Cirrhosis of the liver refers to a state where healthy liver tissue is replaced with hard, non-viable scar tissue. Cirrhosis is never a primary disease: in other words, cirrhosis always occurs as a result of another disease that has affected the liver.
As the disease progresses, more scar tissue replaces healthy tissue and if left untreated, this will continue until the point of liver failure.
The liver is a very important organ as it is responsible for processing the food and drink that are consumed into nutrients and energy, in a form that can be used by the body.
Additionally, it is useful as a tool that removes harmful substances from the blood.
There are multiple chronic diseases that can lead to cirrhosis. Many of these diseases can quickly lead to cirrhosis, while others may take several years.
Some diseases that can lead to cirrhosis include:
- Steatohepatitis (fatty liver)
- Bile duct disease
- Various genetic diseases
- Lack of appetite
- Severe itching
- Weight loss
- Abdominal pain
Cirrhosis cannot be repaired. Nonetheless, treatment goals include the prevention of additional damage to the liver and a reduction of complications related to the disease. Reducing inflammation is one of the more important factors in halting the progression of disease.
Since cirrhosis is mostly driven by an inflammatory process, the available herbal remedies for cirrhosis that may be helpful in halting this disease progression usually have anti-inflammatory properties.
In general, when using medicinal herbs or herbal remedies for cirrhosis or any disease for that matter, caution should always be key, since herbs can interact with other herbs, medications or supplements.
This is especially critical when treating patients with liver disease, because the liver plays an important role in processing almost everything that is consumed.
As a result, it is critical that herbal remedies for cirrhosis should be used only by patients that have first consulted with a physician or other health care provider.
Medicinal herbs with the most promising supportive information for treating cirrhosis
Bupleurum (Bupleurum chinense) Bupleurum kaoi
Bupleurum has been used in traditional Chinese medicine for the treatment of various liver diseases. This herb contains anti-inflammatory substances known as saikosaponins. Saikosaponins are mainly isolated from the roots of the plant, although it is also found in the leaves.
C.T. Liu, PhD, and colleagues at the National Taiwan University, report in their publication that it appears that the saikosaponins found in Bupleurum kaoi (a species native to Taiwan) could be useful as a treatment option for cirrhosis.
In order to characterize the activity of this plant, they prepared a leaf infusion to test the anti-oxidant properties as well as its in vitro hepatoprotective activity.
Their results indicated that the infusion did have anti-oxidant properties and was able to decrease the liver toxicity caused by exposure to acetaminophen and carbon tetrachloride.
Bupleurum, is most easily consumed in a standardized capsule or extract form. Since the potency can vary in commercial products, users should follow the directions provided on the product label.
Alternatively, a bupleurum tea can be prepared by adding dried, chopped bupleurum roots to hot water. After steeping for 10 minutes, the tea can be slowly consumed.
Although information describing the safety of bupleurum is not readily available, it is known that if taken in high enough doses, it can lead to water retention, gastrointestinal swelling, constipation, nausea and vomiting.
Furthermore, bupleurum is a major component in a common Japanese herbal preparation called Sho-saiko-to, which has been implicated in cases of a form of lung disease characterized by progressive scarring of both lungs called interstitial pneumonitis.
Anyone who decides to take this medicinal herb should do so under the advice of their health care practitioner.
Licorice root (Glycyrrhiza glabra)
This herb has been used since ancient times in both China and Rome. While it traditionally has been used in the treatment of respiratory and gastrointestinal disease, support has formed for its use in a variety of other diseases, including that of the liver.
Two of its major components are glycyrrhizin and glycyrrhetinic acid. Glycyrrhizin has anti-inflammatory properties that may lead to its efficacy in the treatment of cirrhosis.
H Kumada, MD, of the Department of Gastroenterology at Toranomon Hospital, in Tokyo, Japan, reported that the inflammatory changes associated with hepatitis C can lead to cirrhosis of the liver, and eventually liver cancer.
As a result of this relationship, he posits that suppressing liver inflammation should be a therapeutic goal. Further, he states that a preparation of glycyrrhizin has been used for many years to treat Japanese patients with hepatitis or cirrhosis.
In a clinical trial that he conducted, patients who received glycyrrhizin-based preparation showed a decrease in liver inflammation after 4 weeks of treatment. Additionally, in an evaluation of patients with hepatitis, after 8 weeks of dosing, microscopic examination of the liver tissue showed less disease, and significantly fewer patients developed cirrhosis.
The author summarizes by stating that long term treatment with a glycyrrhizin-based preparation is helpful in patients with hepatitis, and can prevent the incidence of cirrhosis and liver cancer.
