Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2026:4(1). doi:10.5281/zenodo.17941197 institutoptc.com/journal-complementary-therapies Review Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application. Rossana Maneira Manso1*, Helena Pereira Alonso1, Micael Silva Ribeiro1, Ana Dias de Freitas1, Andreia Pedra Alves1, Joana Ferreira Faria1, and Isabel de Sousa Nascimento1. 1 IPN – Portuguese Institute of Naturology, Porto, Portugal. * Correspondence: [email protected] Abstract Childhood nocturnal enuresis (CNE), defined as involuntary urination during sleep in children over five years of age, is a prevalent condition that can significantly affect emotional well-being, family dynamics, and quality of life. Despite numerous available treatments, both behavioural and pharmacological, many cases remain refractory or prone to relapse. Within Traditional Chinese Medicine (TCM), Paediatric Tui Na is a therapeutic massage designed for children. It has been described as an effective non-invasive intervention aimed at restoring energetic balance and regulating organ function. Evidence indicates that paediatric Tui Na can significantly reduce the frequency of enuretic episodes by promoting the energetic regulation of the Kidney, Spleen, and Bladder systems, enhancing urinary control, and improving sleep quality. In addition to physiological regulation, improvements in emotional security and self-esteem have been consistently reported. The therapy’s safety profile and its acceptance among children further support its clinical use. Paediatric Tui Na represents a promising, safe, and integrative therapeutic approach for childhood nocturnal enuresis. Its combination of physiological and psychological benefits makes it a valuable adjunct or alternative to conventional treatments. Further controlled clinical studies are necessary to consolidate its evidence base and expand its integration into multidisciplinary paediatric care. This narrative review aims to analyse the theoretical foundations, mechanisms of action, and clinical evidence supporting the use of Paediatric Tui Na in the treatment of childhood nocturnal enuresis. Keywords: Childhood Nocturnal Enuresis; Paediatric Tui Na; Traditional Chinese Medicine; Chinese Paediatrics. 1. Introduction CNE is characterised by the involuntary loss of urine in children from the age of five, a stage in which urinary control should already be established, occurring at least twice a week 1. According to the American Psychiatric Association, nocturnal enuresis is considered when a child urinates in bed at least twice a month. The ICD-10 (International Classification of Diseases, 10th version), on the other hand, defines the condition as the loss of urine at least once a month, for three consecutive months 2. In the first months of life, urination is reflexive and involuntary. Around the age of one, there is an increase in bladder capacity and neural maturation of the frontal and parietal regions, which allows the child to recognise the sensation of a full bladder, although still without control over the act of urinating 3,4. Voluntary control of urination, mediated by the cerebral cortex, is acquired later, allowing control according to social norms 5. Daytime urinary control is usually consolidated by the age of three and nocturnal control between four and five years. The absence of this control after this age characterises CNE 6. The disorder is common in Citation: Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application. Journal of Complementary Therapies in Health. 2026;4(1) 10.5281/zenodo.17941197 Academic Editor: Jorge Rodrigues Received: 7 November 2025 Reviewed: 25 November 2025 Revised: 13 December 2025 Accepted: 14 December 2025 Published: 15 December 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2026 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2026: 4(1). 