Chanca piedra

(Phyllanthus niruri, amarus)

Family: Euphorbiaceae
Genus: Phyllanthus
Species: niruri, amarus
Synonyms: Phyllanthus carolinianus, P, sellowianus, P. fraternus, P. kirganella, P. lathyroides, P. lonphali, Nymphanthus niruri
Common Names: Chanca piedra, quebra pedra, stone-breaker, arranca-pedras, punarnava, amli, bhonya, bhoomi amalaki, bhui-amla, bhui amla, bhuianvalah, bhuimy-amali, bhuin-amla, bhumyamalaki, cane peas senna, carry-me-seed, creole senna, daun marisan, derriere-dos, deye do, erva-pombinha, elrageig, elrigeg, evatbimi, gale-wind grass, graine en bas fievre, hurricane weed, jar-amla, jar amla, kizha nelli, malva-pedra, mapatan,para-parai mi, paraparai mi, pei, phyllanto, pombinha, quinine weed, sacha foster, cane senna, creole senna, shka-nin-du, viernes santo, ya-taibai, yaa tai bai, yah-tai-bai, yerba de san pablo
Phytochemicals: alkaloids, astragalin, brevifolin, carboxylic acids, corilagin, cymene, ellagic acid, ellagitannins, gallocatechins, geraniin, hypophyllanthin, lignans, lintetralins, lupeols, methyl salicylate, niranthin, nirtetralin, niruretin, nirurin, nirurine, niruriside, norsecurinines, phyllanthin, phyllanthine, phyllanthenol, phyllochrysine, phyltetralin, repandusinic acids, quercetin, quercetol, quercitrin, rutin, saponins, triacontanal, and tricontanol.
Part Used: Entire plant

HERBAL PROPERTIES AND ACTIONS

Main Actions: expels stones supports kidneys increases urination relieves pain protects liver detoxifies liver reduces spasms kills viruses reduces inflammation kills viruses clears obstructions aids digestion reduces blood sugar lowers blood pressure lowers cholesterol

Other Actions: kills bacteria treats malaria prevents mutation reduces fever mildly laxative expels worms

Standard Dosage: Whole herb. Infusion: 1 cup 2-3 times daily; Fluid Extract: 2-4 ml 2-3 times daily; Capsules: 1-2 g twice daily.

Chanca piedra is a small, erect, annual herb that is indigenous to the rainforests of the Amazon and other tropical areas throughout the world, including the Bahamas, southern India, and China.

Since the mid-1960s, chanca piedra has been the subject of much phytochemical research to determine the active constituents and their pharmacological activities. It is a rich source of plant chemicals, including many which have been found only in the Phyllanthus genus. Many of the "active" constituents are attributed to biologically active lignans, glycosides, flavonoids, alkaloids, ellagitannins, and phenylpropanoids found in the leaf, stem, and root of the plant. Common lipids, sterols, and flavonols also occur in the plant.

It is little wonder that chanca piedra is used for so many purposes in herbal medicine systems: in clinical research over the years, the plant has demonstrated liver protective, antilithic (expels stones), pain-relieving, hypotensive, antispasmodic, antiviral, antibacterial, diuretic, antimutagenic, and hypoglycemic activities.

The first notable area of study has validated chanca piedra's longstanding traditional use for kidney stones. In 1990, the Paulista School of Medicine in São Paulo, Brazil, conducted studies with humans and rats with kidney stones. They were given a simple tea of chanca piedra for 1-3 months and it was reported that the tea promoted the elimination of stones. They also reported a significant increase in urine output as well as sodium and creatine excretion.

In a 1999 in vitro clinical study, a chanca piedra extract exhibited the ability to block the formation of calcium oxalate crystals (the building blocks of most kidney stones) which indicates that it might be a useful preventative aid for people with a history of kidney stones.

Previously (in the mid-1980s) the antispasmodic activity of chanca piedra was reported. This led researchers to surmise that "smooth muscle relaxation within the urinary or biliary tract probably facilitates the expulsion of kidney or bladder calculi." Researchers had already reported chanca piedra's antispasmodic properties and smooth muscle relaxant properties (including a uterine relaxant effect) in earlier studies. In 1990, Nicole Maxwell reported that Dr. Wolfram Wiemann (of Nuremburg, Germany) treated over 100 kidney stone patients with chanca piedra obtained in Peru and found it to be 94% successful in eliminating stones within a week or two.

