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Hepatitis (Holistic)

Hepatitis (Holistic)

About This Condition

Get a handle on hepatitis. This common liver disease can be severe, or even fatal, so it is important to know the facts. According to research or other evidence, the following self-care steps may be helpful.
  • Get evaluated

    See a doctor to determine the cause and best treatment for your condition

  • Check out SAMe

    1,600 mg a day of the supplement S-adenosylmethionine may help resolve blocked bile flow

  • Reduce damage with milk thistle

    Take a standardized herbal extract providing 420 mg a day of silymarin to help the liver

  • Try phyllanthus

    900 to 2,700 mg a day of this herb may be beneficial for people with hepatitis B

About

About This Condition

Hepatitis is a liver disease that can result from long-term alcohol abuse , infection , or exposure to various chemicals and drugs. Because hepatitis is potentially very dangerous, a healthcare professional should be involved in its treatment.

Symptoms

Acute viral hepatitis varies from a minor flu-like illness to an overwhelming infection resulting in liver failure and death. The early phase is characterized by loss of appetite, malaise, nausea and vomiting, and fever. Signs include a darkening of the urine and jaundice (yellowing of the skin and whites of the eyes). Chronic hepatitis may be asymptomatic, or may manifest as malaise, fatigue, loss of appetite and a low-grade fever.

Healthy Lifestyle Tips

Avoiding alcohol is the most obvious way to avoid the liver damage it causes.

A variety of prescription drugs can, on rare occasions, cause hepatitis, as can large amounts of niacin or niacinamide (forms of vitamin B3). Excessive intake of acetaminophen or other painkillers can damage the liver, so excessive intake of these drugs should be avoided. People with hepatitis C who failed to respond to interferon therapy have been found to have a higher amount of iron within the liver.1 People with hepatitis C should, therefore, avoid iron supplements. People with any type of hepatitis should ask their physician whether any medication they are taking poses a risk to the liver.

For infectious (viral) hepatitis, good hygiene is necessary to avoid spreading the infection. The hepatitis A virus can be spread very easily through food that is handled by infected individuals; therefore, people with hepatitis A should wash their hands very carefully after using the restroom and should not handle food at work. The hepatitis viruses B and C are both transmitted by blood and sexual contact.

Supplements

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Supplement Why
3 Stars
Flavonoids
500 to 750 mg daily of catechins
The flavonoid catechin has helped people with acute viral hepatitis, as well as people with chronic hepatitis.

Catechin, a flavonoid , has helped people with acute viral hepatitis,2 as well as individuals with chronic hepatitis,3 though not all trials have found a benefit.4 A typical amount used in successful trials is 500–750 mg three times per day. Although catechin is found in several plants, none contain sufficient amounts to reach the level used in the trials; thus, catechin supplements are needed. However, because of its potential to cause side effects on rare occasions,5 catechin should be used only under medical supervision.

2 Stars
Betaine (Trimethylglycine) (Nonalcoholic Steatohepatitis)
20 grams daily
Supplementing with zinc (in the form of a zinc complex of L-carnosine) enhanced the response to interferon therapy in patients with chronic hepatitis C in a preliminary trial.

In a preliminary trial, supplementation with betaine (20 grams per day) for 12 months improved signs of liver inflammation in seven patients with nonalcoholic steatohepatitis, a type of liver inflammation. No significant side effects were seen.6

2 Stars
Cordyceps
3 to 4.5 grams twice per day
Cordyceps has repeatedly been shown effective in trials at improving liver and immune function in people with chronic hepatitis B, including those with cirrhosis.

Cordyceps has repeatedly been shown effective in clinical trials at reducing fibrosis and improving liver and immune function in people with chronic hepatitis B, including those with cirrhosis.7 , 8 , 9 The usual amount taken is 3 to 4.5 grams twice daily as capsules or simmered for 10 to 15 minutes in water to make tea.

2 Stars
Licorice Intravenous
Take under medical supervision: 2.5 grams licorice three times per day providing 750 mg glycyrrhizin
One of the active constituents in licorice, glycyrrhizin, has been used to some benefit in Japan as an injected therapy for hepatitis B and C.

