Treating Pediatric Bed-wetting with Acupuncture & Chinese Medicine by Robert Helmer Blue Poppy Press Published by: BBLLUUEE PPOOPPPPYY PPRREESSSS AA DDiivviissiioonn ooff BBlluuee PPooppppyy EEnntteerrpprriisseess,, IInncc.. 55444411 WWeesstteerrnn AAvvee..,, SSuuiittee 22 BBOOUULLDDEERR,, CCOO 8800330011 FFiirrsstt EEddiittiioonn,, FFeebbrruuaarryy,, 22000066 ISBN 978-1-891845-33-0 LC 2005938717 CCOOPPYYRRIIGGHHTT ©© BBLLUUEE PPOOPPPPYY PPRREESSSS,, 22000066.. AAllll RRiigghhttss RReesseerrvveedd.. All rights reserved.No part of this book may be reproduced, stored in a retrieval system, transcribed in any form or by any means, electronic, mechanical, photocopy, recording, or any other means, or translated into any language without the prior written permission of the publisher. DISCLAIMER: The information in this book is given in good faith. However, the author and the publishers cannot be held responsible for any error or omission. The publishers will not accept liabilities for any injuries or damages caused to the reader that may result from the reader’s acting upon or using the content contained in this book. The publishers make this information available to English language readers for research and scholarly purposes only. The publishers do not advocate nor endorse self-medication by laypersons. Chinese medicine is a professional medicine. Laypersons interested in availing themselves of the treatments described in this book should seek out a qualified professional practitioner of Chinese medicine. COMP Designation:Original work using a standard translational terminology Cover and text design by Eric J. Brearton 10 9 8 7 6 5 4 3 2 1 Printed at National Hirshfeld, Denver CO, on recycled paper with soy inks “A wonderfully insightful answer for the practitioners, patients, and fami- lies of those who suffer from this devastating difficulty. Robert Helmer has provided a wealth of information and depth of research previously not available in the West. Using the considerable wisdom of traditional Chinese medicine and a profoundly compassionate approach, we now have access to an ancient but fully modern method to resolve this multi- faceted problem. Bravo.” Randine Lewis, MSOM, L.Ac., Ph.D. Author, The Infertility Cure “Paediatric enuresis is a big problems without a real solution in our mod- ern Western medicine. Most treatments that can be offered by Western medicine can cause serious side effects. Nevertheless, one has to be familiar with the Western medical theory to understand the problems aris- ing out of our “normal” treatment methods. Our small patients normally already have an odyssey of unsuccessful Western treatment behind them before they come for treatment with Chinese medicine. For a Chinese medical therapist, it is of utmost importance to know how to deal with the side effects of Western medicine. The book at hand explains this in an outstanding way. In conclusion, this book is a positive enrichment to the Chinese medical literature and helps to shed light on this difficult, complex topic that puts such a large burden on small patients.” Dr. med Dieter Klein, M.D. Neunkirchen-Seelscheid, Germany “This book is an excellent resource for practitioners of Chinese medicine interested in including pediatrics in their practice. Helmer has compiled an impressive amount of clinical information on treating enuresis. By understanding the TCM approach to this very common pediatric condi- tion, practitioners can offer a valuable treatment option to parents and gain valuable insight into the general field of TCM pediatrics.” Kyle Cline, LMT Author, Chinese Pediatric Massage: A Practitioner’s Guide “This book is built around a treasure house of numerous Chinese studies on the treatment of enuresis enabling the reader to view and treat the problem from various perspectives. How to put all this knowledge into practice is demonstrated in quite a few well structured case histories. What makes the book even more useful not only to the non-M.D. reader, but also to me as a M.D. and general practitioner, is the introductory sec- tion on the Western view on pathology and treatment of bedwetting which offers the most up to date information in an easily readable text. This book takes the integration of Western and Chinese medical approaches one step further.” Dr. Andreas Höll, D.O. Mödling, Austria “Instead of writing a book explaining the theoretical basis and standard pattern discrimination of nocturnal enuresis, Helmer presents a vast and varied amount of real-life clinical literature from China. The information gained when mining his translations is eye-opening. For the first time in the treatment of this common pediatric complaint, Western practitioners can base their treatments on the same amount of material which builds the base of clinical practice of expert Chinese doctors.” Simon Becker, Dipl. Ac. & CH (NCCAOM, SBO-TCM) Author, The Treatment of Cardiovascular Diseases with Chinese Medicine and A