Prostatitis is a common disease in urology, mostly in young and middle-aged people. There are three clinical classifications: acute chronic, specific and non-specific, bacterial and non-bacterial, etc. The most common type is chronic sterile non-specific prostatitis. The disease is characterized by perineal and abdominal swelling, frequent urination, painful urination and discomfort in urination. The symptoms and signs of this disease belong to the categories of “white turbidity”, “seminal turbidity”, “kidney deficiency and lumbago” and “laboring lung” in Chinese medicine.
I. Diagnostic basis: 1.
1. 1 Distension and discomfort in the abdomen, perineum and testicles, mild frequency of urination, white discharge from the urethra during urination or defecation.
1.2 It may be accompanied by fatigue, dizziness, lumbago, loss of libido, seminal emission, premature ejaculation, impotence, and infertility.
1.3 It is common in young and middle-aged men, often chronic and recurrent.
1.4 On rectal examination, the seminal ventricles are enlarged with pressure pain, and may shrink in chronic cases.
1.5 Prostate fluid microscopy, more than 10 white cells per high-powered field of view or in piles, lecithin vesicles significantly reduced or disappeared.
The first thing you need to do is to clarify the type of evidence and use the evidence-based treatment for the type of evidence you don’t need.
1. Internal treatment
(1) Damp-heat infusion evidence
Symptoms: frequent urination, urgent urination, painful urination, burning sensation in the urethra, unfavorable urination, dripping white at the end of urination or during stool, painful perineum, less abdomen, testicles, lumbosacral swelling; accompanied by fever, chills, head and body pain, etc.; red tongue, yellowish greasy coating, dazzling smooth pulse or number.
Treatment: Clearing heat and relieving dampness
Remedies: Bazheng San plus or minus: Che Qian Zi 10g, Qu Mai 10g, Q Cun 10g, Slippery Rock 10g, Mountain Gardenia Seeds Ren 10g, Roasted Licorice 6g, Mouton 6g, Rhubarb 10g, decoction.
In case of hematochezia, add Shengdi, Xiaoxi and Baimao Root to cool the blood and stop bleeding. In case of stone shower, we can add Qian Qian Cao, Hai Jin Sha and Shi Wei to dissolve the stones and promote drenching. In case of creamy gonorrhea, Dioscorea Z and Acorus calamus can be added to divide and clear the turbidity.
Assessment of efficacy: This type of symptoms is more common and can be improved by TCM treatment.
(2) Qi stagnation and blood stasis
Symptoms: long duration of the disease, painful swelling in the lesser abdomen, perineum and testicles, feeling of impurity in urination; pressure pain in the prostate gland on finger diagnosis, uneven texture, palpable nodules; dark tongue or petechiae, thin white moss, dizzy and slippery pulse.
Treatment: Promote blood circulation, resolve blood stasis, promote Qi flow and relieve pain.
Remedies: Prostate Tang with addition and subtraction: Wu Ling Li 10g, Pu Huang 10g, Neem 10g, Yan Hu Suo 10g, Chuan Niu Kne 10g, Dandelion 15g, Yu Jin 10g, Sheng Di Huang 10g, Licorice 6g.
If the urine is cloudy, add Atractylodes macrocephala, Che Qian Zi, and Slippery Rock to relieve dampness and promote draining.
Evaluation of efficacy: This type of evidence is common, and the symptoms can be improved by Chinese medicine treatment.
(3) Evidence of Yin deficiency and fire
Symptoms: soreness and weakness of the waist and knees, dizziness and dizziness, insomnia and dreaminess, no heartburn, seminal emission or blood sperm, white turbidity during urination or stool, urethral discomfort; red tongue with little coating and fine pulse.
Treatment: Nourishing Yin and lowering fire.
Remedy: Zhi Bai Di Huang Tang plus or minus: Shu Di Huang 24g, Cornu Cervi Pantotrichum 12g, Dried Yam 12g, Ze Di 9g, Fu Ling 9g (peeled), Dan Pi 9g, Zhi Mu 24g, Huang Bai 24g.
If insomnia and dreaminess, red tongue or mouth sores are seen, remove Shu Di Huang and add Bamboo Leaf, Radix et Rhizoma Dioscorea, Glycyrrhiza Glabra and Radix Notoginseng to clear the heart and lower the fire and direct heat downward; if spermatorrhea and premature ejaculation or urinary frequency and urgency are seen, add Golden Cherry, Calcined Dragon Bone and Calcined Oyster to benefit the kidney and consolidate essence.
