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Oksana Nachataia. “A small pleasure” is of great importance! Treatment of prostate adenoma (BPH) in traditional Chinese Medicine.

As you know, in ancient China, human physiological acts were called “pleasure”. This word means a feeling of good health with normal defecation (great pleasure – “da bian”) and normal urination (small pleasure – “xiao bian”). It’s hard not to agree with it, because the slightest discomfort or pain during these processes can ruin the mood of a person seriously and permanently. In this article I would like to talk about approach to the treatment of benign prostatic hyperplasia in Chinese medicine  as a cause of urinary disorders, the disease is quite benign, but extremely unpleasant due its symptoms. The steady growth of adenoma in some patients doesn’t give choice but to resort to surgery. Exhausting urges to urinate at night, difficulty at outflow of urine, discomfort in the pelvis (lower urinary tract symptoms (LUTS))- all this symptoms greatly reduces the patient’s quality of life, thus proving the truth of the ancient Chinese name “xiao bian”. And this is precisely the area where methods of Traditional Chinese Medicine could find their proper use, and the experts on herbs and acupuncture would have been pleased with the results of their labor.

Western medicine distinguishes hormonal disorders as the primary cause of adenoma development. Chinese medicine, as we know, relates this disease to syndromes “lin» ( “lin zheng”), and they are described in detail in textbooks on the theory. If you touch specifically adenomas, the key to solving this problem is simple and complex at the same time. We must be clear about the mechanisms of pathogenesis and use “drivers” properly. TCM has left a wise decision, that is, selects the main problem, the main syndrome, the treatment of which can manage with all the secondary symptoms.

I asked my teacher, Professor Wei Yu Qi thoroughly about how using herbs can stop adenoma growth and improve the process of urination. So here I present is not my own conclusions. These recommendations consist of the analysis of TCM theory and practical experience of my teacher. From my personal experience I can say that these recommendations are interesting enough to explore their effectiveness from the point of evidence-based medicine.

Chinese medicine binds BPH, ie the benign growth of tissue in conjunction with fluid retention in the pelvic area, to a specific syndrome, namely “a violation of the bladder function of evaporation on the background of the weakened kidney.” This is a basic, fundamental syndrome, which plays a leading role in the development of the disease. All other conditions, such as the “exhaustion of yin of kidney”, “dampness and heat flow down”, “dampness and heat in the lower jiao”, “blood stasis” in the background of  chronic infections, unhealthy diet or nerve stress – it is only the background . These are parallel problems, playing the role of “second violin”, although, of course, in many ways they determine the overall clinical picture. In other words, successful struggle with concomitant syndromes significantly improve the condition of the patient, but will not turn back the process of benign overgrowth of the prostate. Of course, relative syndromes must be treated, to improve the overall situation in the pelvis and in the body as a whole. Moreover, as we know, the prostate gland is relatively well protected by the immune system from all sorts of diseases (this is known in European medicine). And if there is a problem with the prostate gland, it means that there are already other problems common plan (often metabolic syndrome) in the body, and Zheng Qi is not very strong.

The function of evaporation of the bladder is broken for several specific reasons. I have to say that some of these reasons are a pretty modern and worsened morbidity statistics like age, and the number of patients.

There are primary causes that directly affect the evaporation function.

  1. Cold injury (syndrome of Shang Han Lun “TAI YANG FU”, when there is retention of water in the lower jiao and, specifically, in the bladder).
  2. The weakening of the kidney yang, which occurred for different reasons.

Cold climate, change of climate, viral infections occurring in the system of “the six meridians” is important. We should not forget about the side effects of some drugs of Western medicine, such as beta-blockers, tricyclic antidepressants, and others that chronic administration may burden the course of the disease.

Another factor of a violation of the proper motion of qi in the body is syndrome “heat at the top and cold at the bottom” which is prevailing for a long time. From the viewpoint of modern medicine, it can be explained by autonomic disorders, when there is persistent vascular spasm at the low part while pathological redistribution of blood in the upper sections of the body. There are several reasons that are described in TCM.

– Certain syndromes of Shang Han Lun, but in the later stages.

– Long-term nerve stress, leading to the rise of qi upward.

