The main clinical symptoms are frequent urination, urgent urination, post-urinary draining and difficulty in urination. The main clinical symptoms are frequent urination, urgent urination, incomplete urination and difficulty in urination, etc. BPH is a common disease among middle-aged and elderly men over 50 years old, with a prevalence of 50% among middle-aged and elderly men. According to the autopsy results of men aged 60-70 years, the prevalence of BPH by visual examination is 75%; and the prevalence is higher by histopathological examination. The prevalence is higher in the northern region than in the south. As China enters an aging society, the prevalence of BPH has a tendency to gradually increase. Although Chinese medicine does not have the name of prostatic hyperplasia, the knowledge of symptoms related to BPH is scattered in the writings of medical doctors in the past generations, and there are detailed discussions on the evidence and treatment of BPH and its methods and prescriptions, which belong to the category of “essence of infirmity” in Chinese medicine. Theoretical exposition and clinical practice of TCM in the treatment of BPH, especially the treatment of blood circulation and blood stasis as an important treatment method of BPH, have formed a wide consensus in the academic community and have achieved positive clinical efficacy. The prostate gland is like an inverted chestnut, with a horizontal diameter of 4 cm, a longitudinal diameter of 3 cm, and an anterior and posterior diameter of 2 cm, located below the neck of the bladder, wrapping around the bladder opening and the urethra, and this part of the urethra is therefore called the “urethral prostate”. It is possible to say that the prostate gland guards the upper urethra, the prostate gland is ill, urination is affected first. The prostate gland is located at the bottom of the pelvis, above the bladder, below the urethra, in front of the pubic bone, and behind the rectum. The prostate is divided into five lobes, called the anterior lobe, middle lobe, posterior lobe and both lobes, of which the anterior lobe is very small, located between the left and right lobes and the urethra, and is of no clinical importance. The posterior lobe is located behind the middle lobe and both lobes, and is the lobe that is felt during the rectal examination. There is a physiological central sulcus in the middle of it, and during the rectal examination, the prostate is often judged to be enlarged based on whether this central sulcus becomes shallow or disappears. The main areas of the prostate that often produce hyperplasia are the middle lobe and the two lateral lobes. The enlarged prostate causes obstruction of the bladder neck and the bladder contracts more to overcome the neck resistance causing compensatory hypertrophy of the forceps muscle in the form of trabecular protrusions. The pressure in the bladder cavity increases, and the bladder mucosa can expand outward from the weak spot between the muscle bundles, forming a diverticulum bladder neck obstruction. Continued aggravation, urine will varying degrees of residual in the bladder, along with the increase in residual urine, the bladder wall gradually thinning so that the lower end of the ureter obliquely through the muscle layer of the bladder wall formed by the physiological valve role failed. The urine in the bladder then flows back into the ureter and renal pelvis, causing fluid accumulation in the upper urinary tract on both sides, increasing the pressure in the renal pelvis, causing ischemic atrophy of the renal parenchyma and eventually uremia. The etiology of BPH is still poorly understood, but the long-established academic consensus is the endocrine hypothesis that the indispensable factors for the pathology are the presence of testes with normal secretory function and ageing. The basis for this is that BPH does not occur in those who have their testes removed before puberty (e.g., eunuchs); that the prostate volume gradually decreases after the testes are removed in patients with BPH; that biochemical measurements in patients with BPH are often accompanied by abnormal agglutination of the androgen dihydrotestosterone (DHT), which is three to four times higher than normal; that endocrine stimulation is available to form an animal model of prostate enlargement; and that the 5-alpha reductase enzyme, which is used to stimulate the formation of the prostate gland. In addition, the pathogenesis of BPH is also based on the theory that prostate cells are embryonic reawakening, altered cell population ratios, and peptide growth factors. In addition, it is also believed that the pathogenesis of BPH is embryonic reawakening of the prostate cells, alteration of the ratio of cell groups, peptide growth factors, etc. According to Chinese medicine, the pathogenesis of this disease is a deficiency of the root cause and the symptoms of the disease. 