Enuresis includes two conditions, one refers to enuresis, commonly known as bedwetting, and the other refers to enuresis, which means that urine is not only excreted in bed, but also in clothing or other places where it should not be discharged in a non-sleeping state or when awake. From the pathological point of view, the former is mostly due to neurological incoordination and is mostly simple and persistent, i.e., no accompanying symptoms other than bedwetting. The latter are mostly organic lesions, such as neurological damage or occupying lesions of related organs, and are mostly concomitant and transient, i.e., they have other more obvious pathological manifestations besides bedwetting, and may improve with the improvement of other lesions. The discussion is about bedwetting in enuresis that is simple and without organic lesions.
I. Incidence
Sex The incidence of the disease is higher in boys than in girls, and some have a clear family history.
Prognosis The course of the disease is long or recurrent. In severe cases, enuresis may occur even during daytime sleep, and in serious cases, it may cause low self-esteem and affect physical and mental health and growth.
II. Diagnosis
1. The age of onset is above 3 weeks old.
2. Deep sleep, not easy to wake up, bedwetting occurs every night or every other day, or even several times of urine loss every night.
3.No abnormal findings in urine routine and urine culture.
4, X-ray examination, some children can be found hidden spina bifida, or urinary tract imaging can be seen deformities.
Treatment by evidence
1.Kidney Qi is not solid
Symptoms: Frequent loss of urine during sleep, or even several times a night, clear and long urine, waking up, fatigue, white face and cold limbs, soreness and weakness of the waist and legs, poor intelligence, light tongue, thin white fur, sunken and weak pulse.
Treatment Warming the kidney yang and fixing the urine.
Radical: Cuscuta sinensis with addition and subtraction. Commonly used herbs: Cuscuta sinensis, Cistanches, Radix et Rhizoma spp. warm kidney yang, Wu Wei Zi and Oyster benefit kidney and consolidate astringent urine, and Chicken Nei Jin eliminates food and helps transportation to facilitate the effect of warming kidney and consolidating astringent urine to stop miscarriage. The effect can be synergized with Shrinking Spring Pill.
For weakness, poor appetite and loose stools, add Radix et Rhizoma Ginseng, Atractylodes Macrocephalae, Poria, Hawthorn to benefit the spleen and help transport; for poor intelligence, add Radix et Rhizoma Ginseng, Acorus Calamus, Yuan Zhi to replenish heart energy and open the heart orifice.
2.Spleen and lung qi deficiency
Symptoms Urine loss in sleep, little breath and lazy speech, tiredness and fatigue, little color, often sweating, loss of appetite, loose stools, light tongue, thin coating, thin pulse and little strength.
Treatment Benefit Qi and strengthen the spleen, cultivate the vital energy and consolidate astringency.
Radicals: Tonifying Zhong Yi Qi Tang and combining with Shrinking Spring Pill. Commonly used herbs: Huang Qi, Radix Codonopsis, Rhizoma Atractylodis Macrocephalae and Radix Glycyrrhiza Uralensis benefit Qi, strengthen the spleen and cultivate earth to produce gold; Sheng Ma and Chai Hu elevate the qi of clear yang; Angelica Sinensis with Huang Qi tonifies qi and blood; Chen Pi regulates qi and harmonizes the middle. Phyllanthus aristolochiae, yam and ocimum sanctum warm the kidneys, strengthen the spleen and consolidate astringency.
For frequent spontaneous sweating, add calcined oyster and Wu Wei Zi to subdue Yang and astringent Yin to stop sweating; for loss of appetite and loose stools, add sandy saxifrage and Jiao Shen Qu to transport the spleen and open the stomach, eliminate food and stop diarrhea; for phlegm and body fat, add atractylodes, hawthorn and Semen Nux vomica to dry dampness and resolve phlegm; for sleeplessness, add calamus and ephedra to awaken the mind and open the body.
3.Damp heat in the liver meridian
Symptoms: Urine loss in sleep, yellow urine with little volume, stinky urine, irritable and irritable temperament, or nighttime dreaming and grinding of teeth, red tongue, yellow or greasy coating, and stringy pulse.
