Chronic bacterial prostatitis

　　The main pathogenic factor of chronic bacterial prostatitis is the retrograde infection of pathogens, with Staphylococcus species being the main pathogens, followed by Escherichia coli, Corynebacterium species, and Enterococcus species, etc. Prostatic calculi and urine reflux may be important reasons for the persistence of pathogens and the recurrence of infection.

　　Recurrent urinary tract infection is a characteristic of chronic bacterial prostatitis. Although the symptoms and signs of urinary tract infection can be rapidly eliminated after the bacteria in the urine are killed during appropriate antibacterial treatment, the same kind of infection caused by the same bacteria is prone to recur after a period of time. This is because although the bacteria in the urine are completely killed, the pathogenic bacteria in the prostate remain unchanged, as most antibiotics are difficult to penetrate into the prostatic fluid. Therefore, after the treatment is completed, the bacteria still remain in the prostate, which will eventually lead to re-infection of the urinary tract.

　　Ascending upper urinary tract infection and bacterial epididymitis may also be complications of chronic bacterial prostatitis. It can also form infectious prostatic calculi and lead to drug-resistant chronic infection. Sometimes, chronic bacterial prostatitis may be complicated by bladder neck stenosis, leading to bladder urethral obstruction, but it is not clear whether there is a causal relationship between them.

　　The symptoms of chronic bacterial prostatitis are diverse, and the severity varies greatly. Some may have no symptoms at all, while others may feel uncomfortable all over. The common symptoms are roughly in the following aspects.

　　1. Urinary discomfort

　　Bladder irritation symptoms may occur, such as frequent urination, burning sensation during urination, pain that radiates to the head of the penis, and there may be mucus and other secretions at the urethral opening in the morning. There may also be a feeling of difficulty in urination.

　　2. Local symptoms

　　There is a feeling of坠胀不适 in the posterior urethra, perineum, and anal area, and the pain increases when squatting, defecating, or sitting for a long time on chairs and stools.

　　3. Radiating pain

　　The pain of chronic prostatitis is not limited to the urethra and perineum, but it will also radiate to the nearby areas. Lower back pain is the most common, and other areas such as the penis, testicular scrotum, lower abdomen, inguinal area (the root of the thigh), thigh, rectum, etc. may also be affected. It should be pointed out that the lower back pain caused by chronic prostatitis, although it is easy to confuse with back pain caused by orthopedic reasons such as myofascialitis and lumbar muscle strain, is usually higher than the latter, which is near the belt, and can be distinguished.

　　4. Sexual dysfunction

　　Chronic prostatitis can cause a decrease in libido, painful ejaculation, and premature ejaculation, and it can also affect the quality of seminal fluid. There may also be whitish discharge from the urethral opening after urination or defecation, and blood in the semen may occur when combined with seminal vesiculitis.

　　5. Other symptoms

　　Chronic prostatitis can be complicated with neurasthenia, showing symptoms such as fatigue, dizziness, insomnia, etc.; long-term persistent prostatitis can even cause body hypersensitivity reactions, leading to conjunctivitis, arthritis, and other lesions.

　　Because the predisposing factors have not been determined, the prevention of chronic bacterial prostatitis is relatively difficult. Normal prostatic fluid contains zinc elements, which is a powerful antibacterial factor. In patients with chronic bacterial prostatitis, the zinc content in the prostatic fluid is significantly reduced. Some authors believe that this antibacterial factor in male prostatic fluid is a natural defense mechanism against ascending infection of the reproductive and urinary systems. However, oral administration of zinc elements to male patients cannot stimulate an increase in the zinc content of prostatic fluid. It is necessary to actively treat acute bacterial prostatitis and prevent the occurrence of chronic bacterial prostatitis. Strict aseptic techniques should be adopted during transurethral instrument examination and catheterization to prevent iatrogenic prostatic abscess infection.

　　Patients with chronic bacterial prostatitis are generally acute prostatitis that has not been cured or prolonged, and generally require blood counts and B-ultrasound examinations.

