A Review on Herbal Diuretics

 

N. Sirisha1*, M. Sreenivasulu1, K. Sangeeta1, G. Swarna Latha1, A. Lakshmi Devi1 and C. Madhusudhana Chetty2

1Department of Pharmaceutical Chemistry, Annamacharya College of Pharmacy, New Boyanpalli, Rajampet.

2Annamacharya College of Pharmacy, New Boyanpalli, Rajampet.

*Corresponding Author E-mail: sirisha.narapalli@gmail.com

 

ABSTRACT:

Herbs are highly esteemed source of medicine since ancient history. These plants and phytoconstituents are rich source of active principles which themselves are therapeutically active or act as lead compounds for the synthesis of newer drugs. These plants are relatively safe and are free from toxic effects and hence are considered as better choice to treat diseases, when compared to allopathic medicines. Such an example described is the use of herbs by the primitive folklore as diuretics. Diuretics increase the rate of urine flow and are used to adjust the volume and composition of body fluids in a variety of clinical situations. Hence,diuretics remain the cornerstone for the treatment of many pathological conditions. As we are back to herbals, the present article gives a brief review about some folklore herbs that are used as diuretics, which are proved to be effective in many investigations.

 

KEYWORDS: Herbs, diuresis, saluresis, natriuresis, flavanoids, saponins, alkaloids.

 


 

INTRODUCTION:

Diuretics are the drugs that increase the rate of urine flow and are used to adjust the volume and composition of body fluids in a variety of clinical situations including hypertension, heart failure, renal failure, nephrotic syndrome, glaucoma, hyperkalemia, bromide intoxication, anginal syndrome, epilepsy, migaraine and cirrhosis.1 They reduce the volume of extracellular fluid, enhance the urinary excretion of sodium chloride and increase the volume of urine excreted by the kidneys. These maintain adequate urinary volume in severe traumatic injuries or to reduce the concentration of toxic agent in the urine to minimise renal damage. Most diuretics block reabsorption of fluid at different sites like proximal tubule, loop of henle, distal tubule and collecting duct.2

The primary effect of these diuretics is to decrease the reabsorption of electrolytes from the filtrate and to increase water loss.

Diuresis can be achieved by:

·         By the direct action on the cells of nephron.

·         By directly modifying the content of the filtrate.

The primary action of most diuretics is the direct inhibition on Na+ transport at one or more major anatomical sites of the nephron, where Na+ reabsorption takes place.

 

Variety of factors contribute to the efficacy of a diuretic. The capacity of the Na+ reabsorbing sites and the anatomical site of action are the two major factors that affect the efficacy of a diuretic. Diuretics that act at site I(proximal tubule) act by inhibiting carbonic anhydrase may inhibit the reabsorption of about 20-25% of the filtered Na+ load, but are not highly efficacious. Diuretics that inhibit the reabsorption of Na+ at site II (loop of henle) are the most efficacious because absorption of upto 30% filtered Na+ load takes place at this site. Site III(distal tubule) and site IV(collecting duct) are responsible for only 5-8% and 2-3% of the filtered Na+ load and hence the diuretics acting at these sites are considered as relatively low efficacious.3

 

Loop diuretics act primarily on thick ascending loop of henle. As a result they inhibit the Na+/K+/2Cl- symporter in the luminal membrane, thereby inhibiting the transport of sodium chloride out of the tubule into the intestitial fluid. The increased Na+ ion that reaches the distal tubule results in increased loss of H+ and K+. Hence, these loop diuretics also result in acidification of urine. Loss of sodium ions is more significant. Frusemide is the best example of loop diuretic. Thiazides and the like diuretics act on distal tubule, where they decrease the absorption of Na+ and Cl- ions by binding to the Cl- site on the electroneural Na+/Cl- cotransport system and inhibiting its action.K+ loss is more significant,when compared to Na+ loss.These also alter Na+/K+ ratios. Some drugs are potassium sparing. Example of such a drug is Spironolactone, which is a mineralocorticoid, but is an aldosterone antagonist. It competes for aldosterone receptors in the cells of distal tubule. This drug-receptor complex does not attach to DNA, resulting in the inhibition of transcription, translation and production of mediator proteins. As a result, it inhibits Na+ retaining action of aldosterone,as a consequence Na+ excretion is increased whereas excretion of K+ ions is decreased. Hence,these diuretics are potassium sparing. These potassium sparing diuretics also impair Na+/H+ exchange, hence decrease H+ ions resulting in alkalinisation of urine. Some diuretics modify the contents of the filtrate. Such drugs either increase osmolarity or increases Na+ load. Such drugs produce diuretic effect by stimulating thirst and increase fluid intake. Such drugs are pharmacologically inert, act within the receptor, on those especially proximal tubule, distal loop of henle and collecting tubules since they are easily permeable to water.4 Some herbal diuretics produce diuresis by inhibiting the release of ADH(anti diuretic hormone) or by inhibiting the action of ADH on the uriniferous tubules. This is accompanied with an increase in specific gravity of the urine.6 Some induce diuresis  by stimulating the release of endogenous natriuretic peptide which promote sodium ions and water secretion.4,5

 

Diuresis in the body is regulated by ADH. ADH is an octapeptide secreted by neurohypophysis. Hypothalamic osmoreceptors, volume receptors in left atrium, ventricles and pulmonary veins regulate the rate of ADH release, which depends on body hydration.6

 

A number of synthetic drugs are available to induce diuresis to treat a variety of pathological conditions. However, these synthetic drugs are associated with a number of adverse effects such as electrolyte imbalance, metabolic alterations. Hence,there is a need for new diuretics with lower potential of adverse effects. As we are back to herbals, we consider plant based products which are considered as relatively safe. So, the present review gives a brief overview on the palnts which are investigated to possess diuretic activity.

 

SOME HERBAL DIURETICS:

Alangium salvifolium:

The plant Alangium salvifolium sub.sp.Hexapetalum is a small tree and shrub of family of Alangiaceae. Root, leaves, bark, fruits and seeds possess significant therapeutic value. It is used in the treatment of inflammation, hemorrhage and also as an antidote for several poisons.

Apart from these uses,the plant is also tested for diuretic activity.

 

Benzene and ethyl acetate root bark extracts of Alangium salvifolium were studied for such a purpose at a dose of 250 mg/kg b.w, frusemide at a dose of 20 mg/kg i.p., as standard, using albino rats as model animals. Results have shown that both the extracts exhibited diuretic activity as indicated by increase in total urine volume and electrolyte Na+,K+,Cl- in urine. Among both the extracts, ethyl acetate fraction showed higher activity.7 This shows that the phytoconstituents responsible for diuretic activity are better extracted in ethyl acetate. Phytochemical screening of both the extracts revealed the presence of flavanoids, alkaloids and steroids. As flavanoids are associated with diuretic activity,8 presence of these constituents in Alangium salvifolium justify its folklore diuretic activity.

 

Artemesia thuscula:

Artemisis thuscula Cav(syn:Artemisia canarensis Bess.) of family Asteraceae, is an aromatic ramified shrub. In the traditional system of medicine, this plant is used as hypoglycaemic, antidiarrhoeal, uricosuric, spasmolytic, tranquiliser, mosquito repellant and also as diuretic. The folklore diuretic activity of Artemisia was investigated using infusions of aerial parts of Artemisia at doses of 250,500,750 mg/kg b.w, using hydrochlorthiazide at doses of 10,25 mg/kg as standard and male albino rats as model animals. Total urinary volume, pH, density and urinary electrolyte concentration were determined.

 

Results have shown that dose 250 mg/kg exhibited significant increase in urine volume as well as ionic excretion in urine. In contrast, at higher doses, urinary electrolyte excretion is constant where as water excretion began to diminish, as shown by increased conductivity with increased concentration of electrolytes or decreased urinary volume. With respect to K+ excretion, doses of 250 and 500 mg/kg showed K+ saving effect which is comparable to that of hydrochlorthiazide. But the dose of 750 mg/kg exhibited an increase in K+ excretion.

