Kidney stones — causes, treatment and the Chinese medicine view

Name: Dr (TCM) Attilio D'Alberto
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By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham, Berkshire

Kidney stones affect around one in ten UK adults at some point in their lives, and once a person has had a kidney stone they have around a 50% chance of forming another within 5–10 years if no prevention work is done. The pain of an acute attack is famously severe — routinely described as worse than childbirth — and the experience of one stone is usually enough to motivate a sustained interest in not having another. The good news is that kidney stones are one of the most preventable urological conditions, with strong evidence-based dietary and lifestyle measures that meaningfully reduce recurrence. Chinese medicine has a long tradition in stone-related conditions, with classical herbal formulae specifically designed to facilitate stone passage and prevent recurrence, and a constitutional framework (Kidney and Bladder Damp-Heat) that maps onto the modern understanding of the metabolic and dietary drivers. This article covers what kidney stones are, how acute stones are managed under NICE NG118, the evidence-based prevention work, the TCM view, and where acupuncture and Chinese herbal medicine fit honestly into the picture.

On this page

What are kidney stones?
Types of kidney stones
Risk factors
Symptoms and complications
Diagnosis
Conventional treatment under NICE NG118
Prevention — the evidence-based approach
The TCM view — Kidney and Bladder Damp-Heat
Acupuncture for kidney-stone-related symptoms
Chinese herbs and formulae
Diet and lifestyle
Cautions and what TCM cannot replace
When to see a practitioner
Frequently asked questions
Related reading
References

1. What are kidney stones?

Kidney stones (urolithiasis or nephrolithiasis) are hard crystalline mineral deposits that form within the kidneys when urine becomes supersaturated with stone-forming minerals or under-supplied with the inhibitors that normally keep them in solution. Stones can range from microscopic crystals to large “staghorn” stones that fill the renal pelvis. Their journey from the kidney through the ureter to the bladder is what produces the famously severe pain known as renal colic.

UK prevalence has roughly doubled over the past three decades, reflecting changes in diet, weight, hydration and possibly climate. Around 10–15% of UK men and 6–8% of UK women will have a kidney stone in their lifetime; men have historically had higher rates, but the gender gap is narrowing as female prevalence rises. Recurrence is common — around 50% of patients will form a second stone within 5–10 years if no preventive measures are taken — which is why prevention is as important clinically as treatment.

2. Types of kidney stones

The type of stone matters because the mechanism of formation, the dietary and metabolic drivers, and the prevention strategy all differ:

Calcium oxalate stones (around 70–80%) — the commonest type. Form when urinary calcium and oxalate combine. Drivers include low urine volume, dietary factors, low citrate, certain metabolic disorders. The stones most amenable to dietary prevention.
Calcium phosphate stones (around 10%) — often associated with higher urine pH; sometimes seen in renal tubular acidosis or alkalising medications.
Uric acid stones (around 5–10%) — form in persistently acidic urine; classical patients include those with gout, obesity, diabetes and metabolic syndrome. These stones are radiolucent (do not show on plain X-ray) but can be dissolved with urinary alkalinisation, making them unique among the stone types.
Struvite (magnesium ammonium phosphate) stones (around 5%) — infection-related, associated with urease-producing bacteria (most commonly Proteus); often form large staghorn stones that fill the renal pelvis.
Cystine stones (under 1%) — rare, hereditary (cystinuria); usually present in childhood or young adulthood with recurrent stones.

Stone analysis — collecting any passed stone and sending it for analysis — is one of the most important steps after a first stone, because it directs the subsequent prevention work. Many patients are not offered this; it is worth asking.

3. Risk factors

Inadequate fluid intake — the single strongest modifiable risk factor; concentrated urine is the universal precursor to stone formation
Hot climate or occupational heat exposure — dehydration risk; UK rates are highest in summer
Diet — high salt, high animal protein, high oxalate, low calcium (counter-intuitively), low citrate, low potassium and excess refined sugar all increase risk
Obesity and metabolic syndrome
Type 2 diabetes — particularly for uric acid stones
Family history — significantly increases risk; first-degree relatives have around 2–3 times the lifetime risk
Recurrent urinary tract infections — for struvite stones
Previous kidney stones — the strongest single risk factor for the next stone; around 50% recurrence within 10 years without prevention
Inflammatory bowel disease and ileal resection — through enteric hyperoxaluria
Hyperparathyroidism — raises serum and urine calcium
Certain medications — topiramate, acetazolamide, calcium-based antacids in excess, certain HIV medications
Sedentary lifestyle and immobilisation

4. Symptoms and complications

Asymptomatic stones

Many stones remain quietly in the kidney for years without producing symptoms. These are often found incidentally on imaging performed for other reasons and may not need any active treatment, but they need follow-up because larger stones in the kidney can progress and small ones can move into the ureter.

