Heath Notes

Bupleurum

Common names: Thorowax, Saiko, Hare’s ear, Chai hu

Botanical names: Bupleurum chinense, Bupleurum falcatum

Parts used and where grown

These Asian plants are part of the Apiaceae (Umbelliferae) family, and resemble dill or fennel. However, bupleurum has long thin leaves rather than the lacy appearance of fennel and dill leaves. The Chinese name for bupleurum, chai hu, means “kindling of the barbarians.” The origin of this name is unclear. The roots of the plant are used in herbal medicine.

Bupleurum has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings	Health Concerns
	Epilepsy Hepatitis (viral) Irritable bowel syndrome (Chinese herbal combination formula containing wormwood, ginger, bupleurum, schisandra, dan shen, and other extracts) Liver cirrhosis
	HIV/AIDS
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Science Ratings

Health Concerns

Epilepsy

Hepatitis (viral)

Irritable bowel syndrome (Chinese herbal combination formula containing wormwood, ginger, bupleurum, schisandra, dan shen, and other extracts)

Liver cirrhosis

HIV/AIDS

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies)

Bupleurum has been used in Traditional Chinese Medicine for thousands of years to help relieve numerous conditions. Most particularly, infections with fever, liver problems, indigestion, hemorrhoids, and uterine prolapse.¹

Bupleurum is a key ingredient in the formula known as sho-saiko-to. This is a Japanese kampo or traditional herbal medicine formula based on the traditional Chinese formula xiao-chai-hu-tang. In English, it has been called minor bupleurum formula. Bupleurum makes up 16% of the formula for sho-saiko-to (see below for the complete contents of the formula). Results reported for sho-saiko-to cannot be attributed solely to bupleurum because the other herbs in the formula also contribute.²

Sho-saiko-to (xao-chai-hu-tang or minor bupleurum formula) contains the following:

Bupleurum falcatum (thorowax) root, 16%
Paeonia lactiflora (peony) root, 16%
Pinellia ternata (ban xia) rhizome, 14%
Cinnamomum cassia (cassia) bark, 11%
Zingiber officinale (ginger) rhizome, 11%
Zizyphus jujuba (jujube) fruit, 11%
Panax ginseng (Asian ginseng) root, 8%
Scutellaria baicalensis (Chinese scullcap) root, 8%
Glycyrrhiza uralensis (licorice, gan cao) rhizome, 5%

Active constituents

Bupleurum contains constituents known as saikosaponins that appear to account for much of the medicinal activity of the plant. Test tube studies have shown that the sho-saiko-to combination can increase production of various chemicals (known as cytokines) that immune cells use to signal one another.³ Test tube studies have also found that saikosaponins can inhibit growth of liver cancer cells,⁴ and are anti-inflammatory.⁵ ⁶

Human trials, only one double-blind, have shown that the bupleurum-containing formula sho-saiko-to may help reduce symptoms and blood liver enzyme levels in children and adults with chronic active viral hepatitis.⁷ ⁸ ⁹ ¹⁰ Most of these studies were in people with hepatitis B infection, though one preliminary human trial has also shown a benefit in people with hepatitis C.¹¹ Sho-saiko-to was also found, in a large, preliminary (but not double-blind), study to decrease the risk of people with chronic viral hepatitis developing liver cancer.¹²

Sho-saiko-to has also been used to reduce symptoms of and possibly decrease the severity of liver cirrhosis, though clinical studies on this condition are generally lacking. One randomized trial (it was unclear if this trial was double-blind) found that sho-saiko-to could reduce the rate of liver cancer in people with liver cirrhosis.¹³

Several uncontrolled trials in Japan have shown that sho-saiko-to or very similar traditional Japanese and Chinese herbal formulas (all containing bupleurum) can reduce seizure frequency and/or severity in people with epilepsy that does not respond to anti-seizure medications.¹⁴ ¹⁵ ¹⁶ ¹⁷ However, double-blind trials are still needed to determine the importance of these findings.

Sho-saiko-to has been found to inhibit human immunodeficiency virus (HIV) in the test tube.¹⁸ Yet, it is unclear to what degree bupleurum or saikosaponins contributed to this effect. Sho-saiko-to also increased the efficacy of the standard anti-HIV drug lamivudine in the test tube.¹⁹ Human data are lacking on the benefit of sho-saiko-to or bupleurum in people with HIV infection or acquired immunodeficiency syndrome (AIDS).

How much is usually taken?

Generally 500–2,000 mg bupleurum dry root are taken three times daily in capsules.²⁰ Traditionally, and in some clinical studies, bupleurum was prepared as a tea in which the root is decocted or cooked for hours before use. Some people take 1–4 grams per cup of water, three times daily. Sho-saiko-to formula is typically given in capsules (1.8–2.5 grams) three times per day. The amount given to children should be proportionally reduced based on individual weight and height as compared to adults.²¹

Are there any side effects or interactions?

