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Tribulus Terrestris

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Background & General Info

Tribulus terrestris is a dicotyledonous herbaceous perennial belonging to the Zygophyllaceae family. Known more commonly as chih-hsing in China and goat head, puncture vine, and small caltrops in Western countries, this creeping weed species thrives in tropical, subtropical, and arid climate regions across the world, from Mexico and the United States, to Europe such as Spain, Macedonia, Bulgaria, and Greece, to Asia such as India, China, and Vietnam. [1] It is a whitish silky pubescent herb that has long been a component of tonics and aphrodisiacs prescribed in Indian Ayurvedic practice, where the plant is referred to as “gokshura” in Sanskrit.

Herbal supplements derived from Tribulus terrestris have become widely available in various high street dietary supplement retailers and on the Internet, with prices normally below £0.1 for every capsule. Patents have been advanced by producers of performance-enhancing food supplements containing Tribulus terrestris extract, which primarily comprises aerial portions of Tribulus terrestris or its fruits, and the plant persists to be valued as a safe, legal herbal alternative to anabolic steroids. [2]



Botany

Tribulus terrestris is a tap-rooted perennial plant but grows as a summer annual in colder climates. It possesses frequently branching stems that radiate from the crown and pinnately compound leaves, with leaflets, around 3 to 6 pairs, being less than a quarter-inch long. This trailing and spreading herbaceous plant is typically prostrate and forms flat patches, but may grow upward under shaded areas or among taller plants. Five white or lemon-yellow petals comprise the 4- to10-mm-wide solitary flowers, which arise from the axils of leaves, and following a week after each flower blooms, a globose, spinous, or tuberculate fruit emerges and effortlessly falls apart into four or five single-seeded nutlets. These nutlets or “seeds” are tough and bear two to three hard sharp spines, which enable the fruit to cling to clothes and bodies of animals and to be transported. [3]

History & Traditional Use

The use of extract of the aerial parts and fruits of Tribulus terrestris has transitioned over decades from being a diuretic, tonic, and aphrodisiac in ancient medicine to currently an agent advertised and marketed to improve testosterone concentrations among athletes and bodybuilders. [2] In the 1970s, the plant’s properties started to be popularly recognized in Eastern Europe when a certain Bulgarian Olympic weightlifting team discovered its benefits. [2] In Turkey, Tribulus terrestris L. is frequently used as a folk medicine for inducing diuresis and for treating colic pains, hypertension, and hypercholesterolemia. [4] Traditional medicinal systems in China and India promote the use of this plant as treatment of a variety of human disorders and ailments and as a booster of male sexual functions, an energizer, and a revitalizer. [1] In classical Chinese medicine, Tribulus terrestris is advised as remedy for hypertension and coronary heart disease, ocular inflammation, and infertility of both sexes. [5]

General Herbal Uses

Having an appreciably worldwide distribution, the roots, seeds, fruits, and leaves of Tribulus terrestris have been traditionally used for a number of therapeutic purposes. Tribulus terrestris has been believed to allegedly elevate levels of serum testosterone levels in the human body and has received considerable popularity among male bodybuilders and athletes as an herb for muscular hypertrophy and skeletal muscle strength development and as a preparation that boosts libido, promotes testicular development, and relieves hypertension, kidney disorders, and colic. [2] The fruits and seeds of the plant are employed in oriental medicine as an aphrodisiac, diuretic, and anthelmintic, as well as a remedy for coughs, kidney failure, and urinary disorders. Alongside other medicinal herbs, Tribulus terrestris is also used in diverse Ayurvedic formulations to treat osteoarthritis. [1] It is used too as a remedy for leprosy, scabies, psoriasis, headache, hepatitis, inappetence, ophthalmia, stomatitis, vitiligo, and vision disorders and has been found to increase free serum testosterone. [5]



