According to the American Journal of Medicine:

*Acupuncture was twice as effective as sham acupuncture at easing symptoms of chronic prostatitis and prostatodynia

*Any adverse acupuncture effects were minor and resolved quickly.

*These results with acupuncture are more encouraging than those of other interventions.

Full Study Here

There are three common conditions that afflict the prostate; inflammation (prostatitis and prostatodynia), benign prostatic hyperplasia (BPH) and cancer of the prostate.

Acute prostatitis, unlike chronic prostatitis and prostatodynia, usually has a sudden onset and is characterized by fever, urinary frequency, urgency and pain on voiding, as well as pain in the lower part of the abdomen.

Chronic prostatitis tends to occur in patients with a history of urinary tract infection, therefore it is very important to treat urethritis, cystitis or bladder infections immediately to prevent this complication.

Prostatodynia (non-bacterial prostatitis) is similar to chronic bacterial prostatitis in signs and symptoms. The main difference in diagnosis is that the lab results do not show evidence of infection.

Rather than breaking a disease down into a condition such as prostatitis or prostatodynia, a TCM or acupuncture practitioner looks at the picture painted by the signs and symptoms of each case individually.

Damp-Heat is usually at the forefront in acute prostatitis.

Stagnant Liver Qi - this condition usually happens when the acute stage of prostatitis has become chronic, or it may arise on its own.

Middle Jiao Deficiency syndrome occurs after the disease has become chronic, or if there is a pre-existing weakness of the Middle Jiao. Symptoms tend to present themselves with typical Spleen deficient signs.

Kidney Qi deficiency usually occurs when prostatitis has become chronic and has lasted for a long time. In cases of advanced age or ill health, the signs may present themselves shortly after the initial bout with prostatitis.

Kidney Yin Deficiency presents with a combination of Yin deficiency of the Kidney and Qi deficiency of the Middle Jiao and Kidney. There will likely be weight loss, difficult and painful urination with possible hematuria, dizziness, weak lower back and knees, lassitude and a weak and thready pulse.

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Prostatitis and Prostatodynia

by Dan Schalm R.Ac, R.TCMP

Introduction

The purpose of this paper is to describe the physical and functional characteristics of the prostate, the pathological condition of prostatitis and prostatodynia and their treatment using both Western and Eastern medical approaches. Western medicine relies on surgery and drugs as treatment, whereas Eastern medicine, particularly Chinese medicine uses herbal medicine and acupuncture.

Western medical science is based on theory and observations about the biological, chemical and atomic structure of the human organism and how these components function. It follows a cause and effect principle which tends to be mechanistic in nature. Traditionally, Western allopathic medicine doesn't accept the idea of a non-quantifiable energy system (e.g. Qi, Pranayama) as being part of the human structure. Though quantum physics and an increasing amount of research in psycho-neurology is presently being done to support this idea, the approach is still not embraced by the existing medical system in North America.

Traditional Chinese medicine (TCM) which includes the practice of acupuncture, along with other complimentary health disciplines, stresses that the human being is a holistic entity. Rather than break it down into smaller and smaller units and particles to try to understand it, TCM focuses on the relationship between the body's main components and the surrounding world. Health is thought to be a proper balance between energy systems and no differentiation is made between the human and the surrounding environment. It is all one thing. Thus, the actual physical structure is not as important as the dynamics that animate it. Acupuncture theory works with the energy balance of the human body and not as much the physical structure.

First, we'll begin with the Western medical view.

Western medicine

1. What is the prostate?

The prostate is a small gland peculiar to the male anatomy that sits at the base of the bladder and surrounds the prostatic urethra. It is about the size and shape of a walnut and is partly glandular and partly fibro-muscular. Within the structure, there are ducts that open into the prostate urethra, as well as a junction where the seminal vesicles open into the urethra.

Its purpose is not clearly understood, but the gland functions to produce a prostate fluid that mixes with sperm during ejaculation, thus forming semen. The fluid may serve to nourish sperm, make the vagina less acidic and lubricate the urethra but scientists don't know for certain. Approximately 20% of the total ejaculate contains prostate secretion.

2. Prostatitis and Prostatodynia

There are three common conditions that afflict the prostate; inflammation (prostatitis and prostatodynia), benign prostatic hyperplasia (BPH) and cancer of the prostate. The latter two will not be discussed in this paper, but it is important to note how they differ from the former condition. Cancer and BHP tend to occur in older males (over 50) and are considered to be a physical enlargement of the gland. That is, the cells either multiply or become larger in size.

