bubble_chart Concept

Turbid urine, abbreviated as turbid urine, also known as turbid urine, refers to urine that is cloudy and unclear, without symptoms of painful urination. Turbid urine that is white like rice water is called white turbidity. If the initial urine is not cloudy but becomes so after standing for a while, with a sediment resembling accumulated powder, it also falls under this condition.

Suwen．Zhizhenyao Da Lun refers to it as "cloudy urine". Zhubing Yuanhou Lun．deficiency fatigue disease various conditions》 refers to it as "white turbidity". Danxi Xinfa divides it into "red and white turbidity". Jingyue Quanshu refers to it as "residual turbidity" and "stool turbidity". Leizheng Zhicai．lin turbidity refers to it as "turbid urine". Zabing Yuanliu Xizhu refers to it as "two turbidities".

This condition is different from painful urination. Painful urination often includes turbid urine, but the main symptom is painful urination. In this condition, there is no pain during urination, or only grade I heat and astringent pain.

Urine that is turbid due to hematuria is different in nature from this condition, and urine that is turbid due to clear discharge is also not part of this condition. Refer to hematuria and the section on clear discharge in urine.

Ancient medical practitioners had different understandings of the concept of white turbidity. Some referred to this condition, some referred to urine with clear discharge, or it was a general term for these two conditions. Historical literature also refers to red turbidity, which actually refers to turbid essence (chronic prostatitis) or hematuria, and is not within the scope of this condition.

bubble_chart Pattern Analysis

1. Dampness-heat in Lower Energizer︰Turbid urine resembling rice water, sometimes mixed with greasy substances, or dark urine that is cloudy and unclear, often accompanied by frequent and scanty urination, a hot and astringent sensation during urination, or mild pain, along with chest and epigastric fullness, thirst without a desire to drink much, a red tongue with yellow and greasy coating, and a slippery-rapid or soggy-rapid pulse. Dampness-heat in the lower energizer turbid urine is caused by excessive consumption of rich and sweet foods or alcohol, leading to the production of dampness and heat; or by external dampness-heat pathogens invading the lower energizer, resulting in this syndrome. Dampness-heat in the lower energizer affects bladder qi transformation, impairing its separating and secreting functions, causing the downward flow of turbid fluids, hence the turbid urine resembling rice water or mixed with greasy substances; or scanty and dark urine, accompanied by frequent, urgent, and painful urination. It is often accompanied by chest and epigastric fullness, thirst without a desire to drink much, a red tongue with yellow and greasy coating, and a slippery-rapid or soggy-rapid pulse, which are signs of internal accumulation of dampness-heat. The treatment principle is to clear and drain damp-heat, separating the lucid from the turbid, and the recommended formula is Cheng's Rhizoma Dioscoreae Decoction for Clearing Turbid Urine.
2. Kidney Yin Deficiency︰The urine is turbid like rice water, with scanty output, accompanied by dizziness, tinnitus, deafness, dry throat, flushed cheeks, night sweats, steaming bone fever (consumptive fever), soreness and weakness of the waist and knees, dry stools, a red tongue with thin coating, and a thready rapid pulse. Kidney yin deficiency leads to turbid urine, which may result from constitutional yin deficiency or Rebing damaging yin. Yin deficiency with internal heat causes heat to shift to the bladder, disrupting qi transformation and the separation of clear and turbid, resulting in urine as turbid as rice water or dark urine, though frequent urination and dysuria are rare. It is often accompanied by dizziness, tinnitus, flushed cheeks, night sweats, restlessness, insomnia, soreness and weakness of the waist and knees, and other signs of yin deficiency with exuberant fire. The treatment should focus on nourishing yin and reducing fire, as well as separating the lucid and turbid. The recommended formula is Anemarrhena, Phellodendron and Rehmannia Pill with the addition of Hypoglaucous Yam.
3. Kidney Yang Deficiency︰Turbid urine, frequent and clear urination, accompanied by pale complexion, listlessness, cold and sore back, cold limbs, impotence, pale tongue with white coating and often tooth marks, deep and weak pulse. Kidney yang deficiency leads to dysfunction of the bladder in separation and retention, resulting in turbid urine that is pale and not concentrated. This is commonly seen in the elderly and physically weak individuals, often accompanied by pale or dull complexion, dizziness, tinnitus, listlessness, cold limbs, impotence, soreness and weakness of the waist and knees, etc. Treatment should focus on warming the kidney and reinforcing astringency. The prescription recommended is Right-Restoring Pill supplemented with Psoralea and Schisandra Fruit.
4. Sinking of Spleen Qi︰Turbid urine persists for a long time without improvement, or the urine is not very turbid during urination but shows sediment resembling accumulated powder, with dribbling after urination. It may be accompanied by a shallow yellow complexion, physical fatigue, mental fatigue, reduced appetite, lower abdominal distension and sagging, loose stools, a pale tongue with white coating, and a weak, feeble pulse. Due to excessive exertion, overthinking, or improper diet, the spleen yang is injured, leading to spleen deficiency and qi sinking, resulting in weakened control and the downward leakage of essential substances. Hence, turbid urine occurs. Although the urine may not appear very turbid during urination, sediment resembling accumulated powder often forms after standing, and symptoms worsen after exertion. It is often accompanied by reduced appetite, loose stools, lower abdominal distension and sagging, or even prolapse of the rectum. The treatment should focus on tonifying the middle and replenishing qi. The prescription may include the Original-Qi Preserving Decoction with the addition of Gordon Euryale Seed and Cimicifuga Rhizome, or the modified use of Middle-Tonifying Qi-Replenishing Decoction.
5. Spleen-kidney Qi Deficiency︰Turbid urine, frequent and clear urination, dizziness, tinnitus, pale yellow complexion, reduced appetite, shortness of breath, mental fatigue, muscle wasting, cold limbs, soreness and weakness in the lower back and legs, pale tongue with white and slippery coating, weak and slow pulse. The spleen fails to ascend the clear, the kidney fails to store essence, and the bladder loses its restraint, leading to turbid urine. Its characteristics include clinical manifestations of both spleen deficiency with qi sinking causing turbid urine and kidney yang deficiency with turbid urine. The symptoms and signs are relatively complex, manifesting as physical fatigue, mental fatigue, lower abdominal distension and sagging, reduced appetite, loose stools, as well as dizziness, tinnitus, soreness and weakness in the lower back and knees, impotence, and other symptoms. Treatment should equally emphasize strengthening the spleen and tonifying the kidney. The prescription is Middle-Tonifying Qi-Replenishing Decoction combined with Incomparable Chinese Yam Pill.

