Children over 3 years old, especially children over 5 years old, often enuresis during sleep, ranging from once every few days to several times a night. This is pathological and is called enuresis.
The incidence of this disease is higher in boys than in girls, and some of them have obvious family history. The course of the disease is long, or it recurs. In severe cases, it will also enuresis when sleeping during the day, and in severe cases, it will produce inferiority complex, which will affect physical and mental health and growth and development.
The literature record of enuresis was first seen in Neijing, such as "Nine Treasures of Lingshu": "Bladder does not drown." It is clearly pointed out that enuresis is caused by uncontrolled bladder. "On the Causes and Symptoms of Miscellaneous Diseases in Children" also said: "Enuresis is caused by deficiency and cold of bladder, so it cannot be caused by water." Later generations of physicians have elaborated. Through the X-ray diagnosis of modern medicine, it is found that some children's intractable enuresis is related to spina bifida occulta, which is difficult to treat.
[Etiology and pathogenesis]
"Su Wen Meridian Differentiation" said: "Drinking people in the stomach, swimming with essence, losing in the spleen, dispersing essence in the spleen, losing in the lungs, and losing water in the bladder." It shows that after digestion, the essence in the stomach of the eater spreads to the spleen, from which it is lost to the lungs, and through the declaration of the lungs, the waterway is unblocked, while the excess water in the body is lost to the bladder and then excreted, which is the process of water-liquid metabolism. "On the Secret Code of Su Wenling's Orchid" says: "Bladder, the official of the state, contains body fluid, and can be gasified." Another cloud said, "If you have triple energizer, you can't get it by water." In addition, the kidney governs water, and water and bladder flow from the outside to the inside. The gasification of bladder depends on the sufficiency and warmth of kidney qi. Therefore, the production and excretion of urine are closely related to lung, spleen, kidney, triple energizer and bladder. Although the pathogenesis of enuresis mainly lies in bladder arrest, it is related to the imbalance of lung, spleen and kidney function, as well as the qi deficiency of triple energizer. Its main diseases are deficiency of kidney-qi, deficiency of spleen and lung, and damp-heat of liver meridian.
Deficiency of kidney qi is the main cause of enuresis, and enuresis is mostly caused by congenital deficiency, such as premature delivery, twins and fetal timidity. , leading to insufficient essence, kidney yang deficiency, lower body deficiency and cold, inability to warm bladder, bladder gasification dysfunction, hiding and dereliction of duty, unable to limit urine, so it is enuresis.
Spleen and lung deficiency, physical weakness, frequent cough, asthma, diarrhea, or spleen and lung deficiency after a serious illness. If spleen deficiency loses its essence, lung deficiency fails to treat stagnation, water fails, triple energizer fails to gasify, bladder fails to keep an appointment, and body fluid is not stored, resulting in enuresis. If spleen deficiency leads to malnutrition, deficiency of heart-qi, or phlegm stagnation, it can also make children sleepy at night and enuresis.
Liver meridian is hot and humid, irritable, frustrated, depressed, or phlegm-dampness and obesity. Damp-heat accumulation in the liver meridian leads to abnormal excretion, and the liver meridian circulates in the yin organ, which affects the normal dredging of the triple energizer waterway and leads to enuresis due to forced injection of damp-heat into the bladder.
In addition, there are children who lack education since childhood, do not form the habit of getting up at night to urinate, let it be natural, and over time, form habitual enuresis.
[Clinical diagnosis]
1. The onset age is over 3 years old.
2. Sleep deeply, don't wake up easily, wet the bed every night or the next day, or even enuresis several times every night.
3. There is no abnormality in urine routine and urine culture.
4.x-ray examination shows that some children can find spina bifida occulta, or make urography to show deformity.
First, treatment based on syndrome differentiation]
First, the key points of syndrome differentiation
Enuresis lasts for a long time, with excessive urine and a large amount. When you see cold limbs, pale face, mental fatigue, and spontaneous sweating, you are deficient in cold. Early enuresis, short and astringent urine, less fever, strong body and restless sleep belong to excess heat. Deficiency-cold patients are mostly caused by kidney deficiency, qi deficiency and bladder deficiency. Excess heat is mostly attributed to damp-heat of liver meridian.
Second, the principle of treatment
The treatment of this disease, deficiency syndrome is mainly warming kidney, strengthening spleen and tonifying lung; The empirical evidence is mainly based on purging liver, clearing heat and promoting diuresis, combined with acupuncture, laser and external treatment.
