Introduction: Traditional Chinese medicine (TCM) has treated Urinary Tract Infections (UTI) for over 2 millennia. This review aims to trace the history of the classical diagnosis of “urinary syndrome (US)” in TCM and the four herbal ingredients of the tonic, Huang-lian-Jie-du Decoction (HLJDD), used to treat US. Contemporary research shows these herbs have a role in the management of UTI. UTI is among the most common causes for antibiotic use worldwide. Although standard treatment is antibiotics, increase in microbial resistance to antibiotics poses a rising threat and motivates the exploration of alternative therapies. Methods: A review of primary Chinese texts with accompanied translations, medical literature and academic publications was undertaken to investigate the treatment of US with HLJDD in TCM. This study examines the historical development of the diagnosis of US, and the incorporation of HLJDD as one of its treatments. Results: US, classically known as lin, appeared in the Yellow Emperor’s Classic of Internal. Medicine in 100 BCE. In 610 CE, Chao Yuanfang described a combination of herbs, exercises, and lifestyle changes to treat US. In 752 CE, Wang Tao differentiated five types of US: Stone, Qi, Sticky, Fatigue and Heat, where Heat US correlates with the Western diagnosis of UTI. Wang Tao was the first to record HLJDD as a drug for heat clearing. As stated in The Handbook of Prescriptions for Emergencies (220 CE), HLJDD is composed of the herbs: Coptis Chinensis Franch, Radix Scutellariae, Cortex Phellodendri, and Fructus Gradeniae in a 3:2:2:3 proportion. Today, HLJDD and its ingredients have been included in several clinical trials investigating the efficacy of alternative treatments for UTI. Two trials which tested mixtures containing ingredients of C. chinensis, C. phellodendri, and R. scutellariae were found to provide more effective treatment for acute UTIs and when taken prophylactically for prevention of recurrent infections than antibiotics alone in postmenopausal women. Trials that included C. phellodendri concluded that the mixture helped potentiate antibiotic effectiveness for acute treatment when compared to antibiotics alone. Most recently, C. chinensis was found to have inhibitory activity against many uropathogenic bacteria, including E. coli. Conclusions: This historical perspective provides a more complete understanding of the evolution of Heat US in TCM and its correlation to the modern diagnosis of UTI, along with the herbal ingredients of HJLDD as treatment. Modern research confirms the application of HLJDD and its ingredients as alternative treatment for UTI. SOURCE OF Funding: None