Treatment Clearing heat and dampness from the liver.
Radix gentian and liver diarrhea soup with reduction. Commonly used herbs: gentian herb, scutellaria, gardenia to clear liver fire, zedoary, mouton, and psyllium to clear damp-heat in the bladder. Radix Angelicae Sinensis and Radix Rehmanniae nourish Blood and nourish Yin, with Chai Hu to regulate Liver Qi to soften the Liver. Licorice harmonizes the herbs.
For restless sleep at night, add Huang Lian, Bamboo leaf and Lian Qiao to clear the heart and remove irritation; for heavy urine odor and yellow tongue coating, add Huang Bai and Slippery Rock to clear damp-heat. If phlegm and dampness are contained in the body, and sleepiness is difficult, add Bile Star, Radix Panax, Calamus and Yuan Zhi to clear phlegm and dampness and open the orifice to awaken the mind. If the disease is prolonged, the body is emaciated, the tongue is red with little coating, the pulse is thin, and the kidney yin has been injured despite the heat, use Zhi Bai Di Huang Wan to nourish the kidney yin and clear the deficiency fire.
IV. Other therapies
(A) Chinese herbal medicine
1.Wu Zi Yan Zong Wan 3~5g per serving, 3 times a day. Used for kidney deficiency evidence.
2.Shrinking Spring Pill 3~5g per dose, 3 times a day. Used for deficiency of urinary emission.
3.Tonic Zhong Yi Qi Pill 3-5g per dose, 3 times a day. Used for deficiency of spleen and lung Qi.
4. Gentian and Liver Pill: 3-5g per dose, 3 times a day. Used for damp-heat in the liver meridian.
(II) Single prescriptions
Nocturnal urination vigilance soup: 12g of ginseng, 10g each of ephedra and calamus, 15g of mulberry cuttlebone, 1 pig bladder. Wash the pig’s bladder and decoct for half an hour, then decoct for another half an hour, remove the residue and take the juice in 2 doses. Take 1 dose daily for 4 to 8 doses. It is used for urinary emission due to kidney deficiency and phlegm.
(C) External treatment
1. 3g of each of Wu Bei Zi and He Shou Wu, grinded. Apply to the umbilicus with vinegar, cover with oil paper and gauze, and fix with adhesive tape. Apply once a night for 3 to 5 times. It is used for the deficiency of urinary emission.
2. 3 white onions with beard and 3g of raw sulphur powder. pound the white onions first, then mash them into the sulphur powder to make a paste, put the paste on the umbilicus before going to bed, cover with oil paper and gauze, and fix with adhesive tape. Remove it in the morning, 7 days for a course of treatment. It is used for deficiency evidence of urine loss.
(D) Acupuncture therapy
1. Acupuncture the nocturnal urinary point (at the midpoint of the transverse line of the second phalangeal joint on the metacarpal surface of the little finger), and leave the needle for 15-20 minutes each time. Daily or every other day, 7 times for a course of treatment.
2.Auricular acupuncture Main acupuncture point: enuresis point (between the kidney point and endocrine point, below the esophageal point). Supporting points: renal point, subcortical. Retain the needle for 30 minutes each time, once a day or every other day.
(V) Laser therapy
Take the points Guan Yuan, Qi Hai, Bai Hui, Foot San Li, and San Yin Jiao. Irradiate with a 1.5 to 2.0 mw helium-neon laser. Each point should be irradiated for 1 to 2 minutes, once a day or every other day, 6 to 10 times for a course of treatment, for 2 to 3 courses of treatment. It is used for urinary emission due to deficiency of kidney qi and spleen-lung qi.
V. Prevention
1.Cultivate the good habit of urinating on time and before bedtime since early childhood.
2. Actively prevent and treat diseases that can cause enuresis.
Care
1.For children with enuresis, we should educate and guide them patiently, avoid scolding and chastising them, encourage them to eliminate shyness and nervousness, and build up confidence to overcome the disease.
2. Pay attention to the control of water consumption after dinner every day.
3. Wake up to urinate in time before the time when enuresis often occurs at night, and insist on training for 1 to 2 weeks.