Hematospermia and inguinal hernia, hydrocele need to be differentiated.
Seminal vesiculitis can cause numerous problems, so timely treatment is essential. Traditional Chinese medicine (TCM) treatment follows the principles of careful examination to determine the underlying cause and differentiate syndromes for appropriate treatment. Treatment is tailored to the nature of the symptoms, focusing on either clearing heat or tonifying. For example, if there is damp-heat accumulation, the treatment focuses on clearing heat and eliminating dampness; if there is yin deficiency and damage to the blood vessels, the treatment focuses on nourishing yin and clearing heat; if there is qi deficiency and blood stasis, the treatment focuses on tonifying qi and consolidating blood; and for chronic cases, the treatment focuses on promoting blood circulation and removing blood stasis. Furthermore, appropriate hemostatic drugs are added based on the differentiation of syndromes to achieve a comprehensive treatment that addresses both the root cause and the symptoms.
Western medicine treatment:
1. For acute seminal vesiculitis, rest is important, sexual activity should be avoided, and bowel movements should be kept regular.
2. Antibiotic treatment: Administer macrolides or quinolones. Administer a full dose for half a month. If ineffective, and the blood is dark red, consider the possibility of tuberculosis and try a tuberculosis treatment regimen for one month.
3. Seminal vesicle abscess, which can be drained via rectal or perineal incision. (Now rare)
4. Regular prostate massage can help with the drainage and discharge of seminal vesiculitis.
5. If the above treatments are ineffective, a transscrotal vas deferens puncture technique can be used to infuse medication into the seminal vesicle from the vas deferens. The puncture method is the same as that for vas deferens-seminal vesicle angiography.
Seminal vesiculitis is a common clinical condition, characterized by hematospermia and painful ejaculation. It often coexists with prostatitis and can lead to decreased semen quality and even infertility. Therefore, prevention and treatment of this disease should be emphasized. Alleviating the patient's anxiety and treating the underlying cause are crucial. Early, adequate, and sensitive antibiotic treatment combined with heat-clearing, detoxifying, and urinary tract-clearing herbs, or yin-nourishing and blood-cooling traditional Chinese medicine, can quickly improve local and systemic symptoms and achieve good results. In the acute phase, Western antibiotics are the main treatment, combined with traditional Chinese medicine; in the chronic phase, traditional Chinese medicine is the main treatment, combined with antibiotics. However, seminal vesiculitis often coexists with prostatitis, and the anatomical structure of the seminal vesicles makes it easy for secretions to accumulate and drainage to be poor, making treatment difficult. If the inflammation is not completely controlled, it is prone to becoming chronic, with a prolonged course and frequent relapses. We advocate using a combination of traditional Chinese and Western medicine to treat this disease to shorten the course of the disease, reduce recurrence, and cure most patients. After treatment to eliminate hematospermia, treatment should continue for about one month to consolidate the results.
Traditional Chinese medicine believes that the root cause of this disease is yin deficiency, while damp-heat and toxicity are the symptoms, often accompanied by blood stasis. Treatment focuses on nourishing yin and reducing fire, supplemented by clearing damp-heat, cooling blood, and stopping bleeding. Traditional Chinese medicine has significant advantages in treating this disease, especially in the treatment of chronic seminal vesiculitis, where methods such as promoting blood circulation, nourishing yin and cooling blood, and strengthening the spleen and kidneys often yield good results.
Inguinal hernia is like two mountains in the heart and body.
Legend has it that during the late Qing Dynasty, a wealthy Russian merchant named Mikhailov visited China. One day, while boating on West Lake in Hangzhou, he was enjoying the beautiful scenery when he suddenly suffered a hernia attack, causing him to cry out in pain. The Russian doctors accompanying him were all helpless. At this point, the boatman recommended an old traditional Chinese medicine doctor. The doctor ground one ounce of fennel seeds into a coarse powder and had Mikhailov take it with two ounces of rice wine. About 20 minutes later, his hernia pain miraculously lessened and quickly disappeared. Overjoyed, he hailed the doctor as a miracle worker, and the story quickly became a popular tale.