Much of the research on the use of licorice in the treatment of cirrhosis was conducted using an intravenous formulation of glycyrrhizin that is not readily available in all regions of the world.
In the absence of this preparation, licorice roots can be dried and ground, then used to make liquid extracts or decoctions.
Alternatively, if the ground root is boiled, the resultant sweet and sticky liquid can be concentrated for use in making cakes or sticks suitable for consumption.
Since a reasonable and safe dose is not readily known, it is advisable to begin with a small amount of licorice, increasing the dose slowly, as tolerated.
Most people can safely use licorice for the treatment of cirrhosis. The majority of adverse events reported have occurred after consumption of large quantities of candies containing real licorice.
Healthy people can most likely consume medicinal licorice without and side effects, but should be aware of the main indication symptoms of overdose, which include: facial puffiness; ankle swelling; lethargy; weakness and/or headache.
The use of licorice should be avoided in women who are pregnant, trying to become pregnant or nursing, or anyone with a history of diabetes, adrenal problems, high blood pressure, stroke, heart disease or glaucoma. Nonetheless, licorice is recognized by the US Food & Drug Administration as a generally safe herb.
As with all herbal remedies for cirrhosis, it is vital to take licorice under the advice of their health care practitioner.
Milk Thistle (Silybum marianum)
Milk thistle is probably one of the best known herbal remedies for cirrhosis. It has been cited in folklore for over 2,000 years for the treatment of liver disorders.
All parts of the milk thistle, native to Southern Europe, are edible, though slightly bitter and astringent. Traditionally, it was often made into a tea for the treatment of liver disorders.
Joel Berth, PharmD and Kathryn Strong, PharmD, Clinical Assistant Professors of Psychiatric Pharmacy at the Universities of Connecticut and Rhode Island Colleges of Pharmacy, respectively, investigated the mechanism by which Silybum marianum is able to protect the liver.
Although they have provided no definitive answer, they hypothesize that it concentrates within the liver cells and crowds out the toxins, competing for absorption by the liver. They conclude that a number of clinical evaluations suggest that Silybum marianum can benefit cirrhosis patients with minimal side effects, even with long term use.
P. Ferenci, MD, of the Ist Department of Gastroenterology and Hepatology at the University of Vienna, et al, note that milk thisle is able to protect animals against liver toxicity elicited by various chemicals.
In order to confirm this finding in humans, they conducted a study enrolling a total of 170 patients afflicted with cirrhosis. Approximately half of the subjects were administered 140 mg of Silybum marianum three times daily, while the other half received placebo.
The average length of treatment was 41 months. The four year survival rate was 58% in the Silybum marianum group, versus 39% in the patients who received placebo. The investigators did not report any side effects and concluded that Silybum marianum was effective at reducing mortality in patients with cirrhosis.
Milk thistle is not highly soluble in water, so infusions or decoctions are not effective at delivering useful amounts of the herb. As a result, likely the most dependable dosing method for milk thistle is a commercially procured, standardized extract.
A dose of extract containing 140 mg should be consumed, as tablets or capsules, 3-4 times daily.
While milk thistle is generally regarded as a safe herb, there have been some reports of it causing upset stomach, or acting as a laxative.
Pregnant women, women who are trying to become pregnant or nursing should not use milk thistle. Allergic reactions or unexpected side effects can occur with any herbal medicine. If this should occur, the dose should be reduced or discontinued, as appropriate.
Children under two should also not be administered milk thistle. Older children can usually use a lower dose, based on their weight, relative to a 150 pound adult.
Patients older than 65 should also consider a lower dose. As with any herb, interactions with other herbs, medications or supplements are possible, so the use of milk thistle should be discussed with a qualified health care practitioner.
Cordyceps (Cordyces sinensis)
Cordyceps is a fungus, sometimes known as “Caterpillar fungus,” that occurs naturally at high altitudes in Asia.
It is a parasite that has been shown to be toxic to insects and caterpillars. Traditionally, Cordyceps sinensis was used in the Himalayas, and is still one of the most frequently used treatments in certain regions of Nepal.
Cordyceps sinensis was quite uncommon in traditional Chinese medicine, used similarly to Asian ginseng, only by the Emperor, and his family.
Although the uses of Cordyceps sinensis are many and varied in traditional medicine, a common theme appears to converge around its anti-oxidant and immune stimulating properties. Chinese studies show that Cordyceps sinensis has the potential to improve liver function in people with cirrhosis and/or hepatitis.
Drs Yu-Kan Liu and Wei Shen of the Department of Gastroenterology at the Second Affiliated Hospital (Chongqing University of Medical Sciences) in Chongqing, China set out to characterize the impact of Cordyceps Sinensis in rats with chemically-induced hepatic fibrosis (which leads to cirrhosis).
