Enuresis refers to the involuntary discharge of urine during sleep in the children over three years of age.

Etiology and Pathogenesis

Deficiency of kidney-qi, spleen-qi and lung-qi, weakness and coldness of the lower unit, or retention of dampness-heat in the liver meridian may lead to dysfunction of the bladder, causing enuresis. Some of the cases fail to establish a habit of timely urination at night and discharge urine whenever they please.

In addition, congenital defects, such atelencephalia, bifid spine, deformity of urinary tract, oxyuriasis, urethritis, diabetes mellitus and diabetes insipidus, may be the cause of enuresis, but these are not included in this section.

Syndrome Differentiation and Therapeutic Principles

A. Syndrome differentiation

(a) Differentiation between enuresis and incontinence of urine: Although both disorders are characterized by involuntary discharge of urine, in case of incontinence of urine, the urine discharge will frequently be dripping in character, occur usually during the daytime and typically involve the aged.

(b) Differentiation between cold and heat syndromes: A heat-syndrome is marked by frequent discharge of scanty, deep-colored urine with a hot feeling during urination. A cold-syndrome is characterized by discharge of a large amount of clear urine without a hot sensation during urination.

(c) Differentiation between asthenia and sthenia syndromes: An early case with strong physique and forceful pulse is attributed to sthenia-syndrome, while a longstanding case with spiritlessness, shortness of breath and thready weak pulse to asthenia-syndrome.

B. Therapeutic principles

Tonifying therapy for asthenia-syndrome and expelling therapy for sthenia-syndrome are the general principles. For cases caused by asthenia-cold of the kidneys, the therapy of warming and strengthening the kidneys is advisable. For those due to deficiency of spleen-qi and lung-qi, the therapies of benefiting qi and preserving fluids are recommended. As for those resulting from the retention of dampness-heat in the liver meridian, the therapy of clearing away dampness-heat should be employed, while for those due to asthenic fire, that of tonifying yin and clearing away heat should be applied.

Classification and Treatment

A. Asthenia-cold of the kidneys

Manifestations: Frequent enuresis during sleep, pale complexion, soreness and weakness of lumbus and knees, frequent discharge of clear urine during the daytime, coldness of limbs, pale tongue with white coating and deep, slow and weak pulse.

Therapeutic principles: Warm kidney-yang, and control urination.

Prescription: The Modification of Ootheca Mantidis Powder and Gongdi Bolus

Ootheca Mantidis 10 g
Semen Cuscutae 10 g
Fructus Alpiniae Oxyphyllae 10 g
Fructus Psoraleae 10 g
Fructus Rubi 10 g
Fructus Schisandrae 10 g
Radix Aconiti Lateralis Praeparata 10 g
Radix Codonopsis Pilosulae 10 g
Os Draconis (decocted) 15 g

B. Deficiency of spleen-qi and lung-qi

Manifestations: Enuresis during sleep, frequent discharge of scanty urine during the daytime, pale complexion, listlessness, fatigue, weakness of limbs, poor appetite, loose stool, pale tongue with thin, white coating and slow or deep and thready pulse.

Therapeutic principles: Invigorate the spleen, benefit qi, raise yang, and preserve body fluids.

Prescription: The Modified Decoction for Strengthening Middle-Jiao and Benefiting Qi

Radix Astragali 15 g
Rhizoma Atractylodis Macrocephalae Praeparata 10 g
Pericarpium Citri Reticulatae 6 g
Radix Bupleuri 6 g
Rhizoma Cimicifugae 3 g
Radix Angelicae Sinensis 10 g
Rhizoma Dioscoreae 10 g
Fructus Alpiniae Oxyphyllae 10 g
Fructus Schisandrae 10 g
Fructus Rosae Laevigatae 10 g

C. Retention of dampness-heat in the liver meridian

Manifestations: Frequent enuresis with scanty yellow and odorous urine, irritability, teeth grinding, flushed face, red lips, red tongue with yellow or yellow, greasy coating and wiry and smooth pulse.

Therapeutic principles: Purge liver-fire, and clear away heat.

Prescription: The Modified Decoction of Gentianae for Purging Liver-Fire

Radix Gentianae 10 g
Radix Scutellariae 10 g
Fructus Gardeniae 5 g
Radix Bupleuri 6 g
Semen Plantaginis (wrapped in cloth) 10 g
Rhizoma Alismatis 6 g
Caulis Akebiae 6 g
Cortex Phellodendri 6 g
Radix Glycyrrhizae 3 g

Remarks: Add Rhizoma Picrorrhizae (6 g) and Massa Fermentata Medicinalis (prepared with Cinnabaris) for cases with teeth grinding and restlessness at night. For cases with red tongue with little coating and wiry, thready and rapid pulse due to yin deficiency and fire hyperactivity, apply Bolus of Anemarrhenae, Phellodendri and Rehmanniae to nourish yin and suppress fire.

Experiential Prescriptions

A. Fructus Alpiniae Oxyphyllae (10 g); prepared with vinegar and powdered; taken by three divided doses a day; applicable to cases caused by insufficiency of kidney-qi and asthenia-cold of the bladder.

B. Ootheca Mantidis (10 g), Poria (10 g), Fructus Psoraleae (10 g) and Fructus Alpiniae Oxyphyllae (10 g); put into a pig's bladder, dried by a slow fire and powdered; take two grams twice daily; applicable to cases with insufficiency of kidney-qi.

C. Semen Euryales and Semen Nelumbinis in a moderate amount; cooked as a soup; applicable to cases with deficiency of spleen-qi and lung-qi and dysfunction of the bladder.

Copyright 1995 Hopkins Technology