 

All these show that Artemisia thuscula at lower dose exhibits diuretic as well as saluretic effect by inhibiting tubular excretion of water and sodium, whereas decrease in urinary volume without reduction in ionic concentration at higher doses is attributed due to the decrease in glomerular filtration rate,justified by the presence of essential oil contents in the plant. However, the diuretic activity is less than that of standard hydrochlorthazide.

 

Phytochemical screening of both the extracts revealed the presence of flavanoids, coumarins, essential oils, eudesmanolide, a sesquiterpene lactone.9 As flavanoids are associated with diuretic activity, presence of these constituents Artemisia justifies its folklore diuretic activity.

 

Balanites roxburghii:

Balanites roxburghii is a spiny, evergreen tree, belonging to the family Balanitaceae. In Ayurveda, it is indicated as anthelmintic, analgesic and also for the treatment of skin ailments in Unani system. It is reported to possess anti inflammatory, hepatoprotective, antinociceptive, antioxidant and hypocholesterolemic activity.

 

Balanites was also investigated for diuretic activity by ehanolic and methanolic extracts of leaves at doses of 100,300,1000 and 2000 mg/kg b.w using frusemide as standard and male albino rats as model animals. Results have shown that both the extracts are potent natriuretic buth weak diuretic. The lowest dose induced natriuresis but not diuresis, whereas highest dose induces both natriuresis and diuresis. Methanolic extract showed significant activity than ethanolic extract. The natriuretic effect suggests that the mechanism is due to the inhibition of Na+/K+/2Cl- symporter in the thick ascending loop of henle. The phytoconstituents present are alkaloids, glycosides, flavones, saponins. These constituents may contribute for the diuretic activity.10

All these justify its use as a folklore diuretic.

 

Camellia sinensis:

Camellia sinensis (L) O. Kuntz, belonging to the family Theaceae, is used by the traditional Sri Lankan physicians to promote urinary flushing as diuretic. Camellia sinensis contains methylxanthines of which caffeine is the most important.

 

For the evaluation of its folklore diuretic property, tea brew is made from tea powder by boiling in water and carrying further dilutions. Different doses of hot black tea brew (BTB) 84, 167, 501, 1336 mg/ml b.w are administered orally to the rat models using frusemide (13 mg/kg) as reference.

 

Results have shown that BTB induces diuresis in a dose dependent manner starting from the dose of 167 mg/ml. The diuretic effect had a rapid onset(2 hr), but relatively short duration of action(3 hr). This suggests that the active constituents responsible for diuretic activity are rapidly absorbed and undergo rapid metabolism. The urinary volume and urinary frequency have been increased, with an increase in Na+  but not that of K+. However the diuretic activity is much less compared to that of frusemide. All these suggests that Camellia sinensis is a mild to moderate diuretic with natriuretic effect. A possible mechanism in the diuretic activity of Camellia sinensis is that it induces diuresis by impairing pitutary release of ADH or by impairing the responsiveness of ADH to water resorption at the renal tubules.

 

The diuretic action is mainly due to the presence of caffeine, since decaffeination almost abolished its diuresis. Another mechanism of natriuretic effect of BTB is inhibition of Na+ reabsorption in the nephron by caffeine, also BTB increses glomerular filtration rate which is responsible for natriuretic effect.11

All these justify the use of Camellia sinensis as a diuretic in folklore medicine.

 

Elettaria cardamomum:

Elettaria cardamomum(syn:caradamom) is a perennial herb of family Scintaminaceae. It is used in the folklore system of medicine as carminative, stomachic, diuretic, abortifacient, antibacterial, anti viral, anti fungal and is also useful in the treatment of constipation, diarrhoea, epilepsy and CVS diseases.

 

Its folklore diuretic property was investigated using fruit extracts, frusemide (10 mg/kg) as standard and rats as model animals. Crude, petroleum spirit, chloroform, ethylacetate extracts of fruits were used for such a purpose. Results have shown that among all the extracts, the crude extract exhibited significant diuretic effect, with respect to increase in urinary volume as well as enhanced Na+ and K+ excretion. This is similar to that of frusemide. Hence, cardamom exhibits diuretic as well as saluretic activity similar in efficacy to frusemide, a loop diuretic, which acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle.

 

Phytochemical screening of extracts revealed the presence of alkaloids, flavanoids, tannins, saponins.12 As flavanoids and saponins are associated with diuretic activity,13 the presence of these constituents in the extracts justifies the diuretic activity of cardamom. However the specific constituent responsible for the diuretic action is not isolated in the investigation.

Thus the use of cardamom as diuretic in the folklore medicine is justified.

 

Carum carvi and Tenacetum vulgare:

The dried ripe fruits of Carum carvi (syn:Caraway) of family Apiaceae are used in the folk medicine as carminative and its aqueous extract is used as a tranquiliser, diuretic, emmenagogue, spasmolytic and aphrodisiac. The plant extract and the volatile oils are also used as anti ulcerogenic agents.

 

Tenacetum vulgare (syn:Tansy) is an herbaceous plant belonging to the family Asteraceae. Its folklore uses are as anthelmintic, antispasmodic, antidiabetic, diuretic and antihypertensive agent.

 

Both Carum carvi and Tenacetum vulgare were investigated for experimental evidence of diuretic activity. The diuretic activity has been determined by the aqueous extracts of dried fruits of Carum carvi and the leaves of Tenacetum vulgare at an oral dose of 100 mg/kg b.w and frusemide(10 mg/kg) as reference, using rats as model animals.

 

Results have shown that both the extracts at the given dose increased urinary volume, which is similar in profile to that of frusemide. Also,both the extracts exhibited natriuresis and kaliuresis, while frusemide increased urinary excretion of only Na+ and decreased K+. After 8 days of the treatment, all the three exhibited diuresis and natriuresis, whereas only Tenacetum induced kaliuresis. Tenacetum caused a significant increase in the urinary volume during the first hour of the treatment, whereas Carum has taken 4 hours to produce the same. Thus it could be said that among  Caraway and Tenacetum, Tenacetum is a faster acting diuretic when compared to Caraway. Thus from the pattern of aquauresis, natriuresis and kaliuresis, it could be concluded that both the extracts contains two types of active principles, one having frusemide like activity, natriuresis and the other contains a principle having thiazide like activity.

 

Caraway contains carvone, methanetriols, glucosides, limonene and Tansy contains flavanoids, polyphenols, thujones, polysaccharides.14 As flavanoids are associated with diuretic activity, the presence of these constituents justify its diuretic activity. However, the specific constituent responsible for diuretic activity is not isolated in the investigation. This confirms the use of Carum carvi and Tenacetum vulgare as diuretics in the folklore system of medicine.

 

Rosamarinus officinalis, Centaurium erythraca:

Rosamarinus officinalis(syn:Rosemary) is a plant belonging to the family Labiatae. It is used as a folklore medicine in the treatment of urinary ailments. Centaurium erythraca L. of Gentianaceae family, is used in the pharmacoepias of about 23 different countries. Its decoction is used as a traditional medicine in the treatment of urine retention as diuretic and abdominal colic.

 

Both the aqueous extracts of Rosemary and Centaurium were evaluated for their folklore diuretic activity in adult male Wistar rats. Both the extracts were given at the doses of 8% and 16% .

 

Results have shown that both the extracts at 8% dose exhibited increased urinary volume on the fifth day of the treatment. With respect to electrolyte excretion, both the extracts at the dose of 8% exhibited a significant increse in urinary excretion of Na+,K+,Cl+  ions from the fifth day of the treatment. The aqueous extract of Rosemary at the dose of 16%  did not show any increase in urinary volume, but showed a significant increase in urinary excretion of Na+,K+,Cl+ ions after five days of the treatment, whereas Centaury extract at the same dose exhibited a significant increase in electrolyte excretion after five days of the treatment. Centaurium contains flavanoids, sapononis and organic acids which are responsible for diuretic activity.15 Rosamarinus contains volatile oil, a triterpenoid rofficerone, caffeic acid, chlorogenic acid and rosamaric acids.16 As triterpenoids and caffeic acids are associated with diuretic activity,17 presence of these compounds in Rosamarinus justify its diuretic activity. These reveal that both Rosemary officinalis and Centaurium erythraca are delayed diuretics as well as delayed saluretics and delayed kaliuretics.

