shown to have a stimulatory effect on malignant liver tissue. 6,15,16,10,17
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5. Competitive Binding with Some Toxins: Silymarin appears to compete with amanita phalloides – based toxins (from
toadstool (deathcap) mushrooms) for a receptor on the cell membrane. Under experimented conditions, silymarin
prevents death in animals exposed to these very lethal liver toxins when given prior to the amanita phalloides
toxins, or within 10 minutes after exposure to these toxins. 10,7,8,18
6. Increased Superoxide Dismutase Concentrations: Silymarin has been shown to increase the concentrations of
superoxide dismutase – a very powerful intracellular antioxidant, which quenches the superoxide anion (a very
aggressive
damaging
and
reactive,
free
radical
oxygen
species).
19
Clinical Applications: (Primarily The Treatment of Various Liver Conditions)
1. Cirrhosis: Patients with liver damage due to excess alcohol consumption have shown improvement in laboratory,
and liver biopsy assessment after silymarin treatment. Another study revealed improved survival in patients with
cirrhosis who were treated with silymarin versus placebo, in a 4-year study involving 87 patients. 20,21,22 A double-
blind, placebo-controlled study involving 106 Finnish soldiers with alcoholic liver disease revealed that treatment
with Milk Thistle produced improvement in regards to a reduction in liver enzyme blood levels and histological
improvement of liver cells, as evidenced by liver biopsy samples in 29 subjects. 49 Two other studies have provided
similar evidence 50, 51, although not all studies performed to date have demonstrated these types of positive results
in alcoholic liver disease. 52,53
2. Chronic Viral Hepatitis and Acute Hepatitis: Most, but not all, studies have shown the effectiveness of silymarin in
treating both acute and chronic hepatitis. 10,23,24,47 In the majority of these studies improvement in bilirubin levels
and liver serum enzymes have been documented, and a reduction in abdominal discomfort, fatigue, and improved
appetite have been reported in patients treated with silymarin. To date the majority of successful clinical trials have
administered silymarin intravenously (I.V.) and therefore, the applicability of these findings to the oral ingestion of
silymarin is not completely known. 10,23,24,25 However, one recently completed, well-designed clinical trial showed
that the oral intake of Milk Thistle (yielding 240 mg per day) decreased blood levels of AST, ALT, and gamma-
glutamyltransferase (GGT) in a study of 20 patients with chronic viral hepatitis. These are all known to be important
liver enzyme blood tests that are highly correlated with the degree of liver damage. 23
3. Protection from Chemical Toxins: Animal studies reveal that Milk Thistle extract protects the liver from a variety of
toxins including alpha-amanitin and phalloidin (both from the extremely poisonous Deathcap or Toadstool
mushroom), carbon tetrachloride, thioacetamide, DL-ethionine, phenothiazines acetaminophen and ethanol
(alcohol).
10,26,27,28,29,47
Several human studies have shown that silymarin can reverse certain instances of liver damage induced by alcohol
consumption (treated subjects demonstrated improved values for amino transferase (AST) and alanine
aminotransferase (ALT) in blood testing). There was also a trend in the concentrations of total and conjugated
serum
bilirubins
in
the
silymarin
group,
compared
to
the
controls.
