Study On TCM Syndrome Epidemiology And Exploration On Strategy Of Prevention And Treatment Of Chronic Prostatitis In The Male College Students In Guangdong Province

Objective: To study the characteristics of TCM syndrome epidemiology and explore the strategy of prevention and treatment of chronic prostatitis in the male students of college in Guangdong province.Methods: About 1431 College students were drawn randomly from Guangzhou Univ. of TCM, Xinghai Music College, Normal Univ. of Southern China and Zhongshan University. They were investigated about their cognition on chronic prostatitis and its physical signs, their psychological condition, existing risk factors and responding measures by the methods of the Symptom Checklist-90-R (SCL-90-R) and the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) and self made inquiry lists. The expressed prostatic secretions were taken by the method of rectal prostate massage and were tested by microscopy. The chronic prostatitis (CP) patients were grouped according to TCM syndrome and the differences of incidence rates and TCM syndromes were compared. The correlation intensity of the main TCM syndromes with the patient' s physical signs or psychological condition or rectal prostate finger diagnostic results or microscopic EPS test was assessed. The high risk factors for CP were analysed by conditioned logistic regression. The cognition difference and responding movements were compared between the male students with prostatitis and those without prostatitis. The incidence rates ofdifferent responding movements were calculated.Results: 1. The total incidence rate for chronic prostatitis was 46.6% in male students of Guangdong colleges and the incidence rates were significantly different between the students from different residence area or birth place and between those with different economic condition or school study scores(P < 0.01).But the incidence rates were not significantly different among students with different speciality or ages or with different degree of personal relationship harmony (P>0. 05). Most TCM syndromes are complex of some radical syndromes. Among the syndromes the single typed syndromes constitute about 32.98%. the incidence rates for the damp-heat syndrome, blood stasis syndrome , yin deficiency syndrome of liver and kidney and yang deficiency syndrome of kidney were 63. 28%. 47. 59%. 39. 39% and 33. 69% respectively.2. The incidence rates of the blood stasis syndrome and the yin deficiency syndrome of liver and kidney were significantly different between different age groups (P<0. 01) but not different for the damp-heat syndrome and the yang deficiency syndrome of kidney (P>0. 05). The medical speciality group had a higher incidence rate of blood stasis syndrome than the non-medical speciality group (P<0. 01), but had no different rates of damp-heat syndrome or yin deficiency syndrome of liver and kidney or yang deficiency syndrome of kidney (P>0. 05). Compared with the northern students group, the southern group had decreased rates of damp-heat syndrome (P<0. 01) and of yin deficiency syndrome of liver and kidney (P<0. 05) and no significantly different rates of blood stasis syndrome and yang deficiency syndrome of kidney (P>0. 05). The rates of damp-heat syndrome and yin deficiency syndrome of liver and kidney were significantly different between the groups of different origin area (P<0. 01) but the rates of blood stasis syndrome and the yang deficiency of kidney were not significantly different (P>0. 05). The rate of damp-heat syndrome was significantly different between the groups of different economic conditions (P<0. 01) but the rates of blood stasis syndrome and yin deficiency syndrome of liver and kidney and the yang deficiency of kidney were not significantly different (P>0. 05). The groups of different personal relationship harmony had significantly different rates of yin deficiency syndrome of liver and kidney (P<0. 01) but not significantly different rates of damp-heat syndrome and blood stasis syndrome and the yang deficiency of kidney (P>0. 05).3. The damp-heat group had a much higher NIH-CPSI score on difficulturination than the group of yin deficiency syndrome of liver and kidney and the group of blood stasis syndrome and that of the yang deficiency of kidney (P<0. 01 or P<0. 05). The damp-heat group also had a much higher NIH-CPSI score on life quality than the group of yin deficiency syndrome of liver and the group of the yang deficiency of kidney (P<0. 01 or P<0. 05). The blood stasis syndrome group had much higher NIH-CPSI scores than the group of yin deficiency syndrome of liver and kidney (P<0. 05), and the NIH-CPSI score in the group of the yang deficiency of kidney was lower than that of blood stasis syndrome group (P<0. 01). The NIH-CPSI scores in the other main syndrome groups had no significant differences ( P>0.05)4. In the damp-heat group ,the SCL-90 scores on the factors of forced behavior and hostile attitude and monomania were lower than that in the group of blood stasis (P<0. 01 or P<0. 05), and the score on the factor of forced behavior was lower than the group of the yang deficiency of kidney (P<0. 05), and the scores on the factors of phobia and monomania lower than the group of yin deficiency syndrome of liver and kidney (P<0. 