Clinical Diseases Responding Specifically To Traditional Chinese Medicine：Chronic Prostatitis

Abstract: Chronic prostatitis is a common and frequently occurring disease in male clinics. Due to the diverse symptoms, complex etiology, unclear mechanisms, and recurrent episodes of chronic prostatitis, Western medicine often faces the challenge of limited treatment options and unsatisfactory outcomes. In order to fully leverage the unique advantages of traditional Chinese medicine (TCM) in the treatment of chronic prostatitis, the China Association of Chinese Medicine organized a discussion among experts from the fields of TCM urology, Western urology, and related pharmacy. The experts focused on the advancements in the understanding of chronic prostatitis in modern medicine, various theories on the etiology, pathogenesis, and treatment of chronic prostatitis in TCM, entry points from interdisciplinary fields, the role and advantages of TCM in the comprehensive management of chronic prostatitis, and research into mechanisms related to chronic prostatitis. After discussions, the experts concluded that chronic prostatitis is one of the diseases where TCM has a distinct advantage. TCM can effectively improve the clinical syndromes of chronic prostatitis, including urinary issues, social psychology, organ specificity, infection, nervous system problems, pain and discomfort, sexual dysfunction, etc., and can enhance the quality of life. For patients with chronic prostatitis who cannot tolerate or may not accept the adverse effects of regular medicine, as well as for those with non-inflammatory chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), those with pain as the primary symptom, those with urinary tract symptoms, those with coexisting anxiety and depression, and those with abnormal semen liquefaction, TCM-based treatment can be the main approach. Currently, the optimal diagnosis and treatment strategy for chronic prostatitis has not yet been established, and further research from perspectives such as clinical epidemiology, evidence-based medicine, and molecular biology is needed. Both TCM and Western medicine should integrate their respective strengths, clarify the role and advantages of TCM interventions based on mutual reference, and improve the diagnosis and treatment standards for chronic prostatitis in China.

Keywords: chronic prostatitis; diseases responding specifically to traditional Chinese medicine; expert guidance and suggestions; integrated traditional Chinese and regular medicine

 

NEW TCM CISTANCHE SUPPLEMENTS FOR TREATING CP IN A NATURAL WAY

 

Chronic prostatitis (CP) is a common and frequently occurring condition in the field of andrology. It is characterized as a clinical syndrome primarily manifested by pain in the pelvic-genital area and symptoms of urinary irritation [1]. Epidemiological studies indicate that approximately 50% of men will experience prostatitis at some point in their lives [2]. Although CP is not a life-threatening disease, its prolonged course and recurrent episodes severely affect patients' physical and mental health as well as their quality of life.

Due to the diverse clinical presentations, complex and unclear etiology, and pathological mechanisms of CP, especially chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), Western medicine lacks satisfactory treatment options. There are no evidence-based, highly effective pharmacological treatments for CP [3]. In contrast, traditional Chinese medicine (TCM), guided by holistic principles, treats CP based on the functions of the liver, spleen, kidneys, and bladder. TCM addresses pathological factors such as damp heat, qi stagnation, blood stasis, and deficiency syndromes through comprehensive therapeutic approaches. These methods have been shown to effectively improve clinical symptoms and enhance patients' quality of life, making TCM one of the primary treatments for CP in clinical practice [4].

To further explore the advantages of TCM in the treatment of CP, the Chinese Association of Traditional Chinese Medicine invited 20 experts from various institutions, including Guangdong Provincial Hospital of Traditional Chinese Medicine (Zhuhai Branch), the Fifth Affiliated Hospital of Sun Yat-sen University, Dongzhimen Hospital of Beijing University of Chinese Medicine, Peking University First Hospital, Jinan University, the First Affiliated Hospital of Anhui Medical University, the First Affiliated Hospital of Wenzhou Medical University, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, the First Affiliated Hospital of Yunnan University of Chinese Medicine, Shenzhen Traditional Chinese Medicine Hospital, Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine, and Xiamen Traditional Chinese Medicine Hospital.

These experts engaged in in-depth discussions and rigorous evaluations, focusing on the advantages of integrating traditional Chinese and Western medicine in treating CP, optimal treatment regimens, and future expectations and recommendations. Based on their collaborative efforts and repeated deliberations, they reached the following consensus to provide guidance for clinical practitioners.

1. The Modern Medical Understanding of CP Is Evolving

The etiology of chronic prostatitis (CP) is highly complex, and its pathogenesis has not yet been fully elucidated. Most researchers believe that CP is primarily associated with various factors, including pathogenic infections, urinary dysfunction, neuroendocrine factors, oxidative stress, pelvic-related diseases, psychological factors, abnormal immune responses, and unhealthy lifestyle habits [5].

As understanding of CP deepens, some experts have proposed replacing the term "chronic prostatitis" with "prostate-pelvic syndrome" [6], aiming to reduce the excessive focus of andrologists and patients on "inflammation" of the prostate. This terminology better aligns with the recognition by many scholars that CP is a "clinical syndrome." Furthermore, a classification system known as UPOINTS has been proposed for the clinical management of CP [7]. This system provides a comprehensive framework to reflect the clinical manifestations of CP, thereby enabling clinicians to implement more tailored and targeted comprehensive treatments for individual patients.

