Article 46: Chronic Renal Failure (Yang Deficiency and Yin Excess Syndrome) and Benign Prostatic Hyperplasia (Bladder Damp-Heat and Blood Stasis Obstruction Syndrome)

II. Yang deficiency and Yin excess

The clinical manifestations of this syndrome include persistent and recurrent edema, pale and ashen complexion, fatigue, dizziness, nausea and vomiting, loss of appetite, abdominal distension, aversion to cold, lethargy, decreased libido, impotence, decreased urination or even anuria, loose stools, pale and swollen tongue with teeth marks on the edges, white and greasy tongue coating, and a deep and thready pulse. Treatment should focus on warming and tonifying the spleen and kidneys, and eliminating turbidity and rebellious qi. Formulas such as Wenpi Tang and Wuling San can be used.

1. Warming Spleen Decoction

Source: Qianjin Fang (Prescriptions Worth a Thousand Pieces of Gold).

Composition: 12g rhubarb (added later), 6g red ginseng, 6g prepared licorice root, 6g dried ginger, 10g prepared aconite root.

Usage: Grind the above-mentioned herbs into coarse powder, add 800 ml of water, first decoct ginseng, licorice, ginger, and aconite, then add rhubarb when the decoction is almost ready, and decoct to obtain 300 ml of liquid. Take the decoction in two divided doses while warm.

Functions: Warms and tonifies spleen yang, and purges cold accumulation. Used to treat chronic renal failure with yang deficiency and cold accumulation, characterized by constipation, abdominal pain, cold hands and feet, impotence, and a deep, wiry pulse.

Note: In this formula, aconite and dried ginger warm the yang and dispel cold, red ginseng and licorice invigorate qi and tonify the spleen, and rhubarb clears away stagnation. Experimental studies have shown that rhubarb, rhein, and emodin all have diuretic effects, increasing urine output and promoting ureteral peristalsis after administration, while also significantly increasing the sodium and potassium content in the urine.

2. Wu Ling San

Source: Practical Prescriptions for Urogenital Diseases.

Composition: 15g cinnamon twig, 12g atractylodes macrocephala, 12g alisma plantago-aquatica, 12g polyporus umbellatus, 12g poria cocos.

Usage: One dose per day, decocted twice with water, taken warm in the morning and evening.

Functions: Promotes qi circulation and diuresis. Used to treat early-stage renal insufficiency due to spleen yang deficiency and water retention, with symptoms such as edema, heaviness of the body, scanty and cloudy urine, and a white and greasy tongue coating.

Notes: In this formula, cinnamon twig invigorates yang and promotes qi circulation, atractylodes macrocephala strengthens the spleen and promotes diuresis, while poria cocos, polyporus umbellatus, and alisma plantago-aquatica promote diuresis and eliminate dampness. Experimental studies have reported that cinnamon twig has a diuretic effect. Atractylodes macrocephala has a significant diuretic effect in dogs, rabbits, and rats, and promotes the excretion of electrolytes, especially copper. Alisma plantago-aquatica has a significant diuretic effect, increasing the excretion of urea and sodium chloride, and lowering blood pressure. Poria cocos extract and its compound preparations have significant diuretic effects, similar in strength to mercuric chloride. However, some experiments have failed to prove the diuretic effect of poria cocos. Polyporus umbellatus decoction has a significant diuretic effect, with a diuretic strength higher than caffeine, akebia stem, and poria cocos. While increasing urine volume, it also increases the excretion of sodium, potassium, and chloride ions. Its diuretic mechanism may be the inhibition of renal tubular reabsorption of electrolytes and water. Clinical studies have reported that this formula was used to treat 20 cases of early-stage renal insufficiency, with 6 cases showing significant improvement, 8 cases showing improvement, and a total effective rate of 70%.

Benign prostatic hyperplasia (BPH) is a common disease in men over 50 years of age. Mild cases may be asymptomatic. Early symptoms typically include frequent urination, followed by nocturia, slowed urine flow, difficulty urinating, and residual urine. When complicated by infection, burning and urgency may occur during urination.

Increased residual urine can lead to complete urinary retention. When combined with bladder stones, it can cause terminal hematuria and dysuria. A digital rectal examination can confirm the diagnosis, and ultrasound can assist in diagnosis and assess the amount of residual urine. Asymptomatic individuals without residual urine do not require treatment.

For patients with less than 60 ml of residual urine, intermittent catheterization or indwelling catheterization can be used, and alpha-blockers and alpha-reductase inhibitors are effective. If the residual urine volume exceeds 60 ml, and there are recurrent acute urinary retention, gross hematuria, urinary tract infections, bladder stones, or diverticula, surgical treatment should be considered.

