1 Physiology and Pathology of Weeding in Seedbed
In the process of human urination, the mixed liquid urine, such as excess water, electrolyte, body garbage and body cell metabolites, which are decomposed and discharged by the kidneys, is gradually stored in the bladder. When the bladder reaches a certain volume, the pressure of urine stimulates the baroreceptor located on the bladder wall, and the urination signal sent by the baroreceptor is transmitted to the central nervous system through the peripheral nervous system. After analysis and treatment, the central nervous system sends out urination instructions at the right time, reaching the bladder, relaxing the urethral sphincter and contracting the detrusor muscle, thus discharging urine from the body.
From this physiological process, if the nervous system is damaged, or the bladder and other related organs have space-occupying lesions, it can cause abnormal urination, that is, enuresis. This kind of enuresis can occur day and night, whether in bed or not, whether awake or not, and often occurs at the same time as other diseases. Bed-wetting is different: first, bed-wetting is to discharge urine on the bed when the client is unconscious; Secondly, bedwetting is generally not accompanied by other typical signs of nervous system lesions or space-occupying lesions; Third, the physical and chemical examination of bedwetting patients is within the normal range. According to this analysis, bedwetting is only caused by immature nervous system or uncoordinated nervous function. For example, when the bladder baroreceptor reaction threshold is low, resulting in a small amount of urine in the patient's bladder, it can cause pressure to send out urination signals to cause urination, so the patient has small urine bubbles and frequent urination. The excitation and inhibition function of patients' urination center is disordered, and patients often have blurred vision and disorientation when they urinate or get up in their dreams. When the average person is sleeping, the work of the urinary system should be in a depressed state, while patients who wet the bed are often the opposite, and the urinary system is still working excitedly.
Some people think that bed wetting seems to be hereditary. Although there are indeed many elderly people with a history of bed wetting in clinic, we have not found any abnormal changes in the chromosomes of the genetic material of patients with bed wetting. Therefore, the author only agrees that bedwetting has a family tendency, but does not agree with the theory that bedwetting is hereditary. To sum up, bedwetting is caused by the disharmony of nerve function and has a family tendency. So far, no genetic evidence has been found.
2 Current treatment status
The treatment of bedwetting can be divided into drug therapy, physical therapy and instrument calibration. Drug therapy is divided into traditional Chinese medicine treatment and western medicine treatment.
According to syndrome differentiation, TCM treatment can be divided into deficiency of cold in lower jiao, deficiency of lung and spleen, deficiency of heart and kidney, deficiency of kidney supervision, downward flow of damp heat and damp heat in lower jiao. Accordingly, patients take Jisheng Cuscuta Pill, Buzhong Yiqi Decoction, Koushi Ootheca Powder, Shenshi Cuscuta Pill, Bazheng Powder or Daididang Pill. From the point of clinical application, as long as the syndrome differentiation is accurate and the medication is adhered to, about half of the patients can have curative effect and some can be cured. The disadvantage is that it is difficult to insist on taking it and to grasp the syndrome differentiation of most patients.
Western medicine uses central nervous system stimulants, such as chlorpyrifos or parasympathetic nerve blockers and sympathomimetic drugs, such as atropine and ephedrine; Others use vasopressin, such as arginine vasopressin or miconide. Although some patients are effective, the recurrence rate is high. The application of antidiuretic hormone in patients with simple bedwetting is still dangerous because some indications are difficult to master.
In recent years, some hospitals are carrying out external drug therapy and have made some gratifying progress. In this respect, the magnetic medicine bag developed by Wuhan Huimin Medical Research Institute is more representative. It adopts the external treatment method of traditional Chinese medicine, and applies the medicine bag on the navel shenque. This method is easy to use (worn every day for 12 hours), and has the advantages of good curative effect (half of users can stop wetting the bed from the same day, and most of them take effect within one week), no limit on the amount of drinking water, no need to wake up at night, no toxic side effects and so on.
Physical therapy of bed wetting includes acupuncture, acupoint injection, massage and acupoint therapy. Although all of them have certain effects, it is difficult to adapt to these methods because most of the patients are children. But for adults or older children, physical therapy is also an effective method. According to the report of the Surgical Bed-wetting Group in Wuhan New Century Hospital of Integrated Traditional Chinese and Western Medicine, acupoint therapy may achieve satisfactory results for adults or children over 0/2 years old who have not been cured by various methods.
At present, it is rarely used in China to correct bed wetting with instruments, and it is used in the United States to correct nocturia alarm. It achieves the purpose of treatment by "waking up after wetting the bed" for a long time and forming conditioned reflex. General treatment takes more than half a year.
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Medical papers