小兒夜尿之中醫辨證治療補充

The Supplement to Treatment of Nocturnal Enuresis with Traditional Chinese Medicine

小兒夜尿為兒科常見疾病之一，是指五歲以上小兒除器質性病變外，表現為不能自主控制排尿，經常於睡夢中小便自遺，醒後方覺的一種疾病。具有睡眠深沉、不易喚醒的特點。現代醫學目前認為與孩童排尿中樞發育不全或發育遲緩、睡眠和覺醒功能發育不協調、神經內分泌因素、器質性因素、遺傳因素及精神心理因素等有關。中醫認為「臟氣虛寒，膀胱氣化不固」是小兒夜尿最重要的病機，依臨床表現可區分為下元虛寒，治以溫補腎陽，佐以固澀；脾腎兩虛，治以溫補脾腎，佐以固澀；脾肺氣虛，治以益氣健脾，佐以升陽固攝；心腎失交，治以清心滋腎，佐以安神固澀；肝經濕熱，治以瀉肝清熱，佐以疏利。因現今分型在治療上仍有不足，不斷有醫家提出新的治則，故欲藉由本文補充並提出治療小兒夜尿之新思維，使治療能更全面，以改善孩童及家屬的生活品質。經臨床觀察發現，夜尿之孩童常見併有過敏性鼻炎的問題，經六經辨證可分為太陽表實證及太陽表虛證，表實者用麻黃湯，表虛者用桂枝湯，可同時治療夜尿並改善過敏性鼻炎及其它過敏之症狀，臨床上用之皆有一定的療效。此外，因現代生活型態及飲食習慣的改變，濕熱所致之夜尿比例日漸增加，且濕熱並不侷限於肝經，故於治療上亦有其重要性。

Nocturnal enuresis is a common pediatric diseases. It means involuntary urination while asleep after more than five years old and without organic disease. It has characteristics of sleeping deeply and difficult to awaken. Current Western medicine considers that nocturnal enuresis is associated with micturition center hypoplasia or developmental delay, the uncoordinated between sleep and wake functions, neuroendocrine, organic, genetic and psychological. TCM believes that ＂visceral qi deficiency cold, inhibited bladder qi transformation＂ is the most important reason for nocturnal enuresis. According to clinical manifestations that can be divided into the Kidney yang deficiency, Spleen and kidney deficiency, Spleen-lung qi deficiency pattern, Non-interaction between the heart and kidney, Dampness-heat in the liver meridian. Nowadays, because the classification of treatments are still not enough, there are many doctors proposing new thinking process and treatment. Therefore, we want to add some complements and thoughts of treatment for children with nocturnal enuresis by this article, so that the treatment can be more comprehensive to improve quality of life for children and families. The clinical observation that children with nocturnal enuresis combined with allergic rhinitis are common. According to the Six-Meridian Pattern Identification can be divided into the Greater Yang exterior excess and Greater Yang exterior deficiency. Children with exterior excess can be treated with MA HUANG TANG, and with exterior deficiency can be treated with GUI ZHI TANG. In the meantime, the above treatments can improve the symptom of nocturnal enuresis and reform allergic rhinitis and other allergic symptoms. In addition, due to the modern lifestyle and eating habits' change, the proportion of nocturnal enuresis is increasing caused by children with constitution of dampness-heat, and the dampness-heat is not limited to the liver meridian, it's also importance in the treatment.