The Cycle Completed: Elimination
There is a simple yet stunning way to think of health, and that it is in relation to the three basic functions of the individual cell. Each cell must (1) take in nutrients and (2) metabolize those nutrients; and (3) the by-products of this metabolism must be carried away. So the simplest way to think of disease is as a condition in which one or more of these three cellular functions has become disordered. Either the nutrient substances are wrong and harmful, or they are not being metabolized correctly, or the by-products are not being carried away efficiently.
We have examined the quality and quantity of foods and nutrient substances and many factors relative to the measurement of the life-force functions of metabolism. Now we shall discover the significance of the signs of the elimination of the by-products of bodily metabolism.
It is in the West that perhaps the greatest aversion to and embarrassment over bodily wastes is encountered. Virtually no one cares to discuss urine and feces, much less to look at them! Nonetheless, there are important signs to be found in these substances, which after all are simply a product of one's own natural bodily functions. And, in health at least, they are no more offensive than what is being carried around within the body at all times. In the East it is the custom to squat while performing the toilet functions, and to use the hand and water for cleansing afterward. While this may seem peculiar to some Westerners, it does afford each person a direct knowledge of the by-products of digestion--and the chance to take corrective action at the very slightest and first signs of disorder. Every physician will agree that one of the most important factors in treating disease is to seek advice at the very earliest signs of imbalance. Too often people are unaware of the signs because they have never observed their bodily wastes.
Before proceeding with a simple explanation of urinalysis, it would be worthwhile here to quote from the British medical doctor O. Cameron Gruner, who translated the first book of Avicenna's Canon into English. He was trained in Western orthodox medicine, yet he remained firmly convinced of the enduring value--even superiority--of the diagnostic modes employed by our predecessors. Dr. Gruner writes in his translation of the Canon:
"For the detection of changes in the composition of the urine, the ancients were restricted to the evidence afforded by the color, odor, and what may be called "texture." The evidence was apt to be [considered] fallacious because wide difference of composition may produce similar appearances, and differences of appearance do not always denote noteworthy changes of composition.
On the other hand, the limitations in the utility of these simple observations were balanced by the relatively vague conception of the bodily functions. The whole outlook on disease was lacking in detail without being basically incorrect. Thus, many diseased states were ascribed to defective digestive processes, a fact often overlooked today ....
To say that the whole body is concerned in digestion is, broadly speaking, correct, especially if we realize that the term digestion covers what we call metabolism. In the Canon, digestion is viewed in two aspects: (1) that which begins in the alimentary canal and ends in the liver; (2) that which is called "maturation," which concerns the digestive products in their course through the body and ending in tissues. If such maturation is not completed, surplus substances appear, and may undergo sedimentation. The phenomena of disease are attributable to this defective maturation. Consequently, the business of diagnosis and prognosis comes to be a matter of assessing the efficiency or otherwise of maturation.
The study of the urine is therefore directed to this assessment, its different physical properties being noted, both in health and under various unhealthy conditions. Translucence, opacity, separation out into visibility of various substances, the appearance of gaseous matter (in foam), and changes in odor--all these are interpreted in light of the two-fold division of digestion: that culminating in the liver, and that culminating in the tissues.
This basis of study is reasonable, and it is not right that they should have been superseded as is the case in modern times ...."
Dr. Gruner then makes note of the insufficiency of modern laboratory analysis, which excludes the dynamic aspects of the patient, who after all is the repository and site of the processes that are disordered. Dr. Gruner continues:
"So if we visualize in a practical form everything that is relevant, we must not forget the dynamic aspect of the matter. Changes are going on hour by hour, and the laboratory cannot keep pace with them. Consequently, we shall in the end make use of the self-same data which Avicenna relied on entirely, and we learn from him to scrutinize the urine--not merely to find such things as albumin, blood or pus or casts--but deliberately to know: (1) Is there any insufficiency in the digestive process in the pre-[liver] stages? (2) If not, is there any [liver] insufficiency, and in what direction? (3) If so, or if there is trouble in the tissues at large, arising out of an abnormal condition of one or more of the humors--which one is at fault? In what way is it at fault? Is it entirely morbid or not? (4) What is the degree of vitality of the patient (Avicenna included "innate heat" in this)? Is the vitality increasing, or failing, or inactive?--recovery from illness, or its duration, or succumbing to illness is often primarily a matter of vitality ...."
