Table 3 Herbal formulations for overactive bladder treatment

TCM formulations (Proprietary Chinese medicine)

Bu-Zhong-Yi-Qi-Tang (补中益气汤)

Astragalus membranaceus

Leguminosae

Milkvetch or huáng qí 黄芪

Roots

1. Co-treatment with BZYQT and SPXS significantly improved the frequency of voiding, urgency and urge incontinence as well as increased the voiding volume and QOL

2. Significantly improved OABSS and QOL after 4 weeks treatment

3. Co-treatment with BZYQT and propiverine improved OAB symptoms and showed better efficacy than treatment with propiverine alone

1. 21 OAB patients

2. 28 female OAB patients with pattern of collapse from Qi deficiency

3. 34 patients with OAB with Qi deficency syndrome

NA

1. [95]

2. [91]

3. [33]

Atractylodes macrocephala

Asteraceae

bái zhú 白术

Roots

Panax ginseng

Araliaceae

Ginseng, rén shēn 人参

Root

Angelica sinensis

Apiaceae

Chinese Angelica Root, dāng guī 当归

Root

Bupleurum chinense

Apiaceae

Bupleurum, hare’s ear root, thorowax root, chái hú 柴胡

Root

Ziziphus zizyphus

Rhamnaceae

Jujube fruit, Chinese date, dà zǎo 大枣

Fruit

Citrus reticulata

Rutaceae

mandarin orange, chén pí 陈皮

Aged mandarin orange peel

Glycyrrhiza uralensis

Leguminosae

Chinese liquorice, gān cǎo 甘草

Roots

Cimicifuga foetida

Ranunculaceae

Foetid Bugbane, shēng má 升麻

Rhizome

Zingiber officinale

Zingiberaceae

Ginger, shēng jiāng 生姜

Rhizome

Ba-Wei-Di-Huang-Wan (八味地黄丸); Hachi-mi-jio-gan

Rehmannia glutinosa

Scrophulariaceae

Chinese foxglove, dì huáng 地黄

Root tuber

1. Lowered plasma glucose level, partially reversed the increases in contractile response to APE and the M2 receptor protein density

2. Inhibited acetylcholine-induced contraction

3. Ameliorated the reduced voiding interval, micturition volume, and bladder capacity induced by ATP solution

4. Ameliorated CYP-induced ongoing bladder overactivity and acidic ATP solution-induced hyperactivity on rats’ prestimulated bladder

5. Depressed SP-enhanced pelvic afferent nerve activity, bladder NF-kB/ICAM-1 expression, leukocyte infiltration, and ROS amount, and alliveated bladder hyperactivity

1. Streptozotocin-induced diabetic rats

2. Isolated rat bladder strips

3. Female SHRs

4. Female Wistar rats with CYP-induced ongoing bladder overactivity

5. Exogenous SP-induced bladder hyperactivity in female Wistar rats

1. Alleviation of M2 receptor overexpression

2. Binding to muscarinic receptors, 1,4-DHP receptors and purinergic receptors

3. Reduction in expression of tachykinins and P2X3 and TRPV1 receptors

4. Inhibition of the overexpression of mucosal P2X2, P2X3, M2 and M3-mAChR protein, as well as detrusor M2 and M3-mAChR protein; prevention of TRPV1 and P2X3 receptor overexpression

5. Inhibition of SP/neurokinin-1 receptor and NF-kB/ICAM-1 signaling pathway

1. [144]

2. [66]

3. [63]

4. [88]

5. [145]

