Cystitis is one of the main types of urinary tract infections and is most commonly seen in married women. Cystitis is classified as either acute or chronic, and can also be categorized as specific or nonspecific. Here, we will focus solely on nonspecific, acute, and chronic cystitis.
Under normal circumstances, a small number of bacteria may be present in the anterior portion of the urethra. However, because the kidneys have an extremely rich blood supply—whose endothelial cells can phagocytose bacteria—and because urea in urine possesses some bactericidal properties, the bladder mucosa has strong antibacterial defenses, and changes in urine acidity can inhibit bacterial growth and reproduction. Additionally, the kidneys excrete large volumes of urine daily, effectively flushing the urinary tract. Consequently, urinary tract infections generally do not occur easily. However, cystitis is more likely to occur when a person’s overall resistance is weakened, or when conditions such as bladder stones, foreign bodies, benign prostatic hyperplasia, or urethral strictures impede the smooth flow of urine. Women are particularly susceptible to cystitis due to their shorter urethras, which are located close to the vagina and anus, as well as during the early stages of marriage or pregnancy.
According to Traditional Chinese Medicine (TCM), the primary functions of the bladder are to store and excrete urine. In the body’s fluid metabolism process, fluids are distributed throughout the body through the actions of the lungs, spleen, kidneys, and Triple Energizer. After being utilized, these fluids descend to the bladder, where they are transformed into urine and excreted from the body through the bladder’s “transformation and vaporization” function. If damp-heat descends into the bladder and impairs its transformation and vaporization function, symptoms such as frequent urination, urinary urgency, and dysuria may occur.
I. Etiology of Cystitis
Traditional Chinese Medicine holds that this condition arises from the accumulation of damp-heat in the lower jiao. The kidney and bladder form a zang-fu pair, with their physiological functions closely interrelated; if the zang organ is deficient, the fu organ’s function will be impaired; if the fu organ is affected by pathogenic factors, the zang organ will be compromised. When kidney deficiency prevents proper regulation of fluids, damp-heat is prone to accumulate in the bladder; conversely, when the bladder’s qi-transformation function is disrupted and damp-heat becomes internally retained, it inevitably permeates the kidneys. Once pathogenic factors exploit this vulnerability to invade the body, they may spread from the kidneys to the bladder or from the bladder to the kidneys, thereby causing simultaneous disease in both the zang and fu organs. The accumulation of damp-heat in the bladder obstructs the flow of fluids, leading to a series of symptoms.
Modern medicine has confirmed that cystitis is caused by bacteria. The most common pathogens of nonspecific cystitis include Escherichia coli, Enterobacter, Aerobacter, Proteus, and Pseudomonas aeruginosa; followed by Staphylococcus, Enterococcus, and Streptococcus viridans; and, occasionally, fungi, protozoa, and viruses. Cystitis may be caused by a single bacterium or by a mixed infection involving several types of bacteria.
II. Clinical Manifestations of Cystitis
Patients with acute cystitis often present with sudden onset of frequent urination, urinary urgency, dysuria, bladder irritation symptoms, hematuria, pyuria, and increased urethral discharge, sometimes accompanied by a low-grade fever. In severe cases, the frequent urination and dysuria can be unbearable, interfering with work, study, and rest; however, with active treatment, symptoms typically resolve within a few days.
If a patient has a high fever, lower back pain, and pronounced systemic symptoms, this indicates concurrent pyelonephritis, which requires even more aggressive treatment.
The symptoms of chronic cystitis are milder than those of acute cystitis but may fluctuate and recur.
Laboratory Tests: Urine from patients with acute or chronic cystitis contains red blood cells and pus cells, and urine culture may reveal pathogenic bacteria; urine from patients with concurrent pyelonephritis may contain protein.
III. Treatment of Cystitis
Treatment of Acute Cystitis
(1) Systemic Treatment: Patients with cystitis accompanied by fever should rest in bed, receive adequate nutrition, and replenish fluids to maintain a daily urine output of at least 1,500 milliliters to promote the excretion of toxins. For patients with pronounced bladder irritation symptoms, a low dose of Atropine Compound may be administered to alleviate intolerable symptoms such as dysuria, frequent urination, and urinary urgency.
(2) Traditional Chinese Medicine Treatment:
For acute cystitis, supports should focus on clearing heat, eliminating dampness, promoting diuresis, and alleviating pain; the modified Ba Zheng San formula should be used. If heat has injured the blood vessels and hematuria is severe, herbs that clear heat, cool the blood, or stop bleeding should be added, such as Carbunculus Nelumbinis Nodus (charred lotus root nodes), Cirsium japonicum (small thistle), Rehmannia glutinosa (raw rehmannia root), Colla Corii Asini (donkey-hide gelatin), and Imperata cylindrica (白茅根).
(3) Auricular Acupoint Application: The use of auricular acupoint application to treat acute cystitis is effective, convenient, and practical. Acupoint selection: Primary points include Bladder, Urethra, Endocrine, Triple Energizer, Shenmen, and Ear Tip; auxiliary points include Adrenal Gland and Kidney.
(4) Use of Effective Antibiotics: Such as piperacillin, ciprofloxacin, gentamicin, and kanamycin.
(5) Altering Urine Acidity: This can enhance the effectiveness of antibiotics. Use sodium bicarbonate to acidify the urine; use ammonium chloride to acidify the urine; or take large doses of vitamin C (1,500 mg daily).
(6) Removing Foci That Trigger Cystitis: Conditions such as bladder stones and urethral strictures should be treated to maintain unobstructed urination. (Note: These underlying conditions must be addressed only after the inflammation has been controlled to prevent the spread of infection.)
Treatment of Chronic Cystitis
(1) Treating underlying infections: Conditions such as pelvic inflammatory disease, sinusitis, cholecystitis, chronic colitis, and chronic prostatitis should be actively treated, as this is a crucial step in preventing recurrence of chronic cystitis.
(2) Correct urinary tract obstruction: Treat conditions such as bladder stones, urethral strictures, and benign prostatic hyperplasia to ensure unobstructed urination.
(3) Adjust the pH of the urine. (Method as above)
(4) Perform a urine culture and administer effective antimicrobial medications.
(5) Traditional Chinese Medicine (TCM) treatment: For patients with kidney yin deficiency and lingering damp-heat, treatment should focus on nourishing yin and the kidneys, clearing heat, and reducing fire, using the formula Zhibai Dihuang Wan with additions of white茅根, plantain seed, dandelion, and honeysuckle vine; for patients with both qi and yin deficiency and residual heat pathogens, treatment should focus on tonifying qi, nourishing yin, clearing heat, and draining dampness, using modified Shengmai San and Daoqi San.
The author believes that treatment for chronic cystitis should focus on regulating the whole body while simultaneously clearing heat and eliminating toxins. In acute cases, treat the symptoms first; in chronic cases, treat both the symptoms and the root cause simultaneously. Since this condition is in the chronic stage—characterized by a prolonged course, recurrent episodes, and resistance to treatment—it often manifests as a combination of deficiency and excess. Treatment must therefore address both the symptoms and the root cause; combining tonifying and reinforcing the body’s vital energy with heat-clearing, toxin-eliminating, and diuretic herbs can yield favorable results.