2 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 childhood, with a similar prevalence worldwide, affecting approximately 30% of children at 4 years, 10% at 7 years, 3% at 12 years, and 1% at 18 years, being more frequent in boys and with a family history of enuresis 7,8. It is a transient condition, with a tendency for spontaneous resolution in about 15% of cases per year 9. Enuresis can be classified as: • Primary: When the child has never acquired urinary control and has no organic alterations, such as urinary tract infection, neurological dysfunction, or urological disorders. • Secondary: Occurs after a minimum period of six months of continence and is frequently associated with emotional factors or stressful situations, such as parental separation, a change of school, or the birth of a sibling 10. • Monosymptomatic: When the only symptom is nocturnal urine loss. • Polysymptomatic (or complex): When it is associated with other urinary symptoms, such as urinary urgency, daytime incontinence, a weak stream, dysuria (painful urination), or pollakiuria (increased urinary frequency with decreased urinary volume) 11-14. Enuresis is a multifactorial disorder, involving physical, genetic, psychological, and social aspects 10,15. Although some studies indicate that emotional and family factors are not the direct cause of enuresis, with psychological symptoms being a consequence of the problem 13,16, other authors reinforce the association of the cause of enuresis with pre-existing behavioural or psychological disorders 10,11,14. In allopathic medicine, treatment involves behavioural and pharmacological approaches. Behavioural measures include controlling fluid intake, urinating before sleep, and treating constipation, if present. As a pharmacological approach, the use of desmopressin and imipramine can reduce nocturnal enuretic episodes, but with limitations and adverse effects 17-19. In addition to these approaches, the use of a nocturnal alarm is considered the most effective long-term method in cases that do not have organic causes, promoting the learning of waking up to urinate 20-22. In TCM, nocturnal enuresis is also defined as the involuntary loss of urine during sleep in children over five years of age, and for some authors, from three years onwards 23,24. The formation and excretion of urine are related to the proper functioning of body fluid metabolism (Jin Ye), which depends on the harmony and proper functioning of the Kidney, Lung, and Spleen systems. From the perspective of Traditional Chinese Medicine, Nocturnal Enuresis is understood as the result of a congenital deficiency of Kidney Qi, a deficiency of Lung and Spleen Qi, or the accumulation of dampness-heat in the Liver meridian, factors that compromise the Bladder's function in controlling urination 24-27. In addition to the main patterns, the residual pathogenic factor is also considered, which may be associated with various causes, such as recurrent infections not completely resolved, inappropriate use of medications, and the administration of vaccines, as these factors can also interfere with water metabolism 28. The emotional factor is also recognised as a possible cause of enuresis. During phases of childhood life in which significant changes in routine occur, such as entering a new school, parental separation, the birth of a sibling, the loss of a loved one or pet, states of mental agitation may arise. This condition favours an increase in the physiological heat of the Heart, which, in turn, consumes Kidney Qi. When the Kidney is weakened, its function of controlling the sphincters is compromised, resulting in the occurrence of enuresis 29. TCM distinguishes different syndrome patterns (energetic diagnoses) associated with CNE, according to the following signs and symptoms 24-27,29-31: Journal of Complementary Therapies in Health 2026: 4(1). 3 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 1. Kidney Qi deficiency, characterised by weakness, cold limbs, and abundant clear urine; 2. Spleen and Lung Qi deficiency, often linked to fatigue, poor appetite, and loose stools and; 3. Damp-heat accumulation in the Liver meridian, manifesting as irritability, thirst, and scanty yellow urine. While Western medicine primarily employs behavioural interventions, enuresis alarms, and pharmacotherapy (such as desmopressin and imipramine) to manage CNE, these treatments can be associated with side effects and relapse upon discontinuation 5,13,14,17,18,23. In contrast, TCM emphasises restoring systemic balance and addressing the root cause of the dysfunction, often