Third, treatment based on syndrome differentiation
1. Deficiency of kidney qi
Symptoms: frequent urination during sleep, even several times a night, long urination, fatigue after waking up, cold face and limbs, weakness of waist and legs, poor intelligence, pale tongue, thin and white fur, heavy and thin pulse and weakness.
Analysis: Kidney qi is weak, bladder is weak and cold, and it can't be restrained. Therefore, when sleeping, you often have enuresis, with a large amount of urine and a long time. Kidney deficiency is caused by deficiency of true yang, deficiency of essence and qi, mental fatigue, white face and cold limbs. The waist is the house of the kidney, and the bone governs the kidney. Kidney deficiency makes waist and legs weak. The kidney governs the marrow, the brain is the marrow sea, and the kidney deficiency is the brain marrow deficiency, so the intelligence is poor. Pale tongue, thin white fur and weak pulse are all manifestations of deficiency of kidney-qi and deficiency and cold of lower yuan.
Treatment: Warming kidney yang and promoting diuresis.
Prescription: Semen Cuscutae powder. Commonly used drugs: Semen Cuscutae, Cistanche deserticola, Radix Aconiti Lateralis Preparata, Fructus Schisandrae Chinensis and Concha Ostreae, and Endothelium Corneum Gigeriae Galli help digestion and transport, which have the effects of warming kidney and stopping residual diseases. It can be used in combination with Shuquan Pill to play its role synergistically.
Fatigue, loose stool hair, plus Codonopsis pilosula, Atractylodes macrocephala, Poria, hawthorn, qi and spleen, help transport; For people with poor intelligence, ginseng, calamus and polygala tenuifolia can strengthen the heart and make them happy.
2. Spleen and lung qi deficiency
Symptoms: nocturnal enuresis, shortness of breath, laziness in speaking, listlessness, pallor, frequent spontaneous sweating, loss of appetite, thin stool, pale tongue, thin fur and thready pulse.
Analysis: Qi deficiency of spleen and lung, unfavorable gasification of triple energizer, bladder failure, so enuresis during sleep. Spleen and lung qi deficiency, no transport, qi and blood deficiency, can not be proud of the face, so the face is Hua Shao; You can't support your limbs, so you are tired and weak. Lung-qi deficiency, lack of qi, laziness in speaking, and frequent sweating; Weakness of temper leads to loss of appetite and thin stool. A pale tongue with thin fur and thin pulse and little qi are all manifestations of qi deficiency.
Treatment: Yiqi Jianpi, Peiyuan Gushe. .
Buzhong Yiqi decoction combined with Su Quan pill. Commonly used drugs: Radix Astragali, Radix Codonopsis, Rhizoma Atractylodis Macrocephalae, Radix Glycyrrhizae Preparata, Yiqi Jianpi, Nourishing Native Gold, Cimicifuga Radix Bupleuri, Radix Angelicae Sinensis and Radix Astragali for regulating qi and blood, Pericarpium Citri Tangerinae for regulating qi, Fructus Alpinae Oxyphyllae, and Chinese yam.
Often spontaneous sweating, add calcined oysters and Schisandra chinensis to suppress yang and stop sweating; For anorexia, loose stool, Amomum villosum and Jiao Qushen are added to stimulate spleen and appetite, promote digestion and stop diarrhea; Phlegm is full of body fat, and Rhizoma Atractylodis, Fructus Crataegi and Rhizoma Pinelliae are added to eliminate dampness and resolve phlegm; If you are sleepy, add Acorus gramineus and Ephedra to wake up.
3. Damp-heat of liver meridian
Symptoms: nocturnal enuresis, scanty yellow urine, smelly urine, impatience and irritability, or dreamy grinding of teeth at night, red tongue, yellow or greasy fur, and rapid pulse.
Analysis: the liver meridian is damp and hot, accumulating lower energizer, consuming body fluid and forcing bladder injection, so the urine is nocturnal enuresis, with little yellow urine and foul smell. The liver meridian is hot and the liver fire is strong, so the mood is irritable and irritable; Liver fire disturbs the mind, so I dream about grinding my teeth. Red tongue, yellow greasy fur and rapid pulse are all signs of damp-heat in liver meridian.
Treatment: purging liver, clearing heat and promoting diuresis.
Prescription: Longdan Xiegan Decoction. Commonly used drugs: Radix Gentianae, Scutellariae Radix, Fructus Gardeniae for clearing liver, Rhizoma Alismatis, Caulis Akebiae, and Herba Plantaginis for clearing bladder damp heat. Angelica sinensis and Radix Rehmanniae nourish blood and yin, and are used together with Bupleurum to regulate liver qi and soften liver. Glycyrrhiza uralensis Fisch blends various drugs.
