Expert Consensus On Clinical Diseases Responding Specifically To Traditional Chinese Medicine：Chronic Prostatitis

3.4 CP patients with lower urinary tract symptoms CP patients usually present with varying degrees of lower urinary tract symptoms in clinical practice, including storage symptoms such as urinary urgency, frequent urination, increased nocturia, and urge incontinence, urination symptoms such as delayed urination, thin urine stream, and dysuria, and post-urination symptoms such as incomplete urination and post-urination dripping. Western medicine often uses α-receptor blockers to improve lower urinary tract symptoms, but some patients have poor efficacy or experience intolerable adverse reactions such as dizziness, orthostatic hypotension, and retrograde ejaculation [18]. Therefore, for CP patients with lower urinary tract symptoms, traditional Chinese medicine can be used as the main treatment method. Lower urinary tract symptoms belong to the categories of "urinary retention" and "semen turbidity" in traditional Chinese medicine. The disease is located in the bladder, involving the spleen, lungs, kidneys, and triple energizers. The pathogenesis is bladder qi dysfunction [19]. In the TCM syndrome differentiation of CP, the main manifestations of lower urinary tract symptoms include damp-heat descending syndrome, damp-heat stasis syndrome, kidney yang deficiency syndrome, and kidney yin deficiency syndrome. Therefore, to relieve the lower urinary tract symptoms of CP patients, the treatment should be to clear away heat and dampness, remove turbidity and relieve stranguria, warm the kidney and transform qi, and remove blood stasis and open the orifices[20-21]. Multiple research analyses have shown that Longqing Tablets can improve clinical symptoms such as urethral burning sensation, frequent urination, urgency, and urinary pain[22]; Ningmitai Capsules can improve clinical symptoms such as difficulty urinating, dripping and painful urination[23]; Shumitong Capsules can improve clinical symptoms such as dysuria, small urine volume, and incomplete urination[24].

TCM emphasizes the holistic concept, treats the urinary system as a whole, and conducts comprehensive and systematic regulation of complex lower urinary tract symptoms, which can significantly improve the overall symptoms of patients, relieve dysuria, reduce pain and discomfort, and improve the quality of life.

HERBAL FORMULATION FOR CP PATIENTS WITH LOWER URINARY TRACT SYMPTOMS

3.5 CP patients with mild anxiety and depression. Anxiety and depression not only affect the patient's mental health, but also affect the patient's compliance during treatment, which in turn affects the efficacy and prognosis of the disease [25]. Reasons why CP patients are prone to anxiety and depression: ①CP disease course

The symptoms persist for a long time, the condition is lingering, difficult to heal and easy to relapse. Generally, the curative effect is poor. The long treatment process puts a burden on the patient's spirit and economy, which in turn induces pessimism, negativity, anxiety and depression. ② The patient's own lack of correct understanding of the disease, coupled with the erroneous propaganda of some institutions, has caused the patient's understanding of his condition to be seriously exaggerated and distorted, so his heart is gradually filled with anxiety and depression. ③The CP ward is relatively private. Under the background of traditional Chinese culture, some patients are ashamed to talk about it, and some even avoid medical treatment. And as the disease progresses, some patients gradually develop sexual dysfunction such as erectile dysfunction or premature ejaculation, which further aggravates the patient's anxiety and depression.

CP and anxiety and depression interact with each other and are cause and effect. Therefore, in order to pursue better actual clinical efficacy, it is necessary to improve the patient's mental state as much as possible while treating CP. When Western medicine treats such patients, they usually use commonly used psychotropic drugs and invite psychiatrists to conduct psychological tests on the patients.

Intervention, psychotropic drugs have many side effects and adverse reactions, and the efficacy of psychological intervention also varies from person to person and is not highly executable. Under the current medical conditions in my country, most patients are resistant to psychotropic drugs, and some patients are not qualified for joint treatment by psychiatrists, so the overall curative effect is poor. Based on this, CP patients with mild anxiety and depression should be treated with traditional Chinese medicine.

Anxiety and depression belong to the category of "depression disease" in traditional Chinese medicine. The disease is located in the liver and heart. The core pathogenesis is liver qi stagnation and restlessness. The treatment is to soothe the liver and regulate qi, calm the heart and calm the mind [26]. Expert consensus and guidelines recommend the use of Wuling Capsules to treat CP patients with anxiety and depression, which can help relieve the anxiety of CP patients.

anxiety and depression, improve quality of life, and improve clinical efficacy [27-28]. Traditional Chinese medicine has attached great importance to the influence of emotions on diseases since ancient times. It has the theoretical basis of the seven emotions causing disease and the five spirit organs. It focuses on regulating the body and mind through daily diet and daily life. There are also traditions such as Baduanjin and Tai Chi that can improve mild anxiety and depression. Kung Fu [29]. Therefore, the holistic treatment of traditional Chinese medicine for CP patients with mild anxiety and depression has advantages and is worthy of clinical promotion. 3.6 CP patients with abnormal semen liquefaction refers to the failure of semen to liquefy for more than 60 minutes at room temperature. Abnormal semen liquefaction limits sperm motility, which in turn affects the fertilization process and leads to male infertility. According to relevant survey data, CP patients have abnormal semen liquefaction, which is higher than that of the normal population [30]; the reason is that the activity of proteolytic enzymes in the prostatic fluid of CP patients decreases, resulting in semen

The fibrin hydrolysis process is blocked, eventually leading to abnormal semen liquefaction [31]. Abnormal semen liquefaction has no significant impact on the course and treatment of CP. However, in clinical practice, male infertility caused by abnormal semen liquefaction can greatly aggravate the patient's anxiety and depression and damage the patient's emotional and mental state. This will comprehensively affect the efficacy and prognosis. Therefore, for CP patients with abnormal semen liquefaction, the problem of abnormal semen liquefaction must be solved while treating CP. Western medicine has not yet reached a consensus on the pathogenesis of abnormal semen liquefaction. Clinical treatment mainly uses antibiotics for patients with reproductive tract infections, testosterone preparations for patients with testosterone deficiency, or uses intrauterine artificial insemination technology to avoid the impact of abnormal semen liquefaction on the fertilization zone. negative impacts. However, there are many problems such as insufficient efficacy, unsuitable for long-term use, low success rate, and high cost [32].