integrating acupuncture, herbal medicine, moxibustion, auriculotherapy, cupping, dietary therapy, and Tui Na, as non-invasive, holistic interventions 25,32,33. Among these, Pediatric Tui Na is a specialised form of Chinese therapeutic massage for children. It has gained attention for its safety, accessibility, and effectiveness 34-36. By applying gentle manipulations on specific meridians and acupoints, Tui Na aims to harmonise Qi and blood (Xue), strengthen organ function, and promote the child’s physical and emotional equilibrium. Clinical observations and controlled trials suggest that Pediatric Tui Na can significantly reduce the frequency of enuretic episodes, improve bladder control, and enhance sleep and emotional stability 23. Given the increasing interest in integrative paediatric care, this review seeks to synthesise theoretical foundations and available evidence regarding the application of paediatric Tui Na in the treatment of childhood nocturnal enuresis. Through a narrative synthesis of classical literature and modern research, this paper aims to contextualise the role of Tui Na within both traditional Chinese medical theory and contemporary clinical practice. 2. Methodology The research was carried out by analysing various sources, including specialised books on Traditional Chinese Medicine, scientific articles focused on child health, and publications available in academic databases such as SciELO, Google Scholar, PubMed, and CNKI. The following keywords were used for the search and selection of materials: Childhood Nocturnal Enuresis, Traditional Chinese Medicine, Chinese paediatrics, and paediatric Tui Na. Through this review, the intention is to deepen the understanding of the foundations and therapeutic benefits of Tui Na in the management of Childhood Nocturnal Enuresis, as well as to highlight the relevance of its integration with other therapeutic approaches. In this way, the study seeks to contribute to the promotion of children's health and well-being in a comprehensive and effective manner. 3. Results and Discussion 3.1. Pathophysiology of Childhood Nocturnal Enuresis from the Perspective of Conventional Medicine CNE is a multifactorial disorder characterised by involuntary urination during sleep after the age when bladder control should normally be established. Its aetiology is complex, involving an interaction of genetic, physiological, psychological, and environmental factors 5,9-15. Studies suggest that delayed neurological maturation, altered circadian rhythm of antidiuretic hormone (ADH) secretion, reduced bladder capacity, and sleep arousal difficulties contribute significantly to its occurrence 37-41. Studies indicate that most children with nocturnal enuresis have the primary and monosymptomatic type, meaning they have never acquired nocturnal urinary control and do not present other associated symptoms. A large part of these cases is related to inadequate training of urination habits, especially during the potty-training process and in controlling fluid intake.10 To a lesser extent, there are organic causes involved, more frequent Journal of Complementary Therapies in Health 2026: 4(1). 4 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 in the secondary and polysymptomatic forms, such as urological malformations, inflammation, urinary tract infection, constipation that puts pressure on the bladder, diabetes, kidney failure, and neurological and sleep disorders 28. Genetic factors play a relevant role; if one of the parents had a history of enuresis, the risk in the child is about 30%, and if both had the disorder in childhood, the possibility of the child developing it can exceed 70% 42-46. Although emotional factors are not always the primary cause, they can exacerbate or perpetuate enuresis by influencing sleep patterns and arousal thresholds 47-49. Current conventional treatments include behavioural interventions, such as fluid restriction before sleep, scheduled voiding, and the use of nocturnal alarms, as well as pharmacological therapies, mainly desmopressin and imipramine. While these approaches can be effective, relapse after treatment discontinuation is frequent, and adverse effects are not uncommon 5,13,14,17,18,23. These