Enuresis

　　Enuresis is mostly caused by insufficient congenital kidney Qi and cold deficiency of the lower Yuan. If the Qi of the kidney and bladder is both deficient, they cannot control the waterway, thus leading to enuresis. Enuresis can also occur due to spleen and lung deficiency caused by various diseases, with Qi deficiency and descent.

　　遗尿多见于小儿先天不足，素来体弱，面色苍白，恶风寒，肢冷无力，饮食无味儿，白天小便频数，夜间梦中小便自遗，或大便溏泻。

　　Bedwetting is more common in children with congenital deficiencies, weak constitution, pale complexion, aversion to cold, cold limbs, lack of appetite, frequent urination during the day, bedwetting in dreams, or loose stools.

　　Nighttime bedwetting is often dominant in the family, if both parents have been nighttime bedwetters, their children have a 3/4 chance of bedwetting. If one parent has been a bedwetter, their children have a 1/2 chance of being affected. This is a very serious case, please parents find it and treat it in time. There are many diseases that can cause bedwetting such as pinworm infection, urinary tract infection, kidney disease, local inflammation of the urethral opening, spina bifida, spinal cord injury, sacral nerve dysfunction, epilepsy, incomplete brain development, and small bladder capacity, etc., but bedwetting caused by disease only accounts for a small proportion. The vast majority of children's bedwetting is related to mental factors, hygiene habits, and environmental factors.

　　Bedwetting patients generally do not have special complications, but it can lead to tension, inferiority, and anxiety. This disease severely affects the daily life of patients, so it should be actively prevented. It should attract the high attention of clinical doctors and patients.

　　Unintentional urination during sleep, such as when tired during the day or on rainy days, may occur. Mild cases may have bedwetting once every few nights, while severe cases may have bedwetting once or twice a night, or even more. Long-term bedwetting may cause symptoms such as a pale complexion, decreased intelligence, lack of vitality, dizziness, lumbar pain, and cold limbs in children. Older children may be shy or anxious.

　　1. Sleepy, grinding teeth, difficult to wake up, night sweats；

　　2. Inattention, hyperactivity；

　　3. Poor development: short stature, thin or overweight；

　　4. Yellow and soft hair, cold hands and feet；

　　5. Pale complexion, picky eating, and anorexia；

　　6. Frequent bedwetting, urgency, or inability to hold urine；

　　7. Distracted during homework and classes, declining memory, affecting learning；

　　8. Shy, timid, irritable, and任性；

　　9. Delayed development during adolescence, etc.

　　If bedwetting is caused by a disease factor, treat the disease first. If the bedwetting is caused by poor living habits after excluding disease factors, it can be corrected through patient education, explanation, and comfort. First, help children understand that bedwetting is a temporary functional disorder, eliminate the psychological burden, and treatment can be cured with cooperation.

　　1. To avoid children not waking up easily after a deep sleep at night, be careful not to overwork them during the day, and it is best to arrange for an hour of sleep time at noon.

　　2. Reduce the amount of salt, water, and soup in the evening meal.

　　3. Before going to bed, prevent children from being overly excited and encourage them to empty their bladder before going to bed.

　　4, Parents should cultivate the habit of children getting up to urinate consciously. Remind the child to self-mutter 'get up to urinate at this time tonight' before going to bed, and parents can also wake the child up before the time when he usually has enuresis, so that he can urinate while awake.

　　5, Training children to hold their urine during the day can also be a method. When urination is felt, actively control and temporarily do not urinate. At first, it can be delayed for a few minutes, and gradually extend the time.

　　6, In the process of treatment, frequent encouragement can strengthen the children's confidence and achieve twice the result with half the effort. If there is no bedwetting on any day, give praise and encouragement, which can increase the children's enthusiasm for participating in treatment. In addition, parents should never scold or punish the children.

　　Enuresis patients generally have normal urine routine, and no bacterial growth is found in urine culture. Measure the content of arginine vasopressin (AVP) secreted by the neurohypophysis in urine during the day and night. Normally, it increases at night compared to the day, its antidiuretic effect reduces urine output at night. Enuresis patients do not increase AVP secretion at night due to delayed development of the thalamus and pituitary, resulting in increased urine output at night.

　　1, Ultrasound, IVU, and voiding cystourethrogram

　　Understand the condition of the kidney, ureter, and bladder, generally no abnormalities are found. There are no congenital spinal defects and meningocele on X-ray films.

