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Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia (BPH, also known as benign prostatic hypertrophy) or swelling of the prostate, is characterized by symptoms of bladder outlet obstruction, progressive urinary urgency and frequency, increased nightly urination, and urination with reduced force and caliber of urine.  Patients with BPH typically present with an enlarged, inflamed and swollen prostate smooth muscle, glandular epithelium and stromal tissue in the peri-urethral region of the prostate.  Experts estimate that BPS affects 50-60% of men between 40 and 59 years of age in the United States, resulting in a projected annual overall cost of hospital care and surgery of over one billion dollars per year.  Neglect of prostate inflammation and swelling can lead to a rise in prostatic specific antigen (PSA). It is important to note that the connection between elevated PSA scores and prostate cancer has now been debunked.  Prolonged obstruction can also result in uremia, also known as chronic renal failure.

Analysis of BPH biochemistry shows that it is an androgen-dependent disorder of metabolism primarily reflecting changes in steroid levels in aging men.  Testosterone and other hormone levels decrease with age after the age of about 40.  This causes an increased concentration in the prostate of dihydrotestosterone (DHT), a potent derivative of testosterone.  The accumulation of DHT is a one chemical factor in congestion and swelling of the prostate, but it is insufficient by itself to account for the whole problem - which is why using strong pharmaceuticals to drop DHT can cause impotence and side effects.  It therefore makes sense to look at the problem in broader terms TCM theory, for example, states that patients with this disease have heat and dampness in the lower abdomen caused primarily by Kidney (hormone) deficiency related to aging.  It is important to remember that when there is significant physical growth of the prostate tissue-- while I recommend trying the various herbal options first -- surgery may be necessary. Newer surgical techniqes have lower side effects.

Some BPH patients have shown benefit from the following lifestyle changes:

• Be sure to drink 6-8 glasses of pure spring water each day for a harmless diuretic effect.  This can aid the kidney in removing metabolic wastes.  Insufficient water intake is a general causative factor in many inflammatory diseases. Of course, drinking water late at night can cause more frequent trips to the bathrooom, so I advise patients to limit water intake in the evening.

• Engage in regular exercise, which is necessary for maintaining muscle and cardiac tone and good blood circulation.  Due to its anatomical location the prostate is especially subject to venous congestion.  A sedentary lifestyle may exacerbate this congestion.

• Follow a diet tailored to reducing inflammation and swelling in the prostate.  This is generally accomplished by eating plenty of fresh fruits and vegetables, and limiting poor quality fats and oils.  The diet should also be as free as possible from pesticides and other contaminants, since many of these compounds have strong effects on male hormones.  Also avoid Diethylstilbesterol (DES) because it produces changes in rat prostates that are histologically similar to those caused by BPH.

• Increase your dietary intake of soy.  Soybeans and soy foods can decrease circulating levels of endogenous estrogens, replacing them with less inflammatory phyto-estrogens.  Estrogen levels in men increase with age, which facilitates the activity of DHT by enhancing the amount of androgen receptor protein present in the tissue.  This may paritally explain the lower incidence of BPH in Chinese males, who consume soy products at least two times per week. 

• Follow a higher protein and lower fat diet to reduce the very inflammatory chemical 5-HETE (Ghosh J, Myers CE 1997).

Herbal Treatment of BPH

At our clinic we have seen many patients relieved of BPH symptoms using herbal strategies from the Western, Ayurvedic and TCM systems.  We usually start with Western herbs, due to ease of procurement, and utilize more complex formulations from the other systems if these are not sufficiently successful. In more advanced cases combining herbal treatments with western medications can create stronger results.

Saw palmetto berry (Serenoa repens) is the most well known herb for BPH.  Herbalist David Winston reviews in great detail the scientific and traditional literature supporting its use for BPH in his book Saw Palmetto for Men & Women.  He explains how combining it with other herbs into an integrated formula based upon signs and symptoms yields superior clinical results.  (A Cochrane review of Saw Palmetto evidence showed mild to moderate benefits, but by itself it does not show results in advanced cases.) David also argues against the pigeonholing of this herb as useful only for BPH, mentioning benefits for cystic acne, stimulation of sexual maturation in delayed puberty and male infertility. Saw Palmetto can also be used for prostatitis.

An important saw palmetto mechanism of action is inhibition of the inflammation-promoting enzyme 5-alpha reductase, an action which it shares with stinging nettle root (Urtica dioica), another herb useful for BPH.

However, these actions are not strong enough to account for the reported results.  A closer look at the research shows that the positive actions are due to a number of related mechanisms, such as inhibition of inflammatory arachadonic acid metabolites and inhibition of epithelial growth factors (Winston, 1999).

