Dark urine refers to an abnormal manifestation where the color of urine appears dark yellow, reddish-yellow, or brownish-yellow, even resembling strong tea.

Dark urine was first mentioned in Suwen, and is also referred to as "reddish urine." Lingshu, in the chapter Jingmai, describes it as "yellow urine." Maijue and Yixue Zhengzhuan refer to it as "reddish and astringent urine."

This condition does not include changes in urine color caused by hematuria. As for dark urine caused by hot weather, excessive sweating, or insufficient water intake, it is considered a normal phenomenon and will not be discussed here.

bubble_chart Pattern Analysis

1. Excessive Heat in the Heart Meridian︰Short and scanty dark urine, painful and burning urination, fever with a flushed face, restlessness and insomnia, dream-disturbed sleep, or even unconsciousness and delirious speech, a red tongue with prickles at the tip, yellow or even scorched yellow coating, and a rapid pulse. This condition arises from emotional disturbances or excessive consumption of spicy and heat-inducing foods, leading to intense heart fire or the inward invasion of dampness-heat into the pericardium. The heart fire then transfers heat to the small intestine, impairing its separating function and resulting in short, scanty dark urine. It may be accompanied by irritability, a red tongue tip with prickles, and a burning sensation during urination. Treatment involves Stomach-Clearing Powder to clear stomach fire.
2. Stomach and Intestine Excess Heat︰Scanty dark urine, thirst with desire to drink, fetid mouth odor, severe constipation, abdominal distension and fullness with tenderness, red tongue with yellow dry coating, slippery and rapid pulse or deep, replete, and rapid pulse. It is caused by external pathogens transforming into heat upon entering the interior or excessive consumption of spicy and rich foods, leading to heat toxin accumulation in the stomach and intestines, which affects the bladder and results in scanty dark urine. Stomach heat in excess may be accompanied by fetid mouth odor and toothache, while pathogenic heat binding in the large intestine manifests as constipation, abdominal distension and fullness, and pain with tenderness. Dark urine due to exuberant heart fire is treated by clearing the heart and reducing fire, using the prescription Redness-Removing Powder. If there is clouded consciousness, heat-clearing for resuscitation should be added, administering Palace-Clearing Decoction to deliver Peaceful Palace Bovine Bezoar Pill. For dark urine due to excess heat in the stomach and intestines, it is necessary to differentiate whether the pathogenic heat is in the stomach or intestines, using Minor Purgative Decoction to purge heat and promote bowel movement.
3. Liver-gallbladder Dampness-heat︰The urine is scanty and yellow or reddish-yellow, and in severe cases, the color resembles strong tea. There is a bitter taste in the mouth, reduced appetite, nausea, vomiting, and pain in the hypochondriac region. Yellowing of the body and eyes is commonly seen, sometimes accompanied by fever or alternating chills and fever. The tongue is red with a yellow and greasy coating, and the pulse is wiry and rapid. This is due to dampness-heat invading the liver and gallbladder internally, or prolonged stagnation of dampness-heat in the spleen and stomach spreading to the liver and gallbladder, leading to impaired free flow and downward infusion into the bladder, resulting in scanty and reddish urine. It belongs to a yang pattern, characterized by a dry mouth, bitter taste, hypochondriac pain, and alternating chills and fever, with a sudden onset and short course. Treatment should focus on clearing and purging the liver and gallbladder, draining heat, and eliminating dampness. The recommended formula is Gentian Liver-Draining Decoction with modifications.
4. Cold-dampness Stagnation︰The urine is dark like tea but not scanty, the complexion is dull, the body and eyes are jaundiced, there is mental fatigue and limb weariness, anorexia with abdominal distension and fullness, aversion to cold, loose stools, a pale tongue with white greasy coating, and a soggy slow pulse. This is due to internal accumulation of cold-dampness damaging spleen yang, leading to depression and stagnation of qi movement and obstruction of dampness, hence the dark yellow urine. The key points for differentiation are: it belongs to a yin pattern, accompanied by symptoms such as a dull complexion, mental fatigue and limb weariness, anorexia with abdominal distension and fullness, with a slow onset and prolonged course. The treatment involves warming the middle to fortify the spleen and dispelling cold to transform dampness, using Virgate Wormwood Decoction with Atractylodes and Aconite (Yinchen Zhufu Tang) with modifications.
5. Bladder Dampness-heat︰Short and yellow or reddish urine is often accompanied by frequent urination, urgency, painful urination, or difficulty in urination, lower abdominal pain or distending pain, bitter taste in the mouth, dry throat, thirst without desire to drink much, red tongue with yellow coating, and slippery-rapid pulse. This condition arises due to internal invasion of dampness-heat or excessive consumption of spicy, greasy, or sweet foods, leading to internal obstruction of dampness-heat, which stagnates and transforms into heat. It belongs to an excess pattern, hence the accompanying symptoms such as bitter taste in the mouth, dry throat, and thirst without desire to drink. The accumulation of dampness-heat in the bladder disrupts qi transformation, resulting in symptoms like short reddish urine, frequent urination, urgency, painful urination, and lower abdominal pain. Treatment should focus on clearing and draining damp-heat and promoting urination. The recommended formula is Eight-Ingredient Rectification Powder.
6. Yin Deficiency︰Short and dark yellow urine with a burning sensation, dizziness, tinnitus, dry throat, afternoon tidal fever, vexing heat in the chest, palms, and soles, soreness and weakness of the lower back and knees, nocturnal emission or spermatorrhea, a red tongue with scant coating, and a thin, rapid pulse. Due to inherent yin deficiency, prolonged illness damaging yin, excessive sexual activity or overconsumption of warm and drying substances leading to yin damage, yin deficiency resulting in internal heat, this belongs to a deficiency pattern. Hence, symptoms such as dizziness, tinnitus, afternoon tidal fever, and vexing heat in the chest, palms, and soles manifest. The key diagnostic points include: short and dark yellow urine with only grade I burning sensation, accompanied by tinnitus, vexing heat in the chest, palms, and soles, soreness and weakness of the lower back and knees, and other symptoms. Treatment involves nourishing yin and reducing fire, with the prescription choice being Anemarrhena, Phelloendron, and Rehmannia Pill.

