Urinary Tract Infections (UTI)

Introduction	Back to Top
Urinary tract infections refer to infection at any location along the urinary tract as a result of a pathogen invasion. Inflammation of the upper urinary tracts includes pyelonephritis and ureteritis, while inflammation of the lower urinary tract includes cystitis and urethritis. Clinically, cystitis and urethritis are manifested in frequency of micturition, urgency of micturition, urodynia, vesical tenesmus, and other symptoms of bladder irritation. In cases of pyelonephritis, general symptoms like fever, backache, and percussion tenderness over the kidney region are common, and because pyelonephritis is often accompanied by inflammation of the lower urinary tract, patients also often manifest bladder irritation symptoms.

Etiology/Pathogenisis	Back to Top
Urinary tract infections refer to infection at any location along the urinary tract as a result of a pathogen invasion. Inflammation of the upper urinary tracts includes pyelonephritis and ureteritis, while inflammation of the lower urinary tract includes cystitis and urethritis. Clinically, cystitis and urethritis are manifested in frequency of micturition, urgency of micturition, urodynia, vesical tenesmus, and other symptoms of bladder irritation. In cases of pyelonephritis, general symptoms like fever, backache, and percussion tenderness over the kidney region are common, and because pyelonephritis is often accompanied by inflammation of the lower urinary tract, patients also often manifest bladder irritation symptoms.

Primary Treatments with Medicinal Herbs	Back to Top
Ba Zheng San Gao et al. treated 40 cases of urinary tract infections with Ba Zheng San. The formula consisted of Mu Tong (Akebia), Che Qian Zi (Plaintain Seed), Bian Xu (Polygonum), Qu Mai (Diathus), Hua Shi (Talc), Sheng Huang (Rehmannia), Zhi Shi (Immature Bitter Orange), Jin Qian Cao (Glechoma), Gan Cao (Licorice), Deng Xin Cao, Jin Yin Hua (Lonicera Flower), and Niu Xi (Achyranthes). Modifications were made to suit the individual patients' symptoms. One dose of the formula in a decoction was administered daily. The results were that 32 cases were resolved, 6 cases had improved, and the remaining case did not respond to the treatment, with a total effectiveness rate of 95%.(3) Jiang treated 30 cases of urinary tract infection with Ba Zheng San. The formula consisted of Huang Qi (Astragalus), Shan Yao (Dioscorea), Mu Tong (Akebia), Bian Xu (Polygonum), Qu Mai (Dianthus), Che Qian Zi (Plantain Seed), Du Zhong (Eucommia), Dong Gua Pi (Benincasa Seed), Jin Qian Cao (Glechoma), Jin Yin Hua (Lonicera Flower), and Gan Cao (Licorice). One dose of the formula in a decoction was administered daily, and one course of treatment lasted 5 days. A comparison group of 28 cases was treated with a cinrofloxacin injection solution, 0.4g/day with IV drips. The results were that the treatment group had total effectiveness rate of 94.73%, while the comparison group had a total effectiveness rate of 83.25%.(4)