One of the active constituents in licorice , glycyrrhizin, is sometimes used in Japan as an injected therapy for hepatitis B and C.10 , 11 Glycyrrhizin also blocks hepatitis A virus from replicating in test tubes.12 One preliminary trial found that use of 2.5 grams licorice three times per day providing 750 mg glycyrrhizin was superior to the drug inosine polyIC in helping people with acute and chronic viral hepatitis.13 Because glycyrrhizin can cause high blood pressure and other problems, it should only be taken on the advice of a healthcare practitioner.

2 Stars
Milk Thistle
420 mg of silymarin daily
Supplementing with milk thistle may support the liver.

Silymarin, the flavonoid extracted from milk thistle , has been studied for treating all types of liver disease. The standard amount used in most trials has delivered 420 mg of silymarin per day. For acute hepatitis, double-blind trials have shown mixed results.14 , 15 A preparation of silymarin and phosphatidylcholine was reported to help sufferers of chronic viral hepatitis. One small preliminary trial found that at least 420 mg of silymarin was necessary each day.16 A controlled trial found that silymarin decreased liver damage.17 One trial has suggested that silymarin may be more effective for hepatitis B as opposed to hepatitis C.18

Recent findings have shown that silymarin has the ability to block fibrosis, a process that contributes to the eventual development of cirrhosis in persons with inflammatory liver conditions secondary to alcohol abuse or hepatitis.19 While there are no published clinical trials in people with hepatitis C to date, this action makes milk thistle extract potentially attractive as a supportive treatment for the condition—particularly for those that have not responded to standard drug therapy. The effectiveness of silymarin (particularly its antifibrotic actions) needs to be studied in larger numbers of persons with hepatitis C to determine whether it is an effective treatment for this condition.

2 Stars
Peony
1 to 3 grams three times per day
Red peony root has been shown to be helpful for people with viral hepatitis.

A crude extract of red peony root was shown in a small, preliminary trial to reduce cirrhosis in some people with chronic viral hepatitis.20 Other preliminary trials published in Chinese demonstrated that red peony root was helpful (by reducing liver enzyme levels or symptoms or both) for people with viral hepatitis.21

2 Stars
Phyllanthus
900 to 2,700 mg daily
Taking the herb phyllanthus may be beneficial for people with hepatitis B.

Phyllanthus (Phyllanthus amarus), an Ayurvedic herb, has been studied primarily in carriers of the hepatitis B virus, as opposed to those with chronic active hepatitis. In one trial, administering this herb for 30 days appeared to eliminate the hepatitis B virus in 22 of 37 cases (59%).22 However, other trials have failed to confirm a beneficial effect of Phyllanthus amarus against hepatitis B.23 , 24 A West Indian species, Phyllanthus urinaria (not widely available in the United States or Europe), has achieved much better results than Indian Phyllanthus amarus. 25 Thus, the specific plant species used may have a significant impact on the results. The amount of phyllanthus used in clinical trials has ranged from 900–2,700 mg per day.

2 Stars
SAMe (Cholestasis)
1,600 mg daily
Supplementing with SAMe may help resolve blocked bile flow.

SAMe (S-adenosylmethionine) (1,600 mg/day orally or 800 mg/day intravenously) has been shown to aid in the resolution of blocked bile flow (cholestasis), a common complication of chronic hepatitis.26 , 27

2 Stars
Sho-Saiko-To (Bupleurum, Peony, Pinellia, Cassia, Ginger, Jujube, Asian Ginseng, Asian Scullcap, and Licorice)
Take 2.5 grams of sho-saiko-to three times per day
Trials have shown that the bupleurum-containing formula sho-saiko-to can help reduce symptoms and blood liver enzyme levels in people with chronic active viral hepatitis.

Preliminary trials have shown that the bupleurum -containing formula sho-saiko-to can help reduce symptoms and blood liver enzyme levels in children and adults with chronic active viral hepatitis.28 , 29 , 30 , 31 Most of theses trials were in people with hepatitis B infection, though one preliminary trial has also shown a benefit in people with hepatitis C.32 Sho-saiko-to was also found, in a large preliminary trial to decrease the risk of people with chronic viral hepatitis developing liver cancer. However, people who had a sign of recent hepatitis B infection were not as strongly protected in this trial.33 The usual amount of sho-saiko-to used is 2.5 grams three times daily. Sho-saiko-to should not be used together with interferon drug therapy as it may increase risk of pneumonitis - a potentially dangerous inflammation in the lungs.34

2 Stars
Thymus Extracts
200 mg of crude extracts or 40 mg purified proteins three times per day
Proteins from the thymus gland, an important part of the immune system, may have a beneficial effect in people with chronic hepatitis B and C.

