Doctor's Q&A: Appropriate Medical Treatment, Differentiation Between Varicocele and Gonorrhea in Traditional Chinese and Western Medicine

**It's not advisable to seek treatment haphazardly when you're sick.**

As the saying goes, "When you're sick, you'll try anything." Many patients with chronic prostatitis are so eager to get better that they often see both Western and traditional Chinese medicine doctors. If their condition doesn't improve after taking medicine from quack doctors, they try folk remedies. They see one doctor for a few days and then go to another, but their condition never shows any significant improvement, which makes them even more confused and panicked.

Currently, there are many individual medical practitioners, and the number of unqualified practitioners is mixed. Medical advertisements are a mix of truth and falsehood. Some manufacturers and individuals use tactics such as "free expert consultation and free examination" to gain the trust of patients and sell their own drugs. Misdiagnosis and mistreatment of chronic prostatitis occur frequently.

"Seeking treatment haphazardly when you're sick" ultimately harms the patient themselves.

So, what is the correct way to seek medical treatment?

(1) Note: You can choose a regular hospital's urology department to make an appointment with a doctor.

(2) Take initiative: Actively seek the cause of the disease with the help of a doctor.

(3) Learning: Patients should buy books about prostatitis to read in order to understand the diagnosis and prevention of the disease.

(4) Confidence: The belief that specialist doctors will take responsibility for you.

(5) Follow the doctor’s advice; the doctor will recommend some self-regulation and treatment methods, such as abstaining from alcohol, eating less spicy food, and taking hot sitz baths.

(6) Treatment: Do not use expensive drugs at the beginning; some common symptomatic drugs can be used instead.

(7) Interaction: If treatment is ineffective after a period of time, you can consult the doctor who first diagnosed you to find out the cause so that the doctor can thoroughly understand the patient's condition. The patient should also understand the doctor's treatment approach. Doctor-patient cooperation will make the condition turn around quickly.

(8) Understanding: Patients should understand what disease they have, what caused it, what examinations the doctor performed, what the purpose was, and what the value was, what medications the doctor prescribed, and what adverse reactions, prices, and prognosis are.

To truly understand medical conditions and receive treatment with a clear conscience.

(9) Understand: When a physician performs special or invasive examinations on a patient, he or she shall sign the consent form.

Protect the right to know of patients and their families.

Why do men get varicocele?

The spermatic vein in men originates from numerous small veins in the testis.

Therefore, the testicular vein and the spermatic vein are the same thing.

Blood from the testis returns via the testicular vein, blood from the epididymis and vas deferens returns via the vas deferens vein, and blood from the tunica vaginalis returns via the cremasteric vein. These three veins form the pampiniform plexus of veins in the spermatic cord.

The spermatic vein communicates with certain veins in the scrotum, perineum, and pelvis during its course.

(1) Prevalence of varicocele: Varicocele refers to the abnormal dilation of veins in the spermatic cord due to obstruction of blood return.

Most studies indicate that 78%–95% of cases occur on the left side, with bilateral varicocele accounting for 7%–22%, and isolated occurrence on the right side being rare.

In the past, this disease did not receive enough attention and lacked in-depth research.

As early as 1700, when Barwell discovered varicocele, he believed that about 16% of men aged 15 to 40 suffered from the disease.

In 1970, Johnson et al. reported that they found asymptomatic varicocele in 151 out of 1,592 military personnel during physical examinations.

Post et al. reported that the prevalence of varicocele is 5%–17%.

In 1971, Jakob et al. conducted a physical examination on 1,072 adolescents aged 6 to 19 and found that 136 (16.2%) of the 188 children aged 6 to 9 had left-sided varicocele.

Among 425 middle school students, 56 (13.2%) were found to have varicocele.

Airforce et al. examined 1,592 men aged 17 to 24 and found that 151 of them had varicocele, accounting for 9.5%.

The prevalence of varicocele is as high as 41% among men with primary infertility.

Recent studies have corrected the view that bilateral varicocele accounts for only about 15% of all cases.

Cockrell et al. found that 65% of patients with left-sided varicocele also had right-sided varicocele.

In another group of 870 patients with varicocele, surgery revealed bilateral varicocele in 57% of cases.

Ma Quanfu et al. discovered this during surgery in a group of 70 patients with left-sided varicocele, and pathological examination confirmed the presence of segmental spermatic veins. They found that 45% of the patients had bilateral varicocele.

(2) The relationship between the symptoms and signs of varicocele and the prostate: Most patients with varicocele may be asymptomatic and are only discovered during a physical examination.

Some patients with varicocele experience swelling, pain, and a feeling of heaviness in the scrotum on the affected side.

