Journal of Ethnopharmacology 114 (2007) 1–31

Review

Herbal medicines as diuretics: A review of

the scientific evidence
C.I. Wright ∗ , L. Van-Buren, C.I. Kroner, M.M.G. Koning
Nutrition, Nutrition and Health Enhancement, Unilever Food and Health Research Institute,
Olivier van Noortlaan 120, P.O. Box 114, 3130 AC, Vlaardingen, The Netherlands
Received 20 July 2007; accepted 25 July 2007
Available online 31 July 2007

Abstract
There is increasing interest in the health and wellness benefits of herbs and botanicals. This is with good reason as they might offer a natu-
ral safeguard against the development of certain conditions and be a putative treatment for some diseases. One such area may be the lowering
of blood pressure in those where it is elevated (i.e., hypertension). One class of clinical medicines used to lower blood pressure are known as
diuretics and work by increasing the excretion of urine from the body as well as the amount of sodium in urine. There are a growing num-
ber of studies purporting diuretic effects with traditional medicines. The aim of this article was to review these studies and identify which
extracts promote diuresis (which we assessed on terms of urine excreted and urinary sodium excretion) and also to identify the research needs
in this area. We identified a number of species and genuses reporting diuretic effects. Of these, the most promising, at the present time, are
the species Foeniculum vulgare, Fraxinus excelsior, Hibiscus sabdariffa, Petroselinum sativum and Spergularia purpurea, and species from the
genuses Cucumis (Cucumis melo and Cucumis trigonus), Equisetum (Equisetum bogotense, Equisetum fluviatile, Equisetum giganteum, Equise-
tum hiemale var. affine and Equisetum myriochaetum), Lepidium (Lepidium latifolium and Lepidium sativum), Phyllanthus (Phyllanthus amarus,
Phyllanthus corcovadensis and Phyllanthus sellowianus) and Sambucus (Sambucus mexicana and Sambucus nigra). However, there the number
of studies is limited and we recommend that further studies be conducted to confirm reported effects. Such evidence is needed to provide scien-
tific credence to the folklore use of traditional medicines and even be helpful in the development of future medicines, treatments and treatment
guidelines.
© 2007 Elsevier Ireland Ltd. All rights reserved.

Keywords: Medicine; Traditional; Natural; Diuretic; Natriuretic

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2. Methodology. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.1. MEDLINE search . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.2. Capturing study design and effects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3. Dealing with differences in the duration of the intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.4. Assessing the efficacy of a natural extract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.5. Assessing the scientific support for an extract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3. Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1. Alliaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
3.1.1. Allium sativum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

∗ Corresponding author at: Unilever R&D Vlaardingen, Olivier van Noortlaan 120, P.O. Box 114, 3130 AC Vlaardingen, The Netherlands.
Tel.: +44 7967 230 155; fax: +44 1482 582526.
E-mail address: ciwright26@hotmail.com (C.I. Wright).

0378-8741/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.jep.2007.07.023
2 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

3.2. Amaranthaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.2.1. Aerva lanata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.3. Apiaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.3.1. Foeniculum vulgare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.3.2. Petroselinum sativum (also known as Carum petroselinum and Petroselinum hortense) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.4. Asteraceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.4.1. Taraxacum officinale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.5. Brassicaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.5.1. Lepidium latifolium and Lepidium sativum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.6. Caprifoliaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.6.1. Sambucus mexicana and Sambucus nigra . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
3.7. Cecropiaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.7.1. Cecropia leucocoma and Cecropia pachystachya . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.8. Caryophyllaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.8.1. Spergularia purpurea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3.9. Cucurbitaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.9.1. Cucumis melo and Cucumis trigonus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.10. Equisetaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.10.1. Elephantopus scaber . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
3.11. Equisetaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.11.1. Equisetum bogotense, Equisetum fluviatile, Equisetum giganteum, Equisetum hiemale var. affine and
Equisetum myriochaetum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.12. Euphorbiaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.12.1. Phyllanthus amarus, Phyllanthus corcovadensis and Phyllanthus sellowianus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.13. Lamiaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.13.1. Orthosiphon stamineus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.14. Oleaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.14.1. Fraxinus excelsior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
3.15. Malvaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.15.1. Hibiscus sabdariffa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.16. Oleaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.16.1. Olea europaea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.17. Poaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.17.1. Imperata cylindrica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.17.2. Zea mays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.18. Urticaceae. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.18.1. Urtica dioica . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
3.19. Zygophyllaceae . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.19.1. Tribulus terrestris . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.1. Future needs for this area of research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.2. Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
4.3. Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

1. Introduction rial constrictor effects of angiotensin-II (Wright et al., 2005).

Beta receptor blockers act to counter the stimulatory effects
Hypertension is considered to be a predisposing factor for of vascular and cardiac noradrenergic receptors (Rabbia et
stroke, coronary heart disease, peripheral arterial disease, heart al., 2001). CCB’s inhibit calcium entry thus decreasing the
failure and end-state renal disease (Williams et al., 2004; tone of vascular smooth muscle and promoting vasodilatation
Godfraind, 2006). Common clinical strategies to achieve a low- (Godfraind, 2006). Diuretics work by promoting the expulsion
ering of blood pressure include the use of angiotensin converting of urine (measured as the urine volume [UV] excreted) and uri-
enzyme (ACE) inhibitors, beta blockers, calcium channel block- nary sodium (UNa) from the body and this helps reduce the
ers (or CCB’s) and diuretics (Williams et al., 2004; Gallagher volume of blood circulating through the cardiovascular system
et al., 2006). For simplistic reasons, these agents work by (Reyes and Taylor, 1999; Williams et al., 2004; Gallagher et al.,
reducing arterial resistance and/or decreasing cardiac output. 2006).
Indeed, ACE inhibitors work by interrupting the conversion of In their strictest sense, diuretics are substances that act within
angiotensin-I to angiotensin-II and therefore attenuating the arte- the kidney and promote the loss of fluid from the body (Brater,
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
2000). To be clinically effective, however, such compounds must
induce the loss of sodium (Lahlou et al., 2006). This is achieved
by compounds interfering with the reabsorption of ions, as well
as water, through the walls of the kidney tubules (Materson,
1983; Puschett, 1994; Brater, 2000) and this promotes their
excretion from the body.
There is growing interest in the health benefits of herbs
and botanicals (Foote and Cohen, 1998). In line with this
there are an increasing number of published articles claim-
ing that plants or plant-derived actives may function as mild
diuretic agents. A large majority of this research has deter-
mined the degree of clinical support for the traditional use of
common or folklore medicines. Such evidence is needed in
order to determine whether there is any scientific basis for their
use.
Of the published studies, we were unclear which plant
extracts worked like a clinical diuretic. Therefore, to test this
we reviewed all available literature with the intention of (1) cap-
turing what studies had been performed; (2) identifying which
extracts had been tested; (3) determining the effect of extracts
on UV and UNa. Using this information we hoped to determine
the degree of support for each specific extract. Finally, we used
this information to identify the future research needs of studies
in this area and the potential use of the information from this
review.
2. Methodology
2.1. MEDLINE search
To determine the evidence to support this idea we conducted
a systematic review using the MEDLINE database. All relevant
English-language articles published between 1970 and 2005
were searched using the terms ‘natriuresis’, ‘natriuretic’, ‘diure-
sis’, ‘diuretic’, ‘aquaretic’, ‘urinary flow’, combined with terms
‘food’, ‘herb’, ‘botanical’, ‘nutrient’ or ‘extract’. The search did
not include minerals or vitamins. All plant identified were con-
firmed using http://www.ipni.org. Some extracts [e.g., caffeine
containing beverages, Passmore et al., 1987; Bergman et al.,
1990; Neuhauser et al., 1997; Armstrong et al., 2005; flavonoids
isolated from citrus fruit, Galati et al., 1996; Linoleic acid, Adam
and Wolfram, 1984; and glycosides from the leaves of Ste-
via Rebaudiana, Melis and Sainati, 1991a,b; Melis, 1992a,b,c,
1995, 1996, 1999] and extract decoctions [e.g., the Japanese tra-
ditional medicine known as Sairei-to (TJ-114), Fujitsuka et al.,
2004, and the polyherbal preparation Jawarish Zarooni Sada,
Afzal et al., 2004] were not included as they have no tradi-
tional uses in the treatment of urinary or cardiovascular ailments.
Table 1 shows the plants identified using our search and indicates
whether or not the plant has a traditional ethnopharmacological
use.
2.2. Capturing study design and effects
Details regarding the study design (dose, model [and strain],
population, duration and placebo group) and effects on UV and
UNa were captured in a database.
3
2.3. Dealing with differences in the duration of the
intervention
Duration ranged from minutes, to hours, to days and to weeks.
In those studies investigating effects occurring within minutes or
hours, significant changes refer to a change taking place within
the time-frame of the recording period. In longer-term interven-
tion trials, the effect refers to that change reported at the end
of intervention phase and not at recording points that may have
been performed within this phase.
2.4. Assessing the efficacy of a natural extract
We determined whether the volume of urine and/or concen-
tration of sodium in urine changed significantly, with significant
increases and decreases shown by ‘+ve’ or ‘−ve’, respectively,
and indifferent responses being indicated with a ‘0’.
2.5. Assessing the scientific support for an extract
Evidence for the support of an extract was assessed from
multiple studies (i.e., >1 article). The spelling of all extracts and
family names were checked at http://www.ipni.org. Botanical
descriptions were checked using MEDLINE and by referring to
http://www.wikipedia.org and http://www.nybg.org.
3. Results
Seventy-seven articles were reviewed (see Table 1). Nine of
these were human intervention trials (see Table 2); 13 were
conducted in anaesthetised animals (Table 3); and 55 were per-
formed in conscious animals (Table 4). These were reviewed
to identify multiple references to a particular species or genus.
These findings are discussed below, where species have been
grouped by family.
3.1. Alliaceae
3.1.1. Allium sativum
3.1.1.1. Botanical description. Allium sativum is a perennial
herb and grows top a length of roughly two feet (Grover et al.,
2002). The bulb is the part used in traditional medicine and
consists of between 4 and 20 cloves. Originally it comes from
central Asia, but is now cultivated throughout the world.
3.1.1.2. Ethnobotany. Allium sativum is commonly used as a
flavouring agent and has been used as a traditional medicine for
thousands of years (Rahman and Lowe, 2006). Its main active is
allicin, which is responsible for its characteristic smell and has
been used for its anti-bacterial properties (Wright et al., 2005).
Allium sativum is reputed to offer protection against strokes,
coronary thrombosis, atherosclerosis and platelet aggregation,
and work as an anti-hypertensive, anti-hyperglycaemic and
anti-hyperlipidemic agent (Sharafatullah et al., 1986; Ribeiro
et al., 1988; Pantoja et al., 1991, 1996, 2000; Grover et al.,
2002). In traditional medicine, it is administered as a diuretic
Table 1

4
An overview of plants with putative diuretic effects
Family Species Common names Traditional diuretic use? Part used Reference

Alismataceae Echinodorus grandiflorus (Cham. Amazon sword plant specie N (anti-hypertensive) Leaf Ribeiro et al. (1988)
& Schltdl.) Micheli
Alliaceae Allium sativum L. Garlic N (anti-hypertensive) Bulb Pantoja et al. (1991,
1996, 2000), Ribeiro
et al. (1988),
Sharafatullah et al.
(1986)
Amaranthaceae Aerva lanata Linn. Common Sri Lankan Herb, Kapurijadi, Y (urinary infections) Plant; leaf; flower Goonaratna et al.
Katumpangan Ayer, Oepas Oepan, Pindi (1993), Selvam et al.
kura, Pindi Kura, Roempoet Oepas (2001), Udupihille
Oepan, Wool Plant, and Jiffry (1986)
Annonaceae Xylopia aethiopica A.Rich. Ethiopian pepper plant, Guinea pepper N Fruit Somova et al. (2001)

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

plant
Apiaceae Alepidea amatymbica Eckl. & Larger tinsel flower, Kalmoes, Iqwili, N Rhizome Somova et al. (2001)
Zeyh. Ikhathazo
Apiaceae Carum carvi L. (see Petroselium) Caraway Y Ripe fruit Lahlou et al. (2006)
Apiaceae Carum petroselinum Benth. & Parsley N (anti-hypertensive) Seed Ribeiro et al. (1988)
Hook.f.
Apiaceae Coriandrum sativum L. Coriander N Seed Udupihille and Jiffry
(1986)
Apiaceae Foeniculum vulgare L. Fennel Y Root Beaux et al. (1997),
Caceres et al. (1987),
El Bardai et al. (2001)
Apiaceae Foeniculum vulgare Mill Fennel Y Root; rhizome Caceres et al. (1987)
Apiaceae Foeniculum vulgare var dulce Fennel Y Fruit El Bardai et al. (2001)
(D.C.)
Apiaceae Petroselinum hortense Hoffm. Parsley Y Seeds Kreydiyyeh and Usta
(2002)
Apiaceae Petroselinum sativum Hoffm. Parsley Y Seedlings Kreydiyyeh and Usta
(2002)
Apiaceae Steganotaenia araliacea Hochst. Carrot tree Y Bark Agunu et al. (2005)
Apocynaceae Apocynum venetum L. LuoBuma in Chinese; Rafuma in Y Leaf Kim et al. (2000)
Japanese
Apocynaceae Carissa edulis Vahl Natal Plum Y Root Nedi et al. (2004)
Asteraceae Achyrocline satureioides DC. Macela N Inflorecences Rocha et al. (1994)
Asteraceae Artemisia thuscula Cav. Artemisia thuscula, an endemic species Y Aerial part Benjumea et al.
of the Canary Islands (2005)
Asteraceae Bidens odorata Cav. Common black jack Y (renal disorders) Aerial part Camargo et al. (2004)
Asteraceae Centaurea phyllocephala Boiss. A common weed N (anti-hypertensive) Leaf Twaij et al. (1983)
Asteraceae Cichorium endivia L. Endive N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Asteraceae Helichrysum ceres Unclear N (anti-hypertensive) Leaf; root Musabayane et al.
(2003)
Asteraceae Hieracium pilosella L. Mouseear hawkweed Y Aerial part Beaux et al. (1999)
Asteraceae Mikania glomerata Spreng. Guaco, guace, bejuco de finca, cepu, N (anti-hypertensive) Leaf Ribeiro et al. (1988)
liane Francois, matafinca, vedolin, cipó
caatinga, huaco, erva das serpentes,
coração de Jesus, erva-de-cobra,
guaco-de-cheiro
Asteraceae Solidago gigantea Ait. Giant goldenrot (Herb) N Plant Leuschner (1995)
Asteraceae Spilanthes acmella Murr. Toothache Plant, Paracress Y Flowers Ratnasooriya et al.
(2004)
Asteraceae Tanacetum vulgare L. Common tansy Y Leaf Lahlou et al. (2006)
Asteraceae Taraxacum officinale Weber Dandelion Y Root (Hook et al., Hook et al. (1993),
1993; Racz-Kotilla et al.
Racz-Kotilla et al., (1974)
1974), herb
(Racz-Kotilla et
al., 1974)
Asteraceae Vernonia polyanthes Less. Weed: Assa peixe, chamarrita N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Bignoniaceae Tecoma stans (L.) H.B. & K. Trumpetbush, yellow elder, yellowbells Y (urinary ailments) Bark Caceres et al. (1987)
Brassicaceae Eruca sativa Mill. Rocket, garden rocket, rocketsalad N (anti-hypertensive) Leaf Ribeiro et al. (1988)