Chanca piedra is also used in herbal medicine for gallstones and, while no research has been performed that specifically validated this use, one study does indicate that chanca piedra has an effect on gallbladder processes. In a 2002 study, Indian researchers reported that chanca piedra increased bile acid secretion in the gallbladder and significantly lowered blood cholesterol levels in rats.

The plant's traditional use for hypertension has been explored by research as well. In 1995 Indian researchers gave human subjects with high blood pressure chanca piedra leaf powder in capsules and reported a significant reduction in systolic blood pressure, a significant increase in urine volume and sodium excretion.

In the above 1995 study, researchers also reported that blood sugar levels were reduced significantly in human subjects studied. Yet another study documented chanca piedra with aldose reductase inhibition (ARI) properties. Aldose reductases are substances that act on nerve endings exposed to high blood sugar concentration and can lead to diabetic neuropathy and macular degeneration. Substances which inhibit these substances can prevent some of the chemical imbalances that occur and thus protect the nerve. This ARI effect of chanca piedra was attributed, in part, to a plant chemical called ellagic acid. This well-studied plant chemical has been documented with many other beneficial effects in numerous clinical studies (over 300 to date).

Another area of research has focused on the pain-relieving effects of chanca piedra and performed at a Brazilian university. So far, they've published six studies on their findings. The first three studies reported strong and dose-dependent pain-relieving effects in mice given extracts of chanca piedra against six different laboratory-induced pain models. In 1996, they isolated and tested chanca piedra's hypotensive plant chemical geraniin and reported that it was seven times more potent as a pain-reliever than aspirin or acetaminophen. Their last two studies (published in 2000) continued to document chanca piedra's pain-relieving effects against normal pain models in mice, and, newly-tested nerve-related pain models. Again, they related this effect to the geraniin plant chemical and reported its 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 have antiulcerous properties and to protect the gastric tract instead. This pain-relieving effect is probably why so many people taking chanca piedra for kidney stones (a very painful affair) report such quick relief and long before chanca piedra could actually break down and expel a stone.

The liver-protecting activity of chanca piedra is another subject which has been established with clinical research. These effects have been attributed to (at least) two novel plant chemicals in chanca piedra named phyllanthin and hypophyllanthin. The researchers who reported the cholesterol-lowering effects also reported that chanca piedra protected rats from liver damage induced by alcohol, and normalized a "fatty liver." One in vitro study and four in vivo studies document that extracts of chanca piedra effectively protect against liver damage from various chemical liver toxins. Two human studies reported chanca piedra's liver protective and detoxifying actions in children with hepatitis and jaundice. Indian researchers reported that chanca piedra was an effective single drug in the treatment of jaundice in children, and British researchers reported that children treated with a chanca piedra extract for acute hepatitis had liver function return to normal within five days. Researchers in China also reported liver protective actions when chanca piedra was given to adults with chronic hepatitis.

A 2000 study even documented that chanca piedra increased the life span of mice with liver cancer from thirty-tree weeks (control group without treatment) to fifty-two weeks. Another research group tried to induce liver cancer in mice that had been pre-treated with a water extract of chanca piedra. Their results indicated the chanca piedra extract dose-dependently lowered tumor incidence, levels of carcinogen-metabolizing enzymes, levels of liver cancer markers, and liver injury markers. Both studies indicate that the plant has a better ability to prevent and slow down the growth of tumors rather than a direct toxic effect or ability to kill cancer cells.

It may well be that chanca piedra's documented ability to stop cells from mutating plays an important factor in this reported anticancerous activity. In several animal studies (as well as within cell cultures), extracts of chanca piedra have stopped or inhibited cells (including liver cells) from mutating in the presence of chemical substances known to create cellular mutations and DNA strand breaks (which can lead to the creation of cancerous cells). Again, one of these studies indicated that chanca piedra inhibited several enzyme processes peculiar to cancer cells' replication and growth-rather than a direct toxic effect of killing the cancer cell (sarcoma, carcinoma, and lymphoma cells were studied). This cellular-protective quality was evidenced in other research which indicated that chanca piedra protected against chemically-induced bone marrow damage in mice, as well as against radiation-induced damage in mice.

