Epididymitis
This disease is mainly due to infection of bacteria through the spermatic duct, usually originating from infection of urethra, prostate or seminal vesicle. TCM includes it in the category of Ziyong (acute or chronic orchitis and epididymitis).

Pathomechanism and Pathogenesis
Stagnation of Qi and blood in he testis due to going down of damp-heat in the Liver Channels led to this disease. Excessive heat duet to long stagnation of Qi and blood may turn flesh into pus. Qi and blood retained so long will turn into chronic mass.
Clinical Manifestations
Sudden onset in acute cases, swelling and pain of the epididymis, the testis enlarged when it has been involved in the inflammation, red-swelling and burning-pain of the scrotum, dragging pain in the lower abdomen occurring when the inflammation involves the funiculus, red swollen bright sin of the scrotum whose center is soft and raised due to suppuration, the symptoms vanishing more rapidly and the sore healing gradually after incision or ulceration of the abscess which is followed by discharging of pus and purging of toxins, chills, fever, thirst, deep-colored urine, enlarged remarkably tender epididymis and testis seen through examination, complications of funiculitis and hydrocele testis, and slightly tender or tenesmic distending cold-painful tough mass or hard node in the epididymis or testis of chronic cases.
Differential Diagnosis
Chronic epididymitis need be differentiated from the following diseases.
1. Tuberculosis of epididymis
Some symptoms in the early stage of this disease are similar to those of acute epididymitis. By the late stage, the tail of epididymis or the whole epididymis has become a hard node without severe tenderness. Cementing with the skin of scrotum, this hard node may involve the testis and have sinus. There are nodes like a string of beads in the spermatic duct. Hard nodes in the prostate and seminal vesicle may be palpable when digital examination of rectum is conducted.
2. Cystis of epididymis
Tenser semi-transparent mass maybe occurring in any part of the epididymis and located at the back of the testis.
3. Orchioncus
Enlarged, not painful, solid and heavier testis with node-like surface but without the original elasticity, possible distant transfer lymphnodes, and complications of hydrocele of tunica vaginalis and hematoma of scrotum.
Treatment
1. Internal Treatment
(1) In the acute stage (syndrome due to damp-heat having gone down).
Main Symptoms: Red swollen burning painful tender epididymis and scrotum, chills, fever, thirst, yellowish urine, dry stools, yellow greasy tongue coating, and taut slippery rapid pulse.
Therapeutic Method: Clearing away heat from the liver, promoting diuresis, removing toxic material and subduing swelling.
Prescription: Modified Longdan Xiegan Decoction
Ingredients:
Longdancao Radix Gentianae
Chaihu Radix Bupleuri
Huangqi Radix Scutellariae
Huangbai Cortex Phellodendri
Zhizi Fructus Gardeniae
Rhizmoa Alismatis
Juhe Semen Citri Reticulatae
Chuanniuxi Radix Cyathulae
Chishao Radix Paeoniae Rubra
Zihuadiding Herba Violae
Banlangen Radix Isatidis
Jinyinhua Flos Lonicerae
Administration: Decocted in water twice for the decoction, which is taken warm in the morning and evening, 1 dose daily.
Modification: In case of persistent high fever, the dosage of Chaihu and Huangqin in the original prescription is separately changed into 15g, and 15g of Liangqiao (Fructus Forsythiae) is added.
In case of constipation, 10g of Dahuang (Radix et Rhizoma Rhei) is added last.
In case of severe swelling and pain, 1.5-3g of Xihuang Wan Pill is infused in water and then taken.
After suppuration, the herbs added are
Shanjiazhu Squama Mantidis Preparata
Zaojiaoci Spina Gleditsiae
(2) In the chronic stage (syndrome due to stagnation of qi and blood)
Main Symptoms: Tough mass or hard node with mild tenderness in the effected part; tenesmus, distension, cold-pain in the lower abdomen; he swelling and pain probably aggravated by overstrain or pungent food, white tongue coating, and thready taut pulse.
Therapeutic Method: Soothing the liver, regulating qi, removing blood stasis and dispersing mass.
Prescription: Modified Decoction with Orange.
Ingredients:
Gouju Fructus Citri Reticulatae
Chuanlianzi Fructus Toosendan
Jiangcan Bombyx Batryticatus
Shanjiazhu Squanma Mantidis Preparata
Juhe Semen Citri Reticulatae
Lizhihe Semen Litchi
Shanzhahe Semen Crataegi
Niuxi Radix Achyranthis Bidentatae
Wuyao Radix Linderae
Chaihu Radix Bupleuri
Xiakucao Spica Prunellae
Kunbu Thallus Laminariae seu Echloniae
Chishao Radix Paeoniae Rubra
Xiaohuixiang Fructus Foeniculi
Shufuzi Radix Aconiti Lateralis Preparata
Administration: Decocted in water twice for the decoction which is taken warm in the morning and evening, 1 dose daily.
Modification: together with the decoction, Sanjie Tablet is taken for the purpose of subduing swelling and resolving mass.
2. External Treatment
(1) In the acute stage
Jinhuang Gao or Daqing Gao is externally applied to the local part. Incision for drainage should be conducted after suppuration. Routine dressing change is carried out according to that in treatment of pyogenic diseases after ulceration. Bed rest is suggested with the scrotum supported with bandage of scrotal support.
(2) In the chronic stage
30g of Chonghegao Fen is infused with 300ml of boiling water. The affected part is soaked in, and washed with, the medicated water. which is kept warm, 20 minutes each time, twice daily.
Dr. Ming's TCM Medical Center,
Hua Xi Xiao Yuan, Hutian Developing Area,
Huaihua city, Hunan province
China