HERBAL TREATMENT FOR URINARY STONES

Received 01 January, 2010; received in revised form 19 January, 2010; accepted 25 January, 2010                                 

HERBAL TREATMENT FOR URINARY STONES

HAVAGIRAY R. CHITME *¹,SHASHI ALOK ², S. K. JAIN ², MONIKA SABHARWAL ³

Oman Medical College *¹, Muscat, Sultanate of Oman

Department of Pharmacognosy, Institute Of Pharmacy, Bundelkhand University², Jhansi (U.P.), India

University Institute of Applied Management Sciences, Panjab University³, Chandigarh (U.T.), India

ABSTRACT

Herbs and herbal drugs have created interest among the people by its clinically proven effects like immunomodulation, adaptogenic and antimutagenic. Also, the overuse of synthetic drugs, which results in higher incidence of adverse drug reactions, has motivated humans to return to nature for safe remedies. The problem of urinary stones or calculi is a very ancient one and many remedies have been employed during the ages these stones are found in all parts of the urinary tract, the kidney, the ureters and the urinary bladder and may vary considerably in size. In the present article, an attempt has been made to emphasis on herbal option for urinary stone.

INTRODUCTION:

Herbs and herbal drugs have created interest among the people by its clinically proven effects like immunomodulation, adaptogenic and antimutagenic. Also, the overuse of synthetic drugs, which results in higher incidence of adverse drug reactions, has motivated humans to return to nature for safe remedies. The origins, according to many, can be sourced to the World Health Organization’s Canberre conference in 1976, which promoted the concept of ‘Traditional’ medicines for the developing countries.¹

The problem of urinary stones or calculi is a very ancient one and many remedies have been employed during the ages these stones are found in all parts of the urinary tract, the kidney, the ureters and the urinary bladder and may vary considerably in size, Linacre, who had founded the college of physicians, London in 1518 died of urinary stone, a condition he could diagnose but could not true².Diet containing low amounts of inferior quality proteins and high intake of animal proteins might augment the risk of stone formation. The incidence of urolithiasis is very common in Northern India compared to southern state. It is speculated that higher incidence may be due to wheat diets. People living in rocky areas, where the climate is hot and dry, seem to be more to urinary calculi disease³.

Physicians usually do not treat kidney stone: they just medicate the pain until the stones pass out their own; and in view of Dake J.K., near-vegetarian diet, heavy on herbs and liquids, can be helpful in the prevention and treatment of kidney stone. So the best way to prevent kidney stone is to drink plenty of water and take a vegetarian diet high in magnesium⁴.In the present article, an attempt has been made to emphasize on herbal treatment for urinary stone.

Ancient Medical Literature: In ancient Rome, Celsus (25 BC-50 AD) described lithotomy in his book ‘De Medicine’ and the technique was being followed almost without alterations till the end of 16^th century. Hippocrates (370-460 BC) knew both the renal and vestical types of stones and described the typical ureteric colic and symptoms of bladder calculus.

In the writings of Charaka, Sushruta and Vagbhatta, who lived in 2^nd, 5th and 7^th century AD, we find real description of the disease and indications for treatment. They recognized four types of stones. Majority of urinary calculi are made up of either calcium phosphate, calcium oxalate, uric acid (urates) or magnesium ammonium phosphate. In India, the common component of urinary calculi is calcium oxalate. A number of vegetable drugs have been used in India and elsewhere and claims of efficient cure of urinary stone have been made. During the 18^th century in Europe, among the moer rational lithotriptics, were the ashes of vine twigs or wood suspended in parsley water.

As early as 23-79 AD Pliny the prescribed infusions of Paeonia officinalis, Mentha spp and Cicer arietinum to dissolve stones in the bladder and kidney, Hippocrates, disbelived in all the stone solvents but used diuretic for its relief. Avicenna recommended the use of laurel, cypress oil and ashes of scorpion egg shells, melon seeds etc. for the dissolution of stone. Earlier Hindu writings also contain many prescriptions for dissolving the stone, wiz, a mixture of butter, pepper and ginger to which was added drop by drop the urine of a sheep⁵.

