Chronic Prostatitis & Benign Prostatic Hypertrophy (BPH)

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

Chronic prostatitis refers to chronic inflammation of the prostate. Such prostatitis may be either bacterial or nonbacterial in nature. When it is bacterial, it is treated with antibiotics in Western medicine. However, when it is nonbacterial, Western medicine does not have an effective treatment for it. Some researchers believe that the nonbacterial type is an autoimmune response and that chronic, nonbacterial prostatitis leads to benign prostatic hypertrophy. Also called benign prostatic hyperplasia, this is a benign adenomatous hyperplasia of the periurethral prostate gland commonly seen in men over 50 years of age. In fact, one out of four men will eventually require treatment for BPH at some point in their life, and congestion and overgrowth of the prostate gland is virtually universal in men over the age of 60. This hyperplasia causes var-iable degrees of bladder outlet obstruction. Bladder outlet obstruction symptoms include progressive urinary frequency, urgency, and nocturia due to incomplete emptying and rapid refilling of the bladder. Hesitancy and inter-mittency with decreased size and force of the urinary stream occur. Sensations of incomplete emptying, terminal dribbling, almost continuous overflow incontinence, and complete urinary retention may ensue. Episodes of acute complete urinary retention may follow prolonged attempts to retain urine, immobolization, exposure to cold, anesthetic agents, anticholinergic and sympatho-mimetic drugs, and ingestion of alcohol. Pro-longed urinary retention, whether partial or com-plete, may cause progressive renal failure and azotemia.

The Western medical diagnosis of BPH is based on the signs and symptoms and a rectal digital exam. Other tests include catheterization after voiding to measure residual urine and cystoscopy to estimate gland size. When BPH is complicated by secondary chronic bacterial prostatitis, antibiotics may be used to treat bacterial infection. Catheter drainage, whether urethral or suprapubic may be used to treat acute urinary retention. Although new drugs (finasteride, Proscar) have shown some success in shrinking enlarged prostates, till recently, surgery (transurethral resection of the prostate) has been the definitive treatment. There are approximately 400,000 surgical operations each year in the U.S. for this condition. Though the prognosis after surgery is usually excellent, 18% of men experience complications, such as infection, bleeding, incontinence, and impotence.

In Chinese medicine, this condition is associated with three main disease mechanisms. First, there may be spleen and/or kidney vacuity. It is the qi which moves the excess fluids outside the body as well as keeps righteous fluids inside the body. Therefore, either spleen or kidney qi vacuity may cause lack of force to discharge the urine and/or leakage and incontinence. Spleen and kidney vacuity in older middle-aged and elderly patients are the result of a lifetime accumulation of damages and detriments. Secondly, there may be something blocking the yin orifice. This may be either or any combination of qi stagnation, blood stasis, or phlegm obstruction. And third, damp heat may cause urinary urgency, frequency, burning, and pain. While textbooks list each of these three mechanisms as separate patterns and give separate formulas for each, in real life, it is more common to see variable combinations of these three or more patterns forming complicated, knotted or bound combinations. In such cases, it is necessary to use relatively large, more complicated formulas to treat such complicated, interlocking disease mechanisms. Blue Poppy Herbs' Jade Chamber is such a complicated formula which addresses all the above disease mechanisms of chronic prostatitis and benign prostatic hypertrophy.

This formula is a research formula developed by Gan Xiao-yong of the Yanan University Medical College Affiliated Hospital in Shanxi. We have modified Dr. Gan's original formula slightly so that it no longer contains any endangered or animal species. This formula is for the treatment of a combination of damp heat, qi stagnation, and blood stasis complicated by spleen-kidney qi vacuity resulting in dribbling urinary block and strangury conditions. Another way of describing the patterns which this formula addresses are a liver-spleen-stomach disharmony with damp heat stasis and stagnation and spleen vacuity leading to kidney qi vacuity. This complicated constellation of patterns often presents in middle-aged men with chronic prostatitis and benign prostatic hypertrophy. Although this formula is not designed to lower blood pressure, it may have that effect as well due to its combination of diuretics and vasodilators.

Within this formula, Di Fu Zi clears heat and disinhibits dampness, frees the flow and disinhibits the low burner. In terms of treating dampness and heat, it is the ruling medicinal in this formula. Even though Di Fu Zi is bitter and cold in flavor and nature, Zhang Xi-chun, a famous early 20th century practitioner, used it in formulas for the treatment of both yang vacuity inhibited urination and yin vacuity inhibited urination. This medicinal has also been used traditionally to treat liver vacuity dimming of vision as well as sparrow blindness. This suggests that, although this medicinal is attacking and draining, it is not excessively attacking and draining. This may, in part, be explained by its also being sweet. Zhu Ling, Qu Mai, Tong Cao, and Dong Kui Zi disinhibit urination and free the flow of strangury. These are the ministers assisting Di Fu Zi in clearing heat via seeping dampness from the lower burner and freeing the flow of urination. Huang Qin clears heat and eliminates dampness, while Zhi Mu drains fire and hardens yin. Specifically, Huang Qin clears heat from the lungs, liver-gallbladder, stomach, and intestines. Typically, men with this condition have a tendency to spleen vacuity causing dampness pouring downward as well as stomach heat (assoc-iated with liver depression/depressive heat). Since "the kidneys are the sluice-gate of the stomach," if the stomach is hot and, therefore, hyperactive, it may send to many fluids downward to the kidneys and bladder for excretion. The inclusion of Huang Qin in this formula helps deal with this stomach heat and the role it plays in the overall disease mechanisms causing this condition.

Hai Zao, Bai Jiang Cao, Chi Shao, Wang Bu Liu Xing, Zao Jiao Ci, and Di Long soften the hard and scatter nodulation (or binding), free the flow of the orifices and open blockage. Because "blood and fluids move together" and because phlegm is nothing other than congealed fluids, enduring dampness commonly becomes complicated by blood stasis and phlegm which then all bind together. In particular, Bai Jiang Cao is an excellent medicinal for quickening the blood in the lower burner when blood stasis is combined with damp heat, while Di Long is especially effective in freeing the flow of urination inhibited by heat binding in the bladder. According to modern research, Wang Bu Liu Xing is especially effective for treating benign prostatic hyertrophy. Because Zhi Mu supplements yin, its inclusion in this formula also addresses the incipient yin vacuity often found in late middle-aged men with prostatism. Huang Qi and Dang Shen supplement the qi in order to invigorate the qi transformation. Supplementing the qi provides the power to transform stasis. Sheng Ma and Zhi Shi upbear yang and move the qi, thus diffusing and freeing the flow of the qi mechanism. One upbears, while the other down-bears. When dampness pouring downward due to spleen vacuity combines with liver depression transforming heat, damp heat is all the more likely to be engendered. In that case, one must upbear yang to resolve depression and promote the division of clear and turbid. Thus, this formula treats root and branch simultaneously.

This formula (in its original form, i.e., plus Squama Manitis Pentadactylis, Chuan Shan Jia, and minus Bai Jiang Cao and Chi Shao) has proven 92.7% effective for the treatment of benign prostatic hypertrophy in a study of 110 men 50-82 years old. Seventy-eight of these cases were judged to have gotten a marked effect. This was defined as disappearance of clinical symptoms, freely and easily flowing urination, and reduction in the size of the prostate by 50% or more. Another 24 cases were judged to have gotten some effect, which was defined as basic disappearance of clinical symptoms, marked decrease in difficult urination, and reduction in the size of the prostate by 30% or more. The shortest course of treatment in this study was 14 days and the longest was 62 days.

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