The last area of published research (which is the most extensive and the most confusing) concerns chanca piedra's antiviral properties. Studies indicate that chanca piedra can protect the liver, even during hepatitis infection. Chanca piedra has also been reported to have direct antiviral activity. Over 20 clinical studies have been published to date about these effects, and the results have been inconsistent and confusing (unless thoroughly evaluated).

Hepatitis is enough of a worldwide concern to merit sifting through the disparate studies. Hepatitis B infection (HBV) is the leading cause of liver cancer worldwide - which is considered 100% fatal. So when Dr. Baruch Blumberg reported that chanca piedra could clear up the chronic carrier state of Hepatitis B in 1988, it was a big deal. Dr. Blumberg was the winner of the 1963 Nobel Prize for discovering the HBV antigen in the first place. This led to the discovery that HBV was the primary cause of liver cancer and initiated the development of HBV vaccines.

Most of Blumberg's early research was carried out in India in collaboration with an Indian research group. Their first human study reported that a water extract of Phyllanthus amarus cleared the HBV surface antigen from 22 of 37 chronic HBV patients in only 30 days (and they continued to test negative for 9 months, at which time the report was published). This same group had published several earlier in vitro studies as well as animal (woodchuck) studies. (Woodchucks respond to chronic HBV infection in much the same manner as do humans which is why they are chosen for such research). All reported similar and effective anti-HBV effects. By that time, Blumberg was employed with the Fox Chase Cancer Center in Philadelphia; he, Fox Chase, and the Indian researchers filed two patents on the plant's ability to treat HBV and its antiviral properties in 1985 and 1988 (now calling the plant P. niruri). The first patent was specific to HBV; the second stated that the plant's antiviral properties were achieved in part through a strong inhibition of reverse transcriptase (chemicals necessary for many types of viruses to grow) which made it possible to treat such retroviruses as HIV and sarcoma and leukemia viruses.

It was also during this time that the group developed a new and "better" extraction process. This process involved multiple, complicated extractions in which the plant was first soaked in cold water, then the resulting fluid was extracted first in hexane, then in benzene, then in methanol, and back into water. Their documentation revealed, however, that they didn't know specifically what the active chemicals were in the final extract that were providing the antiviral effects! While it was certainly a complicated and patentable process, much of the subsequent published research by this group throughout the 1990s using this new, patented "water extract" conflicted with their earlier studies, and was not as effective in the in vivo research for HBV. This caused much confusion as to whether chanca piedra (P. niruri or P. amarus) was an effective treatment or not. To add to the confusion, in 1994, a New Zealand research group prepared a chemically-altered extract (of P. amarus) which was standardized to the geraniin chemical content (the chemical documented with analgesic and hypotensive properties). They started a double-blind HBV human trial, later discontinued it due to lack of response, and published another negative result study.

Meanwhile, a separate research group in China (where HBV is wide-spread) working with a straight water extract and/or herb powder published two positive studies showing good results with human HBV patients in 1994 and 1995. Their second study suggested that different results were obtained through different Phyllanthus species of plants used (and that yet another species - P. urinaria provided the best anti-HBV results). The Chinese published a more recent (2001) study which compared 30 chronic HBV patients taking a chanca piedra extract to 25 patients taking interferon (the leading conventional drug used for HBV) for three months. Both treatments showed an equal effectiveness of 83%, but the chanca piedra group rated significantly higher in the normalization of liver enzymes and recovery of liver function than the interferon-treated group. They published yet another study in 2003 which attributed the anti-HVB effects mainly to four chemicals in chanca piedra: niranthin, nirtetralin, hinokinin, and geraniin.

Finally, The Cochrane Hepato-Biliary Research Group in Copenhagen reviewed all the HBV published research (22 randomized trials) and published an independent review of the results. It stated that treatment with "Phyllanthus herb" (they acknowledged the confusion among the various species used) had "a positive effect on clearance of serum HBsAg" (HBV surface antigen) comparable to interferon and was better than nonspecific treatment or other herbal medicines for HBV and liver enzyme normalization." They also indicated that large trials were warranted due to these documented positive effects and the lack of standardization of the research methods and plant species used in the various published studies to date.

