Testicular tuberculosis

　　The causes of testicular tuberculosis include kidney and liver deficiency, empty meridians, turbid phlegm invades the kidney, and condenses into turbid phlegm; or yin deficiency and internal heat,虚火上炎，burning essence into phlegm, blocking the meridians, and the intermingling of phlegm and blood stasis. Turbid phlegm for a long time, stagnant and transformed into heat, heat overcomes meat and causes abscesses. If the pus is dripping for a long time, and pus is transformed from Qi and blood, so it can also appear the syndrome of Qi and Yin deficiency, and even Yin damage leads to Yang deficiency, and the manifestations of kidney Yang deficiency appear.

　　Testicular tuberculosis is equivalent to epididymal tuberculosis in Western medicine. Its characteristics are chronic swelling of the affected epididymis, which eventually ulcerates and ruptures, and the pus is thin like sputum, mixed with败絮-like substances, prone to form sinus tracts, and difficult to heal. This disease is prone to complicationsScrotal sinus tract..

　　Testicular tuberculosis often occurs in middle-aged and young adults, with the majority being 20-40 years old. The initial symptoms include a feeling of descent in the scrotum, irregular localized nodules at the tail of the epididymis, which are hard, painful to touch, and often adhere to the scrotal skin. As the course of the disease progresses, chronic cold abscesses may form, and after rupture, the pus is thin and may contain dreg-like fluffy substances, with a strong smell, and is prone to form long-term non-healing scrotal sinus tracts. The vas deferens thickens and hardens, forming multiple nodules in a bead-like pattern. Patients often have symptoms such as restlessness and heat in the five hearts, afternoon fever, night sweats, fatigue, backache, decreased appetite, or cold limbs and aversion to cold, pale complexion, and other systemic symptoms.

　　To prevent testicular tuberculosis, attention should be paid to strengthening physical exercise, improving health level, and paying attention to the prevention and adjustment of tuberculosis. It is forbidden to eat spicy and yin-destroying foods, and appropriate foods that nourish the kidney and yin should be increased, such as turtle, cuttlefish, and foods rich in protein such as eggs, chicken meat, fresh fish, and milk.

　　The diagnosis of testicular tuberculosis, in addition to clinical manifestations, may show red blood cells, white blood cells, and pus cells in the patient's urine routine examination. Erythrocyte sedimentation rate is often increased. The smear of pus can find Mycobacterium tuberculosis, and the culture of pus shows the growth of Mycobacterium tuberculosis.

　　Patients with testicular tuberculosis should avoid spicy and yin-destroying foods, and appropriately increase foods that nourish the kidney and yin, such as turtle, cuttlefish, and foods rich in protein. Patients should eat light and nutritious liquid foods, such as congee, vegetable soup, lotus root starch, egg flower soup, and noodles. Plant oils should be used, and cooking methods such as boiling, steaming, cold dishes, roasting, braising, and stewing should be adopted as much as possible.

　　Deficient patients with turbid phlegm congealing are seen in the early stage of hardening. The renal testicle is acid,胀painful and hard, the spermatic cord appears as a cord-like swelling and hardness; there are no obvious systemic symptoms; thin fur and slippery pulse.

　　Differential Diagnosis and Analysis::Deficiency of Liver and Kidney,空虚of collaterals, turbid phlegm attacks and descends, congeals in the renal testicle, collaterals are blocked, hence the acid,胀pain and hidden pain in the renal testicle, hard nodes in the scrotum, the spermatic cord appears as a cord-like swelling and hardness; in the early stage of the disease, it is only local, hence there are few systemic symptoms; thin fur and slippery pulse are signs of turbid phlegm congealing.

　　Treatment Method::Warming the meridians and collaterals, resolving phlegm and dissipating nodules.

　　Herbal Medicine::Add or subtract the Yang He decoction, and take Xiao Jindan together.

　　Deficient patients with testicular phlegm and formation of pus are seen in the middle stage of suppuration. After several months or a year, the renal testicle necroses and suppurates, the renal testicle is adhered to the scrotal skin, the scrotum becomes red, swollen, and painful; it may be accompanied by low fever, night sweats, fatigue, red cheeks, emaciation; red tongue with little fur and fine, rapid pulse.

　　Differential Diagnosis and Analysis::With the phlegm and dampness lingering for a long time, it transforms into heat, heat胜meat rot, hence the renal testicle necrosis and suppuration; involving the scrotum, hence the redness, swelling, and pain of the scrotum; heat is a Yang pathogen, burning the Yin and blood, leading to Yin and kidney deficiency, endogenous虚heat, hence the possible accompaniment of low fever, red cheeks, emaciation, fatigue; deficient heat forcing body fluid to excrete externally, hence night sweats; red tongue with little fur and fine, rapid pulse are signs of Yin deficiency and endogenous heat.

　　Treatment Method::Nourish Yin and clear heat, eliminate dampness and phlegm, with the assistance of Tuo Pus and detoxifying.

　　Herbal Medicine::Herbal decoction for nourishing Yin and eliminating dampness, combined with modified Tuo Pus powder.

　　Deficient patients with testicular phlegm and formation of fistula are seen in the late stage after ulceration. After the pus breaks through the scrotum, thin pus is discharged, containing degenerated cotton-like substances, the wound is concave, a fistula is formed, healing is slow, or even if healed, it recurs frequently, and the whole body remains with a deficient heat that does not subside; with the disease lasting for a long time, the complexion becomes pale, the limbs are cold, the lower back and knees are sore, impotence or infertility; pale tongue with white fur and deep, fine pulse.

　　Differential Diagnosis and Analysis::Deficiency of Qi and blood, hence the pus is thin and contains degenerated cotton-like substances, the wound is concave; due to insufficient blood, it is difficult to regenerate muscle and close the wound, so the healing is slow and a fistula is formed; with the body's Qi being weak, pathogenic factors are easy to attack, so even if it is healed, it may recur; deficiency of blood and Yin leads to inability to control Yang, hence the whole body remains with a deficient heat that does not subside; with the disease lasting for a long time, Yin damage leads to Yang deficiency, warmth is lost, and movement is weak, hence the pale complexion, cold limbs, soreness in the lower back and knees, impotence or infertility; pale tongue with white fur and deep, fine pulse are signs of insufficient blood and Yang deficiency.

　　Treatment Method::Tonify Qi and nourish blood, warm the kidney-yang.

　　Herbal Medicine:Add or subtract the herbal formula for congenital large testicle, and take Xiao Jindan together.