OverviewChronic prostatitis (chronicprostatitis, CP) is a common disease of the male genitourinary system, most often occurring in young and middle-aged men, and is a hidden concern for young and middle-aged men. Its incidence is high, and at some point in a man’s life, about half of all men, suffer from varying degrees of chronic prostatitis or have some symptoms of chronic prostatitis. The cause of this disease is more complex, the course of the disease is prolonged, and it often causes a lot of mental suffering to the patient, which puts many patients in a state of pessimism and despair for a long time. There are many descriptions of CP symptoms in Chinese medicine, including “gonorrhea”, “leucorrhea”, “hanging pain”, “retention of urine”, “retention of urine”, and “depression of urine”. “Gonorrhea”, “Leukodystrophy”, “Hanging pain”, “Retention of urine”, “Depression of urine”, “Depression” and so on. The theoretical elaboration and clinical practice of these diseases originated from Nei Dao, based on Zhong Jing, and have evolved through the ages, with more development in recent times. Scholars at home and abroad have done a lot of research on this disease, but so far there has been no fundamental breakthrough. Antimicrobials, botanicals, direct administration of drugs, and the application of various therapeutic devices have a certain degree of efficacy, but the course of treatment is long, and the condition is prone to recurrence. The motherland medicine in the treatment of chronic prostatitis, has a strong advantage, in the relief of symptoms and improve the quality of life of the patient has a very good role. The first is that the prostate is made up of glandular tissue and smooth muscle, and there are 30-50 tubular glands within it, forming 15-30 excretory ducts opening in the crypts on both sides of the middle of the prostate, from which the prostate secretes prostatic fluid. If the prostate constitutes the urethra is regarded as a longitudinal pipeline, and the ejaculatory ducts and excretory ducts are like the horizontal rows of fine pipelines, the two form a “non-“-shaped cross-structure, this physiological position triggered a lot of complications related to prostate disease. CP pathogenesis, modern medical knowledge is not particularly clear, there are several theories as follows 1, urine reflux theory: urine reflux into the prostate tissue, resulting in chronic inflammation of the prostate and tissue swelling, followed by urinary obstruction, more urine (aseptic or bacterial) reflux into the prostate, triggering aseptic or bacterial inflammatory response of the prostate tissue. The urodynamic data and the clinical efficacy of a-receptor blockers support this hypothesis.2. Sympathetic excitability theory: increased excitability of a-receptors in the bladder neck and posterior urethral region is the pathological basis for inducing urinary reflux.3. Immune response: the state of the host’s immune function and its ability to adhere to certain infectious agents is one of the mechanisms for inducing CP. Abnormal expression of some cytokines in prostate tissues and the application of non-steroidal anti-inflammatory drugs blocking COX-1 and COX-2 in clinical treatment corroborate this hypothesis.4. Bacterial infections: studies on CP patients have shown that some of them have a history of recurring urological infections prior to the disease, and that there are bacterial expression products present in the EPS of CP patients, and that antibiotics can have short-term efficacy in CP patients. The antibiotics can have short-term therapeutic effect on CP patients. There are many ways to categorize CP, and currently the National Institutes of Health (NIH) classification of prostatitis is used: Type I prostatitis (ABP): acute bacterial prostatitis, characterized by acute lower urinary tract infection symptoms and systemic symptoms, bacteriuria. Type II prostatitis (CBP): chronic bacterial prostatitis, characterized by repeated episodes of lower urinary tract infections, with bacterial localization in the prostate. in the prostate.Type III prostatitis (CPPS): chronic prostatitis/chronic pelvic pain syndrome characterized by pain and discomfort