Materia Medica

Silybum marianum
BY KERRY BONE

Also know as Carduus marianus • It protects against the uptake of some toxins by
the hepatocyte,13 and may also stabilise the
Common Names: St Mary's Thistle, Milk Thistle hepatocyte cell membrane.14
(due to the white markings on the leaves),
• Silymarin stimulates protein synthesis in the cell
Variegated Thistle which is an important step in the repair phase of
Family: Asteraceae liver damage.15
Part Used: Seed

Active Constituents
Flavanolignans (1 to 3%) collectively known as
silymarin.1 Individual components of silymarin are
mainly silybin, silydianin and silychristin.1 The
flavanolignans are often incorrectly classified as
flavonoids. The seeds also contain 20 to 30% fixed
oil which can give liquid extracts a milky colour.
Other components include flavonoids and saponins.

Pharmacological Studies

Hepatoprotective Activity
• Silymarin and isolated silybin have both shown
protective activity against acute administration of
liver toxins such as carbon tetrachloride,2
galactosamine,3 ethanol,4 paracetamol,5
and the toxin of the Death Cap mushroom
(Amanita phalloides).6
• Similar protective activity has also been
demonstrated against chronic administration of
carbon tetrachloride,7 heavy metals,8
thioacetamide9 and several drugs.10

Anticholestatic Activity
• Silybin demonstrated anticholestatic activity
against paracetamol- and ethynylestradiol-
induced cholestasis by countering the reduction
in bile salt output and bile flow.11

Mechanisms of Action
• Silymarin has pronounced antioxidant activity,12
and therefore protects against oxidative damage
to the hepatocyte.

For professional use only. Not for Public Distribution. Modern Phytotherapist 25
 Materia Medica

Toxicology treatment with silymarin significantly reduced

• The acute toxicology of silymarin is very low.
Oral doses of 20 g/kg in mice and 1 g/kg in dogs
resulted in no mortality or any signs of adverse
effects.16
• Long-term studies also failed to demonstrate
toxicity or teratogenic effects.16
Pharmacokinetics
• Components of silymarin are mainly excreted in
the bile as hepatic conjugates.17
• In cirrhotic patients the pharmacokinetic
parameters were comparable to those of healthy
subjects with maximum serum concentrations
ranging from 0.02 to 0.12 µg/mL.18
Clinical Studies
Alcoholic Liver Disease
• In a double blind study, patients with cirrhosis
were treated with 420 mg of silymarin per day
for six months (3 tablets each containing 140
mg).19 Serum levels of hepatic enzymes and
bilirubin were significantly reduced compared to
placebo.19 These improvements were
accompanied by positive histological changes in
the livers of patients receiving silymarin.19
• Significant antioxidant activity was verified in a
double blind clinical trial involving 36 patients
with alcoholic liver disease.20
• Diabetes secondary to alcoholic cirrhosis also
responded favourably to silymarin treatment in a
randomized study on 60 patients.21
mortality.23 This effect was more pronounced in
patients with alcoholic cirrhosis.
Toxic Damage of Different Origins
• In an open study on 2000 patients suffering from
toxic liver damage of differing aetiologies, serum
levels of hepatic enzymes were considerably
reduced.22 Symptoms such as nausea,
discomfort and skin itching were also improved
in 83% of patients.
Poisoning with Amanita phalloides
• Intravenous infusion of silybin, in combination
with normal management techniques,
induced a marked reduction in mortality in a
multi-centre study on 252 cases of intoxication
by Amanita phalloides.24
Chronic Hepatitis
• In a double blind trial on chronic persistent
hepatitis, silybin treatment for 3 months
decreased liver enzymes.25
• Silybin reduced the parameters related to
hepatocellular necrosis in a short-term double
blind study on chronic active hepatitis.26
Actions
Hepatoprotective, hepatic trophorestorative,
choleretic, antioxidant.

Hepatotoxic Effects of
Drugs and Chemicals
• Silymarin administered during the pre- and post-
operative period prevented the increase of
hepatic enzymes in the serum induced by the
toxic effect of general anaesthesia.22
• Silymarin also improved liver function in
patients who had been exposed for many years to
halogenated hydrocarbons.9

Cirrhosis of the Liver

• In a four-year double blind randomized study on
170 patients with cirrhosis of different
aetiologies, it was demonstrated that long-term