 

Centratherum anthelminticum:

The plant Centratherum anthelminticum(L)Kuntz is a sacred plant in Hindu medicine, used as a remedy for leucoderma and other skin diseases. The seeds are used as anthelmintic, purgative and also for asthma and kidney troubles. The seeds are also said to possess tonic, stomachic and diuretic properties.

 

In order to confirm its folklore diuretic property, different extracts - petroleum ether, alcohol and chloroform extracts of seeds of Centratherum anthelminticum in a dose of 200 mg/kg b.w, were tested in rats, using spironolactone, a potassium sparing diuretic, as standard at the dose of 20 mg/kg.

 

The experiments conducted revealed that among all the three extracts, chloroform and alcohol extracts exhibited potent diuretic activity. These extracts promoted Na+ excretion but decreased K+ excretion. This K+ sparing property of Centratherum extracts reveals that its mechanism of action is similar to that of potassium sparing diuretic ‘Spironolactone’. Phytochemical tests revealed the presence of glycosides and sterols in petroleum ether extracts; sterols and alkaloids in chloroform extract and alcohol extracts showed the presence of flavanoids, sterols, phenolic compounds and alkaloids.18 From these phytochemical tests,it can be said that chloroform extract exhibits diuretic activity due to the presence of  alkaloids and not by sterols because petroleum ether extract containing sterols had not shown any diuretic activity. As flavanoids are associated with diuretic activity, the presence of these compounds in the alcohol extract justify the diuretic activity of Centratherum anthelminticum.

Thus, from the above results, the use of Centratherum anthelminticum as diuretic in folklore medicine is justified.

 

Chamaemelum nobile:

Chamaemelum nobile is a plant belonging to the family Asteraceae.The diuretic activity of Chamamelum nobile was investigated using the aqueous extract of the plant at the dose of 200 mg/kg/hr b.w per hour, given intravenously using adult male wistar rats as model animals and frusemide (0.1 mg/kg-1hr-1) as reference standard.

 

Results have shown that the i.v perfusion of the aqueous extract of Chamaemelum nobile at the given dose 200 mg/kg/hr exhibited a significant increase in urinary volume three hours after the start of perfusion and lasted for about three hours of perfusion period. The dose also produced a significant increase in urinary excretion of sodium, potassium and chloride ions after 2 hours of the perfusion. However, this diuretic, saluretic and natriuretic profile of Chamaemelum nobile was less than that of standard drug, frusemide that was chosen for the experiment. The mechanism is mainly due to the inhibition of renal Na+K+ pump, which leads to reduction of reabsorption of renal Na+,K+ and osmotic water flow into the lumen. This diuretic and electrolyte excretion, ultimately reduces arterial blood pressure.

 

Phytochemical screening revealed the presence of flavanoids in the aqueous extract.19 Thus, presence of these constituents justifies  the observed diuretic effect and hence the hypotensive activity which was also investigated.

Thus, the use of Chamaemelum nobile as diuretic in the folklore practice is justified.

 

Cleome rutidosperma:

Cleome rutidosperma is a small herb belonging to the family Capparidaceae. In the folklore practice, its roots and seeds are used as stimulant, anthelmintic and antiscorbutic.

Cleome is investigated for diuretic activity using the aqueous extract of the plant at oral doses of 400 and 600 mg/kg b.w in rats and using frusemide as reference at 20 mg/kg administered intraperitoneally.

 

Results have shown that both the doses exhibited a significant increase in urinary sodium, potassium and chloride ions excretion, with maximum at the dose of 600 mg/kg. At this dose, the effect was compared to that of standard, frusemide.However, only the higher dose produced an increase in urinary volume. Thus Cleome rutidosperma at the dose of 600 mg/kg is a potent diuretic and saluretic as frusemide.

 

Phytochemical screening revealed the presence of tannins, saponins, flavanoids and carbohydrates in the aqueous extract of Cleome rutidosperma.20 Presence of flavanoids and saponins in the extract justifies the diuretic activity of Cleome rutidospema.

Hence, the use of Cleome rutidosperma as diuretic in folklore medicine is justified.

 

Cocculus hirsutus:

Cocculus hirsutus(L.)Diels, of family Menispermaceae, is used as a tribal medicine in India for the treatment of constipation and kidney problems. The aqueous extract of aerial parts and roots are used for the treatment of rheumatism. Apart from these uses, Cocculus is used as diuretic also as a laxative in the folklore medicine.

 

One of its folklore activities, diuretic activity was investigated using aqueous extract of aerial parts of Cocculus hirsutus at oral doses of 100 and 200 mg/kg b.w and urea(750 mg/kg) in saline as standard, using male Wistar rats as model animals.

 

Results have shown that both the doses produced an increase in urine volume and Na+,K+ excretion in urine in a dose dependent manner. Phytochemical screening of the aqueous extract revealed the presence of alkaloids, triterpenes and lignans.21 These constituents may singly or together may be responsible for the diuretic effect of Cocculus hirsutus.

Hence, it can be said that Cocculus hirsutus is good diuretic as well as saluretic. Hence, its use in folklore medicine is justified.

 

Coriandrum sativum:

Coriandrum sativum (syn:coriander) of family Umbelliferae is used for its healing properties.

It is traditionally used in the treatment of dyspepsias, diarrhoea, hypertension. It is also used as refrigerant, tonic, diuretic, anti inflammatory and as antiseptic. The oil is also used in the treatment of rheumatism and neuralgia and as antidiabetic.

 

The folklore diuretic activity of coriander was evaluated by using the aqueous extract of seeds, given as intravenous administration at doses of 40 and 100 mg/kg b.w to Wistar rats. Frusemide is used as standard at the dose of 10 mg/kg.

 

Results have shown that the aqueous extract exhibited a significant increase in diuresis, but is about 21 times less than that of frusemide. Both the doses produced a significant increase in natriuresis, kaliuresis and chlorouresis in a dose dependent manner, with utmost increase as seen at the dose of 100 mg/kg. Natiuretic effect of Coriandrum sativum at the dose of 100 mg/kg is about three times higher than that of lower dose, but is about 10 times lesser than that of frusemide. With respect to kaliuretic effect, both the doses exhibited a significant increase in urinary excretion of K+, but is lesser than that of frusemide. Similarly, excretion of chlorine is higher at the higher dose, but is lesser than that of frusemide. All these suggest that Coriandrum is a good diuretic, saluretic but is lesser efficacious than frusemide. The Na+/K+ index at the higher dose of aqueous extract is less than that of frusemide.22 As it is potassium sparing when compared to frusemide, it could be suggested that it could not be a diuretic as hydrochlorthiazide. However, it could not be a potassium sparing diuretic, since there was kaliuretic effect along with saluretic effect, which could not be the action of potassium sparing diuretic. Therefore, it could be suggested that the mechanism of action is similar to that of frusemide, a loop diuretic, where it inhibits Na+/K+/2Cl- symporter in the thick ascending loop of Henle.

 

Coriandrum, along with volatile oil constituents also contains flavanoids, caffeic acid, sesquiterpene lactones, triterpenes, coumarins and carotenoids.23 Since flavanoids, caffeic acid derivatives and coumarins are associated with diuretic activity, the presence of these constituents in the aqueous extract of Coriandrum justifies its diuretic activity.

By these, the use of coriander as a folklore diuretic is confirmed.

 

Cynodon dactylon:

Cynodon dactylon Pers.(syn:Bermuda grass) belonging to the family Graminae, is a creeping grass, available throughout the year. It is used as fodder for animals and is also considered as a holy plant in India. The juice of the plant is also used as astringent for cuts and wounds. The plant is a traditional remedy for cancer, calculus, cough, hypertension, snake bites, gout and rheumatic disorders and is also used as diuretic, antiemetic.

