Article 47: Symptoms, Examination, and Traditional Chinese and Western Medicine Treatment of Priapism
◇A Guide to Caring for Your Husband's Health as a Good Wife◇
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Treatment and recuperation of common diseases
What are the symptoms?
The onset is sudden, without any specific cause, but it can also be triggered by prolonged sexual intercourse. The penis experiences persistent painful erection, but there is no sexual desire. Local examination reveals that the corpora cavernosa are erect, but the corpus spongiosum and glans penis remain relatively soft.
Some patients often experience mental symptoms such as anxiety, panic, restlessness, and difficulty urinating or urinary retention.
What are the aftereffects?
If an erection lasts for more than two days, a blood clot will form in the corpora cavernosa of the penis, causing the penis to harden and the erection to last longer. The neuroreflexive (functional) erection will be replaced by a thrombotic or sclerotic erection. If it lasts for more than 10 days, fibrosis of the corpora cavernosa will occur, causing serious organic damage and leaving sequelae such as permanent erectile dysfunction.
What tests should be done?
1. Blood analysis: can rule out sickle cell disease and leukemia.
2. Biochemical tests, electrolyte tests, blood urea nitrogen tests, creatinine tests, and blood glucose tests.
3. Penile cavernous body blood gas analysis: The partial pressure of blood CO2 is higher than normal in ischemic priapism, while the partial pressure of blood CO2 is basically normal in non-ischemic priapism.
4. Doppler penile blood flow measurement: helps to understand the changes in blood flow to the corpora cavernosa before and after treatment.
What are the differences between priapism, physiological erection, and hypersexuality?
Physiological erection refers to the phenomenon that a normal man experiences 3 to 5 erections each night after falling asleep, but the duration is relatively short and the erection can subside on its own; hypersexuality refers to an increased sexual desire, sexual demands, and frequency of sexual intercourse, and the penis is also prone to erection, but the penis can subside after ejaculation.
Treatment principles
In the early stages, conservative treatment is used. If this fails, surgical treatment can be performed to restore normal blood circulation in the corpora cavernosa, reduce abnormal erections, and restore normal sexual function.
How does Western medicine treat this?
1. General treatment: Administer sedatives, vasodilators, estrogen, and vagus nerve antagonists, such as nitrazepam 10-20 mg orally three times a day; tolazoline 25 mg orally three times a day; diethylstilbestrol 5 mg orally three times a day; scopolamine 0.3-2.1 mg intravenously in 100-200 ml of 50% glucose solution, and switch to tablets after the condition improves.
2. Anticoagulation therapy: Dextran, dicumarol, heparin, and fibrinolytic drugs may be selected according to the patient's condition.
3. Eliminate nerve and muscle stimulation: Lumbar spinal anesthesia, epidural block anesthesia, and pudendal nerve block are beneficial for vasodilation and improving blood return, while also blocking abnormal nerve stimulation.
4. Surgical Treatment: If non-surgical methods are ineffective, surgical treatment may be considered. One method is the corpus cavernosum aspiration and irrigation method, where a large-bore needle is inserted into one or more points in the corpus cavernosum to aspirate the stagnant blood. Simultaneously, the corpus cavernosum is squeezed by hand until all the stagnant blood is expelled until bright red blood drips. The corpus cavernosum is then repeatedly flushed with a 1:1000 heparinized saline solution. Another method, if aspiration is unsuccessful, can be performed by making multiple small incisions in the corpus cavernosum to remove the blood clot, followed by local flushing with the aforementioned heparinized solution.
How does Traditional Chinese Medicine differentiate syndromes and treat diseases?
1. Liver meridian damp-heat type: Symptoms include abnormal penile erection, swelling, heat and pain, insomnia and dreaminess, flushed face and red eyes, irritability and anger, bitter taste in mouth and dry throat, constipation, scanty dark urine, red tongue with especially red edges, yellow and greasy tongue coating, and wiry and rapid pulse.
Treatment principle: Clear heat and promote diuresis, soften hardness and dissipate nodules.
