Disease and Condition Overview
Enuresis is characterized by night time incontinence in children 3 years or older. In Chinese medicine, it is caused by kidney qi deficiency, deficiency in original qi, or spleen and lung qi deficiency, and damp heat in the lower jiao.

Occasional bedwetting in children over age three is commonly caused by sleep apnea, drinking excessive liquid before bed, or insufficient toilet training. These scenarios are not considered enuresis. This disease is associated with irregularities of cerebral cortex and central nervous system.

Pair-point Treatment Combinations

(1) Guanyuan (RN4), Shenshu (BL23) (Fig 30)
Guanyuan (RN4) strengthens and tonifies kidney. Shenshu (BL23) controls and restricts urine and essence. This pair point combination tonifies congenital qi, nourishes acquired qi and solidifies original qi in the lower jiao. This treatment is appropriate for all types of enuresis.

Needling techniques:
1. Guanyuan (RN4) perpendicular insertion to a depth of 0.5 cun, after needling, applies moxibustion for 10 minutes.
2. Shenshu (BL23) needle use tonify method, after needling, apply moxibustion for 10 minutes.

(2) Qihai (RN6), Sanyinjiao (SP6) (Fig 125)
Qihai (RN6) regulates and tonifies qi in Sanjiao (upper, middle and lower jiao). Sanyinjiao (SP6) regulates qi in the three channels: liver, spleen and kidney. This pair point combination, superior and inferior combined, Solidifies original qi and stops bed wetting. This treatment is appropriate for enuresis caused by qi deficiency.

Needling techniques:
1. Qihai (RN6) perpendicular insertion to a depth of 1 cun, using moxa sticks 10 minutes.
2. Sanyinjiao (SP6) perpendicular insertion to a depth of 1 cun, using moxa sticks 10 minutes.

(3) Zhongji (RN3), Sanyinjiao (SP6) (Fig 128)
Zhongji (RN3): on the lower abdomen, on the anterior midline, 4 cun inferior to the umbilicus.
Sanyinjiao (SP6): on the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in the depression near the posterior border of the tibia.
Zhongji (RN3) is the front-mu point of bladder. Sanyinjiao (SP6) is the confluence point of liver, spleen and kidney channels. This pair point combination, superior and inferior, regulates and strengthens bladder qi and fortifies yuan or congenital qi. This treatment is appropriate for enuresis caused by excess water and dampness.

Needling techniques:
1. Zhongji (RN3) towards inferior oblique insertionor transverse insertion to a depth of 1 cun, after needling, applies moxa using moxa stick 10 minutes.
2. Sanyinjiao (SP6) perpendicular insertion to a depth of 1 cun, using moxa sticks 10 minutes.

Commentaries
Acupuncture treatment of enuresis has good effects.
For syndromes of no excess or deficiency, select Guanyuan (RN4), Shenshu (BL23).
For excess water and dampness in the lower jiao or irregularities in the functions of bladder qi, select Zhongji (RN3), Sanyinjiao (SP6).
For lower original qi deficiency, select Qihai (RN6), Sanyinjiao (SP6), and apply heavy moxibustion on the Qihai (RN6) point.
For patients who do not respond to treatment it is important to perform more extensive exams to check for any anatomical defects.