 

The folklore diuretic activity of Cynodon was investigated using the aqueous extract of root stalk at the doses of 100,250,500 and 750 mg/kg b.w, using frusemide(100 mg/kg) as standard and male albino rats as model animals. The diuretic activity of Cynodon was determined at the above doses, wherein the total urine volume and Na+,K+,Cl+ were measured.

 

The results have shown that there is significant increase in urine volume, beginning from the smaller dose(100 mg/kg) to the larger dose(750 mg/kg). Besides, sodium and chloride ions excretion also followed the same pattern, but this is not so in the case of potassium ions. Although,excretion of K+ was also increased, this was not much effective when compared to that of sodium and chloride ions. Thus Cynodon dactylon is a good diuretic, with saluretic effect similar to that of frusemide. Its saluretic and kaliuretic effect suggests that its mechanism of action is similar to that of frusemide, a loop diuretic, where it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle.

 

Phytochemical screening of the aqueous extract showed the presence of flavanoids and glycosides.24 As flavanoids are associated with diuretic activity, the presence of these constituents justifies the diuretic activity.

Thus,the use of Cynodon dactylon as diuretic in the folklore medicine is confirmed.

 

Erica multiflora:

Erica multiflora is used as a traditional medicine to cure many renal ailments in Morocco. It is reported to be used as a diuretic in Morocco.

The diuretic activity was investigated using the aqueous extract of Erica mutiflora flowers at the doses of 125,250,500 mg/kg b.w and frusemide(15 mg/kg b.w) as reference and adult male Wistar rats as model animals.

Among the three doses, smaller dose of the extract had not produced any significant increase in urine output, but urine output continued to be stimulated from the next two doses. The amount of urinary excretion of both Na+ and K+ started increasing in a dose dependent manner, a higher natriuretic and kaliuretic effect seen at the highest dose. Also, there was slight acidification of urine.25 These saluretic, kaliuretic, diuretic and acidification of urine suggests that its mechanism of action is also similar to that of frusemide, a loop diuretic, acting by inhibiting the Na+/K+/2Cl- symporter in the thick ascending loop of Henle.

Thus, the use of Erica multiflora as a diuretic in the folklore system is justified.

 

Erythrina indica:

Erythrina indica is a middle sized quick growing tree of family Fabaceae. It is used as a folklore medicine to cure many ailments. It is also used traditionally for the treatment of dysentry, convulsions and also used as a diuretic and laxative.

 

Inorder to justify its folklore diuretic activity, many researches were carried out. The diuretic activity of ethanol, chloroform and ethyl acetate extracts of leaves of Erythrina indica Lam. was studied and the activity was compared to that of frusemide. All the extracts were administered to male albino rats at dose ranges of 250mg/kg respectively and frusemide(20 mg/kg i.p) as standard.

 

The results have shown that all the three extracts at the dose range of 250 mg/kg exhibited a significant increase in urine volume, an increase in the urinary excretion of Na+,K+ and Cl- ions. This shows that Erythrina indica us a good diuretic, saluretic as well as kaliuretic. Phytochemical screenung of the extracts showed the presence of flavanoids.26 As the flavanoids are associated with diuretic activity, the presence of these constituents in the extract of Erythrina indica justifies its diuretic activity.

This confirms the use of Erythrina indica as a diuretic in folklore medicine.

 

Foeniculum vulgare:

Foeniculum vulgare, of family Umbelliferae, is used as diuretic, stimulant, digestant and also as febrifuge.

The diuretic activity of Foeniculum vulgare was investigated using the ethanolic extracts of dried ripe fruits at the dose of 500 mg/kg b.w in male Wistar rats using urea(960 mg/kg) as reference.

 

Results have shown that the plant induced diuresis at the given dose and the diuretic effect lasted for about 24 hours. This shows that Foeniculum is a long acting diuretic agent and it is equipotent to urea at that dose. Furthermore, the increase in urine volume is not associated with increased sodium or potassium ion excretion. Hence its mechanism of action is said to be osmotic mechanism similar to that of urea.

 

All these justify that Foeniculum is a long acting diuretic, free of saluretic and kaliuretic effects. Though its mechanism is similar to that of urea, it is equipotent to urea at small dose 500 mg/kg compared to that of urea 960 mg/kg.

 

Phytochemical screening of the extract showed the presence of sterols, triterpenes, flavanoids, coumarins and volatile oils.27 As flavanoids are associaated with diuretic activity, the presence of these constituents in the extracts justifies its diuretic activity.

All these confirm the use of Foeniculum vulgare as diuretic in the folklore medicine.

 

Hygrophila auriculata:

Hygrophila auriculata (Schum) Heine (syn:Asteracantha longifolia Nees, Barleria auriculata) of family Acanthaceae is described in Ayurvedic system of medicine as Seethaveryam, mathuravipaka. In Ayurveda, it is prescribed for the treatment of diabetes and dysentry. The plant is rich in flavanoids and terpenoids. Flavanoids that were reported to be present are apigenin-7-O-glucuronide,apigenin-7-O-glucoside. As it is rich in flavanoids, Hygrophila auriculata was evaluated for its diuretic potential.

 

Its diuretic activity was investigated using petroleum ether, chloroform, ethyl acetate and n-butanol and alcohol at the dose of 200 mg/kg respectively.

 

Resullts have shown that n-butanol fraction induced strong diuresis with strong natriuretic and kaliuretic profiles. This pattern was similar to that of frusemide. Alcoholic extract together with diuretic effect also exhibits natriuretic and kaliuretic effect but the extraction of chloride ions was not significant. The Na+/K+  ratio was more than that of frusemide indicating much more weak kaliuretic profile or potassium property. This may be due to the presence of other polar constituents in the alcohol extracts which could interfere with the diuretic activity of the extract.

 

Phytochemical screening of the alcoholic exracts revealed the presence of flavanoids, terpenoids and tannins where as n-butanol fraction revealed the presence of triterpenoids.28 As flavanoids and tritepenoids are associated with diuretic activity, it could be suggested that these constituents may contribute to the diuretic activity. As n-butanol fraction also exhibited the diuretic activity, presence of triterpenoids in this extract also justifies the diuretic activity.

Hence, the use of Hygrophila auriculata as diuretic in the folklore medicine is confirmed.

 

Ipomea aquatic:

Ipomea aquatica(syn:Ipomea reptans) of family Liliaceae, is an ancient plant used in the treatment of various ailments. It is used by the primitive folklore as diuretic, aphrodisiac and also used in the treatment of debility and diabetes.

The diuretic activity of Ipomea aquatica was investigated using the methanolic extract of the whole plant at doses of 250 mg/kg and 500 mg/kg b.w, using frusemide(500 mg/kg b.w) as standard and albino mice as model animals.

The results have shown that methanolic fraction exhibited diuretic activity in a dose dependent manner, higher dose(500 mg/kg) exhibited maximum activity. The diuretic activity at this higher dose is higher than that of frusemide. Furthermore, the diuretic activity is more at the first hour indicating that Ipomea is a rapid acting diuretic. Furthermore, saluretic and kaliuretic effects higher than that of frusemide suggest that it is potent in action than frusemide.

 

Thus Ipomea aquatica is a potent diuretic, saluretic and kaliuretic than standard well used frusemide, a loop diuretic. Thus, its mechanism of action is said be that of loop diuretic, where it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle, which is responsible for its diuretic, saluretic and kaliureic effects.

Phytochemical screening of the aqueous extract revealed the presence of flavanoids, alkaloids, myrcetin, kaempferol, luteolin and also oxalic acid.29 As flavanoids are associated with diuretic activity, the presence of these constituents in Ipomea justifies its diuretic activity.

All these justify the use of Ipomea aquatica as diuretic by the folklore people.

 

Lagenaria sicerania:

The plant Lagenaria sicerania (syn:Bottle gourd), belonging to the family Cucurbitaceae is traditionally used as diuretic, cardiotonic and cardioprotective.The plant is rich in vitamin B complex, vitamin C, β-carotene, cucurbitans and fibers.

The folklore diuretic activity of was investigated using 90% methanolic extract of fruits and fresh juice  of Lagenaria at the doses of 100,200 mg/kg b.w, using frusemide (20 mg/kg) as standard and adult Wistar rats as model animals.