Such fundamental questions the modern practitioner (even in cities) can still answer from the simple data used of old, and combine them with the intimate study of the pulse, to realize the nature of the processes in the organs and tissues of the sick from day to day "
Let us now consider this illuminating science of urinalysis as formulated by Avicenna. Although mastery of urinalysis requires study with an experienced Hakim, many aspects of urine can be noted and evaluated by the layperson.
Healthy urine is of medium consistency; is lightly tinted, tending to the color of straw; and has a moderate, not offensive odor. If sediment is present, it should be white and light.
The urine alters during the progressive stages of life. In infancy, it is like milk, thus nearly colorless. In childhood, it is thicker and coarser. In adolescence, there is more fire in the constitution, so the urine is more colored. In adulthood it tends to be white and tenuous, and also thicker due to the quality of excess matter being ejected. In old age the urine becomes whiter again. If it becomes very thick, it may indicate the formation of stones.
The urine of females is thicker, whiter, and less clear than that of males. If the urine of males is shaken in a beaker, it becomes cloudy, and this cloudiness ascends to the top of the beaker. The urine of females, when shaken, usually develops a circular foam on top. If urine samples of a male and a female are mixed together, a network of filaments forms almost immediately, which is also true of urine specimens taken immediately after intercourse.
In pregnancy, the urine is quite clear, and there is a light "cloud" on the surface. The color is close to that of chick peas, or yellow with a hue of blue or iridescence in it. There is also present a sort of "tinted cotton" in the midst of it. If there is quite distinct rainbow tint, it is a sign that the initial stage of conception has begun. When the rainbow tint evolves to an overall reddish tint, it means that the impregnation is complete, especially if the urine becomes cloudy when shaken.
There are two general points to consider initially with respect to the urine. First, when the urine is clear at the time of passing, then turns opaque on sitting, this means that the resolution of nutrients is difficult, that the digestive powers are having difficulty refining the food. Second, when opaque urine is passed, then becomes clear after standing, this means that the digestive powers have successfully matured the nutrients. The clearer the urine becomes, and the more rapidly the sediments fall to the bottom, the more complete the digestion. The diagnostic features in the Unani methods of assessing the urine are (1) quantity, (2) odor, (3) color, (4) foam, (5) texture, (6) clearness, and (7) sediment.
It is necessary to obtain a proper specimen of the urine to be evaluated, and for this to be evaluated by a copmpetent practitioner. We can present onlky some of the superficial elements of analysis here.
Evaluation of the Fluid Parts of Urine
There are six colors that are significant: white, yellow, fiery, bright red, dark red, and black.
The color white may be translucent, as with glass, or milky. There are eleven degrees of whiteness, each of which is associated with a different imbalance:
1. Mucilaginous: excess of blood humor.
2. Waxlike: liquefaction of fatty tissue.
3. Greasy, soapy: liquefaction of blood humor; may signify diabetes, active or latent.
4. Musty whiteness, tinted with blood and pus: ulcers discharging into the urinary passages.
5. Musty whiteness, not tinted with blood: great excess of crude, nonmatured matter; stones.
6. Like semen: inflammation arising in blood humor; disease associated with blood humor.
7. Lead-white, no sediment: bad.
8. Milk white, in acute diseases: ominous.
9. Sudden change from red to white in the course of a fever: the patient will become delirious.
10. Whiteness persisting in a person apparently healthy: absence of digestion in the veins, and in diabetes.
11. Whiteness like buttermilk, in acute fevers: may signify lifeless fetus, or wasting of entire body.
Generally, whiteness indicates that the imbalance is due to an altogether cold intemperament, but digestion remains sound. Urine often is white at the onset of a disease and gradually darkens as the disease takes its course. Urine is also white during the waking state. If urine is dusky during daylight hours, it sig-nifies some digestive imbalance. The physical cause of the white color is the inability of bile to mix with the urine or an overabundance of phlegm mixed with the urine.
Yellow color is found in varying degrees: straw yellow, lemon yellow, orange-yellow, flame or saffron yellow, and clear reddish yellow. The last four indicate hot intemperament. A straw yellow color is due to a small amount of bile mixing with the urine; flame yellow is due to a large amount of bile mixing with it; and reddish yellow is from an even larger amount of bile. Urine tends to saffron yellow in maladies known as very hot and burning. The clearer the urine, generally, the more digestion going on. In certain diseases the urine may be tinged with red because of blood in the urine. Gradual loss of blood via urine is a critical sign because it usually means some form of internal hemorrhage.