Concerned with HIV specifically, a Japanese research group reported that a simple water extract of P. niruri inhibited HIV-1 reverse transcriptase in 1992. (Several conventional drugs used today against HIV are classified as "reverse transcriptase inhibitors.") They attributed this effect to a plant chemical in chanca piedra called repandusinic acid A. When they tested this chemical individually it demonstrated significant toxicity to HIV-1 at very small dosages (a 90% in vitro inhibition using only 2.5 mcg). Bristol-Myers Squibb Pharmaceutical Research Institute isolated yet another chemical in chanca piedra with anti-HIV actions-a novel compound that they named niruriside and described in a 1996 study. A German research organization published their first study on chanca piedra and its application with HIV therapy (reporting a 70-75% inhibition of virus) in 2003. In addition to these antiviral properties, the plant has also been documented other antimicrobial effects. Chanca piedra demonstrated in vitro antibacterial actions against Staphylococcus, Micrococcus, and Pasteurella bacteria as well as in vivo and in vitro antimalarial properties, which validates other traditional uses.

The Spanish name of the plant, chanca piedra, means “stone breaker” or “shatter stone.” It was named for its effective use to 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 by the indigenous peoples, including colic, diabetes, malaria, dysentery, fever, flu, tumors, jaundice, vaginitis, gonorrhea, and dyspepsia. Based on its long documented history of use in the region, the plant is generally employed to reduce pain, expel intestinal gas, to stimulate and promote digestion, to expel worms, as a mild laxative.

Chanca piedra has a long history in herbal medicine systems in every tropical country where it grows. For the most part, it is employed for similar conditions worldwide.

Following up, a brief summary of worldwide ethnomedical uses of chanca piedra.

Region	Uses
Amazonia	for bowel inflammation, colic, constipation, diabetes, digestion stimulation, dysentery, dyspepsia, edema, fever, flu, gallstones, gonorrhea, intestinal gas, itch, jaundice, kidney aliments, kidney stones, malaria, pain, proctitis, stomachaches, tumor, urinary insufficiency, urinary tract disorders, vaginitis, worms, and to stimulate menstruation
Bahamas/ Caribbean	for bacterial infections, colds, constipation, fever, flu, hypoglycemic, laxative, liver detoxifier, liver tonic, liver protector, spasms, stomachache, typhoid, urinary insufficiency, viral infections, and as an appetite stimulant
Brazil	for abortions, aches (joint), albuminuria, arthritis, bacterial infections, bile stimulant, biliary conditions, bladder problems, bladder stones, blood cleanser, cancer, catarrh (liver and kidney), cystitis, diabetes, digestion stimulation, edema, fever, gallbladder stimulation, gallstones, gastritis, gastrointestinal problems, gout, hepatitis, hypertension, hypoglycemic, inflammation, jaundice, kidney colic, kidney pain, kidney stones, liver support, liver disorders, malaria, obesity, pain, prostatitis, renal colic, renal problems, spasms, tonic, uric acid excess, urinary insufficiency, urinary problems, uterine relaxant, viral infections, and as a muscle relaxant and to promote perspiration
Haiti	for bowel inflammation, colic, digestive problems, digestion stimulation, fever, flu, indigestion, intestinal gas, malaria, spasms, stomachache, urinary insufficiency
India	for anemia, asthma, bronchitis, conjunctivitis, cough, diabetes, diarrhea, digestion stimulation, dysentery, fevers, edema, eye disorders, genitourinary disorders, gonorrhea, hepatitis, jaundice, lack of milk production, menstrual disorders, ringworm, scabies, thirst, tuberculosis, tumor (abdomen), urinary insufficiency, urogenital tract infections, vaginal discharge, warts
Malaya	for caterpillar stings, constipation, dermatosis, diarrhea, itch, menstruation promoter, miscarriage, renal disorders, syphilis, urinary insufficiency, vertigo
Peru	for gallstones, hepatitis, kidney pain, kidney problems, kidney stones, urinary infections, worms, and to stimulate menstruation
United States	for bile insufficiency, bronchitis, diabetes, fever, gallbladder problems, gallstones, gout, hepatitis, hypertension, kidney problems, kidney stones, liver disease, obstructions, pain, uric acid excess, urinary tract infections, viral infections
Elsewhere	for bile insufficiency, bruises, constipation, cough, cuts, diabetes, diarrhea, dysentery, dyspepsia, edema, eye diseases, fever, gallstones, gonorrhea, itch, jaundice, kidney disease, kidney stones, malaria, menstrual problems, pain, rectitis, stomachache, tuberculosis, urinary insufficiency, urinary tract infections, vaginitis, venereal diseases

