Nocturnal Enuresis

Introduction

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

Etiology and Pathogenesis

The normal excretion of urine is mainly concerned with the activities of thekidney qi and the restraining function of the bladder. The kidney is in chargeof micturition and defecation, and responsible for the formation of urine, whilethe bladder stores and excretes urine. If the kidney qi is insufficient, it willbe unable to maintain the function of the bladder in restraining the urinedischarge, and thus occurs enuresis. Ancient doctors therefore believed thatenuresis is due to deficiency. As stated in General Treatise on the Etiology and Symptomology of Diseases: "Enuresis is caused by cold in the bladder ofdeficiency type, which renders the bladder unable to restrain the urine discharge." Dai Sigong once said, "Involuntary urination during sleep isdue 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 metameric shu and 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:

  • [BL23 - BL28 - RN3 - SP6 - LR1].

Supplementary points:

  • Enuresis with dreams: HT7.
  • Loss of appetite: [BL20 - ST36].

Explanation: The kidney is exteriorly - interiorly related to the bladder, so the metameric shu points of the kidney and bladder are applied. RN3 is the metameric mu point of the bladder. Combined use of the above three points contributes to reinforce the kidney qi and the restraining function. SP6 is added to adjust the qi of the three yin meridians. Moxibustion to LR1, 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.