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.
Dr. Ming's TCM Medical Center,
Hua Xi Xiao Yuan, Hutian Developing Area,
Huaihua
city, Hunan province
China