 

Results have shown that Lagenaria sicerania exhibited dose deoendent diuresis with maximum activity seen at oral dose of 200 mg/kgby boyh juice extract and fruit extracts. Furthermore, both act as hypernatraemic, hyperchloremic and hyperkalaemic at this dose, which can be compared to that of frusemide.30 This also suggests that its mechanism of action is similar to that loop diuretic, where it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle, which is responsible for its diuretic,saluretic and kaliureic effects.

Lagenaria is rich in steroidal saponins31 whose presence contributes to the diuretic activity. All these support the folklore diuretic activity of Lagenaria sicerania in folklore medicine.

 

Lagerstroemia reginae:

Lagerstroemia reginae, known as pride of India or Queens Crape myrthe, belongs to the family Lythraceae. In the trditional system of medicine, its bark decoction is used for the treatment of diarrhoea. Roots have been used for stomach ailments. Old leaves and fruits possess glucose lowering effect. Leaves are used as diuretic.32

 

Diuretic acticvity of Lagerstroemia reginae was investigated using the aqueous extract of leaves at doses of 500,1000 mg/kg b.w, using frusemide as standard and male Wistar rats as model animals.

 

Results have shown that the aqueous extract of Lagerstroemia reginae produced an increase in urinary output and urinary excretion of Na+,  K+ and Cl- ions in a dose dependent manner. This effect is similar to that of frusemide, which is taken as the reference diuretic. Moreover, the extract increased urinary excretion of sodium ions to a greater extent than potassium ions. This higher natriuretic effect than kaliuretic effect suggests that its mechanism of action resembles to that of loop diuretic where it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle. This also shows that Lagerstroemia reginae is a good diuretic with less hyperkaelemic side effects.

Phytochemical screening of aqueous extract revealed the presence of flavanoids,33 which may contribute to the diuretic activity.

Thus,the diuretic activity of Lagerstroemia reginae was confirmed.

 

Lepidium sativum:

Leppidium sativun is an erect, herbaceous plant of family Cruciferae. The plant is said to possess various  medicinal properties. The seeds are used as diuretic, tonic, demulcent, galactogogue and emenagogue.

 

The diuretic activity of Lepidium sativum was investigated using the aqueous and methanolic extracts of Lepidium seeds, at oral doses of 50 and 100 mg/kg b.w using adult male rats as model animals and hydrochlorthiazide(10 mg/kg) as reference.

 

The results have shown that both the extracts exhibited a significant increase in urinary volume in a dose dependent manner, with maximum output at the dose of 100 mg/kg. However, this value is more for aqueous extract when compared to methanolic extract. Urinary excretion of sodium ions also increased in a dose dependent manner with maximum at the dose of 100 mg/kg of aqueous extract. Furthermore,in case of methanolic extract, only the dose 100 mg/kg produced natriuretic effect. Regarding potassium excretion, it was shown that only hydrochlorthiazide and aqueous extract at the dose 100 mg/kg exhibited a significant increase.

 

All these suggest that the constituents responsible for diuretic and saluretic activity are better extracted when water is used as the solvent. Preliminary phytochemical screening of extracts revealed the presence of flavanoids and steroids.34  As flavanoids are associated with diuretic activity, the presence of these constituents justify the diuretic activity of Lepidium sativum.

 

Significant diuretic and natriuretic effect suggests that the herb acts by a mechanism similar to loop diuretic. However,the mechanism of action of Lepidium is also either due to to the stimulation of regional blood flow or initial vasodilation. The natriuretic and diuretic activity also indicates its antihypertensive action.

Hence, the use of Lepidium sativum as a diuretic in the folklore medicine is justified.

 

Mimusops elengi

Mimusops elengi belongs to the family Sapotaceae . As a traditional herb,its bark is used as a diuretic, astringent, aphrodisiac and also to treat dental diseases, cardiac diseases and uterine disorders.

The diuretic activity of Mimusops elengi was investigated using petroleum ether, chloroform and alcohol extracts of stem bark at a dose of 200 mg/kg  b.w, orally in male albino rats, using frusemide(20 mg/kg) as standard.

 

The results have shown that among all the extacts, the alcohol exhibited a potent diuretic as well as significant natriuretic and kaliuretic effects, when compared to other extracts. The natriuretic and kaliuretic effects suggests that the herb may act as a loop diuretic, by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle. Moreover,it can be said that the constituents responsible for diuretic activity are better extracted when alcohol is the solvent.

 

Preliminary phytochemical screening revealed the presence of alkaloids, flavanoids, glycosides, saponins in the alcohol extract.35  These compounds may act singly or together to exhibit diuretic activity.

Hence, the use of Mimusops elengi as diuretic in the folklore medicine is justified.

 

Viscum articulatum, Helicanthus elastic:

Viscum articulatum Burm.f. is a leafless, hemiparasitic shrub belonging to the family Viscaceae. Helicanthus elastica(Ders.)Dans. is a hemiparasitic herb, belonging to the family Loranthaceae.The hemiparasitic plants of these families are described as Mistletoes. Viscum auriculatum is used in Chinese medicine mainly for the treatment of hypertension, epilepsy, arthritis and gout.Helicanthus elastica is used in Indian medicine mainly as a diuretic and mainly indicated in the treatment of renal and vesical calculi and kidney infections.

 

However, the aqueous extract of Helicanthes at the dose of 4000 mg/kg, was reported to have diuretic activity. As this dose was very high, its diuretic activity was investigated at low doses.

The diuretic activity of entire plants of both Viscum articulatum and Helicanthus elastica was investigated using the methanolic extracts at the doses of 100,200 and 400 mg/kg,using frusemide as standard at the dose of 10 mg/kg and male Wistar rats as model animals.

 

Results have shown that both the extracts exert a dose dependent increase in urinary volume, with maximum volume at the dose of 400 mg/kg. At this dose, Helicanthes elastica had a greater increase in urinary volume compared to Viscum articulatum at 24 hrs. With respect to frusemide, the diuretic effect lasted only for 5 hrs suggesting that both Viscum articulatum and Helicanthus elastica are long acting diuretics than frusemide. With respect to electrolyte excretion, Helicanthes exhibited a significant dose dependent urinary excretion of sodium ions, with limited effects on urinary excretion of potassium, chloride ions and urea whereas Viscum exhibited dose dependent urinary excretion of sodium, potassium and chloride ions. However, it has less potent effects on urinary excretion of potassium, chloride ions and urea. All these suggest that both Viscum articulatum and Helicanthus elastica are long acting diuretics than frusemide. The potent saluretic and kaliuretic effects of Viscum auriculatum suggests that its mechanism of action is similar to frusemide, thus it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle. The pronounced natriuretic effect and lower saluretic effect of Helicanthes elastica suggests that it is potassium sparing. Thus, both the plants act through a different mechanism.

Phytochemical screening of the extracts revealed the presence of triterpenoids and polyphenolics,36 whose presence justify the diuretic activity of both the herbs.

 

Nycthanthes arbotristis

Nycthanthes arbotristis Linn. (syn:night flowering jasmine) is a small tree, belonging to the family Oleaceae.It is used as a diuretic in the SriLankan folklore medicine.

The folklore diuretic activity of Nycthanthes arbotristis was evaluated using the aqueous flower extract at the doses of 3.7,7.5,12.5 and 18.7 mg/kg in 1 ml,using frusemide(13 mg/kg) as standard and rats as model animals.

 

The results have shown that the infusion exhibited dose dependent increase in urine volume till the second maximum dose, from 3.7 mg/kg to 12.5 mg/kg. The highest dose 18.7 mg/kg failed to show significant diuretic effects. However,the dose of 12.5mg/kg decreased urinary excretion of both sodium and potassium ions. Peak diuresis was also observed during the first hour of administration.

