Urine is the turbid liquid resulting from the body’s metabolic processes of water and fluids. The normal odor of urine should come from volatile acids present in it. If urine is left standing for a long time, the breakdown of urea can produce an ammonia smell. In pathological conditions, fresh urine may exhibit fishy, foul, or even rotten apple odors. Therefore, by carefully discerning the smell of urine, we can assist in diagnosing diseases.
① Fishy Odor
[Olfactory Diagnosis] Clear and long urine with a slight fishy odor, accompanied by cold limbs and soreness in the lower back and knees.
[Clinical Significance] This indicates kidney qi deficiency and impaired bladder qi transformation. It often results from a congenital deficiency, excessive fatigue, or aging, where kidney yang is insufficient to transform qi.
[Treatment Method] It is advisable to tonify the kidneys and benefit qi, using Jin Gui Shen Qi Wan (Kidney Qi Pill) with modifications.
② Foul Odor
[Olfactory Diagnosis] Urine with a foul smell, yellow and turbid, often accompanied by frequent urination, urgency, and pain during urination.
[Clinical Significance] This is often due to bladder damp-heat. It can result from excessive consumption of spicy, rich foods, or excessive alcohol intake, leading to damp-heat accumulation, or from external exposure to summer dampness, which descends to the bladder, causing the foul odor in urine. According to the “Xing Se Wai Zhen Jian Mo – Olfactory Method,” it states: “If urine is very foul, it indicates excess heat in the heart and bladder; if it is uncontrollable but not foul, it indicates the decline of kidney yang (mingmen) fire.” This indicates that a strong foul odor in urine is due to excess heat in the heart and bladder, while uncontrollable urine without a foul smell indicates the decline of kidney yang fire.
[Treatment Method] It is advisable to clear and drain bladder damp-heat, using Ba Zheng San (Eight Correcting Powder) with modifications.
③ Foul Smell
[Olfactory Diagnosis] Urine that is turbid or contains blood, with a foul odor.
[Clinical Significance] This may indicate bladder tumors, often due to tumor necrosis and subsequent infection.
[Treatment Method] Treatment should be based on the specific clinical condition, selecting appropriate methods and medications.
④ Rotten Apple Odor
[Olfactory Diagnosis] Urine with a rotten apple-like smell.
[Clinical Significance] This is commonly seen in patients with diabetic ketoacidosis.
[Treatment Method] Treatment should be based on the specific clinical condition, selecting appropriate methods and medications.
Additionally, certain foods and medications, such as garlic and onions, can also impart a special odor to urine and should be differentiated.
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