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Urine analysis in Tibetan medicine.

Traditional Tibetan methods of urine analysis is unique and it can be claimed that no other system of traditional medicine have perfected this method of diagnosis as Tibetan physicians have over the centuries.

Next to pulsology, urine analysis is the most important method of finding out and confirming a disorder and its nature, locations and so forth. Though it may seem a simplistic process when one observes it being practised by a Tibetan physician, in reality it has taken the physician years of training to make it so seemingly a simple method of diagnosis.

Generally, a medical student studies the second chapter of the Last Tantra and uses it as a source for studying and practising urine analysis and very often complements his study with the commentary to that work.

In the Last Tantra, urine analysis is explained under eight sections:

1. Preliminary compliances

2. Time of examination

3. Description of container to be used

4. Compositional formation of urine

5. Healthy urine

6. Unhealthy urine

7. Death urine

8. Evil spirit urine

1. Preliminary compliances

As in the case of pulse diagnosis, a patient is required to observe certain compliances particularly during the day before his urine is to be examined, in order to present a urine specimen which gives a true compositional structure of the disorder. Dietary and behavioural compliances are particularly important because the slightest intake of food or performance of behaviour which the patient is not adapted to, will grossly affect the compositional structure of the urine. Following are some of the major compliances a patient is generally required to observe:

a) no intake of cool food items such as tea which affects the colour of a wind urine

b) no intake of whey and so forth which affects the colour of a phlegm urine

c) no intake of hot food items which affects the colour of a bile urine

d) normal intake of liquid

e) abstinence from sexual intercourse

f) sleeping regularly

g) eating regularly

h) avoidance of strenuous activities

i) avoidance of mental exertion

2. Time of Examination

The recommended time of examination of a urine specimen is at the time of dawn when the first sunlight falls on the cup. However, when it is not possible to examine the urine at the recommended time, urine may be examined in bright daylight at any other time of the day.

3. Container to be used

Use a container which will not shade the original colour of the urine, preferably a white procelain cup.

4. Compositional formation of Urine

Soluble and insoluble food ingested is mixed and churned by the decomposing phlegm localised in the upper part of the stomach; and when it reaches the mid part of the stomach, it is thoroughly absorbed and assimilated by the digestive bile; finally when it reaches the lower part of the stomach, it is separated into waste and non-waste products by the fire-like wind. The waste products are channelised into intestines where they are further separated into solid and liquid wastes. The liquid wastes are transferred to the urinary bladder through the ureter and urine is formed and accumulated in the bladder. In the meantime, the non-waste products are transferred to the liver where the blood is produced. Blood that is produced is of two types; waste and productive. The waste blood is transferred to the gall bladder where two types of bile are produced. The productive bile forms lymphatic fluid while the waste bile produced albumin which is transferred and collected in the urinary bladder through the ureter. Albumin is one of the most important sediments the physician looks for in the urine as its presence in quantity or absence will determine whether the disorder is of a hot or cold type. This is because albumin originates from blood and bile which flow through all the parts of the body and consequently carry with them certain characteristics of the condition of various parts of the body.

5. Healthy Urine

The characteristics of a healthy urine:

a) at the stage when the urine is fresh:

slightly malodorous

moderate presence of steam stable steam

moderate sized bubbles

b) at the state when urine stands:

moderate thickness of albumin

albumin is pervasive

albumin dissolutes from the edge

c) at the stage when the urine has undergone transformation:

dilute and white in colour

However, it is important to keep in mind that this standardisation of a healthy urine is set on the assumption that a person does not possess inherent predominance of any of the humours. Because if he does have natural or inherent predominance of any of the humours--and this is generally the case--though he may be totally healthy the colour of his urine will vary from the standard healthy urine colour. For instance, a healthy person with inherent predominance of wind will have a slightly bluish and dilute colour, while a healthy person with inherent bile predominance will have yellowish urine.

6. The Unhealthy Urine

The Actual Method of Urine Analysis:

The actual method of analysing urine is conducted in three stages consisting of nine sections. The three stages are:

a) the stage when the urine is fresh

b) the stage when the urine stands

c) the stage when the urine has undergone total transformation

a) The stage when the urine is fresh, it is examined and analysed in the following order to determine disorder:





b) The stage when the urine stands, it is examined and analysed in the following way:



c) The stage when the urine has undergone total transformation, it should be examined and analysed in the following way:

-transformation period

-method of transformation--post-transformational characteristics

A. Urine Analysis at the stage when the urine is fresh:


Wind urine: bluish and dilute

Bile urine: yellowish or reddish

Phlegm urine: white like milk

Vitiation of blood: reddish

Lympathic disorder: tinted yellow

Triple humoural disorder: smoky dark chocolate colour

A combination of any of the above colours will denote that a

bi-combined. disorder is present.


Developed fever: steam is profusive to the extent of shielding the colour of urine.

Hidden or chronic fever: steam is slight but persistent.

Cold, wind or phlegmic disorders: steam is negligible, and disappears instantly.

Hot and cold disorders: steam is moderate in presence.


Hot disorders: malaodourous

Cold disorders: slight or absence of odour Dyspepsia: odour of an ingested food item


Wind disorder: large circular bubbles which are stable and bluish in colour

Bile disorder: minute congested bubbles in large quantity, yellow in colour, and disappears instantly

Phlegm disorder: separate, congested and stable bubbles

Blood disorder: reddish bubbles Poisoning: rainbow colour bubbles

Diffused or spreading disorder: bubbles scatter

B. Urine Analysis at the stage when the urine stands: Albumin

Wind disorder: albumin like the hairs of a goat are found scattered in the urine of albumin in the urine means that the disorder is localised in the upper extremities, while albumin located at the bottom of the urine container will mean that the disorder is localised in the lower extremities.

