Infantile enuresis refers to the symptom of involuntary urination during sleep in children over the age of three, also known as "nocturnal enuresis."

As early as in the Lingshujing, there is a discussion stating "the bladder fails to restrain, leading to enuresis." Zhubing Yuanhou Lun also mentions in the section on urinary disorders: "The bladder is the organ of body fluids. When the organ is cold and deficient, and yang qi is weak, it cannot control water, thus causing enuresis." Later medical practitioners' understanding of enuresis has mostly not gone beyond these descriptions.

Infantile enuresis is often more common in children than in adults due to the incomplete development of kidney qi zang-fu organs and inadequate care, hence it is discussed as a separate topic. If enuresis is occasionally caused by sudden fright or excessive play, it is not considered pathological and will not be discussed in this text.

bubble_chart Pattern Analysis

1. Kidney Yang Deficiency︰Frequent nocturnal enuresis, with bedwetting every night. The child exhibits delayed development, {|###|}pale complexion{|###|}, cold limbs and {|###|}aversion to cold{|###|}, soreness and weakness in the lower back and knees, pale lips and tongue, and a deep, slow, and weak pulse. This condition is primarily seen in children with congenital insufficiency, due to {|###|}lower energizer{|###|} {|###|}yuan yang deficiency{|###|} and decline, where the life-gate fire fails to steam fluids, promote {|###|}qi transformation{|###|}, or restrain the bladder, leading to nocturnal enuresis. Treatment should focus on {|###|}warming and tonifying kidney yang{|###|}, supplemented with consolidation. Use |Mantis Egg-Case Powder combined with Gongdi Wan (Consolidating Dike Pill) with modifications.
2. Spleen-Lung Qi Deficiency︰Frequent urination with scant urine, nocturnal enuresis, shortness of breath and timid voice, sweating upon exertion, susceptibility to common cold, poor appetite and loose stool, pale and lusterless tongue texture, and thin weak pulse. This condition is commonly seen in children with improper postnatal care or prolonged conditions such as cough, asthma, vomiting, or diarrhea. Due to impaired pectoral qi and qi deficiency failing to lift and control water, enuresis occurs. The key points for clinical differentiation are: kidney yang deficiency must present with cold patterns, such as cold limbs, aversion to cold, slow and weak pulse, and worsening in cold conditions; spleen-lung qi deficiency manifests as symptoms of insufficient pectoral qi, such as sweating upon exertion, shortness of breath and timid voice, poor appetite and loose stool, without obvious cold signs, making it easily distinguishable from kidney yang deficiency. Treatment should focus on tonification, aiming to strengthen the spleen and benefit the lungs, supplemented with astringents. Middle-Tonifying Qi-Replenishing Decoction pills can be modified for use.
3. Liver Channel Stagnant Heat︰Nocturnal enuresis, dark yellow urine, feverish feeling in palms and soles, flushed face and red lips, nighttime teeth grinding, or fright and vigilance with restlessness, thin yellow tongue coating, slippery and rapid pulse. This condition arises from internal accumulation of dampness-heat invading the liver channel, or liver qi stagnation transforming into fire, affecting the bladder's storage function, which can also lead to enuresis—though such cases are relatively rare. The child's urine is often foul-smelling, with scanty and yellow enuresis, accompanied by feverish palms and soles, nighttime fright and vigilance with restlessness, yellow tongue coating, and slippery-rapid pulse. These symptoms and signs are distinctly different from the two types mentioned above, making them easy to distinguish. Treatment should focus on draining the liver and clearing heat, using the modified Gentian Liver-Draining Decoction.

bubble_chart Documentation

1. 《Pediatric Etiology and Treatment: Urination and Defecation》 quotes Liu Wan-su: "Enuresis, or the inability to control urination, is due to cold. The kidneys govern water, and the bladder is the reservoir of body fluids. When both the kidneys and bladder are deficient, and cold qi takes advantage, it cannot restrain the water, leading to involuntary urination, known as enuresis; when it occurs during sleep, it is called bed-wetting. These are all due to deficiency of both the kidneys and bladder, accompanied by cold. It is treated with Chicken Intestine Powder. There is also heat invading the kidney region, affecting the foot Jueyin meridian, causing extreme stagnation at the urethral orifice, and qi and blood cannot circulate freely, leading to wilting impediment and the spirit being unable to function, thus fluids seep into the bladder, resulting in frequent urination and fecal incontinence, and inability to control."