Proteins from the thymus gland, an important part of the immune system , may have a beneficial effect in people with chronic hepatitis B. Initial trials done in Poland used injected thymus proteins with good results.35 Further trials using a variety of thymus extracts by mouth have found that they can improve blood tests that measure liver damage as well as improve immune cell numbers.36 , 37 Preliminary evidence also suggests these extracts may help patients with hepatitis C.38 The standard recommendation for supplementation is 200 mg three times per day of crude extracts or 40 mg three times per day of purified proteins.

2 Stars
Vitamin B1
100 mg daily
In a preliminary report, three patients with chronic hepatitis B had an improvement in the severity of their hepatitis after supplementing with thiamine (vitamin B1).

In a preliminary report, three patients with chronic hepatitis B had an improvement in the severity of their hepatitis after taking 100 mg of thiamine (vitamin B1) per day.39

2 Stars
Zinc (Hepatitis C)
Take zinc L-carnosine supplying 17 mg zinc twice per day
In a preliminary trial, supplementing with betaine improved signs of liver inflammation in patients with nonalcoholic steatohepatitis, a type of liver inflammation.

Supplementation with 17 mg of zinc twice a day (in the form of a zinc complex of L-carnosine) enhanced the response to interferon therapy in patients with chronic hepatitis C, in a preliminary trial.40 It is not known whether this benefit was due primarily to the zinc or the carnosine , or whether other forms of zinc would have the same effect.

1 Star
Açaí
Refer to label instructions
Açaí root tea has been used as a traditional remedy for hepatitis.

Açaí root tea has reportedly been used as a traditional remedy for hepatitis. Certain anthocyanins have been shown to prevent liver toxicity, but açaí root contains no appreciable amounts of anthocyanins. No clinical trials of any part of açaí for hepatitis have been published.

Preliminary human research demonstrates some efficacy for the mushroom reishi in treating chronic hepatitis B; however, additional clinical trials are needed.41

1 Star
Alpha Lipoic Acid
Refer to label instructions
In one trial, a combination of alpha lipoic acid, silymarin, and selenium led to significant improvements in liver function and overall health in people with hepatitis C.

A potent antioxidant combination may protect the liver from damage in people with hepatitis C, possibly decreasing the necessity for a liver transplant. In a preliminary trial,42 three people with liver cirrhosis and esophageal varices (dilated veins in the esophagus that can rupture and cause fatal bleeding) caused by hepatitis C received a combination of Alpha lipoic acid (300 mg twice daily), silymarin (from milk thistle ; 300 mg three times daily), and selenium (selenomethionine; 200 mcg twice daily). After five to eight months of therapy that included other “supportive supplements,” such as vitamin C and B vitamins , all three people had significant improvements in their liver function and overall health. Larger clinical trials are needed to confirm these promising preliminary results.

1 Star
Andrographis
Refer to label instructions
Andrographis, a traditional Indian herb, has been shown to help people with chronic viral hepatitis.

A series of cases of acute viral hepatitis were reported by one group in India, showing picrorhiza , combined with a variety of minerals, to be helpful in hastening recovery.43 A variety of similar reports have appeared in the Indian literature over the years, although no double-blind clinical trials have yet been published. Between 400 and 1,500 mg of powdered, encapsulated picrorhiza per day has been used in a variety of trials. Andrographis , another traditional Indian herb, has shown preliminary benefit for people with chronic viral hepatitis.44

1 Star
Astragalus
2.5 grams licorice three times per day providing 750 mg glycyrrhizin, taken under the supervision of a doctor
Early clinical trials in China suggest astragalus root might benefit people with chronic viral hepatitis.

Early clinical trials in China suggest astragalus root might benefit people with chronic viral hepatitis, though it may take one to two months to see results.45 Textbooks on Chinese herbs recommend taking 9–15 grams of the crude herb per day in decoction form. A decoction is made by boiling the root in water for a few minutes and then brewing the tea.

1 Star
Chinese Scullcap
Refer to label instructions
Chinese skullcap may be useful for liver infections.

Another Chinese herb, Chinese scullcap , might be useful for liver infections. However, the research on this is generally of low quality.46

1 Star
Lecithin (Phosphatidyl Choline)
Refer to label instructions
Taking phosphatidylcholine (found in lecithin) was found to be beneficial in one study of people with chronic hepatitis B.