Other Treatments with Medicinal Herbs	Back to Top
Bu Shen Hua Yu Tong Lin Tang Zhang treated 30 cases of urinary tract infections in the elderly with Bu Shen Hua Yu Tong Lin Tang. This formula consisted of Yin Yang Huo (Epimedium), Sang Ji Sheng (Loranthus), Chi Shao (Red Peony), Shu Di Huang (cooked Rehmannia), Dang Gui (Chinese Angelica Root), Fu Ling (Hoelen), Ze Xie (Alisma), Bian Xu (Polygonum), Qu Mai (Dianthus), Jin Qian Cao (Glechoma), and Gan Cao (Licorice). One dose of the formula in a decoction was administered daily at two takings, and one course of treatment lasted for seven days. A comparison group of 30 cases was treated with San Jin Pian, four tablets a time, three times a day. The results were: of the treatment group, 21 cases were resolved, 6 cases showed great improvement, another 2 cases improved slightly, and the remaining case did not respond to the treatment. Of the comparison group, 14 cases were resolved, 6 cases showed great improvement, another 5 cases improved slightly, and the remaining 5 cases did not respond to the treatment.(5) Fu Yuan Qing Lin Yin Dong et al. treated 85 cases of chronic urinary tract infection with Fu Yuan Qing Lin Yin. The formula consisted of Mu Tong (Akebia), Bian Xu (Polygonum), Qu Mai (Dianthus), Sheng Di Huang (Rehmannia), Shu Di Huang (cooked Rehmannia), Mu Dan Pi (Moutan), Fu Ling (Hoelen), San Qi (Notoginseng), Bai Zhu (White Atractylodis), Nu Zhen Zi (Ligustrum), Shan Zhu Yu (Cornus), Hua Shi (Talc), Xi Yang Shen (American Ginseng), and Gan Cao (Licorice). Modifications were made to suit the individual patients' symptoms. One dose of the formula in a decoction was administered daily, and one course of treatment was five doses. The results were that after 2-4 courses of treatment, 64 cases significantly improved, 18 improved slightly, and the remaining 3 cases did not respond to the treatment, with a total effectiveness rate of 96.4%.(6) Yi Shen Huo Xue Tang Wang treated 30 cases of recurring urinary tract infection in the elderly with Yi Shen Huo Xue Tang. The formula consisted of Sheng Di Huang (Rehmannia), Shu Di Huang (cooked Rehmannia), Yi Mu Cao (Leonurus), Ze Xie (Alisma), Shan Yao (Dioscorea), Niu Xi (Achyranthes), Wang Bu Liu Xing (Vaccaria), Zhu Ling (Polyporus), Fu Ling (Hoelen), Ren Dong Teng (Lonicera Stem), Pu Gong Ying (Dandelion), Shan Zhu Yu (Cornus), Tu Si Zi (Cuscuta), Tao Ren (Persica), Lian Qiao (Forsythia), and Gan Cao (Licorice). Modifications were made to suit the individual patients' symptoms. One dose of the formula in a decoction was administered daily, and one course of treatment lasted seven days. The results were: after 4-6 courses of treatment, 8 cases were resolved, 15 cases showed great improvement, another 5 cases were improved slightly, and the remaining 2 cases did not respond to the treatment, with a total effectiveness rate of 93.3%.(7) Bi Xie Fen Qing Yin Xu treated 41 cases of urinary tract infection with modified Bi Xie Fen Qing Yin. The basic formula consisted of Yi Zhi Ren (Coix), Bi Xie (Tokoro), Wu Yao (Lindera), and Shi Chang Pu (Grassleaved Sweetflag Rhizome). For patients who frequently suffered from micturition and urgency of micturition, processed Mu Li, processed Long Gu, and Qu Mai were added to the formula; for patients who suffered vesical tenesmus, Gui Zhi (Cinnamon Twig), Zhu Ling (Polyporus), Fu Ling (Hoelen), Ze Xie (Alisma), and Hua Shi (Talc) were added; for patients who suffered shortness of breath and were easily fatigued, Huang Qi (Astragalus), Dang Shen (Codonopsis), Sheng Ma (Cimicifuga), and Chai Hu (Bupleurum) were added to the formula; and for patients whose urine tests indicated higher red blood cell presence, Xian He Cao (Agrimony), Mao Gen (Imperata), and Bai Hua She She Cao (Oldenlandia) were added. One dose of the formula in a decoction was administered daily, and one course of treatment lasted for two weeks. The results demonstrated that after one course of treatment, 34 cases were resolved, 5 cases had improved, and the remaining 2 cases did not respond to the treatment.(8) Long Dan Xie Gan Tang Fang et al. treated 60 cases of female chlamydial (or mycoplasmal) urethritis with modified Long Dan Xie Gan Tang. A comparison group of 60 cases was treated with minocycline. One course of treatment lasted 7 days in both groups. The results showed that after two courses of treatment, 65% of the cases in the treatment group were significantly improved and another 26.7% were improved and in the comparison group, 43.3% were significantly improved and another 40% improved.(9)

