How does TCM understand chronic prostatitis? Is the combination of Chinese and Western medicine effective?

Author: Gao Zhan, Chief Physician, Xiyuan Hospital, China Academy of Chinese Medical Sciences

Reviewer: Zhang Kai, Chief Physician, Peking University First Hospital

Most cases of chronic prostatitis are related to lifestyle.

For example, patients who drink alcohol for a long time will suffer from repeated congestion and edema of the prostate due to alcohol stimulation, which will lead to chronic prostatitis over time.

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For example, long periods of sitting, most office workers may sit for 8-10 hours a day, or even 12 or 14 hours. Long periods of sitting can cause pressure on the perineum, which can lead to congestion. Repeated congestion can also cause chronic prostatitis. In addition, some types of work, such as postmen or couriers, can also cause pressure on the perineum due to long-term cycling.

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Chronic prostatitis is partly caused by irregular sexual life. For example, too frequent sexual life and excessive fatigue can also cause chronic prostatitis. Another type is long-term lack of sexual life, which causes prostatic fluid to accumulate in the gland ducts, which can also cause inflammation and make one prone to chronic prostatitis.

There is another situation, such as suffering from urethritis, due to incomplete treatment, chronic prostatitis occurs, this situation is relatively rare.

1. What are the treatments for chronic prostatitis?

Chronic prostatitis is actually a syndrome. It is rarely treated with a single method. Instead, comprehensive treatment is given based on the patient's specific circumstances, with the main focus being on relieving symptoms.

For the pain caused by chronic prostatitis, which is mainly pain and chronic pelvic pain that lasts for more than three months, modern medical treatment mostly uses non-steroidal antipyretic and analgesic drugs, such as celecoxib, indomethacin suppositories, and diclofenac sodium.

Western medicine uses alpha-receptor blockers to treat abnormal urination symptoms such as frequent urination, urgent urination, painful urination, and incomplete urination. They block the alpha receptors in the urethra, causing urethral dilation, and the symptoms of abnormal urination can be alleviated. Commonly used alpha-receptor blockers include tamsulosin, terazosin, doxazosin, naftopidil, etc.

There is also a part of modern medicine, such as herbal extracts, which are not traditional Chinese medicine, but can also treat chronic prostatitis. The principle is relatively complicated, probably because the plant preparations contained in them can reduce inflammatory responses and relieve symptoms.

There are also external treatments, such as topical suppositories, which are placed in the anus to treat the condition. There are also physical therapy methods.

In addition, there is traditional Chinese medicine. Traditional Chinese medicine has a unique understanding of chronic prostatitis. Traditional Chinese medicine has a long history and many methods. It can carry out syndrome differentiation and treatment according to the patient's specific situation, and has achieved good results in treatment.

2. How does Traditional Chinese Medicine understand chronic prostatitis?

Traditional Chinese medicine's understanding of chronic prostatitis: dampness and heat are the symptoms, kidney deficiency is the root cause, and blood stasis is the variation.

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The root cause of chronic prostatitis is kidney deficiency. There is a saying in Chinese medicine that "dampness tends to go downwards and combines with heat". The characteristic of dampness is that it tends to go downwards and easily invades the lower part of the human body. After invading the lower part of the human body, it combines with heat. Dampness and heat are superficial evils, and dampness and heat cause qi stagnation and blood stasis. One is deficiency, and the other is dampness and heat. The combination of the two leads to the disease.

Traditional Chinese medicine divides prostatitis into several types: damp-heat type, qi stagnation and blood stasis type, liver depression and qi stagnation type, middle qi sinking type, kidney yin deficiency type, and kidney yang deficiency type.

In fact, patients who come to see a doctor rarely have a single syndrome. Most of them have combined syndromes, or maybe two syndromes. The most common one is the combination of damp-heat and qi stagnation and blood stasis, which is called the damp-heat and blood stasis syndrome.

There are symptoms of abnormal urination such as frequent urination, urgent urination, painful urination, and hot urination, accompanied by discomfort in the pelvic area, pubic area, groin, lumbar sacral area, and perineum. These symptoms mixed together are called damp-heat and blood stasis type, which accounts for about 60%-70% of all patients.

The treatment of the so-called combined syndrome, such as damp-heat and blood stasis type, needs to be divided into whether the damp-heat or blood stasis is more serious, and treatment is carried out according to the severity of the patient's symptoms. The treatment prescription is prepared, and most of them are prescriptions that are added, subtracted, modified, and adjusted.

There is rarely a single method to treat prostatitis now. Both traditional Chinese medicine and Western medicine have their own advantages.

So, can Chinese medicine and Western medicine be combined for treatment? Will there be any conflict?

3. Can chronic prostatitis be treated with a combination of Chinese and Western medicine?

Chinese and Western medicine can be combined for treatment, and generally speaking there is no conflict.

Chinese medicine is based on syndrome differentiation and treatment, through the Yin and Yang and the Five Elements, and through the rise and fall of evil and righteousness. It is different from the way Western medicine understands diseases and uses different treatment methods. Therefore, it has complementary advantages with Western medicine.

I have a good understanding of both Western medicine and Chinese medicine, and most importantly, I have a very good understanding of the patient's condition. I choose different treatment methods for comprehensive treatment, which will have a better effect than single treatment. Some patients may only need Western medicine, some patients may only need Chinese medicine, and some patients may need both Chinese and Western medicine for various reasons.

How long does it usually take to treat chronic prostatitis with Chinese and Western medicine?

Whether it is Chinese medicine or Western medicine, the course of treatment is the same. The treatment course of chronic prostatitis is currently stipulated in the 2019 edition of the "Guidelines for the Diagnosis and Treatment of Urological Diseases in China" as 12 weeks, nearly 3 months, which is a course of treatment. Most patients will receive 1-2 courses of treatment.

There is evidence that the relapse rate is relatively low for patients who receive more than 1-2 courses of treatment, while the relapse rate is relatively high for patients who stop treatment within 12 weeks.