limitations have encouraged the exploration of integrative and complementary therapies, particularly those emphasising non-invasive and holistic approaches, such as those found in TCM. 3.2. Childhood Nocturnal Enuresis According to Traditional Chinese Medicine From the TCM perspective, urinary control depends on the proper regulation of Qi, Yin-Yang balance, and the harmonious functioning of the Kidney, Spleen, Lung, and Liver systems 24-27,29. When these systems become imbalanced, water metabolism is disturbed, leading to the involuntary release of urine during sleep. TCM classifies CNE primarily into three syndrome patterns (zheng): Kidney Qi Deficiency This is the most frequent pattern in CNE. The Kidney governs growth, bone development, and reproductive functions; in children, much of its energy is directed toward growth, making it prone to deficiency. When Kidney Qi is insufficient, the Bladder loses its ability to consolidate urine, resulting in frequent or abundant urination at night 24,29,50. Clinical features include pale complexion, cold limbs, clear urine, and a deep, slow pulse. Emotional instability, especially fear and insecurity, may further weaken the Kidney’s control function 28,29. Constitutional alterations of the Kidney may be present from birth, leading to subsequent deficiency of its Qi 24,29. Kidney Qi deficiency is considered the primary cause of most CNE cases. This occurs because the Kidney is responsible for bone growth, marrow formation, and brain development, directing a large part of its energy toward the child's growth and maturation. This constant overload can result in energetic deficiency of the Kidney. With the onset of puberty, when growth becomes regulated mainly by hormones, a tendency toward remission of Enuresis is observed. This phenomenon is related to the physiological increase in Kidney Yang, characteristic of adolescence 30. Children who present this syndrome generally have a weak constitution, generalised energetic deficiency, low vitality, slow digestion and growth, and greater susceptibility to colds 26. They are frequently described as quiet, shy, distracted, with a tendency toward overweight, and sensitive to cold. From a clinical point of view, they present manifestations such as clear and abundant urine during the day, pale tongue with thin white coating, and deep, thin, or slow pulse, typical signs of a cold deficiency-type syndrome. In more severe cases, cold limbs and intellectual deficit may occur, as Kidney deficiency leads to insufficient marrow production and brain malnutrition, which may be associated with cognitive deficits. In certain cases, Kidney Qi deficiency can evolve into Kidney Yang deficiency, intensifying the enuresis condition. In this condition, Yang becomes unable to warm and sustain bodily functions, resulting in pallor, aversion to cold, and cold extremities, representing more severe stages of the syndrome. What characterises this pattern distinctively is the elimination of a large volume of urine during sleep. Kidney Qi deficiency compromises the Journal of Complementary Therapies in Health 2026: 4(1). 5 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 Bladder's control function, resulting in failure in water metabolism. This dysfunction explains both the act of urinating involuntarily at night and the increase in daytime urinary volume 24,25,50. The Fire of Ming Men, considered the Original Fire and the vital flame of the organism, constitutes the basis of body heat and is intimately related to Kidney Yang. When this Fire weakens, physiological functions become slow, leading to a lack of vital impulse, developmental delay, and inability to contain urine effectively. Furthermore, children present a physiological Heart heat, which can consume Kidney Yang. This energetic deficiency prevents the Kidney from adequately controlling the sphincters, favouring the occurrence of enuresis. As Kidney Yang is consumed, there is a predominance of Yin, characterised by excess fluids, cold, and downward movement of energy, resulting in involuntary urinary elimination 29. Children with this pattern also tend to present insecurity and recurrent fears, factors that may derive both from their