Enuresis

WESTERN MEDICINE: Involuntary and consistent bedwetting during sleep by children over 5 or 6 years is abnormal and may be a sign of severe underlying pathological changes. 

SYMPTOMS AND SIGNS: Involuntary bedwetting during sleep, accompanied with kidney, spleen, lung or other organs deficiency symptoms and signs; or the damp - heat, or blood stasis at lower burner. This may affect adults as well. 

ETIOLOGY AND PATHOLOGY: The internal etiological changes of enuresis are due to the deficiencies of lung, spleen, kidney, heart and liver, especially the dysfunctions of kidney and urine bladder. Other two commonly seen etiological factors are the damp - heat, or blood stasis at lower burner. The following are the most often seen at clinic practice: 

  1. The Deficiency of five Zhang organs due to exhaustion, prolonged strong unhealthy emotions, or excessive sexual activities, after any chronic illnesses or old age. Urine, as part of body fluids needs to be formed and passed out by the co operative functions of lung, spleen, kidney, heart and liver. Lung's functions of dispersing and descending; spleen's transformation and transportation and kidney Qi Hua all help the formation, distribution and excretion of body fluids. 
  2. The downward attacking of damp - heat at lower burner causes the dysfunction of bladder. 
  3. The blood stasis due to other reasons at lower burner damages the bladder causing enuresis. 

DIFFERENTIATIONS: 

1. Enuresis due to the Deficiency Coldness at Lower Burner:

Indications: General fatigue, aversion to cold, sore and weakness at lumbar region, weakness of two lower legs, profuse and clear urine, cold feeling at back, involuntary bedwetting, or uncontrollable urination. Pale tongue, thin coating, deep, thready and weak pulse. 

Treatment & Formulas: Warm the lower burner and tonify the kidneys. 

Products:

    • Fu Tu Dan (Hoelen and Cuscute Formula, Item No. 2141): This tonifies the kidney and spleen, at the same time, it has the function of an astringent. So it is often used for spermatorrhea, premature ejaculation and other sexual dysfunctions. 
    • Ba Wei Di Huang (Rehmannia Eight Formula, Item No. 2011): This tonifies both kidney Yin and Yang. Popularly used in clinic for kidney deficiency diseases. 
    • Huan Sao Dan (Lycium Formula, Item No. 2264): This is a very good tonic for heart, spleen and kidney, especially for kidney deficiency diseases. It has rejuvenation effects by its tonifying nature. 
    • Jin Suo Gu Jin Wan (Lotus Stamen Formula, Item No. 2114): This is an astringent formula for bedwetting, nocturnal emission, spermatorrhea at late stage after trying other formulas.  

2. Enuresis due to the Qi Deficiencies of Lung and Spleen:

Indications: Frequent urination, or difficulty controlling, bedwetting at night, pale complexion, shortness of breath, coughing, sometimes loss of control of urine during talking or laughing, heavy sensation at lower abdomen, pale tongue, weak, soft and weak pulse. 

Treatment & Formula: Tonify the lung and spleen Qi. 

Products: 

    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No.2225): This is a typical Qi tonic formula for lung and spleen deficiency. The following two herbs can be added for astringent purposes: Mu Li (Oyster shell, Item No. 1093); Wu Wei Zi (Schizandra, Item No. 1048). 

3. Enuresis due to the Disharmony of Heart and Kidney:

Indications: Bed-wetting at night without dreaming, lower spirit, thin looking, insomnia, restlessness, frequent urination. Thin tongue coating, pale or red tongue with red petechiae at the tip of tongue, deep, thready and rapid pulse. 

Treatment & Formulas: Tonify the kidney and harmonize the heart. 

Products:

    • Sang Piao Xiao San (Mantis Formula, Item No. 2147): This is a typical formula for enuresis due to the disharmony of heart and kidney by its astringent and tonic functions. It is also used for chronic and frequent urination, involuntary seminal discharge, forgetfulness, etc. These are all the symptoms and signs of disharmony between the heart and kidney. 
    • Lian Zi Qing Xin Yin (Lotus Seed Combination, Item No. 2254): It clears the heart fire and tonifies the Qi; it also has astringent functions. So this formula is suitable for the enuresis due to the heart fire causing the disharmony of heart and kidney. 
    • Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon and Dragon Bone Combination, Item No. 2163): This is good for enuresis due to neuro -disorders, or neurosis. 
    • Zhi Po Ba Wei Wan (Anemarrhena, Phellodendron, and Rehmannia Formula, Item No. 2123) or Ji Ju Di Huang Wan (Lycium, Chrysanthemum and Rehmannia Six Formula, Item No. 2290): lt treats the enuresis due to the disharmony between heart and kidney, which specifically causes kidney Yin deficiency. 

4. Enuresis due to Downward Damp - Heat:

Indications: Frequent urination, burning sensation, bed-wetting, scanty yellowish urine with strong odor, lower fever, soreness of lumbar region. Red tongue, thin and greasy coating, thready, slippery and rapid pulse. 

Treatment & Formulas: Clear the interior heat and eliminate the dampness. 

Products

    • Ba Zheng San (Dianthus Formula, Item No. 2008): This is a typical formula for the damp - heat at lower burner. 
    • Yin Chen Wu Ling San (Capillaris and Hoelen Five Formula, Item No. 2143):This is also a good formula to clear the interior heat and eliminate the dampness because of its diuretic function. 

5. Enuresis due to the Blood Stasis At Lower Burner:

Indications: Dysuria, or oliguria, fullness or pain at lower abdomen, abdominal mass can be felt, involuntary bedwetting or uncontrollable urination. Deep dark tongue, or with petechiae, thin coating, unsmooth or thready and slippery pulse. 

Treatment & Formulas: Eliminate the blood stasis by promoting the circulation of blood and Qi. 

Products:

    • Gui Zhi Fu Ling Wan (Cinnamon and Hoelen Formula, Item No. 2157)
    • Tao He Cheng Qi Tang (Persica and Rhubarb Combination, Item No. 2165): This is atypical formula for blood stasis at lower burner because of its strong function of promoting blood circulation and purgative function. 
    • Da Huang Mu Dang Pi Tang (Rhubarb and Moutan Combination, Item No. 2040): This is also a strong formula for blood stasis at Iower burner, especially at intestines of lower abdomen. 

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