Macroscopic identification
As the name suggests, the plant appears as a miniature Amla tree. It ranges from 4-12 inches high. Leaves; subsessile, elliptic just as Amla leaves, 0.15 to 0.75 inches long. Flowers; axillary, small, yellow or greenish white, 1-3 male flowers with solitary female flowers. Fruit; globose, smooth like Amla fruit. Seeds; pale brown with 6-7 straight longitudinal ribs

Parts used
Whole plant

Pharmacological action
De-obstruent, diuretic, astringent and cooling Analgesic, antibacterial, antihepatotoxic, anti-inflammatory, antilithic, antimalarial, antimutagenic, antinociceptive, antispasmodic, antiviral, aperitif, carminative, choleretic, deobstruent, digestive, diuretic, febrifuge, hepatotonic, hepatoprotective, hypoglycemic, hypotensive, laxative, stomachic, tonic, vermifuge

Action and uses in Ayurveda
Trsa, kasa, amlapitta, pandu, ksaya, ksata, kustha, prameha, mutr-roga.

Indications
Colic, diabetes, malaria, dysentery, fever, flu, tumors, jaundice, vaginitis, and dyspepsia, kidney and gallbladder stones as cystitis, prostatitis, venereal diseases and urinary tract infections.

Photochemical
Alkaloids, astragalin, brevifolin, carboxylic acids, corilagin, cymene, ellagic acid, ellagitannins, gallocatechins, geraniin, hypophyllanthin, lignans, lintetralins, lupeols, methyl salicylate, niranthin, nirtetralin, niruretin, nirurin, nirurine, niruriside, norsecurinines, phyllanthin, phyllanthine, phyllanthenol, phyllochrysine, phyltetralin, repandusinic acids, quercetin, quercetol, quercitrin, rutin, saponins, triacontanal, tricontanol.

Properties and action
Rasa: kasaya, tikta, madhura
Guna: laghu, ruksha
Virya: sita
Vipaka: madhura
Karma: rochana, dahanashini, pittashamka, mutral

Preparations
Paste, oil, and powder

Therapeutic classification index

• Central nervous system:
• Blood and haemopoeitic tissue:
• Cardiovascular system:
• Digestive system: The fresh root is believed to be an excellent remedy for jaundice.
• Respiratory system:
• Skin: Fruits useful for tubercular ulcers, wounds, sores, scabies and ringworm. A poultice of the leaves with salt cures scabby affection and without salt applied on bruise and wounds.
• Nutrition and metabolism:
• Genito-urinary system: plant is employed in gonorrhea, menorrhagia and other genito urinary troubles
• Musculoskeletal system:
• Eye:
• Immunity system:
• Hair:
• Liver and spleen: decoction and powder is used in jaundice

Use of Bhuiamla in eliminating renal stones
The first notable area of study has validated chanca piedra’s longstanding traditional use for kidney stones. In 1990, the Paulista School of Medicine in São Paulo, Brazil, conducted studies with humans and rats with kidney stones. They were given a simple tea of chanca piedra for 1–3 months and it was reported that the tea promoted the elimination of stones. They also reported a significant increase in diuresis and sodium and creatine excretion. Subsequently the medical school educated new doctors about the ability to treat kidney stones with this natural remedy and now it is found in many pharmacies throughout Brazil. In a 1999 in vitro clinical study, a chanca piedra extract exhibited a potent and effective inhibitory effect on the formation of calcium oxalate crystals (the building blocks of most kidney stones). In a 2002 in vivo study, researchers seeded the bladders of rats with calcium oxalate crystals and treated them for 42 days with a water extract of chanca piedra. Their results indicated that chanca piedra "strongly inhibited the growth of the matrix calculus and reduced the number of stone satellites compared with the group receiving water." Several of the animals even passed the stones which did form. Previously (in the mid-1980s) the antispasmodic activity of chanca piedra was reported. This led researchers to surmise that "smooth muscle relaxation within the urinary or biliary tract probably facilitates the expulsion of kidney or bladder calculi." Researchers had already reported chanca piedra’s antispasmodic properties and smooth muscle relaxant properties (including a uterine relaxant effect) in earlier studies. In 1990, Nicole Maxwell reported that Dr. Wolfram Wiemann (of Nuremburg, Germany) treated over 100 kidney stone patients with chanca piedra obtained in Peru and found it to be 94% successful in eliminating stones within a week or two.

