Prostatic hyperplasia, also known as benign prostatic hyperplasia (BPH), is a common condition affecting middle-aged and elderly men. In its early stages, BPH is often asymptomatic. Initial manifestations typically include urinary frequency and urgency, along with nocturia. Because these symptoms commonly occur in older men under normal circumstances, they are frequently overlooked. As the disease progresses, patients may develop voiding difficulty, a diminished urinary stream, nocturnal urgency, terminal dribbling, and even terminal hematuria — only at this point does the condition usually attract clinical attention. In advanced stages, complete urinary retention may occur.
The etiology of BPH remains incompletely understood. Some investigators postulate a role for sex hormone dysregulation. Due to impaired voiding and urinary stasis, patients are predisposed to urinary tract infections; renal function may also be compromised, with the potential for renovascular hypertension and uremia to develop — all of which pose serious threats to general health. Early diagnosis and timely intervention are therefore essential and should not be neglected.
In Traditional Chinese Medicine (TCM), BPH has historically been attributed to dampness-heat in the lower jiao or deficiency of kidney qi, and is classified under the syndrome of lóng bì (癃閉) — a disorder characterized by dysuria and urinary retention. In the early stages of BPH, when symptoms are not yet severe, TCM pharmacotherapy can yield reasonably satisfactory outcomes. However, patients with advanced disease presenting with significant voiding dysfunction or recurrent episodes of urinary retention generally require surgical prostatectomy. The occurrence of terminal hematuria warrants prompt urological evaluation and management.
TCM Differential Diagnosis and Treatment
TCM management of early-stage BPH, based on pattern differentiation (biànzhèng lùnzhì) within the framework of lóng bì, recognizes two principal patterns: deficiency and excess.
Deficiency Pattern (Kidney Qi Deficiency)
Clinical manifestations: Urinary frequency and urgency; a thin, weak, or dribbling urinary stream; pallor; lumbar soreness and cold intolerance; and in some cases, dizziness and tinnitus.
Therapeutic principle: Tonification and supplementation of kidney qi.
Prescribed formula — Tōngguān Shènqì Tāng (通關腎氣):
Herb
Dosage
Zhīmǔ (Anemarrhena rhizome)
12 g
Shānyúròu (Cornus fruit)
12 g
Huáishān (Chinese yam)
12 g
Shúdì (Prepared rehmannia)
20 g
Dānpí (Moutan bark)
10 g
Fúlíng (Poria)
10 g
Zéxiè (Alisma rhizome)
10 g
Fùzǐ (Aconite root, prepared)
5 g
Ròuguì (Cinnamon bark)
3 g (infused separately)
Chǎo Niúxī (dry-fried Achyranthes root)
6 g
Decoct in water and administer orally. A course of eight to ten consecutive doses is recommended to achieve improvement in urinary symptoms and clinical signs.
Excess Pattern (Dampness-Heat in the Lower Jiao)
Clinical manifestations: Urinary frequency; a burning sensation on micturition; a sense of lower abdominal urgency or distension; frequently complicated by concurrent urinary tract infection.
Therapeutic principle: Clearing and draining dampness-heat from the lower jiao.
Prescribed formula — modified Bāzhèng Sǎn (八正散, “Eight Corrections Powder”):
Herb
Dosage
Mùtōng (Akebia stem)
10 g
Chēqiánzǐ (Plantago seed)
10 g
Biǎnxù (Knotweed)
10 g
Zhīzǐ (Gardenia fruit)
10 g
Huángqín (Scutellaria root)
5 g
Xiǎo Gāncǎo (Licorice root, small)
5 g
Dàhuáng (Rhubarb root)
12 g
Huáshí (Talc)
12 g
Qúmài (Dianthus herb)
12 g
Dēngxīnhuā (Juncus pith)
5 bundles
Decoct in water and administer orally. A course of four to six consecutive doses is generally sufficient to clear lower jiao dampness-heat, restore normal bladder qi transformation and descent, and achieve symptomatic resolution.
