Medical Herbalism: Clinical Articles and Case Studies    

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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


32 year old female, 5’5", 120 lbs. medical student, married, two children. Smokes one pack of cigarettes a day.


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

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.


Emergency treatment for acute onset was to chew the fresh leaves of arctostaphylos. Dramatic improvement of symptoms occured within minutes.

    Avena sativa


    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


24 year old female, 159 lbs. Married with 2 children. Currently has a cold and just began a new job.


    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.


Case 4


29 year old female, 5’6", 115 lbs. Single


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