Efficacy assessment: This type of evidence is rare and can be relieved by Chinese medicine treatment.
(4) Deficiency of kidney yang
Symptoms: soreness and weakness of the waist and knees, lack of warmth in the hands and feet, frequent urination and dripping, impotence and premature ejaculation; pale and fat tongue, white fur, sunken and thin pulse.
Treatment: Warming and tonifying kidney yang.
Remedy: Jisheng Kidney Qi Pill with addition and subtraction: Radix Rehmanniae 160g, Cornus Officinalis (made) 80g, Mudanpi 60g, Yam 80g, Poria 120g, Zeligia 60g, Cinnamon 20g, Radix et Rhizoma (made) 20g, Radix Achyranthes 40g, Carthamus tinctorius 40g.
In case of dyspareunia, add Radix Achyranthes bidentatae and Plantago ovatae to tonify the kidney and promote diuresis; in case of seminal emission and premature ejaculation, add Raspberry, Calcined Dragon Bone and Calcined Oyster to tonify the kidney and fix the essence.
Assessment of efficacy: This type of symptoms is rare and can be improved by TCM treatment.
2. External treatment methods
(1) prostate massage: ① acute prostatitis is contraindicated; ② massage in chronic prostatitis can improve local blood flow and discharge inflammatory secretions from the gland. The actual fact is that you will be able to get a lot more than just a couple of hours of work.
(2) Chinese medicine bath therapy: the corresponding type of oral Chinese medicine juice to about 2000 ml of warm water bath, can promote the pelvic blood flow, improve local microcirculation, and promote the absorption of inflammation. Use 42℃～46℃ warm water sitz bath twice a day, 20 minutes each time, 20 days as a course of treatment.
(3) Chinese herbal medicine retention enema method: Dandelion 30g, Tiger Balm 20g, Danshen 20g, Phellodendron 2g0, Red Peony 20g, decoction of the above medicine to 100ml, about 40 ℃, retention enema 1 to 2 hours, once a day, 10 days for a course of treatment.
(4) Other therapies: such as acupuncture, compress therapy, etc.
Third, the effect of Chinese medicine treatment
3.1 Cure: symptoms disappear, prostate fluid examination is normal.
3.2 Improved: symptoms and signs improved, prostate fluid examination improved.
3.3 Not cured: no improvement in symptoms and prostate fluid examination.
Western medical treatment
(1) antibiotic treatment: first according to the prostate fluid routine smear in the white blood cells, pus cells and prostate fluid bacterial culture and drug sensitivity results, and then choose antibiotics. The actual antibiotics are a good response to acute bacterial prostatitis patients. The preferred choice is cotrimoxazole (TMP-SMZ). The drug can maintain a high concentration in the prostate fluid and has a significant antibacterial effect. The quinolone antibiotics are more effective in treating chronic prostatitis. These drugs have a broad antibacterial spectrum and higher concentrations in the prostate than in the serum.
(2) Prostate laser special treatment: biofeedback combined with electrical stimulation treatment can make the pelvic floor muscle fatigue relaxation and make it tend to be coordinated, while relaxing the external sphincter, thus relieving the perineal discomfort and urinary symptoms of chronic prostatitis and promoting the inflammation of the prostate to subside. The general course of treatment is 10 to 15 times a day, once a day, with 1 to 2 days of rest in each week, each time for 30 minutes.
V. Conditioning
1. life conditioning: do not sit sedentary, do not sit in a cold and damp place; usually prevent staying up late and excessive fatigue; quit bad sex habits.
2. dietary conditioning: diet should be light, avoid spicy, fatty, sweet and thick, as well as easy to breed damp heat products, prohibit alcohol. 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 have been in the business for a long time. The most important thing is to make sure that the drug has an effective local concentration, to improve the efficacy, to increase the cure rate and to reduce the recurrence rate, and to actively and effectively treat the combined male infertility, which is a difficult and important point in the treatment of this disease.
Seven, Chinese medicine treatment response ideas
The overall idea of treating this disease is: focus on the combination of Chinese and Western medicine, strengthen the Chinese medicine evidence-based treatment, drug treatment as the main, food therapy and life guidance as a complementary comprehensive treatment ideas.