Taking 3 grams per day of phosphatidylcholine (found in lecithin) was found to be beneficial in one investigation of people with chronic hepatitis B.47 Signs of liver damage on biopsy were significantly reduced in this trial.

1 Star
Licorice Oral
200 mg of crude extracts or 40 mg purified proteins three times per day
One of the active constituents in licorice, glycyrrhizin, may be helpful for people with acute and chronic viral hepatitis.
One of the active constituents in licorice, glycyrrhizin, is sometimes used in Japan as an injected therapy for hepatitis B and C.48 , 49 Glycyrrhizin also blocks hepatitis A virus from replication gin text tubes.50 One preliminary trial found that us of 2.5 grams licorice three times per day providing 750 mg glycyrrhizin was superior to the drug inosine polyIC in helping people with acute and chronic viral hepatitis.51 Because glycyrrhizin can cause high blood pressure and other problems, it should be only taken on the advice of a healthcare practitioner.
1 Star
Picrorhiza
1,600 mg daily
A series of cases of acute viral hepatitis were reported by one group in India, showing picrorhiza, combined with a variety of minerals, to be helpful in hastening recovery.

A series of cases of acute viral hepatitis were reported by one group in India, showing picrorhiza , combined with a variety of minerals, to be helpful in hastening recovery.52 A variety of similar reports have appeared in the Indian literature over the years, although no double-blind clinical trials have yet been published. Between 400 and 1,500 mg of powdered, encapsulated picrorhiza per day has been used in a variety of trials. Andrographis , another traditional Indian herb, has shown preliminary benefit for people with chronic viral hepatitis.53

1 Star
Reishi
Take zinc L-carnosine supplying 17 mg zinc twice daily
The mushroom reishi appears to be effective in treating chronic hepatitis B, according to preliminary research.

Preliminary human research demonstrates some efficacy for the mushroom reishi in treating chronic hepatitis B; however, additional clinical trials are needed.54

1 Star
Schisandra
420 mg of silymarin per day
Compounds called lignans in schisandra appear to promote regeneration of liver tissue that has been damaged by harmful influences, such as hepatitis viruses or alcohol.

Modern Chinese research suggests that compounds called lignans in schisandra promote regeneration of liver tissue that has been damaged by harmful influences, such as hepatitis viruses or alcohol. In a controlled trial, Chinese patients with chronic viral hepatitis were given 500 mg schisandra extract three times daily or liver extract and B vitamins.55 Among those given schisandra, serum glutamic pyruvic transaminase (SGPT) levels declined to normal levels in 68% compared to 44% of the control group. Lower SGPT levels suggest less liver inflammation. There was also a reduction in symptoms such as insomnia , fatigue, loose stools , and abdominal tension in the schisandra group. A preliminary trial in 5,000 people with various types of hepatitis found normalizations in SGPT or related liver enzymes in 75% of cases using an unspecified amount of schisandra.56

1 Star
Selenium
100 mg per
In one trial, a combination of alpha lipoic acid, silymarin, and selenium led to significant improvements in liver function and overall health in people with hepatitis C.

A potent antioxidant combination may protect the liver from damage in people with hepatitis C, possibly decreasing the necessity for a liver transplant. In a preliminary trial,57 three people with liver cirrhosis and esophageal varices (dilated veins in the esophagus that can rupture and cause fatal bleeding) caused by hepatitis C received a combination of Alpha lipoic acid (300 mg twice daily), silymarin (from milk thistle ; 300 mg three times daily), and selenium (selenomethionine; 200 mcg twice daily). After five to eight months of therapy that included other “supportive supplements,” such as vitamin C and B vitamins , all three people had significant improvements in their liver function and overall health. Larger clinical trials are needed to confirm these promising preliminary results.

1 Star
Shiitake
Refer to label instructions
One study found that shiitake formulations containing Lentinus edodes mycelium may help decrease blood markers of liver inflammation

An uncontrolled trial found that shiitake formulations containing Lentinus edodes mycelium (LEM— the powdered mycelium of the mushroom before the cap and stem grow) may help decrease blood markers of liver inflammation.58 One marker of hepatitis B infection in the blood (HBeAg) disappeared in 14% of the patients in this trial. Given the preliminary nature of the research, more information is needed to determine if LEM is effective for hepatitis.

