Pipsissewa (Chimaphila umbellata) has a long history of use in traditional herbal medicine, particularly among Native American tribes and in early North American herbalism. It was commonly prepared as a tea or tincture to address urinary tract issues, including bladder discomfort, urinary tract infections, and as a mild diuretic. The plant was reputed to support bladder health by promoting urination and alleviating symptoms of cystitis and other urinary complaints.

While Pipsissewa contains several bioactive compounds (such as hydroquinones, including arbutin, and flavonoids) that may possess mild antimicrobial and diuretic properties, there is a lack of robust scientific studies or clinical trials validating its efficacy for bladder health in humans. Most of the available evidence is anecdotal or based on traditional usage patterns rather than modern pharmacological research.

In summary, the use of Pipsissewa for supporting the bladder is primarily justified by traditional use, with only limited and indirect scientific rationale based on its phytochemical composition. Its rating reflects the substantial traditional support but the absence of strong scientific validation.