Table 3.
Herbal formulations for overactive bladder treatment
| Formulation | Plant/herbal drug | Family | Common name | Part used | Effect | Study object(s) | Therapeutic target(s)/ mechanisms | References |
|---|---|---|---|---|---|---|---|---|
| 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 | |||||
NA not available