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Benign Prostatic Hyperplasia (BPH)

• A 56-year-old male presents with a confirmed diagnosis of BPH.
• PSA levels are normal, and no signs of infection are present.
• A rectal exam reveals a boggy, enlarged prostate.
• The patient experiences frequent urination with incomplete voiding, urgency, and disrupted sleep due to nocturia.
• BPH is associated with low activity levels and a diet high in carbohydrates and low in vegetables.

TCM Integration of BPH

• The prostate is considered an extraordinary organ manifested by the Kidneys, connected to the Heart, similar to the uterus in women (Jing and Shen meeting point).
• BPH is a damp cold condition (lower burner) caused by Kidney yang deficiency, often from over-consumption of Kidney Yang and Jing through misused sexual energy.
• Treatment involves nourishing Kidney yang and clearing Dampness and Phlegm.

BPH Outcome Measures

• Decrease frequency of urination, especially nocturia
• Decrease feeling of urgency and improve voiding
• Decrease swelling of the prostate

Featured Herbs for BPH

• Achillea millefolium (Yarrow)
• Ceanothus americanus (Red root)
• Ginkgo biloba (Ginkgo)
• Hibiscus sabdariffa (Hibiscus)
• Hydrangea arborescens (Hydrangea)
• Hydrastis canadensis (Goldenseal)
• Poria cocos (Poria)
• Rhodiola rosea (Rhodiola)
• Panax ginseng (Korean red ginseng)
• Urtica dioica (Nettle root)
• Usnea barbata (Old man's beard)
• Lepidioum meyenii (Maca)
• Pausinystalia yohimbe (Yohimbe)
• Epimedium grandiflorum (Horny goat weed)
• Pygeum africanum (Pygeum)
• Serenoa repens (Saw palmetto)
• Smilax officinalis (Sarsaparilla)
• Tribulus terrestris (Puncture vine)
• Xanthoxylum americanum (Prickly ash)

Rhodiola (Rhodiola rosea)

• Primary actions: alterative, endocrine modulator, astringent
• Secondary actions: lymphatic, circulatory tonic
• Other actions to consider: diuretic

Selected Herbs by Desired Botanical Actions

• Alterative herbs include:
  • Sarsaparilla (Smilax officinalis)
  • Goldenseal (Hydrastis canadensis)
  • Yarrow (Achillea millefolium)
  • Old man's beard (Usnea barbata)
  • Cleavers (Galium aparine)
• Endocrine modulator herbs include:
  • Saw palmetto (Serenoa repens)
  • Sarsaparilla (Smilax officinalis)
  • Nettle root (Urtica dioica)
  • Pygeum (Pygeum africanum)
  • Puncture vine (Tribulus terrestris)
  • Horny goat weed (Epimedium grandiflorum)
  • Maca (Lepidioum meyenii)
  • Korean red ginseng (Panax ginseng)
  • Yohimbe (Pausinystalia yohimbe a.k.a. Coryanthes yohimbe)
  • Coffee (Coffea arabica)
• Astringent herbs include:
  • Goldenseal (Hydrastis canadensis)
  • Sarsaparilla (Smilax officinalis)
  • Old man's beard (Usnea barbata)
  • Hibiscus (Hibiscus sabdariffa)
  • Coffee (Coffea arabica)
  • Rhodiola rosea (Rhodiola)
  • Bearberry (Arctostaphylos uva ursi)
  • Saw palmetto (Serenoa repens)
  • Yarrow (Achillea millefolium)
  • Poria (Poria cocos)
• Lymphatic herbs include:
  • Cleavers (Galium aparine)
  • Goldenseal (Hydrastis canadensis)
  • Old man's beard (Usnea barbata)
  • Red root (Ceanothus americanus)
  • Nettle root (Urtica dioica radix)
  • Poria (Poria cocos) Circulatory Tonic herbs include:
  • Prickly ash (Xanthoxylum americanum)
  • Ginkgo (Ginkgo biloba)
  • Hibiscus (Hibiscus sabdariffa)
  • Coffee (Coffea arabica)
• Diuretic herbs include:
  • Saw palmetto (Serenoa repens)
  • Bearberry (Arctostaphylos uva ursi)
  • Yarrow (Achillea millefolium)
  • Old man's beard (Usnea barbata)
  • Nettle root (Urtica dioica radix)
  • Poria (Poria cocos)
  • Coffee (Coffea arabica)

