Thank You, Mighty Frequent-Urination Gene
My deepest childhood memory is of bedwetting. No matter how much I told myself before sleep that tonight I absolutely must not wet the bed, I would, unfortunately, always do so. I kept wetting the bed until near graduation from primary school, and for that I became the butt of ridicule among my family, neighbors and classmates. So as a child I grew up in an environment of discrimination; had it not been for my parents protecting my dignity, I would probably have had no self-confidence at all.
Holding urine is a painful business; in middle school I often could not last through a single class. It was then that my parents realized something might be wrong with my body. For the problem of frequent urination, almost every Chinese person's intuitive response is that it is caused by kidney deficiency, so as a child I was frequently treated as a kidney-deficiency patient—such is the depth of influence of this stereotyped TCM view in Chinese folk culture.
Because of the frequent urination, on top of puberty, I needed to drink a lot of water in middle school. So under my desk I kept a thermos with a liner, and I bought one of those cheap water-boiling gadgets—a “hot-fast” immersion heater—to boil my own drinking water; it was a cheap appliance students of my era commonly plugged into a cup of water to boil it.
In the second year of high school, once when I was boiling water with the immersion heater it exploded. Of course this explosion was not very destructive; it was just a little episode in class. After the math teacher on duty found the cause of the accident, he cracked a humorous joke at my expense, which set the whole class roaring with laughter.
This physiological trait of mine cast a shadow of inferiority over me from childhood; my parents took me to see doctors. Many doctors confidently believed they had found the cause of my illness and thought it was no big deal, easily cured.
But after taking countless doses of Chinese and Western medicine, my “illness” still could not be cured. A master of medicine at our county people's hospital, a graduate of Tongji Medical University, was greatly distressed when he failed to treat me, and even accused me of merely performing, to win my family's sympathy. My father said angrily: my son has wet the bed since childhood, several times every night; does such a small child even know how to perform? It was simply nonsense.
My older brother and I were deeply close. In his first year of college he worked his way through school and, by selling books, earned the first income of his life. He bought me the most upmarket T-shirt and a pair of jeans I had worn up to that point. During summer vacation he took me to Shanghai (where he was attending university), registered with an academician in urology, and asked him to examine and treat me.
I still remember the elderly academician, as he examined me, saying to his students: these cheap jeans are obviously street-market goods, unhealthy to wear, and it is they that cause urinary problems in so many people. That was the first pair of jeans I had ever worn in my life; given my family's circumstances, had my brother not worked and earned a bit of money, I could not even have afforded such jeans—my parents were unwilling to buy us such clothes. We explained to the old academician that it was not the jeans; he frowned and said nothing. This treatment, of course, ended in failure as well.
While in college I wrote a novel titled The Real World and the Story World, whose protagonist was a boy who had wet the bed since childhood; his physical affliction filled his growth with setbacks, so much so that he developed a split personality. In his life there was one world that was real and another that was as false as a story. He always took refuge in fantasy, escaping the distress of reality in imagination, very much like a schizophrenic.
Undoubtedly, the prototype of this protagonist was myself. Later, I came to disdain my own writing, feeling that the articles and novels I had written were a pile of rubbish. In my twenties, I pessimistically concluded that I had no talent for literary creation, and burned all the manuscripts I had written over the years.
Frequent urination was simply a nightmare for me; it has dogged me like a shadow right up to today. I believe I cannot rid myself of this congenital frequent urination in my lifetime. As a child I not only saw many doctors but also tried all manner of folk remedies. After I grew up, I consulted many TCM and Western doctors, both in hospitals and among folk practitioners. Schools of TCM all claimed they could explain the cause and solve the problem, but they all failed. Some doctors suspected I had diabetes and again and again ordered blood glucose tests. The glucometer, disappointingly, never gave them the result they wanted. At first I dutifully served as their guinea pig; later I lost that patience.
Because of this personal suffering, I resolved from childhood to study medicine. I read many medical books and tried many ways to treat myself, to no avail—I now have enough knowledge to write a monograph on treating frequent urination. This also gave me a deep appreciation of the saying: a thousand formulas are easy to come by, but one effective result is hard to find. After thirty, I accepted the reality that my frequent urination was incurable, and from then on stopped torturing myself over it.
If you had read only the above, you might think my life had been ruined by this physical affliction. But that is an illusion; compared with the harms it brought, the benefits it brought me were greater.
Because of the frequent urination, I developed an early interest in medicine. And because of the trouble it caused, I also developed a strong interest in spiritual philosophy. Over the years I have written many popular-science medical articles, and some readers admire how much I read. To be honest, had my body not had such an unspeakable and insoluble problem, I would never have had the drive and patience to read so many professional books that most people find tedious.
Also because of the frequent urination, from middle school on I liked being alone. In high school I was probably the quietest student in my class, always sitting alone in a corner of the classroom, reading, doing exercises and writing with undivided attention. And for this reason I gained more freedom than most. From high school on, my time was basically my own to dispose of; my teachers allowed me to skip classes and only take exams. After graduating from high school I was essentially never again constrained by anything.
How severe was my frequent urination? I once calculated that the volume of water I excreted in urine in a day was several times the water I drank. This is not surprising; after all, most of the content of almost all the food we eat is simply water.
I have been assiduously studying medicine, hoping one day to understand why humans urinate frequently. From the medical literature I learned that about 140 million people in the world share my affliction; this number surprised me a little—it turns out so many people have the same problem.
Deep study taught me that people with frequent urination who do not have diabetes or kidney disease mostly have some problem with the thalamus. Some patients with brain tumors or brain injury have frequent urination or urinary incontinence; more cases are due to a deficiency of a hormone produced by brain cells.
