Chanca piedra

Chanca Piedra (Phyllanthus niruri L.): A Comprehensive Reference

1. Identity, Taxonomy, and Botanical Description

Phyllanthus niruri belongs to the genus Phyllanthus of the family Phyllanthaceae and is a widespread tropical plant commonly found in coastal areas from Texas southward through Mexico, Central America, and wide regions of South America and India. It carries the common name chanca piedra among numerous others in Spanish.

The name "chanca piedra" translates to "stone breaker" in Spanish, a term that encapsulates the plant's long-standing reputation in traditional medicine for its effectiveness in breaking down and facilitating the expulsion of kidney and gallstones. The Spanish form derives from two words — "chanca," meaning to break or crush, and "piedra," meaning stone — and this compelling name reflects centuries of observation and traditional use.

Synonyms and Related Species

The Phyllanthus genus contains over 600 species of shrubs, trees, and annual or biennial herbs distributed throughout the tropical and subtropical regions of both hemispheres. P. amarus and P. sellowianus are closely related to P. niruri in appearance, phytochemical structure, and history of use, but typically are found in the drier tropical climates of India, Brazil, and even Florida and Texas. In some published research, especially in earlier studies which started in the 1960s, scientists make little or no distinction between P. niruri, P. urinaria, and P. amarus because of the very similar phytochemical makeup and appearance of these plants. There remains a great deal of confusion among scientists regarding plant identification, and in many cases plant misidentification makes evaluation of published information difficult.

Common Names by Region

P. niruri is probably the most widespread herb of Phyllanthus, known by numerous names including "chanka piedra," "bhuiamlki," "zhuzicao," "dukung anak," "quebra-pedra," and "chanca piedra." In Brazil, the plant is known as quebra-pedra or arranca-pedras, both of which also translate to "break-stone." In India, it is called "Bhumyamalaki." The repeated appearance of "stone" or "breaker" themes in these names across continents reflects the broad cross-cultural observation of a shared property.

Botanical Description

The plant grows 50–70 cm (20–28 in) tall and bears ascending herbaceous branches. The bark is smooth and light green. It bears numerous pale green flowers, which are often flushed with red, and fruits that are tiny, smooth capsules containing seeds. One of the most distinctive features of Phyllanthus niruri is the way its seed capsules develop beneath the leaves, a characteristic that has inspired some of its common names, such as "Seed-under-leaf."

Distribution and Habitat

P. niruri is indigenous to the rainforests of the Amazon and other tropical areas throughout the world, including the Bahamas, southern India, and China, and is quite prevalent in the Amazon and other wet rainforests, growing and spreading freely, much like a weed.

Plant Parts Used

Dietary supplements and teas that contain chanca piedra are made from the stems, leaves, and seeds of the plant. The whole aerial part is used medicinally.

2. Traditional and Historical Use

Amazon Basin and South America

The Spanish name of the plant, chanca piedra, meaning "stone breaker," 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, and as a mild laxative.

Chanca piedra is still used widely in herbal medicine in South America; it is the most popular remedy for gallstones and kidney stones throughout Peruvian herbal medicine, and is also used for hepatitis, urinary infections, and as a diuretic. In Brazilian herbal medicine, where it has been used for thousands of years under the name quebra-pedra, it is considered an excellent remedy to remove uric acid from the urine and to eliminate stones.

It is used in Brazil for hydropsy, urinary and bladder infections, blood ailments, painful joints, cystitis, prostate disorders, kidney disorders, diabetes, and as an antispasmodic and muscle relaxant specific to the urinary tract system.

Ayurvedic Tradition

In Ayurvedic medicine, the plant has been used for over 2,000 years, with a wide number of traditional uses including internal use for jaundice, gonorrhea, frequent menstruation, and diabetes, and topical use as a poultice for skin ulcers, sores, swelling, itchiness, and dysentery.

Traditional Chinese Medicine

Chinese traditional medicine incorporated chanca piedra into formulas for supporting urinary health and healthy blood sugar levels. The plant has also been used in Chinese traditional medicine to treat liver injury.

Traditional Preparations

In these traditional systems, chanca piedra was most often prepared as a tea or decoction, though some cultures would also use the fresh plant. Based on its long documented history of use, the plant has been regarded in traditional contexts as analgesic and as an aperitif, carminative, digestive, emmenagogue, laxative, stomachic, tonic, and vermifuge.

