Herbal treatments for hepatitis

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Herbal treatments for hepatitis

 

By Andrew Pengelly

 

Andrew Pengelly is author of The Constituents of Medicinal Plants

 

 

 

Introduction

 

Hepatitis refers to inflammation of the liver, and is usually but not

always the result of a virus. Most of the publicity we hear these days

concerns the spread of Hepatitis C. In fact hepatitis can be caused by

alcohol and chemicals as well as many different viruses. Most of the

cases of viral hepatitis in Australia are classified as types A, B or

C. Types A and B were discovered over 20 years ago but type C (HVC)

was discovered as recently as 1988. HVC is now considered to be the

most prevalent type in Australia. Over 1500 cases have been notified

in the Hunter Valley alone, where it is 10 times more prevalent than

the HIV virus. There are at least 6 known strains of HVC and a mixture

of strains may occur in an infected person.

 

While it is known that HVC is spread by blood, through such agents as

hypodermic needles, blood transfusions (before 1990) and through cuts

and scratches, almost half infected patients don't know the source of

the infection. The disease is further complicated since carriers can

take up to 20 years before aquiring liver damage, and many cases

remain symptomless. In fact cases of clinically acute hepatitis are

relatively rare. The long duration between infection and illness

represents an opportunity for the individual to seek alternative or

complementary treatments, and to adopt lifestyle and dietary changes

which will enhance liver performance and overall health status.

 

Whatever the cause of the hepatitis its treatment will follow similar

principles, whichever system of medicine is used. In many Asian

countries there have been treatments available within their

traditional healing systems for centuries. The Chinese (T.C.M.) and

Indian (Ayurvedic) pharmacopoeias contain numerous references to

specific medicines and formulas, usually used in conjunction with

other techniques such as acupuncture and dietary therapy. Presently a

clinical trial is underway using a Chinese herbal formula with HVC

patients at the John Hunter Hospital, Newcastle, under its director of

gastroenterology Professor Bob Batey. The results are eagerly awaited.

When it comes to western medicine there is very little on offer for

hepatitis sufferers, apart from blood tests and biopsies. The only

treatment available is interferon, which is very expensive (up to

$5000 for a course), ineffective in many cases, and has possible side

effects including headaches, depression and flu-like symptoms.

 

This article reviews the treatment of hepatitis using western, Chinese

and Ayurvedic herbs, and offers some dietary advice and sources of

support and information about this much feared and misunderstood

condition.

PRINCIPLES FOR TREATMENT OF LIVER DISORDERS.

 

The liver is clearly one of the largest and most important organs in

our bodies, and it is not suprising therefore that inflammation of the

organ can lead to numerous unpleasant symptoms and loss of vitality.

In the long term it can cause liver cirrhosis and death. However most

carriers of the disease will experience less severe symptoms including

pain around the liver, nausea, anorexia and fatigue. Digestion of fats

is impaired and alcohol cannot be tolerated. The first indication is

often jaundiced skin and dark urine- these signs can be confirmed by a

blood test that measures levels of the enzyme ALT (alanine

aminotransferase) which are elevated in acute hepatitis, but are often

normal in chronic cases. Blood tests also reveal the presence of

antibodies to specific viruses. Any person suspecting they may have

hepatitis should immediately seek a medical diagnosis- the earlier the

detection of the disease the more successful subsequent treatment is

likely to be.

 

The presence of blood abnormalities, ie. raised liver enzymes and

presence of viral anti-bodies, point to two ways in which herbal

treatments can be of assistance. Firstly there are a number of herbal

remedies which protect liver cells from damage by poisons and viruses,

and there are ample published reports of animal studies and clinical

trials which have demonstrated an ability of a herb to lower levels of

liver enzymes (including ALT) in affected individuals. Some of these

studies are listed in the bibliography. A medicine with the ability to

protect liver cells in this way is referred to as a hepatoprotective.

In a recent article in the Australian Journal of Medical Herbalism

(email: ajmh.hunterlink.net.au) I identified 26 common herbs for which

hepatoprotective properties have been demonstrated in controlled studies.

 

The second means by which herbal remedies can be of help is in

supporting the immune systems efforts to fight off the virus. In some

cases (eg. Phyllanthus) specific antiviral properties have been

demonstrated. In other cases (eg. Echinacea) the action is

non-specific and involves a boost to the whole immune system.