In the process of cleansing the blood, our kidneys reclaim about 15 liters of fluid from the urine every day. This reclamation work of the kidneys is helped by a brain hormone that inhibits water excretion; hence the hormone is called antidiuretic hormone (ADH). ADH also raises blood pressure, so it is often called vasopressin. This hormone exists not only in the human body but widely across the entire animal kingdom, including insects.
Antidiuretic hormone is a small protein produced by brain cells located in the hypothalamus. The hypothalamus sends the hormone it produces to the very back of the pituitary gland, from where it is released into the bloodstream. When a patient has a genetic defect in the DNA for antidiuretic hormone, the frequent-urination problem caused by deficiency of the hormone appears: the patient excretes about 15 liters of urine per day.
In 1992, a team led by the Dutch brain scientist Professor Dick Swaab, in collaboration with a research group in Hamburg, jointly discovered a tiny DNA defect in a family from Amsterdam with diabetes insipidus—a building block of the DNA on their chromosome 20 was the culprit. Scientists also found a way to treat the disease: by giving patients long-acting antidiuretic hormone through medication or nasal spray, their frequent urination can be resolved. Some patients, however, are unwilling to take long-term medication; they have accepted this trait of their bodies, and I am one of them.
In this study I found the true cause of my own condition and that of my fourth uncle, my paternal cousin-uncle and my grandnephew. During an accidental trip I took together with my fourth uncle, I discovered to my surprise that he had the same problem; he also told me that one of my paternal cousin-uncles was the same. On another occasion, when I was alone with one of my grandnephews, I noticed he too had frequent urination; I asked him, and sure enough it was so. That is to say, our frequent urination is caused by a hereditary family gene. In our family, some people are merely carriers of this gene, while others are patients of the genetic disease it causes.
This hereditary hypothalamic problem does not make people stupider; it merely causes frequent urination in those who have it. In fact, my high-school grades were so excellent as to be unbelievable; although I did not attend classes like a normal student, I could place first in every subject, and the second-place student in the whole school trailed me by a large margin. My grandnephew's academic performance is also excellent. This defect does not make the body weak either; my fourth uncle was a much-feared martial arts master in our area. The local martial-arts culture ran strong, but everyone knew not to provoke my fourth uncle lightly, for doing so would only bring trouble on oneself. It does not affect lifespan either; my cousin-uncle is now in his eighties and still in good shape.
Worldwide, as many as 130–140 million people have this problem; beyond them there is an even larger number of silent carriers of the gene, who simply are not in a symptomatic state. From the perspective of evolutionary medicine, it is no accident that so many people carry this gene; behind it there must be factors of natural selection. That is to say, this gene is actually not a disadvantage gene but an advantage gene—an advantage gene that helped humans survive plagues and natural disasters.
One possible explanation is that this gene evolved during a climate period of bitter cold, similar to the Younger Dryas. The piercing cold waves of the Younger Dryas froze large numbers of living things to death, our ancestors included. To adapt to such a cold climate, organisms naturally evolved the corresponding genes; only those that could adapt to the sudden climate change survived and had the chance to reproduce, which is why so many of us carry this gene.
Most people have probably had this experience: in the cold season, we easily shiver, our hands and feet grow cold, and we urinate more than in the hot season. This is because when the body feels cold, it automatically constricts the sparse capillary networks of the extremities—first the fingers and toes, then those of the arms and legs. Why does the body constrict the capillaries? Because it wants to squeeze blood out of these areas and push it into the trunk of the body, so as to protect the vital organs and keep them at a relatively safe temperature. This is the body's wise choice of sacrificing the pawn to save the king; the hands and feet may thus be frostbitten, but life is preserved.
But constriction of the blood-vessel walls has a side effect: it raises blood pressure, and when blood pressure rises to a certain level it can cause stroke. The body then intelligently regulates itself; it lowers blood pressure by eliminating the action of vasopressin (i.e., antidiuretic hormone). So do not be surprised that the blood-pressure drugs of both Chinese and Western medicine have a diuretic side effect, because antidiuretic hormone (ADH) is the culprit behind elevated blood pressure. We can lower blood pressure through diuresis; I have treated dozens of hypertension patients, resolving the problem with TCM herbs and formulas that have a diuretic action.
The organisms that narrowly survived cold waves like those of the Younger Dryas evolved a gene mutation countering ADH; it is no surprise that some of their descendants exhibit “frequent urination.” Strictly speaking, frequent urination is not a disease at all, but a phenomenon by which living things adapt to the environment; we have merely mistakenly taken phenomena we consider abnormal to be diseases.
In the past, seeking treatment for this problem, I saw dozens of doctors, the most senior of whom was an academician; regrettably, not one had knowledge broad enough to explain the phenomenon. Some TCM doctors treated people like us as yang-deficiency patients, also with no effect at all. Other TCM doctors always hinted in their words that people like us had indulged in excessive sex—which, of course, was also nonsense.
Frequent urination helped me open door after door of life science; each time a door opened, I saw a vast, boundless wilderness. This exposure taught me that every field of learning has great limitations, and that only deep study can bring a deeper understanding of life science. This experience also kept me from being as arrogant and conceited as some ignorant people; what we do not know far exceeds what we know. Only humility and self-awareness can keep us from being so disagreeable.
Frequent urination caused me distress, but humans are animals with extraordinary adaptability; if distress cannot destroy us, we destroy distress, and temper extraordinary psychological resilience. Frequent urination made me ashamed to be with others, yet inadvertently made me someone who has enjoyed full freedom and spiritual independence.
In a certain sense, it is precisely this frequent-urination gene—able to survive even in extreme environments—that has given those of us who carry it, from birth onward, a strong ability to adapt to the environment (other genes may protest, for they deserve some of the credit too). So how could I not be grateful to the frequent-urination gene?