Clinical Note
Many patients are reluctant to undergo or have concerns regarding surgical intervention. Where surgery is indicated by clinical assessment, however, patients are advised to follow their physician’s guidance. That said, patients with early-stage disease may reasonably attempt a trial of the appropriate TCM formula based on pattern differentiation, as described above — an approach that carries meaningful potential benefit with minimal risk.
In developed nations, many individuals experience a metabolic slowdown upon reaching middle age. Without adequate physical activity, weight gain occurs easily. Furthermore, some individuals are predisposed to obesity from childhood due to genetic factors.
When caloric intake exceeds energy expenditure, the excess is converted into adipose tissue and stored within the body. Therefore, individuals with obesity should adhere to a macronutrient-restricted diet (limiting fats and sugars). It is also essential to increase physical activity—such as morning exercise, Tai Chi, jogging, or Qigong—to help lower serum lipid levels.
While there is currently no “silver bullet” for treating obesity, clinical experience suggests that the Lipid-Lowering Decoction offers therapeutic benefits.
Administration: Decoct in an appropriate amount of water. One dose per day, consumed consistently for two to three months. This formula is mild in nature with no reported adverse effects; it aims to gradually reduce body weight and blood lipid levels.
Pharmacological Basis
The efficacy of this decoction is supported by the properties of its constituents:
Radix Polygoni Multiflori: Rich in lecithin, it possesses anti-aging properties and helps regulate lipid metabolism.
Folium Nelumbinis: Contains various alkaloids (such as nuciferine). Its functions include clearing heat, tonifying the spleen and stomach, and lowering blood pressure.
Fructus Ligustri Lucidi: Acts as an adjuvant to nourish the liver, extinguish “internal wind,” and tonify the kidney.
The synergistic effect of these three ingredients provides significant clinical results.
Alternative Preparation
Recently, some scholars have recommended a Lotus Leaf Congee (using 10g of lotus leaf) or simply a Lotus Leaf infusion (using fresh or dried leaves). Consistently consuming this for two to three months has shown positive outcomes. For those concerned with weight management, this remains a viable option to explore.
Clinical Note: While these herbal remedies are traditional, it is always recommended to consult with a healthcare professional before starting a long-term herbal regimen, especially if you have underlying conditions or are taking concurrent medications.
Constipation in elderly patients is generally attributable to reduced physical activity, impaired mastication, consumption of low-residue foods, and insufficient intake of fiber-rich fruits and vegetables. Combined with age-related qi deficiency, irregular bowel habits develop over time, eventually progressing to chronic habitual constipation. Traditional Chinese Medicine (TCM) attributes constipation in the elderly to qi deficiency with intestinal atony. In such cases, cathartic or purgative agents are contraindicated, as they risk further debilitating the patient. The preferred therapeutic approach is the classical formula known as “Geng Yi Wan” (更衣丸): Composition: 肉蓯蓉 Rou Cong Rong (Cistanche) 20g, 黑芝蔴 Hei Zhi Ma (black sesame) 30g, 厚朴 Hou Po (Magnolia bark) 6g, 枳實 Zhi Shi (aurantii immaturus) 6g, 柏子仁 Bai Zi Ren (Platycladi semen) 12g, 黨蔘 Dang Shen (Codonopsis) 20g, 木香 Mu Xiang (Aucklandiae radix) 3g. Decocted in water for oral administration.
This formula addresses qi-deficient intestinal atony by lubricating the intestines and promoting bowel transit. The recommended dosage is three to four decoctions per month, administered one to two times weekly, with satisfactory clinical outcomes expected. By tonifying qi and moistening the intestines, the formula supports improvement of overall constitution.
It should also be noted that constipation may represent an early symptom of an underlying pathology. In elderly patients presenting with constipation or progressively narrowing stool caliber, colorectal carcinoma should be the primary differential diagnosis. Benign prostatic hyperplasia causing urinary retention may also contribute to defecatory difficulty. Diabetes mellitus and hypothyroidism are among the systemic conditions that may cause constipation, and clinical evaluation by a physician is recommended for confirmation. That said, Geng Yi Wan may provide symptomatic relief and remains applicable even in these patient populations.