constitutional nature and from external influences, such as family, school, or social environment 28,29. The immature Shen contributes to alterations of the Zhi, the mental and emotional aspect of the Kidney, associated with courage and fear. Situations of emotional instability, especially frequent fear and stress, weaken Kidney Qi, compromising urinary control 29. Spleen and Lung Qi Deficiency The Spleen governs transformation and transportation of fluids, while the Lung regulates water pathways through dispersing and descending functions. Recurrent respiratory illnesses, poor diet, or medication misuse can weaken these organs, impairing their fluid metabolism and leading to enuresis 24,28,50. Symptoms include fatigue, poor appetite, loose stools, spontaneous sweating, and weak voice. Since the Spleen governs the muscles, its deficiency may reduce sphincter tone, exacerbating urinary. Due to the action of pathogenic factors, each episode of respiratory disturbance alters the metabolism of body fluids, compromising the functions of the Lung and Spleen. In these cases, enuresis tends to be temporary and generally disappears spontaneously after the resolution of the illness. However, there are situations in which the child presents chronic weakness of the Lung, Spleen, and Ming Men, associated with a history of recurrent digestive and respiratory disturbances 28. Clinical manifestations include frequent enuresis with a small amount of urine, constitutional pallor, fatigue, lack of appetite, loose stools, poor digestion, weak chronic cough, debilitated voice, spontaneous sweating, pale tongue, and slow pulse 24,50. Lung deficiency compromises its functions of dispersing and descending body fluids toward the Kidneys, impairing the passage of water and urinary control by the Bladder. Pulmonary debility interferes with the descending function of Qi, resulting in shortness of breath and weak cough. Furthermore, the disturbance in the mechanism of opening and closing the pores favours the occurrence of spontaneous nocturnal sweating 51. In turn, as the Spleen governs the muscles, its deficiency generates an imbalance in muscle tone, including the tone of the muscles responsible for urination control. The functional debility of the Spleen compromises the transportation and transformation of fluids, which can facilitate involuntary urination, especially during sleep, when the body is in a state of relaxation. Additionally, Spleen dysfunction can lead to the accumulation of dampness in the Middle Jiao, manifesting through symptoms such as lack of appetite and loose stools. Lung and Spleen Qi deficiency also compromises the production of Qi and blood, as well as the capacity to transform and transport the essence of food throughout the organism. This dysfunction results in a pale constitution, fatigue, and general decrease in vitality. Due to Qi insufficiency, a reduction in blood supply is observed, which manifests clinically through signs such as pale tongue and slow or deep pulse 25. Damp-Heat in the Liver Meridian When Liver Qi stagnates, often due to emotional tension, diet, or infection, heat and dampness may accumulate in the Lower Jiao, disturbing Bladder function 28,29,31. Children with this pattern exhibit irritability, restless sleep, thirst, flushed face, and yellow, strongsmelling urine. The tongue often presents a yellow coating, and the pulse is rapid and Journal of Complementary Therapies in Health 2026: 4(1). 6 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 slippery 24,50,52. Treatment therefore focuses on clearing heat, resolving dampness, and regulating Liver Qi. These patterns underline how TCM interprets CNE as a systemic imbalance rather than a localised urological dysfunction, emphasising individualised and holistic therapeutic strategies. The Liver is responsible for ensuring the free circulation of Qi throughout the organism, and any interruption in this flow can cause imbalances in other organs. The syndrome in question has as its main aetiology the stagnation of Liver Qi, which may result from emotional factors, inadequate diet, or the invasion of wind-cold transforming into heat in the Liver meridian. Frequently, Liver Qi stagnation compromises emotional flow, just as emotional imbalances, especially anger and frustration, can negatively affect the energetic function of the Liver 31. An inadequate diet interferes with the functioning of the Spleen, which begins to perform its functions ineffectively, compromising the metabolism of fluids and favouring the accumulation of dampness-heat, also in the Lower Jiao 28,29,50,52. 