Benign prostatic hyperplasia
Benign prostatic hyperplasia BPH is a common problem of aging for men. It has been proposed that the disorder has two phases, BPH messa in scena that BPH messa in scena no clinical signs and the other that is manifested as disorders of urination from urinary tract obstruction by an enlarged prostate 1. In the first phase, there are microscopic changes within the prostate that may occur as early as the fourth decade of life and these may then be followed by macroscopic changes, namely enlargement of the prostate that typically begins during the fifth or sixth decade of life.
However, clinical signs of the disorder occur only if the enlargement is substantial and becomes complicated by other disorders, such as prostatitis, or if the gland becomes hardened or deformed. The progression to clinical disease is most often seen after age It is further suggested that while nearly all men will experience the microscopic changes in the prostate if they live long enough, only BPH messa in scena half will experience prostate enlargement, and, of those, only about half will develop clinical symptoms.
The question then arises: what causes the relatively common occurrence of prostate changes that lead to clinical disease? Epidemiological studies have demonstrated that many of the same risk factors associated with cardiovascular diseases apply as risk factors BPH messa in scena BPH.
These risk factors include obesity, hypertension, and diabetes. The diabetes connection is considered especially strong; the BPH messa in scena is non-insulin dependent diabetes mellitus NIDDMwhich often involves excessive insulin levels, a possible direct contributor to the growth of the prostate 2, 3. As with cardiovascular disease, both exercise and moderate alcohol consumption appear to be protective for BPH.
The influence of cigarette smoking on BPH has been unclear: some studies indicate a protective effect there is a protective effect of smoking for ulcerative colitis that is well-established, so this result is not to be rejected out of handbut other studies indicate a negative impact, BPH messa in scena least for heavy smokers 4, 5.
Hormones affect the development and progression of BPH. Men with liver cirrhosis have a lower incidence of BPH than those who BPH messa in scena normal liver function, probably because the liver damage reduces the metabolism of hormones to compounds that adversely influence BPH.
Not all hormonal influences on BPH have been determined, but both sex hormones estrogen, testosterone, prolactin and insulin have been shown to have an effect thus far. In particular, it is thought that the conversion of testosterone to 5-alpha-dihydrotestosterone DHT may be a significant risk factor for BPH 6. The drug Finasteride suppresses DHT production by inhibiting the enzyme 5-alpha reductase that converts testosterone to DHT, and this drug has been shown effective BPH messa in scena reducing symptoms of BPH.
DHT, produced in sebaceous glands, is also a contributor to male-pattern balding. It is not known whether BPH messa in scena, nutritional, or drug treatments for cardiovascular disease would also have an impact on BPH. However, the alpha-adrenoceptor agonist drug Doxazosin used for treating hypertension also appears to have therapeutic value for BPH 7. Chinese medical literature has been relatively silent on the problem of BPH 8.
Disorders of urination have been noted since ancient times, classified as " lin " syndromes. However, most times when obstruction of urination is noted, there are also accompanying signs mentioned that are not characteristic of BPH, such as blood in the urine or passing of stones or cloudy urine. Therefore, while BPH may have been experienced and treated as one of the lin syndromes, it is unclear whether BPH messa in scena of the therapies were specific for BPH.
In Japan, BPH has been described by medical doctors who prescribe herbal therapies. These BPH messa in scena practitioners rely on a relatively small set of formulas from which one or two are selected for administration according to differential diagnosis by constitutional factors. Toyohiko Kikutani described his knowledge of such treatment methods, and this information was relayed by Hong-yen Hsu of the Oriental Healing Arts Institute.
This formula is commonly used for disorders of aging, and is also applied in Japan for treating hypertension. The BPH messa in scena of these latter two formulas fit better with acute prostatitis rather than BPH, but this acute condition may trigger the clinical manifestation of the preclinical BPH.
Sometimes the two approaches are combined: Dr. In an update by Dr. Achyranthes and Plantago Formula is also used in Kampo medicine to treat diabetes, including nephritic and neurological effects of the disease. Modern journals of Chinese medicine remain relatively silent on the subject. By contrast, the Western literature has numerous reports on therapies for BPH based on herbs.
Chinese researchers have addressed the problem of prostate disorders, but usually include a broad range of problems-dominated by acute prostatitis-in the study group, for which differential diagnosis is applied. Typical therapeutic categories are qi and blood stasis, damp-heat accumulation, and kidney-deficiency syndrome The formulas administered vary considerably, but most formulations for treating qi and blood stasis include vacarria wangbuliuxing ; virtually all formulations for treating damp heat and urinary obstruction include plantago seed cheqianzi.