Constituents/Active Components

The dried fruits of the plant contain semi-drying oil, peroxides, diastase, traces of glucosides, resins, protein, and excellent quantities of inorganic matters. Sitosterol and stigmasterol can be isolated from the roots, stems, and leaves, [3] and phytochemical studies on Tribulus terrestris have detected a number of steroidal saponins, flavonoids, phenolic amides, and alkaloids. Furostanol and spirostanol saponins of tigogenin, neotigogenin, gitogenin, neogitogenin, hecogenin, neohecogenin, diosgenin, chlorogenin, ruscogenin, and sarsasapogenin types have also been reported in this plant, as well as furostanol glycosides such as protodioscin and protogracillin, with protodioscin being the most dominant saponin. [6]

A phytochemical study by Hammoda et al. (2013) detected two oligosaccharides and a stereoisomer of di-p-coumaroylquinic acid from the aerial parts of Tribulus terrestris. The two isolated oligosaccharides were O-β-d-fructofuranosyl-(2 → 6)-α-d-glucopyranosyl-(1 → 6)-β-d-fructofuranosyl-(2 → 6)-β-d-fructofuranosyl-(2 → 1)-α-d-glucopyranosyl-(6 → 2)-β-d-fructofuranoside and O-α-d-glucopyranosyl-(1 → 4)-α-d-glucopyranosyl-(1 → 4)-α-d-glucopyranosyl-(1 → 2)-β-d-fructofuranoside. [7]

Identified oil components from the aerial parts of Tribulus terrestris by GC/MS are summarized in the table below, based on the results of Dastagir et al. (2014). The oil obtained from Tribulus terrestris demonstrates very high content of oxygenated monoterpenes (90.99%) and esters (5.8%) but an absence of monoterpene and sesquiterpene hydrocarbons. [8]

Tribulus Terrestris Compounds

Medicinal/Scientific Research

For the past few years, a number of extensive scientific investigations have been conducted to verify the traditional health-promoting claims and biological properties of Tribulus terrestris, including its diuretic, aphrodisiac, antiurolithic, immunomodulatory, antidiabetic, absorption-enhancing, hypolipidemic, cardiotonic, hepatoprotective, anti-inflammatory, analgesic, antispasmodic, anticancer, antibacterial, anthelmintic, larvicidal, and anticariogenic activities, which have all been ascribed to its various chemical constituents such as flavonoids, flavonol glycosides, steroidal saponins, and alkaloids. [6]

Cardiovascular

Early studies had indicated the hypotensive and cardiac-depressant effects of Tribulus terrestris extracts, as well as their contractile activities on smooth muscles. [5] Phillips, Mathew, and Oriowo (2006) demonstrated the noteworthy antihypertensive activity of methanol and aqueous extracts derived from Tribulus terrestris in spontaneously hypertensive rats, which has been elucidated as a consequence of a direct relaxation of arterial smooth muscles, probably involving nitric oxide release and membrane hyperpolarization. Both Tribulus terrestris extracts were shown to dose-dependently decrease blood pressure of spontaneously hypertensive rats, although the aqueous fraction performed better than its methanol equivalent at all tested doses. However, only the methanol extract in vitro generated a dose-dependent elevation of perfusion pressure of the mesenteric vascular bed. Its administration at low dose resulted in vasoconstriction, whereas at higher doses, it produced a dose-dependent reduction in perfusion pressure. On the other hand, a dose-dependent decrease in perfusion pressure was noted at all doses of Tribulus terrestris aqueous extract when perfusion pressure was raised with phenylephrine. The vasodilation-related responses to both aqueous and methanol extracts of Tribulus terrestris were considerably diminished in preparations wherein perfusion pressure was raised with 60 mM of potassium chloride. [9]

