Chinese medicine: transurethral resection of the prostate (TURP) and Zhu Ling Tang.Keywords: Chinese medicine, Chinese herbal medicine, urology, benign prostatic hypertrophy (BPH), TURP
Most Western MDs recommend removal of the enlarged part of the prostate as the best long-term solution for patients with benign prostatic hypertrophy (BPH). A procedure called transurethral resection of the prostate (TURP) is used for 90% of all prostate surgeries done for BPH. With TURP, an instrument called a resectoscope is inserted through the penis. The resectoscope, which is about 12 inches long and 1/2 inch in diameter, contains a light, valves for controlling irrigating fluid, and an electrical loop that cuts tissue and seals blood vessels. During the 90-minute operation, the surgeon uses the resectoscope's wire loop to remove the obstructing tissue one piece at a time. The pieces of tissue are carried by the fluid into the bladder and then flushed out at the end of the operation. Patients receiving this procedure stay in the hospital from 3 to 10 days, depending on how quickly they recover. The catheter is usually left in place for several days. After surgery, patients typically have some blood or clots in their urine as the wound starts to heal. If their bladder is being irrigated (i.e., flushed with water), their urine may become red once the irrigation is stopped. Some bleeding after this procedure is normal, but it should clear up by the time the patient leaves the hospital.
On pages 700-701 of issue 11, 2008, of Shi Yong Zhong Yi Yao Za Zhi (Journal of Practical Chinese Medicine & Pharmacology), Zou Chuan-bing et al. of the Jiangsu Provincial Chinese-Western Medical Hospital in Nanjing published an article titled "Observations on the Use of Zhu Ling Tang in Electric Slicing Surgery of the Prostate." A summary of this article is presented below. It suggests that routine administration of Zhu Ling Tang (Polyporus Decoction) post-TURP can speed recovery.
Altogether, there were 86 cases enrolled in this two-wing comparison study. These men's average age was 72.5 years. They had suffered from BPH for from three months to 15 years, with an average disease duration of 3.8 years. Residual urine volume (RUV) was in excess of 60 mL in all cases. Maximum flow rate (Qmax) was less than 10 mL per second. International Prostate Symptom Score (IPSS) was less than 24.6 points. All these men underwent the TURP procedure. Afterwards, they were randomly divided into two groups of 43 cases each--a treatment group that received Chinese medicine on top of standard Western medical post-TURP care, and a comparison group who only received standard Western medical care. In terms of age, size of the prostate, IPSS, RUV, and Qmax, there were no significant statistical differences between these two groups, which were deemed comparable for the purposes of this study.
In addition to standard Western medical post-TURP treatment, all members of the treatment group were orally administered the following Chinese medicinal formula:
Zhu Ling (Polyporus), 20g
Fu Ling (Poria), 15g
Ze Xie (Rhizoma Alismatis), 15g
Hua Shi (Talcum), 15g
E Jiao (Gelatinum Corii Asini), 20g
One packet of these medicinals was decocted in water and administered per day in two divided doses for a continuous four weeks.
If hematuria was marked, 10 grams each of Xiao Ji (Herba Cirsii) and Qian Cao (Radix Rubiae) were added.
If expulsion of urine was forceless and there was low back and knee soreness and limpness, 10 grams each of Huang Qi (Radix Astragali), Shu Di (cooked Radix Rehmanniae), and Niu Xi (Radix Achyranthis Bidentatae) were added.
In the treatment group, hematuria turned negative in a mean of 11.9 [+ or -] 4.1 days. In the comparison group, hematuria turned negative in a mean of 22.3 [+ or -] 4.8 days. Therefore, hematuria resolved markedly quicker in the treatment group than the comparison group. Before surgery and at two and four weeks after surgery, Qmax was 9.2 [+ or -] 3.3 mL per second, 15.9 [+ or -] 3.6 mL per second, and 18.2 [+ or -] 4.9 mL per second in the treatment group. By comparison, Qmax at these same times in the comparison group were 9.4 [+ or -] 3.4, 14.1 [+ or -] 3.4, and 14.2 [+ or -] 4.1 mL per second. Therefore, Qmax in the treatment group was better at both 2 and 4 weeks after surgery than in the comparison group. These results suggest that the addition of orally administered Zhu Ling Tang post-TURP shortens the recovery time and achieves a better surgical outcome.
According to the authors of this article, BPH primarily occurs in older men whose kidney qi is declining daily. Thus their qi transformation is inhibited and their bladder qi transformation is unable to upbear the clear qi or to downbear turbid yin. Over time, the essence is vanquished and damp heat and blood stasis collect internally. Hence the urine is not able to be discharged normally and this results in dribbling urinary block. The authors also posit that the high heat of the TURP damages and causes detriment to kidney yin. Thus, they believe that the root of this condition is kidney yin vacuity and its tips or branches are the gathering and accumulation of blood stasis and damp heat. Zhu Ling Tang comes from Zhang Zhong-jing's Shang Han Lun (Treatise on Damage [Due to] Cold), where it is indicated for the treatment of inhibited urination due to a combination of water heat and damage to yin. Since these indications match this condition's disease mechanism, this formula gets a good therapeutic effect.
Within Zhu Ling Tang, Zhu Ling, Fu Ling, and Ze Xie blandly seep and disinhibit dampness. Fu Ling also fortifies the spleen to bank earth. It also connects the free flow of the heart and kidneys. Zhu Ling abducts heat and moves it downward so as not to damage yin. Ze Xie ascends and enriches yin fluids. Thus it disinhibits water at the same time as supplementing yin insufficiency. Hua Shi disinhibits the orifices and frees the flow of strangury. It also abducts and drains heat. E jiao enriches true yin and also helps heart fire to descend to join with the kidneys. When these five medicinals are used together, they disinhibit water without damaging yin and they enrich yin without retaining evils. Their net effect is to disinhibit water, recuperate yin, and clear heat.
Any readers considering undergoing TURP might consider taking this formula postprocedure. To get a prescription, please see your local licensed acupuncturist (LAc). You might call them first to make sure they do Chinese herbal medicine, since not all acupuncturists also prescribe Chinese herbs. To me, this study suggests the use of this Chinese herbal formula as a routine part of anyone's recuperation from TURP.
Copyright[c] Blue Poppy Press, 2009. All rights reserved.
by Bob Flaws, L.Ac., FNAAOM (USA), FRCHM (UK)
Bob Flaws, LAc, has practiced Chinese medicine for more than 30 years. He is also one of the world's best-known authors, translators, and teachers of Chinese medicine.