Handbook of Chinese Hematology “I have done quite a bit of pediatric acupuncture and herbology for a long time, and so I know that this is a very good book by an experienced clini- cian and researcher. The author is very thorough in Western and Chinese diagnosis and treatment of enuresis and he has also done a convincing job that his modality of diagnosis and treatment really works. I could also tell that the author has treated many children with this problem. I highly recommend this book to any physician and acupuncturist who treat this difficult, recalcitrant problem.” Miki Shima, L.Ac., OMD Author, Channel Divergences: Deeper Pathways of the Web; The Medical I Ching Table of Contents Foreward ……………………………………………………… v Preface ………………………………………………………… 1 1. Introduction ………………………………………………… 3 2. Psychological & Social Impact of Enuresis …………… 9 3. The Western Medical Causes of Enuresis …………… 11 4. The Western Medical Diagnosis of Enuresis ………… 23 5. The Western Medical Treatment of Enuresis ………… 27 6. The Chinese Medical Causes & Mechanisms of Enuresis 39 7. Treatment Based on Pattern Discrimination ………… 43 8. Chinese Research on the Treatment of Pediatric Enuresis 51 9. Representative Case Histories ………………………… 185 10. Conclusion ………………………………………………… 207 Appendix 1: Nocturnal Enuresis In-take Form …………… 209 Appendix 2: Tips for Dryer Nights ………………………… 213 Appendix 3: Guided Imagery Exercise ……………………… 219 Appendix 4:How to Measure a Childs Bladder Capacity …… 221 Appendix 5: Hints On Prescribing & Administering ……… 223 Appendix 6: Hints On Administering Acupuncture ……… 225 English Language Bibliography …………………………… 227 Index …………………………………………………………… 231 Bedwetting Book 2/8/06 2:11 PM Page 1 Preface This book is a clinical manual on the treatment of pediatric enure- sis or bed-wetting. It is based on my research and translation of the Chinese medical literature, my studies with numerous Chinese medical pediatricians in China over a number of years, and my own clinical practice of Chinese medical pediatrics in Canada. For 2,000 years, Chinese medical practitioners have treat- ed pediatric enuresis using a variety of modalities, and, over the last 25 years, clinical trials have proven that these treatments are effective for the cure of this condition. Modern Western medi- cine, on the other hand, does not have an effective treatment for this disease, and, in terms of biomedical pathophysiology, there is no known cause in 97-99% of cases of pediatric bed-wetting. In fact, within the Chinese medical literature, there is far more research on these traditional Chinese medical treatments for this condition than there is in English on the modern Western medical pharmaceuticals used to treat this disease. Unfortunately for prac- titioners of Chinese medicine and their patients, prior to this book, this information was only available in the Chinese language. I have also chosen to write about pediatric enuresis because it is easy to determine how effective the treatment has been. Therefore, the information in this book can be used for further research on the traditional Chinese medical (TCM) treatment of this disorder in the non-Chinese setting. I trust this book will help Chinese medicine grow and flourish in years to come and help establish TCM as an effective treatment for enuresis outside of China. The book begins with discussions of the modern Western medical nosology, etiology, pathophysiology, diagnosis, and treatment of this common condition. This is followed by discussions of its modern Chinese medical disease causes and mechanisms, pat- tern discrimination, and standard, textbook treatment via acupunc- Bedwetting Book 2/8/06 2:11 PM Page 2 ture, tuina, and internally administered herbal medicine. However, the bulk of the book is a presentation of summaries of numerous recently published Chinese clinical trials on the treatment of pedi- atric enuresis with a host of treatment modalities and protocols. This section of the book gives a better idea of how pediatric enuresis is actually treated in the People’s Republic of China and with what outcomes. My standard for the translation of Chinese medical terminology is Nigel Wiseman and Feng Ye’s A Practical Dictionary of Chinese Medicine, Paradigm Publications, 1999. Medicinal identifications are based on Bensky et al.’s Chinese Herbal Medicine: Materia Medica, 3rd edition, Eastland Press, 2005. Readers may notice that there is no Chinese language bibliography. This is because the bibliographic information for each clinical trial is given in the body of the text. There is an English language bibliography as well as several, hopefully useful appendices. Entries in the English lan- guage bibliography are numbered. Where these sources are cited in the text, the reader will find a corresponding number in paren- theses in order to identify the source. Robert Helmer June 2005 Bedwetting Book 2/8/06 2:11 PM Page 3 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.