Rats were assigned to receive either Cordyceps Sinensis or placebo 10 days prior to the induction of hepatic fibrosis. Dosing was continued for an additional 8 weeks. At that time, both blood and tissue samples were examined.
Compared to the placebo group, rats given Cordyceps Sinensis had reduced levels of hepatic enzymes (suggesting reduced liver damage). Examination of the tissue also suggested a decrease in collagen, a major contributor to fibrosis.
The investigators concluded that Cordyceps Sinensis may inhibit the fibrosis derived from liver injury and slow the development of cirrhosis.
HY Gong, MD, et al of the Department of Infectious Disease, Third Affiliated Hospital (Hunan Medical University) in Changsha China conducted a study enrolling 25 patients with chronic hepatitis B. These subjects were treated with cordyceps sinensis for 3 months.
This study showed that certain markers of immunity were increased, while concentrations of collagen decreased. These results suggest that cordyceps sinensis may be useful in preventing hepatic fibrosis in patients with hepatitis B, potentially decreasing the incidence of cirrhosis.
It appears that 3 grams per day of cordyceps sinensis is a reasonable dose, although traditional Chinese medical practitioners may suggest as much as 9 grams of powdered cordyceps sinensis daily.
While it can be consumed in any number of ways, it can easily be mixed into soup.
It appears that the use of cordyceps sinensis is relatively safe, and does not cause extensive side effects. With this said, it should be understood that well controlled, comprehensive clinical safety studies have not been conducted.
Of interest, there have been at least two case reports submitted detailing instances of lead poisoning.
There is no available safety information available in young children, pregnant women, women trying to become pregnant, nursing mothers or patients with severe liver or kidney disease.
Based on this lack of information, it is prudent to use cordyceps sinensis only under the consultation and supervision of a qualified healthcare provider.
Other herbs that may be useful as herbal remedies for cirrhosis
- Angelica (Angelica Archangelica)
- Centella (Centella asiatica)
- Dandelion (Taraxacum officinale)
- Reishi mushroom (Ganoderma lucidum)
- Asian ginseng (Panax ginseng)
- Chinese privet (Ligustrum lucidum)
- Japanese knotweed (Polygonum cuspidatum)
- Kudzu (Pueraria lobata)
The American Liver Foundation, 2012.
The University of Maryland Medical Center. Complementary Medicine, 2010.
Yamamoto M, Kumagai A, Yamamura Y. Structure and actions of saikosaponins isolated from Bupleurum falcatum L. I. Anti-inflammatory action of saikosaponins. Arzneimittelforschung. 1975 ; 25:1021-3.
Liu CT, Chuang PT, Wu CY, et al. Antioxidative and in vitro hepatoprotective activity of Bupleurum kaoi leaf infusion. Phytother Res. 2006; 20:1003-8.
Live and Feel, 2013.
Memorial Sloan-Kettering Cancer Center, 2013.
James A Duke: The Green Pharmacy: Herbal handbook. Emmaus, PA. Rodale, Inc. 2000.
Kumada H. Long-term treatment of chronic hepatitis C with glycyrrhizin [stronger neo-minophagen C (SNMC)] for preventing liver cirrhosis and hepatocellular carcinoma. Oncology. 2002;62 Suppl 1:94-100.
Steven Foster & Rebecca Johnson: Desk reference to nature’s medicine. Washington DC. National Geographic. 2006.
Michael Castleman: The new healing Herbs: The classic guide to nature’s best medicines. Emmaus, PA. Rodale, Inc. 2001.
James Duke. Dr. Dukes essential herbs. Emmaus, PA. Rodale, Inc. 1999.
Strong J, Strong KM. The clinical utility of milk thistle (Silybum marianum) in cirrhosis of the liver. J Dietary Suppl. 2002; 2:11-17.
Ferenci P, Dragosics B, Dittrich H, et al. Randomized, controlled trial of silymarin treatment in patients with cirrhosis of the liver. Journal of Hepatology. 1989; 9:105-113.
Michael Castleman. The new healing Herbs: the essential guide to more than 125 of nature’s most potent herbal remedies. Emmaus, PA. Rodale, Inc. 1999
Liu YK, Shen W. Inhibitive effect of cordyceps sinensis on experimental hepatic fibrosis and its possible mechanism. World J Gastroenterol 2003; 9:529-533.
Gong HY, Wang KQ, Tang SG. Effects of cordyceps sinensis on T lymphocyte subsets and hepatofibrosis in patients with chronic hepatitis B. Hunan Yi Ke Da Xue Xue Bao. 2000; 25:248-50.
NYU Langone Medical Center, 2011.