Skip to main content

Advertisement

SpringerLink
Log in

Herbal Medicines for Liver Diseases

  • Review Article
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Herbal medicines have been used in the treatment of liver diseases for a long time. A number of herbal preparations are available in the market. This article reviews four commonly used herbal preparations: (1) Phyllanthus, (2) Silybum marianum (milk thistle), (3) glycyrrhizin (licorice root extract), and (4) Liv 52 (mixture of herbs). Phyllanthus has a positive effect on clearance of HBV markers and there are no major adverse effects; there are no data from randomized controlled trials on clinically relevant outcomes, such as progression of chronic hepatitis to cirrhosis and/or liver cancer, and on survival. Silymarin does not reduce mortality and does not improve biochemistry and histology among patients with chronic liver disease; however, it appears to be safe and well tolerated. Stronger neominophagen C (SNMC) is a Japanese preparation that contains 0.2% glycyrrhizin, 0.1% cysteine, and 2% glyceine. SNMC does not have antiviral properties; it primarily acts as an anti-inflammatory or cytoprotective drug. It improves mortality in patients with subacute liver failure and improves liver functions in patients with subacute hepatic failure, chronic hepatitis, and cirrhosis with activity. SNMC does not reduce mortality among patients with cirrhosis with activity. SNMC may prevent the development of hepatocellular carcinoma in patients with chronic hepatitis C, however, prospective data are lacking. Liv 52, an Ayurvedic hepatoprotective agent, is not useful in the management of alcohol-induced liver disease. Standardization of herbal medicines has been a problem and prospective, randomized, placebo-controlled clinical trials are lacking to support their efficacy. The methodological qualities of clinical trials of treatment with herbal preparations are poor. The efficacy of these herbal preparations need to be evaluated in rigorously designed, larger randomized, double-blind, placebo-controlled multicenter trials.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Thyagrajan SP, Jayaram S, Gopalakrishnan V, Han R, Jayakumar P, Sripathi MS: Herbal medicines for liver diseases in India. J Gastroenterol Hepatol 17:S370–S376, 2002

    Article  PubMed  Google Scholar 

  2. Schuppan D, Jia J-D, Brinkhaus B, Hahn EG: Herbal products for liver diseases: A therapeutic challenge for the new millennium. Hepatology 30:1099–1104, 1999

    Article  PubMed  Google Scholar 

  3. Dhiman RK: Herbal hepatoprotective agents: marketing gimmick or potential therapies? Trop Gastroenterol 24:160–162, 2003

    PubMed  Google Scholar 

  4. Woolf SH, Sox HC Jr: The Expert Panel on Preventive Services: continuing the work of the U.S.Preventive Services Task Force. Am J Prev Med 7:326–330, 1991

    PubMed  Google Scholar 

  5. Venkateswaran PS, Millman I, Blumberg BS: Effects of an abstract of Phyllanthus niuri on hepatitis B and woodchuck hepatitis viruses: in vitro and in vivo studies. Proc Natl Acad Sci USA 84:274–278, 1987

    PubMed  Google Scholar 

  6. Ott M, Thayagrajan SP, Gupta S: Phyllanthus amarus suppresses hepatitis B virus by interrupting interactions between HBV enhancer I and cellular transcription factors. Eur J Clin Invest 27:908–915, 1997

    Article  PubMed  Google Scholar 

  7. Lee CD, Ott M, Thyagarajan SP, Sharfritz DA, Burk RD, Gupta S: Phyllanthus amarus down regulates hepatitis B virus mRNA transcription and replication. Eur J Clin Invest 24:161–168, 1996

    Google Scholar 

  8. Polya GM, Wang BH, Foo LY: Inhibition of signal regulated protein kinases by plant derived hydrolyzable tannins. Phytochemistry 38:307–314, 1995

    Article  PubMed  Google Scholar 

  9. Thyagarajan SP, Subramanian S, Thirunaksundari T, Venkateswaran PS, Blumberg BS: Effects of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet 2:764–766, 1988