in the pelvic area, various urinary symptoms and abnormal sexual function without obvious signs of infection.Type IIIA is an inflammatory CPPS, with a high number of white blood cells (WBCs) seen in prostate fluid (EPS)/post-prostate massage urine (VB3)/semen.Type IIIB is a non-inflammatory CPPS, with EPS, EPS, EPS, EPS, VB3, and semen.Type IIIB is a non-inflammatory CPPS with EPS, EPS, EPS, EPS, EPS, EPS, EPS, EPS, EPS, EPS, EPS, VB3 and EPS. Inflammatory CPPS with normal WBC in EPS/VB3/seminal fluid.Type IV prostatitis (AIP): asymptomatic inflammatory prostatitis characterized by inflammatory manifestations in biopsy/EPS/VB3/seminal fluid without clinical symptoms. The Chinese medicine believes that the etiology of this disease can be summarized in the following aspects: 1. Dampness, heat and stagnation: excessive drinking, spicy and thick food, damage to the spleen and stomach, internal dampness and heat, or external dampness and heat of the evil, the injection of the bladder, the accumulation in the seminal room. Dampness and heat evil impede the lower jiao, blood flow is not smooth, or stagnation, dampness, heat and blood stasis and hostage to the disease, and see the urine is not good, white dripping, perineum pain. 2, dampness and stagnation: living in cold and wet places for a long time, wading in the water, the outside of the cold and dampness of the evil, or spleen and kidney deficiency, internal dampness and turbidity, lower jiao qi unfavorable, and see the lumbar and knee cold pain, cold and wet scrotum, drenched in urine. 3, stagnation of qi and blood stasis: emotional and emotional displeasure, depression, injuring the liver, liver loss of detachment, not to regulate the qi, or not to adjust the qi. No way to regulate the qi, or dampness and heat, dampness and turbidity of the evil blocking the qi, qi is not smooth, no blood, resulting in stagnation of blood stasis, or stagnation of blood impede qi and blood, resulting in lingering, manifested as perineum tingling, astringency of urination, etc., 4, blood stasis of renal deficiency: renal yin insufficiency, the phasic fire partial blaze, burned blood, resulting in blood, essence, blood, or renal yang deficiency, no warmth, qi and blood cold stagnation, stasis of the lower focal point, resulting in lumbar and knee pain, perineum astringency pain. Clinically, the disease is mostly characterized by kidney deficiency, dampness, heat and blood stasis. Western diagnosis and differentiation I. Western diagnosis (a) Symptoms The main clinical manifestations of chronic prostatitis, including pain in the area below the waist and above the knee, urinary abnormalities and psychosomatic symptoms. type IV prostatitis has no symptoms. Most CP patients complain of pain or discomfort in the lower back, lower abdomen, perineum, inner femur, etc. This pain or discomfort is often mild and not intense, but the symptoms flare up intermittently, often due to sedentary, spicy food or alcohol, and after sex. most CP patients complain of frequent urination, with an increase in urination during the daytime, and a few patients urinate frequently at night. Some patients may have urinary urgency, painful urination, dysuria, dribbling of urine, difficulty in urination, etc. Dribbling of urine is also a more common symptom, and a few patients may have ejaculatory pain and hematospermia. Sexual dysfunction is also a common manifestation of CP, often characterized by low libido, impotence, and premature ejaculation. These manifestations are related to the pathology of CP itself and have been associated with psychiatric factors. The vast majority of CP patients, there are generally mental symptoms, due to the direct suffering caused by the disease itself, and excessive attention to the discomfort caused by the disease, resulting in patients with heavy worries, depressed mood, or even complication of neurosis, manifested as insomnia, dizziness, blurred vision, fatigue, depression, and individual patients may even have nuisance, suicide and other extreme behavior. Chronic prostatitis symptom score (NIH-CPSI) is divided into pain or discomfort symptom score, urination symptom score and quality of life score, the