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24. Bed-wettingBed-wetting refers to the involuntary discharge of urine during sleep at night in childrenover three years of age. It is mainly due to the inherent immaturity of the kidneys inchildren. The kidneys control growth and development according to Chinese medicine. Forinstance, one’s second or permanent teeth and puerty are oth signs of the maturation of 

the Chinese concept of the kidneys. !s in "estern medicine, the kidneys are alsoresponsilefor urination. #owever, pediatric enuresis, as this condition is technically called,may also e due to spleen and lung vacuity or damp heat.

Treatment based on pattern discrimination:

1. Kidney vacuity (a.k.a. vacuity cold o t!e lower origin"#ain symptoms: $ighttime enuresis %-& or more times each night, fre'uent, clearurination, a pale facial comple(ion, a tendency to low ack or knee soreness or weakness,possile chilled lims and a fear of cold, a pale tongue with thin, white fur

Treatment principles: "arm and supplement kidney yang, secure and astringe the

urination

2. $pleen%lung &i vacuity#ain symptoms: $ighttime enuresis, shortness of reath, disinclination to speak,lassitude of the spirit, lack of strength, a somer white facial comple(ion, devitali)edappetite, loose stools, spontaneous perspiration, a pale tongue with white fur, a pulsewith diminished force

Treatment principles: Bank the origin and oost the 'i, secure and astringe theurination

'. iver c!annel damp !eat#ain symptoms: *lippage of a small amount of urine which smells foul and is colored

relatively yellow, emotional tension and agitation, talking in their sleep, ru(ismduring sleep, red lips, yellow tongue fur, a rapid, forceful pulse

Treatment principles: +rain the liver and clear heat

)cupuncture * mo+ibustion$eedle Ye Niao Dian $ighttime rination oint/ located at the center of the secondtransversecrease on the palmar surface of the little 0nger. 1r one may needle San Yin Jiao *p2/ and Guan Yuan ( C3 4/. If there is concomitant spleen vacuity, add Zu San Li *t 52/.

)d,unctive treatmentsFor vacuity cold of the lower origin make a tea out of cinnamon and licorice and add &teaspoons of molasses. For either kidney vacuity or lung-spleen vacuity, do spinalpinchpullseveral times each day to strengthen the odily constitution. 1ne can also grind asmall amount of Gong Ding Xiang Flos Caryophylli/, Bai Jie Zi *emen *inapis/, Yi ZhiRen Fructus !lpiniae 1(yphyllae/, Wu Yao 6adi( 7inderae/, and Xi Xin #era !sari/into powder. This is then mi(ed with vinegar and held in place with Shang Shi Zhi TongT /0)3$0$ * T)T#T 35 63##37 638T/ 9/0)T06 /0$)$$ 11

Gao In8ury 9due to: +ampness, *top ain lasters/ at Zhong Ji C3 5/, Da He ;i %&/,and San Yin Jiao *p 2/. These should e changed % time each day. !nd for oth thevacuity and damp heat patterns, a clear, land diet is very important. For vacuity coldcases, they should avoid anything which is chilled, cold, or fro)en. For lung-spleen vacuity

cases, they should avoid sugar and sweets as well as chilled and raw foods. In the caseof the damp heat in the liver channel, it is also important to help the child developstressreducing

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and rela(ation techni'ues as well as to identify and correct any causes of emotionaltension and frustration.

6ommentsIn my clinical practice, the cases of pediatric enuresis I commonly see are due to kidneyvacuity and lung-spleen 'i vacuity. <uite frankly, such cases may only present with ascant few of the symptoms listed aove. #appily, when due to kidney vacuity, Jin Suo Gu

 Jing Wan =olden 7ock *ecure the >ssence ills/, which comes as ready-made pills, areeasy for young children to swallow and usually provide cheap, easy, and e?ectivetreatment."hen due to lung-spleen vacuity, I usually prescrie a decoction which is thenadministered y an eyedropper.*ome parents oth in China and the "est try to shame their children into stopping theired-wetting, ut this is seldom the answer. If the child has weak kidneys, the fear of theparents anger or disdain will only further damage the kidneys according to Chinesemedicine."hile children with damp heat enuresis in part due to anger and frustration willoviously only get worse in response to their parents’ anger and frustration.1viously, if a child is having troule with ed-wetting, they should not e allowed todrink too much in the evening, and the parents should make sure the child empties theirladder efore ed each evening. In addition, if due to kidney de0ciency or lung-spleende0ciency, the child should not e allowed to ecome too fatigued efore going to ed.1verfatigue only results in further weakening of the kidneys, spleen, and lungs.