    Article  PubMed  Google Scholar 

  10. Thyagrajan SP, Jayaram S, Valliammae T, Madangopalan N, Pal VG, Jayaraman K: Phyllanthus amarus and hepatitis B. Lancet 336:949–950, 1990

    Article  Google Scholar 

  11. Thyagarajan SP, Jayaram S, Panneeselvam A, et al.: Effect of Phyllanthus amarus, an Indian medicinal plant on healthy carriers of hepatitis B virus. Results of six clinical trials. Indian J Gastroenterol 18 (Suppl 1):S26, 1999 (abstr)

    Google Scholar 

  12. Liu J, Lin H, McIntosh H: Genus Phyllanthus for chronic hepatitis B virus infection: a systematic review. J Viral Hepat 8:358–366, 2001

    Article  PubMed  Google Scholar 

  13. Jadad AR, Moore A, Carroll D, et al.: Assessing the quality of reports of randomized clinical trials: Is blinding necessary? Control Clin Trials 17:1–12, 1996

    Article  PubMed  Google Scholar 

  14. Leelarasamee A, Trakulsomboon S, Maunwongyathi P, Somanabandhu A, Pidetcha P, Matrakool B, Lebnak T, Ridthimat W, Chandanayingyong D: Failure of Phyllanthus amarus to eradicate hepatitis B surface antigen from symptomless carriers. Lancet 335:1600–1601, 1990

    Article  PubMed  Google Scholar 

  15. Wang M, Zhou HB, Zhao GI, Zhao S, Mai K: Phyllanthus amarus cannot eliminate HBsAg in chronic B virus infection. Hepatology 21:22–24, 1991

    Google Scholar 

  16. Berk L, de Man RA, Schalm SW, Labadie RP, Heijtink RA: Beneficial effects of Phyllanthus amarus for chronic hepatitis B, not confirmed. J Hepatol 12:405–406, 1991

    Article  PubMed  Google Scholar 

  17. Thamlikitkul V, Wasuwat S, Kanchanapee P: Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers. J Med Assoc Thai 74:381–385, 1991

    PubMed  Google Scholar 

  18. Milne A, Hopkirk N, Lucas CR, Waldon J, Foo Y: Failure of New Zealand hepatitis B carriers to respond to Phyllanthus amarus. NZ Med J 107:243, 1994

    Google Scholar 

  19. Luper S: A review of plants used in the treatment of liver disease: Part 1. Altern Med Rev 3:410–421, 1998

    PubMed  Google Scholar 

  20. Feher J, Lang I, Nekam KJ, Gergely P, Muzes G: In vivo effect of free radical scavenger hepatoprotective agents on superoxide dismutase (SOD) activity in patients. Tokai Exp Clin Med 15:129–134, 1990

    Google Scholar 

  21. Campos R, Garrido A, Guerra R, Valenzuela A: Silybin dihemisuccinate protects against glutathione depletion and lipid peroxidation induced by acetaminophen on rat liver. Planta Med 55:417–419, 1989

    PubMed  Google Scholar 

  22. Pietrangelo A, Borrella F, Casalgraudi G, et al.: Antioxidant activity of slilybin in vivo during long-term iron overload in rats. Gastroenterology 109:1941–1949, 1995

    Article  PubMed  Google Scholar 

  23. Boigk G, Stroedter I, Herbst H, Waldschmidt J, Riecken EO, Schuppan D: Silymarin retards collagen accumulation in early and advanced biliary fibrosis secondary to complete bile duct obliteration in rats. Hepatology 26:643–649, 1997

    PubMed  Google Scholar 

  24. Tuchweber B, Sieck R, Trost W: Prevention of silybin of phalloidin induced acute hepatoxicity. Toxicol Appl Pharmacol 51:265–275, 1979

    Article  PubMed  Google Scholar 

  25. Faulstich H, Jahn W, Wieland T: Silybin inhibition of amatoxin uptake in the perfused rat liver. Arzneimittelforschung 30:452–454, 1980

