Other conditions that need to be asked about include the condition of the five sense organs, sleep, food intake, taste in the mouth, urine and urination, stool and defecation, and conditions of the reproductive system. However, in this part of the chapter, we are only going to discuss urine and urination, stool and defecation, and signs and symptoms of the reproductive system.

Heat and dryness can cause constipation because they consume yin fluid. Yin fluid deficiency can cause constipation because stool cannot be moistened. Qi deficiency can cause constipation because deficient qi makes the stool move down slowly, which causes the fluid in the stool to be absorbed* more.

Diarrhea can be caused by spleen yang qi deficiency, kidney yang deficiency, cold or cold-dampness in the gastrointestinal tract*, dampness-heat in the gastrointestinal tract, and liver depression with spleen deficiency.

Undigested food in the stool* refers to a pathological condition in which the stool contains undigested food, usually due to spleen or kidney yang deficiency. Stool sometimes sloppy and sometimes bound* refers to stool that varies greatly in consistency, usually caused by liver depression and spleen deficiency. In this case, liver qi invades the intestines. Stool containing pus and blood is usually due to accumulation or obstruction of dampness-heat in the intestine, or epidemic toxin in the intestines.

Hematochezia can be caused by spleen qi deficiency failing to control the blood, heat or dampness-heat accumulation in the stomach or intestine damaging their collaterals, or qi stagnation and blood stasis in the stomach or intestine.

Tenesmus* refers to ineffectual and painful straining at stool, a painful spasm of the anal sphincter* accompanied by an urgent desire to evacuate* the bowel* and involuntary straining that results in passing little or no stool, usually caused by dampness-heat in the large intestine. Ungratifying diarrhea* refers to diarrhea that leaves the patient with a feeling that the bowel has not been satisfactorily emptied, usually caused by dampness-heat accumulating in the gastrointestinal tract, depressed liver qi invading the spleen, or food accumulation. Fecal incontinence* means inability to control defecation, with involuntary passage of feces, mostly caused by spleen qi deficiency failing to bear up, kidney deficiency failing to control the anus, prolonged illness, or advanced age in patients. Bearing down sensation of the anus* refers to the subjective feeling of bearing down of the anus, usually caused by spleen qi deficiency or dampness-heat in the gastrointestinal tract.

Abnormal increase of urine is often caused by lower wasting-thirst* and deficiency cold. The main causes of urine decrease are listed in Fig. 8-3.

Fig. 8-3 The main causes of abnormal decrease of urine

Frequent urination* refers to increased frequency of urination, usually resulting from dampness-heat accumulation in the bladder and urinary tract, or kidney deficiency leading to insecurity* of the bladder.* Dribbling urinary block* refers to dribbling urination or complete blockage of urine flow, usually caused by urinary tract obstruction or kidney yang qi deficiency failing to perform its opening and closing functions to the bladder. Difficult painful urination* is usually caused by dampness-heat accumulation in the urinary bladder or urinary tract, stone in the urinary tract, static blood obstructing the urinary tract, liver depression with bladder qi stagnation, or yin deficiency with effulgent fire scorching the bladder or urinary tract. Incomplete urination* is mostly caused by kidney yang deficiency, or insecurity of kidney qi. Urinary incontinence* refers to failure of voluntary control of urination, mostly due to insecurity of kidney qi, bladder retention failure*, sunken spleen qi, unconsciousness, and bladder deficiency cold, because qi in all these conditions is not powerful enough to astringe the urine. Enuresis* refers to involuntary discharge of urine during sleep, usually due to kidney qi deficiency, spleen deficiency, or urinary bladder deficiency cold.

Impotence* refers to an abnormal state of a male characterized by inability to initiate* or maintain an erection* in sexual intercourse, which can be caused by kidney yang deficiency, essential qi deficiency, essence chamber obstruction, liver qi depression, dampness-heat pouring down, as well as frightening.

Seminal emission* is a diseased state characterized by involuntary emission of semen, which includes spermatorrhea and dream emission. Spermatorrhea* is involuntary and frequent discharge of semen without copulation* while a person is awake; while dream emission (disease) is involuntary emission of semen during sleep associated with dreaming. Seminal emission is usually caused by kidney yin deficiency with effulgent fire, insecurity of kidney qi, dual deficiency of the heart and spleen, or dampness-heat pouring downward into essence chamber.

Premature ejaculation* refers to ejaculation of semen immediately after or even prior to penetration*. It is usually caused by deficiency of kidney yang, insecurity of kidney qi, or yin deficiency with effulgent fire.

Advanced menstruation* refers to menstrual periods* that come one week or more ahead of due time, for more than two successive periods. Advanced menstruation can be caused by spleen qi deficiency, insecurity of kidney qi, yang exuberance with blood heat, depressed liver qi transforming into fire, or yin deficiency with effulgent fire.

Delayed menstruation* refers to periods that come one week or more after due time, for more than two successive periods, usually caused by deficiency of nutrient and blood, insufficiency of kidney essence, or yang qi deficiency. Menstruation at irregular intervals* refers to periods that come with an irregular cycle, more than one week early or late, mostly due to liver qi depression or spleen and kidney deficiency.

Prolonged menstruation* is usually caused by blood heat or dampness-heat in the uterus, phlegm-dampness, and sometimes qi deficiency. Profuse menstruation* usually arises when heat disturbs the blood and drives the blood to flow frenetically, and blood stasis obstructs the thoroughfare and conception vessels. Scanty menstruation* is usually caused by yin deficiency, deficiency of nutrient and blood, kidney essence deficiency, or kidney qi deficiency.

Flooding and spotting* refers to sudden onset of profuse uterine bleeding or incessant dripping of blood, occurring not in the regular menstruation periods. The morbid condition is usually caused by heat impairing the thoroughfare and conception vessels and driving blood to extravasate*, blood stagnation in the uterus causing blood flowing out of the meridians, spleen deficiency failing to control the blood, kidney yang deficiency leading to insecurity of thoroughfare and conception vessels, or kidney yin deficiency with effulgent fire driving blood out of the vessels.

Amenorrhea* refers to failure of menstruation to occur at puberty* or abnormal stoppage of the menses for more than three months after menarche*. Deficiency of the liver blood and deficiency of kidney essence or kidney yin may lead to amenorrhea. Qi stagnation, blood stasis, yang deficiency, cold congelation, phlegm-dampness can all cause amenorrhea, because they can cause blockage in thoroughfare and conception vessels.

Light colored and thin menses is a sign of blood deficiency (blood is diluted); while dark red and thick menses indicates intense heat in blood. Purple dark menses with blood clots is usually caused by blood stasis.

Dysmenorrhea* refers to lower abdominal pain or referring pain to the lower back occurring around or during the menstrual period. Blood stasis, qi stagnation, cold congelation, dampness-heat accumulation, yang deficiency, and qi and blood deficiency can all cause dysmenorrhea to occur.

White vaginal discharge* pathologically indicates yang deficiency of the spleen and kidneys or cold-dampness pouring downward. Yellow vaginal discharge* usually indicates the presence of dampness-heat. White and yellow vaginal discharge* often indicates heat accumulation in the liver meridian. White and yellow vaginal discharge can also indicate accumulation, steaming and binding of dampness-toxin in the uterus, as dampness-toxin can damage the vessels.

Additionally, questions should also be asked about special symptoms, which include vertigo*, dizziness*, oppression in the chest*, palpitation*, hypochondriac distension*, gastric stuffiness*, abdominal distension, numbness of the skin, paralysis, heavy body, vomiting, itching, and nausea.