Fasting almost invariably causes the urine to become deeply colored and bitter-smelling.
The color green in urine ranges from that of the shade of pistachios to leek green and emerald green. A light green tint to urine usually indicates lack of internal combustion. If observed after great physical labor, it means there is an internal spasm. Some physicians say that a rainbow green indicates poisoning, and that if there is sediment in the urine, there is hope of recovery, while no sediment indicates that the poisoning is likely to be fatal. Green the color of rusted brass is a sign of impending death due to complete extinguishing of the innate heat.
"Black" urine actually refers to the density of red coloration to the point of utter darkness. Such coloration of the urine means there is high oxidation taking place, a great internal cold, imminent death, a healing crisis (detoxification), or evacuation of superfluous black bile humor.
Dark coloration of urine is a good sign in acute diseases if it occurs at the time expected in relation to the healing crisis (generally in the middle of the crisis). Dark urine at the onset or end of a fever disease is an ominous sign. The appearance of dark urine in the elderly is always a bad sign, for it can only indicate massive destruction of organs. In women who are experiencing childbirth, dark urine may presage convulsions.
Thinness of urine is the result of either indigestion or obstruction. Denseness of urine is a sign of the maturation of the humors (meaning that a healing crisis is imminent) or indicates that a thick humor is being eliminated and is mixing with the urine. A balanced consistency comes from a balanced quality, quantity, and maturation of the humors.
It must be noted that urine can be thin on expulsion, then later thicken or remain thin. If it is thin and remains thin, the pathenogenic matters are not yet ripened and ready to expel.
Types Of Urine
The Unani practitiooner finds clues to a course of treatment in many other aspects of urine analysis, the types of urine with respect to color, transparency, thickness, clearness, foam, sediments, residues and so forth, reveal the conditions indicated by such signs.
The Alvine Discharge
The contents of the stool are called the alvine discharge and are evaluated in terms of quantity and consistency. It is first useful to have an idea of the nature of the healthy stool.
The healthy stool should (1) be held together and not loose; (2) have watery and solid parts mixed about equally; (3) be soft and tending to honey in consistency; (4) be easily evacuated; (5) be of a color nearing yellow (stools the color of the food eaten means that digestion is incomplete); (6) have an odor that is not offensive, yet not be entirely odorless; (7) be passed without audible sound or gurgling of gas; (8) be passed at the times normal for a healthy person, and (9) have a bulk nearly the same as the food consumed.
Quantity. The quantity should not be greater than the food eaten. If there is more in bulk than the food eaten, it means there is an overabundance of humors. If less than the amount of food eaten, it means there is (1) diminishing of humors, (2) retention of the food in the colon, or (3) weakness of the expulsive power.
Consistency. Moist feces indicate defective digestion or obstruction at some stage of digestion, so that insufficient water is absorbed from the food. Frothy fecal matter indicates mixing of gases with the humors, or very great internal heat.
Dry stools result from very great physical labor, internal heat, drying foods, or an extended time in passing through the colon. When the feces are both hard and dry, it is due to lack of bile or a delay in the colon with excessive moisture.
Color. White stool signifies an obstruction of the passages carrying bile and is seen with jaundice. If there is also an offensive odor, it may mean that an inflammatory mass has ruptured. It should be noted that a healthy person who seldom exercises often passes odorous matter, which acts as a natural purgative to the system.
A very reddish color of the stool reveals the crisis point of a disease.
Dark or black stool means high oxidation, maturing of a disease caused by imbalance of the black bile humor. There may be a silvery sheen to the stool from the passing of black bile humor. The passing of black bile in the stool or vomit is a bad sign.
Blackness of the stool can also be caused by the presence of blood in small or great quantities, which is a sign of diseases of the liver, intestinal ulcer, or rupture of internal vessels.
Greenish stool indicates diminished innate heat. The green coloration is due to a peculiar form of bile.
Intensely yellow stool, if occurring at the beginning of a disease, is a sign of an imbalance of the yellow bile humor. If at the end of a disease, it is a good sign, as it indicates that the body is eliminating harmful substances.
Multicolored, pus-filled, very sticky stool are all very grave signs of degeneration of the internal organs.
A bulky shape indicates the presence of intestinal gas. If the feces are passed through rapidly, it means there is an excess of bile in the gallbladder and a weak retentive power.
A long term of passage of feces is a sign of poor digestion, coldness of intestines, excessive moisture, too much sleep, and flatulence.