    PubMed  Google Scholar 

  26. Jacobs BP, Dennehy C, Ramirej G, Sapp J, Lawrence VA: Milk thistle for the treatment of liver diseases: a systematic review and meta-analysis. Am J Med 113:506–515, 2002

    Article  PubMed  Google Scholar 

  27. Seef LB, Lindsay KL, Bacon BR, Kresina TF, Hoofnagle JH: Complementary and alternative medicine in chronic liver disease. Hepatology 34:595–603, 2001

    Article  PubMed  Google Scholar 

  28. van Rossum TG, Vulto AG, de Man RA, Browner JT, Schalm SW: Review article: glycyrrhizin as a potential treatment for chronic hepatitis C. Aliment pharmacol Ther 12:199–205, 1998

    Article  PubMed  Google Scholar 

  29. Yoshikawa M, Matsui Y, Kawamoto H, et al.: Effects of glycyrrhizin on immune mediated cytotoxicity. J Gastroenterol Hepatol 12:243–247, 1997

    PubMed  Google Scholar 

  30. Miyaji C, Miyakawa R, Watanabe H, Kawamura H, Abo T: Mechanisms underlying the activation of cytotoxic function mediated by hepatic lymphocytes following the administration of glycyrrhizin. Int Immunopharmacol 2:1079–1086, 2002

    Article  PubMed  Google Scholar 

  31. Shiki Y, Shinai K, Satto Y, Yoshida S, Mosi Y, Wakashin M: Effect of glycyrrhizin on lysis of hepatocyte membranes induced by anti-liver cell membrance antibody. J Gastroenterol Hepatol 7:12–16, 1992

    PubMed  Google Scholar 

  32. Abe N, Ebina T, Ishida N: Interferon induction by glycyrrhizin and glycyrrhetinic acid in mice. Microbiol Immunol 26:535–539, 1982

    PubMed  Google Scholar 

  33. Abe Y, Ueda T, Kato T, Kohli Y: Effectiveness of interferon, glycyrrhizin combination therapy in patients with chronic hepatitis C. Nippon Rinsho 52:1817–1822, 1994

    PubMed  Google Scholar 

  34. Zhang L, Wang B: Randomized clinical trial with two doses (100 and 40 ml) of Stronger Neo-Minophagen C in Chinese patients with chronic hepatitis B. Hepatol Res 24:220, 2002

    Article  PubMed  Google Scholar 

  35. Miyake K, Tango T, Ota Y, et al.: Efficacy of Stronger Neo-Minophagen C compared between two doses administered three times a week on patients with chronic viral hepatitis. J Gastroenterol Hepatol 17:198–204, 2002

    Article  Google Scholar 

  36. Iino S, Tango T, Matsushima T, Toda G, Miyake K, Hino K, Kumada H, Yasuda K, Kuroki T, Hirayama C, Suzuki H: Therapeutic effects of stronger neo-minophagen C at different doses on chronic hepatitis and liver cirrhosis. Hepatol Res 19:31–40, 2001

    Article  PubMed  Google Scholar 

  37. Kumada H: Long-term treatment of chronic hepatitis C with glycyrrhizin [stronger neo-minophagen C (SNMC)] for preventing liver cirrhosis and hepatocellular carcinoma. Oncology 62 (Suppl 1):94–100, 2002

    Article  PubMed  Google Scholar 

  38. Arase Y, Ikeda K, Murashima N, Chayama K, Tsubota A, Koida I, Suzuki Y, Saitoh S, Kobayashi M, Kumada H: The long term efficacy of glycyrrhizin in chronic hepatitis C patients. Cancer 79:1494–1500, 1997

    Article  PubMed  Google Scholar 

  39. Acharya SK, Dasarathy S, Tandon A, Joshi YK, Tandon BN: A preliminary open trial on interferon stimulator (SNMC) derived from Glycyrrhiza glabra in the treatment of subacute hepatic failure. Indian J Med Res 98:69–74, 1993