3.3. Traditional Chinese Therapeutic Approaches for Childhood Nocturnal Enuresis Throughout TCM history, treatment approaches have evolved according to philosophical and clinical paradigms. The Han Dynasty emphasised warming and tonifying; the Song Dynasty focused on astringency and fluid conservation; and by the Ming Dynasty, syndrome differentiation became central 53,54. Core treatment principles include warming and nourishing Kidney Yang, strengthening the Spleen and Lung, harmonising Liver Qi, eliminating dampness, and calming the Shen. Therapeutic modalities applied in Chinese paediatrics include: • Acupuncture: Activates the Bladder and Kidney meridians, regulating urination and calming the mind. The most frequently employed points include Zhong Ji (CV3), Guan Yuan (CV4), Qi Hai (CV6), Shen Shu (BL23), Ci Liao (BL32), Tai Xi (KI3), Zu San Li (ST36), San Yin Jiao (SP6), Tai Chong (LR3), Qu Quan (LR8), Shen Men (HT7), Yin Tang (EX-HN3), and Bai Hui (GV20) 23,25,27,29,53. • Herbal medicine: Formulas such as Jin Suo Gu Jing Wan, Jin Gui Shen Qi Wan, Suo Quan Wan, and Bu Zhong Yi Qi Wan, Zhi Bai Di Huang Wan, Long Dan Xie Gan Wan; tonify Kidney and Spleen Qi while regulating bladder function 25,26. • Cupping: Promote Qi circulation, eliminate cold, and strengthen Yang 25,29. • Auriculotherapy: Stimulates auricular points like Shen Men, Kidney, Bladder, Subcortex, and Tension to balance Qi and regulate emotions 25,29. • Dietary therapy: Uses specific foods and preparation, such as such as cooked rice and pork bladder with Poria (Chinese fungus) and lotus seeds is recommended, these having astringent and calming properties, in addition to recipes such as boiled egg with white pepper or chicken liver with cinnamon, indicated to warm and tonify Yang. However, caution is necessary due to the risk of irritation in young children 28. Among these, paediatric Tui Na is especially valued for its safety, simplicity, and adaptability, making it ideal for children and suitable for integration with other therapies 23,28,29,51,55,56. 3.4. Principles and Mechanisms Tui Na The term Tui Na comes from the words "Tui" (to push) and "Na" (to grasp), designating a therapeutic practice that, through body manipulation, promotes energetic and physiological reactions capable of restoring organic balance, strengthening the body. In TCM, paediatric Tui Na is a branch of this technique, used since the Ming and Qing Dynasties in the treatment of various childhood illnesses, in addition to contributing to the strengthening of immunity, also acting in the prevention of common childhood diseases. Unlike the application in adults, paediatric Tui Na uses specific points and zones of Journal of Complementary Therapies in Health 2026: 4(1). 7 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 the child's body, characterised by lighter, gentler, and more harmonious manoeuvres, yet rapid, vigorous, and stimulating, without causing pain, with an average duration of 2 minutes or 70 to 300 repetitions per point or area 26,29,51. The intensity of the manoeuvres varies according to the child's age and the treated region. This approach is considered highly effective and can be applied alone or in association with other therapies. It stands out for its good acceptance among children, as it is a non-invasive and comfortable technique 23,28,29,51,55,56. By stimulating acupoints and specific areas, Tui Na enhances the flow of Qi and Xue, clears meridian blockages, tonifies deficiencies, disperses pathogenic factors, and harmonises internal organs. In the context of CNE, it strengthens Kidney Qi, regulates Bladder function, harmonises the Lower Jiao, and calms emotional agitation that may accompany nocturnal urination 25,29,51,57. The main manipulative techniques include 25,26,28,29,51: • Zhi Tui Fa (pushing) – stimulate the circulation of Qi and