bubble_chart Concept

Enuresis mostly occurs during sleep at night and is more commonly seen in children. Suwen. Xuanming Wuqi refers to it as "involuntary urination." The name "enuresis" was first proposed in the

chapter of "Jingui: Lung Atrophy, Lung Abscess, Cough, Abnormal Rising of Qi, Abnormal Pulse Syndromes and Their Treatment." If enuresis occurs during the course of diseases such as apoplexy, cold-damage disease, or warm disease, it often indicates that the disease has penetrated deeply into the internal organs and has reached a severe stage. However, since it is not the main symptom, it is not within the scope of discussion for this condition.

bubble_chart Modern Research

Western medicine believes that enuresis can be classified into organic, physiological, and functional types. Functional enuresis in children is the most common, which is due to a developmental delay in the nervous system's control over bladder function, often caused by poor nighttime toilet training or psychological factors.

bubble_chart Pattern Analysis

1. Kidney Yang Deficiency︰Nocturnal enuresis or incontinence of urine, pale complexion, fear of cold with cold limbs, soreness and weakness in the lower back and knees, frequent and clear profuse urine, pale tongue texture, deep thready and weak pulse. This condition is often caused by congenital deficiency, inherent weakness, kidney damage due to sexual overindulgence, declining kidney qi in old age, or insufficient development of the Governor and Conception Vessels in children with cold exposure to the soles of the feet. These factors can lead to kidney yang deficiency, deficiency-cold in the lower origin, resulting in failure of the hiding and storing functions and bladder incontinence, thus causing enuresis. For yang deficiency, the treatment involves warming the kidneys and securing retention, with the prescription of Gongdi Wan (Kidney-Securing Pill).
2. Kidney Yin Deficiency︰Frequent but scanty urine, dark-colored and hot, flushed cheeks and red lips, or even tidal fever night sweat, or nocturnal emission, tongue texture red with scant coating, deep thready and rapid pulse. Mostly caused by exhaustion of essence and fluids, indulgence of desires, frenetic stirring of ministerial fire, leading to dysfunction of bladder opening and closing, resulting in enuresis. For yin deficiency, treatment involves nourishing yin and reducing fire, using Anemarrhena, Phelloendron and Rehmannia Pill.
3. Sinking of Spleen Qi︰Overwork leads to enuresis, limb fatigue, shortage of qi, reluctance to speak, drowsiness, poor appetite, bloating immediately after eating, or concurrent symptoms such as prolapse of rectum and prolapse of uterus. The tongue texture is pale with scant coating, and the pulse manifestation is slow and weak. This is often caused by excessive fatigue and overthinking, which injure the heart and spleen, leading to sinking of spleen qi, or postpartum middle qi deficiency type of inward invasion, resulting in enuresis. The prescription used is Gu Pao Tang.
4. Lung Qi Deficiency with Cold︰Enuresis accompanied by chronic cough disease, vomiting frothy saliva, tongue texture swollen with teeth marks, white coating, and a fine slow pulse. It is often seen in cases of lung qi deficiency and weakness, where the governing and regulating functions fail, leading to an inability to restrain the lower energizer and resulting in enuresis. Liquorice and Dried Ginger Decoction with Ginseng is the primary treatment.

The main differences between enuresis due to kidney yang deficiency and enuresis due to kidney yin deficiency are as follows: the former is characterized by frequent urination with a large volume of clear and pale urine, caused by kidney yang deficiency leading to impaired qi transformation; the latter is characterized by frequent urination with a small volume of dark and hot urine, caused by yin deficiency with effulgent fire. In terms of tongue and pulse diagnosis, yang deficiency presents with a pale tongue, thin and sparse coating, and a deep, thin, and weak pulse without signs of rapidness; yin deficiency presents with a red tongue texture, sparse coating, and a thin and rapid pulse.

The clinical manifestations of spleen qi deficiency and lung qi deficiency are very similar and often coexist. For sinking of spleen qi, the focus should be on symptoms such as limb fatigue, reduced appetite with bloating, and conditions like chronic diarrhea, prolapse of the rectum, and prolapse of the uterus; for lung qi deficiency with cold, symptoms include coughing with excessive saliva.

The basic mechanism of disease for enuresis is the loss of bladder control. The control of the bladder is related to the function of qi transformation, which in turn is closely associated with the warming function of heart yang, the diffusion and descent of lung qi, the free flow of liver qi, the lifting function of spleen qi, and especially the warming and nourishing function of kidney and governor vessel yang qi. Therefore, the occurrence of enuresis involves the heart, lung, spleen, liver, and kidney, the five zang organs, with the kidney playing a primary role due to its control over the opening and closing of the two lower orifices.

This condition is mostly a deficiency pattern. The Lingshu . Benshu states: "Deficiency leads to enuresis, and enuresis should be treated by tonifying." Clinically, there are also cases of excess pattern, such as enuresis caused by impaired liver qi flow, but these are less common.

bubble_chart Documentation

1. 《Chinese Internal Medicine Reference．Enuresis》: "There is enuresis with the pattern of White Tiger Decoction, and enuresis with the pattern of Liquorice and Dried Ginger Decoction. The former is the extreme point of yang, while the latter is purely a yin pattern. Although both are enuresis, their mechanisms are in direct antagonism. ...Enuresis with a yang pattern is due to the dullness of bladder sensation. ...Enuresis with the pattern of Liquorice and Dried Ginger Decoction arises from insufficient contraction force, hence the urine is passed but not in large amounts."
2. Renzhai Zhizhi Fang: "Accumulation of blood in the lower energizer and internal damage from deficiency fatigue lead to involuntary urination without awareness."
3. Bencao Gangmu．Volume 3．Frequent Urination and Enuresis》: "Liver excess leads to ischuria, while deficiency leads to enuresis."