 

It must be pointed out that herbal treatments are not designed for

acute stages of hepatitis. In this case bed rest and low fat diet,

along with gentle herbal diaphoretics such as elderflowers (Sambucus

nigra) and catnip (Nepeta cataria) are the limit of treatment

recommended. The more widespread and longer lasting chronic stages of

hepatitis lend themselves to treatments with herbal remedies and other

natural therapies. Herbalists believe strongly in the need for bitter

compounds as foods and medicines in order to stimulate production of

gastric juices and bile from the liver. Herbs which stimulate bile

flow are known as choleretics, while those that stimulate excretion of

bile from the gall bladder are known as cholagogues. Many herbs have

both properties and these are extremely useful in correcting digestive

disorders in general, and for helping detoxify the liver in

particular. Herbs with these properties include gentian (Gentiana

lutea), wormwood (Artemisia absinthium) and horehound (Marrubium

vulgare). Traditional compounds such as the well-known Swedish Bitters

have similar effects.

 

I have found the use of herbal decoctions to be of great assistance in

hepatitis cases. Although less concentrated than fluid extracts and

tinctures they have the advantage of being free of alcoholic solvents,

an important consideration in any liver disorder. Some people will

object to the taste, however the bitterness is an important aspect of

the treatment as noted above. Ingestion of herbal tablets and capsules

does not give this effect.

DIETARY PRINCIPLES

 

There is no doubting the importance of low fat diets for hepatitis

sufferers. One of the main roles of bile (which the liver

manufactures) is to break down fats so the body can absorb them, as

well as to convert fat soluable toxins and wastes into water soluable

compounds the body can eliminate. These functions are severely

impaired when the liver is inflammed so that avoidance of fatty foods

is a way of resting the liver. Foods to be avoided or taken in

moderation are full fat dairy protects, fried foods, red meats and

vegetable oils. A dessertspoon of olive oil on a daily basis can be of

benefit so long as it is well tolerated. Its digestibility is assisted

by combining with lemon juice. Protein intake on the other hand is

necessary to assist the liver in the process of cell regeneration.

White meats (fish and chicken) are preferred to red meats for their

lower fat content, while vegetable proteins are best taken in

combinations of pulses (beans, peas, lentils, tofu) with wholgrains

such as rice, wheat and barley.

 

Just as bitter herbs are prescribed to correct liver sluggishness, so

are bitter foods added to the diet to improve digestive function. Wild

greens such as dandelion, plantain and dock leaves can be added to

meals and sandwiches, or cultivated greens such as chicory and endive.

In traditional Asian systems of healing there is also emphasis placed

on balancing the five tastes- sweet, salty, sour, bitter and pungent

(hot). It is unwise to have an excess or deficiency of these flavours

in the diet. There are also several foods and spices which are known

to have hepatoprotective properties. These include the globe artichoke

which can be easily cultivated, both for their leaves which are used

in medicines, and their edible and delicious hearts. Spices containing

hepatoprotective compounds are turmeric, garlic and black pepper.

HERBAL REMEDIES FOR HEPATITIS

St. Mary's Thistle. (Silybum marianum)

 

silybum-marianum-1

Silybum marianum, milk thistle

 

Also known as milk thistle and variegated thistle, it is a common weed

of pastures in Eastern Australia as well as in Europe and North

America. It is regarded as the standard amongst hepatoprotective herbs

and remains the most well studied (up to 50 studies and clinical trials).

 

Constituents:

Flavonolignans. These are unusual polyphenolic compounds referred to

collectively as silymarin.

 

Actions and use:

Early studies conducted by Vogel and others demonstrated the dual

effect of the flavonolignans from Silybum on the liver, ie. a membrane

stabilizing effect (protecting liver cells from destruction from

toxins) via anti-oxidant action, and protein synthesis enhancing

effect, whereby the protected cells act as regeneration centres for

new cells. The studies on silymarin conclusively show its

effectiveness in protecting the liver against a wide range of toxins,

from carbon tetrachloride to ethanol. It even prevents poisoning from

the deadly Amanita or death cap mushroom if administered quickly enough.

 

Thistle seed preparations are ideal for chronic and post-acute stages

of hepatitis, rapidly bringing an improvement in appetite and

well-being. It is also used in fatty degeneration and even cirrhosis

of the liver. The seeds can be gathered (use gloves!) and made into

decoctions, or ground up and used quite safely as foods. Avoid

gathering in areas where chemical sprays are used.