3. Key Phytochemical Constituents

Phytochemical studies on this plant, from as early as 1861 when Ottow first isolated the lignan phyllanthin, to more recent isolation of potential anti-HBV phytochemicals nirtetralin and niranthin, have revealed that this plant is rich in tannins, flavonoids, alkaloids, terpenes, coumarins, lignans, and phenylpropanoids, which are responsible for its pharmacological activity.

More than 510 compounds have been isolated from Phyllanthus species, the majority of which are lignins, triterpenoids, flavonoids, and tannins. Lignins and tannins exhibit various activities and are considered to be the biologically active compounds of this genus. Corilagin, geraniin, and gallic acid are the three most prevalent compounds in this genus, and pharmacological research has mainly focused on phyllanthin, niranthin, and geraniin.

Lignans

The anti-hepatotoxic activity of P. niruri has been attributed to two novel lignans, phyllanthin and hypophyllanthin. Additional lignans identified in the plant include niranthin, phyltetralin, niranthine, nirtetralin, and niruriside. Phyllanthus niruri has several bioactive molecules such as lignans, phyllanthin, hypophyllanthin, flavonoids, glycosides, tannins, alkaloids, ellagitannins, triterpenes, phenylpropanoids, steroids, ricinolic acid, niruriside, and phyltetralin.

Hydrolyzable Tannins and Ellagitannins

Ellagitannins are the largest group of hydrolyzable tannins in this genus. Corilagin and geraniin are the most extensively characterized and are characteristic compounds of the ellagitannins, exhibiting multiple activities such as antioxidant, anti-HIV, antitumor, and antihyperalgesic effects.

• Ellagic acid — displays antiviral and anticancer properties.
• Corilagin — exhibits potent anti-inflammatory and nephroprotective effects.
• Geraniin — a polyphenol with strong antioxidant and anti-urolithiatic properties.

Flavonoids

A wide array of flavonoids and their derivatives has been identified in P. niruri extracts, including epicatechin, fustin, orientin, quercetin, vitexin, myricitrin, fisetin, rutin, kaempferol, astragalin, and apigenin. Flavonoids play a crucial role in the antioxidant and anti-inflammatory properties of P. niruri.

Alkaloids and Other Compounds

An alkaloid extract of P. niruri demonstrated smooth muscle relaxation effect specific to the urinary and biliary tracts. Glycosides (quercitin and geraniin) found in P. niruri demonstrated aldose reductase inhibitory (ARI) activity in studies conducted by a Japanese research group in 1988 and 1989. The ARI effect was also attributed to the presence of another ellagitannin phytochemical, ellagic acid.

4. Established and Proposed Mechanisms of Action

Antiurolithiatic Mechanisms

Several in vitro and animal studies have characterized how P. niruri may reduce kidney stone formation and promote passage. Anti-inflammatory, anti-hyperuricemic, and diuretic properties have been described for this plant. Chanca piedra may act as a diuretic, increasing the amount of fluid that flushes through the kidneys as urine. It may also help keep certain substances that can cause kidney stones, such as oxalate, from building up in the kidneys. The constituent geraniin has been specifically identified in animal studies as contributing to anti-urolithiatic effects.

Hepatoprotective Mechanisms

In vivo administration of P. niruri aqueous extract in rats caused normalization of AST, ALT, alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total cholesterol, triglycerides, total bilirubin, glucose, total proteins, urea, and creatinine levels elevated by CCl4. The extract also decreased TNF-α, NF-κB, IL-6, IL-8, IL-10 and COX-2 expression, and significantly antagonized the effect of CCl4 on antioxidant enzymes SOD, catalase, glutathione reductase, and glutathione peroxidase.

Antiviral activity against hepatitis B virus has been attributed to inhibition of viral DNA polymerase activity, suppression of HBV gene expression, and modulation of host transcription factors.

Antihyperuricemic Mechanisms

The antihyperuricemic effect of P. niruri methanol extract may be mainly due to its uricosuric action and partly through xanthine oxidase inhibition, whereas the antihyperuricemic effect of the isolated lignans was attributed principally to their uricosuric action.

Antidiabetic Mechanisms

α-Glucosidase inhibitory activity was observed in aqueous and ethanolic extracts of aerial parts of P. niruri with IC50 values of 3.7 ± 1.1 and 6.3 ± 4.8 μg/mL, respectively. Using HR-bioassay/HPLC-HRMS and NMR analysis, corilagin and repandusinic acid A were identified as the α-glucosidase inhibitors in the water extract, with IC50 values of 0.9 ± 0.1 and 1.9 ± 0.02 μM. Furthermore, the ethanolic extract increased deoxyglucose uptake in C2C12 muscle cells and enhanced adipogenesis in 3T3-L1 fat cells. These are in vitro and cell-based findings only; human clinical evidence for antidiabetic effects has not been established.