Herb Selection and Formula for BPH

• Saw palmetto (Serenoa repens): 20 parts
• Pygeum (Pygeum africanum): 15 parts
• Gingko (Ginkgo biloba): 15 parts
• Nettle root (Urtica dioica): 15 parts
• Fu ling (Wolfporia extensa): 10 parts
• Prickly ash (Zanthoxylum americanum): 10 parts
• Korean red ginseng (Panax ginseng): 10 parts
• Cinnamon (Cinnamomum zeylanicum): 5 parts
• Total: 100 parts

Saw palmetto (Serenoa repens)

• Dosage as a Tincture or powder is optimal
  • Take 3 tablespoons (45 mL) a day, ideally in a mug of hot water.
• Dosage as an Infusion is not optimal.
• Dosage as a Decoction:
  • Add 4 tablespoons to 4 cups (1 L) water, boil on medium for 1 hour, or cook on high overnight in a slow cooker.
• Duration:
  • The dose may be decreased from 3 to 2 tablespoons (45 to 30 mL) after 10–14 days
  • It may be further decreased to 1 tablespoon (15 mL) a day after another 14 days, if symptoms improve.
• Saw palmetto interacts positively with 5-alpha reductase inhibitors
  • The mechanism of action is similar to prescription 5-alpha reductase inhibitors.
  • Combined use achieves a slightly improved effect.
  • Pygeum will likely counter the effects of testosterone supplementation; therefore, they should not be used concurrently.

Other Therapies

• Minimize consumption of dairy, sugar, soy, and alcohol (especially beer).
• Engage in physical activity to the point of sweating three to five times a week.

Achillea millefolium (Yarrow)

• Primary Actions: Alterative, vulnerary, antimicrobial, astringent, diaphoretic, styptic
• Constituents: Volatile oils, sesquiterpene lactones, tannins, alkaloids, flavonoids
• Indications: Skin conditions, digestive congestion, hepatic congestion, topical lesions, hemorrhoids
• Considered safe, Preg B, Lact CC
• Uses: Leaf, flower Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%) Daily Therapeutic Dose Infusion or Decoction: 2-4 g leaf or flower Pairs Well With: Arctium lappa and Angelica sinensis for insufficient digestion. Urtica dioica leaf and Iris versicolor for acne and eczema.
• Closest Substitute: None

Arctostaphylos uva ursi (Bearberry)

• Primary Actions: Urinary antimicrobial, diuretic, astringent
• Constituents: Hydroquinones (arbutin), tannins
• Indications: UTI, kidney stones, pyelonephritis, BPH
• Cautions/Contraindications: Toxicity of hydroquinones not well established, but no toxicity currently reported As a strong acting antimicrobial, may be cycled out every 3 weeks, Preg C, Lact SD
• Less conversion of active arbutin in highly acidic urine or when used with other urinary acidifiers
• Part Used: Leaf
• Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 25%)
• Daily Therapeutic Dose Infusion or Decoction: 4-12 g herb Pairs Well With: Agathosma betulina in UTI combos
• Closest Substitute: Usnea barbata

Ceanothus americanus (Red root)

• Primary Actions: Lymphatic, alterative, decongestant, antimicrobial, astringent
• Constituents: Alkaloids, tannins
• Indications: URTIs, enlarged spleen, palpable lymph nodes, edema, circulatory congestion, lethargy and melancholy, GI bleeding and loose stools Considered safe, has been used as a tea substitute, Safety in pregnancy and lactation not established.
• Part Used: Root, root bark, twigs Daily Therapeutic Dose Tincture: 9–12 mL (1:5 in 40%)
• Daily Therapeutic Dose Infusion or Decoction: 4–6 g dried root
• Pairs Well With: Salvia officinalis and Rosmarinus officinalis in acute URTIs with congestion and swollen lymph nodes
• Closest Substitute: Phytolacca americana