Another 2015 study published in the International Journal for Innovation Education and Research similarly confirmed the significant antihypertensive property (i.e., hypotensive activity) of Tribulus terrestris aqueous extract at doses of 100 and 50 mg/kg body weight in hypertensive rats. Such hypotensive effect possessed by Tribulus terrestris seemed to be due to direct arterial smooth muscle contraction and membrane hypopolarization. In this study, normotensive rats orally and intravenously administered with aqueous extract of Tribulus terrestris manifested an increased blood pressure, with elevated systolic and diastolic blood pressures as compared with control. An addition of an extra dose of the said extract in hypertensive rats noticeably lowered their blood pressure to normal values. Moreover, the treated rats were characterized by a significantly reduced level of mean corpuscular volume and mean total white blood cells and an increased number of platelets, as compared with controls. [5]

Analgesic

Heidari et al. (2007) verified the traditional analgesic claim of Tribulus terrestris. Analgesic property of a methanol extract from the fruits of this plant was evaluated in male albino mice through formalin and tail flick test, and percolated extract was intraperitoneally injected at doses of 50, 100, 200, 400, and 800 mg/kg to mice. At a dose of 100 mg/kg, the percolated extract exhibited the highest analgesic effect compared to control (p < 0.01) based on formalin and tail flick test. When compared with the analgesic effect of 2.5 mg/kg morphine, that of the extract was lower, but in comparison with that of 300 mg/kg aspirin, the extract displayed higher analgesic effect in chronic phase of pain in formalin test (p < 0.05). [10]

Antispasmolytic

Study results of Arcasoy et al. (1998) suggested the potential worth of Tribulus terrestris and its lyophilized saponin mixture in relieving smooth muscle spasms or colic pains. With a median lethal dose (LD50) and 95% confidence limits of 813 and 739–894 mg/kg, respectively, the lyophilized saponin mixture significantly dose-dependently reduced peristaltic movements of isolated sheep ureter and rabbit jejunum preparations (p < 0.05). [11]

Antihyperglycemic And Antidiabetic

Saponins isolated from Tribulus terrestris possess hypoglycemic property and can considerably reduce levels of serum glucose, as demonstrated in the study of Li et al. (2002). These Tribulus terrestris saponins diminished serum glucose levels in normal mice and alloxan-induced diabetic mice at rates of 26.25% and 40.67%, respectively, and serum triglyceride levels at a rate of 23.35%. They had also been found to decrease the content of serum cholesterol and increase the serum SOD activity of the mice. [12] Another study indicated that a decoction from Tribulus terrestris could significantly hinder the process of gluconeogenesis (i.e., glucose generation from non-carbohydrate substrates) in normal mice, affect their metabolism of glucose, and lower their triglyceride level and cholesterol content in the plasma. [13]

Guo et al. (2016) evidenced the hypoglycemic and hypolipidemic properties of protodioscin in rats with diabetes, which was experimentally induced via intraperitoneal injection of streptozotocin after 4 weeks of feeding on a high-fat diet. Protodioscin treatment at doses of 10, 20, and 40 mg/kg for 12 weeks significantly improved glucose tolerance; decreased blood levels of glucose, glycosylated hemoglobin, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and non-esterified fatty acids; and increased the content of high-density lipoprotein cholesterol, adiponectin, and glycogen. Based on a histological examination, disordered liver structure in diabetic rats was also improved by protodioscin treatment. [14]

Immunomodulatory

Saponins present in Tribulus terrestris fruits had been known to dose-dependently increase phagocytosis, indicating stimulation of nonspecific immune response. A 2011 study in African Journal of Biotechnology described the immunomodulatory properties of five different medicinal plants employed in Indian medicinal system on Wistar rats, among which Tribulus terrestris exhibited the highest dose-dependent increase in humoral antibody titer and delayed-type hypersensitivity response, as suggested by an increase in footpad thickness, and demonstrated a substantial increase in phagocytic index in rats. In this study, 0.1% carboxyl methyl cellulose was introduced to the control group, whereas the extracts from the five plants at dissimilar doses were intraperitoneally administered to experimental rats for 7 consecutive days. [15]