Abnormal semen liquefaction belongs to the category of "cold semen" and "hot semen" in traditional Chinese medicine. The etiology and pathogenesis include kidney yin deficiency, kidney yang deficiency, damp heat, and phlegm and blood stasis. [33] When treating with traditional Chinese medicine, the cold and heat deficiency and excess should be clearly identified, and the principle of strengthening the body and eliminating evil and restoring liquefaction should be taken. While treating CP conventionally, the overall treatment should be taken to take into account the regulation of abnormal liquefaction. For patients with inflammatory CP combined with abnormal semen liquefaction, antibiotics can be combined for treatment of traditional Chinese and Western medicine [34]. See Table 2.

Table 2 Clinical advantages of traditional Chinese medicine in the treatment of CP

4 Discussion

CP is a disease with overall advantages of traditional Chinese medicine in the field of men's medicine, which deserves in-depth discussion and exploration. This article mainly sorts out 6 types of situations suitable for traditional Chinese medicine treatment, focusing on the advantages of traditional Chinese medicine, advantages, and advantages. It summarizes the specific advantages of traditional Chinese medicine in the treatment of CP for the reference of the majority of andrologists.

At present, the main methods of traditional Chinese medicine treatment of CP are internal decoction or Chinese patent medicine therapy, external treatment of traditional Chinese medicine, and internal and external treatment combined therapy. The rational use of Chinese herbal decoctions or Chinese patent medicines based on syndrome differentiation and treatment can exert good therapeutic effects and relieve patients' physical and mental symptoms. In addition, plant preparations such as saw palmetto fruit extract have also achieved good clinical efficacy in the treatment of CP [35], which is worthy of further high-quality clinical research to provide key evidence-based medicine. External treatment methods of traditional Chinese medicine include rectal suppositories, acupuncture, acupoint application, moxibustion, massage, Chinese medicine retention enema, sitz bath and other treatment methods [36]. Among them, rectal suppositories and acupuncture have more clinical studies, while other treatments have fewer reports in the literature, and their mechanisms of action can be explored in depth. Due to the special anatomical location and physiological characteristics of prostatitis, many oral drugs are difficult to reach the site and play a good drug effect. However, the external treatment of traditional Chinese medicine avoids the first-pass effect of the liver and can well penetrate the capsule to exert its drug effect. It has the advantages of quick effect, few adverse reactions, good user experience, and high patient compliance. However, the current level of relevant research evidence is low, clinical research is rare, and there is a lack of high-quality clinical research evidence. In the future, high-quality RCT and RWS should be carried out as much as possible to provide high-level evidence-based support. In addition, there is a lack of health economic evaluation of traditional Chinese medicine treatment of CP, which affects the recognition and acceptance of the clinical advantages of traditional Chinese medicine treatment of CP by the people and Western medicine colleagues. In the future, this gap should be filled as soon as possible. See Table 3.

Table 3 Points of unmet clinical needs in CP

5 Expert list

The China Association of Traditional Chinese Medicine hosted the 20th Clinical Advantage Disease Conference, and formulated the above suggestions for CP clinical advantage diseases of traditional Chinese and Western medicine. The specific list of participating experts is as follows.

Liu Ping, Chinese Association of Traditional Chinese Medicine

Zhang Xiaoxiao, Chinese Association of Traditional Chinese Medicine

Li Haisong, Dongzhimen Hospital of Beijing University of Chinese Medicine

Yuan Shaoying, Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine

Tang Yuxin, Fifth Affiliated Hospital of Sun Yat-sen University

Fang Zihan, China Biotechnology Development Center

He Rongrong, School of Traditional Chinese Medicine of Jinan University

Qin Zhan, Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine

Wang Bin, Dongzhimen Hospital of Beijing University of Chinese Medicine

Hong Zhiming, Shenzhen Hospital of Traditional Chinese Medicine

Wang Zhigang, First Affiliated Hospital of Guangzhou University of Chinese Medicine

Chen Wangqiang, Zhejiang Provincial Hospital of Integrated Traditional Chinese and Western Medicine

Yang Yijian, Yunnan Provincial Hospital of Traditional Chinese Medicine

Deng Longsheng, Xiamen Hospital of Traditional Chinese Medicine

Peng Jing, First Hospital of Peking University

Zhang Li, First Affiliated Hospital of Anhui Medical University

Wu Zhigang, First Affiliated Hospital of Wenzhou Medical University

Duan Yonggang, Shenzhen Hospital of the University of Hong Kong

Kong Lingbo, Dongzhimen Hospital of Beijing University of Chinese Medicine

Yan Zhanfeng, Dongzhimen Hospital of Beijing University of Chinese Medicine

Conflict of Interest: There is no conflict of interest in this article.

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