Penile calculus

　　Etiology and Pathogenesis

　　The anterior vulva is where the tendons converge, and the convergence of the spleen and stomach. When the spleen and stomach fail to transport, turbid phlegm is produced internally, flowing downward to the tendons, and condensing into a mass. In patients with yin deficiency and fire hyperactivity of the liver and kidney, turbid phlegm is prone to transform into heat, and there are symptoms of intermingling of phlegm and heat.

　　Western medicine believes that due to fibrosis between the corpus cavernosum and the white membrane of the penis, normal elastic connective tissue is replaced by glassy变性 or fibrous scar, resulting in the appearance of single or multiple plaques on the dorsal or lateral sides of the penis.

　　Due to the superficial mass formation on the skin of the penis, it can cause sexual difficulties and sexual pain in clinical practice, and forced sexual intercourse can cause the mass of the penis to rupture, forming superficial ulcers. It can cause infection due to local skin damage, usually secondary to weakened physique, or long-term use of immunosuppressants, and patients with onychomycosis and other fungal infections. If there is concurrent bacterial infection, there may be symptoms such as fever, skin swelling, ulceration, and purulent secretion. Severe cases can lead to septicemia, so it should attract the attention of clinical doctors.

　　1. The onset is more common in people over 40 years old.

　　2. The course of the disease is slow, and single or multiple hard nodules or cord-like masses can be felt inside the penis, which are as hard as cartilage and are painful to the touch.

　　3. There is no discomfort in the early stage, but the penis may be painful or curved during erection, affecting sexual intercourse, or there may be local tenderness.

　　4. Severe cases may have impotence, dysuria, or poor urine flow.

　　5. X-ray films can show shadow of penile lesions, and cavernosography can display the condition of the lesions.

　　The etiology of this disease is currently considered to be due to fibrosis between the corpus cavernosum and the white membrane of the penis, causing normal elastic connective tissue to be replaced by glassy变性 or fibrous scar. Plaques appear on the dorsal or lateral sides of the penis. Therefore, it is usually directly related to the formation of scar tissue after penile injury, and patients should avoid excessive violent sexual life to induce penile edema and the formation of scar tissue.

　　Diagnostics
　　1. The onset is more common in people over 40 years old.
　　2. The course of the disease is slow, and single or multiple hard nodules or cord-like masses can be felt inside the penis, which are as hard as cartilage and are painful to the touch.
　　3. There is no discomfort in the early stage, but the penis may be painful or curved during erection, affecting sexual intercourse, or there may be local tenderness.
　　4. Severe cases may have impotence, dysuria, or poor urine flow.
　　Disease Differentiation
　　1. Penile carcinoma: In the early stage, papules, nodules, and warty hard substances appear on the glans penis (commonly seen near the corona glandis), which become like flower petals after ulceration, with foul odor or purulent discharge.
　　2. Penile calculus: Hard nodules from the glans penis to the corona glandis, formed by the sedimentation of smegma and urinary salts, which can be seen as brownish hard nodules at the corona glandis when the prepuce is flipped, and can be wiped off after soaking in salt water.
　　3. Chancre: There is a history of sexual promiscuity, and the penis appears as bean-sized hard nodules that are not painful or溃破, or as pustules, which form circular ulcers after rupture, with purulent discharge, and the bacteria culture of the secretion can detect Ducrey's hemophilus.
　　Related Examinations
　　The diagnosis of this disease can also be based on X-ray examination: penile lesion shadows can be seen, and cavernous body angiography can show the condition of the lesion.

　　1. Turbid Phlegm Coagulation Syndrome

　　1. Main Symptoms

　　Phlegm nodules occur on the lateral side of the penis, and fibrous or plaque-like hard nodules can be felt under the skin, one or more.

　　Generally, it will not溃破.

　　There is no obvious feeling in daily life, but the penis can cause curvature and pain during erection, and in severe cases, it can affect sexual life.

　　2. Treatment Method

　　Internal Treatment: Strengthen the Spleen and Stomach, Dissolve Phlegm and Disperse Masses.

　　External Treatment: Apply Yuzhu Dan or Erbai San mixed with vinegar.

　　External Treatment: Apply Yuzhu Dan or Erbai San mixed with vinegar.

　　3. Medicines

　　Huajian Erchen Decoction (from 'Compendium of Medical Miracles'), and take Xiaojin Tablet concurrently.

　　10 of Chenpi, 10 of Prepared Semen Belenon, 15 of White Fuling, 5 each of Raw Licorice and Chuan Huanglian, 20 of White Silkworm.

　　Second, Yin Deficiency and Phlegm Fire Syndrome

　　1. Main Symptoms

　　The skin on the surface of the hard nodule is slightly red and painful.

　　There may be systemic low fever, dry throat, soreness and weakness in the waist and legs, etc.

　　2. Treatment Method

　　Internal Treatment: Nourish Yin and Reduce Fire, Dissolve Phlegm and Disperse Masses.

　　External Treatment: Same as above.

　　3. Medicines

　　Liuwei Dihuang Wan (from 'Direct Decree of Medicine for Children'), Da Bu Yin Wan (from 'Danxi Xinfa'), and take Xiaonang Wan concurrently.

　　20 of Dihuang, 10 each of Shanyao, Shanyu Rou, Danpi, Fuling, Zexie, and Guiban, 9 each of Zhimu and Huangbai.