Coptidis Rhizoma, Folium Bambusae, and Fructus Forsythiae are added to relieve restlessness at night; The urine stinks and the tongue coating is yellow and greasy. Add Cortex Phellodendri and Talcum to remove damp heat.
If the body contains phlegm-dampness, if you are sleepy and can't wake up, add Bile Star, Pinellia ternata, Acorus calamus and Polygalae to clear phlegm-dampness and enlighten the mind. If you are ill for a long time, your body is emaciated, your tongue is red with little fur, your pulse is thready, and heat stagnation hurts the kidney yin, you can use Baizhi Dihuang Pill to nourish the kidney yin and clear away deficiency fire.
[other therapies]
I. Chinese patent medicines
1. Wuzi Yanzong Pill takes 3-5g each time, 1, three times a day. Used for kidney deficiency.
2. Take Shuchun Pill 3-5g each time, three times a day 1. Used for enuresis deficiency syndrome.
3. Buzhong Yiqi Pill takes 3-5g each time, 1, three times a day. : Used for spleen and lung qi deficiency syndrome.
4. Longdan Xiegan Pill is taken 3-5g each time, 1, three times a day. It is used for damp-heat syndrome of liver meridian.
Second, a single prescription.
Nocturnal urine alarm soup Alpinia oxyphylla 12g, Ephedra and Acorus gramineus 10g, ootheca mantidis 15g, pig bladder 1. Wash and fry the pig bladder for half an hour, then take all the medicines and fry for another half an hour, remove the residue and take the juice, and take it twice. Daily 1 dose, 4-8 doses continuously. It is used for enuresis caused by kidney deficiency and excessive phlegm.
Third, external drugs.
1.3 g of gallnut and 3g of Polygonum multiflorum Thunb, and grinding. Apply vinegar to navel, cover it with oil paper and gauze, and fix it with adhesive tape. 65438 +0 times per night, 3-5 times in a row. Used for enuresis deficiency syndrome.
2.3 Scallion with beard, raw sulfur powder 3so, first mash the scallion, and mash the human sulfur powder evenly into a paste, then stick the ointment on the navel before going to bed, cover it with oil paper and gauze, and fix it with adhesive tape. Every night 1 time, excluding the morning, 7 days is 1 course of treatment. Used for enuresis deficiency syndrome.
Fourthly, acupuncture therapy.
1. Acupuncture at Nocturnal Urine Point (the midpoint of the second knuckles on the palm of the little finger), and keep the needle for 15-20 minutes each time. 1 once a day or every other day, 7 times as a course of treatment.
2. Main points of auricular acupuncture: enuresis point (between kidney point and endocrine point, below esophagus point). Matching points: kidney points and subcortical points. Leave the needle for 30 minutes each time, every day or every other day 1 time.
Verb (abbreviation for verb) laser therapy
Acupoints Guanyuan, Qihai, Baihui, Zusanli and Sanyinjiao. Irradiate with 1.5-2.0 MW He-Ne laser. Each acupoint is irradiated for 1-2 minutes, irradiated every other day or 1 time, and 6-1 time is 1 course, lasting for 2-3 courses. It is used for enuresis caused by deficiency of kidney qi and deficiency of spleen and lung qi.
[preventive health care]
I. Prevention
1. Cultivate the good habit of urinating on time and before going to bed from an early age.
2. Actively prevent and treat diseases that can lead to enuresis.
Second, nursing.
1. Children with enuresis should be patiently educated and guided, and not beaten and punished. Children should be encouraged to get rid of shyness and nervousness, and build up confidence in overcoming diseases.
2. Pay attention to control the amount of drinking water after dinner every day.
3. Before the time when enuresis often occurs at night, wake up to urinate in time and keep training 1-2 weeks.
[abstract of literature]
"Su Wenyi Ming Wu Qi": "The bladder is unfavorable, so I don't want to drown."
Ren Zhai's Theory of Prescriptions Attached to Children and Defecation: "People who urinate have body fluids. Kidney governs water, bladder is the fu-organ of body fluid, both kidney and bladder are deficient, and cold brings it, which cannot be restrained. Its water can't help but come out. This is called enuresis. Coming out of sleep is called bed wetting. This is also caused by kidney deficiency, bladder deficiency and cold. "
"Children gathering to urinate is not conducive to treatment": "Those who can't help urinating are called enuresis; What comes out of sleep is called bed wetting. This is both kidney deficiency and bladder deficiency. "