Enlarged prostate, also known as prostatic hyperplasia, is a very common disease that occurs in old male patients. Generally, this disease is considered to be associated with the disturbance of sexual hormones. The main manifestations are uroschesis and difficulty of urination. It belongs to the category of (retention of urine ) in TCM.

Main Points of Diagnosis

1. It occurs mostly in aged people who are over 50.

2. Symptoms

1) Frequent Micturation: This is a symptom at the early stage of the disease. Gradually, the frequency of urination increases, which is obvious especially at night. In mild cases the urination will happen 4-5 times a night and in serious cases it may occur dozens of times.

2)Diffculty in Urination: At the beginning, the  patient has to wait for a while before urination. Later on, the obstructional condition becomes more serious, accompanied with difficulty in urination or even dribbling in urination.

3) Acute Uroschesis: This symptom is due to factors such as constipation, cold, alcoholic drinking and weariness which can cause hyperemia and hydrops of the neck of the urinary bladder. Complete obstruction may be formed and acute uroschesis will result.

4) Urinary Incontinence: When the filling of the urinary bladder reaches an extreme state and the intravesical pressure becomes higher than the resistance of the sphincter muscle of urethra, urine will dribble out continuously from the urethra. This phenomenon is called pseudo-uroschesis.

5) Hematuria: Because of the hyperemia of the neck of urinary bladder, sometimes, hematuria may be found under microscopy or even by gross inspection.

6) Complications: On the one hand, urinary obstruction for a long time may lead to other sicknesses like decrease of renal functions or even renal failure, manifested as loss of appetite, fatigue, then nausea and vomiting, hypertension and anemia, Finally, a coma will follow. On the other hand, a long term difficulty in urination may also cause the increase of the abdominal pressure and produce inguinal hernia, hemorrhoid, proctoptosis, varicose vein in the lower limbs and so on.

3. Examination

1) Digital Examination of Rectum: Prior to the examination, the contents in the urinary bladder should be entirely cleared out. The examination often shows that the prostate gland is larger than usual but its surface is smooth with no nodes on it. Its edge is distinct and the hardness is medium with resilience. The central sulcus becomes shallow or disappears.

2)Residual Urinary Test: The residual urine is the amount of remaining urine which is collected by urethal catheterization immediately after urination.

3) Cystoscopy and Cystography: If the middle lobe of the prostate increases in size, it is necessary to go through cystoscopy and cystography in order to confirm the diagnosis.

4)Ultrasonic Examination: This examination will show the volume, form and internal structure of the prostate gland.

5) Laboratory examination: Through routine urscopy, pus cells or red blood cells may be found. Prolonged urinary retention may influence the function of the kidney. Therefore, a further test of urea nitrogen and creatinine will be required.   

Differentiation and Treatment of Common Syndromes     

1. Internal Treatment

1) Damp-Heat Type

Main Symptoms and Signs: The usual manifestations are dribbling urination, frequent micturation, burning feeling, difficulty and pain in urination, scanty dark yellowish urine, fullness of the lower abdomen, dry mouth, constipation and fever. Other symptoms and signs are red tongue with yellow greasy fur, taut and rapid pulse.

Therapeutic Principle: Clearing away pathogenic heat and dampness, removing blood stasis and activating the stuffy urethra.

Recipe: Modified Eight Health Restoring Powder

Chinese pink here

prostrate knotweed

pyrosia leaf

windweed rhizome

phellodendron bark

climbing fen spore

talc

aristolochia stem

rhubarb

capejasmine fruit

plantain seed (to be wrapped in a piece of cloth before it is decocted)

All the above drugs are to be decocted in water for oral administration.

2) Kidney-Deficiency Type

Main Symptoms and Signs: The urination is blocked up or dribbling and hard-going. Other features are pale complexion, an aching pain at the waist, aversion to cold, weariness and fatigue, pale tongue with thin whitish fur, deep and thready pulse.

Therapeutic Principle: Warming and reinforcing the kidney and promoting diuresis.

Recipe: Modified Life Preserving Pill for Replenishing the Kidney-Qi

Chinese yam

dogwood fruit

pilose asiabell root

cinnamon bark

prepared rehmannia root

prepared aconite root

windweed rhizome

oriental water plantain rhizome

achyranthes root

plantain seed (to be wrapped in a piece of cloth before it is decocted)

All the above herbs are to be decocted in water for oral administration.

For those who have hematuria, add Japanese thistle, field thistle, carbonized hair and grams of lotus node. For those with prolonged sickness marked by symptoms of deficient of qi, add pilose asiabell root, milkvetch root, curculigo rhizome and morinda root. For those whose sickness has lasted for a very long time and with mental fatigue, loss of appetite, no desire to speak, abdominal fullness and prolapse of anus, Bolus for Reinforcing Middle and Replenishing qi should be take at the same time.  

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