Performance-enhancing

Tribulus terrestris has been theoretically proposed to increase levels of serum testosterone by stimulating the androgen receptors within the brain to induce the posterior pituitary gland to secrete more luteinizing hormone; this in turn triggers the testes to synthesize more testosterone. A 2014 systematic review accumulated evidence from a limited number of animal studies that substantiated that Tribulus terrestris treatment, as part of a combined supplement administration, significantly increases serum testosterone levels in humans. An electronic literature search from seven databases and a patent database up to August 2013 amassed results from randomized control trials involving healthy human study participants who were orally administered with Tribulus terrestris alone or in combination with supplement and from animal studies with Tribulus terrestris as a sole treatment across a range of species. [2]

Nephroprotective And Hepatoprotective

The protective effect of Tribulus terrestris on the liver and kidneys had been demonstrated by Lakshmi et al. (2012) in cadmium-intoxicated rats. Administration of an ethanol extract from Tribulus terrestris significantly reversed alterations triggered by administration of cadmium and additionally decreased the cadmium load. Such cadmium-induced changes amended by Tribulus terrestris treatment included an elevation of peroxidation markers, such as malondialdehyde and protein carbonyls; a decrease in antioxidant markers, such as super oxide dismutase; a reduction of glutathione in liver and kidney tissues; an alteration in serum hepatic and renal functional markers, namely, total protein, albumin, alanine transaminase, blood urea nitrogen, and creatinine; notable pathological changes in the liver such as severe vascular and sinusoidal congestion with diffuse degenerative alterations and mononuclear infiltration into peripheral areas; and lastly vascular and glomerular congestion and cloudy swelling of tubular epithelium in the kidneys. [16]

Another study validated the protective effects of an extract from the aerial parts of Tribulus terrestris against acute kidney injury, with its oral administration for 2 weeks having been found to lessen kidney functional disturbance, oxidative stress, and cellular damages as a result of reperfusion injury in rats. Acute kidney injury was evoked in this study by 30-minute ischemia, followed by a 24-hour reperfusion in male Sprague-Dawley rats. Rats orally treated with Tribulus terrestris extract at a dose of 11 mg/kg for 13 days were characterized by a significantly less increase in plasma creatinine and urea nitrogen concentrations after reperfusion and higher creatinine clearance and urine osmolarity than the nontreated group with acute kidney injury. Furthermore, sodium absolute excretion, fractional excretion of potassium, oxidative stress, and cellular damages were also observed to be less in kidney tissues harvested for histological studies. [17]

Kidney Stones

Tribulus terrestris is a traditionally used antiurolithiatic herb that seems to entirely inhibit stone formation and has long been employed empirically to drive urinary stones out of the system. Its fruits are used in Ayurveda to treat several urinary disorders including urolithiasis. The diuretic and contractile attributes of Tribulus terrestris had been demonstrated in the study of Al-Ali et al. (2003), suggesting the potential of the plant as an agent that can propel urinary stones. An orally administered aqueous extract obtained from the leaves and fruits of Tribulus terrestris at a dose of 5 g/kg favorably induced diuresis in Wistar male rats. Such diuretic effect by the Tribulus terrestris extract was considered slightly greater than that of furosemide, a potent loop diuretic medication. The Tribulus terrestris extract had also elicited a contractile activity on isolated guinea pig ileum. [18]

In albino rats with experimentally induced urolithiasis, an ethanol extract from the fruits of Tribulus terrestris had been evidenced to display a dose-dependent antiurolithiatic activity. Orally administered to rats at doses of 25, 50, and 100 mg/kg for 4 months, the extract almost totally suppressed the formation of stones and effectively reversed histopathologic alterations in the urinary bladder and changes in biochemical parameters in urine and serum during the process of stone formation. [19]

Colic

1998 investigation had confirmed the ability of a liophilized saponin mixture of Tribulus terrestris to cause a significant dose-dependent reduction in peristaltic movements of isolated sheep ureter and rabbit jejunum preparations (p < 0.05), with LD50 value and 95% confidence limit of 813 and 739–894 mg/kg, respectively. Such liophilized mixture was acquired from the dried and powdered plant through specific extraction method for saponins. Nevertheless, isolated rabbit aorta and its contractile response to KCl or noradrenaline remained unaffected in this study. Overall, the results pointed out the promising utility of Tribulus terrestris and its saponin mixture on some smooth muscle spasms or colic pains. [4]

