abstracted & translated by

Bob Flaws, Dipl. Ac., & C.H., Lic. Ac., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, benign prostatic hypertrophy (BPH), treatment based on pattern discrimination

Benign prostatic hypertrophy refers to adenomatous hyperplasia of the periurethral prostate gland which causes varying degrees of bladder outlet obstruction. Benign prostatic hypertrophy is present in 8% of men 31-40 years of age and in 40-50% of men 51-60 years of age. Its incidence increases to more than 80% by 80 years of age. The symptoms of BPH are progressive urinary frequency, urgency, and nocturia due to incomplete emptying and rapid refilling of the bladder. Decreased size and force of the urinary stream produce hesitancy and intermittency. On rectal examination, the prostate is usually enlarged, has a rubbery consistency, and frequently has lost its median furrow. Serum prostate-specific antigen (PSA) is moderately elevated in 30-50% of patients with BPH. Definitive Western medical therapy is surgical, with 5-10% of patients treated surgically having problems with sexual potency and continence afterwards. In issue #2, 2003 of the Yun Nan Zhong Yi Zhong Yao Za Zhi (Yunnan Journal of Chinese Medicine & Chinese Medicinals), Ceng Duan-gang and Duan Deng-zhi published an article titled, "A Study of the Therapeutic Efficacy of Treating 93 Cases of Prostatic Hyperplasia by Pattern Discrimination." This study appeared on page 21 of that journal and a summary is given below. The assumption of these two authors is that BPH always presents a pattern of blood stasis no matter what other concomitant patterns it presents.

Cohort description:

All 93 men in this study were diagnosed with BPH as out-patients at the authors’ hospital via digital rectal examination and ultrasonography. None of these patients had any acute urinary tract infections or functional disturbances of their hearts, livers, lungs, or kidneys. Clinical symptoms included frequent night-time urination, fine urine stream, terminal dribbling and dripping, frequent urination, urinary urgency, and difficulty expressing urine. Ages of the men were not given.

Treatment method:

1. Yang vacuity & blood stasis

Symptoms: Cold body, chilled limbs, low back and knee soreness and limpness, no force expressing urine, uneasy urination, possible dribbling and dripping and non-free flow, lower abdominal cramping and pain, prostatic enlargement, a relatively hard prostate, a fat, pale or dark, purple tongue, and a deep, fine, moderate (slightly slow) pulse

Treatment methods: Warm yang and quicken the blood

Rx: Radix Lateralis Praeparatus Aconiti Carmichaeli (Fu Zi), 30g, cooked Radix Rehmanniae Glutinosae (Shu Di), 15g, Radix Dioscoreae Oppositae (Shan Yao), 10g, Fructus Corni Officinalis (Shan Zhu Yu), 10g, Radix Achyranthis Bidentatae (Niu Xi), 10g, Sclerotium Poriae Cocos (Fu Ling), 10g, Rhizoma Alismatis (Ze Xie), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 10g, Radix Et Rhizoma Rhei (Da Huang), 10g, blast-fried Squama Manitis Pentadactylis (Chuan Shan Jia), 10g, Hirudo Seu Whitmania (Shui Zhi), 15g

2. Qi vacuity & blood stasis

Symptoms: Forceless urination, terminal dribbling, intermittent flow, scanty qi, disinclination to speak, torpid intake, abdominal distention, loose stools, prostatic enlargement with medium consistency, a pale tongue with white fur, and a moderate (slightly slow), forceless pulse

Treatment methods: Boost the qi and quicken the blood

Rx: Radix Astragali Membranacei (Huang Qi), 60g, Radix Codonopsitis Pilosulae (Dang Shen), 10g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Rhizoma Cimicifugae (Sheng Ma), 10g, Radix Bupleuri (Chai Hu), 10g, Radix Glycyrrhizae Uralensis (Gan Cao), 5g, blast-fried Squama Manitis Pentadactylis (Chuan Shan Jia), 10g, Radix Angelicae Sinensis (Dang Gui), 15g, Hirudo Seu Whitmania (Shui Zhi), 10g

