INTRODUCTION: Alternative agents have been proposed for the management of kidney or ureteral stones. This study aimed to investigate the safety and efficacy of Blumea balsamifera (sambong) compared with a terpene combination drug as treatment for ureterolithiasis. METHODS: Patients with clinically stable kidney function and ureteral stones of ≤ 5 mm were randomized to receive a special terpene combination (Rowatinex ®) or Blumea balsamifera. All patients had a physical examination, and diagnosis of kidney stones was made by ultrasound at baseline and after 6 and 12 weeks of treatment. Primary outcomes were change in stone size and stone-free status, defined as obviously successful expansion of calculi/fragments, documented by ultrasound. RESULTS: After 6 weeks, five patients in the sambong group and six in the terpene group were stone free (p = 0.90). After 12 weeks, seven in the sambong and eight in the terpene group were stone free (p = 0.31). In terms of stone size, there was a significant decrease in the mean diameter in the sambong group (1.81 ± 2.01 mm, p = 0.008 and 1.12 ± 1.43 mm p<0.005) at 6 and 12 weeks, respectively. However, there was no significant difference between the two groups. Urine pH also increased in both groups compared to baseline but the difference was not statistically significant when comparing the two arms. CONCLUSION Blumea balsamifera is comparable with a terpene combination in the dissolution of urolithiasis and is well-tolerated and safe.