Hernia pain, medically known as hydrocele, refers to a condition where fluid accumulates in the tunica vaginalis surrounding the testis, exceeding the normal amount. This is a relatively common male condition, accounting for 5% to 7% of urology outpatient visits. Generally, the incidence is higher in tropical regions. It can occur at any age, but is most common in young and middle-aged men and women.
This condition falls under the category of "hydrocele" in Traditional Chinese Medicine. Primary hydrocele is generally asymptomatic. Large amounts of fluid and high pressure can cause a feeling of heaviness, pulling pain, or distending pain. Large hydroces can affect activity, urination, and sexual intercourse. Secondary hydroces often present with symptoms of the primary disease. Because the cystic mass within the scrotum is often pear-shaped, smooth, and has an elastic, cystic feel upon palpation, it is not adherent to the scrotal skin and cannot be reduced. The testis and epididymis are often difficult to palpate due to the fluid accumulation, while in spermatic cord hydroces, the normal testis and epididymis can be palpated below. Transillumination of the mass is positive; however, if the hydrocele is very thick, or the fluid is bloody, purulent, or chylous, the transillumination test will be negative. Large hydroces can cause penile retraction.
Hydrocele can be classified into the following categories:
1. Hydrocele is the most common type of hydrocele, which occurs within the hydrocele cavity of the testis, forming a spherical or pear-shaped mass. The testis and epididymis are enclosed and not easily palpable. In cases where the testis has not descended completely, the fluid accumulation may appear as a cystic mass in the groin or beside the pubic bone, depending on the position of the testis.
2. Hydrocele of the spermatic cord: A cystic accumulation of fluid due to the incomplete closure of the processus vaginalis of the spermatic cord. The mass is located above the scrotum or in the inguinal canal, and is oval or fusiform in shape. Sometimes it is multicystic and dumbbell-shaped. When the testis or spermatic cord is pulled down, the mass moves downward with it.
3. Mixed type, which is a mixture of testicular hydrocele and spermatic cord hydrocele.
4. Infantile hydrocele is a pear-shaped hydrocele where the processus vaginalis fails to close and forms a single unit with the tunica vaginalis cavity of the testis. The external inguinal ring is enlarged due to pressure from the fluid, but it does not communicate with the abdominal cavity. The amount of fluid is unrelated to body position. This type of hydrocele often resolves spontaneously with age.
5. Congenital hydrocele (communicating): Due to the incomplete closure of the processus vaginalis of the spermatic cord, the abdominal cavity communicates with the tunica vaginalis of the testis. When standing, abdominal fluid flows into the tunica vaginalis of the testis. The amount of fluid changes with body position and disappears when lying down. Inguinal hernia may occur at the same time, which is called herniated hydrocele.
Traditional Chinese medicine believes that these types of diseases are mostly caused by the downward flow and accumulation of dampness in the scrotum. The spleen and kidneys are the organs responsible for controlling water; the spleen governs transformation and transportation, the kidneys govern water, and the liver's function of regulating water flow is also related to the movement of dampness. Therefore, these diseases can also affect organs such as the spleen and liver. The main causes are as follows:
1. Living in damp places for a long time, or wading through water in the cold winter, can lead to the accumulation of cold and dampness, causing water retention and resulting in "water hernia". The "Confucian Family Matters" points out that this type of water hernia "is caused by drinking water and getting drunk, which leads to excessive internal heat. When sweating occurs and one encounters wind, cold and dampness, the water accumulates in the scrotum, causing excessive water retention and sudden hernia."
2. Or the person may have a constitution with phlegm and dampness, or have a diet high in rich and fatty foods, which leads to poor digestion in the middle jiao, causing dampness to accumulate and transform into heat, which then descends to the scrotum and causes "hydrocele".