In healthy individuals, diurnal urine production typically exceeds nocturnal output. Following sleep onset, most individuals maintain continence throughout the night without requiring micturition. This physiological pattern of reduced nocturnal urine production is considered normal and serves to preserve uninterrupted sleep in healthy adults.
Nocturia demonstrates increased prevalence among the geriatric population. In elderly males, benign prostatic hyperplasia of varying severity is commonly observed. In elderly females, progressive weakening of detrusor musculature and pelvic floor support structures frequently occurs. Consequently, both older men and women typically experience increased urinary frequency compared to younger adults.
When nocturia becomes pronounced—particularly when accompanied by increased daytime frequency—yet urinalysis reveals dilute, clear, and non-painful urination, Traditional Chinese Medicine (TCM) pathophysiology attributes this presentation to Kidney Qi deficiency with cold pattern, resulting in impaired bladder sphincter control. Herbal pharmacotherapy has demonstrated favorable therapeutic outcomes in such cases.
The author’s formulation, “Modified Suo-quan Pill 縮泉丸 (Jia-wei Suo-quan Wan 加味縮泉丸),” represents an efficacious treatment protocol comprising:
20 g each: Calcined Os Draconis (Longgu), Calcined Concha Ostreae (Muli)
Preparation Method: The thirteen ingredients are moistened with dilute saline solution, subjected to thorough steam processing, desiccated, pulverized into fine powder, and combined with refined honey to form pills approximately 6-8mm in diameter (mung bean size).
Dosing Regimen:
Adult dose: 10 grams twice daily, administered orally with warm water
Therapeutic Action: Modified Suoquan Pill functions to tonify Kidney Yang, supplement essence (Jing), and strengthen bladder sphincter control.
Clinical Experience: The author has employed this formulation extensively over multiple years in treating geriatric patients presenting with Kidney Qi deficiency-cold pattern, nocturnal polyuria, and urinary incontinence, achieving significant therapeutic efficacy. For cases where pill preparation is impractical, the formula may be administered as a decoction at 50% of the stated dosage quantities, yielding comparable clinical outcomes.
High ambient temperatures combined with excessive perspiration and reduced urinary output may predispose individuals to lower urinary tract inflammation. Common presenting symptoms include:
Dark yellow urine
Dysuria (burning sensation during or after urination)
Increased urinary frequency
Suprapubic discomfort
These findings are consistent with lower urinary tract infection (UTI) involving both the bladder and urethra—clinically referred to as cystourethritis.
Clinical Classification
Urethritis: Pain localized to the urethral tract
Cystitis: Suprapubic or lower abdominal pain
These conditions frequently co-exist and are collectively termed cystourethritis.
Acute Cystourethritis: Key Symptoms
Frequency: Voiding every 30–60 minutes, occasionally more often
Urgency: Sudden, compelling need to urinate
Dysuria: Burning pain post-micturition, possibly radiating to the perineum or suprapubic region
Pyuria or microscopic haematuria: Cloudy urine or presence of red blood cells on urinalysis
Systemic signs: Fever is typically absent
Chronic Cystourethritis
Symptoms are less intense
Daytime polyuria and nocturia (3–4 episodes nightly)
History of recurrent acute flares
Urinalysis may reveal proteinuria, haematuria, and pyuria
Traditional Chinese Medicine (TCM) Interpretation
In TCM, this condition is classified as Re Lin (熱淋)—a heat-induced urinary disorder attributed to damp-heat accumulation in the lower burner.
TCM symptom profile:
Painful, difficult urination
Burning sensation
Dark yellow, concentrated urine
Frequent and urgent voiding
Herbal Protocol: “Huo Fu Dan” (火府丹)
This formula is designed to:
Clear internal heat
Eliminate dampness
Detoxify
Promote diuresis
It is considered safe for short-term use during acute episodes.
