Herbs and the Alphabet Soup of Hepatitis
Over ninety percent of chronic hepatitis sufferers in Japan, some 1.5
million people, are taking a safe, natural medicine, used by
conventional physicians there and proven effective in hundreds of papers
This natural medicine, however, is still unknown in the West, to the
millions suffering viral hepatitis in the United States. Studies have
shown that this herbal formula strengthens the immune system, reduces
viral loads, and can stop the progression of chronic viral hepatitis
into serious liver damage, cirrhosis and even liver cancer. This herbal
formula, studied by scientists in modern Japan, is from Ancient China.
The formula name is Minor Bupleurum, first reported in the Shan Han Lun,
Discussion of Cold Induced Disorders, written between 300 BC and 300 AD.
According to the Hepatitis Foundation International, the Hepatitis B
and C viruses have infected 520 million people globally, 6 million in
the US alone, and most do not know they are infected. This article
reviews the viral hepatitis "alphabet" and reviews the literature on the
formula and other promising liver herbs.
Hepatitis is not a single disease but is actually a term meaning
"inflammation of the liver." This disease has been plaguing human beings
for centuries. There are reports describing hepatitis in the literature
of Traditional Chinese Medicine going back thousands of years.
Hippocrates noted occurrences of jaundice epidemics around battlefields
with the concentrated populations of soldiers and their attending
unhygienic conditions. During the American Civil War, at least 70,000
soldiers fell ill with infectious hepatitis. Today science has
identified an entire "alphabet soup" of hepatitis viruses: Hepatitis A,
B, C, D, E, F and G.
Other viruses, (such as Cytomegalovirus and Epstein Barr) can cause
hepatitis and can also activate sleeping hepatitis viruses lying dormant
in liver cells. Hepatitis can also be chemically induced.
Hepatitis A (HAV), once known as infectious hepatitis, is short-term
and self-limiting. HAV is the least dangerous of the hepatitis viruses,
with an incubation period of 2 to 6 weeks. HAV is spread by direct
contact from an infected person or through fecal infected food or water.
It can be stopped with injections of gamma globulin.
Hepatitis B (HBV) is more serious and, like HCV, is known as the
"silent killer." It was clinically distinguished from (HAV) in the
1930's, and has an incubation period of 6 weeks to 6 months. Fortunately
there is a vaccination for HBV. Classified as a venereal disease, it can
be passed by seminal fluid, vaginal secretions, contaminated blood, and
blood products or via tiny cuts and abrasions, using an infected needle
or even toothbrush, body piercing, dental work or childbirth. Before
routine testing of the US blood supply in the 1990's, HBV infected and
killed thousands of people. It is 100 times more infectious than HIV,
and every year 5,000 Americans die from cirrhosis and 1,000 from liver
cancer caused by HBV.
Hepatitis C (HCV) is transmitted through tainted blood, sharing of
needles, personal care items or transplant of infected tissue. It is not
easily spread through sex. It is responsible for up to 4 million
infections nationwide with 30,000 new cases and 8,000 to 10,000 deaths
reported each year. HCV infection is expected to triple in the next 10
to 20 years. It is estimated that 75% of those infected will be infected
for life. According to the Center for Disease Control, between 20% and
50% will go on to develop cirrhosis, (a scarring of the liver) and 20%
to 30% of those will develop liver cancer.
HCV is called the hidden epidemic because it can go undetected for
many years. When symptoms do appear, often the damage is already done.
It could cost up to $26 billion nationwide and is the leading cause of
liver transplants. The mortality rate is rapidly rising because many
people were originally infected ten, twenty or even thirty years ago,
mainly through transfusions before blood supply screening started in
1992. Early detection is very important. Although 15% are able to
successfully fight off the virus, about 85% of those infected with HCV
go on to develop liver disease. Out of that 85%, modern treatment can
cure up to 40%. Globally, only 10% of those infected can afford
Hepatitis D (HDV) only thrives in the presence of HBV, worsening its
symptoms. It survives and thrives off the HBV virus coating material.
Hepatitis E (HEV) is rare in the United States, confined to tropical
areas after flooding, producing a similar symptom pattern as HAV.
Hepatitis F (HFV) is very rare. HFV is passed from primates to
Hepatitis G (HGV) is mild and does not commonly cause serious liver
damage, yet it accounts for 9% of all hepatitis infections. HGV has been
recently identified as a group of three virus sub-types of HCV.
