OBJECTIVE: To explore the supportive evidence for the use of Ayurvedic medicine in the management of existing and recurrent nephrolithiasis. METHOD: Nine Ayurvedic medicines commonly utilized in the management of nephrolithiasis were identified by discussions with Ayurvedic practitioners in India. Mechanistic and clinical studies evaluating the use of these agents were identified using the Medline database and bibliographies suggested by Ayurvedic practitioners. The articles were then critically reviewed and summarized. RESULTS: Four in vitro mechanistic studies, eight animal studies, and seven human trials were identified. Phyllanthus niruri has undergone mechanistic in vitro, animal, and clinical trials that support its impact on calcium oxalate crystallization. Preliminary clinical trials have evaluated the role of Dolichos biflorus and Orthosiphon grandiflorus in the prevention of urolithiasis and fish stone as a method of stone expulsion, yet the treatment effect and mechanism of action remains to be elucidated. CONCLUSION: Ayurvedic medicine holds promise as a complementary approach to the management and prevention of nephrolithiasis. The best studied compound is P. niruri. Further controlled randomized clinical trials are justified to support or refute the potential benefits demonstrated in these initial studies.