1

Introduction

“Enuresis” is a term of Greek origin that literally means “to expel

urine.” In traditional Chinese medicine or TCM, this disease is
usually referred to as yi niao. The literal translation of this into
English is “loss of urine.” In North America, enuresis is what we
commonly refer to as bed-wetting. The modern Western medical
term for bed-wetting is nocturnal enuresis. This is described as
the involuntary voiding of urine during sleep beyond the age of
anticipated urinary control. This condition most commonly occurs
during childhood. Therefore, pediatric enuresis is the primary
focus of this book. Nevertheless, the basic pattern discrimination
and treatment of enuresis is the same in adults or the elderly as it
is in children. The only difference is that certain Chinese medical
patterns of enuresis tend to be more prominent at certain ages.

There are two types of enuresis in modern Western medicine: pri-

mary and secondary. In TCM, this distinction is not truly neces-
sary during diagnosis and treatment as long as the correct pattern
has been identified. In modern TCM journals, the number of
cases of each of the two respective types of enuresis is usually
identified in the cohort description. However, the treatment is not
changed based on these subtypes.

Primary nocturnal enuresis (PNE)

By far, primary nocturnal enuresis (PNE) is the most commonly
occurring form of enuresis. It is distinguished as the type of
enuresis found in individuals who can control their bladders during
the day (for at least 6-12 months) but who have not been continu-
ously dry at night for at least a six month period since infancy. In
this type of enuresis, bed-wetting has to be present at least two
times per month to make the diagnosis in children 3-6 years of
age and at least one time per month in older individuals.
4 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine

Secondary nocturnal enuresis (SNE)

Secondary nocturnal enuresis (SNE) refers to a relapse after con-
trol has been achieved for a period of at least six months. Twenty-
five percent of bed-wetting cases are diagnosed as SNE. The
prevalence of SNE as a percentage of all cases of nocturnal
enuresis increases with age. In a study of New Zealand children,
7.9% of them developed SNE before they were 10 years of age.
The most notable difference between the two types of enuresis,
is that SNE (unlike PNE) is often caused by psychological factors.
This aspect will be examined in further detail below under the
causes of enuresis according to modern Western medicine.

When is wetting the bed not considered normal?

In modern Western medicine, enuresis may be diagnosed in
females over five years of age, while in males, it is over the age
of six. In TCM journal articles not utilizing these modern Western
medical criteria, bed-wetting is often diagnosed as early as three
years of age. According to my professor in China who specialized
in the treatment of pediatric enuresis, this difference in age crite-
ria between modern Western medicine and TCM is due to the
fact that babies in developed countries wear diapers (whereas in
China this is fairly uncommon). This professor further explained
that (at least in his opinion) children wearing diapers do not feel
the wetness, thus do not wake as easily. Therefore, these chil-
dren’s ability to control their night-time urine is delayed.

In any case, bed-wetting affects many millions of people around

the world. According to studies in the U.S., UK, Israel, and Africa,
10% of six year-olds suffer this disease. (1) For instance, corre-
sponding statistics on enuresis from the Canadian Kidney
Foundation show that this condition is present in:

20% of five year-olds (1 in 5)

10% of six year-olds (1 in 10)
3% of 12 year-olds (1 in 33)
1% of 15 year-olds and older

It is estimated that between 5-7 million children in the U.S. alone

experience nocturnal enuresis. Furthermore, in my home country
of Canada (which has a much smaller population), there are
 Introduction 5

approximately 200,000 children who suffer from this childhood dis-

ease. Various studies report that boys wet the bed more frequently
than do girls. However, this finding has been disputed by other
reports. (2) A review of hundreds of journal articles from the past
25 years on the TCM treatment of enuresis demonstrates that
there is usually a slightly higher incidence of enuresis in males.
Nevertheless, one can find other studies on the same topic which
present a substantially larger number of females suffering from
this condition. Eighty percent of children with enuresis wet the
bed only at night, while approximately 20% also experience day-
time incontinence. (3) In addition, research suggests that there is a
higher incidence of this disease in poorly educated, lower socioe-
conomic groups and in institutionalized children.

During the first 2-3 years of life, bed-wetting at night is normal and
expected, with most children achieving night-time dryness by the
age of four or five. However, for some, this occurs at a later age.
The ability to control urination and remain dry at night directly corre-
lates with the achievement of continence throughout the day. Table
1 demonstrates the percentage of children in the United States
who achieve day- and night-time control of urine at varying ages.
Table 1 below provides some statistical support for the Chinese
diagnosis of enuresis at three years of age. According to the table
below, 78% of children do not wet their bed at this age.

AGE (YEARS) DRY BY DAY DRY BY NIGHT

2.0 25% 10%

2.5 85% 48%
3.0 98% 78%
TABLE 1. PERCENTAGE OF CHILDREN DRY BY DAY AND NIGHT AT
VARIOUS AGES

Further, there is a spontaneous remission rate of 15% per year

after the age of five years old in those who suffer from bed-
wetting. This means that the majority of children with enuresis
will eventually stop by themselves.

However, although this condition is a common one, this common-

ness does not diminish the need for patients and their families to
take action and seek treatment for it. I agree strongly with the
current medical consensus that the worst thing one can do about
6 Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine

a child’s enuresis is nothing. There is no need for these children

to suffer. Unfortunately, it is estimated that only 38% of parents
seek medical assistance for their child’s bed-wetting. Several rea-
sons have been identified for this fact:

1. The parents feel ashamed of the situation and feel that

somehow this condition reflects poorly either on them as par-
ents or their children (which you will discover below is entirely
incorrect).

2. They are not aware that there are excellent treatment

options available. This is one of the primary purposes of this
book—to educate practitioners of TCM and the parents of
these bed-wetting sufferers that Chinese medicine is a valu-
able and effective option. The Chinese medical treatment of
this disease is very successful as indicated by the research in
this book. When compared to modern Western medicine,
these treatments are superior and have better rates of resolu-
tion with no side effects.

3. They have already tried some method of treatment that did

not work and have become discouraged. Rarely outside of
China have families sought out treatment from a practitioner
of TCM to treat their child’s enuresis. As stated above,
Chinese medicine offers a variety of treatments that are
effective in treating enuresis.

4. They simply hope that time will resolve the situation.

However, it is important to remember that, if it is the child’s
birthday and he or she is between five years old and the end
of puberty, there is only a 15% chance that, by the time they
celebrate their next birthday, their enuresis will be gone
unless appropriate treatment is given. Unresolved bed-wetting
means another year of interrupted sleep (for the child and
their family), soiled sheets and clothes, and, most of all, very
discouraged children and their parents. (See Chapter 2, “The
Psychological & Social Effects of Enuresis” for more informa-
tion on this aspect of this condition.) Even worse, once the
individual stops growing, the odds of their case spontaneously
resolving without treatment becomes minute. Even doctors in
China agree that, once an individual reaches puberty, this con-
dition is significantly more difficult to treat.
 Introduction 7

Children who have enuresis deserve relief from their suffering,

and, with the right treatment, almost everyone can improve their
condition within a matter of weeks. From a TCM perspective, a
variety of effective solutions are available and may be used alone
or in combination with other methods. It is a clinical reality that
different treatments work better for different people, and, in the
case of enuresis, this is also true. Included in this book are over
200 Chinese medical treatments that have been proven to be
effective in treating enuresis.