Bupleurum and sho-saiko-to taken as a tea can upset the stomach, an effect that tends to be lessened by taking them with food or in capsules. Bupleurum and sho-saiko-to are not recommended during pregnancy and breast-feeding.

Sho-saiko-to has been used alone and with interferon to treat hepatitis. Eighty or more cases of drug-induced pneumonitis (inflammation of the lungs) have been associated with the use of sho-saiko-to alone or with interferon.²² ²³ ²⁴ ²⁵ ²⁶ Until more is known, sho-saiko-to should not be combined with interferon.

Are there any drug interactions?
Certain medicines may interact with bupleurum. Refer to drug interactions for a list of those medicines.

References
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1. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica, rev ed. Seattle: Eastland Press, 1993, 49–50.

2. Watanabe K, Fujino H, Morita T, et al. Solubilization of saponins of Bupleuri radix with ginseng saponins: Cooperative effect of dammarene saponins. Planta Med 1988;54:405–8.

3. Yamashiki M, Nishimura A, Nomoto M, et al. Herbal medicine sho-saiko-to induces tumor necrosis factor-alpha and granulocyte colony-stimulating factor in vitro in peripheral blood mononuclear cells of patients with hepatocellular carcinoma. J Gastro Hepatol 1996;11:137–42.

4. Motoo Y, Sawabu N. Antitumor effects of saikosaponins, baicalin and baicalein on human hepatoma cell lines. Cancer Lett 1994;86:91–5.

5. Yamamoto M, Kumagai A, Yamamura Y. Structure and actions of saikosaponins isolated from Bupleurum falcatum L. I. Anti-inflammatory action of saikosaponins. Arzneim Forsch 1975;25:1021–3.

6. Utrilla MP, Zarzuelo A, Risco S, et al. Isolation of a saikosaponin responsible for the antiinflammatory activity of Bupleurum gibralticum Lam root extract. Phytother Res 1991;5:43–5.

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

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. Yamamoto S, Oka H, Kanno T, et al. Controlled prospective trial to evaluate Shosaiko-to in preventing hepatocellular carcinoma in patients with cirrhosis of the liver. Gan To Kagaku Ryoho (Jpn J Cancer Chemother) 1989;16:1519–24 [in Japanese].

14. Narita Y, Satowa H, Kokubu T, et al. Treatment of epileptic patients with the Chinese herbal medicine ‘saiko-keishi-to’ (SK). IRCS Med Sci 1982;10:88–9.

15. Nagakubo S, Niwa S-I, Kumagai N, et al. Effects of TJ-960 on Sternberg’s paradigm results in epileptic patients. Jpn J Psych Neur 1993;47:609–19.

16. Packer M, Kligler B. Bupleurum for the treatment of epilepsy. Int J Chin Med 1984;1:55–8.

17. Hiramatsu M, Edamatsu R, Kohno M, et al. The possible involvement of free radicals in seizure mechanism. Jpn J Psych 1986;40:349–52.

18. Buimovici-Klein E, Mohan V, Lange M, et al. Inhibition of HIV replication in lymphocyte cultures of virus-positive subjects in the presence of sho-saiko-to, an oriental plant extract. Antiviral Res 1990;14:279–86.

19. Piras G, Makino M, Baba M. Sho-saiko-to, a traditional kampo medicine, enhances the anti-HIV-1 activity of lamivudine (3TC) in vitro. Microbiol Immunol 1997;41:435–9.

20. Bone K. Bupleurum—a natural steroid effect, part 2. MediHerb Professional Newsletter 1996;51:1–2.

21. 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 1990;94:1811–5.

22. Nakagawa A, Yamaguchi I, Takao T, Amano H. Five cases of drug-induced pneumonitis due to sho-saiko-to or interferon alpha or both. Nippon Kyobu Shikkan Gakkai Zasshi 1995;33:1361–6 [in Japanese].

23. Ishizaki T, Sasaki F, Ameshima S, et al. Pneumonitis during interferon and/or herbal drug therapy in patients with chronic active hepatitis. Eur Respir J 1996;9:2691–6.

24. Sugiyama H, Nagai M, Kotajima F, et al. A case of interstitial pneumonia with chronic hepatitis C following interferon-alpha and sho-saiko-to therapy. Arerugi 1995;44:711–4 [in Japanese].

25. Sato A, Toyoshima M, Kondo A, et al. Pneumonitis induced by the herbal medicine Sho-saiko-to in Japan. Nippon Kyobu Shikkan Gakkai Zasshi 1997;35:391–5 [in Japanese].

26. Miyazaki E, Ando M, Ih K, et al. Pulmonary edema associated with the Chinese medicine shosaikoto. Nihon Kokyuki Gakkai Zasshi 1998;36:776–80 [in Japanese].

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires September 2008.

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