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Brassicaceae Lepidium latifolium L. Pepperweed (broad leaved) Y (renal disorders) Seed Maghrani et al.
(2005b), Navarro et
al. (1994)
Brassicaceae Lepidium sativum L. Pepperweed (garden cress) Y (renal disorders) Leaf Navarro et al. (1994)
Brassicaceae Nasturtium officinale R.Br. Watercress N (anti-hypertensive) Aerial parts Ribeiro et al. (1988)
Brassicaceae Raphanus sativus L. Radish Y (urinary disease) Bark Vargas et al. (1999)
Bromeliaceae Ananas comosus (L.) Merr. Pineapple, Nana of the Tupi Indians Y (renal disorders) Root Sripanidkulchai et al.
(2001)
Cactaceae Opuntia ficus-indica (L.) Mill. Prickly pear, cactus pear, Indian fig, Y Cladode; fruit; Galati et al. (2002)
Barbary fig flower
Caprifoliaceae Sambucus mexicana Presl ex DC. Elderberry (Mexican) N Flower Beaux et al. (1999),
Caceres et al. (1987)
Caprifoliaceae Sambucus nigra L. Elderberry (European) Y (urinary ailments) Bark Beaux et al. (1999),
Caceres et al. (1987)
Caricaceae Carica papaya L. Papaya, Pawpaw, Melon tree Y (dysuria) Root Sripanidkulchai et al.
(2001)
Caryophyllaceae Spergularia purpurea Sand spurrey Y (kidney disease) Plant Jouad et al. (2001b,c)
Cecropiaceae Cecropia leucocoma Miq. Cantalope tree Y Leaf Ribeiro et al. (1988)
Cecropiaceae Cecropia pachystachya Trécul Ambay; Trumpet tree Y Leaf Consolini and
Migliori (2005)
Costaceae Costus spiralis Rosc. Spiral ginger Y Plant Araujo et al. (1999)
Cucurbitaceae Cucumis melo Cantaloupe, Melon, Muskmelon, Y Seed Singh and Sisodia
Honeydew, Sugar melon (1970)
Cucurbitaceae Cucumis trigonus Roxb. Kolhi Kekdi (melon family) N Fruit Naik et al. (1981)
Cucurbitaceae Sechium edule Sw. Chayote N (anti-hypertensive) Leaf; seed Ribeiro et al. (1988)
Cyperaceae Cyperus rotundus L. Cocograss, nutgrass Y (dysuria) Rhizome Sripanidkulchai et al.
(2001)
Equisetaceae Elephantopus scaber Elephant’s Foot, Bull’s Tongue, Y Plant Laranja et al. (1991),
Ironweed, Dog’s tongue Poli et al. (1992)
Equisetaceae Equisetum (fluviatile; hiemale Horsetail (Swamp/Giant/Scouring Y Plant Perez Gutierrez et al.
var. affine; giganteum; rush/Mexican) (1985)
myriochaetum)
Equisetaceae Equisetum bogotense Kunth Andean Horsetail Y Stem Lemus et al. (1996)

5
 6
Table 1 (Continued )
Family Species Common names Traditional diuretic use? Part used Reference

Ericaceae Arctostaphylos uva-ursi (L.) Bearberry Y Leaf Beaux et al. (1999)

Spreng.
Euphorbiaceae Acalypha guatemalensis Pax & Cattail like plant; local plant in Y (urinary ailments) Leaf Caceres et al. (1987)
K.Hoffm. Guatemala
Euphorbiaceae Euphorbia hirta Cats hair, asthma weed, basri dudhi, N Leaf Johnson et al. (1999)
chara, malnommee, pill - bearing spurge,
patikan kerbau, patikan kebo, fei yang
cao, gelang susu, amampat chaiarisi, erva
de santa luzia

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Euphorbiaceae Phyllanthus amarus Schumach. black catnip,child pick-a-back, bhuiamla, Y Plant Srividya and Periwal
& Thonn. gulf leafflower, meniran, chanca piedra, (1995)
shatterstone, stone breaker, quebra pedra,
bahupatra, gale of wind, carry me seed,
hsieh hsia chu.
Euphorbiaceae Phyllanthus corcovadensis Local Indian herb N (anti-hypertensive) Aerial parts Ribeiro et al. (1988)
Müll.Arg.
Euphorbiaceae Phyllanthus sellowianus Sarandı́ blanco Y Bark Hnatyszyn et al.
Müll.Arg. (1999)
Gentianaceae Centaurium erythraea Rafn Common centaury Y (urinary retention and abdominal colic) Plant Haloui et al. (2000)
Illecebraceae Herniaria glabra Smooth rupturewort Y Aerial part Rhiouani et al. (1999)
Lamiaceae Clerodendrum trichotomum Harlequin Glorybower N (anti-hypertensive) Leaf Lu et al. (1994)
Thunb.
Lamiaceae Marrubium vulgare L. Horehound N (anti-hypertensive) El Bardai et al. (2001)
Lamiaceae Ocimum micranthum Willd. Alfavaca N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Lamiaceae Orthosiphon stamineus Cat’s whiskers Java Tea and extract Y Leaf; aerial part Beaux et al. (1999),
Benth./Orthosiphon folium (Methylripariochromene) Doan et al. (1992),
Englert and
Harnischfeger (1992),
Matsubara et al.
(1999), Olah et al.
(2003)
Lamiaceae Rosmarinus officinalis L. Rosemary Y (urinary ailments) Leaf Haloui et al. (2000)
Lamiaceae Salvia officinalis L. Sage N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Lauraceae Persea gratissima Gaertn. Avocado N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Leguminosae Retama raetam Webb & Berthel. White weeping broom N (anti-hypertensive) Plant Maghrani et al.
(2005a)
Leguminosae Vicia faba L. Broad bean N Seedlings Vered et al. (1997)
Liliaceae Allium cepa L. Garden onion N (anti-hypertensive) Bulb Ribeiro et al. (1988)
Loganiaceae Strychnos potatorum Linn. Clearing nut Y Seed Biswas et al. (2001)
Lythraceae Cuphea calophylla Cham. & Local Plant from Central America N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Schltdl.
Malvaceae Hibiscus sabdariffa L. Roselle Y (urinary ailments) Calyx; petals Caceres et al. (1987),
(Odigie et al., Herrera-Arellano et
2003) al. (2004),
Onyenekwe et al.
(1999),
Herrera-Arellano et
al. (2004),
Onyenekwe et al.
(1999)
Menispermaceae Cocculus hirsutus (L.) Diels Jack-switch Y Aerial part Ganapaty et al. (2002)
Moringaceae Moringa oleifera Lam. Horseradish tree N (anti-hypertensive) Bark; stalk; leaf; Caceres et al. (1992)
root; seed
Musaceae Musa sapientum L. Banana N (anti-hypertensive) Leaf Ribeiro et al. (1988)

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Myristicaceae Myristica fragrans Houtt. Nutmeg N (anti-hypertensive) Seed Ribeiro et al. (1988)
Myrtaceae Eugenia uniflora O.Berg Surinam cherry N (anti-hypertensive) Leaf Consolini et al. (1999)
Oleaceae Fraxinus excelsior L. Ash tree Y (facilitate renal excretion) Leaf Casadebaig et al.
(1989), Eddouks et al.
(2005)
Oleaceae Olea europaea L. (African; Olive Y Leaf Ribeiro et al. (1988),
Greek; and, cultivar from Cape Somova et al. (2003)
Town)
Oxalidaceae Averrhoa carambola L. Starfruit, Carabola, Caramba Y (renal disorders) Root Sripanidkulchai et al.
(2001)
Passifloraceae Passiflora edulis Sims Passion fruit N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Piperaceae Piper chaba Hunter Long pepper N Bark Taufiq-Ur-Rahman et
al. (2005)
Plantaginaceae Plantago major L. Broad-leaved plantain N Seed Doan et al. (1992)
Poaceae Coix lacryma-jobi L. Job’s tears N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Poaceae Cymbopogon citratus Stapf Lemon grass N (anti-hypertensive) Root Doan et al. (1992),
Sripanidkulchai et al.
(2001)
Poaceae Imperata cylindrica Beauv. Cogon grass, Cotton grass, Lalang, Y Rhizome Sripanidkulchai et al.
KunaiJapanese blood grass (2001)
Poaceae Imperata cylindrica Linn. Cogon grass, Cotton grass, Lalang, Y Leaf Carbajal et al. (1989)
KunaiJapanese blood grass
Poaceae Phalaris canariensis L. Canary grass N (anti-hypertensive) Seed Ribeiro et al. (1988)
Poaceae Saccharum officinarum L. Sugarcane N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Poaceae Zea mays L. Corn Y Stigmata Al Ali et al. (2003),
Doan et al. (1992),
Maksimovic et al.
(2004), Ribeiro et al.
(1988), Velazquez et
al. (2005)
Polygalaceae Bredemeyera floribunda Willd. Local Plant from amazone, belongs to Y Root Bevevino and Aires
the knotweed family (1994)
Polypodiaceae Phlebodium aureum (L.) J.Sm. Cabbage palm fern, Golden polypody, Y (urinary ailments) Root; rhizome Caceres et al. (1987)
Golden serpent fern

7
 8
Table 1 (Continued )
Family Species Common names Traditional diuretic use? Part used Reference

Portulacaceae Portulaca pilosa L. Chisme, kiss me quick Y Leaf Rocha et al. (1994)
Ranunculaceae Clematis montevidensis Spreng. Clematis montevidensis N Root; aerial part Alvarez et al. (2003)
Rosaceae Rubus brasiliensis Mart. Brazilian/Mauritius raspberry N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Rosaceae Rubus rosaefolius Sm. West ndian Raspberry N (anti-hypertensive) Leaf Ribeiro et al. (1988)

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Rubiaceae Palicourea marcgravii A.St.-Hil. Cafezinho N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Rubiaceae Psychotria malaneoides South american Shrub from the coffee N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Müll.Arg. family
Rubiaceae Psychotria sessilis (Vell.) Unclear N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Müll.Arg.
Rubiaceae Randia echinocarpa Sessé & Papache Y (urinary disease) Fruit Vargas and Perez
Moc. ex DC. Gutierrez (2002)
Rutaceae Citrus limonum Risso Lemon N (anti-hypertensive) Fruit Ribeiro et al. (1988)
Scrophulariaceae Digitalis purpurea Common foxglove, purple foxglove N Fruit Navarro et al. (2000)
Solanaceae Fabiana patagonica Speg. Local Andian shrub Y Aerial part Alvarez et al. (2002)
Solanaceae Solanum paniculatum L. Jurubeba N (anti-hypertensive) Leaf Ribeiro et al. (1988)
Solanaceae Withania somnifera Dunal Winter cherry, ashwagandha N Root Andallu and Radhika
(2000)
Ternstroemiaceae Visnea mocanera L. Mocan N Leaf Hernandez-Perez et
al. (1995)
Urticaceae Urtica dioica L. Stinging nettle Y (urinary ailments) Leaf; aerial part Caceres et al. (1987),
Tahri et al. (2000)
Zingiberaceae Alpinia speciosa Shell plant Y Plant Laranja et al. (1991)
Zingiberaceae Hedychium coronarium J.Koenig White ginger, butterfly ginger, ginger lily, N (anti-hypertensive) Leaf blade; Ribeiro et al. (1988)
white butterfly ginger lily, garland flower sheath; stem
Zygophyllaceae Tribulus terrestris L. Puncture Vine, Caltrop, Yellow Vine Y (kidney disease) Leaf (Al Ali et al., Al Ali et al. (2003),
2003); fruit (Al Singh and Sisodia
Ali et al., 2003; (1971)
Singh and Sisodia,
1971)

Note that common names were identified by referring to research articles and visiting http://plants.usda.gov.
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31 9

Table 2
Summary of studies reporting effects on urinary volume (UV) and sodium (UNa) in humans
Scientific name Dose Reference Study (design/R?/PL?/n) Duration UV UNa

Aerva lanata (leaf; flower; stem) 200 ml decoction Goonaratna et al. (1993) CO/Y/Y/n = 14 10 h 0 0
Aerva lanata (leaf; flower; stem) 200 ml of 50–100 g l−1 Udupihille and Jiffry (1986) P/N/N/n = U 1.5 h +ve –
Coriandrum sativum 200 ml of 50 g l−1 0 –
Alpinia speciosa 0.8 g 100 ml−1 Laranja et al. (1991) CO/N/Y/n = 10 6h +ve 0
Elephantopus scaber 7.5 g 100 ml−1 0 0
Equisetum bogotense 0.75 g Lemus et al. (1996) CO/N/N/n = 25 2d +ve +ve
Hibiscus sabdariffa 10 g Herrera-Arellano et al. (2004) P/Y/N/n = 45 4 wk – +ve
Imperata cylindrica (IC) 50 g Doan et al. (1992) CO/Y/Y/n = 40 1d 0 0
Orthosiphon stamineus (OS) 10 g 0 0
Plantago major (PM) 20 g 0 0
Zea mays (ZM) 40 g 0 0
Mix 120 g ZM, 50 g IC, 20 g PM 0 0
Phyllanthus amarus 5g Srividya and Periwal (1995) P/N/N/n = 7 10 d +ve +ve
Vicia faba 40 g Vered et al. (1997) P/N/N/n = 12 3h – +ve
Withania somnifera 3 g d−1 Andallu and Radhika (2000) P/N/N/n = 12 30 d +ve +ve

Study refers to the design (P, parallel; CO, cross-over), whether the study was randomised (R?), whether a placebo control group (PL?) was included (simply yes
[Y] or no [N]) and the population size (n). Duration is shown in hours (h), days (d) and weeks (wk). Dosage is shown when it was reported. Other abbreviations: U,
unclear; ‘+ve’ and ‘−ve’ represent significant increases and decreases, respectively; ‘0’, no change; and, ‘–’, indicates when a parameter was not measured.

agent, yet, until 1988, no controlled studies had assessed these
effects.
3.1.1.3. Diuretic activity. Five studies (Sharafatullah et al.,
1986; Ribeiro et al., 1988; Pantoja et al., 1991, 1996, 2000)
have tested the diuretic effect of Allium sativum. Pantoja et al.
(1991, 1996, 2000) has performed three trials in anaesthetised
animals. The first (Pantoja et al., 1991) used anaesthetised, saline
hydrated dogs and urine flow was monitored following cannu-
lation of the ureters. A powdered extract Allium sativum was
administered intra-gastrically and increased UV and UNa, with
between 30 and 40 min. Blood pressure was also decreased by
this extract. Unfortunately, however, no statistical comparisons
were performed and responses were deemed indifferent. The
second trial (Pantoja et al., 1996) used anaesthetised rabbits and
the same experimental set-up as above). A purified fraction of
Allium sativum was intravenously injected and increased UV
and UNa in a dose-dependently fashion. It also decreased arte-
rial blood pressure, but, again, no statistics were reported. The
third study performed was in anaesthetised dogs (Pantoja et al.,
2000) and used a purified fraction of Allium sativum. Follow-
ing the intravenous injection of a. Allium sativum, UV (∼0.1
to ∼0.6 ml min−1 ) and UNa (0.4–3.2 mEq 10 min−1 ) were sig-
nificantly increased from baseline levels. The mechanism was
suggested to be via inhibition of kidney membrane N+ , K+ -
ATPase.