higher the total points the more serious the condition. By filling out the questionnaire by CP patients, an objective evaluation of the severity of the disease can be made. (ii) Signs Although patients may have pain in multiple areas, with urinary symptoms and dribbling, the painful areas and vulva are mostly obvious abnormal signs. Prostatic anus palpation, most of the prostate gland size is not obviously changed, the two lobes may be asymmetrical, the surface may also be irregular, the texture is hard or uneven, there may be different sizes of nodules. Elasticity or mobility may be normal, and in a few patients mobility is reduced due to adhesions and fixation around the gland. Most patients have mild tenderness, and a few may have more intense tenderness. (C) Laboratory tests 1. Urine and prostate fluid tests: In most patients with CP, routine urine tests are normal, with leukocytes within the normal range and negative for red blood cells and urinary protein. Prostate fluid routine laboratory tests, leukocytes & gt; 10 / HP, lecithin microsomes are reduced, are suggestive of possible CP. 2, bacterial culture for CP typing diagnosis has significance. Meares-Stamey four-cup method of culture is the classic bacterial culture method, routine disinfection of urethral orifice before the collection of the specimen, take the primary urine 10 ml (VB1), the intermediate 10 ml of urine, the prostate gland massage fluid (EPS), 10ml of initial urine after massage (VB3), respectively in 4 sterile containers, bacterial culture and colony counting of all collected specimens, and drug sensitivity test. 4 cups of specimens are free of bacterial growth, can be diagnosed as non-bacterial prostatitis; VB1, VB2 negative, or 3000 bacterial strains / ml, while the EPS or VB 35000 strains / ml, can be diagnosed as bacterial prostatitis; VB1, VB2 negative, or 3000 strains / ml, and EPS or VB 35000 strains / ml, can be diagnose bacterial prostatitis; VB21000 strains/ml, can diagnose cystitis; if the EPS failed to take out, can be calculated by VB3 on behalf of 100 times dilution of EPS. Due to the cumbersome operation of four-cup method of culture, there are not many practical applications in the clinic, and the simplified two-cup method (i.e., PPMT method) is mostly used instead of the four-cup method. The two-cup method for the prostate massage before and after the urine bacterial culture, simple and easy to implement, clinically is more used. 3, prostate fluid properties, but also has a certain clinical significance. EPS turbidity, suggesting that CP may be CP patients may be elevated PH value of the EPS (EPS PH value of the normal value of 6.3-6.6). If necessary, ultrasonography, radiography and other imaging tests can be performed, as well as uroflowmetry, and if necessary, immunology, histology, cystoscopy, EPS lactate dehydrogenase and zinc levels can be measured. Differential diagnosis, because many diseases may cause symptoms similar to CP, clinically must be excluded from other diseases in order to diagnose CP, so some scholars image of CP diagnosis is compared to the “garbage can diagnosis”. Bacterial culture can not only identify bacterial and non-bacterial CP, but also has significance in the differential diagnosis of urethritis and cystitis. Anorectal diseases, appendiceal diseases, urinary stones, urethral stenosis, prostate tumors, ankylosing spondylitis and other diseases at a certain stage may also manifest as chronic pelvic pain or urinary abnormalities, which should be clinically differentiated accordingly. Chinese medicine identification and typing, a solid evidence and stasis (a) dampness and heat with stasis of exogenous or internal dampness and heat, injected in the lower jiao, blocking qi and blood, and condensing the seminal chamber. The manifestations are frequent urination, urinary urgency, burning or astringent pain in the urethra, dribbling, astringent redness of urine, tingling or astringent pain in the waist and abdomen or perineum, which may be accompanied by dampness in the scrotum, bitter taste in the mouth and dryness in the throat, dryness of the stools or diluted and difficult to dissolve, burning in the anus, with reddish fur