01 or P<0. 05), and the psychopathic SCL-90 score much higher than the group of yin deficiency syndrome of liver and kidney (P<0. 01) . In the group of blood stasis the psychopathic SCL-90 scores on the factors of forced behavior, sensitivity of personal relationship, hostile attitude and anxiety were lower than the group of yin deficiency syndrome of liver and kidney (P<0. 01 or P<0. 05), but the scores on the factors of monomania and depression were higher than the group of yang deficiency of kidney (P<0. 05), and the score on the factor of phobia was lower than the group of yin deficiency syndrome of liver and kidney (P<0. 01). The group of yin deficiency of liver and kidney had higher scores on the factors of phobia and monomania and lower psychopathic SCL-90 score than the group of yang deficiency of kidney (P<0. 05 or <0. 01). The scores on the SCL-90 factors in other syndrome groups were not significantly different (P>0. 05). The incidence rates of mental abnormality in the groups of damp-heat syndrome , blood stasis syndrome , yin deficiency syndrome of liver and kidney and yang deficiency syndrome of kidney were 15. 19%, 17. 50%, 17. 65% and 13. 33% respectively and the incidence rates for the middle degree of mental abnormality were 15. 19% , 17.50% , 17. 65% , 13.33% respectively with no significant differences (P>0. 05).5. The microscopic test of EPS showed a rate between 12. 66% and 35. 29% ofWBC less than 10/Hp with significant difference from the rate of WBC^30/Hp (P<0. 05), but the decrease of the lecithin body in EPS had no significant difference(P>0. 05).6. The prostate rectal diagnosis in all the four groups found that about 39. 23% to 66. 67% were normal in gland volume, about 35. 29% to 60. 00% asymmetric in surface, 25.32% to 67. 50% not smooth surface, 26.67% to 45. 00% of shallow central groove and 27. 50%~70. 59% normal texture and about 33. 33%~56. 96% of tenderness. The rates of smooth surface and normal texture were significantly different (P<0. 05 or <0. 01) but the rates in volume symmetry central groove and tenderness were not (P>0. 05) .7. The scores on the pain or discomfort, difficult urination , life quality and the total score in the prostatitis group were 7.61 + 3.32, 5.01 + 2.85, 8.34 + 2.32 and 20.96 + 6.96 respectively higher than those in the non prostatitis group (P<0. 01), the incidence rate of pain always in the testes was 48. 66%. The incidence rate of difficult urination always as uncomplete urine was 82. 53% and the occurrence of sexual malfunction mostly as decrease of libido was 26.74%.8. In the prostatitis group, the scores on the factors and the number of the positive items in SCL-90 were all higher than those in the non prostatitis group (P<0. 01). The incidence rates of mental abnormality and above the middle degree of abnormality were 51. 16% and 16. 40% respectively. The incidence rates of abnormality and above the middle degree of abnormality for every factor were 17.65% to 34.22% and 3.21% to 7.31% respectively. The total incidence of mental abnormality and the incidences of depression, anxiety, monomania, and abnormal psychological factor were all higher than the non-prostatitis group (P<0. 01). The incidences of depression, anxiety and phobia above the middle degree of abnormality in the prostatitis group were all higher than the non-prostatitis group (P<0. 05). The incidences of monomania above the middle degree of abnormality in the prostatitis group were all higher than the non-prostatitis group (P<0. 01)9. In the damp-heat group, the SCL-90 scores on the factors of forced behavior and hostile attitude and monomania were lower than that in the group of blood stasis (P<0. 01 or P<0. 05), and the score on the factor of forced behavior was lower than the group of the yang deficiency of kidney (P<0. 05), and the scores on the factors of phobia and monomania lower than the groupof yin deficiency syndrome of liver and kidney (P<0. 01 or P<0. 05), and the psychopathic SCL-90 score much higher than the group of yin deficiency syndrome of liver and kidney (P<0. 01) . In the group of blood stasis the psychopathic SCL-90 scores on the factors of forced behavior, sensitivity of personal relationship, hostile attitude and anxiety were lower than the group of yin deficiency syndrome of liver and kidney (P<0. 01 or P<0. 05), but the scores on the factors of monomania and depression were higher than the group of yang deficiency of kidney (P<0. 05), and the score on the factor of phobia was lower than the group of yin deficiency syndrome of liver and kidney (P<0. 01). The group of yin deficiency of liver and kidney had higher scores on the factors of phobia and monomania and lower psychopathic SCL-90 score than the group of yang deficiency of kidney (P<0. 05 or <0. 01). The scores on the SCL-90 factors in other syndrome groups were not significantly different (P > 0. 05). Compared with the non prostatitis group the prostatitis group had higher incidence rates of prostate enlargement and tenderness in the rectal diagnosis(P<0. 01) and higher incidence rates of smooth surface hard texture (P <0. 05) , and the incidence of other items were not significantly different(P>0. 