Table 3
Summary of studies in anaesthetised animals reporting effects on urinary volume (UV) and sodium (UNa) excretion
Scientific name Dose Reference Animal-strain/PL?/n Duration (h) UV UNa

Allium sativum 2.5–15 mg kg−1 Pantoja et al. (1991) D-M/N/n = 3 10 0 0

Allium sativum 2, 4, 6 ␮g kg−1 Pantoja et al. (1996) Rab-U/N/n = 6 1.5 0 0
Allium sativum 6 ␮g kg−1 Pantoja et al. (2000) D-M/N/n = 8 4.3 0 0
Allium sativum 25.9, 54 mg kg−1 Sharafatullah et al. (1986) D-M/N/n = 24 0.5 +ve –
13.5 mg kg−1 0 –
Bredemeyera floribunda 0.05 mg min−1 100 g−1 Bevevino and Aires (1994) R-W/N/n = 9 1.5 +ve +ve
Citrus limonum 25 ml kg−1 of 10–20% decoction Carbajal et al. (1989) R-W/Y/n = 32 5 0 –
Clerodendron trichotomum 0.24 g kg−1 Lu et al. (1994) R-SD/N/n = 10 1.58 0 +ve
Cucumis melo 300–400 mg Singh and Sisodia (1970) D-M/N/n = U 0.5 +ve –
Helichrysum ceres (leaf) 0.3, 0.6, 1.2 ␮g min−1 Musabayane et al. (2003) R-SD/Y/n = 48 7 0 +ve
Helichrysum ceres (root) 0.3, 3, 6 ␮g min−1 +ve +ve
Hibiscus sabdariffa 250 mg kg−1 d for 8 wks Odigie et al. (2003) R-SD (nor- 1.5 0 –
mal/hypertensive)/Y/n = 15
Retama raetam 200 mg kg−1 for 3 wk Maghrani et al. (2005a) R-W/Y/n = 9 4 +ve –
Tribulus terrestris (aqueous) 10 g in 100 ml Singh and Sisodia (1971) D-M/N/n = U 0.5 0 –
Tribulus terrestris (ether) 300–400 mg +ve –
Urtica dioica 4, 24 mg kg−1 Tahri et al. (2000) R-W/N/n = 16 3.75 +ve +ve

The type of extract is shown in brackets. Animal (R, rat; D, dog; Rab, rabbit) and strain (W, Wistar; SD, Sprague-Dawley; M; mongrel) are indicated. PL?, refers to
whether a placebo control group was included (simply yes [Y] or no [N]). Population is shown with an n. Duration is the same as in Table 2. U, unclear; h, hour; d,
day; Y, yes; N, no. Other abbreviations: U, unclear; ‘+ve’ and ‘−ve’ represent significant increases and decreases, respectively; ‘0’, no change; and, ‘–’, indicates
when a parameter was not measured.
10 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Table 4
Summary of studies reporting effects on urinary volume (UV) and sodium (UNa) excretion in chronic animals
Scientific name Dose Reference Animal-strain/ Duration UV UNa
PL?/Admin?/n

Aerva lanata (leaf; with ethylene 6 ml kg−1 day−1 Selvam et al. (2001) R-A/Y/G/36 28 d +ve –
glycol)
Bidens odorata 41, 166 mg kg−1 Camargo et al. (2004) R-W/Y/O/n = 37 6h +ve +ve
Carissa edulis (bark extract, wood 50–100 mg kg−1 Nedi et al. (2004) R-U/Y/O/n = 40 5h +ve +ve
maceration)
Carissa edulis (wood extract) +ve 0
Carissa edulis (bark maceration) 0 0
Carum carvi 100 mg kg−1 Lahlou et al. (2006) R-W/Y/O/n = 15-20 8d +ve +ve
Tanacetum vulgare +ve +ve
Centaurium erythraea 10 ml kg−1 ; 8% Haloui et al. (2000) R-W/Y/O/n = 30 7d +ve +ve
decoction
Centaurium erythraea 16% 0 +ve
Rosmarinus officinalis 8% +ve +ve
Rosmarinus officinalis 16% 0 0
Euphorbia hirta (aqueous) 50, 100 mg kg−1 Johnson et al. (1999) R-W/Y/IP/n = 57 1d +ve +ve
Euphorbia hirta (ethanol) 50, 100 mg kg−1 +ve 0
Equisetum fluviatile; E. hiemale var. 50 mg kg−1 Perez Gutierrez et al. M-CD1/Y/O/n = U 6h +ve +ve
affine, E. giganteum, E. (1985)
myriochaetum)
Spergularia purpurea 100, 200, Jouad et al. (2001b) R-W/Y/O/n = 30 28 d +ve +ve
400 mg kg−1
Spergularia purpurea (flavanoids) 5 mg kg−1 Jouad et al. (2001c) R-SHR&W/Y/O/n = 36 7d +ve +ve
Foeniculum vulgare 500 mg kg−1 Caceres et al. (1987) R-A/Y/G/n = 54 6h 0 0
Hibiscus sabdariffa +ve +ve
Acalypha guatemalensis 0 0
Sambucus nigra 0 0
Tecoma stans 0 0
Phlebodium aureum 0 –
Urtica dioica 0 –
Foeniculum vulgare 190 mg kg−1 El Bardai et al. (2001) R-SHR/Y/O/n = 61 5d +ve +ve
Foeniculum vulgare 190 mg kg−1 R-WKY 0 0
Marrubium vulgare 80 mg kg−1 R-SHR +ve 0
Marrubium vulgare 80 mg kg−1 R-WKY 0 0
Fraxinus excelsior 20 mg kg−1 Eddouks et al. (2005) R-WKY/Y/O/n = 30 21 d +ve +ve
R-SHR 0 +ve
Herniaria glabra (saponins) 200 mg kg−1 Rhiouani et al. (1999) R-SHR/Y/O/n = 15 30 d +ve +ve
Hibiscus sabdariffa Unclear Onyenekwe et al. R-SHR/Y/G/n = 15 24 h +ve –
(∼500–1000 mg kg−1 ) (1999)
R-WKY 0 –
Spilanthes acmella 500, 1000 mg kg−1 Ratnasooriya et al. R-A/Y/O/n = 30 5h 0 0
(2004)
1500 mg kg−1 +ve +ve
Lepidium latifolium 20 mg kg−1 Maghrani et al. R-WKY/Y/O/n = 30 21 d +ve +ve
(2005b)
R-SHR 0 +ve
Lepidium sativum 50,100 mg kg−1 Navarro et al. (1994) R-W/Y/G/n = 30 6h +ve 0
100 mg kg−1 R-W/Y/IP +ve 0
50 mg kg−1 R-W/Y/IP 0 0
Artemisia thuscula 0.25, 0.50 g kg−1 Benjumea et al. R-SD/Y/O/n = 40 8h +ve +ve
(2005)
0.75 g kg−1 0 +ve
Tribulus terrestris 5 g kg−1 Al Ali et al. (2003) R-W/Y/O/n = 30 1d +ve +ve
Zea mays 5 g kg−1 0 0
Tribulus terrestris and Zea mays 5 g & 5 g kg−1 +ve +ve
Zea mays 10 ml kg−1 of 5% Maksimovic et al. R-W/Y/O/n = 24 9d +ve +ve
decoction (2004)
10% 0 +ve
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31 11

Table 4 (Continued )
Scientific name Dose Reference Animal-strain/ Duration UV UNa
PL?/Admin?/n

Phyllanthus sellowianus 400 mg kg−1 Hnatyszyn et al. R-SD/Y/O/n = 30 8h +ve +ve

(1999)
Strychnos potatorum 200, 400 mg kg−1 Biswas et al. (2001) R-W/Y/O/n = 30 5h +ve +ve
600 mg kg−1 +ve 0
Ananas comosus 5, 10 g kg−1 Sripanidkulchai et al. R-SD/Y/O/n = 96 4h +ve 0
(2001)
Carica papaya 10 g kg−1 +ve 0
Carica papaya 5 g kg−1 0 0
Averrhoa carambola 5, 10 g kg−1 0 0
Cyperus rotundus 5, 10 g kg−1 0 0
Imperata cylindrica 5, 10 g kg−1 −ve 0
Steganotaenia araliacea (ethanol, 20 mg kg−1 Agunu et al. (2005) R-W/Y/IP/n = 30 1d +ve 0
methanol, water)
Orthosiphon folium 125, 750, Englert and R-W/Y/G/n = U U 0 0
1000 mg kg−1 Harnischfeger (1992)
Clematis montevidensis (active, 200 mg kg−1 Alvarez et al. (2003) R-W/Y/G/n = U 3h +ve 0
oleanolic acid)
Clematis montevidensis (aerial part, 10% w/w 0 0
root)
Fabiana patagonica (active, 200 mg kg−1 Alvarez et al. (2002) R-W/Y/G/n = U 3h +ve –
oleanolic acid)
Fabiana patagonica (plant, acetone) 250 mg kg−1 +ve –
Petroselinum hortense, Petroselinum 20 g prepared in Kreydiyyeh and Usta R-SD/Y/O/n = 6 1d +ve –
sativum 100 ml (2002)
Allium cepa 40 ml kg−1 of a 50:50 Ribeiro et al. (1988) R-W/Y/O/n = 191 4h +ve –
v/v decoction
Allium sativum +ve –
Carum petroselinum +ve –
Cecropia leucocoma +ve –
Cichorium endivia +ve –
Citrus limonum +ve –
Coix lacryma-jobi +ve –
Cuphea calophylla +ve –
Echinodorus grandiflorus +ve –
Eruca sativa 0 –
Hedychium coronarium +ve –
Mikania glomerata +ve –
Musa sapientum +ve –
Myristica fragrans +ve –
Nasturtium officinale 0 –
Ocimum micranthum 0 –
Olea europaea 0 –
Palicourea marcgravii +ve –
Passiflora edulis +ve –
Persea gratissima +ve –
Phalaris canariensis +ve –
Phyllanthus corcovadensis +ve –
Psychotria sessilis +ve –
Psychotria malaneoides +ve –
Rubus brasiliensis +ve –
Rubus rosaefolius +ve –
Saccharum officinarum +ve –
Salvia officinalis 0 –
Sechium edule +ve –
Solanum paniculatum 0 –
Vernonia polyanthes +ve –
Zea mays +ve –
Olea europaea 60 mg kg−1 Somova et al. (2003) R-Dahl/Y/IP/n = 42 1d 0 –
Randia echinocarpa 10 mg kg−1 Vargas and Perez R-A/Y/G/n = U 1d 0 –
Gutierrez (2002)
20, 40, 60 mg kg−1 +ve –
Cocculus hirsutus 100, 200 mg kg−1 Ganapaty et al. (2002) R-W/Y/O/n = 24 5h 0 +ve
12 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Table 4 (Continued )
Scientific name Dose Reference Animal-strain/ Duration UV UNa
PL?/Admin?/n

Apocynum venetum (roasted, 70 mg d−1 Kim et al. (2000) R-W/Y/O/n = 24 100 d 0 0

unprocessed)
Taraxacum officinale 50 ml kg−1 of a Racz-Kotilla et al. R&M-U/Y/G&O/n = 16 30 d 0 0
0.5–6 g ml−1 (1974)
decoction
Zea mays 25, 50, 200, 350, Velazquez et al. R-W/N/G/n = U 5h 0 0
500 mg kg−1 (2005)
Solidago gigantean 100, 300, Leuschner (1995) R-SD/Y/O/n = U 5–24 h 0 0
1000 mg kg−1
3000 mg kg−1 +ve 0
Arctostaphylos uva-ursi 50 mg kg−1 Beaux et al. (1999) R-SD/Y/IP/n = 145 8–24 h +ve 0
Hieracium pilosella 50 mg kg−1 0 0
Hieracium pilosella 200 mg kg−1 +ve 0
Orthosiphon stamineus 50 mg kg−1 +ve 0
Sambucus nigra 50 mg kg−1 +ve +ve
Opuntia ficus-indica (cladode) 5 ml 100 g of a 15% Galati et al. (2002) R-W/Y/O/n = 150 1 wk 0 0
decoction
Opuntia ficus-indica (flower, fruit) +ve 0
Cucumis trigonus 25, 50 mg kg−1 Naik et al. (1981) R-H/Y/O/n = 9 6h +ve +ve
Elephantopus scaber (aqueous, 100, 300 mg kg−1 Poli et al. (1992) R-W/N/U/n = 8-10 U 0 –
alcoholic)
Moringa oleifera (leaf, roots, stalk) 750, 1000 mg kg−1 Caceres et al. (1992) R-A/Y/O/n = U 6h 0 –
Moringa oleifera (seeds) 1000 mg kg−1 +ve –
Moringa oleifera (seeds) 750 mg kg−1 0 –
Raphanus sativus 40, 70, 140 mg kg−1 Vargas et al. (1999) R-A/Y/O/n = U 24 h +ve –
Foeniculum vulgare 25, 50,100 mg kg−1 Beaux et al. (1997) R-SD/Y/IP/n = 157 24 h 0 –
200 mg kg−1 +ve +ve
Fraxinus excelsior (alcoholic) 140 mg kg−1 Casadebaig et al. R-W/Y/G/n = 25 6h 0 0
(1989)
Fraxinus excelsior (alcoholic) 1400 mg kg−1 0 +ve
Fraxinus excelsior (aqueous) 165 & 1650 mg kg−1 0 0
Cecropia pachystachya 600 mg kg−1 Consolini and R-U/Y/G/n = 24 3h 0 0
Migliori (2005)
Costus spiralis 0.5 g kg−1 Araujo et al. (1999) R-W/Y/O/n = U 12 h 0 –
Achyrocline satureioides 400 mg kg−1 Rocha et al. (1994) R-W/Y/G/n = 39 2h 0 0
Portulaca pilosa 0 0
Digitalis purpurea 15 mg kg−1 Navarro et al. (2000) R-U/Y/IP/n = 16 6h 0 0
30 mg kg−1 +ve 0
Visnea mocanera (acetone, methanol, 0.1–1.0 g kg−1 Hernandez-Perez et R-W/Y/O/n = 120 6h −ve −ve
aqueous) al. (1995)
Visnea mocanera (chloroform) 0.5 g kg−1 −ve 0
Visnea mocanera (infusion) 0.25–10 g kg−1 −ve 0
Visnea mocanera (syrup) 0.25–5.0 g kg−1 −ve −ve
Orthosiphon stamineus 700 mg kg−1 Olah et al. (2003) R-W/Y/O/n = 20 24 h 0 0
Eugenia uniflora 15, 60, Consolini et al. (1999) R-W/Y/G/n = 6 3h 0 −ve
120 mg d.l. kg−1
Alepidea amatymbica 50 mg kg−1 Somova et al. (2001) R-U/Y/O/n = 18 24 h +ve 0
Xylopia aethiopica +ve 0
Piper chaba 125 mg kg−1 Taufiq-Ur-Rahman et M-SA/Y/O/n = 15 5h 0 –
al. (2005)
250 mg kg−1 0 –
500 mg kg−1 2 –
Centaurea phyllocephala 0.42 g kg−1 Twaij et al. (1983) R-U/Y/IP/n = 7 5h 0
Taraxacum officinale (chloroform) U Hook et al. (1993) M-L/Y/O/n = 15 5h 0 +ve
Taraxacum officinale (crude, 0 0
methanol)