3. Or, due to congenital deficiency, kidney qi deficiency, and impaired qi transformation, water and dampness accumulate and form a hernia. As stated in "One Hundred Questions for Infants and Children," "There is also hydrocephalus... Some children are born with this condition, without pain or discomfort. These cases do not require treatment and heal on their own," which refers to this type. Or, due to excessive sexual activity or advanced age, kidney yang deficiency occurs, qi fails to transform water, and fluid accumulates in the scrotum, forming a "hydrocephalus."
4. If a person has a weak spleen and is unable to metabolize fluids, and is then exposed to dampness, the dampness will accumulate and form a hernia in the scrotum.
5. The liver governs the free flow of qi and blood. The liver meridian connects to the genitals. If the qi of the liver meridian is stagnant, the free flow of qi and blood will be impaired. If dampness is also present, the dampness will flow down the meridian to the scrotum, resulting in this disease.
6. Traumatic injuries, parasitic infections, and testicular trauma can lead to blood stasis and obstruction of the meridians. The Ming Dynasty physician Tingxian wrote in his book *Shou Shi Bao Yuan*: "If the external genitalia are injured by a fall, the testicles may become enlarged and sometimes painful, with blood stasis inside, a condition called blood hernia." Alternatively, infection with parasites (filariasis, schistosomiasis) can obstruct the meridians, causing fluid retention and accumulation in the scrotum, resulting in this disease.
The tunica vaginalis of the testis consists of two layers. One layer covers the surface of the testis, epididymis, and spermatic cord, forming the visceral layer of the tunica vaginalis. The other layer, the parietal layer, is in contact with the scrotal wall tissue and connected to the visceral layer. Between these two layers is a potential space called the tunica vaginalis cavity. The peritoneum forms the processus vaginalis below the internal inguinal ring, extending along the spermatic cord to above the testis. The processus vaginalis of the spermatic cord closes naturally before birth or shortly after. Under normal circumstances, the tunica vaginalis cavity contains only a small amount of fluid in balance between exudation and absorption. When the tunica vaginalis itself or adjacent organs are diseased, causing an imbalance between exudation and absorption, or when the processus vaginalis in the abdominal cavity does not completely close, fluid from the abdominal cavity can enter and exit the tunica vaginalis cavity, resulting in hydrocele.
Western medicine classifies the causes of hydrocele into two types: primary and secondary hydrocele.
The cause of primary hydrocele is not fully understood, and the disease progresses slowly. Pathological examination often reveals a chronic inflammatory reaction in the tunica vaginalis, which may be related to chronic injury, inflammation, or congenital factors, such as defects in the lymphatic system of the tunica vaginalis. Secondary hydrocele can be caused by primary diseases such as acute orchitis, epididymitis, or spermatic cord inflammation, which stimulate increased exudation from the tunica vaginalis, resulting in hydrocele. Surgical damage to the lymphatic vessels causing drainage obstruction, as well as high fever, heart failure, and ascites, can manifest as acute hydrocele. Chronic secondary hydrocele is commonly seen in chronic orchitis, epididymitis, syphilis, tuberculosis, and testicular tumors, leading to increased fluid secretion. In southern my country, hydrocele caused by filariasis or schistosomiasis obstructing lymphatic drainage can also be observed.
The tunica vaginalis is a double membrane that surrounds the testis. It is the peritoneum that the testis carries into the scrotum as it descends from the abdominal cavity. Normally, after the testis descends into the scrotum, the passage between the tunica vaginalis and the abdominal cavity closes automatically. If the closure is incomplete, ascites will descend, resulting in hydrocele.
Treatment for hydrocele does not need to be as aggressive as for inguinal hernia, as most cases of hydrocele in infants and newborns resolve spontaneously by age 2. If the hydrocele is severe, it may hinder testicular development, and the fluid can be drained with a syringe. Those that do not resolve spontaneously may require surgical treatment after age 2.