Cornus officinalis

Cornaceae

Asiatic dogwood, Japanese cornel, shān zhū yú 山茱萸

Dry ripe sarcocarp

Dioscorea opposita

Dioscoreaceae

Chinese yam, shān yào 山药

Tuber or root

Alisma orientale

Alismataceae

Asian water plantain, zé xiè  泽泻

Rhizome

Poria cocos (Schw.) Wolf

Polyporaceae

Hoelen, China root, fú líng 茯苓

Filaments under the cap

Paeonia suffruticosa

Paeoniaceae

Moutan peony, mǔ dān pí 牡丹皮

Root bark

Cinnamomum verum

Lauraceae

Cinnamon, guì pí 桂皮

Dried bark

Aconitum carmichaelii

Ranunculaceae

Chinese aconite, Carmichael’s monkshood, fù zǐ 附子

Dried root

Fangjihuangqi Tang (防己黄芪汤)

Stephania tetrandra

Menispermaceae

Stephania-root, fáng jǐ 防己

Roots

Relieved symptoms of lower urinary tract dysfunction

BPH rat model

Regulation of smooth muscles in the bladder and urethra

[31]

Astragalus membranaceus

Leguminosae

Milkvetch or huáng qí 黄芪

Roots

Atractylodes macrocephala

Asteraceae

bái zhú 白术

Roots

Glycyrrhiza uralensis

Leguminosae

Chinese liquorice, gān cǎo 甘草

Roots

Ji‐Sheng‐Shen‐Qi‐Wan (济生肾气丸); Gosha-jinki-gan

Ba-Wei-Di-Huang-Wan

1. Enhanced threshold pressure, voiding interval, micturition volume, and bladder capacity

2. Increased intercontractile intervals and decreased contraction amplitudes; decreased dopamine and serotonin levels in plasma

3. Prevented overexpression of tachykinins and TRPV1 and P2X3 receptors in bladder urothelium

4. Reduced both episodes of nocturia and the IPSS

1. AA induced bladder overactivity in female SD rats

2. AA induced OAB in female rats

3. AA induced detrusor overactivity in female rats

4. 30 patients with nocturia despite treatment with α1-blockers or antimuscarinic drugs for at least 4 weeks

1. Inhibition of resiniferatoxin (RTX)-sensitive afferent neurons

2. Possible effects on the afferent and efferent micturition reflex and central effects on micturition mechanisms

3. Reduced expression of transmitter proteins and sensory receptors without damaging nerve fibers

4. NA

1. [172]

2. [112]

3. [62]

4. [161]

Achyranthes japonica

Amaranthaceae

Oriental chaff flower or Japanese chaff flower, niú xī 牛膝

Root

Plantago asiatica

Plantaginaceae

Chinese plantain, Asiatic plantain, chē qián zǐ 车前子

Dried ripe seed

Modified Ojayeonjonghwan (Wuzi Yanzong wan)

Cornus officinalis

Cornaceae

Asiatic dogwood, Japanese cornel, shān zhū yú 山茱萸

Dried sarcocarp

Similar pharmacologic effects to solifenacin in controlling DO caused by BOO

Partial urethral obstruction-induced DO rat model

Anti-inflammatory effect and antioxidant effects, enhancement of the NO pathway

[15]

Lycium chinense

Solanaceae

Goji Berry, Chinese Wolfberry, gǒu qǐ 枸杞

Fruit

Rubus coreanus

Rosaceae

Korean blackberry, or Korean bramble, fù pén zǐ 覆盆子

Fruit

Cuscuta chinensis

Convolvulaceae

Chinese Dodder, tù sī zǐ 菟丝子

Dry seed

Schisandra chinensis

Schisandraceae

magnolia-vine, magnolia berry or five-flavor-fruit, wǔ wèi zi 五味子

Fruit

Sang Piao Xiao San (Mantis Formula, 桑螵蛸散)

Mantidis Ootheca

Mantidae

Mantis Egg Capsule, Mantis Egg Case

Not a plant, egg chamber

1. Co-treatment with BZYQT and SPXS significantly reduced the frequency of voiding, urgency and urge incontinence as well as improved the voiding volume and QOL

