去年6月底的某天，诊所迎来了一位特殊的病人。病患刚进来时显得很腼腆，对自己的病情吱吱唔唔，很是不好意思，最终说出了“失禁”二字，。我看着他，瞬间也愣了一下，眼前这个大好男青年，怎么会罹患如此的疾病？细问之下，我发现原来并不是“失禁”，而是中医所说的“遗尿”或“尿床”。
“失禁”与“遗尿”，表现形式不同，前者在清醒时小便无法控制，后者在睡中小便自遗，然其病机相近，皆因“小便者，津液之遗也，肾主水，膀胱为津液之腑，肾与膀胱俱虚，而冷气乘之，故不能制约。”(《仁斋直指小儿附方论～大小便诸证》)
仔细询问病情后，发现患者是在8年前开始在晚上熟睡后出现遗尿的症状，从最初的每2～3个月1次，几年后的每月1次，到现在的几乎每星期1～2次，病情日益严重，弄得患者到后期晚上经常不敢熟睡。由于难以启齿的原因，所以一直拖延到现在才医治。以前上大学的时候只学过小儿遗尿，而且都是从婴儿到孩童时期不间断的，从来都没听说过成人也会遗尿？虽然觉得很匪夷所思，但既然病人来了，身为医生就有责任竭尽所能帮助他。
我查阅了一些医书，并没有找到相应的病例，最终决定撇开年龄问题，中医讲究的是辨证论治，只要辩证得当，从疾病的根源下手，肯定能让症状有所缓解。
- 问诊：夜晚熟睡后遗尿，尿量多，每次均完全排出后方清醒。夜晚时自觉口干。纳眠可，大便调。
- 舌诊：舌边尖红苔薄白，中有裂痕。
- 脉诊：脉细，肾阴阳俱沉。
- 血压：95/45 mmHg
- 身高：约179cm
体重：约60kg - 诊断：遗尿 (下元虚冷，脾肾阳虚)
- 治法：温肾健脾，固涩小便。
- 注意事项：避免吃/喝生冷、辛辣之品。
值得庆幸的是，患者对自己的病情很重视，非常配合医嘱。经过3个月的外治(每星期2次，共30次)和一个半月的内治(每星期内服3剂水煎中草药，共15剂)，患者逐渐痊愈，血压也升直平均值105/65mmHg。至今已经超过4个多月了，前些天还特意电话进行了随访，并无复发。
Overview of Bedwetting (Nocturnal Enuresis)
Nocturnal Enuresis, commonly called Bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. It is classified as Primary (PNE) or Secondary (SNE). In Primary Nocturnal Enuresis (PNE), the child has never been consistently dry at night. If the child or adult has experienced at least 6 months of dryness at night and then begins bedwetting, the condition is referred to as Secondary Nocturnal Enuresis (SNE).
Incidence & Prevalence of Bedwetting
Overview of Bedwetting (Nocturnal Enuresis)
Nocturnal Enuresis, commonly called Bedwetting, is involuntary urination while asleep after the age at which bladder control usually occurs. It is classified as Primary (PNE) or Secondary (SNE). In Primary Nocturnal Enuresis (PNE), the child has never been consistently dry at night. If the child or adult has experienced at least 6 months of dryness at night and then begins bedwetting, the condition is referred to as Secondary Nocturnal Enuresis (SNE).
Incidence & Prevalence of Bedwetting
Nocturnal Enuresis is more common in males and prevalence of the condition gradually declines during childhood. Approximately 23% of 5-year old, 20% of 7-year olds, 4% of 10-year old, and 1–2% of those aged 18 and older experience bedwetting. Secondary Nocturnal Enuresis accounts for approximately 25% of cases.
How Does TCM Help SNE
Western Medicine believed that psychological issues and acquired medical conditions cause the development of
SNE. But in the view of Traditional Chinese Medicine, the weakness of kidney and bladder caused this sickness.
The patient above was a 24-year-old guy who troubled by SNE since 8 years ago. He didn't consult any doctor for the past 8 years due to shyness. His parents advised him to come over to my clinic for consultation as they are my father's old friends.
These are some of his medical records:
Symptom: At first, he has bedwetting once every 2-3 months. After few years, it happened every once a month and till now he has been troubled by SNE almost every once or twice a week! This sickness caused a very heavy stress for him and he even tell tell me he didn't dare to fall asleep soundly. He was afraid that once he slept soundly, the bed would be wet again next morning.
Height: 179 cm
Weight: 60kg
BP: 95/45 mmHg
Diagnosis: Secondary Nocturnal Enuresis (SNE)
Treatment: After 3 months of treatment, with every 2 treatments of moxibustion every week (altogether 30 times)and 3 packets of herbs (1 1/2 months, altogether 15 packets of herbs), he is totally recovered from this sickness. The blood pressure increased to 105/65 mmHg.
Note: After 4 months of recovery, I phoned him to follow up, he claimed that everything is good and he never had any bedwetting again till now.
