Post-urethritis syndrome in men refers to the clinical manifestations of urethritis that disappear and the absence of test abnormalities after treatment with a variety of antibacterial drugs in men with gonorrhea or non-gonococcal urethritis, but patients have multiple symptoms and clinical manifestations of discomfort. With the development of society and the change of people’s concept of sex, the incidence of gonorrheal urethritis has increased year by year, and the incidence of post-urethritis syndrome has also increased. The main clinical manifestations are urinary frequency, urinary urgency, burning and stinging urethra, pain in the perineum and groin area, sexual dysfunction, insomnia and memory loss and a series of other symptoms, which seriously affect the life and work of patients.
Case 1: Fan, 34 years old, was first diagnosed on July 21, 2011.
The patient was infected with gonorrheal urethritis due to unclean sex six months ago, and the symptoms were relieved after 1 week of antibiotic treatment at the local hospital, and the purulent urethral discharge disappeared, but the burning and stinging pain in the urethra has been diffuse, without obvious urinary urgency and frequency, and the urine routine was basically normal on recheck, and the culture of mycoplasma and chlamydia was negative. The repeated application of antibiotic treatment in outside hospitals was ineffective. The following: burning and stinging pain in the urethra during urination, dampness of the scrotum, no pain in the lower abdomen, no urinary frequency and urgency, no lumbago, dry mouth, stool regulation, red tongue with yellowish coating and smooth pulse.
Physical examination: foreskin is not long, no redness or swelling of the urethra, no discharge.
The diagnosis is damp-heat injection and mutual stasis and toxicity. Treatment is to clear heat and dampness, resolve blood stasis and detoxify. Remedies.
Fu Ling 20g, Poria cocos 10g, Dan Pi Shen 10g, Zingiber officinale 10g, Wild Chrysanthemum 10g, Fructus septicum 20g, Radix et Rhizoma 15g, Tong Cao 10g, Tempranillo 6g, Radix glycyrrhiza 5g, Plantago ovata 10g. 7 doses, decoction with water.
The second diagnosis complained that the burning and stinging pain in the urethra disappeared, only the smell of urine was stronger, the tongue was red with thin white coating, and the pulse was string. The original formula with vervain 20g, and then 7 doses and healed.
The “Treatise on the Origin of Diseases” says: “Heat gonorrhea is caused by heat in the three jiao, which flows into the kidneys and becomes gonorrhea in the cells, with the symptoms of red and astringent urine.” When heat and dampness are blocked, it is difficult to heal. Especially after sexually transmitted diseases, the local resistance decreases, and failure to treat the disease in a timely manner can easily lead to a chronic state. Treatment should be to clear heat and dampness concurrently, the lack of one is indispensable. This formula has both Tu Fu Ling, poria, Poria, Che Qian Zi, Tong Cao, light bamboo leaves and other water-relieving agents, but also purple flowers, wild chrysanthemum, septoria to clear the flow of heat and detoxification, both Dan Pi, Dan Shen blood swelling products, conducive to the absorption of chronic inflammation, and the addition of raw earth to prevent the bitter cold harm to yin. The formula is strictly forbidden and well thought out, and is a good formula for the treatment of fever gonorrhea.
Case 2: Fan, 45 years old, was first diagnosed on March 24, 2012.
The patient developed purulent urethral discharge with urinary urgency and frequency and urethral stinging pain due to impure sexual intercourse 7 months ago, and was later diagnosed as gonorrheal urethritis. After more than 1 week of treatment with levofloxacin and ceftriaxone, the urethral stinging pain disappeared, but there was still clear and dilute urethral discharge, and the culture of urethral discharge showed: positive for mycoplasma. The patient was treated with macrolide (azithromycin, roxithromycin) antibiotics for more than 5 months, but the culture of mycoplasma was sometimes absent, but the discharge did not decrease, and there was soreness and discomfort in the urethra, and the patient was in great pain. The patient was suffering from pain. He had urethral discharge, especially in the morning, frequent urination, urethral discomfort, loose stools, 2-3 times a day, poor appetite, depressed mood, not easy to sleep, light tongue with white greasy coating, thin pulse.
Physical examination: egg-white-like discharge from the urethra, mild varicose veins on the left spermatic cord.
The diagnosis is that the spleen and stomach are weak and dampness is injected downward. The treatment is to strengthen the spleen and resolve dampness. Prescription.