　　2, Urodynamics examination

　　Urodynamics examination should be performed for those suspected of having neurological diseases, with no pathological changes, daytime urinary incontinence without complications, ineffective conventional treatment for adolescent nocturnal enuresis, incontinence of urination and defecation, persistent difficulty in urination after infection control, recurrent urinary tract infections despite continuous use of antibiotics, and those with bladder trabecula formation or sphincter spasm shown on voiding cystography.

　　Most children with enuresis have primary enuresis, among which nocturnal enuresis is most common, and boys are more prevalent. In addition to general treatment, symptoms can also be alleviated through dietary therapy.

　　1, Eat 10 dried lychee meats per day, regular consumption can be effective.

　　2, Roast the white nuts, for children aged 5 to 10, eat 5 to 7 each time, for adults, eat 8 to 10 each time, twice a day, chew slowly, until no enuresis occurs.

　　3, Bai Guo steamed egg: Two dried white nut kernels (ground into powder) are prepared in advance: crack a small hole in one end of the egg and insert the white nut powder, seal with paper and place with the sealed side up, steam and eat, has the effects of tonifying deficiency and contraction, can treat excessive leukorrhea in women, indigestion and diarrhea in children, and bedwetting in children, and other symptoms.

　　4, Bai Guo skin rice: 10-15 grams of white nuts (peeled), 40-50 grams of tofu skin (tofu stick), an appropriate amount of rice, boil together to make porridge, season with sugar for consumption, has the effects of nourishing the stomach, resolving phlegm, stopping coughing, and controlling asthma, suitable for lung deficiency with cough and asthma, kidney deficiency with bedwetting, frequent urination, elderly pulmonary tuberculosis, physical weakness in women, and excessive leukorrhea, and other symptoms.

　　5, Bai Guo膀胱汤: Pig bladder 100-200 grams (cleaned and cut into pieces), 5 white nuts (roasted and peeled), 10-15 grams of Rubus chinghokensis, boil together to make a soup, season with a moderate amount of salt for consumption. It has the effects of tonifying the liver and kidney, reducing urination, and is suitable for nocturnal enuresis, bedwetting in children, and other symptoms.

　　6. Treat weakness in the waist and knees, impotence and seminal emission, night sweats, and enuresis: 200 grams of scallion, 100 grams of fresh shrimp. After the shrimp is fried and peeled, add the chopped scallion to the pot and fry until done. Add a moderate amount of wine and salt for seasoning and eat it. Take once a day.

　　7. Grind 15 grams of scallion roots into juice, simmer it and take it warm one or two times.

　　8. Take 10 grams of scallion seeds, grind them into powder, mix them with flour, and make pancakes in two servings.

　　9. Fried Shrimp with Scallion: After the shrimp is fried and peeled, the chopped scallion is added to the pot and fried until done. Add a moderate amount of white wine and salt for seasoning. It has the effects of invigorating the Yang, benefiting the essence, and strengthening the stomach. It is suitable for symptoms such as weakness in the waist and knees, impotence and seminal emission, night sweats, and enuresis.

　　To treat enuresis, it is necessary to develop good work and rest habits and hygiene habits, avoid overwork, master the time and routine of bedwetting, and wake the child up to urinate 1-2 times at night with an alarm clock. Sleep for 1-2 hours during the day and avoid excessive excitement or strenuous exercise during the day to prevent deep sleep at night. Throughout the treatment process, confidence should be established. Gradually correct emotions or behaviors such as shyness, anxiety, fear, and timidity, take into account the patient's self-esteem, give more comfort and encouragement, and less criticism and punishment, to reduce their psychological burden, which is the key to treatment success.

　　To properly handle the psychological factors causing enuresis, understand the spiritual causes and possible psychological contradictions leading to enuresis through medical history, and quickly resolve the spiritual stimuli that can be resolved. For contradictions and problems that have already occurred or exist objectively in reality and are subjectively unresolvable, we should focus on educating and explaining them with patience to eliminate mental tension and avoid emotional unrest. Avoid drinking water after dinner, and empty the bladder before going to bed to reduce the frequency of bedwetting.

　　Western medicine can be used for treatment when necessary. Western medicine treatment uses central nervous system stimulants, such as chlorpromazine or combined use of parasympathetic nerve blockers and sympathomimetic drugs, such as atropine and ephedrine; some people also use antidiuretic hormones, such as desmopressin or Mycetin, etc. Although some patients are effective, the recurrence rate is relatively high, and antidiuretic hormones are applied to simple bedwetting patients, due to certain indications that are relatively difficult to master, there is still a certain degree of risk.