| Medical Herbalism: Clinical Articles and Case Studies |
Urinary tract infections
by Chanchal Cabrera, M.N.I.M.H.
Medical Herbalism 3(4):1,4-5
Clinical background
The urinary tract and the urine itself is normally sterile. Infection may affect the urethra (urethritis), bladder (cystitis) or kidney (nephritis).
Most UTId are due to ascending bacteria (usually E. coli) and because of this, urethritis and cystitis are much more common in women because of their relatively short urethra. Men have a longer urethra and hence more barrier against the bacteria.
Occasionally a U.T.I. may be due to a catheter, may be blood-borne to the kidney, may be due to an obstruction further down the tract, or may transmit from adjacent infected organs (e.g. a fistula from diverticulitis or Crohn’s disease may transmit bacteria from the gut to the bladder.) Pregnancy, diabetes mellitus and local trauma increase the incidence of UTI.
Signs and symptoms
Urethritis and cystitis are the more common form of UTI. The presenting symptoms are a scalding, burning pain on urination together with increased frequency and urgency. The inflamed bladder walls tend to go into spasm which causes an intense desire to urinate and a sensation of not being empty. There may also be pain above the public area before and after urination, possible radiating into the loins if the kidneys become involved. Palpation may reveal the supra-pubic pain.
The symptoms of systemic illness may be only a low fever, or there may be some feeling of constitutional unwellness.
The urine may be cloudy or blood-stained and may have an unpleasant odor.
Urinalysis may reveal raised nitrites, proteinuria and the presence of bacteria and pus.
Acute kidney infection is characterized by rapid onset of the above symptoms along with tenderness and guarding of the iliac fossa(e), and a rapidly rising fever with rigors and vomiting.
Case Studies: Urinary tract infection
The
following cases are taken from the teaching clinic at National College
of Naturopathic Medicine in Portland, Oregon. Thanks to Cascade Anderson
Geller, assistant professor in botanical medicine at National, for supplying
the cases.
| Copyright
2001 Paul Bergner 387
|
| Medical Herbalism: Clinical Articles and Case Studies |
Case 1
Patient
32 year old female, 5’5", 120 lbs. medical student, married, two children. Smokes one pack of cigarettes a day.
History
Difficult and painful urination, with frequency and urgency for two weeks previous.
Botanical treatment
Arctostaphyllos uva-ursi 4 drams
Barosma betulina 2 drams
Chimaphila spp. 2 drams
Dose: 60 drops three times a day in cold water between meals. Infusion of althea as needed
Additional treatments:
Increase water intake.
Vitamin C 500 mg. Four times a day
Hot compresses to abdomen as desired
Reduce sugars, coffee and cigarettes.
Follow up #1: two days
Pain and difficult urination diminished but urgency persists, Patient has not been taking the tea
Follow up #2: six days from initial visit
Patient is asymptomatic.
Case 2
Patient
| Copyright
2001 Paul Bergner 388
|
| Medical Herbalism: Clinical Articles and Case Studies |
65 year old female, 5’6", 123 lbs. Divorced mother of four. Chronic smoker. History of hysterectomy.
Treatment
Emergency treatment for acute onset was to chew the fresh leaves of arctostaphylos. Dramatic improvement of symptoms occured within minutes.
Avena sativa
Arctostaphylos
Althea off. (Commercial formula: amounts not given)
Larrea divaricata
Mentha piperita
Juniperis communis
Barosma betulina
Equisetum arvense
Zingiber off.
Dose: 2 caps t.i.d.
Follow up:
Patient continued treatment for two months at the end of which she was completely symptom-fee.
Case 3
Patient
24 year old female, 159 lbs. Married with 2 children. Currently has a cold and just began a new job.
Treatment:
Chimaphila spp. 6 drams
Arctostaphylos uva-ursi 2 drams
| Copyright
2001 Paul Bergner 389
|
| Medical Herbalism: Clinical Articles and Case Studies |
Equisetum arvense 4 drams
Echinacea spp. 4 drams
Cantharis 30 gtt.
Dose: ½ tsp in water every 3 hours.
Other treatments:
Increase fluids.