 

All these suggest that Nycthanthes arbotristis flowers can function as orally acting diuretic agent. The onset of action, within 1 hr suggests that Nycthanthes is a rapid acting diuretic, which may be due to faster absorption from the GIT. Since, there was no access of water by the rats during the experiment, Nycthanthes could not stimulate thirst and fluid increase inorder to produce diuresis. Hence, it could not be a osmotic diuretic. No change in specific gravity of urine indicates that Nycthanthes does not produe diuresis by inhhibiting Anti diuretic hormone(ADH). Since, there was no natriuresis, it could not be a loop diuretic and there was reduction in potassium ions in urine, it could be said that Nycthanthes is not a loop diuretic. Absence of kaliuresis with significant diuresis suggests that Nycthanthes is a potassium sparing diuretic.37  Nyctanthes is rich in flavanoid group of constituents,38  whose presence justify its diuretic activity.

Thus,the use of Nycthanthes arbotristis as a diuretic in Sri Lankan folklore medicine is justified.

 

Phyla nodiflora:

Phyla nodiflora Linn. is a creeping, branched perennial herb, belonging to the family Verbenaceae. In the traditional system of medicine, it is used as diuretic, diaphoretic, astringent and anti lithiatic.

 

One of its folklore uses, diuretic activity was investigated using methanolic and aqueous extracts of aerial parts of Phyla nodiflore at the doses of 250 mg/kg and 500 mg/kg b.w, using frusemide(100 mg/kg) as standard and male albino rats as model animals.

 

Results have shown that both the extracts increased urine volume at the dose of 500 mg/kg b.w, whereas both the extracts increased urinary excretion of Na+ and K+ ions in a dose dependent manner, with maximum increase at the dose of 500 mg/kg. This shows that both methanolic and aqueous extracts are weak diuretics, since the smaller dose 250 mg/kg does not produce diuresis, but even at this dose both the extracts are potent natriuretic.

Preliminary phytochemical screening revealed the presence of flavanoids in both the extracts,39 whose presence justify its diuretic activity.

Hence, the use of Phyla nodiflora as a diuretic in the folklore system is confirmed.

 

Plectranthes amboinicus:

Plectranthes amboinicus(Lour)Spreng is an aromatic perennial succulent herb, belonging to the family Lamiaceae. Its leaves are used as diuretic in the folklore medicine.

 

Its folklore diuretic activity was investigate using 95% ethanolic and aqueous extracts of leaves at the dose of 500 mg/kg b.w, using frusemide(10 mg/kg) in 1% carboxy methyl cellulose as standard and adult male Wistar rats as model animals.

 

Results have shown that both ethanolic and aqueous extracts exhibited significant diuretic activity at the given dose, which is similar to that of standard. The diuretic effect of ethanolic extract was higher than that of aqueous extract. This suggests that the constituents responsible for diuretic action are better extracted in ethanol. With respect to urinary electrolyte excretion, both the extracts produced significant saluresis and kaliuresis,similar to that of frusemide. This suggests that Plectranthes amboinicus acts by a mechanism similar to that of frusemide, a loop diuretic.

 

Phytochemical screening of the extracts revealed the presence of flavanoids, terpenoids, glycosides and phenolic compounds.40 As flavanoids, terpenoids are responsible for diuretic activity, presence of these constituents justify the use of Plectranthes amboinicus as a diuretic in the folklore medicine.

 

Pongamia pinnata:

Pongamia pinnata pierre. (syn:Derrris indica Lam.,Pongamia glabra Vent) is a medium sized evergreen tree belonging to the family Fabaceae. Its leaves are used as folklore remedies in the treatment of cold, coughs, diarrhoea and leprosy.

 

The diuretic activity of Pongamia pinnata was investigated using the petroleum ether and methanolic extracts at oral doses of 250 and 500 mg/kg,using frusemide(10 mg/kg) as standard and male albino rats as model animals.

 

Results have shown that among all the extracts, petroleum ether extract exhibited dose dependent diuretic activity, with maximum increase in urine volume at the dose of 500 mg/kg. Both the extracts exhibited significant saluresis and kaliuresis. This suggests that the herb is a loop diuretic. The onset of action was prompt within one hour and lasted throughout the study period for 5 hrs.41 This indicates that Pongamia pinnata is a rapid but long acting diuretic. Pongamia is rich in flavanoids and furanoflavones42 whose presence justify its diuretic activity.

Hence,the use of Pongamia pinnata as a diuretic in the folklore medicine is justified.

 

Randia echinocarpa:

Randia echinocarpa(syn:Grangel),belonging to the family Rubiaceae,is used as a traditional medicine in Mexico in the treatment of many urinary disorders.For this purpose,the decoction of dry fruit is consumed three times a day by the Mexican communities.it is also used as diuretic by many communities.

 

Its folklore diuretic activity was investigated using the aqueous extract of dried fruit at the doses of 20,40 and 60 mg/kg,using frusemide(10 mg/kg) as standard and adult male albino rats as model animals.

 

Results have shown that the aqueous extract exhibited significant increase in diuretic activity in a dose dependent manner, with maximum increase at the dose range of 60 mg/kg.43  Randia is rich in triterpene lactones of which randiflorin is the main constituent, saponins, coumarin glycosides and p-coumaric esters.[44]  Presence of saponins justify its diuretic activity.

This justifies the use of Randia echinocarpa as a diuretic in the folklore system.

 

Retama raetam:

Retama raetam belongs to the family Fabaceae. In the Moroccon folklore system  of medicine, it is used in the treatment of diabetes. Hypertension is one of the complaints associated with diabetes millitus. Diuretic are used to treat hypertension. As Retama raetam is used to treat diabetes, its diuretic activity was investigated.

The diuretic activity was evaluated using aqueous extract of Retama raetam at the dose of 5 mg/kg/hr and frusemide (0.1 mg/kg/hr) i.v as standard and male rats as model animals. The experiment had a duration of 4 hrs, wherein three blood and urine samples were collected at the beginning, 2 nd hr and 4th hr of the treatment.

 

Results have shown that the aqueous extract induced a significant and cumulative increase in urinary volume, as shown by the samples collected during the experiment. This effect was observed from the second hour of the experiment. The major chemical constituents of Retama raetam are flavanoids,45 whose presence justify its diuretic activity.

 

Rumex abysinicus:

Rumex abysinicus Jacq. is a perennial herb of family Polyganaceae. Its leaves and shoots are edible and the rhizomes are employed to refine butter. Its folklore uses include treatment of hypertension, migraine, breast cancer, rabies and scabies. Ethnobotanical studies show that the plant is used as diuretic and analgesic.

 

The diuretic activity was evaluated using aqueous extract and 80% methanolic extract of rhizomes of Rumex abysinicus. Aqueous extract was given at oral doses of 500,750 and 1000 mg/kg b.w. Methanolic extract was given at the doses of 250,500 and 750 mg/kg, using frusemide as standard and male mice as model animals.

 

Results have shown that the aqueous extract exhibited a dose dependent increase in urinary volume, with maximum urinary volume at the dose of 1000 mg/kg. Onset of action seen from the third hour. There is an increase in the urinary excretion of electrolytes Na+,K+,Cl- at the dose of 500 mg/kg, with maximum increase seen at the dose of 750 mg/kg, however with less impact on sodium ion excretion. This electrolyte excretion profile was similar to that of frusemide. In case of the methanolic extract,the smallest dose (250 mg/kg) increased urinary volume fro the third hour of the experiment, whereas doses 500 and 750 mg/kg consistently increased urinary volume throughout the experiment period. The standard frusemide is more superior than the smaller and moderate doses and has profile similar to frusemide at the maximum dose. The electrolyte excretion profile of the methanolic extract at the given doses was also dose dependent, with maximum increase at the dose of 750 mg/kg. The extract showed a profile similar to frusemide with respect to excretion of Na+,K+,Clions.

 

This shows that the methanolic extract of Rumex is more saluretic than aqueous extract of Rumex. The methanolic extract serves as a potent diuretic than aqueous extract, because the smallest dose,250 mg/kg of methanolic extract was able to produce diuresis in the 5th hour, whereas aqueous extract produced such an effect at the dose of 500 mg/kg. Moreover,the diuretic action of maximum dose, 1000 mg/kg of the aqueous extract was lower than that of maximum dose, 750 mg/kg of aqueous extract.