Kidney-deficiency formulations subdivided into yin- and yang-deficiency categories for prostate disorders usually incorporate herbs for treating blood stasis and damp heat as secondary components It is possible that the microscopic changes in the prostate in the early development of the disease process are consistent with microcirculation changes that are normally BPH messa in scena with blood-vitalizing herbs. Prostate enlargement is consistent with a damp-heat syndrome, since this syndrome is commonly associated with BPH messa in scena swelling in the lower BPH messa in scena.
The final development of clinical symptoms of urination disorders may be associated with more severe blood stasis and damp heat coupled with weakening kidney qi. Thus, the three main diagnostic categories for prostate disorders may have relevance to BPH in terms of its development over several decades BPH messa in scena a progression of the syndromes. Based on such a scenario, the therapy for clinical BPH with Chinese herbs would involve a combination of treating kidney deficiency as a solution for the constitutional disorder associated with aging, along with blood-vitalizing and damp-heat removing herbs as a treatment for the swollen BPH messa in scena.
In accordance with traditional Chinese medicine doctrine, each patient should be treated on the basis of their actual syndrome. For example, yin-deficiency fire treated by modification of Zhi Bai Dihuang Wan or spleen- and lung-qi deficiency treated by modification of Buzhong Yiqi Tang could each be factors contributing to urinary disorders such as those seen with BPH.
Nonetheless, most cases of BPH in essentially healthy men are likely to correspond to the disorder categories generalized above. The treatment of BPH became a medical issue during the same time that cardiovascular disease therapy came to the fore, mainly during the s.
The incidence of these diseases had become very high, and the limited therapies available at the time provided inadequate results. In Germany, where herbal therapy translated as phytotherapy was still pursued by the pharmaceutical industry, the use of herbs was investigated at the same time as other researchers pursued surgical and drug options. Hildebert Wagner, one of the leading proponents of phytotherapy working at the Institute for Pharmaceutical Biology at the University of Munichproposed investigation of the active BPH messa in scena in Sabal serrulata for BPH in This herb, now referred to as Serenoa serrulata or Serenoa repenshad been popular in the U.
The fruit of the plant, a small palm referred to as saw palmetto palmetto BPH messa in scena Spanish for small palm; it has sharp, saw-like leaves that is abundant in Florida, was used as a food for farm and ranch animals and as a medicine for humans.
Research into the effects of Serenoa in Germany, and BPH messa in scena in many other European countries, appeared to confirm a positive action on BPH, so that this became the principal use of the herb.
Bysaw palmetto had become one of the 10 most extensively used Western herbs, with almost all of the commercial supplies going into products for BPH. The fruit is rich in sterols, which appear to be the primary active constituents. Although various proposals have been made as to how the sterols might affect BPH, the mechanism of action is still not clearly BPH messa in scena.
It is thought that the sterols may have, as one mechanism of action, the inhibition of DHT production At the same time, other Western herbs were investigated, with most attention falling to pumpkin seeds Cucurbita pepo BPH messa in scena, nettle root Urtica dioica or Urtica urensbee pollen particularly that from the rye plantAfrican BPH messa in scena tubers of Hypoxis rooperiand the large high-altitude African tree Pygeum africanumalso known as Prunus africanum 13, In most cases, but particularly BPH messa in scena pumpkin seeds and African potato, the BPH messa in scena active components are understood to be the sterols, such as beta-sitosterol, which has been used as a therapeutic agent for BPH by itself Triterpenoids in pygeum have also been proposed to be active components, reducing the swelling of the prostate Among the Chinese herbs recommended for BPH, the iridoid glycosides may be the active components: these include aucubin from plantago seed, catalpol from rehmannia, and morroniside from cornus an ingredient in the rehmannia formulas.
Iridoids have not been found in the Western herbal therapies for BPH and represent a potential new area for future investigation. Iridoids are the recognized active constituents of the Western herb chaste tree berry, Vitex agnus costuswhich has been shown to reduce prolactin levels in women 20 ; elevated prolactin may be a risk factor for prostate enlargement in men.
Triterpenoids found in vaccaria and alisma an ingredient in rehmannia formulas could contribute to their therapeutic effects, in a manner similar to those suggested for pygeum. Today, products for BPH remain one of the primary commercial successes in the field of herbal medicine. The herbs are sold either individually or in combination products with 2 or 3 of the ingredients.
The two most commonly-used substances, both as single herbs or in combination products, are saw palmetto and pygeum. The usual amount of saw palmetto provided in clinical studies is mg of extract per day, in two divided doses Treatment time is from 45 to 90 days to obtain significant improvement in symptoms; treatment BPH messa in scena of 6 months has been reported to have a lasting effect for at least 18 months Adverse effects of the herb therapies for BPH have not been reported.