1, old age and weakness: old age and weakness of Yang, blood transport, cold and damp stagnation, stagnation of Qi and blood is not smooth, then the gland is swollen and hard. Insufficient kidney yang and impaired bladder gasification function result in weak urination or retention of urine. As stated in the book “Medicine in the heart of the West”, “The deficiency of the yang division and the weakness of the qi cannot be pronounced, resulting in unfavorable urination.” In old age and weakness, the spleen and stomach do not function properly to raise the clear and lower the turbid, so there is no way to pass the article, that is to say, “Insufficient middle qi, urination is changed” is also. Old age, physical weakness, indiscretion, or chopping and mourning excessive, color labor injury body, loss of yin essence, no moistening, phase fire delusion, can also cause frequent urination, dripping incomplete. 2. Damp-heat injection: External heat induced by heat, congestion in the lungs, or damp-heat miasma in the lower jiao, or addiction to spicy and hot sunglasses! 3, Qi stagnation and blood stasis: the seven emotions are not in harmony, the liver is depressed, the drainage is out of order, the wood is out of order, the Qi stagnation is not able to move the blood, the blood stasis is blocked in the bladder and the seminal chamber, and the waterway is blocked. 4, stagnation of essence and blood: prolonged absence from intercourse, or withholding sperm without ejaculation, defeating sperm stagnation, or nourishing too much, flowing into the lower jiao, blocking the sperm chamber and bladder, resulting in retention of urine, Zhang Jingyue said “or defeating sperm, or accumulation of blood, blocking the waterway and blocking”. The cause of BPH in Chinese medicine is that the upper, middle and lower jiao can all cause the disease. The normal functions of the lung, the spleen, the spleen, and the kidneys, such as water and warmth, are the prerequisites for the smooth flow of urine. However, the root of the pathology is the obstruction of dampness, heat, blood and essence in the bladder and essence chamber, and the obstruction of blood stasis and other evil qi is the core of the pathogenesis of the disease. Western medical diagnosis and differential diagnosis] I. Western medical diagnosis (a) symptoms 1. Staging: BPH progresses slowly, and the early stage is asymptomatic due to compensatory bladder, or the symptoms are not obvious, called the resting stage of BPH. With the aggravation of lower urinary tract obstruction, the symptoms gradually become obvious, called symptomatic BPH or clinical BPH, the appearance of symptoms is closely related to age, and symptoms usually appear after the age of 50. 2, clinical manifestations: the clinical manifestations of BPH, there are mainly 3 aspects of bladder irritation symptoms, obstruction symptoms, obstruction complications: (1) bladder irritation symptoms: mainly urinary frequency, increased nocturia, urinary urgency or with painful urination, urge incontinence, etc. These symptoms may be related to bladder outlet obstruction, non-obstructive forced urinary muscle instability; among them, the increased number of nocturia is an early symptom of BPH. (2) Obstructive symptoms: mainly include difficulty in urination, hesitation in urination, thinning of urine line, incomplete urination, intermittent urination, final urinary drip, etc. The proliferating glands cause the posterior urethra to lengthen, bend and narrow, or the proliferating middle lobe may protrude toward the bladder neck and form a spherical valve, all of which increase the resistance to urination, of which progressive difficulty in urination is the most important symptom of BPH. (3) Complications of obstruction: serious complications caused by BPH include acute urinary retention, recurrent hematuria, recurrent urinary tract infections, stone production, and renal function impairment or even uremia. The International Prostate Symptom Score (IPSS), designed as a questionnaire, calculates a score based on answers to seven questions about urinary symptoms to determine the severity of symptoms. The total score ranges from 0 to 35 (asymptomatic to very severe symptoms) and is divided into three categories: 0-7 for mild symptoms; 8-19 for moderate symptoms; 20-35 for severe symptoms. (B) Physical signs Anal finger examination of the prostate is a simple but very important examination for BPH, mainly to understand the prostate shape, size, hardness, whether the surface is smooth, whether there are nodules and pressure pain, whether the central groove exists, becomes shallow or disappears, whether the gland is fixed, whether there is a twisting sensation on palpation, etc., and also to understand the anal sphincter, rectum and seminal vesicles. The normal prostate is the size of a