1. For example, if the syndrome belongs to interior heat, dark urine is often seen, and if the heat is severe, the urine may be short and reddish or yellowish-brown.
2. If the urine is dark like strong tea and accompanied by yellowing of the body and eyes, jaundice should be considered. If the urine is short and hot, it is mostly due to liver-gallbladder dampness-heat; conversely, it is due to cold-dampness obstruction.
3. In addition, during summer, dampness-heat may combine and obstruct the middle energizer, leading to dark urine. This can be identified based on symptoms such as hiding fever, gastric stuffiness, nausea, and loose stools with discomfort. Treatment should focus on clearing heat and resolving dampness, regulating qi, and harmonizing the middle. Wang's Coptis and Magnolia Bark Decoction can be modified for this purpose.
4. External contraction of wind-heat invading the lungs and heat accumulation damaging fluids can also lead to dark urine. In this case, clearing heat and promoting diuresis is necessary, and Dryness-Clearing Lung-Rescuing Decoction can be modified for treatment.

bubble_chart Documentation

1. Jingyue Quanshu．Linzhuo: "If the urine is yellow or red, this often indicates fire pattern. However, it must be red, painful, and astringent, and there must be other signs of fire pattern before it can be treated as red turbidity due to fire pattern. If it is due to overstrain, chronic illness, depletion of true yin from excessive alcohol and sexual activity, or long-term use of cooling medications, the urine may become increasingly red and scanty, but without pain or astringency. This is a case of water deficiency and fluid depletion, not red turbidity. As the classic says: 'When middle qi is insufficient, the urine and stool will change,' which refers to this type of condition. The treatment should focus on warming and tonifying kidney qi to promote qi transformation, and the water will naturally clear. Do not treat dark urine as a fire syndrome indiscriminately."