Herbal Treatment of Hepatitis

There is a large body of evidence building over the last 20 years, primarily by Japanese researchers, for the use of the specific traditional Chinese herbal formula Minor Bupleurum, or SST (sho-saiko-to), for the protection of the liver (Herbs and the Alphabet Soup of Hepatitis). There are currently 171 papers and studies listed in a conventional medical database under the Japanese name, Sho Saiko To (SST,) outlining its use for treatment of hepatitis in China and Japan. Robert Rister states in his book, Japanese Herbal Medicine, "Usefulness [of SST] in hepatitis treatment has been confirmed by dozens of studies in Japan, over 90% of chronic hepatitis patients [in Japan] take this formula." In another study it was estimated that 1.5 million people in Japan suffering from hepatitis were taking this formula. Studies show the effectiveness of this formula at nearly every stage of infection for hindering and even stopping the progression of the hepatitis viruses.

What does the herbal formula SST (sho-saiko-to) do?

SST increases the immune system components that both keep the virus from forming proteins and attacks the virus directly. SST has also been shown to boost the immune system through its effects on macrophage functions. "These results suggest that SST enhances the immune response through at least two different routes, that is, through eliminating the inhibition of lymphocyte functions by prostaglandin E2 and through presenting antigen more efficiently." ²²

SST has demonstrated that it can treat viral hepatitis. In a clinical trial the efficacy of SST on 222 patients with chronic active hepatitis was studied in a double-blind, multi-center clinical study. One hundred and sixteen patients received SST in a daily oral dose of 5.4 gm for twelve weeks, followed by the same dose for a further twelve weeks. One hundred and six patients received a placebo containing 0.5 g of SST for twelve weeks, followed by a crossover to SST for a further twelve weeks. Among the liver tests, serum AST and ALT values decreased significantly with the administration of SST. The difference of the mean value between the SST group and the placebo group was significant after twelve weeks.¹⁸

The anti-tumor activity of this formula is well documented, especially for liver cancer, but also lung cancer and renal cell carcinomas. ^2,3,4,21 One study was performed to evaluate the preventative effect of SST on liver cancer development in chronic viral hepatitis, because of the anti-tumor effects documented in experimental animals.^2,3,4 It studied 260 patients with cirrhosis over five years in control groups to determine liver cancer protection. The patients in the trial group were given SST at a daily oral dose of 7.5 gm per day in addition to the conventional drugs given to the control groups. The patients were monitored for sixty months and the cumulative incidence of liver cancer and the survival rate in the two groups were calculated. The conclusion was that SST helped to prevent the development of liver cancer in patients with viral hepatitis.⁵ (Currently being studied by Memorial Sloan-Kettering Cancer Center (www.mskcc.org) to determine its effect against liver cancer. This study is entitled "Sho-Saiko-To after Ablation for Non-Resectable Hepatocellular Carcinoma: A Phase II Trial with Historical Control.)

SST also proves effective in preventing or stopping the progression into liver cancer for patients with cirrhosis. One double-blind study of 260 HBV patients with cirrhosis of the liver were paired together matched for age, sex, and HBV antigens. The trial group was given 7.5 gm of SST daily; the control group was given conventional medical treatment. After 34 months, SST outperformed the conventional treatment and the authors of the study concluded, "SST may prevent or delay the emergence of latent Hepatocellular cancer, in patients with cirrhosis."²⁹

Analysis of this formula is very interesting; it shows the effectiveness is derived from complex molecules found in the whole herbs themselves and not in the simple chemical extracts taken from the herbs.²⁶

The treatment of children with SST has shown to be especially effective in a number of studies.^13,17,26 One clinical trial concluded, "SST seemed to promote clearance of HBeAg in children with chronic HBV infection and with sustained liver disease. SST may be a very useful drug for such patients."¹⁷

Another clinical trail concluded the same and identified the mechanism "by the production of gamma interferon which interferes with the virus's ability to reproduce. Not only able to promote clearance of HbeAg, this formula can prevent the progression of HCV."²⁶

SST has been shown to increase the effects of prednisolone.^14,15 It showed the mild anti-inflammatory action and significantly increased the anti-inflammatory effect of prednisolone (pediaped, prelone). Bupleurum, the main ingredient of SST, has saikosides that along with other chemicals, stimulate the pituitary gland into directing the adrenal glands to produce glucocorticoids, which reduce inflammation.^32,33 Bupleurum also increases the effectiveness of glucocorticoid drugs such as prednisone. This has matched my own anecdotal experience in practice; always use SST to help minimize the side-effects and withdrawal symptoms from prednisone.