– Work related to emotional and mental stress, the need for a lot emotionally talk and sedentary lifestyle at the same time.

Typical symptoms: the deterioration in the complaints when the weather changes, such as a sharp cooling, increased moisture, both in summer and in winter. The difficulty with urination is significantly enhanced. Also there are the feeling of cold in the pelvis and lower back, and symptoms worsen after heavy emotional overfatigue or prolonged lack of exercise and walk. As for the picture of language, it could be very different. For example, the tongue can be red and pulse can be frequent at the syndrome of heat at the top that masks the pathology in a relatively small area of the body.

By the way the syndrome of dysfunction of bladder evaporation and water retention in the pelvis at women manifests by symptoms that generally fall under the diagnosis “neurogenic bladder”. It is frequent urination with a small amount of urine, the need to tense, thin and sluggish stream of urine, feeling cold in the pelvis, awakening at night due to a desire to urinate. More unpleasant “double” of this syndrome in women is one of the varieties of endometriosis – the disease, where the Chinese medicine also can find their proper use.

But let’s back to prostate adenoma. Against the backdrop of a long stagnation of fluids and stagnant qi a tight cluster eventually formed, prostate size increases, the flow of urine is disturbed, leading to secondary symptoms, such as blood stagnation, the appearance of stabbing pain and discomfort.

Now a few words about the treatment. The main objective is to alleviate the symptoms, as well as to reduce the adenoma volume due to the removal of edema and impact on the part of the tissue that has not yet become too dense or turned into fibrosis.

Before to say, what herbs should be added to the recipe, say what methods cannot be used because of the risk of complications. Firstly, do not use a lot of very active ingredients with warm character having properties “PO XUE”. As is known, prostate cancer – is actively metastatic tumor that develops separately or simultaneously with BPH. Of course, these are two completely different diseases, but if Zheng Qi is weakened, the PSA level is increasing and there are some doubts in terms of the risk of cancer development, it is not recommended to actively move the blood and dissolve the seal. If there is a marked deficiency of Zheng Qi, Jing Qi, as well as kidney Qi too strong method of “XIE” is not good to use, and too active dissolving may only hurt the patient. There are plants such as san leng, e zhu, chuan xiong, hong hua, and the like. The same must be said of too active method “BU”. Hot, yang ingredients, which are often used to improve erection, can cause heat on the background of stagnation, blood heat and also provoke oncological process. Chinese medicine believes that the appointment of the ingredients that feed the kidney yang and hot in nature, is possible only if there is a morning erection. If it does not, it indicates abnormal excess in the background of deficiency. In this case, the method of choice is the “HE FA” with an equal amount of ingredients “BU” and “XIE”.

The basis for the formation of a prescription is a recipe of Shang Han Lun «Wu ling san». It restores the function of the evaporation bladder at syndrome “Tai Yang Fu.” But in this case it is advisable to replace gui zhi on rou gui. Cinnamon bark is the herb -“driver” to a small pelvis, warms kidney, relieves spasm of blood vessels in the pelvis, thereby gently activates blood flow and promotes redistribution of blood in the lower parts of the body. If the inflammation is very pronounced, and deficient heat prevails due deficiency of yin, it is advisable to use “Zhu ling tang”, but rou gui will still be needed, but at a lower dose.

The second operating element is a combination wu yao + yi zhi ren, the classic recipe, aimed at normalizing processes qi movement in the pelvis. To help it, you can add xiang fu to alleviate discomfort and distension as an ingredient with a tropism to the liver meridian. To improve the flow of urine is well to add si gua luo.

To effect resorption seals on Professor Wei recommendation, the optimal solution will be a combination kun bu + hai zao. Yi mu cao has a pretty good action to eliminate congestion and increased tropism to the lower back and pelvis. To prevent blood heat on background of using warm ingredients it is advisable to add chi shao.

It is important to pay attention to strengthening the kidneys. The combination of du zhong + sang ji sheng fits for this aim.

In addition to treatment with herbs the patient should go walk more (it is important to prostate health). Acupuncture and moxa can reduce symptoms and reduce the difficulty of urination pretty good. It is useful as well and self-massage consisting of multiple horizontal rubbing the lower abdomen, which also helps to improve blood circulation in the area.