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 gonorrhea” in Chinese medicine.
I. Diagnosis
(Disease diagnosis)
1. Traditional Chinese medicine diagnosis: refer to the “Guidelines for the Treatment of Chronic Prostatitis with Integrative Chinese and Western Medicine (Trial Version)” (Chinese Society of Integrative Chinese and Western Medicine, 2007) and “Guidelines for Clinical Research on New Chinese Medicines” (China Medical Science and Technology Press, 2002).
(1) It is characterized by varying degrees of urinary frequency, urinary urgency, incomplete urination, occasional small amounts of white discharge in the morning, at the end of urination or during stool, and pain and discomfort in the perineum, external genital area, lower abdomen and lumbosacral area.
(2) It occurs in young and strong, and is easy to recur.
2. Western medicine diagnosis: refer to “Wu Jieping Urology” (Shandong Science and Technology Press, 2004), “Prostatitis Diagnosis and Treatment Guide (Trial Version)” (Chinese Medical Association Urology Branch, 2006) “Chronic Prostatitis Combined Chinese and Western Medicine Treatment Guide (Trial Version)” (Chinese Society of Combined Chinese and Western Medicine, 2007).
(1) The symptoms are varying degrees of urinary frequency, urinary urgency, incomplete urination, occasional small amounts of white discharge in the morning, at the end of urination or during stool, pain and discomfort in the perineum, external genital area, lower abdomen and lumbosacral area.
(2) Tenderness of the prostate gland: fullness of the gland, or hard and soft, or inflammatory nodules, or a tough texture, may have limited pressure pain.
(3) International NIH-CPSI score.
(4) Preferably in young adults, easy to recur.
(5) Leukocytes ≥ 10 MHP on EPS examination, or normal (type IIIb)
(2) Symptom diagnosis
1. Damp-heat infusion evidence: hot and painful urination, frequent and urgent urination. Accompanied by yellow and short red urine, dripping after urination, white turbid urine, dampness of the scrotum, irritability and dryness of the mouth, foul breath and wrist plankton. The tongue is yellow and greasy, and the pulse is slippery or stringy.
2. Qi stagnation and blood stasis: pain in perineum, or external genital area, or lower abdomen, or suprapubic area, or lumbosacral and anal areas, with swelling in the above areas. With dripping after urination, painful red urine and dripping urine. The tongue is dark or with petechiae or petechiae, and the pulse is stringent or astringent.
3. Deficiency of kidney yang: fear of cold, weakness or soreness of the waist and knees. With dripping after urination, mental depression, masculinity or low libido. Pale tongue with thin white coating and sunken or weak pulse.
4. Kidney yin deficiency: weakness or soreness of the waist and knees, irritable heat in the five hearts, insomnia and dreaminess. With white and cloudy urine or short red urine. The tongue is red with little coating and the pulse is thin or fine.
The first thing is to clarify the type of evidence and use the evidence-based treatment for the type of evidence not used.
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, smooth or numbered pulse.
Treatment: Clearing heat and relieving dampness
Remedy: Bazheng San plus or minus.
Che Qian Zi 10g, Qu Mai 10g, Q Cun 10g, Slippery Rock 10g, Mountain Gardenia Root 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.
(2) Qi stagnation and blood stasis
Symptoms: long duration of the disease, painful swelling in the 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 coating, smooth pulse.
Treatment: Promote blood circulation, resolve blood stasis, promote Qi flow and relieve pain.
Remedy: 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, Che Qian Zi and Slippery Rock to relieve dampness and promote drenching.
(3) Evidence of Yin deficiency and fire
Symptoms: Soreness and weakness of the waist and knees, dizziness and stringiness of the eyes, insomnia and dreaminess, no heartburn, seminal emission or blood sperm, white turbidity during urination or stool, discomfort in the urethra; red tongue with little coating, thin pulse.
Treatment: Nourishing Yin and lowering fire.
Remedy: Zhi Bai Di Huang Tang with addition and subtraction.
Radix Rehmanniae Praeparata 24g, Cornu Cervi Pantotrichum 12g, Dried Yam 12g, Zeligia 9g, Poria 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 the 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 fix the essence.
(4) Deficiency of kidney yang
Symptoms: soreness and weakness of the waist and knees, lack of warmth in the hands and feet, frequent urination, dripping, impotence and premature ejaculation; pale and fat tongue, white fur, sunken and thin pulse.
Treatment: Warming and tonifying kidney yang.
Remedy: Ji Sheng Kidney Qi Pill with addition and subtraction.
Radix Rehmanniae Praeparata 20g, Cornu Cervi Pantotrichum (made) 15g, Mudanpi 10g, Yam 15g, Poria 12g, Zeligia 10g, Cinnamon 3g, Radix et Rhizoma Polygonati (made) 3g, Radix Bupleurum 10g, Plantago 10g.
If the urine is not smooth, add hyssop and psyllium to tonify the kidney and diuretic; if spermatorrhea and premature ejaculation are seen, add raspberry, calcined keel and calcined oyster to tonify the kidney and fix the essence.
2. External treatment methods
(1) prostate massage: ① acute prostatitis is contraindicated; ② chronic prostatitis massage 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 reserved enema method: Dandelion 30g, Tiger Balm 20g, Danshen 20g, Phellodendron 2g0, Red Peony 20g, decoction of the above medicine to 100ml, about 40℃, reserved enema for 1 to 2 hours, once a day, 10 days for a course of treatment.
(4) Acupuncture: choose the kidney, Guan Yuan, bladder, San Yin Jiao and other points, milli-needle flat tonic and flat diarrhea, 15-30 minutes each time, once a day or every other day.
(5) External treatment: local injection of the prostate gland, compressing the umbilical cord, etc.
Western medicine treatment
(1) antibiotic treatment: first according to the prostate fluid routine smear of 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 tend to coordinate, 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 a break of 1 to 2 days in each week, for 30 minutes each time.
IV. Efficacy evaluation.
Clinical cure: The clinical symptoms and signs of Chinese medicine disappear or basically disappear, and the symptom score is reduced by ≥95%.
Efficacy: clinical symptoms and signs of TCM improve, and the symptom score decreases by ≥70%.
Effective: clinical symptoms and signs of TCM improved, and the symptom score decreased by ≥ 30%.
Ineffective: clinical symptoms and signs of TCM are not significantly improved, or even aggravated, and the reduction of symptom score is <30%.
V. Discharge criteria
Patients who are clinically cured or apparently effective after systematic treatment can appear, and patients with effective treatment can be discharged to continue outpatient treatment.