中醫治療小兒夜尿之病例報告

Nocturnal Enuresis Treated with Traditional Chinese Medicine: A Case Report

小兒夜尿是兒科常見疾病之一，是指五歲以上小兒除了器質性病變外，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。輕者可數夜一次，重則一夜數次，具有睡眠深沉、不易喚醒的特點。現代醫學對本病的病因及發病機制尚不明確，目前治療可分為非藥物及藥物治療，以抗利尿激素（Desmopression，DDAVP）、三環抗憂鬱藥（Tricyc1ic antidepressants，TCA）、抗膽鹼藥物（Anticholinergic drugs）為主，但因其有一定副作用，且停藥後易復發，故希望能以中醫治療以達到更持久的療效及較低的副作用。本篇病例報告一位自幼反覆夜尿的五歲八個月男童，至西醫檢查無器質性病變後，建議觀察追蹤。2009年4月開始中醫診治，臨床診斷為小兒夜尿合併鼻鼽，證屬腎氣不足，膀胱氣化不利，兼太陽表虛，治則以補腎固本，通條水道，兼以調和營衛。經科學中藥複方桂枝湯、五苓散、六味地黃丸為主方加減治療約1.5個月後，夜尿情形已無發作，追蹤至今（2013年7月）未見復發。藉此個案說明中醫藥治療小兒夜尿有確實之療效，值得合理推廣。

Nocturnal enuresis is a common pediatric diseases. Nocturnal enuresis refers to the involuntary passage of urine during sleep after more than five years old and without organic disease. It has characteristics of sleeping deeply and being difficult to wake .Current Western medicine for the disease etiology and pathogenesis is not clear. There are many factors that contribute to nocturnal enuresis, and neurological-developmental delay, physical abnormalities, neuroendocrine factors, genetic factors, and psychological factors are considered generally. The treatment can be divided into non-drug and drug therapy with Desmopression, Tricyclic antidepressants, Anticholinergic drugs. Due to drug therapy has some side effects, and easy to relapse after drug withdrawal. It is hoping Chinese medicine treatment to achieve a more lasting efficacy and lower side effects.This case reports demonstrates a five year and eight month old boy with nocturnal enuresis since childhood. After taking examination and making sure that no organic disease, doctor recommends observation and tracking. He received TCM treatment since April 2009. Clinical diagnosis of TCM was Xiao Er Yi Niao with Bi Qiu. The patterns of TCM was insecurity of kidney qi, and missing appointments of bladder combined greater yang exterior vacuity. The treatment goals were replenishing kidney, through the waterway, harmonizing the construction and defense. After the treatment of finished herbal product of GUI ZHI TANG, WU LING SAN, LIU WEI DI HUANG WAN dominated approximately 1.5 months, the situation of nocturnal enuresis was significantly reduced and disappeared. Until July 2013, the nocturnal enuresis has no recurrence. Via this case, we know that TCM treatment of nocturnal enuresis of pediatric is really effective and safety. It is reasonable to be promoted.