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Traditional Chinese Medicine and Prostate Health

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Traditional Chinese Medicine and Prostate Health
Jillian L. Capodice and Aaron E. Katz

Introduction
Traditional Chinese Medicine (TCM) including acupuncture, Chinese herbology and qi gong may offer great
promise as treatment for common men’s health conditions related to the prostate including symptoms related to
chronic prostatitis, benign prostatic hyperplasia and as supportive care for prostate cancer. The focus of this
article is to discuss TCM as it is applicable to prostate health and introduce some of the current research in the
area of TCM and conditions of the prostate .

Background on prostate conditions

The prostate is a male-specific, glandular and fibromuscular organ that lies inferior to the urinary bladder. In
adult males, its main function is to produce prostatic fluid that contributes to the volume of semen. In males
under the age of 50, the most common condition affecting the prostate is prostatitis, which means
“inflammation of the prostate”. Prostatitis is divided into four categories; acute bacterial prostatitis, chronic
bacterial prostatitis, chronic prostatitis/chronic pelvic pain (non-bacterial), and asymptomatic prostatitis 1.
Acute and chronic bacterial prostatitis are treated with antibiotics and are less common than chronic
prostatitis/chronic pelvic pain (CP/CPPS) which accounts for approximately 2 million U.S. doctor visits
annually 2. Even though it is more common, the etiology and treatment of CP/CPPS is still poorly understood
and antibiotics, non-steroidal anti inflammatory agents, analgesics, and 5- α reducatse inhibitors are some
common medications used for treatment 3,4.

In males over 50, the most common prostate condition is termed benign prostatic hyperplasia (BPH). BPH
affects over half of men aged 60 years and above and up to 80% of men in their seventh and eight decade 1.
BPH can cause symptoms such as decreased urinary flow and difficulty starting and stopping urination.
However, many men with BPH may remain asymptomatic for many years. Additionally, greater prostate
enlargement does not necessarily correlate with more severe symptoms. Conventional treatment for BPH
includes the use of medications such as 5- α reducatase inhibitors and α-adrenergic agents, minimally invasive
procedures such as transurethral microwave thermotherapy (TUMT) and surgical procedures such as
transurethral resection of the prostate (TURP) 1,5,6.

Prostate cancer is the third most common cancer in U.S males and accounts for approximately 290,000 newly
diagnosed cases and 28,000 deaths annually 7. Prostate cancer is generally a disease of older men and current
recommendations suggest the initiation of prostate screening at age 45 if you have a known family history or are
African American. Standard screening requires both the digital rectal examination and the blood test for
prostate specific antigen (PSA). It is also important to note that an elevated PSA alone does not necessarily
mean you have prostate cancer. Other possible reasons for elevated PSA could be due to prostatitis or BPH.

Background on TCM view of the prostate

The prostate is not recognized in the classic texts of Chinese medicine and acupuncture. However, based on its
anatomy and physiology and TCM theory of zang-fu classification, the prostate is considered a fu organ (hollow
organ which things pass through) with zang characteristics (creates semen, stores semen). It has both yin
(semen is moistening and nourishing) and yang (related to the male gentalia, production of testosterone, relation
to sperm (yang) principles.

Based on meridian classification the three leg yin channels, spleen-tai yin, kidney-shao yin, liver-jue yin and du
and ren mai are related to the prostate. The extraordinary channels including the yin qiao, yang wei and dai mai
are also important. In addition, the paired channels and organs of the three leg yin channels may also be
affected. Based on the combination of meridian and organ pathology, acupuncture, Chinese herbal medicine
and qi gong could all be used to treat conditions of the prostate by coursing the free flow of qi, eliminating
stagnation, assisting kidney yin and yang, draining pathological factors including shi, re, and han (damp, heat
and cold) and strengthening the dan tian. Briefly acupuncture, herbal medicine and qi gong will be discussed
below and any currently related evidence based research will be introduced.

Acupuncture for the prostate

Acupuncture for chronic prostatitis
Acupuncture may be clinically useful for symptoms related to chronic prostatitis/chronic pelvic pain (CP/CPPS)
such as pain in the prostate, groin, perineum, testicular and low back areas, urinary symptoms related to
decreased stream and other related conditions that may affect quality of life (QOL) such as difficulty sleeping
and stress. In modern day practice of acupuncture and TCM, each individual is assessed at baseline, a pattern
diagnosed and a subsequent treatment plan created according to principles of nourishing, draining, and coursing
qi as it relates to each persons condition.

Furthermore, evidence based research on the utility of acupuncture treatment for CP/CPPS exists. Two pilot
clinical trials testing acupuncture for symptoms related to CP/CPPS determined that the administration of
acupuncture was effective in reducing symptoms of CP/CPPS based on a validated, quantitative outcome
measure, the National Institutes of Health-Chronic Prostatitis Symptom Index 8,9. The outcomes of these trials
thus warrant further study of acupuncture for symptoms related to CP/CPPS.

Acupuncture for lower urinary tract symptoms related to BPH

Acupuncture may also be useful in treating some of the lower urinary tract symptoms (LUTS) related to BPH
such as slowed urinary stream or difficulty starting and stopping urination. A similar pattern described in
classic TCM texts refer to dribbling urinary block as “long bi” of which the deficiency types (spleen qi xu,
kidney yang xu) are most related to LUTS symptoms in BPH.

