Complementary and alternative medicine in chronic liver disease

CAM represents medical and health care practices that are not an integral part of conventional (Western) medicine. At least 42% of the general population and a similar proportion of liver disease patients use some form of CAM on a regular basis. Herbal preparations are used by 20% of liver disease patients, typically without the advice or even knowledge of their physician, the most common herb used being milk thistle or silymarin. Other candidate herbals for liver disease are glycyrrhizin, HM861, TJ-9, and Phyllanthus amarus. Many of these have been shown to protect against experimental liver injury in vivo, and most possess one or a combination of anti-oxidant, antifibrogenic, immune modulatory, or antiviral activities. None, however, have been shown to be effective in ameliorating the course of chronic liver disease in properly conducted RCTs. Current impediments to progress in developing reliable information on the safety and efficacy of botanicals are the incomplete understanding of their modes of action, the lack of standardization in their manufacture, and the complexity of the chemical ingredients in the average herbal extract.