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.
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