Male Fertility

A 2000 study explored the effect of oral treatment of Tribulus terrestris extract on isolated corpus cavernosal tissues of New Zealand white rabbits and had demonstrated the proerectile activity of protodioscin, a major steroidal saponin of Tribulus terrestris, as evidenced by over 10%, 24% and 10% relaxant responses to acetylcholine, nitroglycerin, and electrical field stimulation, respectively, in comparison to their control values and an absence of such effect on the contractile response to noradrenaline and histamine. In the study, 24 New Zealand white rabbits were randomly grouped into four clusters, with the first group being the control and the other three groups being orally treated with Tribulus terrestris extract daily at concentrations of 2.5 mg/kg, 5 mg/kg, and 10 mg/kg body weight, respectively, for a period of 8 weeks. Afterward, penile tissues from sacrificed rabbits were isolated to assess their responses to both contracting and relaxing pharmacological agents and electrical field stimulation. The findings from this study indicated a concentration-dependent elevation of relaxation with regard to relaxant responses to electrical field stimulation, acetylcholine, and nitroglycerin in noradrenaline-precontracted tissues from treated groups, as compared with that of control tissues. An increase in nitric oxide release from the endothelium and nitrergic nerve endings due to Tribulus terrestris extract administration may be responsible for this enhanced relaxation. [20]

Protodioscin, a compound prevalent at no less than 45% of the total plant extract of Tribulus terrestris, has been documented to boost concentration levels of spermatozoa, improve their mobility, and enhance libido in men and laboratory animals. The findings of Arsyad (1996) indicated that an oral treatment of two tablets of protodioscin three times daily for a period of 60 days led to an increase in sperm quantity and quality in 25- to 40-year-old men diagnosed with moderate idiopathic oligozoospermia and restored and improved libido, erection, ejaculation, and orgasm of sexual intercourse in majority of treated men when compared with their status prior to treatment. All studied patients presented an approximately 160% increase in spermatozoa concentration following treatment at day 60 and a continued increase to 200% at day 90, which is 30 days after the last day of administration of protodioscin. A statistically significant increase (p < 0.05) in mobility and the percentage of sperm with normal morphology was also observed. [21]

Aphrodisiac

According to traditional Chinese and Indian systems of medicine, Tribulus terrestris can be used to enhance sexual functions in men. Statistically significant findings by Gauthaman, Adaikan, and Prasad (2002) highlighted the aphrodisiac activity possessed by an extract of Tribulus terrestris, which is likely related to its androgen-increasing property. The study involved an investigation of the sexual behavior and intracavernous pressure of both normal and castrated Sprague-Dawley rats that were treated with either distilled water (normal and castrated rats), subcutaneously provided testosterone (normal and castrated rats at a dose of 10 mg/kg body weight), or orally administered Tribulus terrestris (castrated rats alone at a dose of 5 mg/kg body weight). In castrated rats, body weight, prostate weight, and intracavernous pressure dropped and sexual behavior parameters in general decreased, as revealed by a reduction in mount and intromission frequencies and an increase in mount, intromission, and ejaculation latencies and post-ejaculatory interval. A statistically significant increase in prostate weight and intracavernous pressure was also observed in castrated rats treated with testosterone or Tribulus terrestris extract. [22]

Contraindications, Interactions, And Safety

The oral use of Tribulus terrestris at correct prescribed dosage is considered generally safe, although pregnant and lactating women are still advised to consult expert opinion from qualified healthcare professionals. Due to the presence of saponins, the plant may also be a gastrointestinal irritant and may increase follicle-stimulating hormone and estrogen levels in women.

