

E. Vomiting of yellowish or green fluid with a bitter taste: accumulated heat or dampheat in the liver and gallbladder.

3. Inspection of the Stool

Stool formation is closely related to the functional conditions of the spleen, stomach and intestines. Stool formation is also influenced directly by purification and descent of the lung, free flow of the liver and the warmth of themingmen fire. So, inspection of the stool may help one examine the pathological changes of the spleen, stomach and intestines and the functional conditions of the lung, liver and kidneys. It also can be useful for distinguishing the nature of the disease.

The normal stool is yellowish and soft with the form of a cylinder or log.

Abnormal manifestations and clinical significance of stool:

A. Clear, water-like stool: cold-damp diarrhoea.

B. Yellowish or brown colour, caustic and fetid stool: damp-heat diarrhoea.

C. Clear, thin, undigested food in the stool or viscous, long and thin like duck stool: diarrhoea due to deficiency of the spleen or kidney.

D. Sticky jelly-like and with pus containing blood inside the stool: dysentery.

E. Fresh blood over the surface of the stool or drops before or after defecation: distal bleeding, intestinal wind, anal fissures or haemorrhoids.

F. Dark red or purplish black blood, mixed uniformly with the stool: proximal bleeding, excessive heat of the stomach or intestines, which forces the blood to move frenetically or the spleen failing to control blood.

G. Grey and white colour, alternating loose and dry stool: jaundice, liver invading the spleen.

H. Dry and hard to be passed stool: constipation, intestinal dryness and liquid depletion.

4. Inspection of the Urine

Urine formation is directly related to the metabolism of the fluid in the body. The metabolism of the fluid is influenced by the functional conditions of thezang-fu organs, such as excess or deficiency of yin and yang, qi transformation of the kidneys and bladder, descending function of the lung, transportation and transformation of the spleen and regulation of waterways via thesanjiao (triple burner). Hence, inspection of the urine may help one understand not only the pathological changes of the lung, spleen, kidneys and bladder but also aspects of fluid depletion, cold, heat, deficienct and excess nature of diseases.

Normal urine appears clear, slightly yellow in colour and without sediment.

Abnormal manifestations and clinical significance of urine:

A. Copious, clear urine: a deficiency-cold pattern.

B. Scanty, red urine: an excess-heat pattern.

C. Urine mixed with bleeding: haematuria from heart fire, bloodlín (slow painful urination passed drop by drop), deficiency-consumption of the kidney, tumour in the lowerjiao, etc.

D. Urine mixed with sediment: stonelín: damp-heat burning and condensing impurities in the urine.

E. Turbid urine like rice water or cream: cloudylín: deficiency of the spleen and kidney associated with damp-heat.