Other Treatments	Back to Top
Massage Therapy Sun et al. treated 68 cases of acute urinary tract infection in infants with massage. The following acupoints were selected to receive treatment: Xiao Fu, Qi Hai, Guan Yuan, Zhong Ji, Pi Shu, Shen Shu, Ming Men, Ba Liao, and San Yin Jiao (bilateral). The procedure was conducted with the patient lying on his/her back, and the practitioner kneaded the patient's Xiao Fu point for five minutes clockwise at 150 times/minute. Then, acupoints Qi Hai, Guan Yuan, and Zhong Ji were pressed with a finger for two minutes each; and finally, with the patient lying on his/her stomach, acupoints Pi Shu, Shen Shu, Ming Men, Ba Liao, and San Yin Jiao were pressed with a finger for two minutes each. Full recovery was defined by disappearance of symptoms and normal urine test results. Improvement was defined by disappearance of symptoms, but with improved urine test results. No response is defined as improved symptoms and no changes in urine test results. The results: 54 cases fully recovered, 8 cases improved, and the remaining 6 cases did respond to the treatment, with a total effectiveness rate of 94.25.(10)

Acupuncture & Acupressure	Back to Top
Gu treated 30 cases of chronic urinary tract infection with acupuncture. The following acupoints were selected for treatment: Shen Shu, Pi Shu, Yin Lin Quan, San Yin Jiao (all bilateral points), and Guan Yuan. The patients received the treatment daily, and ten sessions constituted one course of treatment. The results were that 23 cases were resolved (no more frequency of micturition, vesical tenesmus, or discomfort in the lower abdomen, and no relapse within 3 months of treatment), 6 cases improved (symptoms improved), and 1 case did not respond to the treatment.(11) Kang treated 96 cases of urinary tract infection with acupuncture and a modified Ba Zheng San formula (a classic formula for UTI). The acupoints selected for this treatment were Pang Guang Shu, Zhong Ji, Yin Lin Quan, Xing Jian, and Tai Xi. The result of this study shows that 95.8% of the cases were resolved.(12) Li treated 50 cases of urinary tract infection with acupuncture. The acupoints selected for treatment were Cheng Jiang and Guan Yuan. The results were: 80% of the cases were resolved, and the remaining 20% improved.(13)

Footnotes	Back to Top
¹ Zhang Mei. Diagnosing and treating urinary tract infection. Shaanxi Journal of Traditional Chinese Medicine. 1995;16(11):527. ² Tang Zhang Quan, et al. Advances in research on TCM treatment of urinary tract infection. Sichuan Journal of Traditional Chinese Medicine. 1995;13(4):16-18. ³ Gao Quan Guo, et al. 40 cases of urinary tract infection treated with TCM. Journal of Traditional Chinese Medicine. 1998;26(2):29. ⁴ Jiang Da Li. 30 cases of urinary tract infection treated with modified Ba Zheng San. Qinghai Journal of Medicine (TCM special issue). 1999;29(11):26. ⁵ Zhang Mei. 30 cases of urinary tract infection in the elderly treated with Bu Shen Hua Yu Tong Lin Tang. Journal of Applied TCM. 1999;15(1):11. ⁶ Dong Xin Ting, et al. Treating chronic urinary tract infection with Fu Zheng Qing Lin Yin. Jilin Journal of Traditional Chinese Medicine. 1999;19(2):19. ⁷ Wang Bin. 30 cases of recurring urinary tract infection in the elderly treated with Yi Shen Huo Xue Tang. Jiangsu Journal of Traditional Chinese Medicine. 1999;20(5):18-19. ⁸ Xu Yi Mei. 41 cases of urinary tract syndrome treated with Bi Xie Fen Qing Yin. Jiangsu Journal of Traditional Chinese Medicine. 1999;20(5):19. ⁹ Fang Ling, et al. 60 cases of female urethritis treated with modified Long Dan Xie Gan Tang. Anhui Journal of Applied TCM. 1999;11(4):240. ¹⁰ Sun Fu, et al. 68 cases of infantile urinary tract infection treated with massage. Journal of Massage and Induction. 1996;(6):17. ¹¹ Gu Sheng Gao. 30 cases of chronic urinary tract infection treated with acupuncture. Journal of External Application of TCM. 1999;8(6):33-34. ¹² Kang Xiao Ming. 96 cases of urinary tract infection treated with acupuncture and herbs. Shaanxi Journal of Traditional Chinese Medicine. 1997;18(4):177. ¹³ Li Wei Na. 50 cases of urinary tract infection treated with acupuncture. Journal of Clinical Application of Acupuncture. 1998;14(3):49.