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.