Basically, if albumin is concentrated, it means a hot disorder is present, while the absence of albumin. Will denote, a cold disorder. And generally, the colour of albumin will conform with the colour of the urine.


Presence or absence of chyle in the urine helps to determine whether a disorder is hot or cold and this method of diagnosis is also extendable to the third-stage when the urine has undergone total transformation. if. chyle is present and is thick in the urine, the disorder may be confirmed as a hot type while the absence or thin presence of chyle means a cold disorder. if chyle disintegrates into particles without visible cause, it may mean the presence of tumoural growth in a part of the body.

C. Urine Analysis at the stage when the urine has undergone total transformation

Time of transformation:

In the case of a hot disorder, urine transformation takes. place even before the steam of the urine has disappeared. in the case of a cold disorder, however, transformation takes place only after the steam has evaporated and the urine has cooled. When the disorder is combined i.e. both hot and cold factors are involved, transformation occurs simultaneously with the evaporation of steam. However, in applying the time of transformation as a method to determine the nature of disorder it is well to keep in mind the seasonal variation and influence in the speed and process of transformation. For instance, irrespective of the nature of the disorder, during winter urine transformation occurs more or less instantly after urine has been passed; while during spring an autumn transformation takes place a little after the urine has been passed. In summer because of the heat, transformation takes place after considerable period of time after urine has been passed.

Method of Transformation:

In the case of cold disorders, transformation of urine takes place from the sides of the container to the centre. In the case of hot disorders, transformation usually occurs from the bottom of the container to the surface.

Post-transformation characteristics:

Post-transformational urine colour will generally correspond to the original colour of the urine. Urine of post-transformational stage should he analysed for its transparency and concentration. If it is concentrated and of hazy transparency and the Colour of the urine is high, the disorder is definitely hot, while in the case of the urine being, less concentrated and of clear transparency with low colour, the disorder is cold.

Characteristics of specific disorder urine:

Before describing the characteristics of the urine of specific diseases it is important to be able to analyse and recognise a hot and cold disorder urine.

A. Characteristics of hot disorder Urine:

a) Characteristics of the hot urine during the first stage:

Yellowish or reddish; hazy transparency; malaodourous; steam is concentrated and stable; bubbles are minute, yellowish and have high dissappearance rate.

b) Characteristics of hot urine during the 2nd stage:

Concentrated albumin is localised in the centre diffused concentrated cycle.

c) Characteristics of hot urine during the 3rd stage:

Chocolate in colour Highly concentrated

B. Characteristics of cold disorder urine:

a) Characteristics of cold urine during 1st stage:

Clear transparency, white and dilute Low steam

Absence or minimum of odour

Large stable bubbles

b) Characteristics of cold urine during 2nd stage:

Low concentration of albumin and chyle

c) Characteristics of cold urine during the 3rd stage:

Transformation takes place after urine has cooled

Post transformational characteristics: the urine is bluish and dilute

However, it is important to keep in mind the characteristics of urine that can easily be mistaken for that of either a hot or cold disorder. For instance, a bluish and dilute urine will not reflect a cold disorder if it has concentrated albumin present. So though by appearance the urine may seem to be of a cold disorder, by nature it is of a hot disorder. Similarly though the first stage characteristics of a urine is that of a hot disorder, if transformation of urine takes place after urine has cooled, the disorder is of a cold type.

Characteristics of urine for certain disorders which may be mistaken for another:

In the case of the urine of empty fever and hot blood disorder, the colour of the urine is in both cases reddish which may cause one to mistake the one for the other. However, careful observation of the concentration, transparency size of the bubbles will help to arrive at a correct and accurate diagnosis. Similarly in the case of the triple phlegmic disorder and black lympathic disorder the similarity in colour of the two specimens of urine can cause a wrong diagnosis as both the urine colours are chocolate. Here again, careful observations of other characteristics such as concentration transparency will help to determine the real nature of the disorder.

7. Death Urine

a) Hot Disorder Death Urine:

Reddish blood like colour

Malaodourous like that of rotten leather

Non-transformation of colour, odour and so forth.

Besides, if the patient does not respond to a hot disorder, diet, regimen, medication, and accessory theraphy, the above symptoms will conclude that the disorder will prove fatal and that it is only a matter of time before death occurs.

b) Cold Disorder Death Urine:

Bluish and dilute

Absence of odour

Absence of steam

Absence of albumin

Absence of bubbles

Absence of taste

8. Evil Spirit Urine

To analyse a urine specimen believed to be of an evil spirit disorder is both difficult and ritualistic. The urine is taken in a large container and is marked with the four directions. Nine sections are created on the surface of the urine and they represent the realms of the universe, major professions human beings are involved with and the gods and spirits associated with them and so forth.

Characteristics of an evil spirit urine:




appear in the various sectors of the urine. It is important that no movement of urine occurs. If neither discoloration or images appear in the urine, then another method of determination is applied viz. prognostication.

However, this process is more ritualistic and spiritual and only a person with a certain standard of spiritual realisation and aptitude could apply, the method as a form of prognoses.

Basically, urine diagnosis should serve to determine whether a disorder is hot or cold. Pulse analysis should help to localise the disorder further and questioning should help in determining the type of medication to be applied.

Though urine analysis seems well defined and simple, to use it effectively as a method of diagnosis takes years of experience. Not only must one be thoroughly trained in the other methods of diagnosis and have studied the Four Tantras, one must develop skill and experience particularly in analysing the urine during the three different stages.
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Author:Rabgay, Lobsang
Publication:The Tibet Journal
Date:Mar 22, 2013
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