Article 97: Examination, Treatment, and Traditional Chinese Medicine Differentiation of Epididymal Tuberculosis and Epididymal Congestion

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Treatment and recuperation of common diseases

Why does epididymal tuberculosis lead to infertility?

Epididymal tuberculosis often presents only as a prominent manifestation of tuberculosis in the reproductive system. The occurrence of epididymal tuberculosis indicates that many parts of the reproductive organs have been affected. The inflammatory response and secretions not only obstruct the vas deferens, but also, due to the effects of toxins, damage the tissues, severely interfering with and disrupting the spermatogenic environment, leading to spermatogenesis disorders.

In addition, tuberculosis of the reproductive system often develops from tuberculosis in other parts of the body (such as renal tuberculosis and pulmonary tuberculosis). It is a local manifestation of systemic tuberculosis. For example, 50% to 70% of patients with renal tuberculosis also have epididymal tuberculosis, and 90% of patients with epididymal tuberculosis also have renal tuberculosis. Moreover, epididymal tuberculosis often affects both testes, which can seriously impair male fertility and cause infertility.

What tests should be done?

1. The total white blood cell count may be normal, but the differential count shows an increase in lymphocytes. An elevated erythrocyte sedimentation rate, increased lymphocytes, and a positive tuberculin skin test are sufficient for diagnosis.

2. Semen analysis reveals a low semen volume, often less than 1.5 ml, decreased sperm count, reduced sperm motility, and the presence of pus cells. The positive rate for Mycobacterium tuberculosis in semen culture or smear is very low.

3. Repeated 24-hour urine sediment smears for acid-fast bacilli can aid in diagnosis.

4. Plain X-ray of the bladder area may occasionally show partial calcification of the prostate.

5. Cystoscopy is helpful in making a definitive diagnosis.

How does Western medicine treat this?

1. Drug treatment: Streptomycin 0.5g, intramuscular injection, twice daily for 2 weeks, then twice weekly at 0.75g each time; isoniazid 0.1g, orally three times daily; sodium para-aminosalicylate 8-12g daily, divided into 3 oral doses. These drugs are generally used for 12-18 months. If the effect is not good, or if there is a response to streptomycin, the following drugs can be used in combination: rifampin 0.3g, twice daily before meals; isoniazid as before; ethambutol 0.25g, orally three times daily.

During treatment, liver-protecting medications, such as multivitamins, can be taken in conjunction with the treatment, and liver and kidney function should be checked regularly.

2. Surgical Treatment: Early-stage epididymal tuberculosis can be cured with medication. If local caseous necrosis is severe, involves the testis, the lesion is large and has formed an abscess, or medication is ineffective, epididymectomy may be performed. If the testis is involved and the lesion is close to the epididymis, the testis may be partially removed along with the epididymis. Every effort should be made to preserve the testis during surgery. After epididymectomy, seminal vesicle and prostate tuberculosis usually heal gradually.

How does Traditional Chinese Medicine differentiate syndromes and treat diseases?

1. Phlegm-Heat Intermingling Type: Symptoms include swelling of the testis and epididymis, hardening of the testes, adhesion to the scrotum, thickening of the vas deferens with nodules, scrotal swelling and pain, dark red skin, tidal fever and flushed cheeks, night sweats, soreness and weakness of the lower back and legs, red tongue with little coating, and thready and rapid pulse.

Treatment principle: Nourish the kidneys, clear heat, resolve phlegm and dissipate nodules.

Prescription: 15g Rehmannia glutinosa, 10g Angelica sinensis, 10g Paeonia lactiflora, 10g Ligusticum chuanxiong, 6g Bupleurum chinense, 10g Scutellaria baicalensis, 10g Alisma plantago-aquatica, 10g Lycium chinense root bark, 10g Citrus reticulata peel, 10g Anemarrhena asphodeloides, 10g Fritillaria thunbergii, 10g Gleditsia sinensis thorns, 10g processed pangolin scales.

2. Phlegm-Cold Accumulation Type: Symptoms include enlarged testes and epididymis with nodules, thickened spermatic cord, painless nodules or mild swelling and pain, varying sizes, thickened vas deferens with nodules, no redness or heat, cold scrotum, pale complexion, aversion to cold and cold limbs, fatigue, clear and copious urine, pale and swollen tongue with teeth marks, white coating, and thready pulse.

Treatment principle: warm the yang and tonify the kidneys, resolve phlegm and dissipate nodules.

Prescription: 30g Rehmannia glutinosa, 15g deer antler glue (melted and taken with water), 5g dried ginger, 6g cinnamon, 6g ephedra, 10g white mustard seed, 10g tangerine seed, 10g lychee seed, 6g licorice.

3. Yin deficiency with exuberant fire type: Symptoms include scrotal swelling, mild tenderness, low-grade fever, night sweats, fatigue, soreness and weakness of the lower back and knees, red tongue with little coating, and thready and rapid pulse.

Treatment principle: Nourish Yin and tonify the kidneys.

Prescription: 15g Rehmannia glutinosa, 12g Cornus officinalis, 12g Dioscorea opposita, 9g Paeonia suffruticosa, 9g Polygonatum sibiricum, 6g Ligustrum lucidum, 6g Polygonum multiflorum, 6g Anemarrhena asphodeloides, 6g Phellodendron chinense, 6g Lycium chinense root bark, 9g Trionyx sinensis, 9g processed pangolin scales, 6g Glycyrrhiza uralensis.

4. Qi and Blood Deficiency Type: Symptoms include induration and ulceration, thin and clear pus resembling bean curd residue, gradually forming a fistula that is difficult to heal over time, pale complexion, aversion to cold and cold limbs, lethargy, pale red tongue with thin white coating, and weak and thready pulse.

Treatment principle: Tonify Qi and nourish blood, resolve phlegm and eliminate dampness.

Prescription: Codonopsis pilosula 15g, Astragalus membranaceus 30g, Atractylodes macrocephala 10g, Poria cocos 10g, Angelica sinensis 10g, Ligusticum chuanxiong 10g, Rehmannia glutinosa 20g, Paeonia lactiflora 10g, Cinnamomum cassia 3g, Glycyrrhiza uralensis 5g.