Contraindications. The use of SST has been shown to be contraindicated with Interferon treatment as it increases the side effects of the drug. SST has been demonstrated to increase the production of the body's own natural interferon, (which explains why, it increases the side-effects of the synthetic drug Interferon). SST is an interferon inducer. There are some cases where HBV and HCV patients have developed pneumonitis or pneumonia using SST in conjunction with Interferon drug therapy.¹ Supervision by an M.D. is absolutely essential under these conditions. Also some contraindications have been reported for patients with liver cancer and cirrhosis.

A major anti-viral agent, SST has been shown to be useful against other viruses. In HIV studies it was shown to produce a 50% reduction in the ability of HIV to replicate itself and jumps to 80% for leukemia viruses.³⁰ Like Andrographis (Andrographis paniculata), (mentioned later in this booklet) acts by blocking an enzyme known as reverse transcriptase which the virus uses to translate its genetic information into a form it can use to replicate.

SST has also been used traditionally against the influenza virus when used at a certain stage of influenza viral attack, when, according to Traditional Chinese Medicine (TCM), the pathogen is stuck in a superficial "lesser yang" level of disease stalemate. Chronic hepatitis can also be classified by TCM and Japanese Herbal Medicine, Kampo, (on a deeper level) as a disease of the lesser yang level. In this scenario, the body's defenses and the invader have reached a stalemate that can last for many years. The influenza virus has proven vulnerable to SST in this lesser yang stage, where the forces of the pathogen and those of the body are equally matched.

Bupleurum is one of the main ingredients of SST and recent studies indicate that the particular species used in the SST formula makes a significant difference on the therapeutic impact of the formula. A simple and quick quantitative analysis of saikosaponins a, c and d, the major bioactive principles contained in Bupleurum species, by TLC scanner described the following results: with Bupleurum kaoi, the species native to Taiwan, showed that the roots, rhizomes and aerial parts (leaves and stem) have greater quantities of saikosaponins than cultivated B. falcatum var. komarowi and B. chinense used in many commercially available formulas. The liver protective effects of the three different Bupleurum species were evaluated using CCl4-induced toxicity in rats. The acute increase of serum transaminase (SGOT and SGPT) levels caused by CCl4 administration (3.0 ml/kg, s.c.) was dramatically reduced when treated with SST prepared with the roots of B. kaoi.¹⁹ It may have been this particular species had encountered some history fighting bacteria or viruses that has left this species with compounds supportive for the liver and hepatitis.

Schisandra

Schisandrae chinensis is showing great promise in liver protection against viral hepatitis⁹ and toxic chemicals.^10,12 Schisandra is a well-known Chinese herb widely used in ancient China. It protects the liver against toxic chemical damage even when activated into a poison in the liver, such as with carbon tetrachloride. There are no toxic reactions reported even at huge dosages.¹¹During recent decades, it has been found to be effective in viral and chemically induced hepatitis and in repair of the injured liver cells.¹⁶

Milk Thistle

Milk thistle, Silybum marianum, has the active principle, silymarin, that has been demonstrated in animals to protect against various hepato-toxic substances. To determine the effect of silymarin on the outcome of patients with cirrhosis, a double-blind, prospective, randomized study was performed in 170 patients with cirrhosis. Analysis of subgroups indicated that treatment was effective in patients with alcoholic cirrhosis.²⁵

Milk thistle has been used for hundreds of years in Europe to promote liver health and positive mental attitude. Severe liver damage from a poisonous mushroom may be prevented if silymarin is ingested within the forty-eight hours prior to eating the mushroom. This protective action is thought to come from the powerful antioxidant activity (ten times greater than vitamin E) that prevents certain toxins from entering liver cells, while actually stimulating regeneration of damaged cells. Pliny, the Elder, once claimed -- and it now seems confirmed through scientific research -- that milk thistle helps prevent and treat gallstones through its ability to increase the solubility of the bile and lower biliary cholesterol.

