Urinary - Case study

by Cabrera, Chanchal

Medical Herbalism: 12-31-93 5(4): 1, 6-7

Mr. B. first consulted with me in March 1991. In January 1991, he had been sitting at his computer when he was suddenly overtaken by excruciating abdominal pain that had him rolling on the floor and screaming. His terrified wife rushed him to the hospital, but before they arrived the pain spontaneously disappeared and he was left with a sore, bruised feeling, “as though someone had punched him in the belly.” Nothing abnormal was diagnosed in the hospital and he went home feeling shaken up but otherwise fine. Two weeks later the pain reoccurred, just as severe as the first time, but abdominal ultrasound and X-rays came back clear and, again, nothing abnormal was found. After this second episode, he experienced a month of increased frequency of urination and some urgency. In February he had a third episode of the excruciating pain and this time he passed a crystal in the urine. He collected this and took it to the hospital, where it was measured at 1 cm. long and determined to be composed chiefly of calcium oxalate.

Antibiotics were prescribed to treat the pus and blood in the urine resulting from passing the crystal. A 24-hour urinalysis revealed an abnormally high calcium level (370 mg. as compared to an average of 100 - 240 mg. in a healthy adult). The doctors were puzzled by this and referred Mr. B. to a nephrologist. He was waiting for this appointment when he first consulted with me.

At the time of presentation in my clinic, Mr. B. had not had any kidney stone recurrence, and urinalysis revealed normal levels of nitrites, protein, glucose, pH, bilirubin, urobilinogen and ketones, with no pus or blood. The specific gravity was slightly elevated (1.025). The urine calcium level continued abnormally high. He had burning loin pain with increased frequency and urgency of urination, and was very nervous about the possibility of another stone. There was no dysuria and the bladder felt empty after voiding.

Mr. B’s general health was excellent. He was 43 years old and had no previous medical history of any serious illness. The only surgery was an appendectomy as a child and a knee repair operation after a skiing accident. He took regular and vigorous exercise and denied any particular stress in his life. He had a history of labile blood pressure (sometimes measuring as high as 150/92), but when I took it the reading was 140/80. An ECG the previous year had revealed no abnormality in heart function. His digestive and respiratory functions were normal except for occasional indigestion for which he would take an over-the-counter antacid. Mr. B. had lived several years in Japan and his diet reflected this, being generally low in flesh foods and dairy products and mostly comprising fish, rice and vegetables. Since the kidney stone attacks, he had made efforts to avoid any oxalate-rich foods (spinach, chard, rhubarb, nuts and chocolate). Prior to the kidney stone he was not ingesting very much fluid but after the attacks had increased his fluid intake. At the time of consulting with me, he was drinking 3 or 4 cups of herbal tea (mostly dandelion root or bancha twig), 1 or 2 glasses of fruit juice, 1 cup of coffee and 1 beer per day.
 
 
 

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Medical Herbalism: Clinical Articles and Case Studies

The only supplement Mr. B. was taking was calcium ascorbate (Ester C). as a prophylactic against seasonal colds and flu. Ester C is a buffered vitamin C product comprising calcium ascorbate, which provides 600 mg. of ascorbic acid and 80 mg. of calcium per capsule. Mr. B. was taking up to 20 g. per day of vitamin C, which provided the equivalent of around 2.5 g. of calcium. No medical professional had asked about his supplement intake. I did, but it wasn’t until the very end of the consultation that I thought to ask about the actual form of vitamin C he was taking. When I calculated the intake of calcium from the Ester C, it soon became apparent that this was almost certainly the source of the abnormally high urinary output of calcium that was so puzzling to his doctors.

Treatment strategy

The first thing I asked Mr. B. to do was to switch his vitamin C to a non-buffered form and to avoid the Ester C. He was also asked to avoid coffee and beer and to greatly increase his water consumption (up to 3 liters a day). I recommended that he avoid the use of antacids, because alkaline urine may increase the precipitation of calcium oxalate and because aluminum salts common in antacids may aggravate hypercalciuria. I encouraged him to eat lots of green vegetables and I prescribed 2 tablespoons of liquid chlorophyll daily, because water-soluble vitamin K is required for the synthesis of a glycoprotein carried in the urine which inhibits the precipitation of calcium oxalate (ref: Encyclopedia of Natural Medicine, Murray and Pizzorno, Prima, 1991, p.404.)

I also recommended magnesium citrate (300 mg.) and pyridoxine (B6) (100 mg.), which may help to keep calcium in solution in the urine. The citrate and magnesium may also help to prevent calcium crystallization, so this is a very appropriate form of mineral supplementation to use.

Herbal formula

Rubia tinctoria (1:5 25%) (madder)             25 mls

Agropyron repens (1:3 25%) (couch grass)         20 mls

Eupatorium purpureum (1:5 40%) (gravel root)        20 mls

Aphanes arvensis (1:3 25%) (parsley piert)         25 mls

Viburnum opulus (1:3 45%) (cramp bark)         1 mls

100 mls. per week

sig. 5 mls. tid. aq. cal. A.c. (5 mls three times in hot water before meals)
 
 
 
 
 
 
 

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Medical Herbalism: Clinical Articles and Case Studies

Plantago lanceolata (plantain)             50 g

Solidago virgaurea (goldenrod)             50 g

Taraxacum off. folia (dandelion leaf)         50 g

1 tsp. per cup boiling water as an infusion. 3 cups daily.
 
 

Althea off. folia (marshmallow leaf)         50 g

2 tsp. per cup of cold water steeped overnight and added to

3 cups of the hot infusion.