Radix Codonopsis Pilosulae 15g, Atractylodes Macrocephala 10g, Poria Shen 15g, Radix et Rhizoma Glycyrrhiza Uralensis 5g, Semen Coicis 20g, Pericarpium Citri Reticulatae 10g, Semen Cassia 10g, Astragalus Membranaceus 20g, Cardamom 5g, Phyllanthus Macrocephala 10g, Radix Bupleurum 10g, Radix et Rhizoma Chai Hu 10g, Radix et Rhizoma Dioscorea 10g, Cinnamon 3g. 7 doses with water.
The second diagnosis complained of obvious reduction of discharge, frequent and incomplete urination also relieved than before, urethral discomfort disappeared, appetite slightly improved, stool still thin, tongue coating greasy. After 14 doses, the overall symptoms improved significantly.
Press: antibiotics taste bitter, similar to Chinese medicine to clear heat and detoxification drugs, long use is easy to damage the spleen and stomach, cold and damp stagnation. It is not uncommon to see reports of antibiotics causing black moss, which is thought to be caused by a dysbiosis of the body flora. The black moss is caused by yang deficiency, cold dampness or heat that injures yin, which is in line with the theory that antibiotics damage the spleen and stomach.
In this case, the patient’s spleen and stomach are deficient, after a large number of antibiotics damage the righteousness, resulting in the disease evil stay and not go, in the indicator manifested as mycoplasma positive. Some doctors who see only the indicators but not the patient, will repeatedly misuse antibiotics, resulting in more injury to the vital energy, forming a cycle of nausea. At this point, only the combination of strengthening the spleen and dampness, tonifying the righteousness and eliminating evil can be effective. Therefore, Six Gentlemen’s Tonic is the main ingredient to tonify the spleen and benefit the qi, supplemented by dampness and fluids, which is calm and effective, although slow, but step by step, finally healing the patient.
Case 3: Zhu, 28 years old, was first diagnosed on July 18, 2012.
The patient visited the clinic for more than half a year because of urinary urgency and frequency after impure sexual intercourse, taking antibiotics, proprietary Chinese medicine and traditional Chinese medicine since the onset of the disease did not see any significant effect, the urinary routine is normal, the prostate fluid routine is good and bad. The following: urinary frequency, urinary urgency, after urination after the shower does not end, accompanied by small abdominal cramps, lumbar acidity, no urethral stinging pain, can, stool is still adjustable, tongue light moss yellow greasy, pulse sunken astringent. There is no discrepancy on physical examination.
The treatment is to tonify the kidneys, promote dampness, move Qi and invigorate Blood. Prescription.
Rhizoma Dioscorea Z 10g, Semen Cuscutae 10g, Radix Polygonum Oleiferae 10g, Rhizoma Acorus Calamus 6g, Calcined Oyster 20g, Plantago Asiatica 10g, Fructus Schisandrae 10g, Verbascum 20g, Radix Bupleurum 10g, Radix Rehmanniae 20g, Radix Leech 10g.
On July 25, the patient complained of significant improvement in urinary symptoms, abdominal cramps, light tongue with thin yellow coating and string pulse. The original formula was supplemented with 20g of raw Astragalus, and the symptoms basically disappeared after 21 more doses, and 7 more doses of consolidation treatment were given.
The actual fact is that, after a certain period of time, if the symptoms of acute urethritis have been relieved, and there are still symptoms such as recurrent dyspareunia, perineal swelling and discomfort in the bladder area, the possibility of chronic prostatitis should be highly suspected. 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. If you’re not treated promptly or thoroughly, it’s easy to infect the prostate upstream.
Treatment should be based on tonifying the kidney and resolving dampness, as well as moving Qi and resolving blood stasis. Therefore, the treatment is to tonify the kidney and channel dampness with Chai Hu. The medicine is consistent with the evidence, and the effect is quicker.
Summary
1, male post-urethritis syndrome patients seeking treatment urgently, the clinical often according to “persistent recurrent urethritis” continue to be treated with a variety of antibacterial drugs, but the efficacy of many poor, adding to the psychological and economic burden of patients. The main symptoms are frequent urination, painful urination, incomplete urination, pain in the perineum and groin area, distension and discomfort in the suprapubic area, irritability and insomnia, loss of libido and erectile dysfunction. This disease is mostly classified as “hot gonorrhea” and “spermatorrhea” in Chinese medicine. The common subtypes are damp-heat injection, spleen deficiency, cold-dampness, kidney deficiency and damp-heat. It can be seen that dampness is the main cause of this disease, or clearing, or warming, is the key to the treatment of this disease.
2, in the treatment of this disease is to strictly grasp the indications of antibiotics, not because of the patient or other factors, and abuse of antibiotics. Especially some patients with weak spleen and stomach or cold and damp body, overdose is easy to cause the spleen and Yang deficiency, cold and damp does not transform, and the disease is chronic.