Animal (R, rat; M, mouse) and strain (H, Hafkine; SA, Swiss albino; L, Laca) are defined. PL?, refers to whether a placebo control was included (i.e., yes [Y] or
no [N]). How the extract was administered is shown (i.e., G, intra-gastric; IP, intra-peritoneal; O, oral). Duration is the same as defined in previous tables. Other
abbreviations used: d.l., dried leaf; U, unclear; ‘+ve’ and ‘-’ represent significant increases and decreases, respectively; ‘0’, no change; and, ‘–’, indicates when a
parameter was not measured.
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
Sharafatullah et al. (1986) used anaesthetised animals and
collected urine in graduated syringes after 30–40 min. 3 doses
were tested with the lowest dose, 13.5 mg kg−1 , having no effect
and the two highest doses, 25.9 and 54 mg kg−1 , increased UV
by 22.8 and 33.1%. The changes achieved with the highest dose
were, in fact, comparable with those seen with 1 mg kg−1 of
furosemide (+34.6%). UNa was not measured in this study.
Ribeiro et al. (1988) performed conscious rat study. Diure-
sis was measured via catheterisation of the urinary bladder and
exteriorised on the back of the neck. UV was measured for
30 min before intervention and then monitored every 15 min
for the subsequent 4 h. Allium sativum was shown to acutely
increase UV after 2 (4.2 ml versus 0.9 ml [versus placebo])
and 4 h (5.0 ml versus 1.6 ml). For comparative purposes, the
diuretic effects of furosemide (10 mg kg−1 ) and potassium-
chloride (≤10 mmol kg−1 l) were similar to those of Allium
sativum. Again, effects on UNa were not tested.
3.1.1.4. Conclusion Allium sativum. Studies seem to suggest
that Allium sativum may increase UV. At the present time, how-
ever, there is a distinct lack of placebo-controlled studies and
this must be addressed in order to properly determine whether
Allium sativum acts as a diuretic. What is not known is whether
Allium sativum really does effect the excretion of sodium or not.
This needs further testing.
3.2. Amaranthaceae
3.2.1. Aerva lanata
3.2.1.1. Botanical description. It is an erect herbaceous weed
with many branches with spikes (shades ranging from white to
pink) that are clustered and range between 1 and 1.5 in. in length
(Vetrichelvan and Jegadeesan, 2002; Shirwaikar et al., 2004). It
is common in India, Sri Lanka, Arabia, Egypt, Ceylon, tropical
Africa, Java and the Philippines (Shirwaikar et al., 2004).
3.2.1.2. Ethnobotany. It is usually prepared as an herbal drink
(Udupihille and Jiffry, 1986; Goonaratna et al., 1993). It has
traditional uses in Sri Lanka, being commonly prescribed by
Ayurvedic doctors, alone or in combination, as a treatment for
urinary infections (Attygalle, 1912). This is not its only use,
however, as it is suggested to possess analgesic, anthelmintic,
anti-inflammatory, anti-malarial, anti-venin, diuretic and seda-
tive properties (Vetrichelvan and Jegadeesan, 2002; Shirwaikar
et al., 2004). It is also suggested to be of use in the treatment
of bronchitis, coughs, fractures, hematemesis, nasal bleeding,
scorpion stings, spermatorrhoea, to clear the uterus after deliv-
ery, to prevent lactation and urinary calculi (Selvam et al., 2001;
Vetrichelvan and Jegadeesan, 2002; Shirwaikar et al., 2004).
3.2.1.3. Diuretic activity. Three studies, of which two were car-
ried out in humans (Udupihille and Jiffry, 1986; Goonaratna
et al., 1993) and one in conscious rats (Selvam et al., 2001).
Udupihille and Jiffry (1986) concluded that its leaves and flow-
ers evoked a higher increase in UV than the whole herb itself.
Unfortunately, however, this study did not include a placebo
group for comparison and no numbers or statistics were reported
13
in the text. The second study (Goonaratna et al., 1993) included
a placebo group and showed that Aerva lanata induced changes
that did not differ from placebo. The study in rats (Selvam et
al., 2001) induced investigated the urolithiatic effects of Aerva
lanata over the course of 4 weeks. Ethylene glycol was used to
promote the deposition of calcium oxalate crystals and this was
used as a model of kidney stone formation. Urinary output along
with the excretion of calcium, oxalate, uric acid, phosphorus
and protein were all measured. When ethylene glycol was taken
alone, 24 h urine volume increased by ∼13 ml, which was simi-
lar to the volume excreted (∼10 ml [versus ∼5 ml in the placebo
group]) when ethylene glycol and Aerva lanata were ingested
together. This finding suggests that Aerva lanata did not have a
clear diuretic effect and if anything seemed to reduce urinary out-
put. Urinary excretion of calcium, oxalate, uric acid, phosphorus
and protein were all increased by the aforementioned treatment.
Although, what the authors did find Aerva lanata reduced uri-
nary calcium and oxalate, when compared with ethylene glycol.
Therefore suggesting that Aerva lanata might help reduce the
risk of kidney stone formations.
3.2.1.4. Conclusion Aerva lanata. The above studies seem to
suggest that Aerva lanata is not a promising diuretic treatment,
although it seems to change urinary output with no change in
urinary sodium. However, only one study has looked at its effect
of urinary sodium excretion and further studies should clarify
that Aerva lanata has no natriuretic effect.
3.3. Apiaceae
3.3.1. Foeniculum vulgare
3.3.1.1. Botanical description. Foeniculum vulgare is a
glabrous, glaucous perennial or biennial plant growing up to
2.5 cm high. It has 3–4 pinnate leaves that are triangular in shape,
long (5–50 mm) and filiform, with acuminate lobes which are
cartilaginous at their apex. Its petals are yellow and oblong in
shape. The fruit are also oblong, 4–10.5 mm long (Conforti et al.,
2006). It is found across Europe (except the north), India, Java,
Japan, Egypt, Guatemala and Morocco (Caceres et al., 1987; El
Bardai et al., 2001; Conforti et al., 2006).
3.3.1.2. Ethnobotany. Foeniculum vulgare is believed to exert
natural analgesic, anti-inflammatory, anti-spasmodic, antidia-
betic and antihypertensive effects (Beaux et al., 1997; El Bardai
et al., 2001; Conforti et al., 2006).
3.3.1.3. Diuretic activity. Three studies have investigated the
diuretic properties of Foeniculum vulgare (Caceres et al., 1987;
Beaux et al., 1997; El Bardai et al., 2001). Beaux et al.
(1997) used administered a hydroalcohol root extract to saline
loaded rats. Two studies were then conducted. The first deter-
mined responses to 200 mg kg−1 of Foeniculum vulgare and
10 mg kg−1 of hydrochlorothiazide and compared them with
placebo. Both interventions significantly increased UV at 8 h
(Foeniculum vulgare, 5.3 ml 100 g−1 versus 4.6 ml 100 g−1 ;
hydrochlorothiazide, 5.6 ml 100 g−1 versus 3.9 ml 100 g−1 [ver-
sus placebo]) but were no different from placebo after 24 h.
14 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
This change was accompanied by a significant increase in
UNa after 8 h (Foeniculum vulgare, ∼0.3 mmol 100 g−1 versus
∼0.2 mmol 100 g−1 ; hydrochlorothiazide, ∼0.4 mmol 100 g−1
versus ∼0.2 mmol 100 g−1 [versus placebo]). In the second part
of this study, lower doses were tested (i.e., 25, 50, 100 and
200 mg kg−1 ). Only changes in UV were reported, with the high-
est 3 doses eliciting similar changes in UV (5.2, 5.0 and 4.6 ml
100 g−1 [200,100 and 50 mg kg−1 ) and the lowest dose having
no effect. This data showed also that peak urine flow occurred
between 4 and 6 h.
Caceres et al. (1987) performed a study in conscious animals
and administered a powdered extract of the whole plant which
had no effect on UV or UNa. In the third study (El Bardai et
al., 2001) a fruit extract was administered daily for 5 days. SHR
and WKY rats were studied. The primary objective of this study
was to determine an effect on blood pressure. In SHR, systemic
blood pressure started to decrease after 2 days of treatment and
reached a maximum at day 5 (−12 mmHg as compared with
placebo). In WKY, blood pressure maximally decreased on day 2
(−4 mmHg) but then returned to placebo values. A diuretic effect
was only seen in SHR, with a peak increase in UV being seen
at day 3 (+100%) and UNa increasing by day 5 (1.6 mEq day−1
versus 1.3 mEq day−1 [versus untreated rats]). The authors also
showed that Foeniculum vulgare had little effect on the nora-
drenalin contractile responses of aortic rings, thus suggesting
that it worked mainly as a diuretic and natriuretic with little
effect on arterial vascular tone.
3.3.1.4. Conclusion Foeniculum vulgare. These studies pro-
vide mixed evidence for Foeniculum vulgare. Again, such
differences may be explained by the source of the extract, the rat
model used, the method of measuring diuresis (e.g., saline load-
ing versus non-loading), how the extract was administered (i.e.,
gastrically, Caceres et al., 1987, orally, El Bardai et al., 2001,
or intra-peritoneally, Beaux et al., 1997), the dose used (i.e.,
25 mg kg−1 , Beaux et al., 1997, to 500 mg kg−1 , Caceres et al.,
1987) and the duration (3 h, Caceres et al., 1987, 24 h, Beaux et
al., 1997, and 120 h, El Bardai et al., 2001). Future studies need
to identify which part of Foeniculum vulgare is active (i.e., fruit,
root or the whole plant) and this then needs to be investigated in
a controlled study in order to clarify existing studies.
3.3.2. Petroselinum sativum (also known as Carum
petroselinum and Petroselinum hortense)
3.3.2.1. Botanical description. Petroselinum sativum is a
clump-forming biennial herb that grows to around 30 cm high
and 60 cm wide. Petroselinum sativum has green leaves that are
flat or curly, finely divided and held at the end of long stems. The
whole plant has a rounded, almost mound-like appearance. This
plant originates from the Mediterranean, is widely distributed in
Turkey and is found growing in gardens and fields (Ozsoy-Sacan
et al., 2006).
3.3.2.2. Ethnobotany. The foliage from Petroselinum sativum
is used in cooking as a seasoning and garnish, and also has
uses in the pharmaceutical, perfume, and cosmetic industries
(Ozsoy-Sacan et al., 2006). It is traditionally used to help the
stimulation of digestion and menstruation; as a carminative; an
abortifacient; and may have anti-diabetic and anti-hypertensive
properties (Yarnell, 2002; Ozsoy-Sacan et al., 2006; Tahraoui et
al., 2007).
3.3.2.3. Diuretic activity. In the state of São Paulo, Carum Pet-
roselinum sativum is thought to be able to lower blood pressure
(Ribeiro et al., 1988). Ribeiro et al. (1988) prepared an aqueous
extract from the seeds of Petroselinum sativum and adminis-
tered it to rats where it was shown to increase UV after 4 h
(5.5 ml versus 1.6 ml [versus placebo]). This was similar to
that of furosemide, at a dose of 25 mg kg−1 , which increased
UV to 6.0 ml after 4 h. Kreydiyyeh and Usta (2002) also tested
the diuretic effects of an aqueous extract prepared from Pet-
roselinum sativum seeds. Urine was collected for 24 h. This was
conducted on 2 days, with 1 day serving as placebo and the
other day the rats received the extract. Compared with placebo,
Petroselinum sativum increased UV (12.8 ml versus 10.9 ml per
24 h [versus placebo]) and the fraction of water intake elimi-
nated as urine (0.40 ml versus 0.34 ml [versus placebo]). The
content of sodium in urine was not measured, but the authors
did try to elucidate the site of action. This was determined in
two ways: using an isolated and perfused kidney; and, Na+ –K+
ATPase activity from a kidney homogenate. The kidney model
showed that urinary flow was unaffected by the blockade of
sodium channels or NaKCl2 symporters (a type of transport
channel found on the ascending loop of Henle) using furosemide
or amiloride. When potassium channels were inactivated, how-
ever, urine flow was unchanged by Petroselinum sativum and
suggests it may work by blocking either potassium absorption
or secretion, or may be both, and in keeping with this finding, the
authors showed that Petroselinum sativum led to the inhibition
of Na+ –K+ pump activity. The result being that K+ secretion and
Na+ –K+ absorption would be decreased, which would lead to the
accumulation of Na+ and K+ in the lumen of the kidney tubule
and this was hypothesised as one of the ways that Petroselinum
sativum promotes diuresis.
The third study assessed the acute and chronic effects of Pet-
roselinum sativum in acute, volume loaded rats (Lahlou et al.,
2006). After 24 h, UV (∼13 ml versus ∼8 ml [versus placebo])
and UNa (139 mmol l−1 versus 89 mmol l−1 [versus placebo])
were significantly increased compared with placebo. In the sec-
ond part of this trial, the effects of Petroselinum sativum were
assessed after 8 days. Findings were in keeping with those shown
in the acute trial. However, the authors showed that Petroselinum
sativum increased UV on day 1 and reached near maximal effects
by day 4, at which time UNa started to increase as compared
with placebo. No changes were seen in plasma electrolytes or
urinary potassium. These effects are similar to those seen follow-
ing the administration of furosemide and which led the authors
to conclude that Petroselinum sativum acts as a high ceiling
diuretic.
3.3.2.4. Conclusion Petroselinum sativum. These findings
show that Petroselinum sativum is capable of increasing uri-
nary excretion from the body. Two studies have tested the effect
of Petroselinum sativum and neither investigated its effects on
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
UNa. Although, from the conclusions of Kreydiyyeh and Usta
(2002), we speculate that Petroselinum sativum may act to pro-
mote sodium loss as it has been shown to inhibit Na+ –K+ pump
activity in the kidney tubule. Another insight comes from the
work of Lahlou et al. (2006). They showed Petroselinum sativum
increased UV and electrolyte excretion and may be Petroselinum
sativum acts in a similar fashion? Of course these studies clearly
show that further studies are now needed to confirm the diuretic
effect of Petroselinum sativum and also to elucidate its mecha-
nism of action.
3.4. Asteraceae
3.4.1. Taraxacum officinale
3.4.1.1. Botanical description. It is a perennial weed roughly
15–30 cm in length with large, serrated leaves (5–40 cm in
length) clustered in a rosette around the base of the plant. Its
flowering stalks stand upright, are 5–40 cm long and carry a
solitary terminal inflorescence (Schutz et al., 2006). It is widely
distributed in warm temperate areas of the Northern Hemisphere,
inhabiting fields and road and railway sides (Schutz et al., 2006).
3.4.1.2. Ethnobotany. Taraxacum officinale has traditional uses
in Germany, North America, Turkey and China (Schutz et al.,
2006). Briefly, in Germany it has been used in the treatment
of gout, diarrhoea, blisters, and spleen and liver complaints. In
North America, it has been used in kidney disease, dyspepsia and
heartburn. In Mexico is suggested to aid the control of Diabetes.
In Turkey the herb is applied as a laxative, diuretic and used as an
anti-diabetic medicine. In Traditional Chinese Medicine, Tarax-
acum folium is used to treat hepatitis and upper respiratory tract
infections (i.e., bronchitis and pneumonia). Other uses include
the treatment of arthritis and rheumatoid arthritis, certain skin
conditions (e.g., eczema), weight control (Racz-Kotilla et al.,
1974; Hook et al., 1993; Schutz et al., 2006) and as a diuretic.
3.4.1.3. Diuretic activity. The effect of Taraxacum folium
(herb) and Taraxacum radix (root) on diuresis and weight loss, in
conscious rats, have been compared and investigated previously
(Racz-Kotilla et al., 1974). The concentration of the extracts
ranged between 0.5 and 6% and effects were assessed on 2
days—days 1 and 30. UV and UNa were assessed using indices
of diuretic and sodium excretion (i.e., the ratio of responses
to placebo). This comparison showed that the herb had more
marked effects that the root both acutely (diuretic index, 1.9
versus 1.4; and, sodium saliuretic index, 6.3 versus 2.6) and
chronically (diuretic index, 2.1 versus 1.7; and, sodium sali-
uretic index, 4.0 versus 1.3). Numbers on days 1 and 30 seem to
be similar, although this was not equivocal as no statistics were
provided. The authors did provide a comparison by looking at
responses to 80 mg kg−1 of furosemide (the diuretic index was
1.9 and the sodium saliuretic index was 7.9), again suggesting
responses with the herb were similar to those achieved with the
furosemide. In the second part of this study, diuretic effects were
coupled with the measurement of changes in body weight and
led the authors to conclude that diuresis may be one mechanism
explaining decreases in body weight.
15
The diuretic activity of crude and partially purified frac-
tions from Taraxacum radix (chloroform, ether and methanol)
has been assessed (Hook et al., 1993). The ether fraction
is believed to contain ␤-amyrin and ␤-sitosterol, whilst the
methanol contains compounds of medium polarity. The Frac-
tions were administered orally and urine was then collected
for 5 h. Extracts had no effect on UV, but ether and chloro-
form extracts did evoke a small, significant increase in UNa
(∼6.5 mEq kg−1 versus 3.8 mEq kg−1 after 5 h [extracts versus
placebo]). However, this effect was much smaller that than that
of furosemide which led to a three-fold increase in UV and an
increase in UNa to 13.8 mEq kg−1 after 5 h. This lack of effi-
cacy was taken as evidence that Taraxacum radix contained no
organic secondary metabolites with diuretic capabilities.
3.4.1.4. Conclusion Taraxacum officinale. Taraxacum offici-
nale seems capable of modifying UV. Taraxacum folium appears
to be more potent than Taraxacum radix and Taraxacum radix
may even have a small natriuretic effect (Hook et al., 1993).
Presently, further studies to support these effects are needed.
3.5. Brassicaceae
3.5.1. Lepidium latifolium and Lepidium sativum
3.5.1.1. Botanical description. Lepidium latifolium is a peren-
nial plant growing to between 30 cm and even as tall as 2 m.
This plant has woody stems, waxy leaves and small white flow-
ers arranged in clusters. The plant produces fruits in the form
of two reddish seeds and roughly measures 1.6 mm in diameter.
Lepidium sativum is a perennial plant and eaten as a garnish. Lep-
idium is native to southern Europe (Navarro et al., 1994; Jouad
et al., 2001a; Maghrani et al., 2005b; Tahraoui et al., 2007). Lep-
idium latifolium, but not Lepidium sativum, is also native to Asia
and nowadays can be found growing in the wild across North
America.
3.5.1.2. Ethnobotany. The Lepidium latifolium has traditional
uses as anti-escrobte, stomach tonic, aperitif and diuretic
(Navarro et al., 1994; Martinez et al., 2004). In Morocco, Lepid-
ium sativum is considered a herbal medicine and recommended
in the treatment of hypertension, diabetes and renal disease
(Jouad et al., 2001a; Maghrani et al., 2005b; Tahraoui et al.,
2007).