Drink unsweetened cranberry juice
Follow up #1: twenty-four hours
Considerable improvement, no pain or difficulty with urination.
Follow up #2: seven days from initial visit.
Asymptomatic.
Case 4
Patient:
29 year old female, 5’6", 115 lbs. Single
History:
Repeated bouts of UTI and many prescriptions of antibiotics.
Botanical treatment:
Berberis quifolium 2 drams
Equisetum arvense 2 drams
Barosma betulina 2 drams
Chimophilla spp. 2 drams
Apis [toxic] 10 gtt. [toxic]
Dose:
15 drops every two hours till gone.
| Copyright
2001 Paul Bergner 390
|
| Medical Herbalism: Clinical Articles and Case Studies |
Decoction of Althea off., 1 tbsp three times a day
Other treatments:
increase fluid intake.
Follow up #1: seven days
Patient reports diminished symptoms but still some discomfort. Urine analysis shows reduction in bacteria.
New botanical formula
Echinacea spp. 2 drams
Equisetum arvense 2 drams
Hydrastis canadensis 1 dram
Symphytum off. 1 dram
Taraxacum off. 2 drams
Dose: 20 drops three times a day away from food.
Decoction of althea, barosma and equisetum, three cups per day.
Follow up #2: twenty days after intial treatment
Patient reports no symptoms of UTI for one week and urine analysis is clear.
Case commentaries
Case 1
The
tincture formula prescribed contains two herbs with arbutin/hydroquinone
as well as barosma which contains the antiseptic and diuretic diosphenol
in its volatile oil. The prescription was effective at clearing the acute
infection but relief from symptoms may have been obtained more quickly
if demulcent and/or anti-spasmodic herbs were included. Infusions of althea
root or leaf are a good idea, but I would put the tincture into the hot
infusion to evaporate away the alcohol which is potentially irritant to
the kidneys. The hot compresses are an excellent way to bring blood to
the area and to ease muscle spasms.
| Copyright
2001 Paul Bergner 391
|
| Medical Herbalism: Clinical Articles and Case Studies |
Case 2: Comments
This case neatly illustrates the ‘trial and error’ empiricism upon which herbal medicine is traditionally built. In an emergency situation you use whatever is at hand, even if that means raiding the garden! If any other practitioners have tried chewing arctostaphylos leaves for immediate relief from UTI please let us know.
Case 3: Comments
The formula used worked very rapidly with 80% improvement within 24 hours. A demulcent and a diuretic could have improved the formula further.
A mistake was made in recommending cranberry juice at the same time as prescribing arctostaphylos and chimaphila. The cranberry juice is a well-known home remedy for cystitis, acting through its formation of hippuric acid which is anti-bacterial in the bladder. However, it does not complement the use of arctostaphylos and chimaphila because their hydroquinone works best as an antiseptic in an alkaline environment. Some herbalists prescribe these herbs along with bicarbonate of soda to increase alkalinity. [See Uva Ursi and alkaline urine]
Case 4: comments
The inclusion of berberis and later hydrastis is interesting. Both of these herbs contain the alkaloids berberine and hydrastine which are tonic to the mucus membranes and also have antibacterial properties. The second formula in particular is a good blend of diuretic, anti-microbial, demulcent and tonic herbs. The inclusion of echinacea is generally useful for the immune system.
Note that there is some controversy as to the relative benefits of using dried equisetum (e.g. in decoction). Some authorities suggest that the silica is hard to assimilate after oxidation and that the herb should only be used fresh (Mills, Zeylstra).
Because of the history of UTI the practitioner should consider giving a urinary tract tonic formula for six to eight weeks.
General comments
The
four cases described here all illustrate successful treatment of UTI which
indicates that mostly they are relatively easy to treat. The formulas described
all have a flcus on anti-microbial herbs which is appropriate but should
not be at the expense of adjunct and supportive herbal actions. There is
a tendency to approach UTI from an almost allopathic angle, homing in on
the infection itself and neglecting to address the tissue state underlying
it. In general, I would recommend that in addition to one or two anti-microbial
herbs you also use diuretics, anticatarrhals, demulcents, immunomodulators,
and anti-spasmodics.
| Copyright
2001 Paul Bergner 392
|