Examination methods in Ayurveda: 3. urine and stool diagnostics

When I ask my patients in detail about their daily defecation and urination during an initial consultation, it makes some of them blush. „I've never been asked about this in such detail before,“ they often say. Or „You're asking me something, I don't know - what's gone is gone...“.

In Western cultures, people are reluctant to talk about their faeces; for many, these topics are associated with disgust. This usually changes abruptly after an Ayurvedic treatment. Spa guests quickly get used to talking openly about their excretory experiences in the morning.

The disgust is actually unfounded - your urine was recently part of your blood and faeces is nothing more than the indigestible part of your ingested food. The daily observation of our own faeces is of great value and gives us bio-feedback on the state of our nutrition and digestion.

After the pulse and tongue examination, stool and urine diagnostics represent another important pillar within the eight Ayurvedic examination procedures. Traditionally, this examination consisted of a) detailed questioning and b) sensory perception on the part of the doctor. Today, it is essentially limited to the medical history and the biochemical assessment is left to laboratories.

I well remember a patient who visited my practice almost twenty years ago because she suffered from terrible migraines. When I asked her how often she defecated, she said that she defecated once a week. I was shocked and asked if she wasn't suffering from this - her answer was: „No, not really. My GP said once a week was better than not once. I've lived with it ever since.“

In Ayurveda, we assess a person's digestive power on the basis of three phases:

INPUT: intake and transport of food and drink
Splitting, separation, absorption and distribution
OUTPUT: Excretion of faeces and urine

Whether faeces and urine are passed in a healthy manner depends on the one hand on the input and processing. The basic constitution also plays an important role. In general, Vata constitutions tend to have less and more variable bowel movements, Pitta constitutions tend to have more and Kapha constitutions tend to have more sluggish bowel movements.

Mutra Pariksha - the urine test

Emptying the bladder is called micturition. The morning urine in the midstream is best suited for examination. The examiner carries out a visual inspection of the colour, appearance and consistency and detects any noticeable odours.

The Ayurveda therapist will ask you about the following anamnestic parameters:

Daily micturition frequency
Colour, consistency and odour of urine over the course of the day
Urination times (during the day, at night)
Voiding difficulties, residual urine
Micturition complaints such as pain, burning, dripping
Tendency to urinary tract infections

This information, in conjunction with drinking habits, provides a diagnostically useful picture. If a disorder is suspected or as part of a preventive check-up, the urine can be tested for up to 12 parameters with a test strip in the practice with little effort.

In the Middle Ages, under the name Tailabindu Pariksha A further examination was carried out: 1-2 drops of sesame oil were dripped onto the urine with a pipette and observed for a few minutes. The appearance and type of spread of the drop allowed conclusions to be drawn about dosha involvement and the disease assessment.

A snake-shaped appearance was assigned to Vata, umbrella-shaped to Pitta and pearl-shaped to Kapha. If the oil spread quickly, the illness was curable (sadhya) - if it sank to the ground, however, this was considered a sign of incurability (asadhya).

After the 17th century, this traditional examination method faded into the background again and hardly plays a role in today's Ayurveda. It is also highly dubious from a scientific and empirical point of view and should therefore not be used as the primary criterion for a health assessment.

The following signs are described constitutionally:

VATA: high frequency - pale colour - alternating and sometimes painful emptying
PITTA: medium frequency - yellowish colour - tends to burn
KAPHA: low frequency - pale colour - slow drainage, tends to water retention

If there are Ama-related diseases of the urinary tract, the urine becomes cloudy, possibly slimy or streaky and takes on a strong, sometimes penetrating odour.

Healthy urine is concentrated and yellowish in colour in the morning and becomes pale yellow to colourless as the day progresses. Urination takes place without discomfort, with good pressure and without dribbling. A daily frequency of 3-8 voids is normal - if you void less frequently or more frequently, you should check your drinking habits or see a therapist for an assessment.

Mala Pariksha - the stool examination

Emptying the bowels is called defecation. Ayurveda only considers it healthy to defecate one to three times a day, again depending on dietary behaviour.

In the Ayurvedic anamnesis, the Ayurvedic therapist will ask you the following questions:

How often do you defecate daily or weekly and at what times of day?
What colour is your faeces? Medium brown, dark to black, yellowish or discoloured?
Does your faeces smell conspicuously pungent or foul?
Is the consistency moulded, hard, mushy, sticky or liquid?
Do you have to exert force to empty or is it painful?
Have you observed undigested food residues - if so, which ones?
Are there deposits such as mucus, fat or blood on your faeces?

Stool diagnostics are also used to assess ama. If agni in the gastrointestinal tract is weak, ingested food is not fully digested, sticky residues and undigested particles are produced and the faeces also smell foul.

The following constitutional tendencies are described in Ayurveda:

Vata constitutions tend to have dry, sometimes hard, odourless stools and therefore constipation. The longer the faeces remain in the intestine, the darker they become. The amount of faeces excreted tends to be small and is often associated with flatulence. Under stress, Vata constitutions are also prone to watery diarrhoea.
Pitta constitutions once again have the highest turnover, which means they eat a lot and excrete a lot accordingly. The consistency is rather loose, often unformed. In terms of colour, yellowish tones can be perceived, which are sometimes associated with burning sensations.
Kapha constitutions excrete less frequently, but in larger quantities and usually with a soft consistency. Due to their constitutionally weaker body fire (Agni), Kapha-dominated people tend to develop Ama if they eat too much, too heavy, too cold and too late.

According to Ayurveda, optimum defecation takes place in the morning shortly after getting up. To support this, you should drink 1-2 glasses (250-500ml) of warm water quickly - this stimulates movement in the gastrointestinal tract.

Observe your excretions in future, they will provide you with constant valuable feedback on your current nutritional status. In consultation with your trusted Ayurveda guide, you will learn to relate changes in your excretions to your eating, drinking and lifestyle habits and adjust them as required.

Man is what he eats - said the German philosopher Ludwig Feuerbach in 1850. We would rephrase this in Ayurvedic terms: Man is what he digests!

With best wishes for your health,