TCM Approaches for Lower Abdominal Pain Caused by Cystitis Glandularis
Among urinary system diseases, Cystitis glandularis is less well-known than prostatitis but often causes recurrent lower abdominal pain, frequent and urgent urination, and discomfort during urination, significantly affecting daily life. Persistent or intermittent lower abdominal pain not only causes physical distress but may also lead to anxiety and irritability, creating a vicious cycle of "pain → psychological stress → symptom worsening."
Unlike prostatitis, which primarily involves prostate tissue, Cystitis glandularis affects the bladder mucosa. In TCM, treatment focuses on the core pathogenesis of "bladder qi transformation disorder." From pattern differentiation and herbal therapy to characteristic external treatments and daily care, a targeted solution can help relieve lower abdominal pain and improve overall symptoms.
Understanding Lower Abdominal Pain in Cystitis Glandularis from a TCM Perspective
To apply TCM treatment effectively, it is essential to understand the TCM etiology and pathogenesis of lower abdominal pain caused by Cystitis glandularis. In TCM, the bladder is considered the "official in charge of fluids, where body fluids are stored, and qi transformation allows excretion."
Normal storage and urination rely on proper "qi transformation." When this function is disrupted, pathological factors such as dampness, heat, and blood stasis accumulate in the bladder, obstructing the flow of qi and blood. "Blocked qi leads to pain," triggering lower abdominal discomfort. Chronic pathogenic influence can deplete the body's vital energy, causing spleen and kidney deficiency, which leads to recurrent pain that is difficult to cure.
Clinically, lower abdominal pain caused by Cystitis glandularis has specific characteristics:
Often a sense of heaviness, dull ache, or stabbing pain in the lower abdomen.
Pain intensity fluctuates with urination—worsening during bladder fullness and sometimes temporarily relieved after urination, though some patients continue to feel residual discomfort.
Common accompanying symptoms include frequent urination (over 8 times/day or more than 2 times/night), urgent urination, incomplete emptying, cloudy urine, and occasionally hematuria.
These symptoms align with the TCM categories of "lin syndrome" and "abdominal pain," providing a basis for pattern differentiation and treatment.
Core Approach: Pattern Differentiation, Internal Herbal Therapy
The key to TCM management of Cystitis glandularis is "pattern differentiation and treatment." According to the nature of lower abdominal pain, accompanying symptoms, and patient constitution, patients are classified into different patterns, and targeted herbal formulas are prescribed. This approach not only quickly alleviates lower abdominal pain but also regulates bladder qi transformation, clears pathogenic factors, and reduces recurrence.
(A) Damp-Heat Infusion Pattern: Clear Heat, Promote Urination, Relieve Pain — For "Burning Pain, Frequent Urination"
This is the most common type, often caused by external damp-heat, spicy and greasy diet, or prolonged holding of urine. Patients typically present with: burning pain in the lower abdomen, worsened during urination, frequent and urgent urination, yellow or reddish urine, and incomplete voiding. Some may have bitter taste, sticky mouth, or sticky stools. Tongue coating is yellow and greasy; pulse is slippery and rapid.
Treatment principle: Clear heat, remove dampness, promote urination, relieve pain.
Common formula: Modified Ba Zheng San (Plantago seed, Dianthus, Achyranthes, Talc, Gardenia, Licorice, Clematis, Rhubarb).
Formula explanation: Plantago seed, Dianthus, Achyranthes, and Talc clear heat, promote urination, and eliminate damp-heat in the bladder. Gardenia and Rhubarb enhance heat-clearing and relieve burning lower abdominal pain. Clematis (often substituted with Caulis Clematis in clinical practice) facilitates urinary flow, expelling damp-heat through urine. Licorice harmonizes the formula and reduces gastrointestinal irritation. Severe pain may add Corydalis and Toosendan to promote qi circulation and relieve pain. For hematuria, add Small Thistle and Imperata root to cool the blood and stop bleeding.
(B) Qi Stagnation and Blood Stasis Pattern: Invigorate Blood, Move Qi, Relieve Pain — For “Stabbing, Fixed Pain”
This pattern is often due to long-term damp-heat obstruction, emotional stress (anxiety, depression), or trauma, leading to poor blood circulation in bladder meridians and blood stasis. Patients typically present with: stabbing, fixed lower abdominal pain worsened by pressure or at night, frequent and urgent urination, incomplete voiding, and possible slight hematuria. Tongue is dark purple or has ecchymosis; pulse is wiry and choppy.
Treatment principle: Invigorate blood, remove stasis, move qi, relieve pain.
Common formula: Modified Shaofu Zhuyu Tang (Angelica, Pollen Typhae, Myrrh, Red Peony, Fennel, Corydalis, Myrrh, Ligusticum, Cinnamon, Dried Ginger).
Formula explanation: Angelica, Red Peony, Ligusticum invigorate blood circulation and relieve stasis-induced pain. Pollen Typhae, Myrrh help remove stasis and stop bleeding. Corydalis promotes qi and blood circulation; Fennel, Cinnamon, and Dried Ginger warm the meridians, disperse cold, and alleviate stasis-related pain. Severe pain may add Peach Kernel and Safflower; prominent qi stagnation (emotion-related pain) may add Cyperus or Bupleurum.
(C) Spleen and Kidney Deficiency Pattern: Strengthen Spleen and Kidney, Stabilize, Promote Urination — For "Dull, Recurrent Pain"
Common in chronic cases (>3 months) or older patients. Prolonged damp-heat depletes spleen and kidney qi, weakening bladder function. Patients typically present with: dull or heavy lower abdominal pain, mild but recurrent, worsened by fatigue; frequent urination (especially at night), urgency with weak stream, incomplete voiding; low back and knee soreness, fatigue, poor appetite, loose stools; tongue coating thin and white, pulse deep and thin.
