bubble_chart Concept

Nocturnal polyuria refers to the symptom of increased frequency and volume of urination at night. Generally, it is characterized by urinating more than two or three times at night or having nighttime urine output exceeding a quarter of the total daily urine output. In severe cases, nighttime urine output may approach or even exceed daytime output. The key feature of this condition is normal daytime urination with excessive urination at night, distinguishing it from frequent urination.

bubble_chart Pattern Analysis

1. Kidney Yang Deficiency︰Nocturia accompanied by frequent urination, dribbling after urination, or even urinary incontinence or enuresis, tinnitus and hearing impairment, soreness and weakness in the lower back, spermatorrhea and premature ejaculation, a pale and swollen tongue with thin white coating, and deep-thready-weak pulse. It is often caused by constitutional yang deficiency or prolonged illness in the elderly, leading to kidney yang deficiency, failure of storage and containment, and bladder dysfunction. At night, when yin is exuberant and yang is declined, the body loses its ability to retain urine, resulting in frequent and excessive urination. Treatment should focus on tonifying kidney yang, supplemented with astringent therapy, using modified Great Dodder Seed Pill. For milder cases where yang deficiency is not prominent, often seen in short-term conditions or adolescents, the condition is generally attributed to bladder qi deficiency. Treatment should aim at tonifying qi to consolidate the bladder, using modified Mantis Egg-Case Powder.
2. Spleen-kidney Qi Deficiency︰Cold limbs, physical fatigue, mental fatigue, dizziness, tinnitus, soreness and weakness in the lower back and knees, reduced appetite, loose stools or diarrhea with undigested food, frequent urination (especially at night), pale and swollen tongue with a white coating, deep and weak pulse. This is often due to the decline of life-gate fire failing to warm spleen yang, or spleen yang deficiency being too weak to nourish kidney yang, leading to deficiency of both the spleen and kidneys, resulting in instability in warming and retaining the lower origin. Hence, urination increases at night when yin is exuberant and yang is declined. Symptoms of kidney deficiency such as tinnitus and lower back soreness, as well as spleen deficiency signs like emaciation, cold limbs, reduced appetite, and loose stools, are present simultaneously. If treated solely by focusing on the kidneys, the therapeutic effect is often unsatisfactory. It is necessary to tonify both the spleen and kidneys, combining warming yang and astringent methods. The modified Gupo Wan can be used.

The kidneys govern water and control opening and closing, while the bladder stores urine. Therefore, frequent nighttime urination is attributed to the kidneys and bladder. Additionally, day is yang and night is yin. At night, yin is exuberant and yang is declined, so frequent nighttime urination is actually caused by weak yang qi.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．Various syndromes of urinary disorders: Frequent urination is caused by bladder deficiency cold, leading to the smoothness of the bladder. The kidney is the organ, and the bladder is the organ of the kidney. They are both internally and externally related and govern water. Kidney qi flows downward to the yin region. Since the organ is deficient and cold, it cannot warm the organ, hence the urine is pale and frequent. If it is particularly severe at night, it is due to the generation of internal yin qi."
2. 《Luo's Medical Mirror on Incontinence of Urine》: "Therefore, in the young and strong, yin and yang are both sufficient, and there is little urination at night. As one reaches old age, there is frequent urination at night because both water and fire are insufficient. It is treated with Eight-Ingredient Rehmannia Pill, removing Alisma and adding Psoralea, which is also known as Right-Restoring Decoction, and it is also effective."