3. Mutual binding of phlegm & stasis

Symptoms: Urinary dribbling and dripping or fine stream, lower abdominal cramping, distention, fullness, aching, and pain, prostatic enlargement which is not hard when pressed but may have nodular lumps, glossy, white tongue fur with a dark, purple tongue body, and a bowstring, slippery pulse

Treatment methods: Transform phlegm and quicken the blood

Rx: Feces Trogopterori Seu Pteromi (Wu Ling Zhi), 15g, Radix Angelicae Sinensis (Dang Gui), 10g, Radix Ligustici Wallichii (Chuan Xiong), 15g, Semen Pruni Persicae (Tao Ren), 10g, Flos Carthami Tinctorii (Hong Hua), 10g, Radix Rubrus Paeoniae Lactiflorae (Chi Shao), 15g, Cortex Radicis Moutan (Dan Pi), 10g, Rhizoma Corydalis Yanhusuo (Yan Hu Suo), 15g, Radix Linderae Strychnifoliae (Wu Yao), 15g, Rhizoma Cyperi Rotundi (Xiang Fu), 10g, Fructus Citri Aurantii (Zhi Ke), 10g, Radix Scrophulariae Ningpoensis (Xuan Shen), 15g, Bulbus Fritillariae Thunbergii (Zhe Bei Mu), 15g, uncooked Concha Ostreae (Mu Li), 15g

4. Damp heat stasis obstruction

Symptoms: Urinary frequency and urgency, burning, painful urination, possible thin stream, dribbling and dripping, lower abdominal distention and pain, constipation, prostatic enlargement which is relatively hard and/or is accompanied by pressure pain, slimy, yellow tongue fur with a dark, purple tongue, and a bowstring, rapid pulse

Treatment methods: Clear heat and quicken the blood

Rx: Herba Dianthi (Qu Mai), 10g, Semen Plantaginis (Che Qian Zi), 15g, Talcum (Hua Shi), 3g, Cortex Phellodendri (Huang Bai), 15g, Radix Et Rhizoma Rhei (Da Huang), 10g, Rhizoma Smilacis Glabrae (Tu Fu Ling), 20g, Fructus Gardeniae Jasminoidis (Zhi Zi), 15g, Radix Glycyrrhizae Uralensis (Gan Cao), 5g, Semen Pruni Persicae (Tao Ren), 15g, blast-fried Squama Manitis Pentadactylis (Chuan Shan Jia), 10g, Hirudo Seu Whitmania (Shui Zi), 15g

Treatment outcomes:

Three months of treatment equaled one course. Marked effect was defined as improvement in three or more of the six clinical symptoms mentioned above, shrinkage of the prostatic as evidenced by ultrasound, and less than 30ml of residual urine in the bladder as also evidenced by ultrasound. Some effect was defined as improvement in at least two of the six clinical symptoms, while no effect meant that there was no improvement in at least two of the symptoms. Based on these criteria, 25 out of 93 patients were judged to have gotten a marked effect, 47 got some effect, and 21 got no effect. Therefore, the total effectiveness rate was given as 76.67%.

Discussion:

According to the Chinese authors, BPH is a commonly seen male disease with various causative factors and which is relatively difficult to pattern discriminate. Therefore, treatment of this condition also tends to be difficult. Based on their clinical experience, the authors divided their 93 patients into four patterns, all of which included an element of blood stasis. They believe that the existence of blood stasis is evidenced by the prostatic enlargement which is fixed in location and not movable. They equate this type of enlargement which the Chinese medical concept of concretions and accumulations. They also say that this is a disease associated with aging, and that most elderly exhibit more or less signs of blood stasis. Therefore, on top of whatever other treatment methods are necessary, one should use relatively strong blood-quickening medicinals, such as Shui Zhi, Chuan Shan Jia, and Da Huang. However, because the bodies of the elderly are weak and their righteous qi is insufficient, one must be careful when using blood-breaking medicinals so as not to damage the righteous qi. Given these provisos, it is possible to get relatively good treatment effects in this condition.

Copyright © Blue Poppy Press, 2003. All rights reserved.

For more information on the Chinese medical treatment of benign prostatic hypertrophy, see Bob Flaws & Philippe Sionneaus’s The Treatment of Modern Western Medical Diseases with Chinese Medicine available from Blue Poppy Press.