3.5.1.3. Diuretic activity. Navarro et al. (1994) determined the
urinary effects of an aqueous leaf extract (from Lepidium lat-
ifolium) over a 6 h period. When given intra-gastrically, UV
increased (∼60 ml kg−1 versus ∼40 ml kg−1 [versus placebo])
but UNa and potassium were unchanged. These effects were
seen at two doses (50 mg kg−1 and 100 mg kg−1 ). The authors
also tested the responses following the intra-peritoneal injec-
tion of Lepidium. This time, only the highest dose increased UV
(∼50 ml kg−1 versus ∼40 ml kg−1 [versus placebo]). Interest-
ingly, it also increased the excretion of potassium (∼60 mEq l−1
versus ∼40 mEq l−1 [versus placebo]). This data show that Lep-
idium was more potent when given orally and that this route
does not negatively effect potassium excretion. In another study,
16 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
Maghrani et al. (2005b) administered an aqueous extract, from
the seeds of Lepidium sativum, to both normal or hyperten-
sive rats for 3 weeks. The primary goal was to assess an effect
on blood pressure. In spontaneously hypertensive rats (SHR),
systolic blood pressure was lowered (∼178 mmHg) as com-
pared with placebo (∼189 mmHg) after 3 weeks of intervention.
The reference drug (irbesartan, an angiotensin-II blocker) had
even more marked effects, with systolic blood pressure being
∼154 mmHg after 3 weeks. No changes were seen in the nor-
motensive, Wistar-Kyoto rats (WKY). The secondary objective
was to determine whether UV and UNa changed. In WKY, UV
was ∼23 ml 24 h−1 which was significantly elevated compared
with placebo (∼19 ml 24 h−1 ) and similar to that achieved with
irbesartan (∼23 ml 24 h−1 ). In the SHR group, Lepidium had no
effect compared with control. Analysis of urinary electrolytes
showed Lepidium increased UNa in both WKY (∼2.2 compared
to ∼1.3 24 h−1 in the placebo treatment) and SHR models (∼1.0
compared to ∼0.6 24 h−1 seen with placebo). Again, effects
were similar to those induced by irbesartan (∼1.8 and ∼1.2
24 h−1 in SHR and WKY groups, respectively). In both groups
of animals Lepidium increased the excretion of potassium and
chloride in urine. These findings suggest that Lepidium works
as an anti-hypertensive agent when blood pressure is elevated,
but has little or no effect in normotension. Lepidium does seem
to work as a diuretic, increasing both UV and electrolytes in
normotensive rats. There is one other point that needs consider-
ing. In the normotensive rats, UV increased after the first week
of treatment; however, UNa did not reach significance until
week 3. Hence, there is some disparity in the timing of their
onset which may have been missed if this study had lasted 1
week. In the spontaneously hypertensive rats, it seems to work
only as a natriuretic as UNa was significantly elevated after
2 weeks of treatment, but there was no effect on UV during
intervention.
3.5.1.4. Conclusion Lepidium latifolium and Lepidium sativum.
The current evidence seems confusing. One study was acute
(24 h) and showed an increase in UV with no change in UNa
(Navarro et al., 1994). The other study lasted 3 weeks and
showed a natriuretic, as indicated by increased UNa, and diuretic
effect (increased UV) which was seen in normotensive but
not hypertensive rats. These observations raise two issues—the
effect of duration and the animal model used. Another differ-
ence relates to the type of extract used (i.e., leaf versus seed)
and the dosage [20–100 mg kg−1 , Maghrani et al., 2005b, ver-
sus 50–100 mg kg−1 , Navarro et al., 1994]. It seems that further
studies are needed and they must address whether the genus
Lepidium does have diuretic properties and by what mechanism
they work.
3.6. Caprifoliaceae
3.6.1. Sambucus mexicana and Sambucus nigra
3.6.1.1. Botanical description. The genus Sambucus contains
between 5 and 30 species of fast-growing shrubs and small trees
growing that grow to less than 10 m high. Its leaves are serrated
and arranged in opposition to one another in a pinnate with
5–9 leaflets that are 5–30 cm in length and around 3–5 cm in
width. In late Spring Sambucus flowers and this is followed
the production of bunches of small red, bluish or black berries
that are 3–5 mm in diameter. The genus Sambucus is found in
temperate to subtropical regions of the Northern and Southern
Hemispheres, with its distribution being more widespread in the
Northern than Southern Hemisphere (Anon., 2005).
3.6.1.2. Ethnobotany. Sambucus nigra is consumed in pre-
serves, wine and juice, and is recognised as potentially having
health benefits owing to its antioxidant and antiviral proper-
ties, and immune system modulation via cytokines (Anon.,
2005). Thus, areas in which Sambucus nigra has been postu-
lated as beneficial include diabetes, lipid lowering and protection
against vital infections such as HIV, influenza and herpes sim-
plex (Anon., 2005). In complete contrast, Sambucus mexicana
is not as commercialised and not considered for its medicinal
properties (Thole et al., 2006).
3.6.1.3. Diuretic activity. Beaux et al. (1999) tested the leaves
from Sambucus nigra and Caceres et al. (1987) used an ethanol
extract of Sambucus Mexicana. Both species are used in tra-
ditional medicines although the actives are unclear and could
involve di- and tri-terpene, glycosides and phenols (e.g., fla-
vanoids, tannins and coumarins) (Caceres et al., 1987).
Beaux et al. (1999) conducted a trial in conscious rats to
test the acute diuretic effects of four extracts (one of which
was Sambucus nigra). They showed that UV reached a peak
at 6 h. The cumulative volume at 8 and 24 h was 6.0 and
7.5 ml 100 g−1 (+1.4 and +1.1 ml 100 g−1 greater than placebo,
respectively) and UNa at these time points was ∼0.3 and
∼0.4 mmol 100 g−1 . This was significantly greater than placebo
(∼0.2 mmol 100 g−1 ) and not so different from hydrochloroth-
iazide (10 mg kg−1 ) which significantly increased UV (5.6 ml
100 g−1 and 7.1 ml 100 g−1 ) and UNa (∼0.4 mmol 100 g−1 and
∼0.5 mmol 100 g−1 ) at 8 and 24 h, respectively.
The second trial used the results from an ethnobotanical sur-
vey to identify plants used for urinary ailments in Guatemala
(Caceres et al., 1987). From an initial 250 plants, 67 were tested
in four independent trials and one of these Sambucus Mexi-
cana. This was prepared as an ethanol extract (500 mg kg−1 )
and administered nasogastrically. UV was collected for 6 h
and responses compared with placebo and hydrochlorothiazide
(25 mg kg−1 ). In contrast to the European variety (Beaux et
al., 1999), however, responses of UV were no different from
placebo.
3.6.1.4. Conclusion Sambucus mexicana and Sambucus nigra.
Many differences are seen in the aforementioned studies. For
instance, they used different species; administered the extract via
different routes (intra-peritoneally, Caceres et al., 1987 versus
nasogastrically Beaux et al., 1999); and used different extrac-
tion methods (aqueous, Caceres et al., 1987 versus ethanol,
Beaux et al., 1999). Neither of these studies constructed dose-
response curves and this should also be considered in future
studies.
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
3.7. Cecropiaceae
3.7.1. Cecropia leucocoma and Cecropia pachystachya
3.7.1.1. Botanical description. Cecropia is a genus with
roughly 25 species of trees. Cecropia is identified by its large,
circular palmate lobed leaves that are between 30 and 40 cm
in width and deeply divided into 7–11 lobes. In northeast
Argentina, Paraguay and southern Brazil, Cecropia pachys-
tachya can reach heights of around 10 m with large, dual
coloured leaves that are dark-green on their upper-side and
silver-grey on their underside. In central Argentina, Cecropia
pachystachya is not as tall and reaches heights of less than
1 m (Consolini and Migliori, 2005). This tree can is found in
the forests of neotropical regions in paranaense phytogeograph-
ical province in Northeast Argentina, Paraguay and southern
Brazil, and the temperate hilly grasslands of central Argentina
(Consolini and Migliori, 2005; Consolini et al., 2006).
3.7.1.2. Ethnobotany. Cecropia pachystachya is a traditional
medicine and used as a dietary supplement, a treatment for
coughs and asthma, a cardiotonic and as a diuretic (Consolini
et al., 2006). Indeed, studies in rats show it may lower blood
pressure and this could be explained by diuresis (Consolini and
Migliori, 2005). The traditional use of Cecropia leucocoma is
not so well described. Although, we are led to believe that in
the state of Säo Paulo in Brazil it is a medicinal plant popularly
used for its diuretic and hypertensive properties (Ribeiro et al.,
1988).
3.7.1.3. Diuretic activity. Cecropia leucocoma (Ribeiro et al.,
1988) was administered to rats implanted with a urinary catheter.
UV was collected for 4 h after its administration and shown to
increase, compared with a placebo control, after 30, 120 and
240 min. Indeed, at the end of the recording phase UV was
5.5 ml in the treatment group and 1.6 ml in the placebo group.
The second trial explored the cardiovascular effects of Cecropia
pachystachya (Consolini and Migliori, 2005) and showed a low-
ering of steady state blood pressure with extracts obtained from
neotropical and temperate regions. However, the mechanism for
this lowering was not via diuresis as UV and urinary sodium and
potassium after 3 h was unchanged by Cecropia pachystachya.
3.7.1.4. Conclusion Cecropia leucocoma and Cecropia pachys-
tachya. The studies suggest that Cecropia leucocoma may work
as a diuretic, but that Cecropia pachystachya does not. However,
these are the only two studies to have assessed the diuretic effects
of plants from the genus Cecropia and further studies may con-
sider confirming the effect of Cecropia leucocoma on urinary
excretion and combining this with measurements of UNa. More-
over, it may be worthwhile assessing the effect of varying doses
as only one dose was tested (Ribeiro et al., 1988).
3.8. Caryophyllaceae
3.8.1. Spergularia purpurea
3.8.1.1. Botanical description. This is a glabrous or pubescent
plant that inhabits sandy soil with a stem that is around 2–2.5 cm
17
in width and about 5–15 cm in height. Its leaves are arranged in
a rosette and between 8 and 40 mm in length. Its flowers are a
rose-purple colour and 3–4.5 mm in length. This plant originates
from Asia and Europe (Jouad et al., 2001b,c).
3.8.1.2. Ethnobotany. Spergularia purpurea is documented as
being used in traditional Moroccan medicine and a water extract
is prepared from the whole plant and used in the treatment of
renal disease, hypotension and diabetes (Jouad et al., 2001a).
3.8.1.3. Diuretic activity. Jouad et al. (2001b) administered
Spergularia purpurea, furosemide (10 mg kg−1 ) and a placebo
to normal rats and measured UV and urinary electrolytes every
week for 4 weeks. Data showed significant increases in UV with
Spergularia purpurea and were seen after 1 week of intervention
and sustained till week 4 (∼23 ml 24 h−1 with 400 mg kg−1 of
Spergularia purpurea). After 4 weeks of treatment, responses
seemed to be dose-dependent (16.9 and 19.3 ml 24 h−1 with
doses of 100 and 200 mg kg−1 of Spergularia purpurea, respec-
tively), were similar to those of furosemide (∼23 ml 24 h−1 )
and were significantly greater than placebo (∼10 ml 24 h−1 ).
Changes in urinary electrolytes (sodium, potassium and chlo-
ride) mirrored those of UV, with the highest dose increasing UNa
to ∼4 mEq kg−1 as compared with placebo (∼1.5 mEq kg−1 ).
Again, this change was not too dissimilar to that achieved
with furosemide (∼3 mEq kg−1 ). Jouad et al. (2001b) measured
electrolytes in plasma and showed no changes with Spergu-
laria purpurea. Furthermore, effects on glomerular filtration
were measured. At the lowest and highest doses (100 and
400 mg kg−1 ) filtration increased relative to placebo, but was
unchanged by the intermediate dose. Thus, different doses would
seem to elicit differing responses and we could speculate that the
increase in glomerular filtration might reflect a passive response
to a change in blood pressure.
In the second study by Jouad et al. (2001c), the flavonoids
from Spergularia purpurea (5 mg kg−1 ) were extracted and
effects on blood pressure and renal function determined over
a 7 day period. The extract was administered daily to normoten-
sive and hypertensive rats, and compared with placebo and
furosemide (10 mg kg−1 ). In both animal models furosemide
and Spergularia purpurea flavonoids decreased blood pres-
sure to a similar magnitude but did not differ significantly
from placebo. These flavonoids also interfered with the tubu-
lar absorption of electrolytes as shown by significant increases
in UNa, potassium and chloride. Indeed, UV and UNa increased
to ∼60 ml kg−1 24 h−1 and ∼10–15 mEq kg−1 24 h−1 , respec-
tively, in those receiving flavonoids. These effects were roughly
double those seen in the placebo group (∼30 ml kg−1 24 h−1 and
∼7.5 mEq kg−1 24 h−1 ) and were similar to responses seen with
furosemide. From visual inspection of the graphs it also seems
apparent that electrolyte excretion seemed to be greater in nor-
motensive rats and this was especially true for the excretion of
potassium.
3.8.1.4. Conclusion Spergularia purpurea. The present studies
imply that Spergularia purpurea acts as a diuretic by interfer-
ing with the tubular absorption of water and electrolytes. These
18 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
effects seem dose dependent and are seen after 1 week and sus-
tained. Moreover, the active for this change may actually be the
flavanoids as they had similar effects to the extract on UV and
UNa. Blood pressure may partly explain such effects as glomeru-
lar filtration tended to be increased by Spergularia purpurea.
Hence, further studies confounding the present observations are
needed in order to support the use of Spergularia purpurea as a
natural diuretic.
3.9. Cucurbitaceae
3.9.1. Cucumis melo and Cucumis trigonus
3.9.1.1. Botanical description. Cucumis melo is oval in shape,
measures up to around one foot in length, has smooth skin
interspaced by length-wise grooves. Cucumis trigonus, like
Cucumis melo, is a fruit and resembles a small egg streaked
with yellow and green, and is extremely bitter. Cucumis melo is
found Worldwide and Cucumis trigonus can be located in North
India.
3.9.1.2. Ethnobotany. Cucumis trigonus (Naik et al., 1981) and
Cucumis melo (Singh and Sisodia, 1970) are from the Cucur-
bitaceae family. In India the seeds from Cucumis melo are
produced to provide a sweet edible oil that has nutritional value
and analgesic, anti-inflammatory (Naik et al., 1980; Vouldoukis
et al., 2004) and diuretic properties (Singh and Sisodia, 1970). In
contrast, Cucumis trigonus (Naik et al., 1981) has no traditional
usage, but the alcohol extract contains a glycoside frac-
tion which, via its anti-inflammatory properties, may promote
diuresis.
3.9.1.3. Diuretic activity. The diuretic effect of Cucumis
trigonus (Naik et al., 1981) was tested in conscious albino rats
and the study included a placebo group and a positive test group
(i.e., hydrochlorothiazide). After oral administration, UV was
measured for 6 h. The accumulated volume was then tested
for its sodium, chloride and potassium content, and pH. Two
doses (25 and 50 mg kg−1 ) of Cucumis trigonus significantly
increased UV (+165 and +212% from placebo, respectively)
as did hydrochlorothiazide (+253%). Average UNa was also
increased by these treatments: Cucumis trigonus (25 mg kg−1 ),
147; Cucumis trigonus (50 mg kg−1 ), 153; hydrochlorothiazide
(25 mg kg−1 ), 161; and, placebo, 132 mEq l−1 . This data sug-
gests that Cucumis trigonus has similar effects to those of
hydrochlorothiazide and works like a clinical diuretic drug.
Singh and Sisodia (1970) prepared an extract from the seeds of
Cucumis melo. Anaesthetised dogs were volume loaded and the
ureters were cannulated for the collection of urine. Once urine
output had stabilised the extracts were given intravenously. At
the same time, creatinine and chloride were measured in urine
and blood (at 0, 15 and 30 min) to assess their renal clearances.
An ether extract of Cucumis melo significantly increased UV
(151 ml versus 96 ml [versus baseline]) and its chloride con-
tent (114 mEq l−1 versus 95 mEq l−1 [versus baseline]). The
authors investigated the mechanism for this increase in chlo-
ride and showed that glomerular filtration rate increased (90
versus 61 unknown units [versus baseline]) and that its tubular
reabsorption was decreased (as shown using the renal stop flow
technique). Similar effects are also achieved with mercurial and
xanthine diuretics and this study concluded that Cucumis melo
acted in a similar fashion, although no comparison with such
drugs was performed.
3.9.1.4. Conclusion Cucumis melo and Cucumis trigonus.
These studies used different species from the genus Cucumis,
but both extracts were shown to significantly increase UV. They
also showed increases in urinary chloride excretion, which may
be due to the extract interfering with absorption in the renal
tubule (Naik et al., 1981). The present trials suggest that plant
and seed extracts from the genus Cucumis may have diuretic
capabilities and this would seem to warrant further research in
order to address its efficacy.
3.10. Equisetaceae
3.10.1. Elephantopus scaber
3.10.1.1. Botanical description. Elephantopus scaber is a
shrub that grows in the wild. It grows to a height of between
20 and 40 cm, has a high rosette of leaves. Its leaf stems are
very short, white, hairy and can be found close to the ground.
Elephantopus scaber is a small herb that grows in hotter regions
of India (Avani and Neeta, 2005) and throughout America.
3.10.1.2. Ethnobotany. Elephantopus scaber has a wide range
of reported uses in traditional medicine. Indeed, it has been used
as an analgesic, anti-emetic, anti-inflammatory, anti-microbial.
It has been used in conditions such as bronchitis, smallpox,
diarrhoea and suggested to have cytotoxic and anti-tumoral prop-
erties (Laranja et al., 1991; Avani and Neeta, 2005; Xu et al.,
2006).
3.10.1.3. Diuretic activity. Two studies have tested its diuretic
properties; ine in conscious rats (Poli et al., 1992) and the other
in a human trial (Laranja et al., 1991). Poli et al. (1992) gave
Elephantopus scaber to conscious rats and showed no effect on
UV after 3 h. Its effect on UNa not tested. The authors looked
at a number of additional physiological processes that included
toxicity, analgesic activity, anti-pyretic and anti-inflammatory
activities, intestinal transit times and arterial blood pressure.
When given intravenously it was reported to decrease arte-
rial blood pressure as well as heart rate. Oral administration
was not tested. It was also shown to be quite toxic, with an
LD50 of 2 and 6 mg kg−1 when given intra-peritoneally and