Galium aparine (Cleavers)

• Primary Actions: Lymphatic, alterative, astringent
• Constituents: Coumarins, iridoids
• Indications: Recurrent infection, any swelling of lymph glands, eczema, psoriasis
• Considered safe. Preg B, Lact C. Perhaps the best-known and most widely used lymphatic thought of as a specific for skin conditions that present with swollen lymph nodes.
• Part Used: Aerial parts Daily Therapeutic Dose Tincture: 12-24 mL (1:5 in 25%)
• Daily Therapeutic Dose Infusion or Decoction: 4-8 g dried herb
• Pairs Well With: Zanthoxylum americanum in formulas for stagnant lymph and poor circulation
• Closest Substitute: Scrophularia nodosa

Ginkgo biloba (Ginkgo)

• Primary Actions: Circulatory tonic, vasodilator, anti-inflammatory, anticoagulant (as an antiplatelet activator factor [PAF]) nootropic, mild astringent
• Constituents: Flavonoid glycosides, terpene lactones (gingkolides)
• Indications: Poor perfusion of tissues, especially cerebral; inflammation, clot formation, cognitive decline, erectile dysfunction, BPH
• Cautions/Contraindications: Though not toxic, may cause stomach discomfort or cramping. Preg B, Lact CC.
• Is the most ancient species of tree on the planet.
• The females produce a characteristically unpleasant smelling but edible fruit.
• Part Used: Leaf and fruit Daily Therapeutic Dose Tincture: 3–9 mL (1:5 in 40%)
• Daily Therapeutic Dose Infusion or Decoction: 4–10 g dried leaf
• Pairs Well With: Actaea racemosa and Hydrastis canadensis for vertigo Capsicum frutescens in formulas for improved circulation Centella asiatica for enhancing cognitive performance
• Closest Substitute: Centella asiatica

Hibiscus sabdariffa (Hibiscus)

• Primary Actions: Hypotensive, antioxidant, mild nervine, astringent, cooling, mild diuretic, mild alterative, mild emmenagogue
• Constituents: Flavonoids, vitamin C, anthocyanidins, tannins
• Indications: Hypertension, inflammation and heat patterns Long history of use as pleasure tea, broadly considered safe, Safety rating during pregnancy and lactation not established.
• Part Used: Flower Daily Therapeutic Dose Tincture: 6–15 mL (1:5 in 25%)
• Daily Therapeutic Dose Infusion or Decoction: 6–12 g dried flower
• Pairs Well With: Chrysanthemum morifolium for excessive heat patterns Crataegus oxyacantha berry for hypertension and cardiovascular conditions
• The two species are generally thought to be interchangeable
• Closest Substitute: Schisandra sinensis

Hydrangea arborescens (Hydrangea)

• Primary Actions: GU decongestant, antilithic, diuretic
• Constituents: Flavonoids, coumarins, saponins, mucilage
• Indications: BPH, kidney stones considered safe, though potential for interaction with anticoagulant therapy. Preg B, Lact C. Part Used: Root Daily Therapeutic Dose Tincture: 6–12 mL (1:5 in 40%)
• Daily Therapeutic Dose Infusion or Decoction: 8–12 g dried root Pairs Well With: Wolfporia extensa for BPH Solidago canadensis for UTI
• Closest Substitute: Wolfporia extensa

Hydrastis canadensis (Goldenseal)

• Primary Actions: Antimicrobial, decongestant, anti-inflammatory, hepatic, bitter, topical antiseptic and styptic
• Constituents: Isoquinoline alkaloids (hydrastine, berberine)
• Indications: Acute GI infections, acute URTI, chronic sinusitis, vertigo, tinnitus, mucus in stool, chronic skin conditions, post-infection convalescence, mouth ulcers, hepatitis Non-toxic but very strongly bitter Avoid during pregnancy and lactation. Not generally used more than 3 weeks consecutively May impair endogenous flora with long-term use, though this has not been evaluated or observed.
• Daily Therapeutic Dose Infusion or Decoction: 2-4 g
• Pairs Well With: Salvia officinalis as a decongesting antimicrobial. Gingko biloba and Actaea racemosa for vertigo. Berberis vulgaris most the closest substitute:

Lepidioum meyenii (Maca)

• Primary Actions: Endocrine modulator (testosterone), adaptogen, anti-inflammatory
• Constituents: Carbohydrates, proteins, sterols, linoleic and oleic acid, micronutrients including zinc glucosinolates
• Indications: Debility, lowered libido, convalescence
• Considered safe, consumed as food, Safety in pregnancy and lactation not established.
• Though appears to have benefit improvement in perform sexual performance the mechanisms of action isn’t as strong
• Part Used: Root Daily Therapeutic Dose Tincture: Likely ineffective as tincture 8–12 mL (1:5 in 40%)
• Daily Therapeutic Dose Infusion or Decoction: 6–25 g dried root
• Pairs Well With: As powder, Withania somnifera and Panax quinquefolius for physical stamina
• Closest Substitute: Inonotus obliquus

Panax ginseng (Korean red ginseng)

• Primary Actions: Stimulating adaptogen, immune stimulant, libido stimulant, cardiotonic
• Constituents: Triterpene glycosides (ginsenosides), steroidal saponins
• Indications: Debility and convalescence (low dose), depression, end-of-life care
• Cautions/Contraindications: Non-toxic, but can be overstimulating to some individuals, particularly where yin has been weakened through excessive use of stimulants. CI in hypertension and other heat conditions. Preg A, Lact C. Part Used: Root, ,is steamed ,while white ginseng is the unprepared root of the same species. The steamed red root is preferred. Daily Therapeutic Dose Tincture: 2–10 mL (1:5 in 40%)
• Daily Therapeutic Dose Infusion or Decoction: 3–10 g dried root
• Pairs Well With: Astragalus membranaceus and Rehmannia glutinosa for convalescence after blood loss.
• Ganoderma lucidum for depression. Centella asiatica for mental clarity and focus.
• Closest Substitute: Rhodiola rosea

Pausinystalia yohimbe a.k.a. Coryanthes yohimbe (Yohimbe)

Primary Actions: Endocrine modulator (testosterone), mild stimulant

• Constituents: Indole alkaloids (yohimbine, corynanthine)
• Indications: Lowered libido, improved sexual performance and possibly BPH
• Cautions/Contraindications: In larger doses, can cause flushing, dizziness, and elevated blood pressure. Priapism is uncommon but has been reported. CI in pregnancy. Are significant for exertion and diminish are recurrent in less efficacy Best used acutely, and cautioned in individuals with tendency to fainting and dizziness. Also common in weight loss formulas

Serenoa repens (Saw palmetto)

• Primary Actions: Endocrine modulator (male), decongestant, diuretic, possible libido tonic
• Constituents: Volatile oils, fixed oils, fatty acids, sterols, saponins
• Indications: BPH, edema, PCOS with androgen dominance
• berries is eaten as safe food, May interact to enhance efficacy of other,a reductase inhibitors. Part Used: Berry has a characteristic taste

Smilax officinalis (Sarsaparilla)

• Primary Actions: Adaptogen, alterative, anti-inflammatory
• Constituents: Saponins based on the aglycone sarsapogenin, sterols, volatile oils
• Indications: Eczema, psoriasis, BPH, waning libido, RA, gout safe during pregnancy and lactation not established.

Tribulus terrestris (Puncture vine)

Actions: Endocrine modulator (androgen) Constituents: Alkaloids (harmane and norharmane)

• Indications: Lowered libido, erectile function, fatigue and debility, BPH May cause paresis in large doses and perilous dangers

Urtica dioica folia (Nettle leaf)

• Primary Actions: Nutritive, alterative, diuretic
• Constituents: Indoles, flavonoids, formic acid

Usnea barbata (Old man's beard)

• actions: Antimicrobial, antifungal, antiviral, vulnerary, styptic, astringent Constituents: Organic acids Vaginal Yeast infection's Potential toxicity hepatoxicity . is symbiotic

Xanthoxylum americanum (Prickly ash)

Actions: Circulatory tonic, alterative, warming diaphoretic, sialagogue, mild carminative, lymphatic