10,30
Another study with patients taking the psychotropic drugs phenothiazines or butyrophenones, demonstrated that
silymarin decreased liver damage induced by these drugs and decreased serum levels of malondialdehyde (MDA),
which is a biomarker for the production of free radicals. 31 However, a study examining the protective role of Milk
Thistle in Alzheimer’s patients taking the drug tacrine, failed to show that Milk Thistle could prevent the liver
inflammation that is known to be a side effect of this medication. 54
4. Enhance Detoxification: For general support of liver detoxification in anti-aging medicine silymarin has been shown
to significantly increase liver concentrations of glutathione, increase solubility of bile and provides additional
antioxidant support to liver cells. As such, it is recommended by anti-aging and holistic practitioners as supplement
that may help to slow the biological processes of aging and exert a number of health-promoting effects that are
consistent with principles of disease prevention practices. 10,32,11,12
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5. Psoriasis: A number of reports suggest that silymarin may be of value in the treatment of psoriasis, likely due to its
ability to inhibit the synthesis of pro-inflammatory leukotrienes and improve the liver’s capacity to detoxify foreign
compounds and contaminants. Some evidence suggests that certain bioactive agents absorbed in the intestinal
tract, that escape detoxification by the liver and intestinal mucosal cells, may trigger inflammatory reactions
involved in the exacerbation of skin conditions, such as psoriasis. 33,34 This application, however, requires further
substantiation, according to certain authorities. 47
6. Sluggish Liver or Minor Hepatic Insufficiency: This term is usually used by European physicians and American
Naturopaths to describe a myriad of symptoms involving aching beneath the ribs, fatigue, unhealthy skin
appearance, general malaise, constipation, allergies, premenstrual syndrome, and/or chemical sensitivities, for
which Milk Thistle has been recommended. 55
Dosage and Standardized Grade
Most Milk Thistle products are standardized to 70 to 80 percent silymarin content. Thus, a 200 mg (70% silymarin
extract) tablet contains 140 mg of silymarin. 35,36, 46, 47,48
a. Liver Conditions: for the liver conditions mentioned above a dosage of 140 mg of silymarin, three times daily is
often used. 30, 46,47,48 After 8-12 weeks improvement should occur, allowing a reduction to 140 mg twice per day.
38
b. Psoriasis: 140 mg of silymarin, three times daily. 34
c. Therapeutic Detoxification Support: 140 mg of silymarin, twice daily. 38
Adverse Side Effects, Toxicity and Contraindications
Milk Thistle is extremely non-toxic and side effects are rare. It increases bile flow and thus, may cause mild diarrhea in
some individuals. 39,40,41 A study of 2,637 subjects reported in 1992 showed a low incidence of side effects, limited
mainly to mild gastrointestinal disturbance. On rare occasions more severe abdominal discomfort has occurred. 56,57
Drug-Nutrient Interactions
There are no known adverse drug interactions reported for milk thistle. However, as it stimulates liver detoxification
pathways it may potentially speed up the metabolism of some drugs. Thus, practitioners should closely monitor
patients on concurrent medications. 42,43,44,45
Milk Thistle may reduce the liver damage or side effects of certain medications, and thus its concurrent administration
with the following medications may be advisable:
Acetaminophen
Anesthetics
Chemotherapy
Clofibrate
Halopersidol
Metronidazole
Pravastatin
Tacrine43
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Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insufficient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Foster S. Milk Thistle. Silybum marianum. Houston, TX: American Botanical Council;1997:p7
2. Awang D. Milk thistle. Can Pharm J 1993;422:403-4
3. Wagner H. Antihepatotoxic flavonoids. Plant Flavonoids in Biology and Medicine: Biochemical, Pharmacological, and Sturcture-
Activity Relationships (Cody V, Middleton E, Harbourne jV, eds.) Alan R. Liss, New York 1986:p545-58
4. Adzet T. Polyphenolic compounds with biological and pharmacological activity. Herbs Spices Med Plants 1986;1:167-84
5. Hikino H, Kiso Y, Wagner H, Fiebig. Antihepatotoxic actions of flavanolignans from silybum marianum fruits. Planta Medica
1984;50:248-50
6. Wagner H. Plant constituents with antihepatotoxic activity. Natural Products as Medicinal Agents (Beal JL and Reinhard E, eds.)