with yellowish greasy coating on the tongue, and a number of stringy or slippery pulse. (B) Dampness and turbidity holding stasis externally or internally generated dampness and turbidity internal obstruction, the lower jiao for the dampness and turbidity trapped, qi and blood operation is not smooth, blocked in the seminal chamber. Frequent urination, turbidity, whiteness after urination, cold pain in the perineum, accompanied by cold scrotum, cold limbs, epigastric plumpness and dullness, nausea and vomiting, etc. The tongue is huge with teeth marks, purple and dark tongue texture, white slippery or white greasy moss, and the pulse is dull and tight or stringy. (C) qi stagnation and blood stasis, liver dysregulation, qi is not smooth, no blood, qi stagnation and blood stasis, blocked in the seminal chamber. It manifests as unfavorable urination, pain that may reach the chest and hypochondrium, accompanied by distension and fullness in the chest and hypochondrium, good taiyi, bitter mouth and not much to drink. The tongue is purplish or covered with petechiae, and the pulse is stringy or astringent. Deficiency and stasis (a) qi deficiency with stasis, labor injury to the spleen, prolonged illness, spleen deficiency, or heart and liver qi deficiency, the inability to move blood, blocked in the lower jiao channels. Manifestations of abdominal distension, empty pain, like to press, astringent stagnation of urine, the residual force is not exhausted, can be accompanied by a lack of breath and lazy speech, yellowish or white face, etc., the tongue is fat and purple dark, the pulse is weak and slow. (B) Yin deficiency and stasis of kidney yin deficiency, phase fire, burn the yin and fluids, blocking the seminal chamber. The manifestations are frequent or astringent urination, lower abdominal pain, lumbosacral pain, perineum pain, may be accompanied by spermatorrhea, dizziness, tinnitus, fatigue, weakness, red tongue, thin tongue, little or no moss, and fine pulse. (C) Yang deficiency and stagnation of kidney yang deficiency, the fate of the fire is weak, there is no warmth, cold and stagnation, impede the seminal chamber. Cold pain in the waist and knees, cold vulva, frequent and long urination, cold urine, mostly accompanied by impotence and premature ejaculation, dizziness and tinnitus, depression, cold limbs, etc., the tongue is pale, fat and dark, moss is white and moist, and the pulse is astringent and weak. Chinese medicine treatment I. Solid evidence with stasis (a) Dampness-heat with stasis.1 Treatment: clearing away heat and promoting dampness, removing toxins and resolving stasis.2 Formulas: Bazheng San plus subtractions, with the addition of red peony and Wang Buliuxing, etc. as appropriate. Qu mai, car Qian Zi, talcum, gardenia, rhubarb, licorice, red peony, Wang Bu Liuhang, Poria, raw Coix Seed. (B) Dampness and turbidity holding stasis.1 Treatment: dissolve dampness and eliminate stasis, separate clearing and lowering turbidity.2 Prescription: Separate clearing drink. Rhizoma Atractylodis Macrocephalae, Plantago Ovatae, Poria, Acorus calamus, Cyperus rotundus, Lian Zi Xin, Salviae Miltiorrhizae. (C) Qi stagnation and blood stasis.1 Treatment: regulate qi and activate blood circulation, clear the channels and relieve pain.2 Prescription: Shaobuyu Tang Plus Reduction. Second, deficiency with stasis (a) Qi deficiency with stasis.1 Treatment: tonifying the middle and benefiting the qi, elevating the yang and lifting the traps.2 Formulas: tonifying the middle and benefiting the qi, adding calamus and yujin. Astragalus, Radix et Rhizoma Ginseng, Radix Angelicae Sinensis, Rhizoma Atractylodis Macrocephalae, Pericarpium Citri Reticulatae, Radix Achyranthis Bidentatae, Radix Achyranthis Bidentatae, Radix et Rhizoma Glycyrrhizae. (B) Yin deficiency with stasis: nourish Yin and tonify the kidney, and eliminate stasis at the same time. Formula: Zhi Bai Di Huang Wan plus Salviae Miltiorrhizae, Sheng Long Bone, Oyster. Zhi Mu, Cortex Phellodendron, Radix Rehmanniae Praeparata, Cornu Cervi Pantotrichum, Rhizoma Dioscoreae, Rhizoma Dioscoreae, Radix et Rhizoma Zedoariae, Radix et Rhizoma Mudanensis, Poria, Radix Salviae Miltiorrhizae, Radix et Rhizoma