chestnut, flat, with clear edges, tough, even and elastic, without nodules or pressure pain, with a slightly depressed central sulcus, symmetrical on both sides of the lobe, and slightly active on the nudge. In the case of prostate hyperplasia, the gland may be enlarged in length and width, with a smooth surface, clear margins, moderately hard and elastic texture, and a shallow, disappearing or elevated central sulcus. Common ways to describe the size of the gland in prostate enlargement: normal size, Ⅰ degree hyperplasia, Ⅱ degree hyperplasia and Ⅲ degree hyperplasia. In case of urinary retention, a round bulging mass is visible in the middle of the lower abdomen, which can be palpated or palpated with a central turbid zone or with pressure pain, i.e., a full bladder. (C) Laboratory tests 1. Routine urine examination: routine urine examination of BPH patients can sometimes be normal, and red blood cells, white blood cells, proteinuria, pusuria and alkaline urine can be seen in urinary tract infection. The presence or absence of hematuria, urine sugar, bilirubin can also be determined through the examination. Urine smear microscopy with culture for bacteria. When collecting urine, it must be done before rectal finger examination to avoid affecting the examination results. 2, blood routine and blood biochemical examination: blood routine white blood cell count and classification has diagnostic significance for concomitant urinary tract infection. The decrease of hemoglobin has a reference value for the degree of uremia. 3, renal function measurement: BPH patients can choose to check the following items according to the specific situation: blood urea nitrogen, creatinine measurement, phenol red excretion test, indocyanine excretion test, urine concentration and dilution test, ordinary or high-dose intravenous urography, etc. 4. Determination of serum prostate-specific antigen (PSA): The prostate is the most important secretion organ of PSA. It is very important to check PSA and free PSA in BPH patients, and it is a routine examination item for BPH patients. PSA is currently the most sensitive tumor marker for prostate cancer, and the purpose of the examination is to exclude the possibility of prostate cancer. In some cases, there may be false positive increase in PSA, such as after prostate massage, after ejaculation, obvious inflammation of the prostate, etc. Therefore, it is necessary to review PSA regularly. (iv) Special tests 1. Ultrasonography: Ultrasonography is a quick, inexpensive and effective method for the initial evaluation of patients with prostatic hyperplasia, including transabdominal ultrasound (TAUS) and transrectal ultrasound (TRUS), the latter being more accurate. The significance of ultrasound: (1) Measurement of the three diameters of the prostate gland allows for more accurate calculation of the prostate volume size and determination of the presence or absence of hyperplasia, the degree of hyperplasia and the site of hyperplasia in the prostate gland. (2) Measuring the volume of the migratory zone, thus providing a basis for the selection of surgical options, but when the middle lobe of the prostate is significantly enlarged, the ultrasound reports the prostate size is often larger than it actually is. (3) In patients with prostatic hyperplasia with significant enlargement of all three lobes, ultrasound can detect the middle lobe of the prostate that protrudes into the bladder and is superior to other tests in the initial evaluation of the patient. (4) It helps in the detection of prostate cancer, etc. (5) Residual urine measurement: simple, precise and non-invasive, accurate in determining the degree of urinary retention. (6) Transabdominal ultrasound also helps to detect other diseases of the upper urinary tract. 2) Urine flow rate: The urine flow rate can assess the severity of urinary tract obstruction in patients with BPH, but since all diseases that cause decreased bladder contraction and urethral obstruction can result in a decreased urine flow rate, this test lacks specificity for the diagnosis of prostatic hyperplasia and must be combined with other tests. As this index is easily influenced by the individual, urine volume and the external environment, it is important to ensure its reliability as the urine flow rate in the case of continuous (≥2) urination of more than 150 ml. 3, urodynamics: this test has two main important implications for patients with BPH: the diagnosis of BPH and the assessment of surgical outcomes. In addition, urethrography and urethrocystoscopy can also be done when necessary or when other pathologies are suspected. II. Differential diagnosis (a) Prostate cancer: Prostate cancer is often asymptomatic in the early stages. Although there is no relationship between BPH and prostate cancer development, prostate cancer is often found to have an increased PSA when examining