Saw palmetto basically acts as a nutritive tonic, strengthener and normalizer (amphoteric) of the male reproductive system.  It is of course specifically helpful in improving the symptoms associated with an enlarged prostate gland.  It is also useful for genitourinary tract infections.  Numerous open and placebo-controlled studies in large populations have also demonstrated the efficacy of African pygeum bark (Pygeum africanum) in the treatment of BPH and prostate inflammation.  However, the effectiveness is less than saw palmetto, and there are some minor side effects. 

To remove venous congestion in the prostate area, I recommend a tincture of saw palmetto, stinging nettle, stoneroot, gotu kola, white sage (Salvia apiana) and horse chestnut, about 45-60 drops three to four times per day.  A commercial formulation containing a similar constellation of herbs is available from Herbalist & Alchemist.

Europeans have used a particular form of flower pollen to treat prostatitis and BPH for more than 25 years.  Produced by A.  B.  Cerncile of Sweden, the product is marketed under the name Cernilton.  Although its mechanism of action is not yet completely understood, it has been shown quite effective in several double-blind studies without any reported side effects.  It seems to be effective in both BPH and chronic prostatitis (Dutkiewicz, 1996, Rugendorff et al., 1993).

TCM Treatment of Swollen Prostate

Traditional Chinese Medicine offers some insights into the treatment of prostate problems.  In simple terms, a TCM doctor would write a prescription based on the concept that there is both heat (inflammation) and dampness (swelling) in the prostate, restricting the flow of urine.  There may also be a deficiency condition weakening the kidneys.  A BPH formula can be constructed from the following lists of herbs.  If using 4:1 concentrated granules, the dose would be six to nine grams per day.  After one or two weeks, the doctor would be re-assess the patient and adjust the relative proportions of individual herbs according to signs and symptoms, perhaps deleting certain herbs and adding others. 

The following herbs could be included in a basic BPH formula:

• Phellodendron bark to remove heat and dampness.
• Rhubarb root to soften the swollen gland and purge heat and dampness
• Black Atractylodes rhizome to dry out the dampness
• Coix seed (yi yi ren or Coix lachryma) aid removal of dampness
• Persica seed (tao ren or Prunus persica) to break up blood congestion
• Talcum (hua shi or calcium carbonate) to reduce heat, soothe the urinary tract and open obstruction.
• Licorice root to reduce heat and nourish.
• Shi wei leaf (Pyrrosia lingua) to promote urination and reduce heat
• Dandelion root to detoxify and removes heat and dampness
•  Anteater scales (chuan shan jia or Manis pentadactyla) to reduce swelling and promote the discharge of pus
• Lu lu tong fruit (Liquidambar taiwaniana) to promote urination, soften the swollen organ, reduce pain, and unblock the tubes and channels.

Based on the following characterizations and symptoms you can personalize the formula for each patient by adding the appropriate herbs.

With predominant inflammation:

• Scute root to drain heat.
• Coptis rhizome (Huang lian or C.  chinensis) to drain fire (strongly anti-inflammatory)

With a predominance of swelling:

• Water plantain (ze xie or Alisma plantago) to promotes the flow of urine, and leach out dampness when there is stagnation and urinary difficulty.

With signs of coldness (cold limbs, aversion to cold):

• Purified aconite (fu zi or Aconitum palmatum) to alleviates pain and warm (professional use only)
• Cinnamon twigs (gui zhi or C.  cassia) to promote blood circulation and warm.

In patients suffering from deficiency or elderly patients, consider adding:

• Sang ji sheng twigs (Viscum album) to tonify the kidney and removes dampness.
• Eucommia bark (du zhong or E.  ulmoides) to strengthen weakness in the organ.
• Scrophularia root (xuan shen or S.  ningpoensis) relieves toxicity and inflammation, softens nodular swelling and nourishes in the later stages of inflammatory diseases.

With severe blood and venous congestion, common in the later stages of BPH:

• Red peony root to promote blood circulation and remove swelling and pain.
• Zedoary root (E zhu or Curcuma zedoaria) to remove blood stasis, promotes the movement of Qi, alleviate pain, and dissolve accumulations.

With general fatigue and weakness:

• Ginseng root to strengthen vital force and decrease fatigue.

Adding to the traditional understanding, ginseng root possesses a variety of well-studied pharmacological properties.  Animal studies show that ginseng root increases testosterone levels while decreasing prostate weight, as well as stimulating corticosterone secretions (reported in Huang, 1999).  This would seem favorable to BPH patients, since increased testosterone could mean decreased DHT and improved intestinal zinc absorption, and decreased prostate size would help alleviate the symptoms.   

Posted on Sunday, June 26, 2005 at 05:22PM by Registered Commenterposted by Dr. Tillotson in | Comments Off

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