1 Star
Vitamin B12
Refer to label instructions
Vitamin B12 (with or without folic acid) has been reported in trials from the 1950s to help some people with hepatitis.

Vitamin B12 (with or without folic acid ) has been reported in trials from the 1950s to help some people with hepatitis.59 , 60 Vitamin B12 injections are likely to be more beneficial than oral administration, though 1,000 mcg (taken orally) each day can also be supplemented.

1 Star
Vitamin C
Refer to label instructions
Vitamin C has been shown to be effective at preventing hepatitis infection in people receiving blood transfusions and at treating viral hepatitis.

Vitamin C in the amount of 2 grams per day was reported in a preliminary trial to prevent hepatitis infection in individuals receiving blood transfusions.61 This report was followed up by a double-blind trial, in which 3.2 grams per day of vitamin C was reported to have no protective effect against post-transfusion hepatitis.62 (However, in the latter trial, vitamin C actually reduced the incidence of hepatitis by 29%, although this reduction was not statistically significant.) An older trial suggested that injections of vitamin C may be helpful in treating viral hepatitis.63

1 Star
Vitamin E
900 to 2,700 mg per day
Some trials have shown vitamin E to be helpful in treating hepatitis B and to reduce liver damage in people with hepatitis C.

Vitamin E levels have been shown to be low in people with hepatitis,64 as well as in those who later develop liver cancer from long-standing hepatitis.65 Vitamin E levels in the liver may also be decreased in some people with hepatitis.66 In a controlled trial of individuals with hepatitis B, 600 IU of vitamin E per day for nine months resulted in all signs of hepatitis disappearing in five of twelve people.67 In a preliminary trial of adults with hepatitis C, administering 1,200 IU per day of vitamin E for eight weeks appeared to reduce liver damage to some extent.68 In a preliminary trial of people with hepatitis C, 544 IU of vitamin E per day for 24 weeks improved the response to interferon/ antioxidant therapy, although the results did not reach statistical significance.69 However, in children with viral hepatitis, daily injections of vitamin E (300 IU) for seven days did not produce any benefit.70

1 Star
Whey Protein
3 to 4.5 grams twice per day
In one trial, supplementing with whey protein improved blood measures of liver dysfunction in people with hepatitis B.

A preliminary trial found 24 grams per day of whey protein improved blood measures of liver dysfunction in people with hepatitis B, but not those with hepatitis C.71

References

1. Di Bisceglie AM, Bonkovsky HL, Chopra S, et al. Iron reduction as an adjuvant to interferon therapy in patients with chronic hepatitis C who have previously not responded to interferon: a multicenter, prospective, randomized, controlled trial. Hepatology 2000;32:135–8.

2. Blum AL, Doelle W, Kortum K, et al. Treatment of acute viral hepatitis with (+)-cyanidanol-3. Lancet 1977;2:1153–5.

3. Suzuki H, Yamamoto S, Hirayama C, et al. Cianidanol therapy for HBs-antigen-positive chronic hepatitis: a multicentre, double-blind study. Liver 1986;6:35–44.

4. Bar-Meir S, Halpern Z, Gutman M, et al. Effect of (+)-cyanidanol-3 on chronic active hepatitis: A double blind controlled trial. Gut 1985;26:975–9.

5. Conn HO. Cyanidanol: will a hepatotrophic drug from Europe go west? Hepatology 1983;3:121–3.

6. Abdelmalek MF, Angulo P, Jorgensen RA, et al. Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study. Am J Gastroenterol 2001;96:2711–17.

7. 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 Bao 2000;25:248–50 [in Chinese].

8. Zhou L, Yang W, Xu Y, et al. Short-term curative effect of cultured Cordyceps sinensis (Berk.) Sacc. Mycelia in chronic hepatitis B. Zhongguo Zhong Yao Za Zhi 1990;15:53–5, 65 [in Chinese].

9. Zhu JL, Liu C. Modulating effects of extractum semen persicae and cultivated cordyceps hyphae on immuno-dysfunction of inpatients with posthepatitic cirrhosis. Zhongguo Zhong Xi Yi Jie He Za Zhi 1992;12:207–9,195 [in Chinese].

10. Suzuki H, Ohta Y, Takino T, et al. Effects of glycyrrhizin on biochemical tests in patients with chronic hepatitis. Double blind trial. Asian Med J 1983;26:423–38.