The UPOINTS classification system encompasses seven independent factors:

Urinary symptoms (U),

Psychosocial symptoms (P),

Organ-specific symptoms (O),

Infection-related symptoms (I),

Neurogenic/systemic symptoms (N),

Muscle tenderness symptoms (T),

Sexual dysfunction (S).

Currently, single-drug therapies in Western medicine have not shown satisfactory effectiveness for CP. As a result, physical therapies have gained increasing attention from researchers. Common physical therapies for CP include prostate massage, biofeedback therapy, magnetic therapy, ultrasound and shockwave therapy, thermotherapy, acupuncture, and electrophysiological therapy. These approaches aim to improve local blood circulation in the prostate, promote the resolution of inflammation, and relieve muscle tension, thereby achieving clinical benefits either directly or indirectly [8]. See Table 1 for details.

 

1. The Modern Medical Understanding of CP Is in Continuous Exploration and Development

The etiology of chronic prostatitis (CP) is highly complex, and its pathogenesis has not been fully clarified. Most scholars believe that CP is associated with a variety of factors, including pathogenic infections, urinary dysfunction, neuroendocrine factors, oxidative stress, pelvic-related diseases, psychological factors, abnormal immune responses, and unhealthy lifestyle habits [5].

As the understanding of CP deepens, some experts have suggested replacing the term "chronic prostatitis" with "prostate-pelvic syndrome" [6]. This change aims to reduce the excessive focus of urologists and patients on the "inflammatory" aspect of the prostate and better aligns with the recognition of CP as a "clinical syndrome" by many researchers.

Additionally, some scholars have proposed the UPOINTS classification system for the clinical management of CP [7]. This system provides a more comprehensive representation of CP's clinical manifestations, enabling clinicians to deliver more precise and targeted comprehensive treatments tailored to individual patients.

The UPOINTS classification system includes seven independent domains:

Urinary symptoms (U),

Psychosocial symptoms (P),

Organ-specific symptoms (O),

Infection-related symptoms (I),

Neurogenic/systemic symptoms (N),

Muscle tenderness symptoms (T),

Sexual dysfunction (S).

Currently, single-drug treatments in Western medicine have not demonstrated satisfactory outcomes for CP. Consequently, physical therapies have increasingly drawn the attention of researchers. Common physical therapies for CP include prostate massage, biofeedback therapy, magnetic therapy, ultrasound and shockwave therapy, thermotherapy, acupuncture, and electrophysiological therapy. These physical modalities aim to improve local blood circulation in the prostate, promote the resolution of inflammation, and alleviate muscle tension, thereby achieving clinical benefits either directly or indirectly [8]. See Table 1 for details.

 

Table 1 UPOINTS classification system

 

Symptoms	Main Characteristics
Urinary Symptoms	Urgency, frequency, incomplete urination, weak urine stream, prolonged urination, etc.
Psychosocial Symptoms	Anxiety, depression, psychological stress, and reduced quality of life.
Organ-Specific Symptoms	Specific prostate-related symptoms such as pain in the prostate during a digital rectal exam (DRE) or tenderness in the seminal vesicles.
Infection Symptoms	Symptoms of bacterial infections, often with positive findings of bacteria in EPS (expressed prostatic secretions) or urine culture.
Neurogenic/Systemic Symptoms	Chronic pain, general discomfort, and fatigue.
Muscle Tenderness	Pain or tenderness in the perineum, pelvic floor, or surrounding muscles, with abnormal muscle tension.
Sexual Dysfunction	Premature ejaculation, erectile dysfunction, decreased libido, or other sexual performance issues.

 

2. Western Medicine-Dominated Treatment

Western medicine has advantages in certain scenarios, making it suitable as the primary treatment approach in the following cases:

CP Patients with Moderate to Severe Anxiety or Depression:
For these patients, medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (e.g., duloxetine), and tricyclic antidepressants (e.g., amitriptyline) can be considered. Antidepressants and anti-anxiety medications not only improve psychological symptoms in CP patients but also alleviate physical symptoms such as pain [9].

CP Patients with Erectile Dysfunction (ED):
For patients with high expectations for sexual function, the first-line treatment involves phosphodiesterase type 5 inhibitors (PDE5Is). PDE5Is are the gold standard for ED treatment and can boost patients' confidence. Common PDE5Is include sildenafil, tadalafil, and vardenafil.

CP Patients with Premature Ejaculation (PE):
Many of these patients exhibit varying degrees of anxiety, depression, tension, and pessimism. SSRIs significantly improve premature ejaculation symptoms and alleviate psychological symptoms such as anxiety, depression, and tension [10]. SSRIs include two types:

On-demand treatment: Dapoxetine.

Regular treatment: Medications such as citalopram, paroxetine, and sertraline.
The choice of SSRI depends on the patient's condition.

Type II Prostatitis Patients with Confirmed Pathogen Infection via Laboratory Tests:
For patients diagnosed with bacterial infections, sensitive antibiotics can be selected based on bacterial culture results. Antibiotics can improve urinary symptoms, pain, and quality of life scores. However, their use must be guided by pathogen detection, bacterial culture, and drug sensitivity testing to ensure rational use. It is essential to consider the characteristics of the disease, potential drug interactions, contraindications, and avoid overuse.