patients with BPH. Pathological examination of prostate puncture biopsy tissue is currently the gold standard for confirming the diagnosis of prostate cancer. Other major tests are: pelvic MRI or CT, ECT bone scan, chest x-ray, and internal ultrasound. The purpose of doing these examinations is mainly to make a comprehensive assessment of the disease, to determine whether the disease is early or advanced, and whether distant organ or lymph node metastasis has occurred. (b) Bladder cancer: The symptoms of urinary tract irritation and urinary tract obstruction in bladder cancer are easily confused with BPH, but more than 3/4 of patients with bladder cancer have painless hematuria as the first symptom. Urine exfoliative cytology or other urine screening, abdominal plain film and intravenous urography, and cystoscopy can help to confirm the diagnosis. (C) Neurogenic bladder: a bladder-urethral dysfunction caused by damage to the central nervous system or peripheral nerves that control urinary function. patients with BPH and men with neurogenic bladder both have symptoms of abnormal urination, but the urinary dysfunction in neurogenic bladder often has diminished or lost sensation of bladder distention with defecation dysfunction (such as constipation and fecal incontinence), and may have History of trauma, surgery, diabetes mellitus, poliomyelitis, or drug application. Physical examination may show hyperalgesia and hypotonia or increased tone of the anal sphincter. (a) Heat congestion in the lung. Heat congestion in the lung, loss of suction and descent of the lung, unfavorable flow of water, stagnation of the spermatic chamber and bladder, unfavorable urination or dribbling, with dry throat, cough, irritable thirst for drinking, or even shortness of breath, red tongue, yellow fur, slippery pulse. (2) Dampness and heat with stasis. Unfavorable transportation and transformation of the middle jiao, dampness and heat flowing into the lower jiao, or kidney heat moving to the bladder and the jing chamber, burning the fluid and blood, stasis in the jing chamber and bladder, resulting in dribbling of urine, frequency and shortage, burning yellow and red, abdominal urgency and fullness, refusing to press, accompanied by constipation, bitter and sticky mouth, dry mouth without desire to drink, etc. The tongue is red and moist, the tongue is large, the moss is yellow and greasy, and the pulse is slippery. (3) Phlegm and turbidity with stasis Injury to the spleen and stomach by diet, or internal phlegm and turbidity due to prolonged illness, or a phlegm-damp constitution, with phlegm and turbid evil qi stagnating in the seminal chamber, resulting in unpleasant dripping of urine and obstruction, accompanied by thirst without desire to drink, dizziness and dizziness, stuffy abdomen, red tongue, fat tongue with teeth marks, white greasy moss, smooth or sunken string pulse. (4) Qi stagnation and blood stasis, depression, or irritability, liver qi stagnation, qi disorder, no blood flow, resulting in poor urination, weak urination, fine urine flow, accompanied by distension and pain in the lower abdomen, or even stabbing pain, purple and dark tongue or petechiae, and astringent or sunken pulse. (2) Deficiency and stasis (a) Qi deficiency with stasis, Qi is sunken, and blood does not flow when Qi fails, resulting in abdominal cramps, desire to urinate but cannot get out, or even inability to pass urine, clear urine, accompanied by tiredness and laziness, atrophy, shortness of breath and laziness, fatigue and weakness, not thinking about eating and drinking, pale purple tongue, fat tongue with teeth marks, sunken weak or astringent pulse. (2) Kidney yin deficiency with stasis Aging, depletion of yin and fluid, hyperactive phase fire, resulting in urine trickling down, or even no urine, pain in the lower abdomen and pressure, may also see afternoon red cheek, waist and knee soreness, dizziness and tinnitus, dryness of the mouth and throat, heat in the heart of the hands and feet, tinnitus and deafness, sleeplessness, dry stools, etc. The tongue is dark red with little fluid, thin and small, with little or no moss, and astringent and thin pulse. (3) Kidney yang deficiency with stagnation. Old age and weakness, lack of yang energy, resulting in difficulty in urination, dripping, frequent urination during the day, clear urine, dripping urine, and may be accompanied by weakness of the spirit, coldness of the limbs, soreness of the waist and knees, coldness of the scrotum, cold shrinkage of the stem, impotence, etc. The tongue is pale, the tongue is swollen and fat, and the pulse is sunken and astringent and weak. (1) Heat-evil congestion of the lung 1. Treatment: clearing the lung and lowering Qi, and at the same time invigorating Blood. 