Dandelion. (Taraxacum officinalis).

 

taraxacum-officinale-2

Taraxacum sp., dandelions

 

This is one of the most well known herbs and universal weed. Dandelion

has a long history of use for liver ailments, and its nutrient content

is outstanding. While the leaves tend to act as potent diuretics it is

the roots that are used specifically to promote bile and restore liver

function.

 

Constituents:

Vitamins- esp. beta carotine (vit.A) and ascorbic acid.; minerals

including potassium and calcium; inulin and pectin; sterols.

 

Actions and use:

Dandelion is classes as a choleretic, cholagogue, diuretic and mild

laxative. It increases appetite and improves digestion. Its alkalising

effect is beneficial in all detoxification treatments. The dried roots

can be roasted and taken instead of coffee. However unroasted roots

are more therapeutic. They can be taken in decoction form. Fresh juice

of leaves and roots can be taken in 5 ml doses. This is the most

bitter preparation.

Artichoke. (Cynara scolymus).

 

Globe artichoke is a popular food originating in Europe which can be

easily cultivated in Australia. It has a long history of use as a

bitter digestive herb and is a major remedy for liver and gall bladder

disorders. It is the leaf that contains these properties.

 

Constituents:

Cynarin and other phenolic acids; sesquiterpene lactones; flavonoids;

inulin.

Minerals, vitamins and enzymes.

 

Actions and use:

Choleretic; digestive tonic; diuretic; hypocholesterolemic;

hepatoprotective.

 

A safe and reliable herb for all liver disturbances including

hepatitis. Helps lower cholesterol (made in the liver) and assists

weight reduction. It can be made into a leaf decoction and take alone

or in combination with the above two remedies. Artichoke, St.Mary's

thistle and dandelion all belong to the Asteraceae family and work

well in combination.

Schizandra. (Schizandra sinensis).

 

The dried fruits are derived from an aromatic, woody vine that grows

in China and north-east Asia. It is a member of the Magnolia family.

The fruits are sour tasting, subsequently stimulating bile production.

 

Constituents:

Lignans known as schizandrins.

Also contains essential oil, fatty oil and mucilage.

 

Actions and use:

Tonic; astringent; sedative; hepatoprotective.

 

Studies show it decreases liver enzymes rapidly in various forms of

hepatitis. In mice it protects liver cells from toxins and viruses,

and promotes liver protein synthesis.

 

Schizandra is beneficial for insomnia, memory loss and vision

impairment. Chinese herbalists make a decoction of the dried berries,

though they are sometimes eaten. The herb is generally taken as part

of a specific formula.

Reishi Mushroom. (Ganoderma lucidum).

 

This is a polyphore mushroom known in China as Ling-Zhi. It is rated

as one of the greatest of all medicines, even rivalling the legendary

ginseng. The wild fungus is now hard to find, but extensive

cultivation occurs in many Asian countries so it is readily available

though quite expensive.

 

Constituents:

Triterpenes including ganoderic acid; polysaccharides; organic

germanium; adenosine.

 

Actions and use:

Antiviral; antioxidant; antitumor; immuno-stimulant; hypoglycaemic;

cardiotonic; anti-inflammatory. Hepatoprotective action in mice.

Hepatitis patients show improved symptoms and less tiredness in

clinical trials. In China it is frequently used for chronic hepatitis.

It can be obtained in the dried form or in tablets. Daily doses range

between 2 and 10g. This herb should to be taken under the supervision

of a suitably qualified practitioner.

Phyllanthus. (Phyllanthus amarus, P.gasstroemii).

 

Phyllanthus are low shrubs common across southern Asia and Australia.

In parts of India the herb is renowned for its success in treating

hepatitis and jaundice. It has acheived international status since the

publication of a clinical trial with hepatitis B(HVB) patients.

 

Constituents:

Ellagitannins including geraniin; lignans- phyllanthin; flavanoids;

alkaloids.

 

Actions and use:

Astringent; diuretic; cholagogue; antiviral; hepatoprotective.

 

Direct antiviral effects have been demonstrated in human and animal

HVB studies, which could be measured by a reduction in the virus

surface antigen. Several Australian species have also shown antiviral

properties in animal studies on HVB but no clinical data is available.

In India fresh roots are considered the most effective for jaundice.

Australian use is restricted to prescription by medical herbalists.