2. Co-treatment with solifenacin improved TCM symptom scores, the scores of urination, nocturnal urination, urgency of urination and urgency incontinence, compared to treatment with solifenacin alone. It improved bladder compliance, maximum urinary flow rate and maximum bladder capacity, the initial urine volume (VFD), and also lowered NGF and NGF/Cr level to a greater extent than using solifenacin alone

1. 21 OAB patients

2. 128 patients with OAB after menopause

NA

1. [95]

2. [98]

Polygala tenuifolia Willd

Polygalaceae

yuǎn zhì 远志

Root

Acorus gramineus

Acoraceae

Grassy-leaved sweet flag, shí chāng pú 石菖蒲

Root

Fossilia Ossis Mastodi

NA

Dragon’s Bone, lóng gǔ 龙骨

Not a plant, The fossilized bone or vertebrae

Panax ginseng

Araliaceae

Ginseng, rén shēn 人參

Root

Poria cocos (Schw.) Wolf

Polyporaceae

Poria Mushroom with Hostwood, fú shén 茯神

Sclerotium

Angelica sinensis

Apiaceae

Chinese Angelica Root, dāng guī 当归

Root

Carapax Testudinis et Plastrum

Emydidae

Tortoise Carapace and Plastron

Not a plant, carapace and plastron of Chinemys reevesii (Gray)

Suo-Quan-Wan (缩泉丸)

Alpinia oxyphylla Miq

Zingiberaceae

Sharp-leaf galangal, yì zhì rén 益智仁

Fruit

1. Slowed down OAB progress and improved overall bladder function, recovered bladder stability

2. Improved bladder control, storage and contraction ability

3. Enhanced urodynamic urination, attenuated thickened bladder wall, decreased DSM strips contraction response for stimuli

1. BOO rats model

2. Aging rats

3. Diabetic mice

1. Decrease of TRPV1 expression

2. Increase in the sensitivity and expression of β3-AR

3. Mediation of the expression levels of myosin Va and SLC17A9

1. [85]

2. [160]

3. [151]

Dioscorea opposita

Dioscoreaceae

Chinese yam, shān yào 山药

Tuber or root

Lindera strychnifolia

Lauraceae

Uyaku, wū yào 乌药

Root

Wenglitong capsule (翁沥通胶囊)

Coix lachryma-jobi

Poaceae

Job’s tears, adlay or adlay millet, yì yǐ rén 薏苡仁

Seed

Improved OABSS, voiding frequency, average voided volume and urgency incontinence; slower onset and weaker efficacy but lower incidence of side effects. than tolterodine. Cotreatment of WLT and tolterodine was more effective than tolterodine alone in ameliorating OAB symptoms

182 female OAB patients (A prospective, randomized, single-blind multi-center trial)

NA

[159]

Fritillaria thunbergi Bulbus

Liliaceae

Chekiang Fritillary Bulb, zhè bèi mǔ 浙贝母

Bulb

Clematis armandii

Ranunculaceae

Armand Clematis Stem, chuān mù tōng 川木通

Dried lianoid stem

Gardenia jasminoides

Rubiaceae

Cape jasmine, zhī zǐ 栀子

Flower

Lonicera japonica

Caprifoliaceae

Golden-and-silver honeysuckle, jīn yín huā 金银花

Flower bud

Inula japonica

Asteraceae

Japanese Inula Flower, xuán fù huā 旋覆花

Flower

Lycopi Herba

Lamiaceae

Hirsute Shiny Bugleweed Herb, zé lán 泽兰

Whole plant

Mineralium Viridianum

(not a plant)

Verdigris, tóng lǜ 铜绿

NA

Glycyrrhiza uralensis

Leguminosae

Chinese liquorice, gān cǎo 甘草

Roots

Astragalus membranaceus

Leguminosae

Milkvetch or huáng qí 黄芪

Roots

Rheum officinale

Polygonaceae

Chinese rhubarb or dà huáng 大黄

Roots

Non-TCM formulations

Choreito (CRT)

Aluminum sili-cate hydrate with silicon dioxide

(Not a plant)