　　1. Laboratory examination

　　In the absence of acute epididymitis or acute exacerbation of chronic infection, blood counts are generally normal, with no elevated white blood cells, and a large number of inflammatory cells can often be found in the prostatic massage fluid. When secondary cystitis is present, the middle urine may be purulent and bacterial, with the pathogenic bacteria being consistent with the pathogenic bacteria of the infected prostate. When the urine itself is infected, collecting segmented urine and prostatic massage fluid for bacterial culture can determine the source of the pathogenic bacteria. The specimens are injected into the culture medium for culture for 24-48 hours, and the standard microbiological examination methods are used to identify the growth of various bacteria. When the bladder specimens (middle urine) are sterile or basically sterile, the colony count of other specimens is compared to determine the site of infection. If the colony count of the urethral specimens (initial urine) is greatly exceeded (at least 10 times) than that of the prostatic specimens, the infection is located in the urethra, otherwise, the infection originates from the prostate.

　　2. X-ray, B-ultrasound examination

　　Excluding various complications (such as prostatic calculi, prostatic hypertrophy, urethral stricture, kidney infection, etc.), excretory urography is normal.

　　3. Instrument examination

　　Cystoscopy or urethroscopy may show no abnormalities, or find the prostatic urethra congested and edematous, with or without inflammatory polyps. These manifestations are not unique to chronic bacterial prostatitis and can also exist in other prostatitis.

　　In the dietary therapy for chronic bacterial prostatitis patients, mung bean curd stewed with loach fish can be chosen. Each time, 500 grams of live loach fish and 250 grams of fresh tofu can be selected, with an appropriate amount of salt, ginger, and monosodium glutamate. When making it, first cut the loach fish open, remove the gills and internal organs, wash it clean, then put it into a stewing bowl and add an appropriate amount of salt, ginger, and clear water. First, boil it with strong fire, then simmer it with low fire until it is five degrees of maturity, and then add tofu blocks into the stewing bowl, and simmer it with low fire until the loach fish meat is tender, and add seasonings to eat with meals.

　　Western medicine treatment of chronic bacterial prostatitis is a routine method

　　First, differential diagnosis and treatment. The treatment of chronic bacterial prostatitis is based on removing blood stasis and eliminating turbidity, or supplemented with clearing heat and detoxifying, promoting diuresis and removing dampness, or promoting qi flow and guiding retention, or promoting Yin, or warming Yang. Clearing heat and removing dampness, and removing blood stasis and eliminating turbidity are the principles of treatment for this disease. In clinical treatment, according to the condition of differential diagnosis, it can be mainly clearing heat and removing dampness, or mainly activating blood circulation and removing blood stasis, or mainly eliminating turbidity. With a long course of disease, there may also be mixed symptoms of cold and heat, or injury to Yin or Yang, and treatment needs to use both cold and heat herbs, add Er Zhi Wan for Yin injury, and add Guizhi and Rou Gui for Yang injury.

　　(One) Damp-heat syndrome

　　The treatment method is to clear heat, detoxify, remove dampness, and eliminate turbidity. The prescription includes modified Cheng Shi Bai Xie Fen Qing Yin. Huang Bai is used to clear heat, detoxify, and dry dampness; Bai Xie and Plantago asiatica clear and benefit damp-heat; Rhizoma Acori tatarinowii removes dampness and eliminates turbidity; Salvia miltiorrhiza cools blood and activates blood circulation. Added are Polygonum cuspidatum, Patrinia scabiosaefolia, Spatholobus suberectus, and Lonicera japonica to clear heat, detoxify, activate blood circulation, and dissipate boils, which help clear damp-heat in the prostate and promote blood circulation. Rhizoma Smilacis glabra and Equisetum hyemale help clear heat, detoxify, and drain dampness, which help eliminate damp-heat from the urinary tract without flowing into the prostate, and the damp-heat in the prostate also has a way out, that is, from the urinary tract. For constipation, add Rhubarb; for those with significant stabbing pain, add Persica, Paeonia lactiflora, and Bubalus bubalis cornu to remove blood stasis; for those with dry mouth, combine Talcum, which can nourish Yin and produce body fluid, and remove blood stasis and eliminate turbidity.