Anti-inflammatory and Antioxidant Mechanisms

Among the compounds abundantly identified in the plant, catechin, quercetin, and astragalin have been reported for their ability to regulate the immune system through various mechanisms. Catechin has been described to suppress NF-κB activation stimulated by PMA in Jurkat cells.

Antiplatelet Mechanisms

In vitro research suggests that methyl brevifolincarboxylate, a constituent isolated from chanca piedra, can inhibit platelet aggregation. A P. niruri methanol extract showed "remarkable" inhibition of ADP-induced platelet aggregation; several isolated compounds including corilagin potently blocked platelet shape change, secretion, and aggregate formation via G-protein–linked pathways. These are preclinical observations only.

5. Scientific Evidence by Area of Use

5.1 Nephrolithiasis (Kidney Stones)

This is the most extensively studied clinical application of chanca piedra. Phyllanthus niruri is the most commonly listed active ingredient in commercially available herbal therapies for kidney stones, despite limited supporting clinical evidence.

Systematic review and meta-analysis: P. niruri treatment was found to result in a significant decrease in mean stone size compared with placebo or no treatment (SMD −0.39 cm, 95% CI = −0.68 to −0.09, p = 0.01; I² = 76%). High heterogeneity (I² = 76%) across the included trials, however, limits the strength of this pooled result.

Adjuvant to ESWL: A randomized prospective study published in a peer-reviewed urology journal evaluated 150 patients with renal calcium oxalate stones up to 25 mm. All patients received 1 to 3 extracorporeal shock wave lithotripsy (ESWL) sessions; after treatment, 78 of 150 patients (52%) underwent therapy with Uriston, a P. niruri extract at 2 g daily for at least 3 months (group 1), while 72 of 150 patients (48%) served as controls. The stone-free rate was 93.5% in group 1 and 83.3% in group 2 (p = 0.48 for the overall cohort); the effect appeared statistically significant specifically for lower caliceal stone location. The authors concluded that the absolute lack of side effects made this therapy suitable to improve overall outcomes after ESWL for lower pole stones. A notable limitation is that the overall group difference did not reach statistical significance.

Urinary metabolic parameters: A prospective clinical study at the University of São Paulo evaluated 56 patients with kidney stones smaller than 10 mm, conducting clinical, metabolic, and ultrasonography assessment before and after a 12-week infusion of P. niruri tea, followed by a 12-week washout period. Treatment significantly increased urinary excretion of magnesium and potassium, caused a significant decrease in urinary oxalate and uric acid in patients with hyperoxaluria and hyperuricosuria, and the consumption of P. niruri contributed to the elimination of urinary calculi.

Systematic review (2025): Evidence consistently supported P. niruri's long-term safety, confirmed by serial measurements of serum electrolytes and liver function. Novel applications such as use as an adjuvant to ESWL showed benefits for lower renal pole stones. Growing evidence suggests that P. niruri, when used alongside traditional interventions, is safe and may improve stone-free rate outcomes after ESWL.

Overall assessment: Data on clinical efficacy with regard to stone elimination or reduction in size and number are conflicting, and quantitative data on the public's demand for P. niruri are lacking. The totality of human evidence suggests a probable, though not definitively established, benefit for stone passage adjunct therapy, especially for lower pole stones and in individuals with hyperoxaluria or hyperuricosuria. Evidence is preliminary to moderate in strength.

5.2 Chronic Hepatitis B Virus (HBV) Infection

Chanca piedra attracted international research attention in the late 1980s following a 1988 letter in The Lancet reporting that P. amarus cleared hepatitis B surface antigen (HBsAg) from chronic carriers. Subsequent trials have produced more sobering results.

Cochrane review (versus placebo): There is no convincing evidence that phyllanthus, compared with placebo, benefits patients with chronic HBV infection.

Cochrane review (versus antiviral drugs): Phyllanthus had no significant effect on clearance of serum HBsAg (RR 1.00; 95% CI 0.93 to 1.08) or HBV DNA (RR 0.83; 95% CI 0.53 to 1.31) when compared with antiviral drugs. Data on HBeAg seroconversion was reported in one trial and no significant difference was found comparing phyllanthus versus lamivudine (RR 0.89; 95% CI 0.71 to 1.11). There is currently insufficient evidence to support or refute the use of phyllanthus for patients with chronic hepatitis B virus infection.

RCT (2018): A randomized controlled trial investigating efficacy and safety of a 12-month treatment with Phyllanthus niruri in subjects with chronic HBV infection concluded: This study does not support the use of Phyllanthus niruri for the treatment of chronic hepatitis B.