Hippokrates-Verlag, Stuttgart, Germany 1981
7. Vogel G et al. Protection against Amanita phalloides intoxication in beagles. Toxicol appl Pharm 1984;73:355-62
8. Vogel G et al. Studies on pharmacodynamics, site and mechanism of action of silymarin, the anti-hepatotoxic principle from Silybum
marianum (L.) Gaert. Arzneimittel-Forsch 1975;25:179-85
9. Valenzuela A et al. Silymarin protection against hepatic lipid peroxidation induced by acute ethanol intoxication in the rat. Biochem
Pharm 1985;34:2209-12
10. Hikino H, Kiso Y. Natural products for liver diseases. Economic and Medicinal Plant Research 1988;2:39-72
11. Valenzuela A, Aspillaga M, Vial S, Guerra R. Selectivity of silymarin on the increase of the glutathione content in different tissues of
the rat. Planta Medica 1989;55:420-2
12. Campos R, Garrido A, Guerra R, Valenzuela A. Silybin dihemisuccinate protects against gluta thione depletion and lipid peroxisation
induced by acetaminophen in rat liver. Planta Medica 1989;55:417-9
13. Fiebrich F, Koch H. Silymarin, an inhibitor of prostaglandin synthetase. Experientia 1979;35:148-50
14. Fiebrich F, Koch H. Silymarin, an inhibitor of prostaglandin synthetase. Experientia 1979;35:150-2
15. Sonnenbichler J et al. Stimulatory effect of silibinin on the DNA synthesis in partially hepatectomized rat livers: Non-response in
hepatoma and othr malignant cell lines. Biochem Pharm 1986;35:538-41
16. Sonnenbichler J, Zetl I. Biochemical effects of the flavonolignan silibinin on RNA, protein and DNA synthesis in rat livers. Plant
Flavonoids in Biology and Medicine: Biochemical, Pharmacological, and Structure–Activity Relationships (Cody V, Middleton E, and
Harbourne JB, eds.) Alan R. Liss, New York 1986:319-31
17. Magliulo P, Carosi G, Minoli L, Gorini S. Studies on the regenerative capacity of the liver in rats subjected to partial hepatectomy and
treated with silymarin. Arzneimittelforschung 1973;23:161-7
18. Desplaces A et al. The effects of silymarin on experimental phalloidin poisoning. Arzneimittel-Forsch 1975;25:89-96
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Meschino Health Comprehensive Guide to Herbs
19. Muzes G, Deak G, Land I et al. Effect of the bioflavonoid silymarin on the in vitro activity and expression of superoxide dismutase
(SOD) enzyme. Acta Physiologica Hungarica 1991;78(1):3-9
20. Schopen RD, Lange OK: Therapy of hepatoses, Therapeutic use of silymarin. Med Welt 1970;21:691-8
21. Ferenci P et al. Randomized controlled trial of silymarin treatment in patients with cirrhyosis of the liver. J Hepatol 1989;9:105-13
22. Deak G et al. Immunomodulator effect of silymarin therapy in chronic alcoholic liver diseases. Orv Hetil 1990;131:p1291-2 p1295-6
23. Buzzelli G, Moscarella S, Giusti A et al. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in
chronic active hepatitis. International Journal of Clinical Pharmacology Tehrapy and Toxicology 1993;31(9):456060
24. Lirussi F, Okolicsanyi L. Cytoprotection in the nineties: Experience with ursodeoxycholic acid and silymarin in chronic liver disease.
