The prostate is a subsidiary gland organ in male genitourinary system.It is adjacent to the Seminal Vesicles, Vas Deferens, urethra, bladder and rectum, so chronic prostatitis often follows after infections of other genitourinary organs and prostatitis often comes with Seminal Vesiculitis. Because urethra is connected to the outside, bacteria could easily penetrate to the prostate through urethra and cause infection. Negligence of genital sanitation, indulgences on sex, stones of genitourinary organs, piles and abscess around anus could spread the infections to the prostate. Even the infection of the prostate has been cured in time, there are still threats of recurrences because its neighbors are not so friendly.
  Prostatitis is an inflammation of the prostate gland that is usually caused by a bacterial infection that has spread from another part of the body. Prostatitis can develop suddenly as with acute prostatitis, or gradually build up over an extended period of time as with chronic prostatitis.

  Acute prostatitis develops suddenly and is generally caused by a bacterial infection of the prostate brought on by e coli, certain sexually transmitted diseases or sexual contact with an infected person, a urinary tract infection, urethritis, epididymitis, urethral instrumentation, trauma, bladder outlet obstruction, or an infection elsewhere in the body. Acute prostatitis is more common in men aged 20-35, men with multiple sex partners and men who engage in high-risk sexual behaviors.

  It is normal that bacteria live in penis urethra and the membranous urethra. Normally, they could also live in the prostate. A portion of chronic prostatitis is nonbacterial; for example, Chlamydia, Mycoplasma, virus, yeast or autoimmune diseases could be one of the causes. If treated by antibiotics, patients' health will be impaired and it could take a long time without a permanent cure. Some of the patients develop tiny calculus in the prostate and couldn't easily be resolved by oral antibiotics. Blockage of prostate glands by calculus could also induce the recurrence of infection.
The clinical reasons for bacterial prostatitis are:
1)Bacteria enter the urethra and reach the prostate
2)Blood infection, tooth infection, tonsil infection, upper respiratory tract infection, skin disease
3)Pathological changes near the prostate (rectum and anus infection through lymphatic glands)
4)Acute prostatitis to chronic prostatitis
5)Complications from Cystitis or Pyelonephritis
6)Excessive drinking, cold, excessive sex life and harmful sexual habits, damage in perineum, chronic constipation.
7)Penis urethra blockage and difficult urination.
  All of the above could lead to nonbacterial hyperemia of the prostate and create a perfect environment for the invasion and propagation of bacteria. The severity of chronic prostatitis depends on immunity of the body and strength of pathogen. The level of defense of the immune system significantly determines whether one will get infection, the severity of infection and the difficulty of treatment.
The common factors on the level of defense are heavy drinking, frequent masturbation, long distance cycling, siting too long, excessive fatigue, getting a cold and negative thought.
Different pathogens have different strength on human body. For example, Staphylococcus epidermis and E. coli are called conditional pathogens. These pathogens could infection our body only when the immune system is very weak. Conversely, the strongest pathogens could infect almost everyone, such as Chlamydia, Mycoplasma and Gonococcus. The traits of a particular pathogen, amount of invaded pathogen and the growth of them are also the factors. Spicy and high-protein food promotes the growth of pathogen and increases the chance of getting prostate infection.
The majority of chronic prostatitis cases are mixed infection. Bacterial and nonbacterial prostatitis has an unusual close relationship and could swap reciprocally, that is exactly the core problem of treating chronic prostatitis. Effective treatment and prevention are not possible if one is ambiguous of the relationship between the two of them.

After eradication of bacteria, effective medicine and therapy are needed to facilitate the restoration of impaired physiological functions of the prostate and to build up a protective barrier, so as to avoid the invasion of foreign pathogens. Patients who are old, have long medical history, have weak bodies due to long-term antibiotic usage and have psychological difficulty from multiple treatments should stick to the recovery therapy. 

symptom

1. Urethra: Frequent urination, Urgent urination, Urinary retention, Difficult starting urination, Weak urine stream, Pain or burning during urination, Split urinary stream, Blood in urine/milky urine, Blood in urine/milky urine etc.
2. Pain or discomfort: Cold/damp scrotum, Pain during/after ejaculation, Aching and weak lower limbs, Pain in perineum, Pain in lower back, Bloated pain in rectum area, Bloated Pain in testicles, Pain in groin area, Bloated pain in lower abdomen etc.
3.Sex function: Infertility, Blood in semen, Pain during/after ejaculation, Reduced Sexual Desire, Impotent/premature ejaculation etc.
4. neurasthenic: Insomnia, headache, nightmare, poor memory etc.
5. intercurrent: cystitis, spermatic/spermaduct/testicle inflammation.
    20 million men of all ages share the symptoms of non-bacterial prostatitis. While there are several types of prostatitis diagnosed in men, including bacterial prostatitis (acute and chronic), non-bacterial prostatitis and prostatodynia account for 95% of all prostatitis diagnoses. Symptoms can include perineal pain, reduced urine flow and possibly impotence and pain before, during and after ejaculation.

　In clinical practice, prostatitis is divided into the chronic type and acute type, or the inflammatory one and non-inflammatory one, or the specific one and non-specific one.  

Although the disease name of prostatitis does not exist in traditional Chinese medicine (TCM), it belongs to the categories of suspended yang-carbuncle, white turbidity, white evil, fatigue strangury, grease strangury, seminal turbidity, lumbar pains due to kidney deficient, etc.

Acute Prostatitis

Syndrome Identification and Treatment Determination:

1. Damp and Heat Inrushing Downward

Major symptoms: intermittent fevers and chills when occurring first, rapid progress, frequent micturation, urinary urgency with inhibited voiding, burning sensation and stinging pains in the urethra, or visible bloody urine, falling-like distension or pains of the perineum, dry mouth, a bitter taste in the sticky mouth, constipation, distension and pains in the lower abdomen, red tongue, yellow and slimy tongue coating, soggy and rapid pulse.  