Renal colic (the acute attack)

The classical presentation of a stone descending through the ureter:

Severe colicky pain — coming in waves, lasting minutes to hours; the patient is unable to sit still (in contrast to peritonitis), pacing or curled up.
Loin to groin distribution — classically begins in the flank under the lower ribs and radiates downward and forward as the stone descends the ureter, towards the groin or testicle.
Nausea and vomiting — very common
Frequency and urgency — particularly as the stone approaches the bladder
Microscopic or visible blood in the urine (haematuria)
Sweating, pallor, restlessness

Complications requiring urgent care

Stone with fever — obstructed infection (pyonephrosis); this is a urological emergency, requiring urgent drainage (usually by ureteric stent or percutaneous nephrostomy)
Stone with a single kidney — any obstruction risks loss of total renal function
Stone with renal failure (AKI)
Persistent pain not controlled by analgesia
Persistent vomiting precluding oral intake

Long-term complications

Recurrent stones can cause chronic kidney damage through repeated obstruction and infection; recurrent infection in struvite stones can produce progressive renal scarring; rarely, untreated obstruction produces complete loss of function in the affected kidney.

5. Diagnosis

Low-dose non-contrast CT KUB — the first-line investigation in adults with suspected renal colic per NICE NG118. Highly sensitive and specific; identifies stone location, size and complications.
Ultrasound — preferred in pregnancy and children to avoid radiation. Less sensitive than CT.
Plain X-ray (KUB) — can show calcium-containing stones but misses uric acid stones; less used now.
Urine analysis — for blood (almost universal in acute colic), infection markers, crystals
Blood tests — renal function, calcium, urate, electrolytes
Stone analysis — of any passed or surgically removed stone; directs preventive strategy
24-hour urine collection — in recurrent or high-risk stone formers, to quantify urinary volume, calcium, oxalate, citrate, urate, magnesium, sodium and creatinine. The most important single investigation in prevention work.

6. Conventional treatment under NICE NG118

NICE NG118 (Renal and ureteric stones: assessment and management, published 8 January 2019, last updated February 2021) provides the UK framework:

Acute pain control

Diclofenac or other NSAID is the first-line analgesia for renal colic (intramuscular or rectal during the acute attack; oral thereafter). Opioids are an alternative where NSAIDs are contraindicated. NSAIDs work well in renal colic both for analgesia and through their effect on ureteric peristalsis.

Conservative management

For ureteric stones of 5 mm or less, around 80% pass spontaneously within four weeks with adequate hydration, analgesia and time. Larger stones (5–10 mm) pass spontaneously in around 50% of cases. Stones over 10 mm rarely pass and usually need intervention.

Medical expulsive therapy

NICE recommends consideration of tamsulosin (an alpha-blocker) to facilitate passage of ureteric stones, particularly distal ureteric stones 5–10 mm in size. The evidence is modest but generally positive.

Surgical treatment

Extracorporeal shock wave lithotripsy (ESWL) — non-invasive shock-wave fragmentation; suitable for many renal and proximal ureteric stones up to 20 mm
Ureteroscopy (URS) with laser lithotripsy — endoscopic stone removal via the urethra and ureter; increasingly the preferred option for many stones
Percutaneous nephrolithotomy (PCNL) — for large renal stones (typically over 20 mm) and staghorn stones; involves direct surgical access through the back into the kidney
Ureteric stenting — for relief of obstruction, particularly with infection
Open surgery — now rarely needed

Urinary alkalinisation for uric acid stones

Uric acid stones are unique in being dissolvable with urinary alkalinisation (sodium bicarbonate or potassium citrate). This can dissolve existing stones over weeks to months, in addition to preventing new ones.

Metabolic prevention

For recurrent stone formers, NICE recommends 24-hour urine collection, identification of the underlying metabolic abnormality, and targeted prevention with dietary modification and, where appropriate, medication (thiazide diuretics for hypercalciuria, potassium citrate for hypocitraturia or uric acid stones, allopurinol for hyperuricaemia, and so on).

