Phyllanthus niruri, or Chanca Piedra, is a small annual herb that grows and spreads much like a weed; it is native to the rainforests of the Amazon and other tropical areas, including the Bahamas, southern India, and China. Two other species, Phyllanthus amarus and Phyllanthus sellowianus, are closely related to P. niruri in appearance, phytochemical structure, and history of use, but are typically are found in the drier tropical climates of India, Brazil, and even Florida and Texas. In the 1990s, P. amarus was reclassified as a type of P. niruri.
Chanca Piedra, the Spanish name of the plant, means “stone breaker” or “shatter stone”, and its Brazilian name translates similarly. Chanca Piedra was named for its effective use for generations of Amazonian indigenous peoples in eliminating gallstones and kidney stones. In addition to kidney stones, the plant is employed in the Amazon for numerous other conditions including colic, diabetes, malaria, dysentery, fever, flu, tumors, jaundice, vaginitis, gonorrhea, dyspepsia, and pain.
What Do We Know?
Kidney Stones: Calcium oxalate crystals, excreted in urine, are the most common cause of kidney stones. Studies have demonstrated that Chanca Piedra interferes with many stages of kidney stone formation. It has been demonstrated to both reduce crystal aggregation and alter the interaction of crystals with kidney tubular cells, reducing subsequent endocytosis (which otherwise leads to tubular cell damage that is thought to perpetuate the kidney stone cycle). When it comes to existing stones, Chanca Piedra has been demonstrated to reduce the rate of stone growth, and to result in drastically smoother stones (with significant potential for less painful elimination). Clinical trials in patients with existing kidney stones have also demonstrated an increased elimination of stones, which can likely be ascribed to the antispasmodic and relaxant effects of Chanca Piedra upon ureteral mucle. In a study in patients with kidney stones undergoing lithotripsy, pretreatment with Chanca Pidra resulted in a lower incidence of residual stone formation; the authors concluded that Chanca Piedra could be useful as either an alternative or adjunctive treatment to lithotripsy in patients with kidney stones. In hypercalcaemic patients, treatment with Chanca Piedra has been demonstrated to result in significant reductions in mean urinary calcium excretion. As a xanthine oxidase inhibitor (see ‘Gout’ below), Chanca Piedra also protects against uric acid stones, and additionally it is a potent pain-killer.
Gallstones: Research has demonstrated that Chanca Piedra has strong antispasmodic activity; its relaxing effect on smooth muscle probably accounts for its efficacy in expelling stones. The smooth muscle relaxation is specific to the urinary and biliary tract, which researchers surmised to facilitate the expulsion of kidney or bladder calculi.
Liver and Kidneys: Research in small animals has demonstrated that Chanca Piedra is hepatoprotective against a variety of hepatotoxins, including alcohol and paracetamol, and nephroprotective against paracetamol and the antibiotic gentimicin (which can cause Acute Kidney Injury).
Hepatitis A, B and C: In a 4 week study of patients with acute Hepatitis A, Chanca Piedra was demonstrated to bring about significant biochemical and clinical normalcy among the treated patients compared to the control group. In a randomised, double-blind trial of adult carriers of Hepatitis B treated orally with Chanca Piedra for 1 month, 60% of the carriers lost Hepatitis B Virus (HBV) during the observation period. Chanca Piedra has been shown to inhibit the DNA polymerase of HBV, inhibiting replication. When the efficacy and safety of Chanca Piedra for chronic HBV infection was evaluated by a systematic review of randomized clinical trials, the combined results showed that Chanca Piedra was better than nonspecific treatment or other herbal medicines for the clearance of serum HbsAg, HBeAg, HBV DNA, and for liver enzyme normalization. This analysis additionally demonstrated that Interferon used in combination with Chanca Piedra increased clearance of serum HBeAg and HBV DNA more than when Interferon was used alone. Furthermore, in a study of 50 clinically diagnosed patients with Hepatitis C Virus (HCV), Chanca Piedra was suggested to attenuate liver damage. In vitro, Chanca Piedra with Interferon-alpha showed additive effects in the inhibition of HCV RNA replication.
Diabetes, Kidney Disease, Peripheral Neuropathy: Five patients with mild hypertension, and four patients with both mild hypertension and diabetes mellitus, were treated with a Chanca Piedra for 10 days. Blood glucose was significantly reduced in the treated group in comparison with controls. Clinical observations revealed no harmful side effects. Research in small animals has suggested that Chanca Piedra’s anti-diabetic properties are due to inhibition of glucose absorption and enhancement of glucose storage. Such research has also demonstrated that Chanca Piedra protects the kidney from the oxidative stress induced by diabetes. In a clinical trial in patients with diabetic neuropathy (‘nerve damage’), Chanca Piedra in combination with the herb Indian Abutilon reversed diminished vibration and cold perception, and relieved symptoms of numbness, tingling, burning, and lower limb pain over the 30 days of the study. Other research has indicated that Chanca Piedra is a aldose reductase inhibitor. Aldose reductase is an enzyme that converts unused glucose to sorbitol within cells. Sorbitol does not diffuse through cell membranes easily and therefore accumulates, causing osmotic damage which leads to cataracts, retinopathy, kidney and nerve damage, in people with diabetes.