Therapeutic principle: clear heat and excrete damp .  

2.  Intense Heat and Exuberant Toxin

Major symptoms: Sudden onset, persistent high fever, vexation, unrest, thirst, liking drinks, reddening, swelling, heat and pains of the perineum, scanty urine, obstructed urination, or urine with visible pus and blood, burning sensation and pains in the urethra, constipation, red tongue, yellowish tongue coating, rapid and string-like pulse.

  Therapeutic principle: move the qi, check pains, quicken blood circulation, transform stasis.

3.  Deficiency of the Kidney-Yin

Major symptoms: The diseases lasts quite a long term without recovering. The patient is enfeebled due to the chronic course, or he has once indulged in excessive sexual activities or masturbation. White or sticky excretion from the mouth of the urethra usually or at the end of the urination. Post-voiding dribble, aching pains of the loins, soft legs, feverish sensation in the soles and palms in the afternoon, dizziness, tinnitus, insomnia, profuse dreaming, seminal emission, premature ejaculation, hypofunction of the sexual ability, red tongue with few coating, thready and rapid pulse.  

Chronic prostatitis

  The clinical symptoms of the chronic prostatitis has five respects mainly, Namely urethra symptom, pain or uncomfortable, the sex function slack up, neurasthenia, amalgamating disease. When have one or two symptoms among them, you should go to the local hospital to make correlative examination. Prostatitis patients, when doctor massage prostate, should notice the affected part have obvious pain or not, because the pain is one of the inflammation symptoms. Need to learn how to understand the EPS report , EPS report has two main indicators: 1.Lecithin, the normal one should above 75% ( + + +). 2.WBC, the normal one should be less than 10 / HP, If exceeds more than ten, indicate that there is inflammation existing. Certainly, the EPS examination for some nonbacterial prostatitis is normal. Clarify the inflammation is nonbacterial or bacterial, need to carry on overall microbiolody examination in order to find out pathogen. Commonly, the pathogen which can cause prostatitis including all kinds of microorganism, such as Staph.aureus, hemolytic strepto coccus, gonococcus, pseudomomos areuginosa, C.diphtheriae, colon bacillus, mycoplasm, chlamydiae, various kinds of virus and fungi, trichomonad, etc. Bacterial prostatitis should make EPS examination and sensitive drugs test, other pathogenic microorganism should do the special examination. Besides, B unltrsonic wave examination, combine with rectal touch, confirm prostate size, quality, sclerosis, calcific focus, calculus, etc. The result that get like this will be more accurate. Because the structure of prostate is very complicated, it is very difficult to confirm the correct infection position. Generally speaking, the secretion of prostate gland is the mixture of normal secretion and infected secretion. This is the reason that sometimes WBC are many, sometimes is few. This kind of situation depends on doctor's correct sample tactics and the level of examination. The doctor should analyse the condition and the result of laboratory examination comprehensively, In order to make a comprehensive treatment solution finally.

Cure Standard
[1] Negative presence of pathogens from microbiological laboratory examination (Gram stain, culture and blood test). Negative presence of antigens from RTD-PCR test
[2] Microscopic Examination (10x40) of EPS shows < 10 white blood cells per field, red blood cells 0 and lecithin count > 70% (+++)
[3] Microscopic Examination on semen shows < 5 white blood cells per field, red blood cells 0 and normal active sperms > 70%
[4] Digital Rectal Examination shows normal size prostate, soft texture, no pain on pressure, no hard lumps, obvious central groove and normal size under ultrasound examination.
[5] Microscopic Examination on epithelial cells of the urethra and the prostate shows normal state.

　Unlike acute prostatitis, chronic prostatitis develops gradually, continues for a prolonged period of time, and may have subtler symptoms. Chronic prostatitis will develop from an acute prostatitis bacterial infection that keeps recurring or from a urinary tract infection, urethritis, or epididymitis. Chronic prostatitis is more common in men aged 30 to 50 and is thought to also be associated to hormonal changes of aging and also certain lifestyle influences (excessive alcohol drinking, perineal injury, certain sexual practices). 

Enlarged prostate 

The chronic prostatitis will cause the prostate hypertrophy, because the bacteria erode the prostate texture every days, so the prostate texture will become strong and enlarged day by day.When the enlarging prostate gland narrows the urethra, a man will have increasing trouble starting the urine stream. Because some urine remains behind in the bladder, he will have to urinate more often, perhaps two or three times at night (nocturia). The need to urinate can become very urgent and, in time, urine may dribble out to stain a man's clothing. Other symptoms of BPH are a weak and sometimes a split stream and general aching or pain in the perineum (the area between the scrotum and anus). Some men may have considerable enlargement of the prostate before even mild symptoms develop.

If a man must strain hard to force out the urine, small veins in the bladder wall and urethra may rupture, causing blood to appear in the urine. If the urinary stream becomes totally blocked, the urine collecting in the bladder may cause severe discomfort, a condition called acute urinary retention. Urine that stagnates in the bladder can easily become infected. A burning feeling during urination and fever are clues that infection may have developed. Finally, if urine backs up long enough it may increase pressure in the kidneys, though this rarely causes permanent kidney damage.

   The chronic prostatitis cause the serious result to influence men life and  spirit, so the men's health ought to be care by all the society, ought to care by yourself and improve the living environment and habit,  use the green therapy without side-effect is the best choosing for the prostatitis patients.

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Mr.wujiang,  Gaozhou Normal college,  Gaozhou city, Guangdong province, China

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