HBV and HCV are the most serious of the whole "alphabet soup" of
hepatitis viruses and according to some sources, 10% of HBV and 85% of
HCV can develop into chronic forms.  Symptoms range from
asymptomatic, to mild flu-like symptoms, dark urine, light stools,
jaundice, chronic fatigue, serious liver damage and even death. HCV has
the ability to escape detection by our immune system and thus leads to
the high chronic infection rate. Experts agree that sub-type HCV:1b
leads to the most aggressive disease and is the least responsive to
Interferon treatment. More severe liver disease is associated with HCV
patients who abuse alcohol and have HBV or HIV infection.
Once infected, it may be many years before the virus is activated. As
long as the virus remains dormant inside the liver cell, it avoids the
immune system detection, yet, when activated, it can cause the immune
system to attack the liver cells causing liver tissue damage.
Any number of factors may set off or trigger a dormant hepatitis
virus, such as a drinking binge, exposure to toxic chemicals, over
dosage of prescription or over-the-counter pharmaceuticals, stress, a
depleted immune system and even trans-activation (one virus activating
another). Minimizing these factors also reduces the virus' impact.
Conventional treatment in more serious cases can include steroids
used to suppress the immune response from damaging and scarring the
liver. HBV, HCV, and HDV are treated with interferon, a protein that is
naturally produced by our bodies to fight infection. Alpha Interferon is
a synthetic copy of the natural interferon, and is used for more severe
cases or as a pre-emptive strike. According to Carol Turkington in her
book, Hepatitis C, the Silent Epidemic, interferon treatment may only be
effective in 50% of cases. It can cause flu-like symptoms and
depression; it is currently the main treatment. Experts are suggesting
to those who are diagnosed early, that they start an aggressive
treatment course lasting twelve to eighteen months.
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 a specific traditional
Chinese herbal formula, Minor Bupleurum, called Sho Saiko To by the
Japanese, for the protection of the liver. 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, to hinder and even stop the
progression of the hepatitis viruses.
SST increases the immune system components that both keeps the virus
from forming protein 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." 
SST has demonstrated that it can treat viral hepatitis and also
prevent its progression to cirrhosis  and it slows or stops the
progression into liver cancer.  One double blind study of 260 HBV
patients with cirrhoses 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." 
The anti-tumor activity of this formula is well documented,
especially for liver cancer, but also lung cancer and renal cell
carcinomas. [2-3,21] It is important to use SST for the prevention of
liver cancer in patients with cirrhosis. SST has been administered to
1.5 million Japanese patients with chronic liver diseases and has
demonstrated the ability to significantly suppress cancer development in
the liver. 
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. [2-4] 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 60 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 cirrhosis. 
In another 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. 
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.
The treatment of children with SST has been 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." 
Another clinical trial 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." 
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 my practice; I always use SST to help minimize the side effects and
withdrawal symptoms from prednisone.
Contraindications - The use of SST has been shown to be
contra-indicated 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 of HBV and HCV patients that
have developed pneumonitis or pneumonia using SST in conjunction with
interferon drug therapy.  Supervision by an MD is absolutely
essential under these conditions.
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.  Like Andrographis Paniculata mentioned later in this
article, SST 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. 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 CC14-induced
toxicity in rats. The acute increase of serum transaminase (SGOT and
SGPT) levels caused by CC14 administration (3.0 ml/kg, s.c.) was
dramatically reduced when treated with SST prepared with the roots of B.
Other promising herbs for the liver, such as schizandra, fructus
schizandrae, are showing great promise in liver protection against viral
hepatitis  as well as toxic chemicals. [10,12] Schizandra 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.  Schizandra is a
well-known Chinese herb, widely used in ancient China. During recent
decades, it has been found to be effective in viral and chemical induced
hepatitis and repair of the injured liver cells. 
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
Andrographis, 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 of destroying the virus' communication
mechanism, preventing the transmission of the virus to other cells by
modifying cellular signal transmission. 
I have combined SST with Schizandra, Milk Thistle and Andrographis
Paniculata into a formula for use with my patients in order to protect
the liver and for the treatment of acute or chronic hepatitis. Chinese
Medicine also has other suggestions to offer hepatitis sufferers:
Foods to help Hepatitis
The Chinese have identified the energetics of foods that can help
hepatitis: apples, adzuki beans, barley, beet greens, cabbage, carrot,
celery; corn silk, cucumber, dandelion greens, grapefruit, lotus root,
millet, oranges, pears, pineapple, rice, squash, watermelon.
Substances to Avoid
Alcohol, prescription and recreational drugs, over-the-counter
pharmaceuticals, coffee, chocolate, sugar, "hot" spicy, greasy, fatty
and fried foods.
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