Western medicine treatment
The choice of antibiotics is determined by the sensitivity of the drug to the bacteria on the one hand; on the other hand, there is a drug permeation barrier structure in the prostate tissue, and the antibacterial power and permeation ability of the drug must be considered to select the drug.
The first-line drugs are sulfonamides, followed by quinolones and tetracyclines. If mycoplasma or chlamydia infection is suspected, tetracycline or erythromycin is used. For those with culture results and drug sensitivity tests, sensitive drugs should be selected for treatment.
Antibiotic application principles: ① thoroughly remove the cause of the persistence of bacteriuria; ② select long-term adequate antibiotic treatment; ③ symptom relief can be stopped and observed; ④ partial relief of symptoms, available antibiotics of antibacterial dose; ⑤ relapse can be used in the preventive dose of antibiotics; ⑥ no relief of symptoms, massage again, according to the results of drug sensitivity test to switch to antibiotics.
Alpha- receptor blockers Alpha- receptor blockers can reduce urethral pressure, relax the tense bladder neck and prostatic urethra, eliminate urinary reflux in the prostate during urination, reduce the reflux of bacteria with urine, improve the patient’s symptoms and improve the therapeutic effect. Some of these drugs are terazosin, doxazosin, tamsulosin, etc. It is generally recommended to start with small doses, such as 1 mg of terazosin once/day, and then gradually increase the dose. The principle is to achieve the therapeutic effect without significant adverse effects at a dose of ≥ 6 months, which can reduce the recurrence of symptoms. The results are better for those with low urinary flow rate.
Non-steroidal anti-inflammatory drugs such as anti-inflammatory pain, ibuprofen and allopurinol have a short-term effect of reducing inflammation and improving pain symptoms by blocking the inflammatory process. Allopurinol may work by reducing the concentration of uric acid in the prostate fluid (urinary reflux causes high concentrations of uric acid in the prostate fluid). Anti-inflammatory and analgesic drugs are not usually used as a first choice or alone, but are more reasonable as adjuvant therapy.
The drugs in this category act directly on the urinary tract, relieving spasm of the bladder neck and prostatic urethra and improving the reduced urinary flow rate due to prostatitis. Commonly used drugs such as flavone permethrin. The representative botanical drug is sernitone, which is a natural pollen-derived preparation with inhibiting the synthesis of endogenous inflammatory mediators, anti-inflammatory and anti-edema effects, and the contraction of bladder forced urinary muscle and the diastolic effect of urethral smooth muscle. The iontophoresis method selects sensitive, broad-spectrum antibiotics, and treats chronic bacterial prostatitis with a DC induction motor and other instruments. 20 minutes/time, twice every other day, 10 times for a course of treatment.
The anatomy of the lower rectum is closely related to the prostate gland and is connected only by a fascia, and its lymphatic and venous systems are intertwined, which facilitates the absorption of drugs from the rectum and directly into the prostate gland. The use of suppositories, or infusion, drip method, of which suppositories are widely accepted by patients.
Chinese medicine treatment
The main points of identification of the damp-heat-infused type: frequent urination, urgent urination, painful urination, burning in the urethra, and dampness of the scrotum. The tongue is red, the coating is yellow and greasy, and the pulse is slippery. Anal examination of the prostate gland may be enlarged, the surface is not smooth, often with pressure pain. Prostate fluid examination leukocytosis, lecithin vesicles decrease. Treatment principle: clear heat and dampness. The formula is Cheng’s Dioscorea Z and Clear Drink, which consists of Dioscorea Z, Che Qian Zi, Poria, Coix Seed, Acorus Calamus, Atractylodes Macrocephalae, Hou Pu, Slippery Rock, Licorice, Phellodendron, and Qing Dai.
Key points of Qi stagnation and blood stasis: dripping and astringent pain in urine, tingling or swelling pain in perineum, less abdomen and testicles. The tongue is dark with petechiae or spots, and the pulse is astringent. The prostate gland is hard and tough or shrunken, with pressure pain. Prostate fluid is not easily removed, pus cells and epithelial cells are visible, and lecithin vesicles disappear. Treatment principle: invigorate blood circulation, remove blood stasis and move Qi to channel stagnation. The formula is chosen from Prostate Soup, which consists of Salvia, Safflower, Radix Paeoniae Alba, Peach kernel, Zelenia, Wang Bu Liu Xing, Boswellia, Myrrh, Andrographis paniculata, Green bark, Neem, Cumin, Dandelion, and Sulforaphane.