Liquorice. (Glycyrrhiza glabra).

 

glycyrrhiza-glabra-2 glycyrrhiza-glabra

Glycyrrhiza glabra, licorice

 

One of the most widely used herbs throughout the world, liquorice is

regarded by herbalists as a harmoniser or balancing agent. It

certainly improves the flavour of herbal compounds but its properties

extend much further than flavouring.

 

Constituents:

Glycyrrhizin, a triterpenoid saponin; isoflavones

 

Actions and use:

Demulcent; expectorant; antiulcer; tonic; antiviral; antiinflammatory;

hepatoprotective.

 

Chinese teaching hospitals found its effective rate in treatments of

chronic HVB over 70%. The herb has a mineralcorticoid effect and can

cause oedema and hypertension in some people. The popular liquorice

stick candies are of little use therapeutically, since the percentage

of liquorice is small while the sugar content is high. Pure liquorice

root can be obtained in bulk , it has a distinct yellow colour due to

its flavonoid content. Manufacturers use thick liquorice concentrates

which are included into a wide range of products. Liquorice should not

be used over long times unless under supervision of a practitioner.

FURTHER INFORMATION AND ASSISTANCE (for Australians)

 

This list by no means covers all herbs which are used in hepatitis, a

second group will be covered in a future edition. For those wishing to

take a course of herbal treatments it is important that a qualified

herbalist be contacted. A list of those in your area can be obtained

by contacting the National Herbalists Association of Australia at:

 

* NHAA, P.O. Box 61, Broadway 2007. Ph. (02) 211 6437. Email:

nhaa

 

For general information and support there are a number of support

groups, mainly concerned with hepatitis C. Some contact phone numbers are:

 

* Newcastle (049) 47 1206 ; Muswellbrook (065) 43 2677.

 

The Hepatitis C Council of NSW is a non-profit community organization

providing information to people and support groups dealing with HVC.

Contact them at:

 

* 345 Crown St, Surry Hills 2010. Ph. (02) 332 1599. Support Line

1 800 803 990.

 

The Hep.C council and most support groups are not opposed to patients

using herbal or other complementary therapies, and in some cases

encourage it- the proviso being the patient is simultaneously under

medical supervision

BIBLIOGRAPHY

 

* Frawley, D. & Lad, V. The Yoga of Herbs, an Ayurvedic guide to

herbal medicine. Lotus Press, Santa Fe [1986].

* Hirosho Hikino. Chinese medicinal plants used against hepatitis.

In [H.M.Chang et al. eds.] Advances in Chinese Medicinal Materials

Research. World Scientific Publ.Co., Singapore [1985].

* Hobbs, Christopher. Foundations of health. The liver and

digestive herbal. Botanica Press, California [1992].

* Hobbs, Christopher. Milk thistle: the liver herb. Botanica

Press, California [1992].

* Jones, Kenneth. Reishei. Ancient herb for moden times. Sylvan

Press, U.S.A

* Keys, John. Chinese Herbs. Their botany, chemistry and

pharmacodynamics. Charles Tuttle Co, U.S.A. [1976].

* Murray, M. & Pizzorno, J. Encyclopaedia of Natural Medicine,

Macdonald & Co.Ltd., London [1990].

* Pengelly, Andrew. Assessment of hepatoprotective remedies.

Australian Journal of Medical Herbalism Vol. 7 pp. 17-20. [1995]

* Pengelly, Andrew. Herbal feature- St.Mary's Thistle. Herbal

Thymes Vol. 6 pp.14-18 [1994]. Globe artichoke Vol. 5 pp. 5-8 [1993].

* Shead, A. et al. Effects of Phyllanthus plant extracts on duck

hepatitis B virus in vitro and in vivo. Antiviral Research Vol.18

pp.127-138 [1992].

* Vailati, A. et al. Randomized open study of the dose-effect

relationship of a short course of (a Silybum marianum extract) in

patients with viral or alcoholic hepatitis. Fitoterapia Vol. LXIV pp.

219-228 [1993].

* Weiss, R.F. Herbal Medicine. Beaconsfield Pub. Ltd. U.K. [1988].

* Zhou Qingjun. Chinese medicinal herbs in the treatment of viral

hepatitis. In [H.M.Chang et al. eds.] Advances in Chinese Medicinal

Materials Research. World Scientific Publ.Co., Singapore [1985].