NA

NA

Attenuated DO

DO induced by intravesical AA instillation in rats

Remission of urothelial damage and regulation of excess blood flow

[146]

Alisma orientale

Alismataceae

Asian water plantain, zé xiè 泽泻

Rhizome

Polyporus umbellatus

Polyporaceae

lumpy bracket, umbrella polypore

Sclerotium

Poria cocos

Polyporaceae

Hoelen, China root, fú líng 茯苓

Sclerotium

Donkey glue

( Not a plant)

NA

NA

Eviprostat

Equisetum arvense

Equisetaceae

Field horsetail or common horsetail

Ethanol extract

1. Relieved obstructive symptoms of BPH; improved prostatic volume, urinary flow rates and prostatic inflammation

2. Improved IPSS, QOL score, Qmax and Qave

3. Decreased the urinary oxidative stress marker 8-OHDG in a PBOO rabbit model; lowered urinary 8-OHdG levels, reduced IPSS and QOL score in a clinical trial

4. Suppressed the increase of oxidative-stress markers, and pro-inflammatory cytokine levels in bladder; reversed the decrease in the intermicturition interval

5. Prevented the reduction in BBF and increases in bladder weight, malondialdehyde levels, proinflammatory cytokines, and myeloperoxidase activity

6. Improved DO, down-regulated the expression of bladder pharmacological receptors and up-regulated urinary cytokine levels

1. 22 patients with symptomatic BPH

2. 100 patients with BPH

3. A rabbit model of Partial BOO and 9 BPH/LUTS patients

4. A rat model of atherosclerosis-induced chronic bladder ischemia

5. A rat model of bladder overdistension and emptying (OE)

6. Rats with CYP induced cystitis

1. NA

2. NA

3. Antioxidant effect

4. Antioxidant and anti-inflammatory properties

5. Antioxidant and anti-inflammatory effects

6. Anti-inflammatory effects

1. [64]

2. [135]

3. [104]

4. [103]

5. [77]

6. [110]

Pulsatilla pratensis

Ranunculaceae

Pasque Flower

Ethanol extract

Populus tremula

Salicaceae

Aspen, quaking aspen

Ethanol extract

Chimaphila umbellata

Ericaceae

Umbellate wintergreen

Ethanol extract

Triticum aestivum

Poaceae

Common wheat

Germ oil

Granu Fink femina

Cucurbita pepo

Cucurbitaceae

Uromedic pumpkin

Seed oil

Improved all measured aspects of OAB-related QOL after 1 week, with further improvement at 6 and 12 week

117 female (age: 21–78) with OAB

NA

[49]

Rhus aromatica

Anacardiaceae

Fragrant sumac

Bark extract

Humulus lupulus

Cannabaceae

Common hop

Cone extract

Kubiker

Cucurbita maxima

Cucurbitaceae

Winter squash

Fruit

Lowered daily micturitions, nocturia and episodes of urge incontinence, improved PPIUS, OAB-q SF and PGI-I, in a greater level than Solifenacin Succinate

90 consecutive female (mean age 65 years; range 40–75) with symptoms of OAB

NA

[148]

Capsicum annuum

Solanaceae

Chili Pepper

Fruit

Polygonum capsicatum

Polygonaceae

Knotweed, knotgrass

Root and rhizome

Vitamins (C and D)

(Not a plant)

NA

NA

Amino acid l-Glutammina

(Not a plant)

NA

NA

Urox

Crataeva nurvala

Capparaceae

Three leaved caper

Stem bark

Reduced urinary day frequency, episodes of nocturia, symptoms of urgency, total incontinence; improved quality of life, with minimal side-effects

150 participants (Phase-2, parallel double-blinded, randomized clinical study)

NA

[128]

Equisetum arvense

Equisetaceae

Horsetail

Stem

Lindera aggregata

Lauraceae

Spicebush, wū yào 乌药

Root