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.