 

Thus, it can be suggested that the constituents responsible for diuretic activity are less polar and hence are better extracted in 80% methanol than water. When compared to standard frusemide, dose of 1000 mg/kg of aqueous extract and a dose of 750 mg/kg of methanolic extract exhibited similar profile to frusemide. This also indicates that both the doses have potential similar to frusemide to induce diuresis. Thus,the mechanism of action of Rumex abysinicus is inhibition of Na+/K+/2Cl- symporter in the thick ascending loop of Henle.

 

Preliminary phytochemical screening revealed the presence of tannins, saponins, flavanoids, terpenoids.46 As flavanoids and saponins are responsible for diuretic activity,the presence of these constituents in Rumex abysinicus justify its diuretic activity.

Hence, the use of Rumex abysinicus as a diuretic in folklore medicine is confirmed.

 

Rungia pectinata and Rungia repens:

Rungia pectinata, of family Acanthaceae,is a branched herb, found as a weed in the warmer parts.It is a traditional folklore medicine in the treatment of small pox and also as a diuretic. Rungia repens is a demulcent herb,found in most places.It is used as a traditional medicine in the treatment of cough and fever. It is also used as a folklore vermifuge and diuretic.

 

The diuretic activity of both Rungia pectinata and Rungia repens was investigated using hydroalcoholic extracts (ethanol:water 50:50) of leaves at oral doses of 100,200,400,800,1000,2000,3000 and 4000 mg/kg b.w, using frusemide(20 mg/kg) as standard and adult male Wistar rats as model animals.

 

Results have shown that both the extracts produced diuretic effect by increasing the excretion of Na+,K+ and Cl- ions. Rungia repens given at the dose of 400 mg/kg, the increase in urine volume was significant but at the dose of 800 mg/kg, the increase in urinary volume was significant after 5 hrs as well as 24 hrs. Higher electrolyte excretion of Na+ and K+ ions was also observed. Rungia pectinata at the dose of 400 mg/kg has not exhibited any significant increase in urinary volume as well as Na+ excretion, but increased K+ and Cl- excretion. At the dose of 800 mg/kg, increase in urinary volume, increase in urinary volume as well as increase in urinary excretion of Na+,K+ and Cl- ions was also significant. Thus both the extracts exhibited elevated levels of K+ ions in the urine.

 

Phytochemical screening revealed the presence of flavanoids, terpenes, tannins, phytosterols and carbohydrates.47,48  As flavanoids are associated with diuretic activity, presence of these constituents in the extracts justify its diuretic activity.

Thus, the use of Rungia pectinata and Rangia repens as diuretics in the folklore medicine is justified.

Smilax canarensis:

Smilax canarensis is an endemic species of the Canary Islands,belonging to the family Liliaceae. Its rhizomes, leaves and stem are employed to treat various diseases in the folklore medicinal practice. Its traditional uses include as a diuretic, hypoglycaemic and laxative.

 

The diuretic activity of Smilax canarensis was investigated using the aqueous extracts of the plant (rhizomes,leaves and stems-20:40:40) at the doses of 250,500 and 750 mg/kg b.w and methanolic extract of the plant at oral doses of 100 and 200 mg/kg b.w. Urine was collected in a graduated cylinder and its volume was recorded at an interval of 2 hrs for about 8 hours. Hydrochlorthiazide at two doses 10 and 25 mg/kg was used as the standard and male albino rats model animals.

 

The results have shown that both the extracts exhibited significant diuretic activity in a dose dependent manner, with maximum activity seen at the dose of 750 mg/kg in case of aqueous extract and at the dose of 200 mg/kg for methanolic extract. The methanolic extract at the higher dose exhibited diuretic profile, wherein the increase in urinary volume was similar to that of hydrochlorthiazide. With respect to electrolyte excretion, both the extracts exhibited an increase in electrolyte excretion in a dose dependent manner. However, the dose 750 mg/kg of Smilax produced a moderately increase in Na+ excretion, whereas potassium ion excretion is much more than Na+. This kaliuretic profile of Smilax is similar to that of hydrochlorthiazide. At the dose of 200 mg/kg, methanolic extract of Smilax exhibited an increase in Na+ ion excretion, which was higher than that of hydrochlorthiazide, but with a decrease in K+ excretion and was lesser that that of hydrochlorthiazide. The lower kaliuresis suggest that Smilax is a non osmotic diuretic, which is the characteristic feature of phytodiuretic.

 

Phytochemical screening studies revealed the presence of flavanoids and steroidal saponins,49 suggesting that these polar compounds are responsible for diuretic activity.

Thus the use of Smilax canarensis as a diuretic in the folklore medicine is justified.

 

Spergularia purpurea:

Spergularia purpurea is an herbaceous plant belonging to the family Caryophyllaceae. As a traditional folklore, the aqueous extract of the whole plant is used to treat diabetes, hypertension and renal diseases by the Moroccon population. Since, diuretics are adjuvant therapy in the treatment of hypertension, the diuretic activity of Spergularia purpurea was investigated using the aqueous extract of whole plant at oral doses of 100,200 and 400 mg/kg, using frusemide(10 mg/kg) as standard and male Wistar rats as model animals.

 

Results have shown that the aqueous extract of the plant exhibited a significant increase in urinary volume in a dose dependent manner. The lowest dose (100 mg/kg) increased urinary volume after 1 month, whereas extracts at doses 200 and 400 mg/kg increased urinary volume after 4 weeks of the treatment. The highest dose ,400 mg/kg, exhibited a profile similar to that of frusemide. With respect to excretion of electrolytes, the lowest dose (100 mg/kg) showed no effect on the excretion of the urinary excretion of K+, Cl- ions, whereas the intermediate dose (200 mg/kg) showed an increase in excretion of Cl- ions after 2 weeks of the treatment.The highest doses exhibited an increase in the urinary excretion of Na+ ,K+ and Cl-  ions after 4 weeks of the treatment. Thus,the aqueous extract of Spergularia purpurea caused marked diuresis and electrolyte excretion in dose dependent manner. The highest dose exhibited both saluretic and kaliuretic effects along with diuretic effects. This profile was quantitatively similar to that of frusemide. Thus, it can be said that Spergularia purpurea is much active at the dose of 400 mg/kg, however, it is a slow acting diuretic. Significant saluresis and diuresis results in anti hypertensive activity.

 

It could be suggested that the diuretic action of Spergularia purpurea is mainly due to the inhibition of tubular reabsorption of water and other anions. Presence of flavanoids50 in the extract justify its diuretic activity. Moreover,the use of Spergularia purpurea as adjuvant therapy to anti hypertensive therapy is also justified.

 

Spilanthes acmella:

Spilanthes acmella Murr. is an annual or short lived perennial herb, with a prostrate or ascending branched cylindrical hairy stem, belonging to the family Compositae. The plant bears non fragnant flowers.

In the folklore medicinal system of Sri Lanka, the flowers are used as sialogoggue. The cold infusion of the flowers of Spilanthes acmella is said to possess diuretic activity and ability to dissolve renal calculi.

The folklore diuretic activity of Spilanthes acmella was investigated using cold water extract of fresh flowers of Spilanthes acmella, at oral doses of 500,1000 and 1500 mg/kg b.w and frusemide(13 mg/kg) as standard, using adult male albino rats as model animals.

 

Results have shown that aqueous extract of Spilanthes acmella exhibited an increase in urinary output in dose dependent manner. Furthermore, the diuretic effect of the highest dose (1500 mg/kg) was seen from the 1st hour and lasted till the completion of the experiment. The diuretic effect of the highest dose during the 1st hour was similar to that of frusemide at 1st hour. With respect to electrolyte excretion in urine, there was dose dependent increase of Na+,K+ ions, where the highest dose exhibited a massive increase in Na+ and K+ excretion.