Prostatitis and prostatodynia are usually considered to be an inflammation of the prostate and may occur in males of any age group, usually between 20 - 50 years of age. There is no change to the cellular structure and the inflammation usually affects the outer part of the gland only. Prostatitis may be acute or chronic and is diagnosed when signs of infection exist. Prostatodynia presents itself with prostatitis-like signs, but no evidence of infection can be found. Prostatodynia is also known as non-bacterial prostatitis. At the moment there is considerable controversy regarding the two distinctions as some doctors believe many cases of prostatodynia to be infectious even without laboratory support from tests. Only 5% of men with prostatitis symptoms are found to have infection and the rest are therefore placed into the category of prostatodynia.

3. Western Pathogenesis of Prostatitis and Prostatodynia

Acute Prostatitis

Acute prostatitis, unlike chronic prostatitis and prostatodynia, usually has a sudden onset and is characterized by fever, urinary frequency, urgency and pain on voiding, as well as pain in the lower part of the abdomen. Rectal examination shows an acute tenderness of the prostate gland and lab results confirm a bacterial infection. The disease may occur as a complication from bladder infection or urethritis (cystitis) or from catheter installation. It is generally bacterial in nature (common UTI pathogen or Staphylococcus aureus.)

Treatment for acute prostatitis generally consists of a course of antibiotics.

Chronic prostatitis tends to occur in patients with a history of urinary tract infection, therefore it is very important to treat urethritis, cystitis or bladder infections immediately to prevent this complication. Evidence suggests that it can also be sexually transmitted as there is a higher rate of chronic prostatitis in men who are sexually active. Infectious agents are commonly bacteria, but may also be viral, fungal and protozoan. The Herpes simplex II virus has been implicated in an isolated few cases. Therefore, chronic prostatitis is divided further into bacterial and non-bacterial.

The symptoms are less severe than the acute condition, and may include burning urination, sense of urgency to void, burning, full sensation between perineum and anus, pain during ejaculation, possible impotence, milky discharge during urination or after bowel movement, blood in urine and lower back and leg pain. Patients complain that perinial pain is worse when sitting. There may also be a reduction of urine flow volume. Lab results may show signs of an infection.

This chronic form of prostatitis is then treated with antibiotics, unless evidence shows infection from other pathogens. Because the prostate has a low pH, and inhibits the effectiveness of most antibiotics, it is important that they are taken for at least six weeks. If not, the bacterial strain may become resistant and much harder to treat in the future. Generally, chronic prostatitis is very difficult to cure for this reason.

Prostatodynia (non-bacterial prostatitis) is similar to chronic bacterial prostatitis in signs and symptoms. The main difference in diagnosis is that the lab results do not show evidence of infection. As was previously stated, there is quite a lot of controversy surrounding the differentiation between the two diagnoses. Some doctors believe that due to the nature of the prostate circulation, infection is hard to detect, and many cases that are categorized as prostatodynia are possibly due to hidden infection.

Reasons for contracting prostatodynia are unknown at this time, though it is suggested that muscle tension, under use or over use of the organ, withholding ejaculation during sexual activity, physical trauma or even emotional and psychological factors could be to blame. Sometimes it is treated with antibiotics to rule out true infection, otherwise, muscle relaxants, stress relieving therapies, warm sitz baths, regular ejaculation to relieve pressure, prostate massage and coping strategies are employed. The term watchful waiting is also applied to the process of waiting to see whether the condition progresses or regresses.

EASTERN MEDICINE AND ACUPUNCTURE  

WHAT IS THE PROSTATE?

Rather than breaking a disease down into a condition such as prostatitis or prostatodynia, a TCM or acupuncture practitioner looks at the picture painted by the signs and symptoms of each case individually. In an acupuncture practice, three people could come into the clinic diagnosed with chronic bacterial prostatitis but each might be treated differently. This is called syndrome differentiation. Chinese medical treatment is based on differentiating the entire picture presented by the patient rather than just the Western diagnosis. This way, the protocol seeks to restore balance within the individual and with his environment so that the forces of nature can become a major part of the healing process. Since there is, according to Eastern theory, an energetic component to our reality, TCM practitioners will use acupuncture to work with that level of imbalance.

There is no specific reference to the prostate in TCM but it is thought to be part of the Urinary Bladder and Kidney system. Here, Kidney and Bladder refer to an idea and an energetic component, and not necessarily the physical organs of Western medicine. These organs have to do with the urinary function, the sexual energy, as well as the basic foundational energy of the human body, therefore they encompass the function of the prostate.

For acupuncture treatment to be a success, the practitioner must break the general classification into stranguria or lin disease. Then it is further divided into Heat or re lin, taxation or lao lin and qi lin. Some complications include hematuria (xue lin) and chyluria (gao lin), milky urine which indicates the presence of lymphatic fluid.