7. Prevention — the evidence-based approach

Prevention is the area where good evidence-based work makes the biggest difference. The core measures with strongest evidence:

Increase fluid intake — aim for at least 2.5–3 litres of fluid per day to produce at least 2–2.5 litres of urine. This single measure roughly halves recurrence risk in randomised trials. Water is best; lemon water (containing citrate) is particularly favourable; sugar-sweetened drinks, cola and possibly grapefruit juice may increase risk.
Reduce sodium intake — high salt intake increases urinary calcium excretion and stone risk. Aim for <6 g per day; mainly by reducing processed food.
Moderate animal protein — high animal protein increases urinary calcium, oxalate and uric acid while reducing citrate. The DASH-style or Mediterranean-style dietary pattern is well-supported.
Adequate dietary calcium — counter-intuitively, restricting calcium increases (not decreases) stone risk in most calcium oxalate formers, because dietary calcium binds oxalate in the gut and prevents its absorption. Aim for normal calcium intake from food (around 800–1200 mg per day) but avoid calcium supplements unless specifically recommended.
Limit high-oxalate foods in heavy oxalate consumers — spinach, rhubarb, beetroot, almonds and very large amounts of tea, chocolate or peanuts. Moderate intake is fine; the issue is excess.
Increase citrate intake — citrate is a natural inhibitor of stone formation. Lemon juice, lime juice and orange juice all provide it; potassium citrate is sometimes prescribed.
Reduce refined sugar and high-fructose intake
Maintain healthy weight
Regular physical activity
Stop smoking, limit alcohol
Targeted treatment of any underlying metabolic disorder — hyperparathyroidism, gout, renal tubular acidosis

8. The TCM view — Kidney and Bladder Damp-Heat

Traditional Chinese medicine has a well-developed framework for urolithiasis (called Shi Lin, “Stone Lin”) that has been used clinically for centuries. The classical patterns:

Kidney and Bladder Damp-Heat (Xia Jiao Shi Re) — the foundational pattern. Produces lower-abdominal heaviness, dark concentrated urine, burning on urination, frequency and urgency, and the formation of urinary stones (the physical condensation of accumulated Damp-Heat in the lower burner). Treatment clears Damp-Heat from the Lower Jiao and facilitates urinary flow.
Qi stagnation with stone obstruction (Qi Zhi Shi Zu) — the acute renal colic pattern, with severe paroxysmal pain, restlessness, and the desperate inability to find comfort. Treatment moves Qi, facilitates stone passage and relieves pain.
Blood stasis (Xue Yu) — the chronic pattern with fixed flank pain, haematuria and the sense of obstruction. Often present in long-standing recurrent stone disease.
Kidney Yin deficiency with empty Heat — the recurrent stone former with constitutional weakness, lower back ache, night sweats and dry mouth; the prevention pattern.
Kidney Yang deficiency — with cold sensation, frequency of pale urine, fatigue; less commonly associated with stones but important in some recurrent stone patients.
Spleen and Kidney Qi deficiency — underlying constitutional weakness driving recurrent stone formation; the prevention work pattern.

The TCM treatment principle — clear Damp-Heat in the acute phase, move Qi and dissolve stones, support Kidney function and prevent recurrence — aligns well with the modern hydration, dietary and metabolic prevention framework.

9. Acupuncture for kidney-stone-related symptoms

Acupuncture has no role in dissolving established stones, but it has useful applications in stone-related management:

Acute renal colic pain management — there is a meaningful body of acupuncture-for-renal-colic literature, with several randomised trials showing analgesia comparable to NSAIDs or opioids in the emergency setting. Acupuncture is rarely the first-line treatment in UK A&E but is a reasonable adjunct.
Facilitating ureteric stone passage — experimental and clinical work suggests acupuncture can promote ureteric peristalsis. Used in some integrative protocols alongside hydration and tamsulosin.
Preventive constitutional treatment — in patients with recurrent stones and an identifiable TCM pattern, regular acupuncture supports the underlying constitutional work.
Post-procedural recovery — after ureteric stenting, lithotripsy or ureteroscopy, when discomfort and bladder symptoms can persist for weeks.
Stress regulation — for the patient whose recurrent stones have produced a level of urological anxiety that is itself distressing.