The pain is described as dull and aching, and may radiate to the perineum and both sides of the lower abdomen. Walking and standing can aggravate the symptoms, while lying down and resting can alleviate them.

A small number of patients often experience neurasthenia symptoms such as insomnia and difficulty concentrating, as well as a feeling of soreness and distension in the perineum.

Patients with more severe varicocele may experience anxiety, general weakness, impotence, and ipsilateral testicular atrophy. They often seek medical attention because of their small testicles.

Varicocele can lead to infertility.

When the patient stands up, the skin of the affected scrotum is loose and lower than that of the healthy side, and engorged and dilated veins can be seen on the surface.

When you touch varicose veins with your fingers, they feel like a "clump of earthworms," ​​and this feeling becomes more pronounced after the patient moves around.

When lying flat or with the scrotum supported, the dilated veins shrink and refill when standing.

Varicocele is often associated with inguinal hernia, hydrocele, spermatic cord hydrocele, or communicating hydrocele, and these conditions should be differentiated.

In areas where filariasis is prevalent, varicocele of the spermatic cord caused by filariasis should be considered.

Microfilariae can often be found in blood.

Thickening and hardening of the spermatic cord due to tuberculosis or gonococcal infection should also be considered.

Severe varicocele is clinically obvious and is generally easy to diagnose through the patient's complaints, local signs, and palpation in an upright position.

As can be seen from the above, many symptoms of varicocele are the same as those of chronic prostatitis.

Some people believe that the chance of patients with chronic prostatitis also having varicocele is as high as 50%.

Some disagree with this result, arguing that the incidence of varicocele in patients with chronic prostatitis is only 14.6%.

However, the observation results of each group were higher than those of the control group. Therefore, some cases of prostatitis without a clear cause may be associated with pelvic venous diseases, and further research is needed to obtain clear evidence.

**Western Medicine Treatment of Gonorrhea and Traditional Chinese Medicine Treatment of Lin Syndrome**

In traditional Chinese medicine, "Lin syndrome" refers to hematuria (blood in urine), chyluria (mostly caused by filariasis), urinary calculi (stones in the urinary system), and urinary tract infection (prostatitis also falls under the category of urinary tract infection).

Traditional Chinese medicine's understanding of this disease can be found in "Synopsis of Prescriptions of the Golden Chamber - Diabetes, Dysuria, and Linbing": "Linbing is characterized by urine resembling millet grains, lower abdominal distension and pain radiating to the navel, frequent and scanty urination with dribbling and stinging pain, a feeling of wanting to urinate but not being able to, lower abdominal distension, or pain radiating to the waist and abdomen."

Gonorrhea, as diagnosed by Western medicine, is a sexually transmitted disease. Its symptoms include frequent urination, painful urination, and a yellow, viscous discharge from the external urethra. It is transmitted through sexual contact.

Western medicine's gonorrhea and traditional Chinese medicine's lin syndrome are two completely different concepts and should not be confused.

**The concept of kidney deficiency in Traditional Chinese Medicine**

Kidney Yin deficiency and Kidney Yang deficiency are diagnostic terms in Traditional Chinese Medicine.

In Traditional Chinese Medicine (TCM), kidney yin deficiency and kidney yang deficiency refer to symptoms related to kidney function. When we talk about kidney deficiency, it actually includes kidney yin deficiency or kidney yang deficiency, as well as deficiency of both yin and yang.

Simply put, this involves the basic theories of Traditional Chinese Medicine and covers a wide range of topics.

Kidney Yin deficiency is material, and both Kidney Yin and Kidney Meridian are material, while Kidney Yang and Kidney Qi are functional.

If people consume too much of their essence, such as kidney essence, or have excessive sexual activity, or engage in excessive labor (including mental and physical labor), or if they are born with a weak body, their material foundation will be poor, and they will experience some symptoms, such as soreness and weakness in the lower back and knees, weakness in the limbs, dizziness and tinnitus, hair loss, loose teeth, memory loss, decreased libido, seminal emission, premature ejaculation, etc., all of which are symptoms of kidney yin deficiency.

Kidney yin deficiency can also easily lead to deficiency heat.

Traditional Chinese medicine has a theory: "Yin deficiency generates internal heat, and Yang deficiency generates external cold." Therefore, kidney Yin deficiency sometimes manifests as five-center heat (feeling heat in the palms, soles, and chest), and night sweats, meaning that one is sweaty when asleep and wakes up. These are characteristics of kidney Yin deficiency.

Kidney Yin deficiency often occurs in young and middle-aged people because they are more active during this period, and their energy and physical resources are depleted through activities such as studying and exercising.

In terms of sexual function, libido is not particularly low, but ejaculation is easy and rapid, and there is nocturnal emission.

