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This
disease is mainly due to infection of bacteria through the spermatic duct,
usually originating from infection of urethra, prostate or seminal vesicle.
TCM includes it in the category of Ziyong (acute or chronic orchitis and
epididymitis).
Pathomechanism and Pathogenesis
Stagnation of Qi and blood in he
testis due to going down of damp-heat in the Liver Channels led to this
disease. Excessive heat duet to long stagnation of Qi and blood may turn flesh
into pus. Qi and blood retained so long will turn into chronic mass.
Clinical Manifestations
Sudden onset in acute cases, swelling
and pain of the epididymis, the testis enlarged when it has been involved in
the inflammation, red-swelling and burning-pain of the scrotum, dragging pain
in the lower abdomen occurring when the inflammation involves the funiculus,
red swollen bright sin of the scrotum whose center is soft and raised due to
suppuration, the symptoms vanishing more rapidly and the sore healing
gradually after incision or ulceration of the abscess which is followed by
discharging of pus and purging of toxins, chills, fever, thirst, deep-colored
urine, enlarged remarkably
tender epididymis and
testis seen through examination, complications of funiculitis and hydrocele
testis, and slightly tender or tenesmic distending cold-painful tough mass or
hard node in the epididymis or testis of chronic cases.
Differential Diagnosis
Chronic epididymitis need be
differentiated from the following diseases.
1. Tuberculosis of epididymis
Some symptoms in the early stage of
this disease are similar to those of acute epididymitis. By the late stage,
the tail of epididymis or the whole epididymis has become a hard node without
severe tenderness. Cementing with the skin of scrotum, this hard node may
involve the testis and have sinus. There are nodes like a string of beads in
the spermatic duct. Hard nodes in the prostate
and seminal vesicle may
be palpable when digital examination of rectum is conducted.
2. Cystis of epididymis
Tenser semi-transparent mass maybe
occurring in any part of the epididymis and located at the back of the testis.
3. Orchioncus
Enlarged, not painful, solid and
heavier testis with node- like
surface but without the
original elasticity, possible distant transfer lymphnodes, and complications
of hydrocele of tunica vaginalis and hematoma of scrotum.
Treatment
1. Internal Treatment
(1) In the acute stage (syndrome due
to damp-heat having gone down).
Main Symptoms: Red swollen burning
painful tender epididymis and scrotum, chills, fever, thirst, yellowish urine,
dry stools, yellow greasy tongue coating, and taut slippery rapid pulse.
Therapeutic Method: Clearing away
heat from the liver, promoting diuresis, removing toxic material and subduing
swelling.
Pr escription:
Modified Longdan Xiegan Decoction
Ingredients:
Longdancao Radix Gentianae
Chaihu Radix Bupleuri
Huangqi Radix Scutellariae
Huangbai Cortex Phellodendri
Zhizi Fructus Gardeniae
Rhizmoa Alismatis
Juhe Semen Citri Reticulatae
Chuanniuxi Radix Cyathulae
Chishao Radix Paeoniae Rubra
Zihuadiding Herba Violae
Banlangen Radix Isatidis
Jinyinhua Flos Lonicerae
Administration: Decocted in water
twice for the decoction, which is taken warm in the morning and evening, 1
dose daily.
Modification: In case of persistent
high fever, the dosage of Chaihu and Huangqin in the original prescription is
separately changed into 15g, and 15g of Liangqiao (Fructus Forsythiae) is
added.
In case of constipation, 10g of
Dahuang (Radix et Rhizoma Rhei) is added last.
In case of severe swelling and pain,
1.5-3g of Xihuang Wan Pill
is infused in water and then taken.
After suppuration, the herbs
added are
Shanjiazhu Squama Mantidis Preparata
Zaojiaoci Spina Gleditsiae
(2) In the chronic stage (syndrome
due to stagnation of qi
and blood)
Main Symptoms: Tough mass or hard
node with mild tenderness in the effected
part; tenesmus, distension, cold-pain in the lower abdomen; he swelling and
pain probably aggravated by overstrain or pungent food, white tongue coating,
and thready taut pulse.
Therapeutic Method: Soothing the
liver, regulating qi,
removing blood stasis and dispersing mass.
Prescription:
Modified Decoction with Orange.
Ingredients:
Gouju Fructus Citri Reticulatae
Chuanlianzi Fructus Toosendan
Jiangcan Bombyx Batryticatus
Shanjiazhu Squanma Mantidis Preparata
Juhe Semen Citri Reticulatae
Lizhihe Semen Litchi
Shanzhahe Semen Crataegi
Niuxi Radix Achyranthis Bidentatae
Wuyao Radix Linderae
Chaihu Radix Bupleuri
Xiakucao Spica Prunellae
Kunbu Thallus Laminariae seu
Echloniae
Chishao Radix Paeoniae Rubra
Xiaohuixiang Fructus Foeniculi
Shufuzi Radix Aconiti Lateralis
Preparata
Administration: Decocted in water
twice for the decoction which is taken warm in the morning and evening, 1 dose
daily.
Modification: together with the
decoction, Sanjie Tablet
is taken for the purpose
of subduing swelling and resolving mass.
2. External Treatment
(1) In the acute stage
Jinhuang Gao or Daqing Gao is
externally applied to the local part. Incision for drainage should be
conducted after suppuration. Routine dressing change is carried out according
to that in treatment of pyogenic diseases after ulceration. Bed rest is
suggested with the scrotum supported with bandage of scrotal support.
(2) In
the chronic stage
30g of Chonghegao Fen is infused with
300ml of boiling water. The affected part is soaked in, and washed with, the
medicated water. which is kept warm, 20 minutes each time, twice daily.
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