Use of Bhuiamla in eliminating gall bladder stone
Chanca piedra is also used in herbal medicine for gallstones and, while no research has been performed that specifically validated this use, one study does indicate that chanca piedra has an effect on gallbladder processes

Use of Bhuiamla in hypertension
The plant’s traditional use for hypertension has been explored by research as well. The hypotensive effects were first reported in a dog study in 1952 (in which a diuretic effect was noted also). The hypotensive effects were attributed to a specific phytochemical in chanca piedra called geraniin (an ellagitannin phytochemical) in a 1988 study. In 1995 Indian researchers gave human hypertensive subjects chanca piedra leaf powder in capsules and reported a significant reduction in systolic blood pressure, a significant increase in urine volume, and in urine and serum sodium excretion. Chanca piedra’s diuretic effect in humans was recorded as far back as 1929. In the above 1995 study, researchers also reported that blood glucose levels were reduced significantly in human subjects studied. Two other studies with rabbits and rats document the hypoglycemic effect of chanca piedra in diabetic animals. Yet another study documented chanca piedra with aldose reductase inhibition (ARI) properties. ARIs are substances that act on nerve endings exposed to high blood sugar concentration to prevent some of the chemical imbalances that occur and thus protect the nerve. (This activity also supports chanca piedra’s traditional use for diabetes). This ARI effect was attributed, in part, to another ellagitannin phytochemical—ellagic acid—found in chanca piedra. This well-studied phytochemical has been documented with many other beneficial effects in numerous clinical studies.

Use of Bhuiamla as an antispasmodic
Another area of study has focused on the pain-relieving and/or antinociceptive effects of chanca piedra and conducted at a Brazilian university. So far, they’ve published six studies on their findings. The first three studies (published in 1994–1995) reported strong and dose-dependent analgesic effects in mice administered water and/or alcohol extracts of chanca piedra (orally, intragastrically, and intraperitoneally) against six different laboratory-induced nociception (pain) models. Even when mice were fed orally with a hydroalcohol extract at only 35 mg/kg these marked analgesic effects were recorded. In 1996, they isolated and tested the hypotensive phytochemical geraniin from chanca piedra and reported that it was seven times more potent as an analgesic than aspirin or acetaminophen. Their last two studies, published in 2000, continued to document chanca piedra’s analgesic properties against normal pain models in mice (as well as newly-tested neurogenic pain models) and report their effectiveness. Again they related this effect to the phytochemical geraniin and reported its ability to inhibit several neurotransmitter processes that relay and receive pain signals in the brain. Unlike aspirin (which can harm the mucosa lining of the stomach and cause ulcers), geraniin has been reported to have anti ulcerous and gastro protective properties instead. This analgesic effect is probably why so many people taking chanca piedra for kidney stones (a very painful affair) report such quick relief (and long before chanca piedra could actually break down and expel a stone).