Kidney yang deficiency type: dripping urine, dripping white urethra, cold pain in the lower abdomen, perineum, testicles and lumbosacral region, coldness, soreness and weakness of the waist and knees, mental depression, impotence, premature ejaculation. Pale tongue, white coating, sunken pulse. Anal examination of the prostate gland is not large, soft in texture, no pressure pain. Prostate fluid examination, leukocytosis, lecithin vesicles decreased or disappeared. Treatment principle: warming and tonifying kidney yang. The formula is chosen from the Jin Kui Kidney Qi Pill, which consists of Gui Zhi, Fructus Pei Zi, Dried Di Huang, Shan Yao, Dan Pi, Ze Di, Cornus Cervi Pantotrichum and Fu Ling.
Yin deficiency of liver and kidney: short urine, dripping white at the end of urine, perineal swelling, dizziness and tinnitus, soreness and weakness of the waist and knees, seminal emission, irritable heat in the five hearts. The tongue is red with little coating and the pulse is fine. Anal examination of the prostate gland is not large, the texture is hard, no pressure pain. Prostate fluid examination, increased white blood cells, or visible red blood cells, lecithin vesicles reduced or disappeared. Treatment principle: nourish Yin and tonify the kidneys. The formula is Zuo Gui Wan, composed of Huai Di Huang, Shan Yao, Fructus Lycii, Cornu Cervi Pantotrichum, Chuan Niu Knee, Semen Cuscutae, Deer Antler Gum and Tortoise Gum.
Damp-heat and stasis type with painful swelling in testicles, lesser abdomen, perineum and lumbosacral region, burning and astringent pain in urethra, and dampness in scrotum. The tongue is dark red, the coating is yellow and greasy, and the pulse is moist or astringent. Anal examination of the prostate has inflammatory nodules, the surface is not smooth, there is pressure pain. Prostate fluid examination, not many white blood cells, lecithin vesicles reduced or disappeared. Treatment principle: clear heat and dampness, activate blood circulation and relieve pain. The formula is chosen from Bazheng San combined with Prostate Tang plus or minus, consisting of Che Qian Zi, q Cun, Qu Mai, Ze Lan, Danshen, Safflower, Red Peony, Tao Ren, Andrographis paniculata, Neem, and Sulforaphane.
Kidney deficiency and dampness-heat type: discomfort in the lower abdomen, perineum, testicles and lumbosacral region, dripping urine, dampness in the perineum, soreness and weakness of the waist and knees. The tongue is red with little fluid and the pulse is moist and thin. The anal examination of the prostate gland is not large, soft in texture, no pressure pain. Prostate fluid examination, leukocytosis, lecithin vesicles decreased or disappeared. Treatment principle: tonifying the kidney and guiding dampness. The formula is Dioscorea Z and Cuscuta Pill with addition and subtraction, consisting of Dioscorea Z, Cuscuta, Plantago ovata, Poria, Zeligia, Radix et Rhizoma, Salviae Sinensis, Acorus calamus, Glycyrrhiza glabra, etc.
Non-pharmacological treatment
Prostate massage Massage can promote the discharge of prostate fluid and prevent the retention of prostate fluid, thus reducing the possibility of infection. It also reduces the tension of the prostate gland and reduces the stimulation of the nerves for the purpose of reducing symptoms. It is a good idea to use it alone for fear of limited efficacy, mostly in combination with medication in comprehensive treatment, etc.
Thermostatic sitz bath method has the effect of improving the symptoms, the general use of the recommended water temperature control at 42-46 ℃, 1 to 2 times / day, 20-30 minutes / time, about 20 days for a course of treatment. Note that this method should be used with caution in unmarried and married patients who have not had children.
The actual acupuncture treatment, auricular acupuncture, electroacupuncture, acupuncture injection therapy, tuina therapy, etc. can be used.
Psychological treatment Patients with chronic prostatitis often have various psychosomatic symptoms, mainly anxiety, depression, fear, pessimism, and sexual dysfunction. Therefore, for those who are ineffective in medication or have obvious psychological symptoms, psychological counseling is advisable, and appropriate anti-anxiety and antidepressant drugs (such as trazodone, St. John’s wort extract) should be given, together with a psychologist if necessary.
The optimization of the treatment plan suggests that chronic prostatitis is a common disease of the genitourinary system caused by a variety of causes, difficult to diagnose the cause, more difficult to treat clinically, long treatment period and prone to recurrence. We found in the clinic that the more treatment means, the longer the treatment time, the more it increases the psychological burden and economic burden of patients. The treatment principle should reduce the number of treatment sessions, especially in terms of medication, and should not use multiple drugs at the same time to shorten the treatment time and reduce the treatment cycle. The psychological treatment should be given special attention and placed in an important position. It is vital to make the nature and characteristics of chronic prostatitis clear to patients. We found that the combined application of Chinese and Western medicines in the course of treatment can improve the efficacy, shorten the course of the disease and reduce adverse reactions. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. The treatment for chronic prostatitis is generally 8 to 12 weeks of regular treatment.