Prescription: Gentian root 6-15g, Scutellaria baicalensis 6-10g, Gardenia jasminoides 6-15g, Alisma plantago-aquatica 10g, Plantago asiatica (wrapped) 15g, Angelica sinensis 10g, Bupleurum chinense 10-15g, Rehmannia glutinosa 12-20g, Paeonia lactiflora 12g, Coix lacryma-jobi 15g, Dioscorea hypoglauca 10g, black soybean 20g, Talcum 10g, Glycyrrhiza uralensis tip 3-10g.
2. Yin deficiency and Yang excess type: Symptoms include abnormal penile erection, swelling and pain, dizziness, dry throat and mouth, five-center heat, insomnia and night sweats, soreness and weakness of the lower back and knees, seminal emission and premature ejaculation, red tongue with little coating, and thready and rapid pulse.
Treatment principle: Nourish Yin and clear heat.
Prescription: 15-20g Rehmannia glutinosa (raw), 15-20g Rehmannia glutinosa (processed), 15g Anemarrhena asphodeloides, 6-10g Phellodendron chinense, 6-10g Cornus officinalis, 20g Dioscorea opposita, 12-20g Scrophularia ningpoensis, 15-20g Morus alba, 15-20g Paeonia lactiflora, 10g Scutellaria baicalensis, 10g Ophiopogon japonicus, 15g processed tortoise plastron, 20g Lycium barbarum, 6-10g Paeonia suffruticosa, 10-20g Poria cocos, 10g Alisma plantago-aquatica.
3. Seminal emission and obstruction of the orifices type: Symptoms include abnormal penile erection, or persistent erection after intercourse without loss of erection, hard and itchy penis, lower abdominal distension, pale red tongue with thin and greasy coating, and wiry, thready and hesitant pulse.
Treatment principle: Remove the stagnant essence, open the orifices and soften the tendons.
Prescription: Angelica sinensis tail 10g, Gleditsia sinensis thorn 10g, Carthamus tinctorius 10g, Sappanwood 10g, processed pangolin scales 10g, Bombyx mori 10g, Forsythia suspensa 10g, Fritillaria thunbergii 10g, Boswellia carterii 10g, Haliotis diversicolor (decocted first) 30g.
4. Liver Fire Excess Type: Symptoms include persistent erectile pain, inability to retract the erection, accompanied by irritability, flushed face and red eyes, bitter taste in the mouth and dry throat, dizziness and tinnitus, red tongue with dry yellow coating, and wiry and forceful pulse.
Treatment principle: Clear liver fire, resolve blood stasis and soften hard masses.
Prescription: Angelica sinensis 12g, Gentiana scabra 6g, Gardenia jasminoides 12g, Coptis chinensis 12g, Phellodendron chinense 12g, Scutellaria baicalensis 12g, Aloe vera 6g, Rheum palmatum 6g, Aucklandia lappa 3g, Musk 1g, Zingiber officinale 10g, Hirudo medicinalis 3g, Paeonia lactiflora 12g, Corydalis yanhusuo 12g, Polygonum cuspidatum 12g, Melia toosendan 12g.
5. Phlegm-fire stagnation type: Symptoms include abnormal and hard penile erection, habitual fondness for strong alcohol, rich and spicy foods, or obesity, sticky and bitter mouth, thirst but no desire to drink, constipation or sticky and unsatisfactory bowel movements, dark urine, red tongue with yellow and greasy coating, and wiry and slippery or slippery and rapid pulse.
Treatment principle: Clear heat and resolve phlegm, soothe the liver and relieve depression.
Prescription: Coptis chinensis 3g, Arisaema cum Bile 10g, Polygala tenuifolia 6g, Citrus reticulata peel 6g, Citrus reticulata peel 6g, Pinellia ternata (processed) 10g, Trichosanthes kirilowii peel 10g, Bambusa textilis 10g, Citrus aurantium 10g, Phellodendron chinense 6g, Glauber's salt (to be taken with water) 6g, Glycyrrhiza uralensis (raw) tip 6g.