orally, respectively, and it had mixed effects on intestinal tran-
sit times; times were decreased by an aqueous extract and
increased by a hydro-alcoholic extract. The second study was
an acute, placebo-controlled trial (6 h) in 10 subjects (Laranja
et al., 1991). The results of this study supported those of Poli
et al. (1992) as UV and urinary, and plasma, electrolytes (i.e.,
calcium, phosphate, uric acid, sodium and potassium) were
unchanged.
3.10.1.4. Conclusion Elephantopus scaber. These studies pro-
vide little support that Elephantopus scaber works as a
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
diuretic. As in other studies, no dose-response curves were
constructed. So, whether diuresis can be achieved with
higher doses, than those tested in these studies, still remains
unclear.
3.11. Equisetaceae
3.11.1. Equisetum bogotense, Equisetum fluviatile,
Equisetum giganteum, Equisetum hiemale var. affine and
Equisetum myriochaetum
3.11.1.1. Botanical description. Equisetum is a genus of peren-
nial plants that reproduce by spores rather than seeds. Plants
normally grow to between 0.2 and 1.5 m high, although some
reach more considerable heights (e.g., Equisetum giganteum can
grow up to 5 m and Equisetum myriochaetum can reach 8 m,
Andrade-Cetto and Heinrich, 2005). The leaves of these plants
are thick and bushy and the stems are hollow, jointed, and have
ridges. This genus is near-cosmopolitan and is only absent from
Australasia and Antarctica. All Equisetum species are herba-
ceous perennials and can be found in temperate (e.g., Equisetum
hiemale) and tropical regions. Equisetum giganteum is native to
southern and central America and found in hot, humid environ-
ments. In contrast, Equisetum fluviatile is found in the Northern
Hemisphere and grows in shallow watery areas like marshes and
streams.
3.11.1.2. Ethnobotany. In Chile and Mexico, Equisetum has
traditional uses as a diuretic and a means of treating kidney
stones. It has also been used for polishing copper utensils, cleans-
ing teeth (Perez Gutierrez et al., 1985; Lemus et al., 1996) and
to have anti-diabetic (Andrade-Cetto and Heinrich, 2005) and
platelet sedating effects (Mekhfi et al., 2004).
3.11.1.3. Diuretic activity. Two studies (Perez Gutierrez et al.,
1985; Lemus et al., 1996) have tested the effects of Equi-
setum. Perez Gutierrez et al. (1985) tested four species of
Equisetum—Equisetum fluviatile, Equisetum hiemale var. affine,
Equisetum giganteum and Equisetum myriochaetum. Extracts
were prepared in distilled water and administered orally. Urine
was then collected every 2 h over a 6 h period. All species
increased UV after 6 h with the largest change being observed
with Equisetum hiemale var. affine (9.0 ml versus 2.9 ml [versus
placebo]) and the smallest with Equisetum giganteum (5.0 ml
versus 2.9 ml [versus placebo]). For comparison, hydrochloroth-
iazide (25 mg kg−1 ) was administered and was not so different
(7.1 ml). Analysis of urinary electrolytes showed a similar trend.
Indeed, with Equisetum hiemale var. affine and Equisetum gigan-
teum, UNa was 161.7 and 147.0 mEq l−1 (versus 110.0 mEq l−1
achieved with placebo). In the group receiving hydrochloroth-
iazide, UNa was 160.0 mEq l−1 . The data also showed that
Equisetum had similar effects on urinary potassium and chlo-
ride excretion, and it was suggested to act in a fashion to
hydrochlorothiazide. The second study also reported positive
effects with Equisetum. This was a clinical trial in humans
in which a 10% solution of Equisetum bogotense (equivalent
to 0.75 g day−1 ) was given for 2 days. Urine was collected
for 24 h on the second day and water balance was assessed
19
from the difference between liquid intake and UV. Equisetum
bogotense significantly decreased the water balance (the net loss
was 496 ml) and increased UNa (+65 from 157 mEq l−1 ). This
was accompanied by significant increases in urinary potassium
and chloride.
3.11.1.4. Conclusion Equisetum bogotense, Equisetum fluvi-
atile, Equisetum giganteum, Equisetum hiemale var. affine and
Equisetum myriochaetum. Studies show that the genus Equise-
tum has positive effects on UV and UNa, and would seem to
support its diuretic and natriuretic effect. However, the human
trial did not include a placebo control with the point being that
more controlled trials are still needed.
3.12. Euphorbiaceae
3.12.1. Phyllanthus amarus, Phyllanthus corcovadensis
and Phyllanthus sellowianus
3.12.1.1. Botanical description. Phyllanthus is suggested to be
made up of some 750 species and comprise trees, bushes, and
annual or biennial herbs (Hnatyszyn et al., 1999). Phyllanthus
amarus is an annual, glabrous herb that grows to between 30 and
60 cm. Its stems are angular with distichously, elliptic-oblong
shaped leaves and its flowers are yellow and numerous. Its fruits
are capsule shaped, very small and smooth and its seeds are
longitudinally ribbed on the back. Phyllanthus corcovadensis
and Phyllanthus sellowianus are closely related to Phyllanthus
niruri in appearance, phytochemical structure and history of use
but the difference is that they are found in drier tropical climates.
In appearance, they are small erect annual herbs growing to
between 30 and 40 cm in height. They have alternately arranged
leaves with each leaf being oval-elliptic in shape, having a small
projecting tip, a greenish-white in colour, having no petals and
being glabrous. Individual flowers occur on flower stalks and are
star-shaped and their fruits are small capsule shaped, green and
glabrous (Jones, 2007). Phyllanthus is found in tropical areas,
although it is found in subtropical regions and is usually quite
scattered in its distribution (Unander et al., 1990; Jones, 2007).
3.12.1.2. Ethnobotany. Traditional uses vary from place to
place, but Phyllanthus has been medicinally to treat urolithiasis
(Calixto et al., 1984; Freitas et al., 2002), as an anti-hypertensive
(Ribeiro et al., 1988), an anti-diabetic (Srividya and Periwal,
1995), an analgesic (Gorski et al., 1993), a treatment for liver dis-
eases (Dhiman and Chawla, 2005), as an anti-viral agent (Martin
and Ernst, 2003), as a laxative and anti-septic (Hnatyszyn et al.,
1999).
3.12.1.3. Diuretic activity. Phyllanthus corcovadensis (Ribeiro
et al., 1988) and Phyllanthus sellowianus (Hnatyszyn et al.,
1999) have been assessed in rats. Phyllanthus sellowianus was
given at a dose of 400 mg kg−1 and changes in UV and uri-
nary electrolytes were monitored for the subsequent 8 h. UV was
shown to be significantly increased compared to a placebo con-
trol (3.6 ml versus 2.7 ml), as was UNa which was 178 mEq l−1
(versus 136 achieved with the placebo). Urinary potassium and
chloride were measured and a significant increase in the latter
20 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
was reported. Comparisons were also made with hydrochloroth-
iazide which increased UV 2 h after it was given. In bladder
cannulated rats, Phyllanthus corcovadensis (Ribeiro et al., 1988)
was also shown to increase UV (5.9 ml versus 1.6 ml [versus
placebo]) 4 h after its administration. Significant increases were
also seen after 2 h. This study did not, however, measure changes
in urinary electrolytes.
The third study was conducted in 40–60 year old subjects
and they were asked to ingest Phyllanthus amarus for 10 days
(Srividya and Periwal, 1995). At the end of this period blood
pressure was measured and urine was collected for 24 h. A con-
trol group was included, but this is an unreliable comparison as
only 5 subjects were recruited and they were not matched (i.e.,
age and blood pressures) with the treatment group. Both UV
(2.4 l versus 1.5 l) and UNa (26.1 mEq l−1 versus 19.1 mEq l−1 )
were shown to be significantly increased in the treatment
group, but this finding is confounded by the higher blood
pressures in this group which would have influenced urinary
output.
3.12.1.4. Conclusion Phyllanthus amarus, Phyllanthus corco-
vadensis and Phyllanthus sellowianus. Phyllanthus may have
diuretic and natriuretic effects, although caution should be aired
when interpreting the findings from the human clinical trial as
this was not very well designed and so whether the findings from
the animal trials can be translated to humans still remains to be
determined.
3.13. Lamiaceae
3.13.1. Orthosiphon stamineus
3.13.1.1. Botanical description. Orthosiphon stamineus comes
from little oval, green leaves that are finely toothed and rolled
like ordinary tea. Orthosiphon stamineus is an herb that is found
growing in tropical areas and is popular medicinal plant in South-
east Asia where it is consumed as an herbal tea (Doan et al., 1992;
Beaux et al., 1999; Olah et al., 2003).
3.13.1.2. Ethnobotany. Orthosiphon stamineus is tradition-
ally used to treat hypertension, diabetes, urinary disorders,
rheumatism, tonsillitis and menstrual disorders (Englert and
Harnischfeger, 1992; Beaux et al., 1997; Matsubara et al., 1999;
Sriplang et al., 2007). It is also documented in the German Phar-
macopoeia DAB 9 and considered effective in humans by the
Commission E of the Federal Health Authority (BGA) (Englert
and Harnischfeger, 1992; Matsubara et al., 1999).
3.13.1.3. Diuretic activity. Three trials have been conducted in
rats. Englert and Harnischfeger (1992) tested the diuretic effect
of a mixture of leaves and stems from Orthosiphon in conscious,
volume loaded rats. UV was unchanged by this intervention,
but UNa increased (∼2-fold, compared with placebo, at a dose
of 750 mg kg−1 ), as did urinary potassium (∼2-fold) and chlo-
ride (∼3-fold). However, no statistics were reported and for this
reason we scored these effects as not being significantly differ-
ent and conclude Orthosiphon stamineus had no effect. Beaux
et al. (1999) also looked at its diuretic effects of Orthosiphon
stamineus. Urine was collected for 24 h and peak changes were
shown to occur between 5 and 6 h after administration. At 8 h (5.9
100 g−1 versus 3.9 100 g−1 [versus placebo]) and 24 h (6.9 ml
100 g−1 versus 5.7 ml 100 g−1 [versus placebo]) UV was sig-
nificantly elevated compared to placebo. UNa was not changed
(0.26 mmol g−1 and 0.38 mmol g−1 at 8 and 24 h, respectively).
In another study (Olah et al., 2003), 50 or 70% ethanol was
used to extract two tinctures of Orthosiphon stamineus and were
shown to increase UV (41.9 and 28.9 ml 24 h−1 kg−1 [50 and
70%, respectively]) and UNa (5.7 and 4.6 mEq 24 h−1 kg−1 ).
However, no statistical analyses were reported and this was
taken as evidence that responses were no different from placebo
(32.4 ml 24 h−1 kg−1 and 3.6 mEq 24 h−1 kg−1 ).
Doan et al. (1992) conducted a trial in humans looking at the
acute (within 1 day) effects of Orthosiphon stamineus. In this
trial food and water intake was standardised. Urine was collected
at 8 am and served as a control, and then was measured every
2 h between until 10 pm. However, no significant changes were
in UV or UNa were found.
3.13.1.4. Conclusion Orthosiphon stamineus. On this evi-
dence, Orthosiphon stamineus does not act like a clinical diuretic
drug as only one study (Beaux et al., 1999) demonstrated a
significant increase in UV with no change in UNa, and the
remaining studies reported no effects (Doan et al., 1992; Englert
and Harnischfeger, 1992; Olah et al., 2003).
3.14. Oleaceae
3.14.1. Fraxinus excelsior
3.14.1.1. Botanical description. Fraxinus excelsior is a decid-
uous tree capable of growing between 20 and 35 m tall. Its
leaves are arranged in a pinnate fashion, are usually between
20 and 35 cm in length and are clustered in groups of 9–13. It
can be found in forests, parks and gardens across middle Euro-
pean temperate zones (e.g., northern Spain, the British Isles,
France, central Europe, and southern Scandinavia) (Hemmer
et al., 2000). It is also a native shrub widely distributed
throughout the southeastern region of Morocco (Eddouks et al.,
2005).
3.14.1.2. Ethnobotany. Fraxinus excelsior is suggested to be an
analgesic, anti-inflammatory, anti-oxidant, anti-rheumatic and
anti-pyretic, and to have hypoglycaemic (Maghrani et al., 2004;
Eddouks et al., 2005).
3.14.1.3. Diuretic activity. Two studies have investigated its
diuretic effects in conscious rats (Casadebaig et al., 1989;
Eddouks et al., 2005). Casadebaig et al. (1989) looked at
the acute (4 h) effects of alcoholic and aqueous spray dried
powders. The aqueous extract had no significant effect on
UV and tended (P = 0.07) to increase UNa (0.11 ± 0.03 mEq
versus 0.08 ± 0.02 mEq [lowest dose versus placebo]). The
alcohol-based spray had no effect on UV and (at the high-
est dose) significantly increased UNa (0.14 ± 0.03 mEq versus
0.08 ± 0.02 mEq [treatment versus placebo]). An aqueous
extract was employed in the second study (Eddouks et al., 2005)
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
and was administered to rats for 3 weeks. In spontaneously
hypertensive rats (SHR), UV increased significantly at weeks
1 and 2 with a peak change at week 1 (∼18.3 ml 24 h−1 ver-
sus ∼10.8 ml 24 h−1 [versus placebo after 1 week]). This was
accompanied by significant increases in UNa with a peak change
occurring at week 2 (∼1.0 mmol 24 h−1 versus ∼0.8 mmol
24 h−1 [versus placebo]) and significant increases being seen
at all weeks. In Wistar-Kyoto rats (WKY), UV significantly
increased at weeks 2 and 3, with the peak effect seen at week
3 (∼27.8 ml 24 h−1 versus ∼18.0 ml 24 h−1 [versus placebo]).
UNa reached a maximum (∼1.8 mmol 24 h−1 versus ∼1.2 mmol
24 h−1 [versus placebo]) at week 1 and was maintained through
to week 3.
3.14.1.4. Conclusion Fraxinus excelsior. One study showed no
effect with an aqueous extract of Fraxinus excelsior and signif-
icant increases in UNa with an alcohol extract (Casadebaig et
al., 1989). The second trial showed an aqueous extract increased
both UNa and UV (Eddouks et al., 2005). At first glance this
evidence would seem to be inconsistent; however, this may be
partly explained by the number of extent of differences between
the 2 trials. For instance, the type of extract (aqueous versus
alcoholic); the animal model (Wistar, WKY and SHR); and,
differing doses tested. Indeed, in both studies an aqueous decoc-
tion was used. One study reported a positive increase at a dose
of 20 mg kg−1 and the second showed no effect at a dose of
1650 mg kg−1 . Therefore, further studies are needed in order to
define whether Fraxinus excelsior does, or does not, work as a
diuretic.
3.15. Malvaceae
3.15.1. Hibiscus sabdariffa
3.15.1.1. Botanical description. Hibiscus sabdariffa is an
annual or perennial herb or woody-based sub-shrub that grows
to around 2 m tall. Its leaves are lobed, roughly 8–15 cm in
length and are alternately arranged along a stem. The flowers of
Hibiscus sabdariffa are 8–10 cm across, have a whitish-yellow
appearance and a dark red spot at the base of each petal. At the
base of the petals there is a stout fleshy red calyx (∼1.5–2 cm in
width) which brightens as the fruit matures. Hibiscus sabdariffa
is a tropical plant and can be found growing across West Africa
(Odigie et al., 2003; Onyenekwe et al., 1999).
3.15.1.2. Ethnobotany. Various parts of the plant (flower,
leaves, calyx and corolla) are prepared as a drink or for medic-
inal purposes (Herrera-Arellano et al., 2004). Indeed, its leaves
are commonly used as a diuretic, sedative and refrigerant, and
its fruits are considered to be an anti-scorbutic. Its calyces are
commonly prepared as a drink and used as a mild diuretic, a
colorectal, an intestinal anti-septic, a mild laxative, as an aid in
heart and nerve conditions, to lower blood pressure and to treat
calcified arteries (Onyenekwe et al., 1999; Ajay et al., 2007).
3.15.1.3. Diuretic activity. Several studies have assessed its
diuretic capabilities. Odigie et al. (2003) assessed its effects
on blood pressure in renovascular hypertensive rats. Six weeks
21
after surgery rats received an aqueous Hibiscus sabdariffa petal
extract for 8 weeks. Rats were compared with sham-operated
rats and a placebo group. At the end of intervention, blood pres-
sure in the hypertensive rats receiving Hibiscus sabdariffa and
sham-operated rats was similar (mean arterial pressures were
109 and 107 mmHg [Hibiscus sabdariffa and sham-operated
rats]), but lower than the pressure in those rats ingesting placebo
(147 mmHg). No difference in heart rate was seen between these
groups. Rats were then anaesthetised and the urinary bladder
cannulated. Urine was collected for 90 min and no effect was evi-
dence as determined by the lack of differences between groups.
Onyenekwe et al. (1999) conducted an interventional trial in
which an aqueous extract from Hibiscus sabdariffa calyces
was given to spontaneously hypertensive rats for 3 weeks. The
primary objective in this study was blood pressure. In the nor-
mal group no change was observed and in the hypertensive
group, systolic and diastolic blood pressures were shown to be
lower than placebo (systolic blood pressure, 135 mmHg ver-
sus 153 mmHg [versus placebo]; and, diastolic blood pressure,
89 mmHg versus 70 mmHg). In the spontaneous rats receiving
Hibiscus sabdariffa, UV was significantly increased compared
with placebo (5.0 cm3 day−1 versus 3.9 cm3 day−1 [versus
placebo]) and unchanged in the normotensive group. How-
ever, when the difference between water intake and UV was
calculated, the data seem to imply that Hibiscus sabdariffa
changed body water balance in hypertensive and normotensive
rats (water balance was ∼5.0–5.0 cm3 day−1 in those ingest-
ing Hibiscus sabdariffa and 8.5 cm3 day−1 those administered
placebo). The third animal trial assessed the excretion of urine
and its electrolytes (Ribeiro et al., 1988). After administra-
tion of an aqueous decoction of Hibiscus sabdariffa calyces,
urine was collected for 6 h and was increased to 103 ml kg−1 .
This was significantly higher than that achieved with a water
placebo (46 ml kg−1 ) and similar to that following the ingestion
of 25 mg kg−1 of hydrochlorothiazide (83 ml kg−1 ). UNa was
significantly increased (6.5 mEq kg−1 versus 2.7 mEq kg−1 [ver-
sus placebo]) and, again, this change was similar to responses
with hydrochlorothiazide (4.2 mEq kg−1 ). Urinary potassium
and uric acid were also increased by Hibiscus sabdariffa.
Only 1 human trial has been conducted with Hibiscus sab-
dariffa calyces (Herrera-Arellano et al., 2004). Hypertensive
patients were recruited and aged between 30 and 80 years of
age. 10 grams of Hibiscus sabdariffa was consumed with 0.5 l
of water and ingested, at breakfast, for 4 weeks. Responses
were measured on the first and last day of the trial, and
compared with captopril (25 mg, twice a day). Hibiscus sab-
dariffa decreased systolic and diastolic blood pressure by 14
and 11 mmHg, respectively, which did not differ significantly
from those responses with captopril (−16 and 13 mmHg, respec-
tively). Assessment of urinary parameters showed that chloride,