Base Composition
Ingredient
Dosage
Radix Rehmannia (生地黃 Sheng Di Huang)
15g
Akebia quinata Thunb Decne (木通 Mu Tong)
10g
Radix Scutellaria (黃芩 Huang Qin)
6g
Flos Lonicerae Japonicae (金銀花 Jin Yin Hua)
18g
Herba Taraxaci (蒲公英 Pu Gong Ying)
18g
Herba Violae (紫花地丁 Zi Hua Di Ding)
18g
Talcum (滑石 Hua Shi)
12g
Polyporus (豬苓 Zhu Ling)
12g
Herba Plantaginis (車前草 Che Qian Cao)
30g
Formula Modifications
For severe urethral pain: Add Spora Lygodii (海金沙 Hai Jin Sha) – 10g
For pyuria or haematuria: Add Herba Cirsii (小薊 Xiao Ji) – 12g and Rhizoma Imperatae (白茅根 Bai Mao Gen) – 15g
This protocol is also applicable to post-coital cystitis, commonly referred to as “honeymoon cystitis.”
Supportive Lifestyle Measures
Maintain adequate hydration
Consume a light, easily digestible diet
Ensure sufficient rest and recovery
These interventions aid symptom resolution and reduce recurrence risk.
When women reach the ages of 45 to 52, natural cessation of menstruation occurs, which in medicine is called “menopause.”
The onset of menopause leads to physiological changes. Some women, due to constitutional weakness or psychological influences, may not be able to adapt promptly. This imbalance of endocrine function may result in obvious dysfunction of internal organs, known medically as “menopausal syndrome.”
In the early stages, symptoms may include insomnia, dizziness, headache, fatigue, tachycardia or bradycardia, loss of appetite, reduced work capacity, lumbago or joint pain, obesity, excessive sweating, and various vague complaints. As the condition progresses, women may develop prominent neuropsychiatric symptoms such as anxiety, depression, suspicion, or hysteria.
These symptoms may involve the neuropsychiatric system, sensory disturbances, vasomotor symptoms, musculoskeletal complaints, digestive system issues, or urinary system problems. All of these arise from endocrine imbalance and hence are categorized as “menopausal syndrome.” Naturally, symptoms vary among individuals due to differences in physical and psychological conditions. Therefore, treatment must be individualized according to syndrome differentiation. Importantly, despite these neurasthenic-like manifestations, there is no substantial organic pathology in the internal organs.
Although Traditional Chinese Medicine (TCM) does not have a specific name for this condition, it has long recognized the physiological and pathological states of women during menopause. It is attributed to declining Kidney-Chi, exhaustion of Tian-Gui (reproductive essence), and disharmony of the Chong and Ren meridians. Based on syndrome differentiation, many treatment principles have been established, summarized as “nourishing the heart, replenishing yin, calming the spirit, and subduing hyperactivity.”
Following these principles, the author has formulated the prescription “Geng-Nian-Kang Decoction” for treatment:
Radix Scrophulariae (Xuan Shen) – 10 g
Radix Salviae Miltiorrhizae (Dan Shen) – 10 g
Radix Codonopsis (Dang Shen) – 10 g
Radix Ophiopogonis (Mai Dong) – 5 g
Radix Asparagi (Tian Dong) – 5 g
Rehmanniae Radix, raw and prepared (Sheng Di, Shu Di) – 20 g each
Semen Platycladi (Bai Zi Ren) – 10 g
Semen Ziziphi Spinosae (Suan Zao Ren) – 10 g
Radix Polygalae (Yuan Zhi) – 5 g
Radix Angelicae Sinensis (Dang Gui) – 3 g
Poria (Fu Ling) – 10 g
Fructus Tritici Levis (Fu Xiao Mai) – 10 g
Radix Paeoniae Alba (Bai Shao) – 10 g
Radix Corydalis (Yan Hu Suo) – 6 g
Os Draconis (Long Gu) – 15 g
Concha Ostreae (Mu Li) – 15 g
Fructus Schisandrae (Wu Wei Zi) – 5 g
Radix Platycodi (Jie Geng) – 5 g
The herbs are decocted in water for oral administration. A course consists of 16 doses.
This formula has shown favourable therapeutic effects in menopausal women presenting with emotional depression, irritability, palpitations, insomnia, low-grade fever, decreased body fluids, suspicion, excessive worrying, musculoskeletal aches resembling “flu-like” symptoms, dizziness, and headaches.
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