Andrographis Paniculata.htm

Andrographis paniculata, used in Chinese and Ayurvedic medicine, is another herbal rising star. Recently acclaimed for its ability to protect the liver and help the liver regenerate itself, it has the added benefit of hindering the replication of viruses, by altering cell-to-cell transmissions.^23,24 The ingredient andrographide is suspected in destroying the virus' communication mechanism, preventing the transmission of the virus to other cells by modifying cellular signal transmission.²⁸ Andrographis acts by blocking an enzyme known as reverse transcriptase, which the virus uses to translate its genetic information in order to replicate. The ingredient andrographide is suspected of destroying the virus’ communication mechanism by modifying cellular signal transmission. Andrographis is commonly known as "King of Bitters” for its bitter flavor. It seems to have a real affinity for liver and gallbladder complaints. It is classically used throughout Asia to treat GI tract and upper respiratory infections, fever, herpes, sore throat, and a variety of other chronic and infectious diseases. In TCM it is used to clear “heat-toxins from the body”. In Scandinavian countries, it is commonly used to prevent and treat common colds. Swedish research has confirmed that Andrographis is extremely beneficial in the treatment of influenza. Andrographolides are thought to enhance immune system functions such as production of white blood cells, release of interferon, and activity of the lymph system.

The major 10 benefits of andrographis are as follows:

1. Immune enhancement: increases production of white blood cells, release of interferon, and activity of the lymph system, stimulates scavengers of bacteria and other foreign matter, phagocytosis, inhibits HIV-1, hepatitis B and C, influenza virus replication, and improves CD4+ and T lymphocyte counts;

2. Supports, alters, and stimulates the properties and flow of bile;

3. Anti-inflammatory: reduces swelling and cuts down exudation from capillaries;

4. Antibacterial: fights bacterial activity; it appears to have a weak direct action yet can be remarkably beneficial effect in reducing diarrhea and symptoms arising from bacterial infections;

5. Anti-malarial: counteracts periodic/intermittent diseases;

6. Prevent blood clots, used preventatively;

7. Fights, even kills, cancer cells;

8. Cardio-protective: it protects heart muscles and researchers have reported that an extract of Andrographis was effective for lowering blood pressure;

9. Cleans and purifies the blood;

10. Relaxing herb: it is a mild relaxant.

Andrographis is a major herb in at least 26 classic Ayurvedic formulas used to treat liver disorders. In relation to liver & gallbladder protection for thousands of years, there are three major points to recommend its use:

1. Significant protective effect in the liver. Four of its related medicinal compounds were tested for a protective effect against liver toxicity produced in mice by poisoning them with a cleaning solvent, alcohol, or other toxic chemicals. These chemicals damage the liver by a process whereby free radicals are produced by the chemical attack and destroy cellular membranes that surround liver cells. When Andrographis was given to animals three days before the toxic chemicals there was a pronounced protective effect against the toxins. This effect was attributed to the antioxidant ability of the Andrographis compounds.

2. More potent than silymarin in milk thistle, the famous liver-protective herb. Infective hepatitis is an acute inflammatory condition of the liver. Ancient Ayurvedic physicians used to treat similar liver ailments with Andrographis. A study conducted to evaluate the effect of AP in infective hepatitis demonstrated a marked improvement in the majority of patients tested.

3. Potent stimulator of gallbladder function due to the andrographolides. In animal experiments, those that received andrographolides for seven consecutive days showed an increase in bile flow, bile salts, and bile acid, helping to improve gallbladder function.

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