Lobatae, Radix et Rhizoma Ostrea. (C) Yang deficiency with stasis.1 Treatment: warming and tonifying kidney yang, and removing stasis at the same time.2 Formulas: Jin Gui Kidney Qi Pill with Acorus calamus, Ul Jin, Salviae Miltiorrhizae, Yizi Yan, Shayuan Zi, Raspberry. Cinnamon, ripe epimedium, yam, ripe huangdi, cornelian cherry, mudanpi, zedoary, poria, calamus, yujin, danshen, yizhi ren, shayuanzi, raspberry. Other therapies I. Acupuncture and moxibustion treatment takes Guanyuan, Sanyinjiao, Taixi and Huiyin points as 1 group; Zhongji, Baihuan Yu, Ashigaru, Yinlingquan and Ren Yu as 1 group. Medium intensity stimulation, intermittent needle 15 minutes, 2 times a day, alternating between morning and afternoon for each group. 7 days for a course of treatment. Second, drug bath therapy according to clinical diagnosis and typing, the use of different bath drugs. 1, kidney deficiency stasis type: Cuscuta chinensis, Cortex Eucommiae, Cornus officinalis, Radix et Rhizoma Dioscoreae, Mudanpi, red peony, Angelica sinensis, Salvia miltiorrhiza, safflower, cypress 10g, water bath, 1 time per day, 1 time for 20 minutes, 30 days as a course of treatment. 2, kidney deficiency hosting dampness heat, heat and toxins: Cuscuta chinensis, Eucommiae chinensis, Cortex Eucommiae, Radix et rhizoma Dioscoreae, Radix et rhizoma Dioscoreae, Radix et rhizoma Dioscoreae, Radix et rhizoma Dioscoreae, bitter ginseng, Huanglian, Psyllium, Zedoary, red peony, money grass, seaweed 10g each, water bath, 1 time 20 minutes, 30 days for a course of treatment. 3, to perineum and other local pain: vinegar-fermented Wu Ling Lipid, raw Pu Huang, Yanhuisuo, Chuanxian hyssop, ophiopogon, woodruff, neem, gao liangjiang, white peony, raw licorice 10g each, water bath, 1 time 20 minutes, 30 days for a course of treatment. In addition, there are other clinical treatments such as drug acupoint injection, electroacupuncture, ionic Chinese medicine penetration, ultrasonic Chinese medicine penetration, Chinese medicine enema, etc., which have also been proven to be effective and can be chosen appropriately. Chronic prostatitis blood stasis evidence and activation of blood stasis research progress CP’s main pathological changes for the prostate gland ducts of inflammation obstruction, resulting in the prostate gland ducts of poor drainage, and then aggravate the inflammation of the gland ducts of obstruction, the vicious circle, recurrent episodes, resulting in the CP lingering difficult to cure. Poor drainage and obstruction of the glandular ducts may affect the blood circulation of the prostate gland, resulting in microcirculation disorders, which in turn aggravate the chronic inflammation of the prostate gland, manifesting as chronic pain in the perineum, testicles, inner thighs, lower abdomen, lumbosacral region and other parts of the perineum, urinary frequency, urgency, urinary divergence, urinary dribbling, urinary pain, painful ejaculation, dribbling of white and other symptoms of urinary and ejaculatory discharge, and the pathological features of which are in line with those of the blood stasis syndrome of traditional Chinese medicine. Clinical onset of different etiology and pathogenesis, clinical manifestations are also different, can be due to the real evil caused by stasis, can also be due to the deficiency caused by stasis. The stagnation of blood in the lower Jiao Jing chamber, not only the meridians are obstructed, but also the collaterals are affected by the stagnation of blood.The stasis of blood in CP is often more obvious, and in most cases, it will be combined with the deficiency of qi, renal deficiency, depression of the liver, dampness, dampness-heat and so on, and clinically, it is caused by a variety of etiological factors, but the stagnation of blood is often present throughout the whole course of this disease. A large number of basic and clinical trials have confirmed that Chinese medicines that activate blood stasis can improve microcirculation and vascular permeability, improve blood rheological indexes, promote the excretion and absorption of inflammatory secretions, improve and prevent fibrosis of the tissues around the lesions, and promote tissue repair.