Category:Hepatoprotective herbs

A hepatoprotective herb is a plant medicine used to protect the liver from injury, support hepatic function in chronic liver disease, or regenerate hepatocellular damage. The category sits at the intersection of herbal medicines and the Western pharmaceutical category of hepatoprotective agents, with substantial overlap in the contemporary clinical evidence base.

The foundational hepatoprotective herb is milk thistle (Silybum marianum), the standardised silymarin extract of whose fruit (technically the achene, not the seed) is one of the few herbal medicines to have entered routine Western clinical practice for a specific hepatic indication. The active flavonolignan complex silymarin, composed of silibinin, silidianin, silichristin, and isosilibinin, is concentrated in the achene and is extracted in the standardised commercial preparations (typically 70 to 80 percent silymarin by weight). The principal evidence-based indication is the intravenous silibinin antidote (Legalon SIL) for Amanita phalloides poisoning, where it competitively inhibits the hepatic uptake of amatoxin and reduces hepatic injury in case-controlled studies. Oral milk thistle has more modest evidence for alcoholic and viral hepatitis, with Cochrane review showing inconsistent benefit; it is widely used as adjunctive therapy in chronic liver disease.

The other principal hepatoprotective herbs are turmeric (Curcuma longa), whose curcuminoid fraction has demonstrated antifibrotic and anti-inflammatory effects in animal hepatic-injury models and modest improvement in non-alcoholic fatty liver disease in small controlled trials; schisandra (Schisandra chinensis), the Chinese hepatoprotective whose lignans (schisandrin A, B, C; wuweizisu) reduce alanine aminotransferase elevation in chronic viral hepatitis; licorice (Glycyrrhiza glabra and Glycyrrhiza uralensis), whose glycyrrhizin is approved in Japan as Stronger Neo-Minophagen C intravenous for chronic hepatitis C (the cardiovascular and electrolyte side-effects of chronic high-dose glycyrrhizin limit Western use); artichoke leaf (Cynara scolymus), whose cynarin and chlorogenic acid produce a choleretic effect and modest improvement in functional dyspepsia and non-alcoholic fatty liver disease; Andrographis (Andrographis paniculata), used in Ayurvedic and TCM hepatic protection; and dandelion root (Taraxacum officinale), the gentle Western bitter-and-choleretic.

A separate sub-set, the cholagogue and choleretic herbs that act on biliary flow rather than on hepatocellular protection per se, includes chelidonium (Chelidonium majus, greater celandine; with the caveat of idiosyncratic hepatotoxicity case reports that have led to its EMA restriction since 2008), boldo (Peumus boldus), turmeric, and artichoke. The distinction between hepatoprotective and choleretic action is mechanistic; the categories overlap in practice.

Milk thistle (Silybum marianum), turmeric (Curcuma longa), schisandra (Schisandra chinensis), licorice (Glycyrrhiza glabra and Glycyrrhiza uralensis), artichoke leaf (Cynara scolymus), andrographis (Andrographis paniculata), dandelion root (Taraxacum officinale), greater celandine (Chelidonium majus), boldo (Peumus boldus), Phyllanthus species (P. amarus and P. niruri), Picrorhiza kurroa (kutki), and bupleurum (Bupleurum chinense).

The boundary of this category is "herb prescribed primarily for hepatocellular or hepatobiliary protection or support." The pharmaceutical hepatotoxicity antidotes (intravenous N-acetylcysteine for paracetamol overdose, intravenous silibinin for Amanita poisoning) are listed at their primary indication. Herbs whose action is principally on biliary flow rather than hepatocyte protection (the choleretic herbs) are cross-listed but their bias of action is noted. Herbs with hepatotoxicity rather than hepatoprotection (the pyrrolizidine-alkaloid-containing comfrey, coltsfoot, borage; the unidentified hepatotoxicity of black cohosh and kava; the case-report hepatotoxicity of greater celandine) are noted under their individual monograph safety sections rather than collected here.

This category page is an encyclopedia article about its subject. The actual index of herbs belonging to the category is generated automatically by the wiki engine, from category-membership declarations on the individual herb pages, and appears at the foot of the page below the references.