CHANCA PIEDRA PLANT SUMMARY

Main Preparation Method:	infusion
Main Actions (in order):	antilithic (prevents and eliminate kidney stones), hepatoprotective (liver protector), diuretic, antihepatotoxic (liver detoxifier), antiviral
Main Uses:	for kidney stones and gallstones (active stones and as a preventative) to tone, balance, strengthen, detoxify and protect the liver (and to balance liver enzymes) for viruses, including hepatitis A, B, and C, herpes, and HIV to tone, balance, strengthen, detoxify and protect the kidneys and to reduce uric acid and increase urination for hypertension and high cholesterol levels
Properties/Actions Documented by Research:	analgesic (pain-reliever), antiulcerous , antibacterial, antihepatotoxic (liver detoxifier), antilithic (prevents and eliminates kidney stones), antimalarial, antimutagenic (cellular protector), antispasmodic, antiviral, contraceptive, diuretic, gastrototonic (tones, balances, strengthens the gastric system), hepatoprotective (liver protector), hepatotonic (tones, balances, strengthens the liver), hypocholesterolemic (lowers cholesterol), hypoglycemic, hypotensive (lowers blood pressure), uterine relaxant
Other Properties/Actions Documented by Traditional Use:	anti-inflammatory, blood cleanser, carminative, detoxifier, diaphoretic (promotes sweating), febrifuge (reduces fever), laxative, menstrual stimulant, tonic (tones, balances, strengthens overall body systems), vermifuge (expels worms)
Traditional Remedy:	Infusion/ decotion: Depending on what it's employed for, 1-3 cups are taken daily. Prevention and health maintenance dosages for kidney stones are reported by practitioners to be 1-3 cups weekly while 3-4 cups daily are used to expel existing stones. Fluid extracts or water/glycerine extracts: Depending on the concentration of the extracts, 2-6 ml are taken 2-3 times daily. Tablets/ capsules: Since most of the active chemicals are water soluble (and broken down during digestion) 2-3 g in tablets or capsules twice daily can be substituted if desired.
Contraindications:	Chanca piedra has demonstrated hypotensive effects in animals and humans. People with a heart condition and/or taking prescription heart medications should consult their doctor before taking this plant. It may be contraindicated for some individuals with heart conditions and/or heart medications may need monitoring and adjusting. Chanca piedra has been considered in herbal medicine to be abortive (at high dosages) as well as a menstrual promoter. While not studied specifically in humans or animals, animal studies do indicate it has uterine relaxant effects. It should therefore be considered contraindicated during pregnancy. Chanca piedra has been documented with female antifertility effects in one mouse study (the effect was reversed 45 days after cessation of dosing). While this effect has not been documented in humans, the use of the plant is probably contraindicated in women seeking pregnancy or taking fertility drugs. This effect has not been substantiated sufficiently to be used as a contraceptive, however, and should not be relied on for such. Chanca piedra has demonstrated hypoglycemic effects. It is contraindicated for people with hypoglycemia. Diabetics should consult their doctor before taking this plant as insulin medications may need monitoring and adjusting. Chanca piedra has been documented with diuretic effects. Chronic and acute use of this plant may be contraindicated in various other medical conditions where diuretics are not advised. Chronic long-term use of any diuretic can cause electrolyte and mineral imbalances; however, human studies with chanca piedra (for up to three months of chronic use) has not reported any side effects. Consult your doctor if you choose to use this plant chronically for longer than three months concerning possible side effects of long term diuretic use.
Drug Interactions:	May potentiate insulin and antidiabetic drugs. This plant contains a naturally-occurring phytochemical called geraniin. This chemical has been documented with negative chronotropic, negative inotropic, hypotensive and angiotensin-converting enzyme inhibitor effects in animal studies with frogs, mice and rats. As such, this plant may potentiate antihypertensive drugs, beta-blocker drugs and other heart medications (including chronotropic and inotropic drugs)

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