Anti-hepatotoxic and anti-mutagenic activity of bhuiamla
The anti hepatotoxic (liver-protecting) activity of chanca piedra is another area of study which has been established with clinical research. These effects have been attributed to (at least) two novel lignan phytochemical named phyllanthin and hypophyllanthin. The researchers who reported the cholesterol-lowering effects also reported that chanca piedra protected rats from liver damage induced by alcohol, and normalized a "fatty liver." One in vitro study and four in vivo studies (with rats and mice) document that extracts of chanca piedra effectively protect against liver damage from various chemical liver toxins. Two human studies reported chanca piedra’s anti hepatotoxic actions in children with hepatitis and jaundice. Indian researchers reported that chanca piedra was an effective single drug in the treatment of jaundice in children, and British researchers reported that children treated with a chanca piedra extract for acute hepatitis had liver function return to normal within five days. Researchers in China also reported anti hepatotoxic actions when chanca piedra was administered (900 mg powdered herb twice daily) to adults with chronic hepatitis. A recent (2000) study even documented that chanca piedra (in a water extract given orally) increased the life span of mice with liver cancer from 33 weeks (control group without treatment) to 52 weeks. Another research group tried to induce liver cancer in mice that had been pre-treated with a water extract of chanca piedra. Their results indicated the chanca piedra extract dose-dependently lowered tumor incidence, levels of carcinogen-metabolizing enzymes, levels of liver cancer markers, and liver injury markers. Both studies indicate that the plant has more of a protective and anti proliferative effect against cancer than a direct anti-tumorous effect or selective ability to kill a cancer cell.It may well be that chanca piedra’s documented antimutagenic effect plays an important factor in this reported anticancerous activity. In several animal studies (as well as within cell cultures), extracts of chanca piedra have stopped or inhibited cells (including liver cells) from mutating in the presence of chemical substances known to create cellular mutations and DNA strand breaks (which can lead to the creation of cancerous cells). One of these studies indicated that chanca piedra inhibited several enzyme processes peculiar to cancer cells’ replication and growth—rather than a direct cytotoxic ability to kill the cancer cell (sarcoma, carcinoma, and lymphoma cells were studied). This cellular-protective quality was evidenced in other research, which indicated that chanca piedra protected against chemically induced bone marrow chromosome damage in mice, as well as against radiation-induced chromosome damage in mice. The latter study reported that only 25 mg of extract per kg of animal body weight protected mouse chromosomes against 4 gy of gamma radiation damage

Role of bhuiamla in treating hepatitis
Research group in China (where HBV is endemic) working with a straight water extract and/or herb powder published two positive studies showing good results with human HBV patients in 1994 and 1995. Their second study suggested that different results were obtained through different Phyllanthus species of plants used (and that yet another species– P. Urinaria provided the best anti-HBV results). The Chinese published a more recent (2001) study, which compared 30 chronic HBV patients taking a chanca piedra extract to 25 patients taking interferon (IFN-alpha 1B) for three months. Both treatments showed an equal effectiveness of 83%, but the chanca piedra group rated significantly higher in the normalization of liver enzymes (ALT, AG, and SB) and recovery of liver function than the interferon-treated group. Finally, The Cochran Hepato-Biliary Research Group in Copenhagen reviewed all the HBV published research (22 randomized trials) and published an independent review of the results. It stated that treatment with "Phyllanthus herb" (they acknowledged the confusion in nomenclature among the species) had "a positive effect on clearance of serum HBsAg" (HBV surface antigen) comparable to interferon and was better than nonspecific treatment or other herbal medicines for HBV and liver enzyme normalization

In a preliminary study, carriers of hepatitis B virus were treated with a preparation of the plant Phyllanthus amarus for 30 days. 22 of 37 (59%) treated patients had lost hepatitis B surface antigen when tested 15-20 days after the end of the treatment compared with only 1 of 23 (4%) placebo-treated controls. Some subjects have been followed for up to 9 months. In no case has the surface antigen returned

Phyllanthus blocks DNA polymerase, the enzyme needed for the hepatitis B virus to reproduce. Fifty-nine percent of those infected with chronic viral hepatitis B lost one of the major blood markers of HBV infection (e.g., hepatitis B surface antigen) after using phyllanthus for thirty days. While clinical studies on the outcome of phyllanthus and HBV have been mixed, the species P. urinaria and P. niruri seem to work far better than P. amarus.

Dose: powder-3-6g
Fresh juice 10-20 ml
Capsule Bhuiamla contains pure and concentrated Bhuiamla
Dosage: one capsule twice a day
Package size: 60 capsules.

References

1. Dr.KM Nadkarni, The Indian Materia Medica, Vol.I, pg 947
2. Prof P.V Sharma, Dravya Guna Vigyana, Vol II, pg 640
3. The Ayurvedic Pharmacopoeia Of India, Part I, Vol.I, pg 111