Rationale

Rubia tinctoria (madder) is a member of the bedstraw (Rubiaceae) family the root of which contains a red pigment called alizarin. Alizarin glycosides may be the active constituents of the plant. The medicinal effects are a slight diuresis and a strong relaxation of the ureters and urethra such that kidney or bladder stones are permitted to pass unimpeded. It is necessary to prescribe it in sufficient doses to color the urine a strong red, which can alarm patients who then think they are bleeding into the urine. Treatment with madder should be continued for 2 to 3 months for optimum results. Practitioners in England have claimed that madder can dissolve kidney stones and promote the passing of sand in the urine.

Agropyron repens (couch grass) is prescribed as a strong osmotic diuretic. The sugar complexes in the rhizome of this plant include mannitol and a mucilage known as triticin. One theory is that they are absorbed whole from the gut and pass into the glomerular filtrate from which they cannot be reabsorbed into the blood; this would exert an osmotic effect to keep water in the renal tubules. As well as being a diuretic, couch grass is a soothing demulcent to the renal tissues and has an antibiotic effect. There is also a high content of silica (30% of ash), which may help heal and strengthen the tissues.

Eupatorium purpureum (gravel root) contains a yellow flavonoid compound called euparin and an oleo-resin called eupurparin or eupurpurin. There is also a trace of volatile oil. This plant appears to be a strong diuretic and Kings American Dispensatory suggests that it may even act to dissolve renal calculi.

Aphanes arvensis L./Alchemilla arvensis Scop. (parsley piert) is indigenous to Britain and rarely employed in other countries. It is a member of the Rosaceae family and the entire aerial parts are medicinal. The major active constituent appears to be tannin compounds. These are tissue specific to the kidney and act as a trophorestorative and tonic to the tubules. It is an invaluable remedy for hematuria (blood in the urine) as well as pus or mucous in the urine and will strengthen all renal functions. It is also somewhat diuretic and is reputed to aid in dissolving urinary deposits.
 

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Medical Herbalism: Clinical Articles and Case Studies

Viburnum opulus (cramp bark) is employed as an anti-spasmodic and anodyne (pain-reliever). It contains anti-inflammatory salicylates as well as valerianic acid, which acts on the medulla oblongata to reduce respiratory rate and blood pressure. It also contains a bitter called viburnin which is antispasmodic with a tissue specificity to the uterus and arterial tree.

Plantago lanceolata (plantain) was prescribed for its soothing, healing effects. The combination of tannins, zinc, mucilage, vitamin C and silica make it an eminent vulnerary, and it has particular effects in the lungs and kidneys. It is nourishing and trophorestorative to these organs and strengthens the mucous membrane linings of the alveoli and renal tubules.

Solidago virgaurea (goldenrod) is high in bioflavonoids, particularly quercitrin and rutin, and this makes it valuable in treating capillary fragility and bleeding disorders. It is also high in tannins which make it astringent, especially to the mucous membranes of the naso-pharynx and the kidneys. Thus it is effective as an anti-catarrhal for upper respiratory tract or kidney infections. There are also saponins in the aerial parts of this plant and these are believed to be responsible for the diuretic and expectorant effects. The exact mechanism is not known, but it appears that irritation in the gut causes a reflex reaction in embryologically related areas (lungs and kidneys), resulting in a tissue response to flush away the offending substance. This provides goldenrod with an interesting paradoxical effect, on the one hand being astringent and anti-catarrhal and on the other hand increasing the production of thin, easily eliminated mucous. The precise degree to which either effect occurs appears to depend upon the tissue state: tissues congested with thick, sticky mucous will benefit from a thinning of the mucous which makes for easier elimination; tissues producing too much mucous and tending to weakness will be benefited by a drying and toning action.

Taraxacum off. (dandelion) was included for its powerful diuretic action. It provides plenty of potassium to replace that which is lost in the urine and has a generally cleansing effect on the renal tubules.

Althea off. (marshmallow) was included for its demulcent and vulnerary properties due to the high content of mucilage. It is also a soothing osmotic diuretic and nourishing to the kidney tissues. This plant infusion should be made cold to avoid extraction of the starchy principles and concentrate the effects of the mucilage.

The focus of the herbal treatment was to flush out the kidneys and bladder by the use of diuretics while at the same time providing a soothing and Vulnerary effect. The flushing of the urinary tract was intended to remove sand which could act as foci for further crystallization to occur. The herbal formula was also intended to heal damaged or stressed tissues and to regulate mucous production in the tubules.

Follow up

Mr. B. returned one month later to report complete cessation of all urinary symptoms. Frequency and urgency had disappeared and all urine tests were normal. His urine calcium was down to 140 mg./24 hours. He continued to follow all the dietary recommendations and to drink lots of fluids. At this time I prescribed a repeat of the formula with a dose of 5 mls. bid. for one month and asked him after that time to continue to drink the herbal tea for a further 2 months. Now 2 1/2 years after the original problem he remains completely symptom free.
 

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Medical Herbalism: Clinical Articles and Case Studies

Commentary

With this case it appears very likely that the trigger for the calcium oxalate stone formation was the excessive intake of calcium in the form of Ester C. In these times when high dosing with vitamin C is popular, it may be worth warning patients not to use calcium ascorbate for this purpose. Plain generic ascorbic acid or ascorbic acid from a natural source would be safer. If stomach sensitivity is a problem then time-release forms may help, or the patient can drink an infusion of equal parts Chamomile recutita, Melissa off. and Filipendula ulmaris.
 

Copyright 2001 Paul Bergner    411