Antibiotic, Antifungal: Traditionally, Chanca Piedra is used for Urinary Tract Infections (UTIS), prostatitis, and Sexually Transmitted Infections (STIs). In vitro, Chanca Piedra has been demonstrated to have very broad-spectrum antibacterial activity. It has activity against the urinary pathogens Escherichia coli, Pseudomonas, Proteus, Klebsiella, and Enterococcus. It also has additional activity against the gastrointestinal pathogens Salmonella, Enterobacter, Citrobacter, Shigella, Bacteriodes, Bacillus, and cholera. It is active against the common gram positive bacteria Staphylococcus and Streptococcus, and a wide range of bacteria that cause ocular infections. Chanca Piedra has also been demonstrated to have antifungal activity against Candida albicans (the most common cause of ‘thrush’).
Immunostimulant: In vitro, Chanca Piedra has been demonstrated to enhance the structural and functional maturation of dendritic cells and their antigen-presenting function, and stimulate lymphocytes, monocytes, and macrophages (all White Blood Cells or WBCs). These effects may be relevant in immunodeficient conditions, cancer, and in infectious diseases.
Diarrhea: Research in small animals has demonstrated that Chanca Piedra is an effective anti-diarrheal. In animals treated with castor oil, Chanca Piedra delayed the onset of diarrhea and significantly reduced frequency of defecation. Intestinal transit was recorded to be inhibited by 79.94%, compared to 86.92% in animals given the opiate drug morphine (opiate derivatives like loperamide are commonly used to treat diarrhea, based on the observation that opiates used for pain-relief commonly cause constipation). Additionally, in virto, Chanca Piedra has activity against the gastrointestinal pathogens Salmonella, Enterobacter, Citrobacter, Shigella, Bacteriodes, Bacillus, and cholera.
Maleria: Chanca Piedra has been demonstrated to have strong antimalerial activity, both in vitro and in small animals. In small animals, the antiplasmodial effects of Chanca Piedra were shown to be comparable to the standard prophylactic and chemotherapeutic drugs used in chloroquine resistant plasmodium infection (ie drug resistant maleria).
HIV: One study has supported that Chanca Piedra has inhibitory effects on HIV both in vitro and in humans. In vitro, Chanca Piedra has been demonstrated to inhibit both the HIV-1 and HIV-2 strains via combined inhibition of reverse transcriptase and REV/RRE binding. Additionally, Chanca Piedra was found to be non-toxic to human cells at concentrations able to stop viral replication.
Peptic Ulcer: In vitro, Chanca Piedra has been demonstrated to have activity against Helicobactor pylori, the bacterium believed to be responsible for up to 90% of gastric and duodenal ulcers. Additionally, Chanca Piedra treatment did not affect beneficial lactic acid bacteria. In multiple studies in animals, Chanca Piedra has been demonstrated to protect gastric mucosa against ulceration, including that caused by alcohol.
Cancer: In vitro, Chanca Piedra has been demonstrated to have potent anti-tumour activity on melanoma, prostate, ovarian, breast, lung, and hepatic cell lines via modulation of multiple survival signalling pathways. In the liver, Chanca Piedra has been shown to be selectively toxic towards cancer cell lines, yet protective towards normal cells. There is a huge body of animal research into Chanca Piedra’s activity in cancer. In summary, Chanca Piedra has been demonstrated to prevent or stop cells from mutation due to chemical agents (particularly stomach cancer), reduce tumour volumes, and significantly enhance the life-spans of animals with cancer (particularly leukaemia and liver cancer). It has also been demonstrated to work synergistically with a variety of chemotherapy drugs, and protect against their toxic side-effects (including bone-marrow suppression and damage to heart muscle). Chanca Piedra has also been shown to be protective against bone-marrow suppression in radiotherapy.
Gout: In a study in small animals with raised plasma uric acid levels, Chanca Piedra was demonstrated to normalise uric acid in a dose-dependent manner, comparable to that of allopurinol, benzbromarone and probenecid (the drugs currently in use to prevent recurrent attacks of gout in people prone to these due to raised plasma uric acid). A follow-up study, also in hyperuricemic animals, demonstrated that Chanca Piedra has xanthine oxidase inhibitory activity, reducing the production of uric acid in a similar fashion to allopurinol.
Blood Clotting: In vitro research has demonstrated that Chanca Piedra is a potent inhibitor of platelet aggregation. This may be useful in the prevention of cardiovascular disease.