2. TCM PATHOLOGY OF PROSTATITIS AND PROSTATODYNIA

Usually the prostate affliction begins as a Damp-Heat condition pouring into the lower jiao. Over time and if not properly treated, the excess Heat also causes Kidney and/or Spleen depletion and thus transforms into deficiency. During the phase change, both excess and deficiency exist simultaneously and treatment must take this into consideration. Qi stagnation, due to either excess or deficiency may also be a cause of stranguria syndrome or conversely, may be a result or complication of the pathogenesis.

Damp-Heat

Damp-Heat is usually at the forefront in acute prostatitis. It may arise from an invasion of external pathogens (in Western terms, bacteria, virus, fungus etc.) or it may be related to improper dietary habits. Over consumption of greasy foods or alcohol lead to Damp-Heat, which may then move downward into the lower jiao.

Symptoms include general indicators of excess Damp-Heat such as fever, restlessness, and bitter taste in the mouth. Frequent micturation and urgency usually present at this acute stage. Pain on urination can be sharp or burning and is generally worse during the voiding process. It may radiate to the sacral area or the lower back. Stools tend to be loose and purulent and there may be dull ache or constant and acute pain in the lumbosacral area. The tongue will be red and the coat will be yellow and sticky, especially at the root. Pulse tends to be slippery or soft and rapid.

At this stage of the disease, the acupuncture and herbal treatment principle would be to clear excess type Damp-Heat from the Lower Jiao and move turbid stagnation in the area. The herbal formula most commonly used would be:

• Ba Zheng San: (Che Qian Zi 20g; Qu Mai 15g; Bian Xu 15g; Hua Shi 15g; Zhi Zi 15g; Mu Tong 15g; Zhi Da Huang 15g; Zhi Gan Cao 10g; Deng Xin Cao 5g)

This TCM herbal formula expels excess pathogens from the lower burner and restores its function to normal. It should only be used in cases of excess.

If there are excess Liver-Fire signs the following herbal formula could be used:

• Long Dan Xie Gan Tang: (Long Dan Cao; Huang Qin; Zhi Zi; Ze Xie; Mu Tong; Che Qian Zi; Dang gui; Sheng Di Huang; Chai Hu; Gan Cao)

This TCM formula is similar to Ba Zheng San but it moves Qi and Blood as well as draining Heat from the Liver and Gallbladder. I can be used if the acute phase is prolonged and causing stagnation or arises from Liver excess.

If the condition presents with chyluria (milky urine), use the following Chinese herbs:

• Bie Xie Feng Qin Yin (Bie Xie 20g; Yi Zhi Ren 20g; Chang Pu 20g; Wu Yao 20g)

In the case of excess Damp-Heat, chyluria results from the inability of the Lower Jiao to separate the clear and turbid Qi. Use this herbal formula only for excess.

Useful acupuncture points:

Acupuncture point SP-10-Xue Hai can be added for hematuria and if there is fever, use LI04-Hegu, LI11-Quchi.

Ear acupuncture can consist of the following points: Prostate Gland, Bladder, Internal Genitals, San Jiao, Urethra, Adrenals.

Moxa is not generally applicable in this case.

Stagnant Liver Qi

This condition usually happens when the acute stage has become chronic, or it may arise on its own. Damp Heat can lead to stagnation if prolonged or not treated right away. Depression or repressed anger can lead to the internal generation of Heat in the Liver which may lead to stagnation in the Lower Jiao. It is then classified as Qi Lin.

The signs and symptoms are not as severe as the previous condition, though Damp-Heat, in milder form, generally tends to remain part of the picture. Pain is not acute, and the burning or difficulty of urination may occur previous to and not during micturation. There may still be frequency, and the condition is sometimes accompanied by painful ejaculation and impotence. There may be a discharge of prostate fluid after a bowel movement. The perineum can have a full sensation and there may be flatulence. The general discomfort and symptoms tend to be aggravated with emotional stress and frustration. Treatment principle aims to restore smooth circulation to the Middle and Lower Jiao.

The tongue may be dark or slightly purple in prolonged cases. The pulse tends to be wiry.

If deficiency is not part of the picture and the condition is still excessive, use the following TCM herbal formula:

• Chen Xiang San: (Chen Xiang 1.5g; Shi Wei 15g; Hua Shi 20g; Dang Gui 10g; Bai Shao Yao 15g; Chen Pi 15g; Dong Kui Zi 15g; Wang Bu Liu Xing 15g; Gan Cao 10g)

TCM Herbs such as Chi Shao Yao, Hong hua and Chuan Niu Xi may be added if Qi and Blood stasis is particularly pronounced due to prolonged course of the disease.

