Traditional Chinese Herbal Medicines in Overactive Bladder Syndrome: Mechanistic Rationale and Current Evidences

- Overactive bladder syndrome (OAB) is a lower urinary tract condition that affects about 16–18% of the population. It is characterized by urinary urgency, nocturia, increased frequency, and urge urinary incontinence, which can significantly reduce quality of life, especially in older adults. While standard treatments using antimuscarinic agents, β3-adrenoceptor agonists, and neuromodulation therapies offer symptomatic relief, their long-term use often results in adverse effects. – The literature search was performed across PubMed, Scopus, Web of Science, ScienceDirect, and CNKI databases for relevant published research studies and articles from 1993 to 2026. The keywords used were "Medicinal plants", "Overactive Bladder", "TCM", and the common names of medicinal plants (for example, "Guipi"). We searched the literature to identify peer-reviewed in vitro studies, animal studies, and randomized and non-randomized clinical studies of TCM-based herbal medicines that targeted bladder function, mechanism, or clinical efficacy outcomes. Non-peer-reviewed literature, conference presentations, theses, expert opinion papers, and studies which lacked clarity of method or clinical efficacy outcomes were excluded from the meta-analysis. Because of the heterogeneity in herbal preparations, experimental models, and outcome measures, a qualitative synthesis of the data was performed. – TCM interventions, including Ji-Sheng-Shen-Qi-Wan, Ba-Wei-Di-Huang-Wan, and Sang-Piao-Xiao-San, have been reported to have regulatory effects on muscarinic and β3-adrenoreceptors, purinergic signaling, TRP channels, as well as oxidative stress and inflammatory pathways. Both single herbs and multi-component formulations have shown efficacy in alleviating symptoms of overactive bladder. However, the majority of the available evidence are based on small-scale clinical trials, small case studies, or animal models, rendering these findings preliminary. – Traditional Chinese Medicine (TCM) has a long history of managing urinary disorders and may serve as a complementary approach for the treatment of overactive bladder. In the future, high-quality randomized controlled clinical trials (RCTs), mechanistic studies, and standardization of novel formulations are required to validate efficacy and to facilitate translation into modern clinical practice.