Hypertension: Five patients with mild hypertension, and four patients with both mild hypertension and diabetes mellitus, were treated with a Chanca Piedra for 10 days. Significant increases in 24 hr urine volume and urine and serum sodium levels were observed, indicating that Chanca Piedra has diuretic activity. A significant reduction in systolic blood pressure was also noted in non-diabetic hypertensives and female subjects. Clinical observation revealed no harmful side effects. In isolated tissue, Chanca Piedra has been demonstrated to have vasorelaxant, negative chronotropic (reducing heart rate), and negative inotropic (reducing strength of heart contraction) properties, suggested to be at least partly attributable to Calcium Channel Blocker (CCB) activity (see ‘Troubleshooting’). In vitro, Chanca Piedra has been demonstrated to have ACE Inhibitor (ACEI) activity. Both CCB and ACEI drugs are commonly used to treat hypertension in conventional medicine.
Cholesterol: In a small animal model of a high cholesterol diet, administration of Chanca Piedra for 30 days resulted in a lowering of VLDL and LDL (‘bad’ cholesterol). The beneficial activity of Chanca Piedra was determined to be mediated through inhibition of hepatic cholesterol biosynthesis, increased cholesterol excretion in bile, and enhanced plasma lecithin:cholesterol acyltransferase activity (theoretically this would also enhance HDL, or ‘good’ cholesterol, production). In a small animal model of alcoholism (high alcohol intake in addition to a high cholesterol diet), Chanca Piedra was demonstrated to both reduce hyperlipidaemia and protect the liver from damage.
Cognition, Memory: Research in small animals has demonstrated that Chanca Piedra can produce a dose-dependent improvement in the memory scores of both young and older animals. It has also been reported to successfully reverse the amnesia induced by scopolamine (the active ingredient in motion-sickness patches) and diazepam (a sedative drug). In vitro, Chanca Piedra has been demonstrated to be a potent dual inhibitor of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Acetylcholinesterase inhibiting drugs (such as donepezil) are now frequently prescribed in the early stages of Alzheimer’s Disease, however dual cholinesterase inhibitors have been shown to produce better clinical efficacy than those that selectively inhibit one form of the enzyme alone.
Pain, Inflammation, Neuropathic Pain (‘Nerve’ Pain): Studies in small animals have demonstrated that Chanca Piedra has strong, dose-dependent pain-relieving effects in six different pain models. In 1996, Chanca Piedra’s anti-hypertensive phytochemical geraniin was reported to be seven times more potent as a pain-reliever than aspirin or paracetamol. Further to this, in a small animal model of neuropathic pain due to sciatic nerve damage, Chanca Piedra inhibited allodynia (pain due to a stimulus such as touch which should not normally cause pain) with a similar efficacy to the drug gabapentin. Again, this effect was related to geraniin and its reported ability to inhibit several neurotransmitter processes that relay and receive pain signals in the brain. Unlike aspirin (which can harm the mucosal lining of the stomach and cause ulcers), geraniin has been reported to protect the gastric mucosa. In vitro, Chanca Piedra has been demonstrated to have anti-inflammatory activity, inhibiting the activation of NF-kB and reducing the expression of iNOS and COX-2 (ibuprofen and Voltaren are examples of drugs which inhibit COX-2). It has also been shown to inhibit the induction of the inflammatory cytokines interleukin (IL)-1b, IL-10, and INF-gamma in human blood, and to reduce TNF-alpha production in vivo.
Fever: Traditionally, Chanca Piedra has been used to reduce fever. This effect has been confirmed in small animal studies.
Menstruation: Traditionally, Chanca Piedra has been used to stimulate menstrual flow. Studies do indicate it is a uterine relaxant, and therefore Chanca Piedra should be avoided in pregnancy.
Treatment with Chanca Piedra costs around $15NZ per month.
Chanca Piedra has no known side effects at proper therapeutic dosages.
Chanca Piedra is contraindicated in pregnancy, but considered safe in lactation.
Chanca Piedra has documented antifertility effects in male and female animals, and therefore is best avoided in both men and women seeking pregnancy.
In people taking insulin and sulphonylurea drugs (eg gliclazide and glipizide), Chanca Piedra should only be taken under the supervision of a Medical Herbalist or doctor experienced in its use. In such situations, Chanca Piedra may predispose to hypoglycaemic episodes.
In people taking antihypertensive drugs, beta-blocker drugs, and other heart medications, Chanca Piedra should only be taken under the supervision of a Medical Herbalist or doctor experienced in its use. Chanca Piedra has been documented with negative chronotropic, negative inotropic, vasorelaxant and ACEI activity; it may reduce heart rate, cardiac output, and blood pressure, which may be detrimental in those with existing cardiovascular compromise.
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