Talasaz et al. (2010) reported a case of an Iranian male patient who developed hepatotoxicity, nephrotoxicity, and neurotoxicity following the use of Tribulus terrestris extract for 2 days as a preventive aid against kidney stone formation. The patient manifested seizure and very high levels of serum aminotransferases and creatinine, and cessation of Tribulus terrestris extract use, along with dialysis, led to symptom improvement and normalization of his liver enzymes. [23]

References:

[1] M. Shishovska, Z. Arsova-Sarafinovska and S. Memeti, "A simple method for determination of protodioscin in Tribulus terrestris L. and pharmaceuticals by high-performance liquid chromatography using diode-array detection," Journal of Chemical Engineering Research Updates, vol. 2, p. 12–21, 2015. http://eprints.ugd.edu.mk/13129/

[2] A. Qureshi, D. P. Naughton and A. Petroczi, "A systematic review on the herbal extract Tribulus terrestris and the roots of its putative aphrodisiac and performance enhancing effect," Journal of Dietary Supplements, vol. 11, no. 1, p. 64–79, 2014. https://www.ncbi.nlm.nih.gov/pubmed/24559105

[3] M. Akram, H. Asif, N. Akhtar, et al., "Tribulus terrestris Linn.: A review article," Journal of Medicinal Plants Research, vol. 5, no. 16, p. 3601–3605, 2011. https://www.researchgate.net/publication/260210811

[4] H. Arcasoy, A. Erenmemisoglu, Y. Tekol, S. Kurucu and M. Kartal, "Effect of Tribulus terrestris L. saponin mixture on some smooth muscle preparations: a preliminary study," Bollettino Chimico Farmaceutico, vol. 137, no. 11, p. 473–475, 1998. https://www.ncbi.nlm.nih.gov/pubmed/10077881

[5] N. A. E.-A. Eljabri, A. K. Ahmed and A. Ahmed, "Antihypertensive and hematological effects of Tribulus terrestris aqueous extract," International Journal for Innovation Education and Research, vol. 3, no. 8, 2015. https://www.ncbi.nlm.nih.gov/pubmed/16289603

[6] S. Chhatre, T. Nesari, G. Somani, D. Kanchan and S. Sathaye, "Phytopharmacological overview of Tribulus terrestris," Pharmacognosy Reviews, vol. 8, no. 15, p. 45–51, 2014. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3931200/

[7] H. M. Hammoda, N. M. Ghazy, et al., "Chemical constituents from Tribulus terrestris and screening of their antioxidant activity," Phytochemistry, vol. 92, p. 153–159, 2013. https://www.ncbi.nlm.nih.gov/pubmed/23642392

[8] G. Dastagir, F. Hussain and A. I. U. Rehman, "Essential oil composition of some plants of family Zygophyllaceae and Euphorbiaceae," Pakistan Journal of Botany, vol. 46, no. 6, p. 2043–2049, 2014. https://www.researchgate.net/publication/279026005

[9] O. Phillips, K. Mathew and M. Oriowo, "Antihypertensive and vasodilator effects of methanolic and aqueous extracts of Tribulus terrestris in rats," Journal of Ethnopharmacology, vol. 104, no. 3, p. 351–355, 2006. https://www.ncbi.nlm.nih.gov/pubmed/16289603

[10] M. Heidari, M. Mehrabani, A. Pardakhty, et al., "The analgesic effect of Tribulus terrestris extract and comparison of gastric ulcerogenicity of the extract with indomethacine in animal experiments," Annals of the New York Academy of Sciences, vol. 1095, p. 418–427, 2007. https://www.ncbi.nlm.nih.gov/pubmed/17404054

[11] H. Arcasoy, A. Erenmemisoglu, Y. Tekol, S. Kurucu and M. Kartal, "Effect of Tribulus terrestris L. saponin mixture on some smooth muscle preparations: a preliminary study," Bollettino Chimico Farmaceutico, vol. 137, no. 11, p. 473–475, 1998. https://www.ncbi.nlm.nih.gov/pubmed/10077881