Xue, unblock the meridians, and reduce pain. • An Fa (pressing) - Its objective is to warm the meridians, calm the mind, favor the free circulation of the collaterals, and relieve pain. • Rou Fa (Kneading or Massaging) – This manoeuvre aims to move Qi, activate the circulation of Xue, clear the meridians, and favour the unblocking of the organs. • Cuo Fa (Rubbing and Rolling) - promote the regulation of Qi, harmonise Xue, and relax tendons. • Nie Fa (Pinching the Spine) – It seeks to favor the balance between Yin and Yang, regulate the circulation of Qi and Xue, harmonise the internal organs, and tonify deficiencies. • Ji Fa (Pinching and Squeezing).) – eliminates stagnation and heat; • Ca Fa (Rubbing) - promotes warming, facilitating the circulation of Qi in the meridians, tonifying deficiency, and stimulating original Yang. • Qie Fa or Qia (Marking) - It has a calming effect, contributing to the reduction of fear and mental agitation, opens passages, drains orifices, and alleviates convulsions and spasms. • Yun Fa (revolving) – harmonises internal organs. 3.5. Therapeutic Points and Meridian Zones in Paediatric Tui Na for Childhood Nocturnal Enuresis In the analysis of the selection of points used in paediatric Tui Na for the treatment of CNE 23,25,26,28,29,50-52,57-59, a greater concentration was found in regions corresponding to the Du Mai / Governing Vessel (GV) channels, Ren Mai / Conception Vessel (CV), Bladder and Spleen meridians, in addition to areas and lines distributed on the hands, forearms, abdomen, and lumbosacral region. These elements are organised below according to their anatomical location (Table 1). Basic Manipulations Although there is no absolute consensus in the literature on the adoption of basic manipulations (Table 2) and additional manoeuvres (Table 3), selected according to the differential diagnosis of syndromes, there is a majority tendency among authors to adopt similar approaches as a therapeutic strategy in the treatment of CNE, although some present divergent approaches. All, however, have as a common objective to restore Kidney Yang, cultivate essence, tonify the Spleen, invigorate Qi, and harmonise the Liver 23,25,26,28,29,50-52,57-59. Journal of Complementary Therapies in Health 2026: 4(1). 8 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 Table 1. Anatomical Location of paediatric Tui na Points. Region Point / Line Meridian / Channel Location / Description Palm & Anterior Forearm Pi Jing Spleen Distal Phalanx Of The Thumb Shen Jing Kidney Distal Phalanx Of The Fifth Finger Gan Jing Liver Distal Phalanx Of The Index Finger Fei Jing Lung Distal Phalanx Of The Fourth Finger San Guan – Anterior Forearm, Radial Side Tian He Shui – Anterior Forearm, Central Line Liu Fu – Anterior Forearm, Ulnar Side Dorsum Of Hand & Posterior Forearm Wai Lao Gong – Center Of Dorsum Of The Hand Er Ma / Er Ren Shang Ma – Depression Between 4th And 5th Mcp Joints Bo Yang Chi – 3 Cun Above Center Of Wrist Extensor Crease Abdomen Fu Yin Yang – Line Below Costal Margins Shen Que / Qi Zhong (Cv8) Conception Vessel At The Navel Qi Hai (Cv6) Conception Vessel Anterior Midline, 1.5 Cun Below Navel Dan Tian – Pubic Region, Between Navel & Pubic Bone Zhong Ji (Cv3) Conception Vessel Anterior Midline, 4 Cun Below Navel Qu Gu (Cv2) Conception Vessel Upper Border Of Pubic Bone, Central Dorsal Region Ji Zhu – Over Spinal Column, C7 To Coccyx Fei Shu (Bl13) Bladder 1.5 Cun Lateral To T3 Spinous Process Xin Shu (Bl15) Bladder 1.5 Cun Lateral To T5 Spinous Process Gan Shu (Bl18) Bladder 1.5 Cun Lateral To T9 Spinous Process Pi Shu (Bl20) Bladder 1.5 Cun Lateral To T11 Spinous Process Wei Shu (Bl21) Bladder 1.5 Cun Lateral To T12 Spinous Process Shen Shu (Bl23) Bladder 1.5 Cun Lateral To L2 Spinous Process Ming Men (GV4) Governing Vessel Posterior Midline, Below L2 Spinous Process Qi Jie Gu – Line From Coccyx Tip To L4 Pang Guang Shu (Bl28) Bladder 1.5 Cun Lateral To S2 Ba Liao – Sacrum, 4 Sacral Foramina Each Side Gui Wei (GV1) Governing Vessel Lower End Of Coccyx Lower Limbs Zu San Li (St36) Stomach 3 Cun Below Patella, 1 Cun Lateral To Tibia San Yin Jiao (Sp6) Spleen Medial Leg, 3 Cun Above Medial Malleolus Tai Chong (LR3) Liver Dorsum Of Foot, Between 1st & 2nd