Seattle Institute of Oriental Medicine

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A New Understanding of Enuresis and Urinary Incontinence

Enuresis is frequently encountered in children, while urinary incontinence is generally encountered in the elderly. Because the kidney controls urine and stool, and the urinary bladder governs restraint [of urine], our ancestors viewed these problems as being related to these organs. However, I have achieved satisfactory clinical results by treating enuresis and incontinence through the liver and the lungs.

1. Discussion and Treatment from the Liver

The liver channel wraps around the genitals, so diseases of the lower source are related to the liver channel. The liver body is yïn, but its activity is yáng; further, the body is blood and the activity is qì. The liver stores the blood in order to nourish the body and it courses the qì in order to fulfill this activity. If the liver loses it coursing and draining activity, at first there will be qì stagnation, and then eventually, blood stasis. When qì and blood cease to move freely through the liver channel, the qì and blood fail to nourish the genitals. As a result, the urinary bladder loses its normal control and there is urinary incontinence. In clinic, I often use Drive out Blood Stasis in the Mansion of Blood Decoction (xuè fû zhú yü täng) , which although a blood-moving formula, also contains medicinals to course the liver and regulate the qì. This formula normalizes the outward movement of the liver, such that qì and blood flow smoothly, which then causes the incontinence to cease. In cases where there is also debility of the lower source, I often add Fluoritum (zî shí yïng) and Allii tuberosi Semen (jiû cài zî) . If there is sinking of the qì mechanism, then I add Cimicifugae Rhizoma (shëng má).

Case 1: Ms. Dàn, 17 years old: She reported enuresis off and on for the last six years. She had a dry mouth, recurrent low-grade fever, and frequent dreams. She showed evidence of stasis macules and her pulse was fine, wiry, and slightly rapid. Her tongue was purplish red with a thin slimy fur. She had unsuccessfully tried formulas to supplement qì and boost the kidney. These only made the excess more excess, when what was required was to course the liver, regulate the qì, quicken the blood, and transform stasis.

Formula: Rehmanniae Radix (shëng dì huáng) 15, Angelicae sinensis Radix (däng guï) 9, Chuanxiong Rhizoma (chuän xiöng) 9, Carthami Flos (hóng huä) 9, Persicae Semen (táo rén) 9, Paeoniae Radix rubra (chì sháo) 9, Bupleuri Radix (chái hú) 6, Platycodi Radix (jié gêng) 6, Aurantii Fructus (zhî ké) 6, Allii tuberosi Semen (jiû cài zî) 9, Cimicifugae Rhizoma (shëng má) 6, and Glycyrrhizae Radix (gän câo) 3.

After about one month on this formula, the enuresis and all the other symptoms had resolved.

2. Discussion and Treatment from the Lungs

The lungs are the officer of passage, they regulate outward movement, and they control the qì of the whole body. There are no channels that do not reach them and no organs that do not transfer through them. The lungs are also the upper source of water. They connect with the urinary bladder through qì transformation. When the lung qì diffuses properly, qì moves and thus water moves. Fluids are distributed throughout the body and the waterways are free flowing. The flow of the urine is intimately related to the lungs. If the lung qì is congested and stagnant, qì transformation fails to reach throughout the body, the urinary bladder loses restraint, and the result is incontinence. I like to use Ephedra, Apricot Kernel, Gypsum, and Licorice Decoction (má xìng shí gän täng) in order to clear and diffuse the lung qì, open and regulate the waterways, descend into the urinary bladder, open the qì transformation throughout the body, and unblock the upper so as to reach the lower. If the qì dynamic is also constrained, as Aurantii Fructus (zhî ké) and Platycodi Radix (jié gêng) ; if the qì is deficient and stagnant, add Astragali Radix (huáng qí) , Codonopsis Radix (dâng shën) , and Cimicifugae Rhizoma (shëng má) .

Case 2: Ms. Wu, 55 years old: She reports one month of incontinence, mostly during sleep. When it is mild, it happens once per night and when severe, three times per night. It often happens between the hours of 11 p.m.-3 a.m.. She also reports incontinence with coughing or sneezing. She had previously tried formulas to warm and supplement, as well as astringent formulas, all without success. She is fatigued and lacks strength. She also reports chest oppression and rib-side distention, and cough with yellow sticky phlegm that is difficult to expectorate. Her tongue is red with a thin yellow fur. Her pulse is fine and wiry. This pattern belongs to liver constraint transforming to fire, upwardly harassing the lungs, and causing lung heat so that the lungs lose control of the water pathways. It is appropriate to clear the lungs and course the liver.

Formula: Ephedrae Herba (má huáng) 6, Armeniacae Semen (xìng rén) 10, Gypsum fibrosum (shí gäo) 30 (precook), Glycyrrhizae Radix (gän câo) 3, Atractylodis macrocephalae Rhizoma (bái zhú) 10, Paeoniae Radix alba (bái sháo) 10, Saposhnikoviae Radix (fáng fëng) 6, Citri reticulatae Pericarpium (chén pí) 6, Cimicifugae Rhizoma (shëng má) 3, Puerariae Radix (gé gën) 6.

After 5 packs of herbs, the incontinence was improved. She took the same formula for one more week and the incontinence ceased.

One Hundred Years, One Hundred Masters in Chinese Clinical Medicine: Yán Déxïn, China Chinese Medicine Publishing, Beijing, China; 2001, pp. 195-197.

Translated by Craig Mitchell