potassium and pH were unchanged by Hibiscus sabdariffa. In
addition to these, UNa was shown to increase significantly (+19,
from 106 mEq l−1 24 h−1 ). How these changes compared with
captopril was not determined.
3.15.1.4. Conclusion Hibiscus sabdariffa. The current stud-
ies provide mixed evidence for Hibiscus sabdariffa with two
22 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
studies showing it increased UNa (Caceres et al., 1987;
Herrera-Arellano et al., 2004). Its effects on UV are less
clear. Caceres et al. (1987) reported an increase, Odigie et
al. (2003) no change, Onyenekwe et al. (1999) showed an
effect but only when hypertensive rats were used. Going on
this evidence further studies are needed to clarify the effect
of animal strains on measured responses; to determine concur-
rent changes in urine excretion and solute output; to establish
the acute (i.e., hours) and chronic (days) effect of Hibiscus
sabdariffa.
3.16. Oleaceae
3.16.1. Olea europaea
3.16.1.1. Botanical description. Olea europaea is an evergreen
tree or shrub that is around 8–15 m in height. Its leaves are
silver-green, oblong in shape and measure 4–10 cm in length
and 1–3 cm in width. It has a trunk that is gnarled and twisted
and it has a drupe shaped fruit that is 1–2.5 cm in length. Olea
europaea is native to Europe, Asia and Africa (Somova et al.,
2003) and cultivated for its fruit and oil.
3.16.1.2. Ethnobotany. Olea europaea has traditional uses as a
diuretic, anti-hypertensive, emollient, febrifuge, a tonic for uri-
nary and bladder infections and headaches, and in cardiovascular
disease (Ribeiro et al., 1988; Jouad et al., 2001a; Somova et al.,
2003; Tahraoui et al., 2007).
3.16.1.3. Diuretic activity. Somova et al. (2003) investigated
the diuretic effects of Olea europaea which was cultivated in
African, Greece or Christ town. Ursolic acid and oleanolic acid
were also tested. Urine was collected at 5 and 24 h after intra-
peritoneal application of the various extracts. Urea (1 g kg−1 )
and hydrochlorothiazide (25 mg kg−1 ) were used as a placebo
and positive control, respectively. In general, the data showed
that none of the extracts induced effects different from urea.
There were a few exceptions. Indeed, after 5 h the saliuretic
index (sodium plus potassium) was decreased by oleanolic acid
(376 mmol l−1 versus 440 mmol l−1 , respectively); and the car-
bonic anhydrase activity (taken as chloride divided by sodium
plus) was decreased by ursolic acid (0.47 mmol l−1 versus
0.65 mmol l−1 ) and the wild African cultivated Olea europaea
(0.50 mmol l−1 ) as compared with urea. When compared with
hydrochlorothiazide, however, effects with Olea europaea or its
actives were markedly diminished after 5 and 24 h. Ribeiro et
al. (1988) prepared an ethanol extract from the leaves of Olea
europea and this was administered orally. UV was collected at
15, 30, 45, 60, 120 and 240 min and shown to be no different
from placebo.
3.16.1.4. Conclusion Olea europaea. Leaf extracts evoked no
changes in diuresis or natriuresis. Whether their actives have
diuretic effects need further attention (i.e., oleanolic acid,
Alvarez et al., 2002, 2003; Somova et al., 2003 and polyphe-
nols, Singh et al., 2007). Studies should also address the effect
of differing doses.
3.17. Poaceae
3.17.1. Imperata cylindrica
3.17.1.1. Botanical description. Imperata cylindrica grows up
to 3 m high and has leaves that are roughly 2 cm wide, which
narrow to a point at their tips. The leaf edges are fine toothed and
embedded with sharp silica crystals. The dorsal surface of the
leaf is hairy whilst the ventral side is not. Imperata cylindrica is
a perennial rhizomatous grass native to south-east Asia. It can be
found in humid tropics, but has spread to warm temperate zones
worldwide. Indeed, in 1911 it was accidentally introduced to the
United States of America and can now be found in Florida, parts
of Alabama, Georgia, Louisiana, and Mississippi, and South
Carolina (King and Grace, 2000).
3.17.1.2. Ethnobotany. In Thailand and Vietnam, Imperata
cylindrica is deemed a medicinal plant by the Vietnamese Min-
istry of Health (Doan et al., 1992).
3.17.1.3. Diuretic activity. Sripanidkulchai et al. (2001) pre-
pared an aqueous extract from the root of Imperata cylindrica
and fed it to adult Sprague-Dawley rats. UV was collected for
4 h. No changes in UNa were observed and assessment of UV
showed a general retention of water (15.6 ml versus 26.3 ml [the
highest dose versus placebo]). The second study also used a root
extract. This was a randomised, placebo designed cross-over trial
in healthy volunteers (Doan et al., 1992). The study was con-
ducted in 40 subjects (2 cohorts of 20 subjects) and lasted 4
days. On the first day subjects reported to the laboratory and
provided blood samples for the measurement of haemoglobin,
creatinine, sodium and potassium. The second and fourth days
served as intervention days and the third was treated as a wash-
out day. On intervention days, subjects were monitored in the
test facility and dietary intake was restricted. UV was collected
every morning at 8 a.m. and prior to any intervention. It was
then collected for 24 h and measured after 14 h, respectively.
None of the interventions tested changed UV or UNa (or its
electrolytes).
3.17.1.4. Conclusion Imperata cylindrica. The present stud-
ies would seem to suggest that Imperata cylindrica, given
alone or in combination with other traditional medicines (Doan
et al., 1992), does not function as a diuretic. If anything,
Imperata cylindrica led to an acute decrease in UV and this
reflects a net retention of water by the body. How this extract
affects other cardiovascular functions is as yet unclear and
perhaps needs addressing to identify potentially undesirable
effects.
3.17.2. Zea mays
3.17.2.1. Botanical description. Zea mays grows annually and
has a distinctive growth form with the lower leaves being quite
broad (50–100 cm in length and 5–10 cm width). Its stems grow
to around 2 m high with many nodes and branching leaves. It is
under these leaves, close to the stem where the ears grow. The
ear, when ripe, is made up of edible grains that are organised in
rows around a white pithy substance. Each ear is estimated to
 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
contain something like 200–400 grains and is around 10–25 cm
in length. Zea mays was originally domesticated in Mesoamer-
ica and then spreading throughout the American continents
and the rest of the world following European contact with the
Americas.
3.17.2.2. Ethnobotany. Zea mays has a wide range of tradi-
tional uses and has been suggested to act as an anti-hypertensive,
to have anti-diabetic properties, to help in the treatment of renal
disease and to help pass stones from the kidney and urinary
tract, and to treat benign prostate hyperplasia, cystitis, gout and
nephritis (Ribeiro et al., 1988; Doan et al., 1992; Jouad et al.,
2001a; Maksimovic et al., 2004; Andrade-Cetto and Heinrich,
2005; Tahraoui et al., 2007).
3.17.2.3. Diuretic activity. Ribeiro et al. (1988) showed UV
was significantly increased 6 h after its ingestion (5.7 ml ver-
sus 1.6 ml [versus placebo]). Al Ali et al. (2003) looked at
effects after 24 h and failed to show any change in UV or
UNa as compared with placebo. It was, however, shown to
increase the excretion of potassium and chloride. Maksimovic
et al. (2004) determined effects of a 5 and 10% decoction of
Zea mays over an 8 day period. The average increase in UV
was 210% by the 5% decoction (versus 119% with placebo),
with the peak change being observed on day 1 (∼250%) and
being no different from placebo on day 4 (∼145%). Inter-
estingly, UV was unchanged with the 10% decoction. Mean
UNa was increased by both doses (94 and 85 mmol l−1 with 5
and 10% decoctions, respectively) as compared with placebo
(58 mmol l−1 ). These effects were seen after 1 day of treat-
ment and were generally sustained throughout the course of
the intervention phase. Both doses led to mean increases in
urinary potassium, urea and chloride (only seen with the 5%
decoction), glomerular filtration rate and urine pH. Plasma elec-
trolytes were also measured and decreases were found in sodium
and chloride after 8 days. No changes in serum potassium,
urea and creatinine were evident. In contract, only 1 human
study has been conducted (Doan et al., 1992). This was a ran-
domised, cross-over designed study in 40 volunteers. Urine was
collected for 24 h on 4 consecutive days—the first day was a
control recording; days 2 and 3 were intervention days; and,
the third day served as a wash-out between study days. Dis-
appointingly, no changes in UV and urinary electrolytes were
found.
3.17.2.4. Conclusion Zea mays. These studies do not seem
to support the notion of Zea mays being a diuretic. In ani-
mals, one study found no changes in UV or UNa (Al Ali et
al., 2003), another found positive effects that were only evi-
dent at low doses (Maksimovic et al., 2004) and the remaining
trial showed an increase in UV but did not assess changes in
UNa (Ribeiro et al., 1988). From reviewing these studies, it is
clear that the intervention period differed and this may provide
some explanation for inconsistencies between their findings.
However, the lack of effect in humans (see Doan et al., 1992)
raises questions as to the duration of intervention was suffi-
cient, whether the dose was high enough to elicit measurable
23
responses and whether the source had any bearing on the study
outcomes.
3.18. Urticaceae
3.18.1. Urtica dioica
3.18.1.1. Botanical description. Urtica dioica grows up to 2 m
high during the summer months and dies down during the win-
ter. It has leaves that are soft and serrated at their edges. They
are roughly 3–15 cm in length and have a cordate base and an
acuminate tip. Brittle, hollow, silky hairs cover the leaves and
stems and contain formic acid which serves as a defence. Urtica
dioica is an herbaceous flowering plant that is native to Africa,
Asia, Europe and North America.
3.18.1.2. Ethnobotany. This plant has traditional uses as an
anti-inflammatory, to stimulate the proliferation of human lym-
phocytes, and as a therapy against prostate enlargement (Tahri
et al., 2000; Yarnell, 2002). Urtica dioica is also reported to
be an anti-diabetic medicine in Mexico and Morocco (Jouad
et al., 2001a; Andrade-Cetto and Heinrich, 2005), as an anti-
hypertensive in Morocco (Jouad et al., 2001a, via promotion of
diuresis, Caceres et al., 1987] and to treat urinary ailments in
Guatemala (Caceres et al., 1987; Koch, 2001). In Turkey Urtica
dioica has a wide variety of additional uses that include anaemia,
pruritus, cancer, obesity, stomach aches and rheumatism (Uzun
et al., 2004).
3.18.1.3. Diuretic activity. Two studies have tested the diuretic
effects of Urtica dioica. In the first study (Caceres et al., 1987),
Urtica dioica was one of 67 plants investigated for its purported
diuretic effects (based on its frequency of use and its availabil-
ity). The authors, however, failed to show any change in UV
up to 6 h after administration and owing to this lack of efficacy
changes in urinary solute excretion were not tested.
The second study was in anaesthetised rats (Tahri et al., 2000).
Blood pressure was measured in the femoral artery and the blad-
der was cannulated for urine collection. A placebo group was not
included and so changes were compared to the baseline. Urtica
dioica was infused for 60 min at doses of 4 and 24 mg−1 kg−1
and decreased arterial blood pressure by 17 and 43 mmHg,
respectively (from 114 mmHg). The change at the highest dose
being not too dissimilar to that achieved with 2 mg−1 kg−1 of
furosemide (−31 mmHg). Concurrent increases in urinary flow
and UNa were also documented. Again, the highest dose pro-
ducing similar increases in urinary flow (+9.1 ␮l min−1 versus
9.6 ␮l min−1 from a baseline of ∼11 ␮l min−1 [highest dose of
Urtica dioica versus furosemide]) and sodium excretion (+1.0
and 1.1 ␮Eq min−1 ) to that of furosemide. Increases in both
parameters were seen at the lowest dose, but they were less
marked (+1.2 ␮l min−1 and 0.2 ␮Eq min−1 , respectively). This
data would suggest that Urtica dioica, when directly infused,
has dilatatory effects on arterial tone and acts as a diuretic and
natriuretic.
3.18.1.4. Conclusion Urtica dioica. Based on this evidence,
Urtica dioica would seem to act as a diuretic/natriuretic when
24 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
given intra-venously. When high doses were given orally
(1 g kg−1 ) no effect was found, however. Whether changes in
the excretion of UNa were changed in this latter study remain
unclear. At the present time this data would not seem to support
the use of Urtica dioica as a traditional diuretic and there is a
need for further studies.
3.19. Zygophyllaceae
3.19.1. Tribulus terrestris
3.19.1.1. Botanical description. Tribulus terrestris is an herba-
ceous perennial plant growing as a summer annual in colder
climates. Its stems branch from its crown to a width between
10 and 100 cm, and are usually flat in appearance. Its leaves
are pinnate and quite short (∼0.5 in length). Tribulus terrestris
is characterised by small (4–10 mm wide) yellow petal flow-
ers and thorny fruits. These latter fruits yield 4–5 seeded nuts
which are hard and have 2 sharp spines (10 mm in length by
roughly 5 mm in width). Tribulus terrestris is widely distributed
in Africa, Southern Europe, China, Japan, Korea and western
parts of Asia (Al Ali et al., 2003; Sharifi et al., 2003).
3.19.1.2. Ethnobotany. In Ayurvedic medicine, the fruits of
Tribulus terrestris are recommended for the treatment of urinary
disorders and in traditional Chinese medicine it has been used as
an anti-hypertensive, coronary heart disease and to treat erectile
dysfunction by increasing serum testosterone levels (Sharifi et
al., 2003). It is also suggested to stimulate melanocyte prolif-
eration and therefore is a putative treatment for vitiligo and it
is reputed to have anti-bacterial and cytotoxic activities (Singh
and Sisodia, 1971; Al Ali et al., 2003).
3.19.1.3. Diuretic activity. In anaesthetised dogs, Singh and
Sisodia (1971) tested the effects of an ether and aqueous extract
from the fruit of Tribulus terrestris. Urine flow was significantly
increased by the ether extract (37–52 ml [versus baseline]) but
not by the aqueous extract. The ether extract was also shown to
increase glomerular filtration (as shown by a significant increase
in creatinine clearance). It did not have any effect on urinary
chloride and changes in UNa were not measured. Al Ali et al.
(2003) tested the effect of an aqueous Tribulus terrestris decoc-
tion prepared from its fruit and leaves. Urine was collected for
the 24 h after administration and shown to increase UV (5.6 ml
versus 16.2 ml) and UNa (0.5 ml versus 0.7 mEq l−1 ) compared
with placebo. These effects were similar to responses achieved
with a 120 mg kg−1 dose of furosemide (15.6 ml 24 h−1 and
1.3 mEq l−1 24 h−1 ). The authors showed that Tribulus terrestris
also significantly increased potassium and chloride excretion.
Tribulus terrestris was then applied to the Guinea pig ileum
which led to dose-wise contractions. Such an effect on ureter
tone was hypothesised as being capable of propelling stones
from the urinary tract.
3.19.1.4. Conclusion Tribulus terrestris. These studies show
that Tribulus terrestris acts as an aquaretic as it only increased
UV. Whether it has a natriuretic effect remains to be confirmed
as one study did not investigate this effect whereas the other
showed an increase in UNa that would seem to be around half
that seem with a clinical diuretic.
4. Discussion
4.1. Future needs for this area of research
Table 5 shows that of the extracts reviewed the majority have
been performed in conscious animals and relatively few have had
their efficacy confirmed in humans. This is one consideration
that we do not acknowledge in our efficacy rating. In fact, only
8 extracts have been tested in a human clinical trial and they
seem to generally support findings in animals. However, this is
clearly one area that needs further investigation as findings in
animals need to be translated to humans in order for a natural
extract to be recommended for traditional use as a diuretic.
The design of trials also needs some attention. Some extracts
may appear to be potentially interesting, but it must be pointed
out that not all trials have been designed in the same manner.
Some may be criticised for lacking a placebo control group or
comparison with a known diuretic. Other considerations that
need to be mentioned are that the type of extract tested was
not always the same (i.e., seed, fruit, and leaves) and this can
influence recorded responses. Some studies failed to measure
UV and UNa and this missing information makes it difficult to
determine whether the extract does act as a diuretic or not. There
was also some variation in the duration and doses used, which
again makes comparisons between trials difficult. A further issue
that needs to be addressed is whether some of these extracts are
safe for human consumption (Foote and Cohen, 1998) when
taken alone or with other foods or drugs. Studies also lack
information on the site of action within the kidney (Materson,
1983; Puschett, 1994) and what effects they have on the
vasculature.
4.2. Limitations
The current article only deals with articles published in
English and this ignores a large volume of studies published
in other languages. In assessing diuresis our criteria were that
urine volume and UNa had to change concurrently and that there
had to be multiple publications in order for it to be considered
potentially interesting. Of course by doing so we ignore those
single studies that report positive effects, however, we have cap-
tured the design characteristics and responses in such studies (see
Tables 2–5) but feel that the lack of clinical trials did not warrant
further attention. The present format will permit their inclusion
should new evidence arise in the hear future. Furthermore, we
used combined changes in UV and sodium excretion to indicate
efficacy. The rationale for doing so is that these measures mean
it is possible to make comparisons with diuretic drugs used in
a clinical setting. Such comparisons enable researchers to draw
conclusions about the physiological relevance of such extracts
(i.e., could changes be used and make a significant difference?)
and to draw conclusions about how they act within the kidney
(i.e., do they have the same effects on the composition of urine
as clinically used diuretics?).
Table 5
Summary of those studies (where there was more that one) and effects on urinary volume (UV) and urinary sodium excretion (UNa)
Extract Study model Efficacy rating Comments