Overall assessment: The current human and clinical evidence does not support the use of chanca piedra for chronic hepatitis B as a primary or adjuvant treatment. Evidence is weak, with two Cochrane reviews and individual RCTs consistently finding no significant benefit over placebo or antiviral drugs.

5.3 Non-Alcoholic Fatty Liver Disease (NAFLD)

Animal studies: A 50% methanolic extract exhibited the highest inhibitory effect against NAFLD progression in rats. It significantly reduced hepatomegaly (16%) and visceral fat weight (22%), decreased NAFLD score, prevented fibrosis, and reduced serum total cholesterol (48%), LDL (65%), free fatty acids (25%), ALT (45%), ALP (38%), insulin concentration (67%), and HOMA-IR (73%) compared to a non-treated high-fat diet group.

Human RCT: A 12-month randomized controlled trial evaluated adults with mild-to-moderate NAFLD (CAP score >250 dB/m and fibrosis score <10 kPa) who were randomly assigned to receive a standardized P. niruri extract at a dose of 3,000 mg daily (n = 112) or a placebo (n = 114). The primary outcomes were changes in CAP score and liver enzyme levels, while secondary outcomes were changes in other metabolic parameters. The data from this trial showed no significant difference in the change of CAP score between intervention and control groups after 12 months, indicating that the strong preclinical findings did not translate to a significant benefit in this human trial at this dose.

Overall assessment: Preclinical (animal) evidence is strong and mechanistically plausible, but the single published human RCT did not demonstrate a significant reduction in liver steatosis or fibrosis scores. Human evidence remains inconclusive; further well-designed trials are warranted.

5.4 Hyperuricemia and Gout

The plant has been found to display hepatoprotective, hypolipidaemic, anti-inflammatory, and antihyperuricaemic effects in preclinical models. The antihyperuricemic mechanism may be mainly due to uricosuric action and partly through xanthine oxidase inhibition; the isolated lignans appear to act principally via uricosuric action. Human clinical evidence for hyperuricemia and gout treatment is lacking; evidence is confined to animal and in vitro models.

5.5 Antidiabetic Activity

Phyllanthus niruri is used in herbal medicine for treatment of diabetes. Mechanistic investigation has identified α-glucosidase inhibition and increased muscle glucose uptake as in vitro properties. The plant is categorized as one of the rich medicinal plants, and one study evaluated the whole plant extract for antioxidant and antidiabetic activity both in vivo and in vitro in streptozotocin-induced albino mice. No high-quality human clinical trials have confirmed antidiabetic efficacy. Evidence is preliminary, based on cell-based and animal studies.

5.6 Antihypertensive and Diuretic Effects

The plant's traditional use for hypertension has been explored by research. Hypotensive effects were first reported in a dog study in 1952, in which a diuretic effect was also noted, and these hypotensive effects were attributed to a specific phytochemical, geraniin, in a 1988 study. No human clinical trials have confirmed antihypertensive efficacy. Evidence remains at the animal study level.

5.7 Gallstones

Chanca piedra is used in herbal medicine for gallstones, and while no research has been performed that specifically validated this use, one study indicated that chanca piedra increased bile acid secretion in the gallbladder and significantly lowered blood cholesterol levels in rats. No human clinical trials have been conducted on this specific use. Evidence is very limited and preclinical.

5.8 Antimicrobial Activity

Extracts of Phyllanthus niruri have demonstrated a wide range of pharmacological activities including antimicrobial, antiviral, hepatoprotective, antioxidant, anticancer, anti-inflammatory, antiplasmodial, and diuretic effects. Studies on antimicrobial activity have been conducted predominantly in vitro. All P. niruri antiplatelet and thrombolytic data are preclinical (in vitro or animal); there are no human pharmacokinetic or interaction studies. Human evidence for antimicrobial applications does not yet exist.

6. Dosage Forms and Reported Clinical Dosages

Common preparations include capsules or tablets containing dried powder or standardized extracts of the aerial parts; tinctures and liquid extracts as alcohol or glycerin-based solutions; dried herb for tea as loose leaves and stems for simmering as a decoction; and combination formulas blended with other kidney or liver-supportive herbs.