Most men with kidney yang deficiency experience poor sexual function and also experience symptoms similar to those of kidney yin deficiency, such as lower back and knee pain, weakness in the limbs, and decreased libido.

Due to Yang deficiency leading to external cold, the patient's complexion is pale, and they are sensitive to cold, have cold hands and feet, frequent and clear urination, and loose stools.

This type of person has a relatively low libido, which is similar to what modern medicine calls low testosterone levels.

Therefore, Yang deficiency manifests externally, and may also be due to a relatively weak body, resulting in symptoms of kidney Yang deficiency.

Kidney deficiency has two characteristics. One is age-related: kidney yin deficiency often occurs in young and middle-aged people, while kidney yang deficiency often occurs in middle-aged and elderly people. Kidney yin deficiency is prone to symptoms of deficiency heat, while kidney yang deficiency is prone to symptoms of fear of cold.

In terms of sexual function, premature ejaculation and seminal emission are more common in those with kidney yin deficiency, while impotence is more common in those with kidney yang deficiency.

Of course, they also have commonalities, such as lower back pain, weakness, and soreness in the limbs, which are common symptoms of kidney deficiency.

Prostatitis is a modern medical term that overlaps with the concepts of kidney yin deficiency and kidney yang deficiency.

Clinically, some people experience symptoms of deficiency heat in the lower abdomen due to excessive internal heat. In addition, consuming spicy foods can lead to damp-heat.

When damp heat and this deficiency fire intertwine, symptoms of prostatitis appear, such as frequent urination, yellow urine, and lower abdominal distension.

In the treatment of chronic prostatitis, if there are symptoms of kidney deficiency, both should be addressed simultaneously; this is a characteristic of traditional Chinese medicine.

Traditional Chinese medicine and modern medical treatments for prostatitis achieve the same result despite their different approaches.

Modern medicine identifies the cause (bacterial, non-bacterial, mycoplasma infection, or gonococcal infection) and treats it with appropriate antibiotics.

Traditional Chinese medicine has its own unique approach to treating this condition – syndrome differentiation and treatment: for damp-heat, it uses heat-clearing and dampness-removing, heat-clearing and detoxifying drugs, which are essentially antibiotics in traditional Chinese medicine. For example, commonly used herbs such as wild chrysanthemum, violet, houttuynia cordata, honeysuckle, and dandelion are also broad-spectrum antibiotics according to modern pharmacology, with few side effects and effective in killing bacteria.

Bacteria can develop drug resistance when Western medicine is used for a long time, but there are no reports of this with traditional Chinese medicine.

Traditional Chinese medicine's approach to treating prostate problems by clearing heat and detoxifying is similar to that of Western medicine's antibiotics.

Traditional Chinese medicine also has other advantages: for example, if a patient has a constitution prone to illness and has deficiency heat, traditional Chinese medicine can use some medicines to clear deficiency heat, improve his physical condition, improve the pathogenic environment, remove deficiency heat and dampness, change his constitution, and reduce his chances of getting sick.

Traditional Chinese medicine can help patients with excessive dampness to eliminate dampness, and can help those with deficiency-heat to reduce deficiency-heat.

Traditional Chinese medicine can repair or alleviate symptoms of damage to the urinary system caused by pathogens.

For example, some patients have been diagnosed with mycoplasma through laboratory tests and the pathogen has been controlled. After a period of medication, the tests for chlamydia and mycoplasma have returned negative, but the patient still has symptoms. In this case, there is no theoretical basis for using antibiotics, and the effect will not be good.

However, Traditional Chinese Medicine can use some drugs that clear turbidity, unblock meridians, soften hard masses, and promote blood circulation, with very good results.

For those experiencing a feeling of heaviness or distension, using some qi-regulating herbs can also be very effective.

According to the theory of traditional Chinese medicine that prolonged illness inevitably leads to deficiency, any disease, if left untreated for a long time, will deplete the body's vital energy. Some people who suffer from prostatitis may experience symptoms such as physical weakness and poor sleep. Traditional Chinese medicine uses methods to support vital energy, benefit the kidneys, strengthen the spleen, and nourish the heart, which can significantly help in the recovery of health.

Therefore, traditional Chinese medicine can not only treat diseases and improve physical condition, but also adjust the bodily dysfunction caused by prostatitis and assist the body's vital energy.

Kidney deficiency and prostatitis are related as a whole. If symptoms of kidney deficiency appear in prostatitis, some kidney-tonifying medications can be used.

It is incorrect to assume that all cases of prostatitis necessarily involve symptoms of kidney deficiency. If the duration of the illness is relatively short and there are no signs of kidney deficiency, then there is no need to tonify the kidneys.