11. Yasuda K, Hino K, Fujioka S, et al. Effects of high dose therapy with Stronger Neo-Minophagen C (SNMC) on hepatic histography in non-A, non-B chronic active hepatitis. In Viral Hepatitis C, D, E, ed. T Shikata, RH Purcell, T Uchida. Amsterdam: Excerpta Medica, 1991, 205–9.

12. Crance JM, L’eveque F, Biziagos E, et al. Studies on mechanism of action on glycyrrhizin against hepatitis A virus replication in vitro. Antiviral Res 1994;23:63–76.

13. Su XS, Chen HM, Wang LH, et al. Clinical and laboratory observation on the effect of glycyrrhizin in acute and chronic viral hepatitis. J Trad Chin Med 1984;4:127–32.

14. Magliulo E, Gagliardi B, Fiori GP. Results of a double blind study on the effect of silymarin in the treatment of acute viral hepatitis carried out at two medical centres. Med Klin 1978;73:1060–5 [in German].

15. Bode JC, Schmidt U, Durr HK. Silymarin for the treatment of acute viral hepatitis? Report of a controlled trial. Med Klin 1977;72:513–8 [in German].

16. Vailati A, Aristia L, Sozze E, et al. Randomized open study of the dose-affect relationship of a short course of IdB 1016 in patients with viral or alcoholic hepatitis. Fitoterapia 1993;64:219–27.

17. Buzzelli G, Moscarella S, Giusti A, et al. A pilot study on the liver protective effect of silybinphosphatidylcholine complex (IdB 1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol 1993;31:456–60.

18. Lirussi F, Okolicsanyi L. Cytoprotection in the nineties: experience with ursodeoxycholic acid and silymarin in chronic liver disease. Acta Physiol Hung 1992;80:363–7.

19. Schuppan D, Strösser W, Burkard G, Walosek G. Legalon® lessens fibrosing activity in patients with chronic liver diseases. Zeits Allgemeinmed 1998;74:577–84.

20. Yang DG. Comparison of pre- and post-treatmental hepatohistology with heavy dosage of Paeonia rubra on chronic active hepatitis caused liver fibrosis. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1994;14:195,207–9 [in Chinese].

21. Wang CB, Chang AM. Plasma thromboxane B2 changes in severe icteric hepatitis treated by traditional Chinese medicine—dispelling the pathogenic heat from blood, promoting blood circulation and administrating large doses of radix Paeoniae—a report of 6 cases. Chung Hsi I Chieh Ho Tsa Chih 1985;5:322,326–8 [in Chinese].

22. Thyagarajan SP, Subramian S, Thirunalasundari T, et al. Effects of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet 1988;2:764–6.

23. Doshi JC, Vaidya AB, Antarkar DS, et al. A two-stage clinical trial of Phyllanthus amarus in hepatitis B carriers: Failure to eradicate the surface antigen. Indian J Gastroenterol 1994;13:7–8.

24. Leelarasamee A, Trakulsomboon S, Maunwongyathi P, et al. Failure of Phyllanthus amarus to eradicate hepatitis B surface antigen from symptomless carriers. Lancet 1990;335:1600–1.

25. Wang M, Cheng H, Li Y, et al. Herbs of the genus Phyllanthus in the treatment of chronic hepatitis B: observations with three preparations from different geographical sites. J Lab Clin Med 1995;126:350–2.

26. Frezza M, Centini G, Cammareri G, et al. S-adenosylmethionine for the treatment of intrahepatic cholestasis of pregnancy. Results of a controlled clinical trial. Hepatogastroenterology 1990;37 Suppl 2:122–5.

27. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology 1990;99:211–5.

28. Hirayama C, Okumura M, Tanikawa K, et al. A multicenter randomized controlled clinical trial of Shosaiko-to in chronic active hepatitis. Gastroent Jap 1989;24:715–9.

29. Fujiwara K, Ohta Y, Ogata I, et al. Treatment trial of traditional Oriental medicine in chronic viral hepatitis. In: Ohta Y (ed) New Trends in Peptic Ulcer and Chronic Hepatitis: Part II. Chronic Hepatitis. Tokyo: Excerpta Medica, 1987, 141–6.

30. Tajiri H, Kozaiwa K, Osaki Y, et al. The study of the effect of sho-saiko-to on HBeAg clearance in children with chronic HBV infection and with abnormal liver function tests. Acta Paediatr Jpn 1991;94:1811–5.

