Nocturnal Enuresis

Nocturnal enuresis is referred to involuntary discharge of the urine occurring at night and during sleep . As a morbid condition , it is mostly seen in children over the age of three years and occasionally in adults . It is mainly caused by deficiency of kidney qi with disability of the bladder to restrain the urine discharge .

Etiology and Pathogenesis

The normal excretion of urine is mainly concerned with the activities of the kidney qi and the restraining function of the bladder . The kidney is in charge of micturition and defecation , and responsible for the formation of urine , while the bladder stores and excretes urine . If the kidney qi is insufficient , it will be unable to maintain the function of the bladder in restraining the urine discharge , and thus occurs enuresis . Ancient doctors therefore believed that enuresis is due to deficiency . As stated in General Treatise on the Etiology and Symptomology of Diseases : Enuresis is caused by cold in the bladder of deficiency type , which renders the bladder unable to restrain the urine discharge . ' ' Dai Sigong once said , Involuntary urination during sleep is due to cold in the kidney causing incontinence of urine .

Differentiation

Main manifestations : Involuntary micturition during sleep with dreams , once in several nights in mild eases , or several times a night in severe cases ; sallow complexion , loss of appetite , and weakness in the prolonged cases , pale tongue , white coating , thready pulse weak at the chi region .

Analysis : Deficiency of the kidney qi with failure of the bladder in restraining the urine discharge causes nocturnal enuresis . Long duration of the disease undermines the kidney qi , and consequently the spleen falls into loss of warming , its function of transportation and transformation being disturbed . Therefore , the appetite is lost . Deficiency of the spleen qi fails to distribute the essence of food to nourish the whole body . This is why the complexion is sallow and the patient is lacking in strength . Pale tongue with white coating , and thready pulse weak at chi region are signs of deficiency .

Treatment

Method : The Back - ( Shu ) and Front - ( Mu ) points of the kidney and bladder are selected as the principal points , with reinforcing or moxibustion to strengthen the kidney and reinforce qi .

Prescription : Shenshu ( B 23 ) , Pang - guangshu ( B 28 ) , Zhongji ( Ren 3 ) , Sanyinjiao ( Sp 6 ) , Dadun ( Liv 1 ) . Supplementary points : Enuresis with dreams : Shenmen ( H 7 ) . Loss of appetite : Pishu ( B 20 ) , Zusanii ( S 36 ) .

Explanation : The kidney is exteriorly - interiorly related to the bladder , so the Back - ( Shu ) points of the kidney and bladder are applied . Zhongji ( Ren 3 ) is the Front - ( Mu ) point of the bladder . Combined use of the above three points contributes to reinforce the kidney qi and the restraining function . Sanyinjiao ( Sp 6 ) is added to adjust the qi of the three yin meridians . Moxibustion to badun ( Liv 1 ) , the Jing - ( Well ) point of the Liver Meridian which curves , round the genitals , can promote the circulation ofqi of the meridian and strenghthen the therapeutic effect .

Remarks

The chief causative factor of this disease is the underdevelopment of cerebral micturition centre and treatment of acupuncture and moxibustion provides satisfactory effect . As for enuresis caused by organic diseases , such as deformity of urinary tract , cryptorachischisis , organic cerebral diseases and oxyuriasis , the treatment should be given to the primary disease .