中医治疗小儿遗尿的机制及研究进展

Research Progress on Traditional Chinese Medicine Treatment of Enuresis in Children

摘要: 小儿遗尿(Nocturnal Enuresis)是5岁以上儿童在夜间睡眠中不自主排尿的一种常见疾病，中医称遗溺。流行病学调查显示，我国6~12岁儿童患病率约为5%~10%，部分患儿症状可持续至青春期，严重影响患儿的自尊心、社交能力及生活质量。长期遗尿易导致泌尿系统感染、外阴炎等并发症，同时引发焦虑、抑郁等心理障碍。中医认为本病病机以肾气不固、脾肺失调为核心，与三焦气化失司密切相关。中药内服以缩泉丸、桑螵蛸散等经典方剂为主，通过温补肾阳、固涩缩尿改善膀胱气化功能；外治法则采用针灸、穴位贴敷等手段，刺激关元、中极等穴位以增强神经–膀胱调控。现代药理学证实，补肾类中药可上调抗利尿激素(AVP)表达，使夜间尿量减少40%以上，而艾灸疗法通过调节下丘脑–垂体轴功能，使患儿觉醒阈值降低35%。本文系统综述该病的中医病因病机，探讨中医治疗策略，为临床提供参考。

Abstract: Nocturnal enuresis in children over 5 years old is a common disease of involuntary urination during nighttime sleep, also known as drowning in traditional Chinese medicine. Epidemiological surveys show that the incidence rate of illness among children aged 6~12 in China is about 5%~10%, and some children’s symptoms can last until adolescence, seriously affecting their self-esteem, social skills, and quality of life. Long term enuresis can easily lead to complications such as urinary tract infections and vulvitis, while also causing psychological disorders such as anxiety and depression. Traditional Chinese Medicine believes that the pathogenesis of this disease is centered around the deficiency of kidney qi and the imbalance of spleen and lungs, which is closely related to the loss of qi in the three burners. Traditional Chinese medicine is mainly taken orally with classic formulas such as Xiaoquan Wan and Sangqiaosan, which improve bladder gasification function by warming and tonifying kidney yang, promoting astringency and reducing urine; The external treatment principle uses acupuncture and moxibustion, acupoint application and other means to stimulate Guanyuan, Zhongji and other acupoints to enhance the neuro bladder regulation. Modern pharmacology has confirmed that kidney tonifying traditional Chinese medicine can upregulate the expression of antidiuretic hormone (AVP), reducing nighttime urine output by more than 40%, while moxibustion therapy can lower the awakening threshold of children by 35% by regulating the hypothalamic pituitary axis function. This article provides a systematic review of the traditional Chinese medicine etiology and pathogenesis of this disease, explores the integrated treatment strategies of traditional Chinese and Western medicine, and provides reference for clinical practice.