05) .10. In the microscopic examination of EPS, the incidence rates of WBC/Hp at the levels of < 10, 10-19, 20-29, 30-39 and ^40 were 21.57%,18.00%, 23.00%, 23.535% and 13.90% respectively. The incidence rates for different levels of the lecithin body from the normal level to light degree of decrease, middle degree of decrease and high degree of decrease were 7. 84%, 27. 99%, 43. 85% and 20. 32%.11. According to the P value from the high level to the low level of significance, the high risk factors for prostatitis were one by one: restraint from ejaculation, repeat masturbation or intercourse, worry about the bad outcome of masturbation or intercourse, restraint from defecation and riding bike.12. The rate for correct recognition about prostatitis in the students were between 16.21%~94.62%. The students at different ages had significantly different rates of recognition about the nature and etiology of the disease and effects on sexual and reproductive functions (P<0.05 or <0. 01). But their recognitions about the anatomic position of prostate and the outcome of prostatitis were at rates with no significant difference(P>0. 05). Comparedwith the non medical group the medical group had no significantly different recognition rates on the questions such as "both urethra and spermaduct pass through the prostate" and "prostatitis is not a venereal disease" (P>0. 05), on the other questions the recognition rates were increased with significant difference (P<0. 05 or <0. 01). The recognition rates on the anatomic position of prostate and the etiology of prostatitis had obviously significant difference between the southern group and the northern group (P<0. 01) , but the rates about the other questions were not significantly different (P> 0.05). The recognition rates on the anatomic position of prostate and the effects and prognosis of prostatitis on the sexual and reproductive functions were significantly different among the city group, county group and the country group (P<0. 01 or <0. 05), but the rates on the pathologic nature and etiology of prostatitis were not significantly different (P>0.05).The recognition rates on the questions such as "both urethra and spermaduct pass through the prostate" and "prostatitis can occur with people without sexual experience and on the pathologic nature and the effects of prostatitis on the sexual and reproductive functions were significantly different among the groups with different degree of social harmony (P<0. 01 or P<0. 05) , but the rates on the other questions were not significantly different (P>0. 05).13. Compared with the non prostatitis group, the prostatitis group were more likely to attend the health education at free time if the lecturer was competent, but not likely to attend but not likely to attend the health education at the condition "must find time to attend" or "if have free time" (P<0. 05 or P<0.01) . The selection on the diagnostic objects had no difference when prostatitis was in suspicion (P>0. 05) . But after diagnosis the more patients select strange doctors (P<0. 05) and less seek help from friends (P<0. 01) and more patients did not like to change their harmful life style (P < 0.05 ) .About 59.33%, 43.82% and 29.63% of college students respectively selected anonymous consultation, self-diagnosis and strange doctor when they were suspicious of prostatitis. After diagnosis about 62.78%, 40.88% and 29.43% of students seek doctors, self and anonymous treatment respectively. When their friends got prostatitis, only 59.61% of students want to keep the secrete.Conclusion: l.The incidence rate of CP in male students of Guangdong colleges was correlated with the students' resident place, origin place,economic condition and the school study scores.2. The TCM syndromes were all complex of simple radical syndromes. The incidence rates of the four main syndrome types of damp-heat syndrome, blood stasis syndrome, yin deficiency syndrome of liver and kidney and yang deficiency syndrome of kidney were related with speciality, ages, origin address, economic condition and friendship of the students.3. The different main syndromes manifested different physical and mental symptoms.4. The results of rectal finger examination of prostate and microscopy analysis of EPS can be used as referent conditions for the differentiation of TCM syndromes.5.Mental symptoms occurred at high rates.6. The pathogenesis is often related with sexual activity.7. The student' s recognition rates about the prognosis of prostatitis were low and were related with their speciality, ages, resident places, economic condition, relationship with classmates and scores of school study.8. The students hold different attitudes toward self and friends when they got prostatitis. They usually disguise their diseases. Their attendance to the related education was determined by the topic and the scholarship of the lecturers.9. The lecturers of high level of scholarship should be selected to promote the prevention and treatment of prostatitis. The content of the education should be determined according to individual states. The health education on prostate should be held for the whole college students. The protection of privacy should be noticed. The treatments should begin with refraint from bad behaviors especially the bad sexual behaviors. Multiple methods are adopted to treat physical and mental symptom at same time.