PASHANBHEDA DRUGS: An attempt has been made during the last decade to study the identical, chemistry, pharmacology and clinical investigations of Pashanbheda plants used for dissolving kidney stones⁶. Pashanbheda is a drug mentioned in the Ayurvedic system of medicine for various ailment but mainly as a diuretic and lithotriptic. It is said to have properly of breaking and disintegrating the stones and is widely used drug. However, its identity is yet debatable.

Many diuretic and other plants such as Alternanthera sessalis and Aerva spp. In South India⁷. Rotula aquatica in Mysore⁸, Ammaunia baceifera in Kerala⁷, Bauhinia racemosa, Coleus spp., Bryophyllum spp., Didymocarpus pedicellata, Ocimum basilicum in Bengal ⁹ and many other have been referred to as Pashanbheda from time to time. Now Bergenia ligulata syn. Saxifrega ligulata is being widely accepted under this name.Chemical efficiency of Bergenia ligulata is dissolving the urinary stones fully justifies the use of various names attributed to it, viz., Pashanbheda, Pashana, Asmaribheda, Ashmabhid, Ashmabhed, Nagabhid, Upalbhedak, Parwatbhed and Shilabhed (dissolving or piercing stones or slabs) etc¹⁰.  The very first mention of this drug in Ayurvedic literature is Charak Samhita (210 BC-170 AD) under the name Pashanbhed. It is recommended for painful micturition, for curing abdominal tumour and for breaking up calculi, Sushruta Samhita ( 170 AD- 340 BC) mentions the drug under various synonyms in Chikitsa silianam- under the name Pashanbhed for uric acid calculi and Ashnibhid for biliary calculi. In Sushruta Samhita, decoction of Pashanbhed, Ashmantaka, Satavari, Vrihati, Bhalluka, Varuna ( Crataeva nurvula), kulatha, kola and kataka seeds have been described for the patients of Vataja Ashmari, while Kusa, Ashmabhid, Patala, Trikantaka, Sirisha, Punarnava and Silajatu and Meduka flower for Pittaja Ashmari have been mentioned ¹¹. Ashtang Hridaya (341 AD-434 AD) mentions the drugs in chiktsit Sthanam- Upalbhed for extreme pain due to obstructed micturition, Pashanbhed for uric acid calculi and ashmabid for biliary calculi.

In Susruta Samhita “Kurantika” or “Sitivaraka” ( Celosia argental) is tested in ‘Viratarvadigana’, which is said to have specific action in urinary diseases, viz., calculi (ashmari), gravels (sarkara), dysuria (mutra krichhra) and suppression of urine etc.Aerva spp., Ammania baccifera and Nothosasrva brachiata have been reported from South India as lithotriptic plants ¹². Celosia argental in Indian system of medicine is considered to be specific for the tratment of ashmari i.e., urinary stone. Aqueous decoction is used for the dissolution and excretion of stones ¹³. Didymocarpus pedicellata, commonly known as Patharphodi or Shila pushp is useful for stones of kidney and bladder, while Homonoia riparia, known as Pashanbhed or kshudra Pashanbhed is useful in vesical calculi. Rotula aqualica syn. Rhabdia lycioides, also known as Pashanbhed is useful for stones in bladder. Bergenia ligulata, syn. Saxifraga ligulata, known as Pashanbheda have strong diuretic and lithotriptic activities but Kalanchoe pinnala syn. Bryophyllum calycinum known as Pashanbhed in Bengal, and others have no diuretic or lithotriptic activity Bridelia Montana also known as Pashanbhed has also not shown any such activites ¹⁴.