While no acupuncture studies were found in the literature assessing acupuncture treatment for symptoms related
to BPH, one study examined acupuncture application to points on the kidney-shao yin and bladder-tai yan
meridians only. Following nine treatments over eight weeks, these investigators demonstrated no significant
changes in LUTS as measured by the International Prostate Symptom Score Index (IPSS) or PSA following
acupuncture treatment 10. This important study demonstrates that application of these points based on minimal
consensus in the literature as being most appropriate for genitourinary complaints and not fully addressed
within a traditional medical framework was not effective in relieving LUTS related to BPH. However, the
importance of this study is noted, and the argument that further clinical trials are necessary in order to test the
application of points utilizing traditional diagnostic framework are imperative.

Acupuncture as prostate cancer supportive care

Acupuncture treatment during prostate cancer treatment as supportive care has also been suggested 11,12. The
use of acupuncture for nausea and vomiting related chemotherapy in adult and pediatric cancer patients has
already been established 13,14. For prostate cancer specifically, symptoms related to hormonal treatment
utilizing androgen ablation therapy such as hot flashes is under investigation 15.

Chinese herbal medicine for the prostate

There are many TCM based formulas that may be beneficial for prostate health. However, very few have been
tested in an evidence-based research setting. Reasons for this are multifold, and one of the most common
problems lies in the difficulty of analyzing herbal amalgams and determining which agents may be specifically
active from a molecular and/or pharmacokinetic perspective and which agents are contributing to therapeutic
result. This concern is less apparent for singly studied herbs. However, compositional analyses and
determination of active ingredients from an herbal versus a pharmaceutical perspective is also a subject of
debate.
Many singly studied botanicals and herbs for prostate health include cernilton, nettles (Urtica dioca), saw
palmetto (Serona repens), pyguem (Pygeum africannum), turmeric-jiang huang (Curcuma longa) and skullcap-
huang qin (Scutellaria baicalensis) have been proposed for the treatment of symptoms related to CP/CPPS and
LUTS related to BPH. While TCM herbal formulations may have utility during cancer supportive care based on
treatment principles to assist qi, strengthen constitution or nourish yin and yang, few have been tested in the
evidence based setting. One Chinese herbal formulation PC-SPES, showed tremendous promise and
demonstrated significant activity against prostate cancer cell lines in vitro and in prospective clinical trials in
patients with advanced prostate cancer. However, this product was temporarily taken off the market due to
contamination and reformulated following withdrawal. This example demonstrates the necessity for basic
science research of herbal formulations, strict quality control and need for more research on potential herb-drug
interactions over short and long term periods.

Qi Gong for the dan tian

Qi gong which translates as “energy (or life force) effort” is a practice of slow moving exercises for health that
are fundamentally based in martial arts. The dan tian is the area concentrated in the lower abdomen and lower
back that is the storehouse of qi and as related to reproductive health (in both males and females) due to its
anatomic location relation to the kidney organ in Chinese medicine. Ultimately, all qi gong exercises can
strengthen the dan tian, but those specifically oriented to focus on the dan tian may be more beneficial for men
concerned about prostate health.

Practical tips for prostate health

Food and water: Chinese dietary therapy is also fundamentally based on qi and yin/yang principles. General
healthy tips for prostate health include eating lighter and with the seasons (i.e.: eating the foods that are
characteristically grown in that season). Drinking water at room temperature is also suggested. Avoiding
excessive consumption of greasy, fried foods and alcohol are also important and are related to both TCM
principles and some epidemiological data that has demonstrated increased risk of prostate cancer incidence in
men with Western-based diets containing high amounts of processed foods 16.

Exercise: As stated previously, qi gong exercises and regular cardiovascular exercises are important for
prostate health. In general, a good motto is: heart healthy equals prostate healthy. It has been also been
suggested that excessive lower abdominal exercise and excessive sitting including bicycle riding may be
detrimental to the prostate however these theories remain controversial 17.

Sexual Health: In TCM, sexual energies are governed by the kidney yin and yang and problems related to male
sexual health also include male infertility and erectile dysfunction. While another good saying is that good
sexual health equals good prostate health, the importance of treating all conditions related to the prostate as well
as male infertility and erectile dysfunction are important for optimal sexual health (though not discussed in this
article).

Conclusions
Prostate conditions including chronic prostatitis/chronic pelvic pain, lower urinary tract symptoms related to
BPH and prostate cancer supportive care are amenable to Traditional Chinese Medicine (TCM) treatment
strategies utilizing acupuncture, Chinese herbology and qi gong. TCM texts offer some discussion on treatment
of these myriad conditions and evidence based research will assist in introducing TCM as a viable treatment
option for patients alone or in combination with conventional therapies.

Jillian L. Capodice, MS, L.Ac., is the Director of Acupuncture at the Center for Holistic Urology,
Department of Urology, Columbia University Medical Center, New York, New York. Her diverse
background includes translational molecular biology research of single and mixed botanicals,
maintenance of the in- and out-patient acupuncture practice within the department, clinical acupuncture
research, and teaching and training of acupuncture and bioscience. She is also a faculty member in the
Department of Biomedical Sciences at Pacific College of Oriental Medicine, New York,

Dr. Aaron E. Katz is currently an Associate Professor of Clinical Urology at Columbia-Presbyterian

Medical Center. He has been a faculty member at Columbia since 1993. He also holds a title as the
Director of the Center for Holistic Urology, a Center which he established in 1998.

References

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