Benign prostatic hyperplasia (BPH) can cause posterior urethral obstruction and urinary retention, making patients prone to urinary tract infections. This can lead to congestion and edema of local tissues and organs, resulting in pain and discomfort during penile erection and ejaculation, thus affecting normal sexual activity. Prolonged pain and discomfort can cause psychological stress, even depression and anxiety, leading to decreased libido and even sexual dysfunction.

Meanwhile, some patients require surgical treatment due to urinary dysfunction. According to literature reports, surgery causes erectile dysfunction in 4% to 30% of patients due to damage to the neurovascular function of penile erection. The incidence of erectile dysfunction after perineal prostatectomy is 29%; after suprapubic prostatectomy it is 16%; and after transurethral prostatectomy it is only 4.5%.

Traditional Chinese medicine believes that benign prostatic hyperplasia (BPH) is generally caused by dysfunction of the triple burner's qi transformation, leading to phlegm-dampness and blood stasis. For cases of excess, the treatment principle is to clear heat and resolve stagnation, invigorate blood and promote qi circulation; for cases of deficiency, the treatment principle is to tonify the kidneys and nourish yin, replenish qi and open the orifices. Common syndromes in BPH complicated with decreased sexual function include bladder damp-heat, turbid blood stasis, kidney yin deficiency, and spleen and kidney qi deficiency.

I. Damp-heat in the bladder

The clinical manifestations of this syndrome include scanty, dark yellow urine, dribbling, cloudy terminal urine, or white mucus discharge from the urethra during defecation; lower abdominal distension; bitter and sticky taste in the mouth; thirst without desire to drink; restlessness; constipation; impotence and premature ejaculation; red tongue with a yellow and greasy coating; and a slippery and rapid pulse. Treatment should focus on clearing heat and dampness, and promoting bladder function. Formulas such as Sanzi Erke Tongguan Decoction, Hantong Decoction, and Niuxi Decoction can be used.

1. Three Seeds and Two Shells Clearing the Gate Soup

Source: Shanghai Journal of Traditional Chinese Medicine, 1991;4:18.

Composition: 15g of Malva verticillata seeds, 15g of Kochia scoparia seeds, 10g of Vaccaria segetalis seeds, 20g of clam shells, 15g of Citrus aurantium shells, and 5g of cinnamon (added later).

Usage: One dose daily, decocted twice with water, taken warm in the morning and evening. One course of treatment is 4 weeks. After the condition stabilizes, switch to intermittent medication, 2-3 doses per week.

Functions: Clears damp-heat, removes blood stasis and eliminates accumulations. Used to treat benign prostatic hyperplasia in the elderly with internal damp-heat and blood stasis, manifested as difficulty urinating, constipation, and impotence.

Note: In this formula, Malva verticillata seed, Kochia scoparia fruit, and Vaccaria segetalis seed promote urination and relieve strangury; Citrus aurantium fruit breaks up qi stagnation and eliminates accumulations; Clam shell softens hardness and disperses nodules; and Cinnamomum cassia warms yang and promotes qi circulation. Clinical research reports that this formula was used to treat 43 cases of benign prostatic hyperplasia. Short-term efficacy: clinical control in 22 cases, symptom relief in 16 cases, and no effect in 5 cases, with a total effective rate of 88.4%.

2. Han Tong Tang (a traditional Chinese medicine formula)

Source: Records of Integrating Chinese and Western Medicine

Composition: 30g talc (wrapped and decocted), 30g raw white peony root, 24g anemarrhena rhizome, 24g phellodendron bark.

Usage: One dose per day, decocted twice with water, taken warm in the morning and evening.

Functions: Clears damp-heat. Used to treat benign prostatic hyperplasia due to damp-heat accumulation in the lower abdomen and impaired bladder qi transformation, with symptoms such as difficulty urinating, dribbling, burning pain, and urinary discomfort.

Note: Talc in this formula promotes urination and relieves strangury; Anemarrhena asphodeloides and Phellodendron chinense clear heat and dry dampness; Paeonia lactiflora nourishes yin and blood. Clinical studies have shown that Phellodendron chinense is significantly effective in treating chronic prostatitis in the elderly.

3. Achyranthes bidentata soup

Source: "A Collection of Effective Prescriptions for Andrology in Ancient and Modern China".

Composition: 1 handful of raw Achyranthes bidentata root and leaves, 15 grams of Scutellaria baicalensis, and 30 grams of roasted Angelica sinensis.

Usage: One dose per day, decocted twice with water, taken warm in the morning and evening.