    PubMed  Google Scholar 

  40. Tandon A, Tandon BN, Bhujwala RA: Clinical spectrum of acute sporadic hepatitis E and possible benefit of glycyrrhizin therapy. Hepatol Res 23:55–61, 2002

    Article  PubMed  Google Scholar 

  41. Acharya SK, Dasarathy S, Panda SK, Joshi YK: Parenteral glycyrrhozin therapy (Stronger Neominophegen C) in patients with subacute hepatic failure (SHF), chronic hepatitis (CH) and cirrhosis with activity. Final report on the ICMR Force Project, Apr 4, 1992, Mar 31, 1997

  42. Tandon BN, Joshi YK, Acharya SK: Subacute liver failure. Natl Med J India 1:124–127, 1988

    Google Scholar 

  43. Anand AC, Seth AK, Nagpal A, Varma PP, Gadela SR, Baliga KV, Chopra GS: Ribavirin plus glycyrrhizin is more effective than ribavirin monotherapy in renal allograft recipients with chronic hepatitis C (Abstr). Indian J Gastroenterol 23:S7, 2004

    Google Scholar 

  44. Takeda R, Morimoto S, Uchida K, Nakai T, Miyamoto M, Hashiba T, Yoshimitsu K, Kim KS, Miwa U: Prolonged pseudoaldosteronism induced by glycyrrhizin. Endocrinol Japan 26:541–547, 1979

    Google Scholar 

  45. Epstein M, Espiner E, Donald R, Hughes H: Effects of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects. Br Med J 1:488–490, 1977

    PubMed  Google Scholar 

  46. Sandhir R, Gill KD: Hepatoprotective effects of Liv 52 on ethanol induced liver damage in rats. Indian J Exp Biol 37:762–766, 1999

    PubMed  Google Scholar 

  47. Pandey S, Gujrati VR, Shanker K, Singh N, Dhawan KN: Hepato protective effect of Liv-52 against CCl4 induced lipid peroxidation in liver of rats. Indian J Exp Biol 32:674–675, 1994

    PubMed  Google Scholar 

  48. Gopumadhavan S, Jagadeesh S, Chauhan BL, Kulkarni RD: Protective effect of Liv 52 on alcohol-induced fetotoxicity. Alcohol Clin Exp Res 17:1089–1092, 1993

    PubMed  Google Scholar 

  49. Roy A, Soni GR, Kolhapure RM, Karnik UR, Patki PS: Down regulation of tumour necrosis factor activity in experimental hepatitis by a herbal formulation, Liv 52. Indian J Exp Biol 32:694–697, 1994

    PubMed  Google Scholar 

  50. Chauhan BL, Kulkarni RD: Effect of Liv 52, an herbal preparation, on absorption and metabolism of ethanol in humans. Eur J Clin Pharmacol 40:189–191, 1991

    PubMed  Google Scholar 

  51. Fleig WW, Morgan MY, Holzer MA, European Multicenter Study Group: The ayurvedic drug Liv 52 in patients with alcoholic cirrhosis. Results of a prospective, randomized, double blind, placebo controlled clinical trial. J Hepatol 26 (Suppl 1):127, 1997 (abstr)

    Google Scholar 

  52. de Silva HA, Saparamadu PA, Thabrew MI, Pathmeswaran A, Fonseka MM, de Silva HJ: Liv 52 in alcoholic liver disease: a prospective, controlled trial. J Ethnopharmacol 84:47–50, 2003

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India

    Radha K. Dhiman MD, DM, MAMS, FACG & Yogesh K. Chawla MD, DM, FAMS, FACG

Authors
  1. Radha K. Dhiman MD, DM, MAMS, FACG
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yogesh K. Chawla MD, DM, FAMS, FACG
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Radha K. Dhiman MD, DM, MAMS, FACG.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dhiman, R.K., Chawla, Y.K. Herbal Medicines for Liver Diseases. Dig Dis Sci 50, 1807–1812 (2005). https://doi.org/10.1007/s10620-005-2942-9

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-005-2942-9

Key Words

Search

Navigation