Understanding Chronic Prostatitis Through The Lens Of TCM And The Internal Abscess (Nei Yong) Theory
Nov 20, 2025
Abstract: Chronic prostatitis is a common and frequently occurring disease in the field of andrology. Its etiology is complex, the symptoms are diverse, the course of the disease is long, and easy to repeat, compared with the traditional western medicine treatment, the use of TCM thinking syndrome differentiation treatment has obvious advantages. Professor Wang Wanchun believes that chronic prostatitis can be "internal carbuncle" treatment, the incidence of kidney deficiency, spleen deficiency as the basis, humidity, heat, stasis, poison as the standard, which happens to coincide with the etiology of internal carbuncle. Therefore, Professor Wang Wanchun put forward chronic prostatitis "new disease is more solid, through the treatment of symptoms; Long illness more than deficiency, fill the root of the treatment idea. From the theory of "internal carbuncle", the author analyzed the theoretical basis and advantages of Professor Wang Wanchun's use of "support" method to treat chronic prostatitis.
Key words: chronic prostatitis; Tofa; Internal carbuncle; Clinical experience
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Chronic prostatitis (CP) is primarily characterized by urinary dysfunction and pelvic pain, which, in more severe cases, can significantly affect a patient's quality of life and mental well-being. It occurs predominantly in young and middle-aged men. Epidemiological studies estimate that up to 50% of men may experience symptoms associated with prostatitis at some point in their lives. In China, approximately 8.4% of men aged 15–60 exhibit signs of prostatitis.
The etiology of CP is believed to be multifactorial, involving lifestyle, sexual habits, and psychological stress. From the perspective of Western medicine, treatment typically focuses on symptom relief through oral medications such as α-blockers, NSAIDs, and anticholinergics, which can provide short-term relief. However, recurrence is common, and long-term use often leads to side effects such as gastrointestinal discomfort. Studies show that only 34.9% of patients are satisfied with conventional treatments.
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In contrast, Traditional Chinese Medicine (TCM) emphasizes a holistic approach, addressing imbalances in the spleen, kidney, liver, and bladder. Treatments are guided by syndrome differentiation involving patterns such as damp-heat, qi stagnation, blood stasis, and deficiency of vital qi, and have shown promising efficacy in improving clinical symptoms. TCM has therefore become a major therapeutic option for CP in clinical practice.
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1. Etiology and Pathogenesis of CP in TCM: A Perspective Based on the "Internal Abscess" Theory
1.1 TCM Understanding of Chronic Prostatitis
Though ancient TCM texts do not describe chronic prostatitis explicitly, its clinical manifestations and pathogenesis align it with traditional categories such as "Stranguria (Lin Zheng)", "Turbid Semen (Jing Zhuo)", and "White Turbidity (Bai Zhuo)".
According to TCM theory, the root causes involve deficiency of righteous qi, disharmony of qi and blood, and invasion of pathogenic factors. The condition typically affects sexually active men and is closely linked to internal organ functions.
Liver governs the smooth flow of qi and is prone to transforming into fire when in excess.
Kidney shares a common source with the liver. Suppressed sexual desire or excessive indulgence can lead to kidney fire and qi stagnation.
Spleen governs transformation and transportation, and dislikes dampness. A diet rich in spicy, greasy food generates damp-heat, which sinks into the lower jiao, obstructing the seminal chamber and causing qi and blood stagnation.
Bladder, responsible for fluid metabolism, is vulnerable to external pathogens disrupting its qi transformation function.
Modern TCM scholars largely agree that the pathogenesis of CP is complex, involving a mix of excess and deficiency. Deficiency may manifest as kidney qi deficiency, spleen-kidney yang deficiency, or yin deficiency with internal heat. Excess patterns are often related to dampness, heat, blood stasis, toxins, and obstruction. Although the disease site is primarily the seminal chamber (jing shi), it implicates multiple internal organs.
Professor Wang Wanchun, a renowned TCM physician from Jiangxi Province and a mentor in China's national TCM heritage program, integrates classical theory with modern understanding. He proposes that CP often arises from kidney qi deficiency, spleen weakness, liver qi stagnation, and invasion of internal or external pathogens.
1.2 CP and the "Internal Abscess (Nei Yong)" Theory
The concept of "Nei Yong" (internal abscess) refers to suppurative conditions within the internal organs. The term originates from ancient texts such as the Ling Shu and Zhu Bing Yuan Hou Lun, which describe it as a result of dietary irregularities, exposure to cold, and pathogenic invasion, leading to blood stasis, qi obstruction, and eventually accumulation of heat and suppuration.
This pathogenesis mirrors that of chronic prostatitis in TCM, which is characterized by damp-heat accumulation, seminal stasis, and transformation into pus due to prolonged heat. Both conditions share the core pathology of qi and blood stagnation, local blockage, and transformation of stasis into heat and eventually pus.
From a modern medical standpoint, CP may result from microbial infection, immune dysfunction, neurological imbalance, or urinary reflux into the prostate. Due to the anatomical complexity of the prostate-situated between the bladder and rectum-it is prone to fluid retention, inflammation, and poor drainage, leading to obstruction of local microcirculation and subsequent disease progression.
Similarly, internal abscesses in Western medicine are associated with vascular reactions to bacterial toxins, also leading to poor drainage and local circulatory disorders. Thus, the inflammatory basis and microcirculatory impairment are shared pathological features in both paradigms.
Clinically, CP may present with congestion, edema, acinar necrosis, and pus discharge, which correlate with TCM descriptions of swelling, pain, and pus formation ("Chuang Yang"). This suggests that diagnostic and treatment strategies from TCM external medicine (Yang Ke) may also be applicable to CP.
Professor Wang observes that the prostate resides deep in the lower jiao, in a narrow space between the bladder and rectum, making it vulnerable to dampness, heat, and blood stasis. The disease course, pathogenesis, and progression of CP closely resemble that of internal abscesses, providing a strong theoretical foundation for applying the "Tu" (draining and supporting) method in treatment.