[12] M. Li, W. Qu, Y. Wang, H. Wan and C. Tian, "Hypoglycemic effect of saponin from Tribulus terrestris," Journal of Chinese Medicinal Materials, vol. 25, no. 6, p. 420–422, 2002. https://www.ncbi.nlm.nih.gov/pubmed/12583337

[13] M. Li, W. Qu, S. Chu, H. Wang, C. Tian and M. Tu, "Effect of the decoction of tribulus terrestris on mice gluconeogenesis," Journal of Chinese Medicinal Materials, vol. 24, no. 8, p. 586–588, 2001. https://www.ncbi.nlm.nih.gov/pubmed/11715199

[14] C. Guo, C. Li, Y. Yu, W. Chen, T. Ma and Z. Zhou, "Antihyperglycemic and antihyperlipidemic activities of protodioscin in a high-fat diet and streptozotocin-induced diabetic rats," RSC Advances, vol. 6, no. 91, p. 88640–88646, 2016. https://www.researchgate.net/publication/308046141

[15] A. Tilwari, N. Shukla and P. Uma Devi, "Effect of five medicinal plants used in Indian system of medicines on immune function in Wistar rats," African Journal of Biotechnology, vol. 10, no. 73, 2011. http://www.academicjournals.org/journal/AJB/article-stat/0EF7BC736703

[16] G. Lakshmi, P. Kumar, K. Bharavi, P. Annapurna, B. Rajendar, P. Patel, C. Kumar and G. Rao, "Protective effect of Tribulus terrestris linn on liver and kidney in cadmium intoxicated rats," Indian Journal of Experimental Biology, vol. 50, no. 2, p. 141–146, 2012. https://www.ncbi.nlm.nih.gov/pubmed/22670477

[17] H. Najafi, M. Firouzifar, O. Shafaat, S. Changizi Ashtiyani and N. Hosseini, "Protective effects of Tribulus terrestris L extract against acute kidney injury induced by reperfusion injury in rats," Iranian Journal of Kidney Diseases, vol. 8, no. 4, p. 292–298, 2014. https://www.ncbi.nlm.nih.gov/pubmed/25001135

[18] M. Al-Ali, S. Wahbi, H. Twaij and A. Al-Badr, "Tribulus terrestris: preliminary study of its diuretic and contractile effects and comparison with Zea mays," Journal of Ethnopharmacology, vol. 85, no. 2–3, p. 257–260, 2003. https://www.ncbi.nlm.nih.gov/pubmed/12639749

[19] R. Anand, G. Patnaik, et al., "Evaluation of antiurolithiatic activity of Tribulus terrestris," International Journal of Pharmacognosy, vol. 32, no. 3, p. 217–224, 1994. https://www.researchgate.net/publication/232089162

[20] P. Adaikan, K. Gauthaman, R. Prasad and S. Ng, "Proerectile pharmacological effects of Tribulus terrestris extract on the rabbit corpus cavernosum," ANNALS Academy of Medicine Singapore, vol. 29, no. 1, p. 22–26, 2000. https://www.ncbi.nlm.nih.gov/pubmed/10748960

[21] K. M. Arsyad, "Effect of protodioscin on the quantity and quality of sperms from males with moderate idiopathic oligozoospermia," Medika, vol. 22, no. 8, p. 614–618, 1996.

[22] K. Gauthaman, P. G. Adaikan and R. V. Prasad, "Aphrodisiac properties of Tribulus terrestris extract (protodioscin) in normal and castrated rats," Life Sciences, vol. 71, no. 12, p. 1385–1396, 2002. https://www.ncbi.nlm.nih.gov/pubmed/12127159

[23] A. H. Talasaz, M.-R. Abbasi, S. Abkhiz and S. Dashti-Khavidaki, "Tribulus terrestris-induced severe nephrotoxicity in a young healthy male," Nephrology Dialysis Transplantation, vol. 25, no. 11, p. 3792–3793, 2010. https://www.ncbi.nlm.nih.gov/pubmed/20667992

Article researched and created by Dan Albir for herbs-info.com. © herbs-info.com 2018

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