Treatment principle: Strengthen spleen and kidney, stabilize, promote urination.
Common formula: Modified Wubi Shanyao Wan (Chinese Yam, Cistanche, Rehmannia, Cornus, Poria, Alisma, Cuscuta, Eucommia, Morinda, Achyranthes, Schisandra, Red Halloysite).
Formula explanation: Chinese Yam, Poria, Alisma strengthen spleen, promote urination, and remove dampness. Rehmannia, Cornus, Cuscuta, Eucommia, Morinda, Cistanche tonify kidney and restore bladder qi transformation, reducing night urination. Schisandra and Red Halloysite stabilize urine. Achyranthes invigorates blood, guiding the effect to the bladder. Severe prolapse may add Astragalus, Codonopsis; serious low back weakness may add Goji and Ligustrum to nourish kidney yin.
Additional treatment: For pronounced damp-heat and blood stasis, Diuretic and Anti-inflammatory Pill can be used, following the principle of clearing heat and promoting urination, improving local blood circulation, and relieving inflammation, effectively reducing lower abdominal pain and urinary discomfort.
Adjunct Therapy: TCM External Treatments for Targeted Pain Relief
Beyond internal herbal therapy, TCM provides multiple external methods to directly act on the lower abdomen and bladder, using heat and topical absorption to quickly relieve pain and improve bladder function, complementing internal treatment.
(A) Herbal Retention Enema: Direct to Bladder, Remove Local Pathogens
The bladder mucosa is the main affected area; oral herbs must be absorbed through the digestive tract. Retention enema delivers herbs directly through the rectal mucosa, bypassing first-pass metabolism, achieving higher local drug concentration in the pelvis and bladder, clearing damp-heat and blood stasis efficiently.
Common formula: Dandelion, Phellodendron, Honeysuckle, Forsythia, Red Peony, Salvia, Corydalis, 15g each; decoct to 100–150 ml, cool to 38–40℃.
Method: Patient lies on the left side, knees bent, enema slowly administered; maintain left side 30 min, supine 30 min, right side 30 min to maximize absorption. Once daily, 10 sessions per course.
Advantages: Avoids gastrointestinal irritation; suitable for patients with weak spleen-stomach or intolerance to bitter herbs; quickly relieves lower abdominal pain, urinary frequency, and urgency.
(B) Moxibustion: Warm Meridians, Dispel Cold, Relieve Pain
Moxibustion stimulates acupuncture points to warm bladder meridians, disperse cold, promote qi and blood circulation, alleviating "blocked qi" and "deficient nourishment" pain. Ideal for cold lower abdominal pain, worse with cold exposure or preference for warmth (commonly spleen-kidney deficiency or qi stagnation with cold).
Key points:
Guanyuan (CV4): 3 cun below umbilicus, regulates bladder qi, warms kidney yang.
Qihai (CV6): 1.5 cun below umbilicus, supplements middle qi, relieves lower abdominal heaviness.
Zhongji (CV3): 4 cun below umbilicus, front-mu point of bladder, regulates bladder, relieves urinary discomfort.
Sanyinjiao (SP6): 3 cun above medial malleolus, intersects 3 yin meridians, strengthens spleen-kidney, promotes circulation.
Method: Use mild moxibustion, 2–3 cm above skin, 10–15 min per point until redness appears, daily, 7 days per course. Avoid burns.
(C) Topical Herbal Application: Local Penetration, Pain Relief
Powder herbs mixed with honey or petroleum jelly applied to lower abdomen, allowing drugs to penetrate bladder region and relieve pain.
Common formula: Frankincense, Myrrh, Corydalis, Angelica, Red Peony, Safflower, 10g each, ground to fine powder, mixed with honey.
Method: Apply 0.5 cm thick layer on gauze, place over lower abdomen (CV4, CV3), secure with tape, retain 6–8 hours, once daily, 10 sessions per course.
Advantages: Simple, non-invasive, suitable for home care, effectively relieves dull or heavy lower abdominal pain, especially for patients who cannot take oral herbs or enemas.
Key Support: Daily Care to Reduce Recurrence
Lower abdominal pain in Cystitis glandularis is prone to recurrence. Daily care during TCM treatment is crucial to minimize triggers, consolidate results, and prevent relapse.
(A) Dietary Care: Avoid Damp-Heat, Nourish Spleen and Kidney
Avoid: Spicy, greasy foods, alcohol (especially beer), coffee, strong tea.
Recommended: Light, digestible foods that strengthen spleen and kidney, clear heat, and remove dampness: winter melon, coix seed, Chinese yam, lotus seeds, green beans, fresh vegetables (celery, spinach, broccoli).
(B) Lifestyle Habits: Protect Bladder, Avoid Prolonged Sitting
Avoid holding urine: Empty bladder fully when needed; double void if necessary.
Reduce prolonged sitting: Stand and stretch every 30–40 min, 5–10 min to improve pelvic blood circulation.
Keep warm: Bladder dislikes cold; protect lower abdomen, especially in winter.
(C) Emotional Regulation: Soothe Liver Qi, Reduce Stress
Liver governs qi flow. Emotional stress (anxiety, tension, depression) can block liver qi, impair bladder function, and worsen pain. Use music, walking, meditation, and communication to reduce stress and maintain a relaxed mood.
If you experience recurrent lower abdominal pain with urinary frequency or urgency, and are diagnosed with Cystitis glandularis, TCM may offer a comprehensive approach. While effects may be slower than Western medicine, it addresses bladder function fundamentally, reduces pain recurrence, and helps break the cycle of "recurrent pain." For more case studies or personalized TCM plans, visit https://www.drleetcmclinic.com/ for professional guidance.