Acta Physiologica Hungarica 1992;80(1-4):363-7
25. Berenguer J et al. Double-blind trial of silymarin versus placebo in the tratment of chronic hepatitis. Muench Med Wochenschr
1971;119:240-60
26. Weiss RF. Herbal Medicine. Gothenburg, Sweden: Ab Areanum 1988:362
27. Hruby C. Silibinin in the treatment of deathcap fungus poisoning. Forum 1984;6:23-6
28. Faulstich II, Jahn W, Wieland T. Silybin inhibition of amatoxin uptake in the perfused rat liver. Arzneimittelforshung 1980;30(1):452-4
29. Tuchweber B, Sieck R, Trost w. Prevention of silybin of phalloidin-induced acute hepatotoxicity. Toxicology and Applied
Pharmacology 1979;51:265-75
30. Salami HA, Sarna S. Effect of silymarin on chemical, functional and morphological alterations of the liver. Scandinavian Journal of
Gastroenterology 1982;17:517-21
31. Palasciano G, Portincasa P, Palmieri V et al. The effect of silymarin on plasma levels of malondialdehyde in patients receiving long-
term treatment with psychotropic drugs. Current Therapeutic Research 1994;55(5)537-45
32. Nassauto G et al. Effect of silibinin on biliary lipid composition. Experimental and clinical study. J Hepatal 1991;12:290-95
33. Kock HP et al. Silymarin: Potent inhibitor of cyclic AMP phosphodiesterase. Meth Find Exp Clin Pharm 1985;7:409-13
34. Weber G et al. The liver, a therapeutic target in dermatoses. Med Welt 1983;34:108-11
35. Blumenthal M, Brusse WR, Goldber A et al. The Complete German Commission E Monographs. Austin, TX: American Botanical
Council 1998:p685
36. Health care professional training program in complementary medicine. Boon H and Smith M. Institute of Applied Complementary
Medicine Inc. 1997:241-5
37. Wagner H et al. The chemistry of silymarin (silybin), the active principle of the fruits of silybum marianum (L.). Gaertn Arzneim-
Forsch Drug Res 1968;18:688-96
38. Brown DJ. Herbal Prescriptions for Better Health. Rocklin, CA:Prima Publishing 1996:151-8
39. Murray MT. The Healing Power of herbs. Rocklin, CA:Prima Publishing 1992:p246
40. Brown D. Silymarin educational monograph. Townsend Newsletter for Doctors 1994;136:1282-5
41. Tyler VE. Herbs of Choice. The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press 1994:p209
42. The Botanical Pharmacy. Quarry Health Books2000. Boon H and Smith M:250-4
43. Beckmann-Knopp S, Rietbrock S, Weyhenmeyer R et al. Inhibitory effects of silibinin on cytochrome P-450 enzymes in human liver
microsomes. Pharmacol Toxicol Jun2000;86(6):2506
44. Venkataramanan R, Ramachandran V, Komoroski BJ et al. Milk Thistle, a herbal supplement, drecreases the activity of CYP3A4 and
uridine disphosphoglucuronosyl transferase in human hepatocyte cultures. Drug Metab Dispos Nov2000;28(11):1270-3
45. Zhao J et al. Tissue distribution of silibinin, the major active constituent of silymarin, in mice and its association with enhancement of
phase II enzymes: Implications in cancer chemoprevention. Carcinogenesis Nov1999;20(11):2101-8
46. Healthnotes Online. Healthnotes Inc, 2000. www.healthnotes.com: Milk Thistle
47. Natural Products Encyclopedia. www.consumerslab.com: Milk Thistle
48. Dietary Supplement Information Bureau. www.content.intramedicine.com: Thistle
49. Salmi HA, Sarna S. Effect of silymarin on chemical, functional and morphological alterations of the liver. A double-blind controlled
study. Scand J Gastroenterol 1982;17:517-21
50. Feher J, Desk G, Muzes G et al. Liver protective action of silymarin therapy in chronic alcoholic liver diseases [in Hungarian]. Orv
hetil 1989;130:2723-7
51. Fintelmann V, Albert A. Proof of the therapeutic efficacy of LegalonW for toxic liver illnesses in a double-blind trial [translated from
German]. Therapiewoche 1980;30:5589-94
52. Trinchet JC, Coste T, Levy VG et al. Treatment of alcoholic hepatitis with silymarin. A double-blind comparative study in 116 patients
[translated from French]. Gastroenterol Clin Biol 1989;13:120-4
53. Bunout D, Hirsch SB, Petermann MT et al. Controlled study of the effect of silymarin on alcoholic liver disease [translated from
Spainch]. Rev Med Chil 1992;120:1370-5
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54. Allain H, Schuck S, lebreton S et al. Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer’s