Metatarsals Yong Quan (KI1) Kidney Depression On Sole, Anterior 1/3 To Middle 1/3 Head Bai Hui (GV20) Governing Vessel Top Of Head, centre Line Connecting Ears The clinical literature offers accumulating evidence that paediatric massage, often combined with adjunctive TCM techniques, may enhance therapeutic outcomes in childhood enuresis. For example, Lou 55 found that children receiving paediatric massage combined with moxibustion and acupoint application achieved improved rates of continence compared to standard care, indicating a synergistic effect of manual therapy plus heat and acupoint stimulation. Wang et al. 56 demonstrated that meridian-viscera massage combined with moxibustion in children with spleenand Kidney-deficiency subtype of enuresis resulted in clinically meaningful improvements in nocturnal bed-wetting, thereby aligning treatment to TCM pattern differentiation. Su et al. 60 reported shortand longterm efficacy of massage in primary enuresis in children, noting sustained benefits and low relapse rates over follow-up. Yan 61 focused on the renal-Qi deficiency subtype, applying Tui Na for “warming the Kidney and strengthening the spleen” and documented Journal of Complementary Therapies in Health 2026: 4(1). 9 of 14 Manso R.S., Alonso H.P., Ribeiro M.S., de Freitas A.D., Alves A.P., Faria J.F., Nascimento I.S. Paediatric Tui Na for Childhood Nocturnal Enuresis: A Review of Theoretical Foundations and Clinical Application doi:10.5281/zenodo.17941197 favourable responses in enuretic children. Wang et al. 62 used data-mining to analyse acupoint selection rules in massage treatments for paediatric enuresis, revealing consistent patterns in point usage (e.g., Kidney and Bladder meridian acupoints) that support protocol standardisation. Su et al. 59 reviewed the status of research on Tui Na for paediatric enuresis, highlighting methodological limitations (small sample sizes, short follow-up, heterogeneity) but nevertheless confirming clinical promise. Table 2. Basic Tui Na Manipulations Used in the Treatment of paediatric Enuresis. Point / Line Meridian / Channel Manipulation / Technique Therapeutic Purpose Shen Jing Kidney Slide With Tip Of Thumb Distal → Proximal Tonify Kidney Pi Jing Spleen Slide With Tip Of Thumb Distal → Proximal Strengthen Spleen, Eliminate Dampness Wai Lao Gong – Circular Pressing Disperse Cold, Warm Lower Jiao San Guan – Push With Index & Middle Fingers From Wrist To Elbow Harmonise Qi, Strengthen Yang, Cultivate Jing, Disperse Bladder Cold Fu Yin Yang – Slide With Thumbs From Center Outward Strengthen Spleen Shen Que (Cv8) Conception Vessel Circular Movements With Palm Warm Yang, Strengthen Spleen, Tonify Deficiencies Dan Tian (Cv4) – Circular Kneading With Palm Base Tonify Kidney, Tonify Lower Jiao Zhong Ji (Cv3) Conception Vessel Kneading Strengthen Kidney, Nourish Essence Qu Gu (Cv2) Conception Vessel Press & Rotate Tonify Kidney, Tonify Lower Jiao Shen Shu (Bl23) Bladder Circular Movements On Dorsal Shu Tonify Kidney & Jing Pang Guang Shu (Bl28) Bladder Circular Movements On Dorsal Shu Strengthen Bladder Function Ming Men (GV4) Governing Vessel Rub Palms & Place Over Point Warm Region, Tonify Original Qi, Strengthen Kidney Yang Qi Jie Gu – Push Upward Tonify Deficiencies Gui Wei (GV1) Governing Vessel Circular Kneading Warm Yang, Calm Fear Ji Zhu – Pinch & Roll Along Spine; Bottom → Top (Deficiency), Top → Bottom (Excess) Harmonise Zang-Fu, Regulate Yin-Yang, Regulate Qi & Xue San Yin Jiao (Sp6) Spleen Press & Rotate Strengthen Liver, Kidney, Spleen; Disperse DampnessHeat; Regulate Lower Burner Zu San Li (St36) Stomach Press Regulate & Strengthen Qi Of Middle Burner, Increase Yang, Eliminate Dampness/Cold, Strengthen Body & Immunity Bai Hui (GV20) Governing Vessel Circular Pressing Tonify Jing, Calm Mind, Soothe Fear The clinical literature offers accumulating evidence that paediatric massage, often combined with adjunctive TCM techniques, may enhance therapeutic outcomes in childhood enuresis. For example, Lou 55 found that children receiving paediatric massage combined with moxibustion and acupoint application achieved improved rates of continence compared to standard care, indicating a synergistic effect of manual therapy plus heat and