2. Formula: Qing lung drink with Shengdi and Danshen, etc. Fu Ling, Huang Bai, Sang Bai Pi, Mai Dong, Radix Platycodon, Ze Xie, Fructus sabdariffa, Sheng Di Huang, Dan Shen. (2) Dampness and heat with stasis 1. Treatment: Clearing heat and dampness, invigorating blood and promoting drenching. 2, prescription: Bazheng San combined with Guiding Chi San plus Dan Shen and Chuan Niu Kne. Qu Mai, Q Cun, Che Qian Zi, Slippery Rock, Mountain Gardenia, Rhubarb, Danshen, Chuan Niu Knee, Sheng Di Huang, Bamboo Leaf, Licorice. (C) phlegm and turbidity with stasis 1. Treatment: Eliminate phlegm and disperse knots, activate blood circulation and resolve stasis. 2. Formula: Si Hai Shu Yu Wan plus or minus. Sea clam shell, seaweed, cuttlebone, kombu, Chen Pi, Mu Xiang, Chuan Niu Knee, Atractylodes Macrocephalae, Wu Yao, Lian Lian, and San Ling. (D) Qi stagnation and blood stasis 1. Treatment: Regulating Qi and invigorating blood, dispersing nodules and promoting blood circulation. 2. Remedies: Chai Hu Dredging Liver with Shen Xiang San. Shen Xiang, Shi Wei, Radix Angelicae Sinensis, Chen Pi, White Peony, Slippery Rock, Dong Qu Zi, Wang Bu Liu Xing, Chai Hu, Citrus aurantium, Wu Yao, Gan Song, Xia Ku Cao. Deficiency with stasis (a) Qi deficiency with stasis 1. Treatment: tonify Qi and invigorate Blood, promote clearing and lower turbidity. 2, prescription: tonifying the middle and benefiting the qi Tang combined with Chunze Tang and Dan Shen. Ginseng, Astragalus, Atractylodes, Radix Angelicae Sinensis, Pericarpium Citri Reticulatae, Radix et Rhizoma, Radix et Rhizoma Chai Hu, Osmanthus, Poria, Poria, Salviae. (2) Kidney Yin deficiency with stasis 1. Treatment: nourish Yin, tonify the kidney, resolve stasis and promote water retention. 2. Formula: Zhi Bai Di Huang Wan combined with Pig Ling Tang plus Dan Shen, Chuan Niu Knee, Wang Bu Li Xing. Zhi Mu, Huang Bai, Shu Di Huang, Cornu Cervi Pantotrichum, Yam, Mudan Pi, Ze Di, Poria, Pig Ling, Slippery Rock, Agaricus, Dan Shen, Chuan Niu Knee, Wang Bu Li Xing. (C) Kidney Yang deficiency with blood stasis 1. Treatment: warming Yang, promoting water circulation, and moving Qi and blood. 2. Formula: Jisheng Kidney Qi Pill with Danshen, Wang Bu Liuxing, Baji Tian, Xian Ling Spleen. Radix et Rhizoma Pseudostellariae, Radix Cinnamomi, Radix Rehmanniae, Cornu Cervi Pantotrichum, Rhizoma Polygonati, Radix Mudanpi, Poria, Radix Zeleniae, Radix Achyranthes Bidentatae, Radix Panax notoginseng, Radix Bidentatae Sinensis, Radix Spleen. Acupuncture and moxibustion treatment: Acupuncture points Guan Yuan, He Gu and San Yin Jiao for damp-heat type; acupuncture points San Yin Jiao, Zhong Ji and Yin Ling Quan for liver qi stagnation type; acupuncture points Foot San Li, San Yin Jiao, Guan Yuan and Zhao Hai for lower jiao stasis type prostate enlargement; acupuncture points Zhong Ji, Yin Ling Quan and Zhao Hai for kidney yin deficiency type; acupuncture points Zhong Ji, Qi Hai and Zhao Hai for kidney yang deficiency type; acupuncture points Guan Yuan, Yin Ling Quan, Tai Xi and Foot San Li for spleen-kidney yang deficiency; and points Foot San Li, Yin Bai, San Yin Jiao, and Qi Hai for spleen spleen sinking. Appropriate application of tonic and diarrhea, can be retained for 10-30 minutes, once a day, 10 times for a course of treatment. Massage of the abdomen: pressure points such as Qihai and Guangyuan are beneficial to the recovery of bladder function. Slight pressure massage after urination can promote bladder emptying and reduce residual fluid. Frequent pressure on lumbar acupuncture points and with lumbar exercises can release local blood stasis. Third, physical therapy Prostate heat therapy, ultrasound therapy, short wave therapy, etc., are commonly used physical therapy methods for BPH. These methods are useful for improving the blood circulation of prostate tissue and improving the environment of the prostate, and can be used clinically as appropriate. BPH blood stasis evidence and the progress of blood circulation and blood stasis research] The location of BPH is in the seminal chamber and bladder, and is related to the dysfunction of the lung, spleen, liver and kidney. The deficiency of the kidney and blood stasis are the most important pathological mechanisms in the pathogenesis of BPH, which are often caused by both deficiency and reality. Blood stasis is an important cause of BPH, and in the process of disease progression of BPH, blood stasis is a pathological product of BPH. A large number of clinical practices in ancient and modern times have proved that on the basis of evidence-based treatment, appropriate treatment to activate blood stasis will have significant effect on the treatment of BPH. The basic research data on blood stasis in BPH and the treatment of BPH by activating blood and removing blood stasis are scarce and not deep enough, and the clinical research based on evidence-based medicine is not systematic yet, which needs to be studied in depth and systematically in the future.