Human (UV/UNa) Animal Conscious Animal Anaesthetised

(UV/UNa) (UV/UNa)

Aerva lanate +ve/– (Udupihille and +ve/– (Selvam et al., Low Studies suggest Aerva lanate might work
Jiffry, 1986), 0/0 2001) as a diuretic with no effect on natiuresis.
(Goonaratna et al., Although, this latter effect needs further
1993) corroboration in controlled human
intervention trials
Allium sativum +ve/– (Ribeiro et al., +ve/– (Sharafatullah et Low Most studies have been conducted in
1988) al.,1986), 0/0 (Pantoja et acute animal studies and show no real

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

Elephantopus scaber 0/0 (Laranja et al., 0/– (Poli et al., 1992)
1991)
Foeniculum vulgare 0/0 (Caceres et al., 1987),
+ve or 0/+ve or 0 (El
Bardai et al., 2001), +ve
or 0/+ve or – (Beaux et
al., 1997)
Fraxinus excelsior 0/0 (Casadebaig et al.,
1989), +ve/+ve (Eddouks
et al., 2005)
Hibiscus sabdariffa –/+ve +ve/+ve (Caceres et al.,
(Herrera-Arellano et 1987), +ve or 0/–
al., 2004) (Onyenekwe et al., 1999)
Imperata cylindrica 0/0 (Doan et al., 1992) −ve/0 (Sripanidkulchai et
al., 2001)
Olea europaea 0/– (Ribeiro et al., 1988),
0/– (Somova et al., 2003)
al., 1996), 0/0 (Pantoja et
al., 1991)
0/– (Odigie et al., 2003)
effects. Such evidence does not seem to
warrant further trials at the present time
Low The single study in humans showed little
effect on diuresis and natriuresis
although questions still remain relating
to the effect of higher doses
Medium Evidence for a diuretic effect with
Foeniculum vulgare seems mixed at the
present time and this relates to a number
of factors that have contributed to these
studies, including: dose; the animal
model used; the method and time at
which diuresis was measured; and, the
route of administration
Medium These studies are conflicting and require
further clarification. Such studies need to
construct dose-response curves;
determine the effect of different extract
preparations; and, account for the
possible effect of differing animal
models
Medium This evidence is again mixed and studies
are needed to assess diuretic and
natiuretic effects are measured
concurrently, and the effect of acute and
chronic ingestion of Hibiscus sabdariffa
Low Imperata cylindrica would not seem to
act as a diuretic as it had no effect on
diuresis or natriuresis
Low Studies have only assessed urinary
output and shown no effect. These have,
however, not determined effects on
urinary sodium excretion or the effect of
differing doses

25
 26
Table 5 (Continued )
Extract Study model Efficacy rating Comments

Human (UV/UNa) Animal Conscious Animal Anaesthetised

(UV/UNa) (UV/UNa)

Orthosiphon stamineus 0/0 (141) +ve/0 (Beaux et al., Low Only one study showed an increase in
1999), 0/0 (Olah et al., urinary volume with this extract and the
2003), 0/0 (Englert and remainder showed little effect, which
Harnischfeger, 1992) suggests Orthosiphon stamineus does not
have diuretic capabilities
Petroselinum sativum +ve/– (Kreydiyyeh and Medium The current evidence is quite positive
Usta, 2002), +ve/– with all studies showing an improvement

C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31

(Ribeiro et al., 1988), in urinary output. However, only one
+ve/+ve (Lahlou et al., study measured urinary sodium excretion
2006) and this should be confirmed in further
studies to suggest its use as a natural
diuretic
Spergularia purpurea +ve/+ve (Jouad et al., High Both studies showed promising effects
2001c), +ve/+ve (Jouad et on urinary output and sodium excretion.
al., 2001b) These effects may be explained by the
flavanol content of Spergularia
purpurea. Further studies are now
needed in humans
Taraxacum officinale 0/+ve (Hook et al., 1993), Low Taraxacum officinale is not a promising
0/0 (Racz-Kotilla et al., diuretic owing to its lack of concurrent
1974) effects on urinary excretion. However,
studies can be criticised for their design
and lack of comparison and so they do
not fully address the issue of whether
Taraxacum officinale is or is not a
diuretic
Tribulus terrestris +ve/+ve (Al Ali et al., +ve/– (Singh and Sisodia, Medium Only one study shows Tribulus terrestris
2003) 1971) to have a natriuretic effect. This needs to
be confirmed in order to suggest its use
as a natural diuretic
Urtica dioica 0/– (Caceres et al., 1987) +ve/+ve (Tahri et al., Low This evidence here was judged as being
2000) low as no effect was seen in conscious
animals when Urtica dioica was given
orally. Studies are now needed to clarify
diuretic status of this extract
Zea mays 0/0 (Doan et al., 1992) 0/0 (Al Ali et al., 2003), Low The main finding here is a lack of effect
+ve/– (Ribeiro et al., in humans with mixed effects being seen
1988), +ve or 0/+ve in conscious animals. The effect of
(Maksimovic et al., 2004) higher doses was not rigorously tested
and this may be considered in future
human trials
Genus Cecropia (Cecropia
leucocoma and Cecropia
pachystachya)
Genus Cucumis (Cucumis melo and
Cucumis trigonus)
Genus Equisetum (Equisetum
bogotense, Equisetum fluviatile,
Equisetum giganteum, Equisetum
hiemale var. affine and Equisetum
myriochaetum)
Genus Lepidium (Lepidium
latifolium and Lepidium sativum)
Genus Phyllanthus (Phyllanthus
amarus, Phyllanthus
corcovadensis and Phyllanthus
sellowianus)
Genus Sambucus (Sambucus
mexicana and Sambucus nigra)
Responses are shown as being indifferent (0), significantly increasing (+ve) or decreasing (−ve). ‘–’ indicates that this was not measured. A rating of low, medium or high was assigned to studies and is used as a
representative measure of efficacy for particular extracts. Please refer to Tables 2–4 for an over-view of the study designs.
+ve/+ve (Lemus et al.,
1996)
+ve/+ve (Srividya and
Periwal, 1995)
+ve/– (Ribeiro et al.,
1988), 0/0 (Consolini and
Migliori, 2005)
+ve/+ve (Naik et al.,
1981)
+ve/+ve (Perez Gutierrez
et al., 1985)
+ve/0 (Navarro et al.,
1994), +ve or 0/+ve
(Maghrani et al., 2005b)
+ve/– (Ribeiro et al.,
1988), +ve/+ve
(Hnatyszyn et al., 1999)
0/0 (Caceres et al., 1987),
+ve/+ve (Beaux et al.,
1999)
Low Two species from the Genus Cecropia
were tested and provided mixed results.
Studies now need to repeat these
experiments to confirm the reported
effects
+ve/– (Singh and Sisodia, Medium The genus Cucumis seems to have
1970) diuretic capabilities. What is still in
question is whether it has natriuretic
effects
High The present evidence seems very
promising as effects have been seen in
humans and conscious animals and with
a wide variety of species from this genus
Medium These studies assessed changes acutely
C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
and chronically which makes their
comparison difficult. In addition to this,
the species differed and so studies are
needed to corroborate the current
findings
Medium The positive finding in humans seems
quite promising, however, this study was
not very well controlled. Studies
supporting an effect in humans is still
lacking and needs further investigation
Medium The European variety of Sambucus was
shown to act as a diuretic, whereas the
Mexican variety had no effects. However,
this was not the only difference as the
routes of administration differed, as did
the extraction methods. Thus, studies
confirming these findings are still needed
27
28 C.I. Wright et al. / Journal of Ethnopharmacology 114 (2007) 1–31
4.3. Conclusions
The current review is intended to provide an overview of the
current knowledge surrounding the use of herbal medicines as
diuretics. Indeed, there are more than a 100 extracts purport-
ing diuretic effects (see Table 1). From these we identified 21
extracts reporting concurrent effects on UV and UNa (Materson,
1983; Puschett, 1994; Foote and Cohen, 1998; Reyes and Taylor,
1999; Brater, 2000) and summarised these into 3-categories of
efficacy (high, medium or low; see Table 5). Extracts which we
regard as being potentially the most efficacious include species
belonging to the genus Equisetum and Spergularia purpurea
as having a high level of efficacy. Others include Foeniculum
vulgare, Fraxinus excelsior, Hibiscus sabdariffa, Petroselinum
sativum, and species belong to the genus Cucumis, Lepidium,
Phyllantus and Sambucus.
So what is the relevance of the current findings? We think the
present findings are of interest where herbal medicines are used
according to folklore. This is extremely important and poten-
tially very useful in countries that have limited resources for
the production and importation of modern medicines (Doan et
al., 1992) as they are accessible, cheap and applicable to the
local population. Our evidence is also of potential use in gen-
erating monographs and recommendations on their use (Englert
and Harnischfeger, 1992; Laranja et al., 1991). Another areas
where the current knowledge can be applied include the sub-
stantiation of marketed products (e.g., Urol mono® ; Leuschner,
1995), where the evidence can be quite limited.
The last issue for us to raise here is whether these results
are relevant to the wider population? We have already outlined
that diuretics are used to lower blood pressure in hypertension.
What we have not dealt with is the safety of natural medicines
when ingested for long periods, such as in the treatment of
chronic diseases like hypertension. Indeed, some of the extracts
we reviewed are recommended for acute disorders like urinary
tract infections rather than ongoing diseases (see Table 1). This
would also be required to compile monographs and recommen-
dations for such extracts. In a clinical setting, we speculate that
these extracts could, one day, offer another possible treatment
to existing drug regimes. One benefit could be the offer of a
more natural treatment or milder effects and fewer side effects.
Milder effects are quite interesting as they could offer a first line
of therapy or as an add-on to conventional medicines as their
lower potency could improve tolerance to more potent drugs.
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