Points commonly used in stone-related presentations include BL23 (Shenshu, the back-shu of the Kidney), BL28 (Pangguangshu, the back-shu of the Bladder), KD3 (Taixi, the source point of the Kidney channel) and KD7 (Fuliu) for the constitutional dimension; SP6 (Sanyinjiao), CV3 (Zhongji, the front-mu of the Bladder), CV4 (Guanyuan) and ST36 (Zusanli) for the local lower-abdominal pattern; and during acute colic, the “four gates” (LI4 + LV3 bilaterally), local ear and auricular points, and pressure or needling at ah-shi points around the affected flank.

10. Chinese herbs and formulae

Chinese herbal medicine has a substantial tradition in kidney-stone management, with both classical and modern protocols:

Jin Qian Cao (Lysimachia) — the principal stone-related herb in Chinese pharmacology, used in many modern protocols. Diuretic, urinary-alkalinising and reputed stone-promoting actions; widely used in Chinese hospitals as part of integrative stone protocols.
Hai Jin Sha (Lygodium spore) — classical herb for urinary stones, often paired with Jin Qian Cao
Ji Nei Jin (chicken gizzard membrane) — classical herb for “dissolving accumulations” including urinary stones; modern interpretation focuses on its calcium-modulating properties
Shi Wei (Pyrrosia leaf) — classical Lin syndrome herb, urinary tract-supporting
Hu Po (amber) — classical Blood-moving and stone-treating mineral

Common classical formulae include:

Ba Zheng San (Eight Corrections Powder) — the foundational formula for urinary tract Damp-Heat with burning urination, urgency, frequency and the Lin syndromes. Contains Mu Tong, Hua Shi, Che Qian Zi, Da Huang and others.
San Jin Tang (Three Golds Decoction) — modern formula specifically for urinary stones, containing Jin Qian Cao, Hai Jin Sha and Ji Nei Jin
Wu Ling San — for Damp accumulation with poor urination; the foundational diuretic formula
Liu Wei Di Huang Wan — for Kidney Yin deficiency presentations in recurrent stone formers; supportive constitutional work
Jin Gui Shen Qi Wan — for Kidney Yang deficiency presentations
Modified Si Ni San or Chai Hu Shu Gan San — for Qi stagnation features in the acute and recurrent settings

All herbs prescribed at this clinic are pharmaceutical-grade granules from Sun Ten in Taiwan, within individually-tailored formulae. Several kidney-stone-relevant Chinese herbs interact with medication — particularly with antihypertensives, anticoagulants and lithium — and the diuretic effect needs to be co-ordinated with any conventional diuretic. Avoid Aristolochia-containing formulae (which historically appeared in some Lin protocols) absolutely; these are nephrotoxic and have been removed from reputable practice.

11. Diet and lifestyle

Dietary and lifestyle prevention is the most effective single intervention for kidney stone disease — the area where TCM tradition and modern evidence agree most clearly:

Hydration — aim for at least 2.5–3 litres of fluid per day, more in hot weather or with physical work. The single most important measure. Pale yellow urine is the practical target.
Lemon water — the juice of half a lemon in a litre of water provides modest urinary citrate alkalinisation, particularly relevant for calcium oxalate and uric acid stones. Cheap, safe, evidence-based.
Reduce salt — under 6 g per day; mainly by reducing processed food intake
Moderate animal protein — particularly red meat and shellfish in heavy stone formers
Adequate dietary calcium from food — not too much, not too little; calcium from food rather than supplements
Moderate high-oxalate foods in heavy consumers (spinach, rhubarb, beetroot, large amounts of tea or chocolate)
Reduce refined sugar and sweetened drinks
Mediterranean-style or DASH-style eating pattern — good supporting evidence for stone prevention
From a TCM perspective — reduce Damp-Heat-generating foods (rich greasy food, alcohol, fried food, spicy excess); favour cooling diuretic foods (winter melon, watermelon, cucumber, mung beans, barley water); maintain warm cooked digestion to support Spleen and Kidney function.
Regular physical activity, weight management, smoking cessation

12. Cautions and what TCM cannot replace

Acute renal colic needs medical assessment. Severe loin-to-groin pain in a previously well person needs A&E or urgent GP review for analgesia, imaging and exclusion of obstructed infection.
Stone with fever is a urological emergency. Pyonephrosis (infected obstructed kidney) needs urgent drainage; delay can be life-threatening.
Large stones do not pass with herbal treatment. Stones over 10 mm rarely pass with any treatment short of surgical intervention. Be realistic about what the herbal approach can do.
Stone analysis is important. Direct the prevention work based on stone type; collect any passed stone and send for analysis.
24-hour urine collection in recurrent stone formers identifies metabolic drivers and guides prevention.
Avoid all Aristolochia-containing herbs. These have caused fatal nephrotoxicity and renal cancer; never appear in reputable modern Chinese herbal practice.
Herb-drug interactions — tell your prescriber about herbal treatment; tell your herbalist about all medications, particularly antihypertensives, anticoagulants and lithium.
Reduced renal function — some herbal formulae need dose adjustment in chronic kidney disease; tell your herbalist.