Functions: Clears heat, promotes diuresis, and invigorates blood circulation. Used to treat benign prostatic hyperplasia due to pathogenic heat obstructing the meridians and impairing qi transformation, with symptoms such as dribbling or even complete urination, and painful urination of the penis.

Note: In this formula, Achyranthes bidentata promotes urination and relieves strangury, Scutellaria baicalensis clears heat and dries dampness, and Angelica sinensis nourishes and invigorates blood.

II. Stagnation and Obstruction

The clinical manifestations of this syndrome include urinary obstruction, dribbling, or a thin urine stream; lower abdominal distension and pain; enlarged, hard, and tender prostate; depression or irritability; impotence; a purplish-dark tongue with petechiae; and a choppy or wiry pulse. Treatment should focus on promoting blood circulation, removing turbidity, and facilitating urination. Formulas such as Achyranthes bidentata extract, Wentong Decoction, and Zhibai Kuncao Decoction can be used.

1. Achyranthes bidentata ointment

Source: The Complete Collection of Chishui Xuanzhu.

Composition: 120g of Achyranthes bidentata (without the root tip, soaked in wine overnight), 30g of Prunus persica (without the skin and tip, stir-fried), 60g of Angelica sinensis (with wine washed), 45g of Paeonia lactiflora, 45g of Rehmannia glutinosa (with wine washed), and 15g of Ligusticum chuanxiong.

Usage: Add 1500 ml of water to the above medicines and simmer over charcoal until reduced to 200 ml. Add a small amount of musk and take in 4 divided doses on an empty stomach.

Functions: Resolves blood stasis and promotes urination. Used to treat benign prostatic hyperplasia (BPH) with symptoms of blood stasis and impaired qi transformation, such as difficulty urinating, dribbling, and constipation.

Note: In this formula, Achyranthes bidentata promotes urination and relieves strangury; Prunus persica, Angelica sinensis (tail), Paeonia lactiflora, and Ligusticum chuanxiong invigorate blood and remove blood stasis; and Rehmannia glutinosa nourishes yin and blood.

2. Warming and invigorating decoction

Source: Records of Integrating Chinese and Western Medicine

Ingredients: 24g of stir-fried and crushed pepper seeds, 24g of stir-fried and crushed fennel seeds, 10g of clematis root, 5g of cinnamon (added later), 10g of aconite root (decocted first), and 10g of dried ginger.

Usage: One dose per day, decocted twice with water, taken warm in the morning and evening.

Functions: Dispels cold, clears the orifices, and promotes urination. Used to treat benign prostatic hyperplasia due to cold in the lower abdomen and impaired qi transformation, with symptoms such as dribbling urination, or even complete urination, lower abdominal distension and pain, and impotence.

Note: In this formula, pepper is used to promote diuresis and reduce swelling; fennel, cinnamon, aconite, and dried ginger are used to warm and invigorate yang qi, dispel cold and relieve pain; and clematis is used to unblock the meridians and relieve pain.

3. Zhi Bai Kun Cao Decoction

Source: "A Collection of Effective Prescriptions for Andrology in Ancient and Modern China".

Composition: 20g of Phellodendron bark, 20g of Anemarrhena rhizome, 20g of Achyranthes root, 30-50g of Salvia miltiorrhiza root, 15g of prepared rhubarb, and 50g of Leonurus root.

Usage: One dose per day, add 1000 ml of water, decoct to 200 ml, and take in the morning and evening.

Functions: Nourishes Yin and clears heat, invigorates blood and dissipates stagnation. Used to treat benign prostatic hyperplasia due to deficiency of kidney Yin and internal accumulation of blood stasis, with symptoms such as dribbling urination, irritability, insomnia, night sweats, seminal emission, and constipation.

Note: The formula contains Anemarrhena asphodeloides and Phellodendron chinense to nourish Yin and clear heat, and Achyranthes bidentata, Salvia miltiorrhiza, Rheum palmatum, and Leonurus japonicus to invigorate blood and remove blood stasis. Clinical studies have reported that this formula was used to treat 80 cases of benign prostatic hyperplasia. Of these, 15 cases took the medication for 1-2 weeks, 51 cases for 2-4 weeks, and 14 cases for more than 4 weeks. All patients with urinary retention underwent indwelling catheterization. Patients with concurrent urinary tract infections were treated with oral nalidixic acid, nitrofurantoin, or intramuscular gentamicin. Results: 43 cases showed significant improvement, 22 cases showed improvement, 4 cases showed slight improvement, and 11 cases showed no improvement, with a total effective rate of 86.3%.

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