Useful acupuncture points:

Middle Jiao Deficiency

The pathogenesis of this syndrome is similar to the first. However, in this case there is deficiency of the Middle Jiao. Generally, the syndrome occurs after the disease has become chronic, or if there is a pre-existing weakness of the Middle Jiao. Symptoms tend to present themselves with typical Spleen deficient signs. There is also pain or fullness in the area between the perineum and the anus and it is described as a bearing down or sinking sensation. Pain of micturation usually follows urination and there may be dribbling after. The symptoms may be worse when the patient is fatigued. Middle Jiao deficiency can be the root of the Western diagnosis of prostatodynia.

The tongue may be pale & tooth-marked with a light coat and the pulse will be weak and thready.

The following TCM herb formula is useful for this condition:

• Bu Zhong Yi Qi Tang: (Huang Qi 15g; Ren Shen 15g; Bai Zhu 15g; Dang Gui 15g; Chen Pi 10g; Sheng Ma 5g; Chai Hu 5g; Zhi Gan Cao 10g)

It aims to uplift the sinking Qi and strengthen the Middle Jiao.

Useful acupuncture points:

Kidney Qi Deficiency

Kidney Qi deficiency usually occurs when the condition has become chronic and has lasted for a long time. In cases of advanced age or ill health, the signs may present themselves shortly after the initial bout with prostatitis. Traditionally, frequent ejaculation is also considered to be a factor in contributing to Kidney Qi deficiency. Symptoms are milder than the acute types and include signs generally associated with Kidney and Spleen Qi deficiency . Chronic prostatitis symptoms, difficult urination, pain after urinating, impotence, lassitude, pale tongue, white coat, deep, thready pulse. Use the following TCM herb formula.

• Wu Bi Shan Yao Wan: (Shan Yao 15g; Ru Cong Rong 15g; Tu Si Zi 15g; Ba Ji Tian 10g; Du Zhong 10g; Shu Di Huang 15g; Shan Zhu Yu 10g; Niu Xi 10g; Wu Wei Zi 7.5g; Chi Shi Zhi 10g; Ze Xie 10g; Fu Shen 10g)

Useful acupuncture points:

Kidney Yin Deficiency

Generally, this condition presents with a combination of Yin deficiency of the Kidney and Qi deficiency of the Middle Jiao and Kidney. There will likely be weight loss, difficult and painful urination with possible hematuria, dizziness, weak lower back and knees, lassitude and a weak and thready pulse. The tongue coat will be thin with a yellow coat at the root. There likely will also be chyluria.

For this case use these TCM herbs:

• Modified Liu Wei Di Huang Wan: (Shu Di Huang 40g; Shan Zhu Yu 20g; Shan Yao 20g; Zei Xie 15g; Mu Dan Pi 15g; Fu Ling 15g; PLUS - Jin Yin Zi 15g; Long Gu 20g; Mu Li 20g)

Useful acupuncture points:

Conclusion

Prostatitis and prostatodynia are difficult conditions to treat. Western medicine has better success when the disease is acute and caused by bacteria, but the chronic condition is not well understood. The TCM and acupuncture approach does not concern itself with the actual diagnosis of prostatitis or prostatodynia, but rather uses the traditional method of syndrome differentiation. In this way, acupuncture or herbal treatment can be designed specifically for each patient involved. Using this method and employing both acupuncture and herbal medicines TCM has better success with the chronic phase of the disease than Western medicine.

References

Chen, Ze-Lin & Mei-Fang; A Comprehensive Guide to Chinese Herbal Medicine; Castle Books, 1992, USA; ISBN 0-7858-1076-5

Yin, Ganglin; Advanced Modern Chinese Acupuncture Therapy: A Practical Handbook for Intermediate and Advanced Study; New World Press, 2000, China;

ISBN 7-80005-558-2

Maciocia, Giovanni; The Practice of Chinese Medicine; Churchill Livingstone, 1994, UK;

ISBN 0-443-043051

Nowak, T. & Handford, A.; Essentials of Pathophysiology; McGraw-Hill, 1999, USA;

ISBN 0-697-25205-1

Harrison, T.R.; Harrison's Principles of Internal Medicine, 12th edition; McGraw-Hill, 1991, USA;

ISBN 0-07-070890-8

State Administration of Traditional Chinese Medicine and Pharmacy; Advanced Textbook on Traditional Chinese Medicine and Pharmacology, New World Press, 1996, China;

ISBN 7-80005-296-6

Lin, Anna; A Handbook of TCM Urology and Male Sexual Dysfunction; Blue Poppy Press, Inc., 1992, USA;

ISBN 0-936185-36-8

Blaivas, Jerry G.; Conquering Bladder and Prostate Problems; Plenum Press, 1998, New York

ISBN 0-306-45864-0

Tenney, Louise; Encyclopedia of Natural Remedies; Woodland Publishing, 1995, USA;

ISBN 0-913923-98-2

Balch and Balch; Prescription for Dietary Wellness; Avery Publishing, 1998, USA;

ISBN 0-89529-868-6

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