disease. Dement Geriatr Cogn Disord 1999;10:181-5
55. Giannola C, Buogo F, Forestiere G et al. A two-center study on the effects of silymarin in pregnant women and adult patients with
so-called minor hepatic insufficiency [in Italian]. Clin Ther 1985;114:129-35
56. Albrecht M, Frerick H, Kuhn U et al. Therapy of toxic liver pathologies with Legalon [in German]. Z Klin Med 1992;47:87-92
57. Adverse Drug Reactions Advisory Committee. An adverse reaction to the herbal medication in milk thistle (Silybum marianum). Med
J Aust 1999;170:218-9
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Meschino Health Comprehensive Guide to Herbs
Muira Puama ( Potency Wood)
General Features
This is one of the best-known herbs for treating erectile dysfunction and is used to enhance libido in both men and
women. This shrub, native to Brazil, has been used traditionally as an aphrodisiac and nerve-stimulant in South
American folk medicine.1 The British Herbal Pharmacopoeia recommends this herb in the treatment of impotence. 4
Principle Active Constituents
Unknown
Clinical Application and Mechanism of Action
1. Erectile Dysfunction
A 1990 study conducted at the Institute of Sexology in Paris, France, demonstrated that 62 percent of men re-
awakened their libido and 51 percent of men reversed erectile failure problems in 262 subjects, who initially
complained of lack of sexual desire and inability to attain or maintain an erection. Results occurred within two
weeks of beginning therapy with Muira Puama supplementation, at a daily dosage of 1000-1500 mg per day. 2
2. Female Libido Enhancement
A unique blend of Muira Puama combined with Ginkgo Biloba (herbal VX) was assessed in 202 healthy women
complaining of low sex drive. After one month of treatment with Herbal VX, 65 percent of women reported statistically
significant improvements in frequency of sexual desires, sexual intercourse, and sexual fantasies, as well as in
satisfaction with sex life, intensity of sexual desires, excitement of fantasies, ability to reach orgasm, and intensity of
orgasm. A double-blind study is planned to further substantiate these results.3
Dosage and Standardized Grade
Erectile Dysfunction – 1000 – 1500 mg per day, in divided doses, if used as a single agent (Standardized to 6:1 extract
from Muira Puama root). 2
Adverse Side Effects, Toxicity and Contraindications
Muira Puama is well tolerated and no significant side effects have been noted. 1,2,3 Muira Puama is reported to be
non-toxic at therapeutic doses. 4
Drug-Nutrient Interactions
There are no well-known drug-nutrient interactions for Muira Puama at this time. 1,4
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Meschino Health Comprehensive Guide to Herbs
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal
vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the
developing fetus and there is generally insufficient evidence at this time to determine an absolute level of
safety for most dietary supplements other than a prenatal supplement. Any supplementation practices
beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium
and the treatment of preeclampsia.)
References: Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and
Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine.
Institute of Applied Complementary Medicine Inc. 1997.
1. Duke JA. Handbook of Medicinal Herbs (Boca Raton: CRC Press) 1985
2. Wyanberg J. Aphrodisiacs: Contribution to the clinical validation and use of ptychopetalum guyanna (murira puama) –
presented at The First International Congress on Ethnopharmacology. Strasber, France June 5-9, 1990
3. Waynberg J, Brewer S. Effects of herbal VX on libido and sexual activity in premenopausal and postmenopausal
women. Adv Ther 2000;17(5):255-62
4. British Herbal Pharmacopoeia. British Herbal Medicine Association. West York, England, 1983:132-133
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Picrorhiza
General Features
Picrorhiza is a perennial plant, whose roots and rhizomes have been used for thousands of years in Indian traditional
medicine. It grows high in the Himalayan mountains. 1,2 Picrorhiza’s most important use is in the treatment and
prevention of liver conditions, whereby man