31. Gibo Y, Nakamura Y, Takahashi N, et al. Clinical study of sho-saiko-to therapy for Japanese patients with chronic hepatitis C (CH-C). Prog Med 1994;14:217–9.

32. Gibo Y, Nakamura Y, Takahashi N, et al. Clinical study of sho-saiko-to therapy for Japanese patients with chronic hepatitis C (CH-C). Prog Med 1994;14:217–9.

33. Oka H, Yamamoto S, Kuroki T, et al. Prospective study of chemoprevention of hepatocellular carcinoma with sho-saiko-to (TJ-9). Cancer 1995;76:743–9.

34. Mizushima Y, Oosaki R, Kobayashi M. Clinical features of pneumonitis induced by herbal drugs. Phytother Res 1997;11:295–8.

35. Skotnicki AB. Therapeutic application of calf thymus extract (TFX). Med Oncol Tumor Pharmacother 1989;6:31–43 [review].

36. Galli M, Crocchiolo P, Negri C, et al. Attempt to treat acute type B hepatitis with an orally administered thymic extract (thymomodulin): Preliminary results. Drugs Exp Clin Res 1985;11:665–9.

37. Bortolotti F, Cadrobbi P, Crivellaro C, et al. Effect of an orally administered thymic derivative, thymomodulin, in chronic type B hepatitis in children. Curr Ther Res 1988;43:67–72.

38. Civeira MP, Castilla A, Morte S, et al. A pilot study of thymus extract in chronic non-A, non-B hepatitis. Aliment Pharmacol Ther 1989;3:395–401.

39. Wallace AE, Weeks WB. Thiamine treatment of chronic hepatitis B infection. Am J Gastroenterol 2001;96:864–8.

40. Takagi H, Nagamine T, Abe T, et al. Zinc supplementation enhances the response to interferon therapy in patients with chronic hepatitis C. J Viral Hepat 2001;8:367–71.

41. Hobbs, C. Medicinal Mushrooms. Santa Cruz, CA: Botanica Press, 1995, 96–107.

42. Berkson BM. A conservative triple antioxidant approach to the treatment of hepatitis C. Combination of Alpha lipoic acid (thioctic acid), silymarin, and selenium: three case histories. Med Klin 1999;94 Suppl 3:84–9.

43. Chaturvedi GN, Singh RH. Jaundice of infectious hepatitis and its treatment with an indigenous drug, Picrorhiza kurrooa[sic]. J Res Ind Med 1966;1:1–13.

44. Chaturvedi GN, Tomar GS, Tiwari SK, Singh KP. Clinical studies on kalmegh (Andrographis paniculata) in infective hepatitis. J Int Inst Ayurveda 1983;2:208–11.

45. Tang W, Eisenbrand G. Chinese Drugs of Plant Origin. Berlin: Springer Verlag, 1992.

46. Bone K, Morgan M. Clinical Applications of Ayurvedic and Chinese Herbs: Monographs for the Western Herbal Practitioner. Warwick, Australia: 1996.

47. Jenkins PJ, Portmann BP, Eddleston AL, Williams R. Use of polyunsaturated phosphatidylcholine in HBsAg negative chronic active hepatitis: Results of prospective double-blind controlled trial. Liver 1982;2:77–81.

48. Suzuki H, Ohta Y, Takino T, et al. Effects of glycyrrhizin on biochemical tests in patients with chronic hepatitis. Double blind trial. Asian Med J 1983;26:423–38.

49. Yasuda K, Hino K, Fujioka S, et al. Effects of high dose therapy with Stronger Neo-Minophagen C (SNMC) on hepatic histography in non-A, non-B chronic active hepatitis. In Viral Hepatitis C, D, E, ed. T Shikata, RH Purcell, T Uchida. Amsterdam: Excerpta Medica, 1991, 205–9.

50. Crance JM, L’eveque F, Biziagos E, et al. Studies on mechanism of action on glycyrrhizin against hepatitis A virus replication in vitro. Antiviral Res 1994;23:63–76.

51. Su XS, Chen HM, Wang LH, et al. Clinical and laboratory observation on the effect of glycyrrhizin in acute and chronic viral hepatitis. J Trad Chin Med 1984;4:127–32

52. Chaturvedi GN, Singh RH. Jaundice of infectious hepatitis and its treatment with an indigenous drug, Picrorhiza kurrooa[sic]. J Res Ind Med 1966;1:1–13.

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