　　(Two) Blood stasis syndrome

　　The treatment method is to remove blood stasis and eliminate turbidity, soften hardness and disperse nodules. The prescription includes modified Fu Yuan Huo Xue Tang. Rhubarb (usually prepared rhubarb), Bubalus bubalis cornu, Persica, Carthamus, Angelica sinensis are used to remove blood stasis, unblock collaterals, soften hardness, and disperse nodules, and Bubalus bubalis cornu has the function of eliminating turbidity. To enhance the power of eliminating turbidity and restore the secretion function of the gland, add Semen Benincasa, Fritillaria thunbergii, Spatholobus suberectus, Patrinia scabiosaefolia, and they also have the effect of clearing heat and detoxifying. Bupleurum chinense guides the drugs into the liver meridian, relieves liver depression, and unblocks collaterals; Talcum clears blood stasis and heat, and eliminates turbidity. For those with prostatic nodules, combine Guizhi Shao Yao Wan with Hirudo and Ophiopogon japonicus to remove blood stasis and eliminate hardness; for those with significant stabbing pain, add San Qi powder; for those with significant urinary tract pain, add Ammonium succinate; for those with depression, add Os Draconis and Conus, or alternate with Chai Hu Jia Long Gu Mu Li Decoction, or take Antelope horn powder appropriately.

　　(Three) Mixed cold and heat syndrome

　　The treatment method combines cold and heat, removing blood stasis and eliminating turbidity. The prescription includes modified Yi Yi Fu Zi Bai Jie San. Coix seed is used to benefit moisture and eliminate turbidity, Aconitum carmichaelii to promote yang and transform qi, and Patrinia scabiosaefolia to clear heat, detoxify, and remove blood stasis and turbidity. Added are Lonicera japonica, Taraxacum mongolicum, Rhizoma Smilacis glabra, Salvia miltiorrhiza, Paeonia lactiflora, Angelica sinensis, and Uncaria rhynchophylla to clear heat, detoxify, nourish blood, and activate blood circulation; Semen Benincasa, and Bubalus bubalis cornu to remove blood stasis and eliminate turbidity. For those with Yin deficiency, add Er Zhi Wan; for those with Yang deficiency, add Cinnamomum cassia and Aconitum carmichaelii to warm and reinforce the life gate and promote blood circulation; for those with significant pain, combine Fu Yuan Huo Xue Tang or add San Qi powder; for those with severe depression, treat the superficial symptoms first, using Chai Hu Jia Long Gu Mu Li Decoction, Bai He Di Huang Decoction, Hou Po Ban Xia Decoction, Gan Mai Da Zao Decoction, Si Ni Powder, etc., for differentiation and treatment. After the depression is relieved, treat prostatitis.

　　二、单方验方治疗

　　1、三七粉3g，每日2次。适宜阴部刺痛的慢性前列腺炎。

　　2、琥珀粉1.5g，每日2次，适宜尿道涩痛、灼热的慢性前列腺炎。

　　3、当归10g、浙贝母10g、苦参10g、滑石15g，每日1剂，煎服2次。适宜尿道灼热，易流分泌物的慢性前列腺炎。该方系《金匮要略》当归贝母苦参丸加滑石治男子小便不利。

　　Second, single prescription treatment

　　1, Panax notoginseng powder 3g, taken twice a day. Suitable for chronic prostatitis with soreness and pain in the genital area.

　　2, Angelica sinensis 10g, Fritillaria thunbergii 10g, Sophora flavescens 10g, Talcum 15g, decoct and take twice a day. Suitable for chronic prostatitis with urinary burning and easy to secrete secretions. This formula is based on the formula 'Angelica Sinensis and Fritillaria Decoction' in 'Jin Gui Yao Lue' adding Talcum to treat male difficulty in urination.

　　3, Cinnamomum cassia 10g, Poria 10g,芍药 15g, Moutan bark 10g, peach kernel 10g, decoct and take twice a day. Suitable for chronic prostatitis with hard prostatic texture. According to Japanese traditional Chinese medicine research, this formula has a good effect on improving the local congestion of the prostate.

　　1, Hot water sitz bath, water temperature 42℃～43℃, once or twice a day, for 20 minutes each time. But not for those who have not given birth.

　　2, TDP treatment for the perineum, once a day.

　　3, Electroiontophoresis of traditional Chinese medicine in the rectum.

　　4, Acupuncture of the perineum acupoint with laser beam.

　　1, Wild chrysanthemum suppository 1粒, inserted into the anus, once a day, for 3 consecutive days. Suitable for chronic prostatitis with anal swelling and pain.

　　2, Dandelion 30g, Viola yedoensis 30g, Smilax glabra 30g, Spatholobus suberectus 30g, Sparganium stoloniferum 10g, Curcuma phaeocaulis 10g, Gleditsia sinensis 10g, decoct the medicine first and then soak in water. Suitable for chronic prostatitis with hard prostatic texture.