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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