Tribulus terrestris fruits have also been found useful in diuretic and kidney stones ¹⁵.  Effective cure of urinary calculi have been prescribed by practitioners in unani system of medicine ¹⁶, while in Homoeopathic system of medicine, Berberis vulgaris, cantharis spp., and Lycopodium spp. Are being use

Clinical And Pharmacological Studies: In recent years, a number of proprietary composite herbal drugs have also been introduced for dissolving kidney calculi of which mention may be made of Cystone¹⁸ ( Himalaya Drug Co., Bombay ) And Calcury ( Charak Pharmaceuticals, Bombay). These drugs are in common use in India. Saxifraga ligueata and Tribulus terrestris are the two common plant ingredients of both these herbo-miniral preparation.

Ureteric calculus disappered within 55 days of treatment with ‘Cystone’ a herbomineral composition¹⁹. Ghoes et al ²⁰, have reported successful treatment of urinary tract infection and urinary calculi with Cystone. Cystone binded the mucine of the calculi followed by laters disintegration and flush out of disintegrated partical with the flow of urine. Cystone relaxes the detrusor muscles and promotes diuretics by virtue of its high content of natural mineral salts. Cystone has also been found to be useful in urolithiasis, crystalluria, and urinary tract infection in human beings ²¹.

Oral administration of another indigenous herbomineral drug calcury (2 tds) in 40 cases of ureteric calculi, showed passing of disintegrated or intect stones through urine in 25 (62. 85 %) cases ²².Pharmacologically, Berginia ligulata has shown no effect in preventing the stone formation but was found useful in dissolving zinc calculi in the urinary bladder in experimental rats ²³. Alcoholic extract of celosia argental is reported to remove the urinary stones and prevent the stone formation in albino rats ²⁴. In some parts of India aqueous decoction of Dolichos biflorus is regarded as a popular household remedy for dissolving kidney stones²⁵ and is being used as a folk medicine in various parts of India for urinary calculi. Varuna, Ghokhru and Kulatha were found to be effective in preventing the deposition of the stones in experimental rates. Vataj (oxalate) and pitiaj (urate and cystine) stones did not dissolve in varuva and kulatha. Gokhru decotions dissolve urate and cystine stones to some extent. Kaphaj (phosphetic) stones were dissolving in all the three drugs. Among them kulatha had marked (87%0 dissolving activity and stones become friable ²⁶. There are many pharmaceutical preparation described in Ayurvedic texts in which kultha is the main ingredient.

Following Plants have been reported to be useful in dissolving Kidney stones by various investigators ¹⁷

Other herbal components of these preparations are:

It has been described as Ashmarighana (destroyer of stone) by Charak, Sushruta and other authorities. Sushruta mentions its efficacy in vataj Ashmari with the characteristics of oxalate stone. Clinical investigations have shown that out of fifteen cases of urinary calculi, nine patients passed their stones within 8-10 days of treatment with Dolichos biflorus. Spontaneous passage of stones was common depending upon the size, site and mobility of the calculus ²⁷.

Metals and non-metals present in hard water at higher concentration might influence the outcome of the disease. Experiments in rats have shown that fluoride when fed at high levels accelerated the incidence of calcium oxalate crystalluria and enhanced the incidence of bladder stones diseases considerably. These studies suggest that other condition being conductive, excess intake of fluoride (possible through water) might aggravate the situation in men also. This concept is supported by reports that in Punjab the incidence is high in areas where fluoride content of drinking water is high ^{28, 29, 30}.

REFERENCES:

1. 1. Edwin E, Sheeja E, Vabbav J and Sheweta D:Toxicology of Herbs. Pharma Times 2005 ; 37(6) : 27.
   2. Insurance Company of Scott and White- Health Plan, Section- Urology, State of Taxes. Source : www.sw.org
   3. Singh PP, Jha S and Chandra R: Herabal remedies for kidney stone. Pharma Times 2006 ; 38(9) :34-36.
   4. Evan AP , Coe FL , Lingeman JE and Worcester E : Prevention and treatment of kidney stone Urological research 2005 ; 240(5) : 488-500.
   5. Mukerjee T, Bhalla N, Singh G and  Jain HC : Herbal drugs for urinary stones . Indian Drugs 1984 : 224-228.
   6. Bahu CP and Seshadri RT : In Advances in Research in Indian Medicine ( B.H.U.) 1970: 77-78.
   7. Chunekar KC: In Vanasuhadi Anushandhan Durshika. 5^th edition ( Chaukhamba vidyabhawan Varanasi)  1969 : 13.
   8. Bhandari CR and Basu BD: In Vanasuhadi Chandrodaya, 2^nd edition. Gyan Mandir, Bhanupura publisher Indor ;  1948 : 48.
   9. Sachroedar HA, kidney stone formation. Trace Elements And Nutrition Faber and Faber  London  1976 ; 37 : 388.
   10. Underwood EJ and Mertz W : Family history and risk of kidney stones Trace Elements in Human And Animal Nutrition, New York, 1987,1,185-215.
   11. Kirtikar KR and Basu BD: Herbal plants in urolithiasis. In Indian Medicinal Plants.  2^nd edition. Lalit Mohan Basu publisher Allahabad; 1933 : 56.
   12. Dush B and Kashyap L : Herbal plants in Kidney stone. In Materia Medica of Ayurveda. Concept Publishing Co.,New Delhi; 1979 : 89.
   13. Bhisa KL: kidney stone. In English Translation of Sushruta Samhita 1981 ; 21 : 106.
   14. Shah CS, Shan N and Mody KD: drugs used in urolithiasis. Q. J. Crude Drug  Research 1972 ;12 : 1882 – 93.
   15. Dubey SD , Singh RS , Sen SP and Kumar N: disease of kidney stone and urinary tract. Med. Surg 1982 ;22  : 9-12.
   16. Shrivastava JG: Herbal plants used in stone. Q. J. Crude Drug Res 1971 ; 11 : 1683-89.
   17. Chopra RN , Nayer SL and Chopra IC: In Glossary of Indian Medicinal Plants ( CSIR New Delhi), 1956:56
   18. Kapoor SL and Kapoor LD: Kidney stone herbs. Sachitra Ayurveda 1976 ; 28 : 769-91.
   19. The Useful Plant of India, Publications & Information Directorate ( CSIR New Delhi), 1986:86.
   20. Jethi RK, Duggal B, Sahota RS, Gupta M and Sofat JB: Important plants used in stone. Indian J Med Res 1983 ;78 : 422-25.
   21. Muthusamy VV and Muthu P:Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic. Prove 1980 ; 19 : 130-131.
   22. Ghose A , Sengupta P , Chatterjee S and Ghosal KK :  Pathophysiologic basis for normouricosuric uric acid nephrolithiasis. Prove 1980 ; 19 : 270-74.
   23. Chatterjee BN: successful treatment of urinary tract infection and urinary calculi with Cystone.  Prove 1982 ; 22 : 27-30.
   24. Yadav JK, Singhvi AN and Sharma N: Indigenous herbomineral drug calcury. Med Surg 1981 ; 21 : 15-18.
   25. Seth SDS, Prabhakar MC, Bupha BC and Arora RB: Berginia ligulata as a antilithiatic. J. Res. Indian Med 1974 ; 9 : 1-3.
   26. Banerjee B, Chahravarti RN and Chaudhuri RN: Alcoholic extract of celosia argental is remove the urinary stones and prevent the stone formation in albino rats Bull. Cal  Suh Trop. Med 1957 ; 5 : 71.
   27. Peshin A and Singla SK: aqueous decoction of Dolichos biflorus is regarded as a popular household remedy for dissolving kidney stones. Indian J. Of  Exp. Biology 1994 ;32 : 889-91.
   28. Kumar P, Despande PJ and Singh LM: Kidney stone dissolving drugs. Bull. Med. Ethanobot. Res 1981 ; 2 : 277- 84.
   29. Singh LM and Kumar P: Pharmaceutical preparation described in Ayurvedic texts. J. Res. Ind. Med 1973 ; 8 : 1-7.
   30. Das A: Gender differences in seasonal variation of urine stone risk factors. Nutrition News, ( National Institute of Nutrition, Hyderabad) 1982 ; 5 : 1.