13. When to see a practitioner

Reasonable indications to consider Chinese medicine support for kidney stone disease include:

Recurrent stone formation despite conventional preventive work, where the constitutional pattern can be addressed
Conservative management of a small ureteric stone where herbal and acupuncture support can facilitate passage and reduce pain
Post-procedural recovery after lithotripsy, ureteroscopy or stenting
Stress and constitutional dimensions of recurrent urological disease
Patient preference for a herbal-supported approach alongside conventional urological care
Patients with asymptomatic stones with significant risk factors for further stones, who want to address the underlying pattern preventively

I see patients with kidney stone disease at my Wokingham, Berkshire clinic and offer online herbal consultations for patients elsewhere in the UK.

14. Frequently asked questions

Can Chinese herbs dissolve kidney stones?

Some uric acid stones (around 5–10% of all kidney stones) can be dissolved with urinary alkalinisation, and some classical Chinese herbal protocols achieve this. Calcium oxalate stones — the majority — cannot reliably be dissolved by herbal or conventional means; the herbal role is preventive and supportive (facilitating passage of small stones, reducing pain, addressing the underlying pattern), not dissolving established stones.

Can acupuncture relieve renal colic?

Yes, there is reasonable evidence that acupuncture provides meaningful analgesia in acute renal colic, comparable to NSAIDs in some trials. It is not the first-line UK treatment but is a reasonable adjunct where conventional analgesia is contraindicated or insufficient.

Will I have another kidney stone?

Without preventive work, the recurrence rate is around 50% within 5–10 years. With sustained preventive measures — particularly hydration, dietary modification, and where indicated targeted medication or herbal support — recurrence rates fall substantially. Stone analysis and 24-hour urine collection direct the most effective prevention.

Should I avoid calcium if I have calcium stones?

No, this is one of the most common misconceptions. Restricting dietary calcium usually increases (not decreases) stone risk, because dietary calcium binds oxalate in the gut and prevents its absorption. Normal calcium from food is appropriate; calcium supplements should be discussed with your urologist.

Is lemon water really helpful?

Yes — modest but real evidence base. The citrate in lemon juice acts as a natural stone inhibitor, particularly for calcium oxalate and uric acid stones. Cheap, safe and a reasonable daily measure.

What about cranberry juice?

Cranberry juice has a role in some urinary infection prevention but is not specifically supported for stone prevention; in fact, very high cranberry intake may modestly increase oxalate-stone risk. Useful where there is recurrent infection, less so for pure stone prevention.

Is acupuncture safe in pregnancy with kidney stones?

Acupuncture is generally safe in pregnancy with a qualified practitioner adapting points and techniques accordingly. Imaging in suspected pregnancy stones uses ultrasound rather than CT. Several stone-related Chinese herbs are contraindicated in pregnancy; specialist supervision is essential.

16. References

National Institute for Health and Care Excellence. Renal and ureteric stones: assessment and management. NICE guideline NG118. Published 8 January 2019; last updated February 2021. nice.org.uk/guidance/ng118
Skolarikos A, Neisius A, Petřík A, et al. EAU Guidelines on Urolithiasis. European Association of Urology, latest edition.
Pearle MS, Goldfarb DS, Assimos DG, et al. Medical management of kidney stones: AUA guideline. J Urol. 2014;192(2):316–324.
Curhan GC. Epidemiology of stone disease. Urol Clin North Am. 2007 Aug;34(3):287–93.
Borghi L, Schianchi T, Meschi T, Guerra A, Allegri F, Maggiore U, Novarini A. Comparison of two diets for the prevention of recurrent stones in idiopathic hypercalciuria. N Engl J Med. 2002 Jan 10;346(2):77–84.
Heilberg IP, Goldfarb DS. Optimum nutrition for kidney stone disease. Adv Chronic Kidney Dis. 2013 Mar;20(2):165–74.

This article is for general information and does not constitute medical advice. Suspected kidney stones require urgent medical assessment. Always consult a qualified healthcare practitioner before changing treatment.