Enuresis refers to involuntary urination during sleep in children over three years old

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MAIN POINTS FOR DIAGNOSIS
    
The common clinical symptoms of the problem is that the affected children often pass water involuntarily in sleep, once several nights in mild cases, and several times a night in severe cases. Enuresis commonly occurs at a relatively fixed time at night, usually before midnight.Enuresis is more likely to occur in patients who are overexcited in the daytime, or in overcast and rainy days.
    
Patients with splenopulmonary asthenia qi manifest symptoms like insufficiency of qi with less speech, lassitude, spontaneous perspiration and night sweating, sallow complexion, poor appetite, and loose stools.

Patients with deficiency of kidney qi may be accompanied by symptoms such as pallor complexion, mental retardation, soreness and weakness in the lumbus and the knees, cold limbs, and clear and profuse urine.
   
Patients with damp-heat in the liver meridian have symptoms like irritability, restless sleep, flushed face and reddened lips, bitter taste in the mouth, preference for sighing, yellow and foul urine.

In TCM, enuresis is mainly due to deficiency of kidney qi and asthenia-cold of the bladder, which fail in controlling the water passage, or splenopulmonary asthenia qi after illness, which fails to regulate the water passage and to control the bladder.

Enuresis refers to involuntary urination during sleep in children over three years old. It is more common in boys. In modern medicine, urination is mainly related to the reflex of the central nervous system. As the cerebral cortex gradually develops, urination of the bladder is controlled by the cerebral cortex and becomes a voluntary action. However, involuntary urination may be developed from dysfunction of the voluntary urination of the bladder,which results from functional disorders of the cerebral cortex caused by various causes. As to infants less than three years old who are mentally under development and growth, and have not developed a habit of regular urination, or children who play excessively in the daytime, or pre-school children who pass water occasionally at night,they are excluded in patients with enuresis.
   
BASIC MANIPULATIONS
    
The principle of tuina therapy.- warming and nourishing the spleen and the kidney, and strengthening the kidney to arrest enuresis.
     
Knead Dantian 100 times, rub-knead the umbilicus and the lower abdomen 100 times respectively, pressknead Sanyinjiao (SP 6) 100 times, knead Shenshu (BL 23) 100 times, press-knead Mingmen (GV 4) 30 times, press-knead Ganshu (BL 18) 50 times, knead Guiwei 100 times, pinch the spine 3 - 5 times, rub transversely the himbesacral region for about one minute until a hot sensation is gained.
    
MODIFIED MANIPULATIONS WITH SYNDROME DIFFERENTIATION
    
Patients with Insufficiency of Kidney Qi. Additionally push Shenjing 300 times, push Sanguan 100 times, and press-knead Yongquan (KI 1) 100 times.
    
Patients with Splenopulmonary Asthenia Qi. Additionally press-knead Baihui (BL 9) 100 times, push Pijing 300 times, push Feijing 300 times, knead Wailaogong (EX-UE 8) 50 times, and push Sanguan 100 times.
    
Patients with Damp-heat in the Liver Meridian.Additionally clear Ganjing 100 times, clear Xiaochang 100 times, reduce Liufu 100 times, press-knead Taichong (LR 3) 50 times, and rub the hypochondrium 50 times.
    
The therapy is given once a day, and ten days form one treatment course. Usually, the problem needs 2 – 3 treatment courses or more.
    
Patient education should be given to those children with enuresis. Encourage them to establish self-confidence, and make them have no fear and tension so as to avoid affecting their physical and mental health. Meanwhile help the child patients to develop a habit of passing water regularly. Patients with enuresis should avoid overfatigue in the daytime, not get overexcited, not drink water or other fluids before going to bed. During sleeps, wake them up to pass water before their usual urination time

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