The symptom of turbid urine can be attributed to both deficiency and excess. The excess pattern is caused by dampness-heat, affecting the bladder, resulting in concentrated turbid urine, possibly accompanied by frequent urination and painful urination. The deficiency pattern is often due to issues with the spleen and kidney, leading to less concentrated turbid urine, with rare occurrences of painful urination. Additionally, there are cases where static blood accumulates in the lower abdomen, affecting the bladder's qi transformation, leading to the inability to separate the clear from the turbid, resulting in turbid urine. This is often accompanied by painful urination, difficulty in urination, or hematuria, with dark purple and turbid urine, slight abdominal distension and fullness pain, and a dark tongue with ecchymosis. Treatment should focus on warming yang and invigorating blood, with the prescription of Lesser Abdomen Stasis-Expelling Decoction plus Akebia Stem and Christina Loosestrife.

bubble_chart Documentation

1. Danxi Xinfa．Red and White Turbidity: "Turbid qi from the stomach flows downward, causing red and white turbidity. Use Erchen Tang with Bupleurum, Cimicifuga Rhizome, Atractylodes Rhizome, and White Atractylodes Rhizome. ... Turbid qi from the stomach flows downward, seeping into the bladder, Indigo, and Clam Shell Powder."
2. Yixue Rumen．Red and White Turbidity: "Red turbidity is due to severe dampness-heat in the blood aspect, governed by the heart and small intestine. Use Redness-Removing Powder, Four Ingredients Decoction with Heaven Ailanthus Bark, Indigo, and Talc. White turbidity is due to mild dampness-heat in the qi aspect, governed by the lungs and large intestine. Use Heart-Clearing Lotus Seed Decoction, or Five Accumulations Powder combined with Four Gentlemen Decoction."
3. Leizheng Zhicai．Lin Syndrome and Turbidity: "Obese individuals often have white turbidity due to damp phlegm, use Two Old Ingredients Decoction. Thin individuals often have red turbidity due to liver fire, use Gentian Liver-Draining Decoction."