 

Thus, both natriuretic and kaliuretic effects and acidification of urine suggests that Spilanthes acmella is a loop diuretic, with mechanism of action similar to that of frusemide, which acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle. Also, the diuretic effect seen in the 1st hour suggests that the herb is a rapid acting diuretic and since the activity lasted till the completion of the experiment, this suggests that it is a long acting duretic. Reduction in the urine osmolality suggests that it also acts by impairing the basal secretion of ADH (Anti diuretic hormone) or diminished responsiveness of uriniferous tubules to the action of ADH. Hence, Spilanthes acmella is a rapid, long acting loop diuretic. Phytochemical screening revealed the presence of alkaloids,51 whose presence justifies the diuretic activity52 of Spilanthes acmella.

Thus, the use of Spilanthes acmella as a diuretic in the folklore system is confirmed.

 

Steganotaenia araliacea hochst:

Steganotaenia araliacea hochst is a small,soft wooded tree with thick bark,belonging to the family Apiaceae.Traditionally,its root is used in the treatment of headache and the leaves are used as vermifuge,as anti convulsant.The plant is also used as diuretic agent.

The diuretic activity of Steganotaenia araliacea was investigated using aqueous,ethanolic and methanolic extracts of its stem bark,given at the intraperitoneal dose of 20 mg/kg b.w respectively,using frusemide as standard,given at the intraperitoneal dose of 20 mg/kg.Adult male Wistar rats are used as model animals.

 

The results have shown that among all the extracts,ethanolic extract exhibited higher urine output,than methanolic and aqueous extracts.Further,ethanolic extract exhibited higher excretion of Na+,K+ and Cl- ions when compared to other extracts. The results were similar to that of frusemide. This shows that the constituents responsible for diuretic activity are better extracted when ethanol is used as the solvent. The mechanism of action can be suggested that these act through inhibition of  [HCO3-/Cl-], [HCO3-/H+] exchangers and the [Na+/H+] antiporter to cause diuresis.53

Thus, the use of Steganotaenia araliacea as diuretic in the folklore medicine is justified.

 

Tribulus terrestris:

Tribulus terrestris, of family Zygophyllaceae, is used as a folklore medicine in the treatment of hypertension and hypercholesterolemia and also used as a diuretic. It is used as a herbal remedy in the treatment of renal calculi.

The diuretic activity was investigated using aqueous extract of leaves and fruits of Tribulus terrestris at the dose of 5 mg/kg b.w, using frusemide as standard and male Wistar rats as model animals.

 

The results have shown that the aqueous extract of leaves and fruits of Tribulus terrestris caused a marked diuresis during the 24 hrs of the experiment. The urine volume was slightly higher than that of frusemide. With respect to electrolyte excretion, the aqueous extract of Tribulus terrestris produced a significant increase in the urinary excretion of Na+,K+ and Cl- ions. The urinary Na+ excretion profile was similar to that of frusemide.54  The natriuretic and diuretic effects suggests that Tribulus terrestris acts through a mechanism similar to that of loop diuretic, where it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle. Moreover,it is also shown that Tribulus is a much better diuretic than frusemide.

Tribulus is rich in steroidal saponins of which protodioscin is the major constituent. It also contains alkaloids and flavanoids.55  The presence these constituents impart diuretic activity to Tribulus terrestris.

This confirms the use of Tribulus terrestris as a diuretic in the folklore medicine.

 

Tropaeolum majus:

Tropaeolum majus (syn:Chaguinha,Capuchinha) is an important medicinal plant, belonging to the family Tropaeolaceae. As a traditional Brazilian medicine,the leaves are used in the treatment of cardiovascular diseases,urinary tract infections and asthma. It is also used as a Brazilian folklore medicine, because of its diuretic effect.

The folklore diuretic activity was investigated using the aqueous extract of leaves of Tropaeolum majus at the doses of 125,250 and 500 mg/kg b.w and hydroethanolic extract of leaves at the doses of 150 and 300 mg/kg b.w. Frusemide(10 mg/kg) is used as reference standard and adult male rats as model animals.

 

Results have shown that the aqueous extract had not exhibited diuretic effect, but the highest dose presented a significant natriuretic effect. In contrast, the hydroethanolic extract presented a dose dependent increase in both urinary volume and sodium ion excretion. The mechanism of action may be due to the inibition of Na+/K+/2Cl- symporter in the thick ascending loop of Henle. Prolonged diuresis also suggests that the mechanism can also be due to the involvement of prostaglandins, which stimulates renal blood flow, resulting in the diuresis.56

Thus, the use of Tropaeolum majus as a diuretic in the folklore medicine is justified.

 

Tylophora indica:

Tylophora indica is a branching climber, belonging to the family Asclepiadaceae. It is used as emetic, expectorant, diaphoretic and also as a diuretic in the traditional medicine.

 

The diuretic activity of Tylophora indica was investigated using the aqueous and alcoholic extract of the leaves at the oral doses of 100 mg/kg b.w, using frusemide(100 mg/kg i.p) as standard and adult male albino rats model animals.

Results have shown that both the extracts exhibited a significant increase in urinary volume, aqueous extract exhibited 2 times higher value than the alcoholic extract. Both the extracts exhibited a significant increase in the urinary excretion of Na+,K+ and Cl- ions in the urine, but this was less than that of frusemide.In contrast to diuretic action, ethanolic extract was more effective than aqueous extract with respect to electrolyte excretion. Thus,the diuretic, saluretic and kaliuretic effects of  Tylophora indica suggests that it acts by inhibiting Na+/K+/2Cl- symporter in the thick ascending loop of Henle, which is the mechanism of loop diuretic.

Phytochemical screening revealed the presence of alkaloids, flavanoids and saponins in both the extracts,[57]  whose presence justify the diuretic activity of Tylophora indica.

Thus, the use of Tylophora indica as a diuretic in the folklore system is justified.

 

Withania aristata:

Withania aristata (Ait.)Pauq.(syn:Orobal) is an endemic plant of  Canary islands belonging to the family Solonaceae. It is used as folklore medicine in the treatment of rheumatism, insomnia, urinary pathologies and is also used as an anti spasmodic.58

 

The diuretic activity of Withania aristata was investigated using the infusion of the leaves at the oral dose of 5 ml/kg b.w in 5,10 and 15% concentrations and methanolic extract at oral doses of 100,200 mg/kg b.w using hydrochlorthiazide (10 mg/kg and 25 mg/kg) as reference and mice as model animals.

 

Results have shown that there  was an increase in urinary volume in dose dependent manner seen both for infusion and methanolic extract, with maximum urinary volume at 15% concentration of the infusion and 200 mg/kg dose of methanolic extract. These values were comparable to that of hydrochlorthiazide. With respect to electrolyte excretion, both infusion and methanolic extracts exhibited a dose dependent increase of Na+ and K+ excretion, although the results were lower than that of hydrochlorthiazide. Both infusion and methanolic extracts exhibited higher net saluretic index, indicating decreased K+ excretion, but this was considerably lower than that of hydrochlorthiaide. Moreover,15% infusion gave results higher than that of reference drug. This shows that 15% infusion was a potent saluretic than hydrochlorthiazide. Furthermore, it can also be said that Withania aristata is a good saluretic.

 

Phytochemical studies of the extracts revealed the presence of flavanoids and steroidal lactones. Presence of steroidal lactones such as Withaferin A and Witharistatin were also be reported.59  Presence of these constituents may confer diuretic activity, synergistically with diuretic activity of flavanoids.

Thus,the use of Withania aristata as a diuretic in the folklore medicine is confirmed.

 

CONCLUSION:

The present review signifies the importance of phytomedicine as diuretics. These plants serve as a rich arsenal of useful chemical constituents, which themselves act as active principles or as leads for the synthesis of newer drugs. Many of these phytoconstituents exhibited better results as well as less adverse effects compared to the modern synthetic medicine. The phytoconstituents such as flavanoids, saponins, triterpenoids and alkaloids exhibited diuretic activity by various mechanisms. Thus, plants are the best natural sources with less toxic effects and better results and can be used as diuretics.

 

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Received on 02.10.2010          Modified on 22.10.2010

Accepted on 28.11.2010         © RJPT All right reserved

Research J. Pharm. and Tech. 4(3): March 2011; Page 335-348