The following dosages have appeared in peer-reviewed clinical studies and are reported here strictly as published — not as recommendations:

• In the ESWL adjuvant trial, 78 patients received Uriston, a P. niruri extract, at 2 g (2,000 mg) daily for at least 3 months.
• In the 12-month NAFLD randomized controlled trial, participants received a standardized P. niruri extract at 3,000 mg daily.
• In the urinary metabolic parameters study at the University of São Paulo, 56 patients consumed a P. niruri infusion tea (dry extract) for 12 weeks.
• A 12-month randomized trial in NAFLD assigned patients to a standardized P. niruri extract at 3,000 mg daily (n = 112) or placebo.

Dosing has not been standardized across clinical or commercial use.

7. Body Systems and Health Areas of Association

Based on accumulated traditional and scientific literature, chanca piedra is associated with the following body systems and health areas:

• Urinary system: Kidney stone formation and passage, diuresis, urinary tract infections, calcium oxalate crystal inhibition, urate excretion.
• Hepatobiliary system: Liver enzyme normalization, hepatoprotection against chemical insult, hepatitis B (studied but not supported clinically), gallbladder bile acid secretion, NAFLD (studied in RCT; not confirmed).
• Metabolic: Hyperuricemia, blood sugar regulation (α-glucosidase inhibition, muscle glucose uptake, insulin sensitivity — all preclinical).
• Cardiovascular: Blood pressure (hypotensive action via geraniin in animal studies), cholesterol lowering (animal studies), antiplatelet activity (in vitro).
• Immune/inflammatory: NF-κB pathway modulation, cytokine suppression, antioxidant enzyme upregulation.
• The whole plant has been traditionally used to treat inflammation, lithiasis, fever, malaria, hepatitis, and gonorrhea.

8. Safety Considerations and Drug Interactions

General Tolerability

Chanca piedra has been used traditionally for centuries with no documented pattern of serious adverse effects. Modern clinical trials ranging from 30 days to 12 months have reported tolerability comparable to placebo in most studies. Acute toxicity in animal models is very low, with an LD50 greater than 5,000 mg/kg in rodent studies, well above any clinical dose.

Chanca piedra is possibly safe when taken by mouth for a short time period (up to 3 months).

Pregnancy and Lactation

Animal studies have shown uterine stimulation and possible fetal effects. There are no human pregnancy studies of adequate size to assess safety. Breastfeeding data are insufficient. Chanca piedra is considered possibly unsafe when taken by mouth by pregnant women or those trying to become pregnant; in large amounts it may block pregnancy, increase the risk of low birth weight, or increase the risk of birth defects.

Anticoagulant and Antiplatelet Drug Interactions

Chanca piedra may slow blood clotting, and using chanca piedra with medications that also slow clotting may increase the risk of bleeding. In vitro research suggests that methyl brevifolincarboxylate, a constituent isolated from chanca piedra, can inhibit platelet aggregation; this effect has not been reported in humans. All P. niruri antiplatelet and thrombolytic data remain preclinical (in vitro or animal); there are no human pharmacokinetic or interaction studies with warfarin or direct oral anticoagulants.

Antihypertensive Drug Interactions

Chanca piedra might lower blood pressure; using it alongside drugs that lower blood pressure might increase the effects of these drugs and lower blood pressure too much.

CYP450 Enzyme Inhibition

Chanca piedra (Phyllanthus amarus) inhibits the activity of CYP450 family liver enzymes that metabolize drugs, including CYP1A1, CYP1A2, CYP2D6, CYP2E1, CYP2B1/2, and CYP3A4. Inhibition of these enzymes may cause unpredictable drug interactions with midazolam, some antidepressants, beta-blockers, statins, warfarin, and anti-seizure drugs. Theoretically, use of chanca piedra might increase the levels and clinical effects of CYP3A4 substrates. In vitro research shows that chanca piedra extract inhibits CYP3A4, but this interaction has not been reported in humans.

Diabetes Medications

Chanca piedra might affect blood sugar levels, which creates a theoretical risk of additive hypoglycemia when used alongside antidiabetic drugs. This concern has been identified in preclinical evidence.

Diuretic Interaction and Lithium

The mild diuretic effect of chanca piedra could increase lithium reabsorption through a mechanism similar to that of thiazide diuretics, potentially raising serum lithium levels and risk of toxicity.

Pre-Surgical Caution

Chanca piedra might lower blood sugar levels, which could interfere with blood sugar control during and after surgery. It might also slow blood clotting and increase the risk of bleeding. Discontinuation at least 2 weeks before a scheduled surgery is recommended.

Species Identification Concerns

There remains a great deal of confusion among scientists regarding plant identification, and in many cases plant misidentification makes evaluation of published information difficult. Consumers and clinicians should verify that a product specifies the correct taxonomic name (P. niruri, P. amarus, or other intended species) and that the species used in reference studies matches the product being used.

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