6 Inspection of excreta
Excreta refers to the secretion and excreta from the human body , including tears , spittle , snivel , sweating , saliva , urine , stool , menstruation , leucorrhea , sputum and vomitus , etc . Excreta is produced by the functional activities of the viscera . Normally , the excretion of tears , spittle snivel , sweating , saliva , urine , stool , menstruation , leucorrhea and sputum follow certain rules .However , under morbid conditions ,there may be some changes in its colour , quality , volume and form .The production of sputum and vomitus is due to the dysfumction of the viscera , So inspection of excreta is helpful for understanding the location and nature of disease as well as the functional states of the viscera .
Inspection of excreta mainly includes examination of its colour , quality , volume and form .Generally speaking , whitish or light-coloured and thin excreta indicates cold syndrome and asthenia syndrome due to retention of dampness resulting from stagnation of pathogenic cold or insufficiency of yangqi and weakness in transportation and transformation ;yellowish or deep-coloured and thick excreta indicates heat and sthenia syndrome due to fumigation by pathogenic heat which condenses body fluid .
Inspection of excreta is rich in content , the following mainly describes the inspection of sputum , snivel , spittle , saliva and vomitus .Sweating , urine , stool , menstruation and leucorrhea will be discussed in the chapter of inquiry .
1.1.2.6.1 Inspection of sputum
Sputum is a kind of sticky fluid , substance produced by disturbance of fluid metabolism , excreted from the lung and trachea due to dysfunction of the lung and the spleen .That is why it is said that ˇ°the spleen is the source of sputum , while the lung is the container of sputum ˇ±. The production of sputum may bring about various disease .So it is said that ˇ°sputum is produced by diseases , but sputum further worsens diseases ˇ±.
Yellowish and sticky , or hard and coagulated sputum is heat-sputum produced by exogenous wind-heat , or by accumulation of endogenous heat which fumigates the lung .Whitish , thin or blackish sputum is cold-sputum due to consumption of yangqi by cold , failure of qi to transform fluid and accumulation of dampness .Thin and forthy sputum is wind-sputum due to pathogenic wind attacking the lung .Whitish , slippery and easily expectorated sputum is damp-sputum due to asthenia of the spleen and exuberance of dampness .Scanty , sticky sputum difficult to expectorate , or with unproductive cough , is dry sputum due to pathogenic dryness attacking lung and consuming fluid in exogenous disease ;in diseases due to internal impairment , sputum results from consumption of pulmonary yin and asthenia-fire scorching the lung .If sputum is mingles with fresh blood , it means that the pulmonary collaterals are impaired due to invasion of dry-heat into the lung as well as asthenia of yin and exuberance of fire .If sputum appears like purulent blood or chyle with foul smell , it is usually seen in pulmonary abscess due to accumulation of heat toxin in the lung and suppuration of the decayed resulting from blood stasis .
1.1.2.6.2 Inspection of spittle and saliva
Spittle refers to thick secretion in the mouth , while saliva refers to the thin part of secretion in the mouth .Spittle is related to the kidney and also to the spleen and stomach ;while saliva is related to the spleen .
Reduced spittle and dry mouth and throat are usually caused by exhaustion of body fluid or failure of body fluid to flow upwards , often seen in consumption of body fluid in exogenous disease , or internal impairment and prolonged disease marked by asthenia of spleen qi , failure of qi to transform fluid or insufficiency of kidney yin .Frequent salivation fluid or insufficiency of the mouth in infant is usually due to failure of the adthenic spleen to control fluid or due to attack of wind-heat .Distorted mouth with inability to close the mouth and spontaneous drooling in adult is usually seen in wind stroke .Frequent regurgitation of clear and thin fluid in the mouth is often caused by asthenic cold in the middle energizer ; or insufficiency of kidney yang and disorder of qi transformation ; or by internal exuberance of clod dampness and upward flow of pathogenic dampness .
1.1.2.6.3. Inspection of snivel
Snivel refers to sticky fluid discharged from the nose .Snivel is related to the lung .Inspection of snivel is helpful for understanding the conditions of pulmonary qi and the nature of the pathogenic factors .
Stuffy nose with clear snivel indicates exogenous wind-cold .Turbid and yellowish snivel indicates exogenous wind-heat or wind-cold transforming into heat .Persistent discharge of turbid yellowish pus-like snivel with foul smell indicates nasosinusitis due to accumulation and retention of damp-heat .Snivel mingled with blood is usually caused by dry-heat impairing collaterals ; frequent discharge of snivel with bloody streaks probably indicates malignant syndrome of nasal cavity and further examination is necessary .
1.1.2.6.4 Inspection of vomitus
Vomiting is caused by upward aderse flow of gastric qi . Inspection of vomitus is helpful for understanding the cause of upward adverse flow of gastric qi and the nature of disease .
Thin vomitus without foul smell indicates cold syndrome due to consumption of gastrosplenic yang or invasion of pathogenic cold in the stomach .Turbid and sour vomitus indicates heat syndrome due to exuberant heat in the stomach or liver fire attacking the stomach .Sour and fetid vomitus with indigested food accompanied by unprssable sbdominal distension and pqin os caused by retention of food due to intemperance of food and indigestion .Vomiting of indigested food without sour and fetid smell is caused by asthenic cold in the spleen and stomach .Vomiting of clear fluid , sputum and saliva is usually due to dysfunction of the spleen due to retention of fluid in the stomach .Vomiting of damp heat in the liver and gallbladder or due to adverse flow of liver and gallbladder qi which invades the stomach .Vomiting of fresh blood or purplish blood with clot or with food dregs is often due to impairment of the collaterals by stomach heat and liver fire or blood stasis in the epigastrium .Vomitus with pus and blood indicates stomach abscess due to accumulation of heat toxin in the stomach and putrefaction of blood stasis .
