Source & Background

Benign prostatic hyperplasia (BPH) is one of the most common geriatric diseases in clinical practice. It is marked by difficult urination, dribbling urine, and even complete urinary retention, corresponding to the TCM category of Long Bi (Urinary Retention).

Clinical observations show that the high prevalence of BPH in the elderly is closely related to their physiological and pathological characteristics: deficient kidney qi and easy stagnation of pathogenic factors. As recorded in Huangdi Neijing (The Yellow Emperor's Internal Classic):

"At eight, a boy's kidney qi becomes abundant… At sixty‑four, Tian Kui is exhausted, essence is scarce, kidneys decline, the body is worn out, teeth and hair fall out."

The kidney governs water metabolism and controls the anterior and posterior orifices. Kidney deficiency leads to disordered bladder qi transformation. Over time, damp‑heat and blood stasis accumulate, causing strangury and urinary obstruction. Therefore, treatment must prioritize tonifying the kidney while eliminating pathogenic factors-only by addressing both the root and branch can therapeutic efficacy be improved.In clinical practice, I often use the Kidney‑Tonifying & Blood‑Activating Method, mainly with modified Zi Shen Tong Guan Wan (Kidney‑Nourishing Passage‑Unblocking Pill), which yields satisfactory short‑ and long‑term outcomes.

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Formula Origin & Mechanism

Zi Shen Tong Guan Wan (also known as Tong Guan Wan / Zi Shen Wan) is originally from Lan Shi Mi Cang (Secret Treasury of the Orchid Chamber) · Chapter on Urinary Strangury and Blockage, which states:

"Treats urinary retention without thirst, where heat lodges in the lower jiao blood division."

It consists of three herbs:

Rhizoma Anemarrhenae (Zhi Mu)

Cortex Phellodendri Chinensis (Huang Bai)

Cortex Cinnamomi (Rou Gui)

BPH mostly arises from dual deficiency of kidney yin and yang, impaired bladder qi transformation, stagnant damp‑heat obstructing urinary flow, and qi‑blood stasis.

Huang Bai clears heat and dries dampness.

Zhi Mu nourishes kidney water and yin.

As the saying goes: "Without yang, yin cannot be generated; without yin, yang cannot be transformed." Nourishing yin alone fails without yang assistance; Rou Gui assists yang, enabling yin to be activated by yang, restoring bladder qi transformation and unobstructed urination.

In clinical use, I often combine this formula with Ba Wei Di Huang Wan (Eight‑Ingredient Rehmannia Pill) to regulate kidney yin‑yang balance, plus blood‑activating and mass‑resolving herbs to dissipate stagnation:Rhizoma Sparganii (San Leng), Rhizoma Curcumae (E Zhu), Semen Persicae (Tao Ren), Radix Paeoniae Rubra (Chi Shao), etc.

Together, these herbs tonify kidney yin‑yang to boost kidney qi, resolve damp‑heat and blood stasis to free the waterways. Once damp‑heat and stasis are eliminated, blockage removed, kidney qi replenished, and qi transformation restored, urination flows smoothly.

For pronounced lower‑jiao damp‑heat (dark yellow urine, burning urethral pain, thick yellow greasy coating at the root of the tongue, wiry‑slippery‑rapid pulse), add:Herba Dianthi (Qu Mai), Herba Polygoni Avicularis (Bian Xu), Herba Taraxaci (Pu Gong Ying), Hedyotis Diffusa (Bai Hua She She Cao) to clear heat, drain dampness, and detoxify-markedly enhancing efficacy.

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Clinical Cases

Case 1

Patient: Li, male, 60 years oldFirst visit: October 29, 1989Chief complaints: Poor urination for >1 week, difficult and painful urination, perineal distension, and impotence for >6 months. Western diagnosis: benign prostatic hyperplasia.Tongue: purple‑darkPulse: deep, especially weak at the chi positionPattern: dual deficiency of kidney yin‑yang, internal obstruction of turbid stasis, impaired bladder qi transformationMethod: tonify kidney, nourish yin, assist yang, activate blood

Prescription:Zhi Mu 15g, Huang Bai 15g, Rou Gui 10g, Shu Di Huang 20g, Gou Qi Zi 15g, Shan Yao 15g, Fu Ling 15g, Mu Dan Pi 15g, Ze Xie 15g, Fu Zi 10g, San Leng 15g, Tao Ren 15g, Chi Shao 15g.Decoction in water, oral administration.

After 12 doses: urination became smooth and uninterrupted; most symptoms resolved, but impotence persisted.Modified prescription: remove San Leng, Tao Ren, Chi Shao; add Herba Epimedii (Yang Huo Ye) 15g, Tu Si Zi 20g, Nv Zhen Zi 15g, Cistanche Tubulosa (Rou cong rong) 15g, Gan Cao 10g.After 12 consecutive doses: all symptoms disappeared, fully recovered. No recurrence in 6‑month follow‑up.

Case 2

Patient: Tao, male, 57 years oldFirst visit: December 7, 1989Chief complaints: poor urination, thin urinary stream, perineal distension, urethral burning pain, lower abdominal distension, dribbling after urination.Western diagnosis: benign prostatic hyperplasia; surgery recommended but refused.Pulse: deep‑slipperyTongue: dark, thin yellow greasy coatingPattern: dual deficiency of kidney yin‑yang, internal obstruction of damp‑heat and blood stasisMethod: tonify kidney, nourish yin, assist yang, activate blood, clear and drain damp‑heat

Prescription:Zhi Mu 15g, Huang Bai 15g, Rou Gui 10g, Fu Zi 10g, Shu Di Huang 25g, Shan Zhu Yu 15g, Shan Yao 15g, Fu Ling 15g, Mu Dan Pi 15g, Ze Xie 15g, San Leng 15g, E Zhu 15g, Tao Ren 15g, Tu Bie Chong 5g, Qu Mai 20g, Bian Xu 20g, Pu Gong Ying 30g.Decoction in water, oral administration.

After 8 follow‑ups and >60 doses: all symptoms resolved, urination normalized, prostate volume reduced and softened. Fully recovered.

Clinical Implications

The Kidney‑Tonifying & Blood‑Activating Therapy is designed based on geriatric physiological features and the pathological mechanism of BPH.It can be applied clinically regardless of obvious kidney deficiency symptoms. In my practice, many BPH patients without marked kidney‑deficiency patterns also respond well to this method.

Important Disclaimer

Individual constitution and condition vary. The therapeutic plans in these cases apply only to the patients described at that time.Do not copy this regimen without professional TCM pattern differentiation. For medical needs, please consult qualified practitioners in formal hospitals to avoid delaying treatment.

Reference Link (Herb for Prostate Health)

https://www.xjcistanche.com/news/say-goodbye-to-prostate-problems-with-cistanch-83534746.html

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