Question:
How does Chinese medicine deal with frequent urination due to prostate enlargement?
Answer:
A 62-year old male patient came to see me with a chief complaint of low back pain on a 7/10 level. He worked in building maintenance and did a lot of heavy lifting in his work. He also complained of cold feet at night and leg cramps, yet he said he was always hot. His pulses were wiry and slow, and his tongue was dusky. My diagnosis was primarily liver qi stagnation, but also kidney yang deficiency and yin deficiency. A combination of yang and yin deficiency is much more common than I ever thought it would be.
The second time I saw him, he reported that he needed help with his libido. But the case was complicated, because he was taking terazosin (Hytrin) for an enlarged prostate, and this medication was interfering with his libido. If he avoided the medication, his libido came back, but he would have to get up four times a night to urinate. If he took the medication, his night time urination was only once, but his sexual performance suffered. Impotence is a known side effect for terazosin. The good news was that his back pain was improved by 50% from the last treatment.
I decided to use as a base formula Liu Wei Di Huang Wan to nourish kidney yin, but modified to also boost the yang, and to astringe the kidney to reduce the frequent urination. The formula consisted of:
Sheng Di Huang
Shan Yao
Shan Zhu Yu
Mu Dan Pi
Ze Xie
NO Fu Ling (because I didn’t want to promote urination)
Yin Yang Huo & Wu Jia Pi for the back pain
Hu Lu Ba and Tu Si Zi for the kidney yang
Niu Xi to move blood and guide the formula to the kidneys
Fu Pen Zi to astringe the kidney
He took 6 bags of this formula, and one month later, he returned with more good news. The back pain was down to a 1/10 level, he had taken no terazosin since the last treatment, and his nighttime urination was down to zero to once per night. His libido was improved.
Over the next three months, he came in occasionally for a refill of the same formula, because he said it “had more of a positive effect to my quality of life than I had thought.” In cases of frequent urination due to an enlarged prostate, you want to astringe somewhat, but not so much that you inhibit urination, and you want to promote urination in the sense of making it more efficient and less hesitant, but not increase it too much. I believe this herbal strategy was a good balance of those two treatment principles. It is also possible that the astringent herbs in this formula actually worked to shrink the tissue of the prostate, but I can’t know for sure.
I have another patient, aged 85, who occasionally experiences actual blockage of urination due to a severely enlarged prostate, and I would not use such a formula for him. I would be afraid the astringents would be too constricting.