26 Modern Phytotherapist For professional use only. Not for Public Distribution.

Medicinal Uses
• Alcoholic liver damage
• Liver damage or toxicity from any cause
• Chronic hepatitis of autoimmune or viral origin
• Acute hepatitis
• After-effects of liver infections
• Gall bladder symptoms
• Chemical, food or drug intolerances
• To improve liver function
• Low grade toxic effects of drugs or
environmental pollutants, such as pesticides
• Fat intolerance, nausea or chronic constipation
due to poor liver function
Contraindications and Cautions
• None known
Dosage and Administration
• 3 to 5 g per day of seed or 3 to 5 mL of the 1:1
liquid extract.
• For more severe cases, such as advanced
cirrhosis, a concentrated extract standardised for
silymarin should be prescribed. A dose of 600
mg per day of 70:1 extract corresponding
to 420 mg of silymarin has been used in several
clinical trials.
• The absorption of silymarin is enhanced by
lecithin, and simultaneous dosing with a lecithin
supplement is recommended.
For professional use only. Not for Public Distribution.
Materia Medica
REFERENCES
1 Morazzoni, P and Bombardelli, E: Fitoterapia 66, 3 (1995)
2 Vogel, G: Arzneim-Forsch 25, 82 (1975)
3 Schriewer, H et al: Arzneim-Forsch 25, 1582 (1975)
4 Valenzuela, A et al: Biochem Pharmacol 34, 2209 (1985)
5 Campos, R et al: Planta Med 55, 417 (1989)
6 Floersheim, G L etal: Toxicol Appl Pharmacol 46, 455 (1978)
7 Mourelle, M et al: Fundam Clin Pharmacol 3, 183 (1989)
8 Barbarino, F et al: Rec Roum Méd-Méd Interne 19, 347 (1981)
9 Leng-Peschlow, E and Strenge-Hesse, A: Z Phytotherapie 12, 162 (1991)
10 Martines, G et al: Arch Sc Med 137, 367 (1980)
11 Shukla, B et al: Planta Med 57, 29 (1991)
12 Bindoli, A et al: Biochem Pharmacol 26, 2405 (1977)
13 Münter, K et al: Biochim Biophys Acta 860, 91 (1986)
14 Roberti, R et al: Pharmacol Res Commun 5, 249 (1973)
15 Sonnenbichler, J and Pohl, A: Hoppe-Seyler's Z Physiol Chem
361, 1757 (1980)
16 Hahn, G et al: Arzneim-Forsch 18, 698 (1968)
17 Flory, P J et al: Planta Med 38, 227 (1980)
18 Orlando, R et al: Med Sci Res 18, 861 (1990)
19 Fehér J et al: Orv Hetil 130, 2723 (1989)
20 Fehér J and Vereckei: Z Gastroenterol 29, 67 (1991)
21 Velussi, M et al: Curr Ther Res 53, 533 (1993)
22 Fintelmann, V: Med Klin 68, 809 (1973)
23 Ferenci, P et al: J Hepatol 9, 105 (1989)
24 Hruby, K and Csomós, G: 1st IGSC, Amsterdam (1989)
25 Marcelli, R et al: Eur Bull Drug Res 1, 131 (1992)
26 Buzzelli, G et al: Int J Clin Pharmacol Ther Toxicol 31, 456 (1993)
Modern Phytotherapist 27

Clinical Notes on Silybum marianum
BY NICHOLAS BURGESS
It is important to note that St Mary's Thistle is not
the only method of treatment for the range of liver
problems a practitioner may encounter in practice. I
have attempted to give a brief outline below of the
various circumstances which require some form of
therapy for the liver.
1 A patient may need treatment to guard against
the toxic threat to the liver from environmental
or ingested substances, including prescribed
drugs, alcohol and pollutants. This requires the
action of hepatoprotective and probably in
addition, hepatorestorative treatments. Herbs
which fulfil this role include Silybum marianum
(or the stronger Silymarin), Bupleurum falcatum,
Picrorrhiza kurroa and Cynara scolymus.
2 Patients who have had liver damage in the past
due to environmental or ingested toxins or
hepatitis will require a hepatorestorative. Herbs
which fulfil this role are Silybum marianum,
Schisandra chinensis and Bupleurum falcatum in
combination with bitters and choleretics or
cholagogues.
3 Patients encountering ongoing destruction of
hepatocytes from infectious or inflammatory
origin need hepatoprotectives and
hepatorestoratives, immune stimulants and
specific antimicrobial therapy.
4 A patient who has sluggish bowel function,
constipation, headaches, period pain etc, the
wholistic diagnosis for which is "liver
congestion", requires a choleretic and
28 Modern Phytotherapist
Clinical
cholagogue. This will help get the bile flowing
and both directly and indirectly assist in relieving
congestion in the liver. Choleretic herbs, some
with cholagogue function, include gentle agents
such as Taraxacum officinale radix, Cynara
scolymus, through to the stronger Berberis
vulgaris, Chelidonium majus and Chionanthus
virginicus.
In short, when dealing with that umbrella
concept in wholistic medicine of "treating the
liver", there are several alternatives. It is necessary
to take a good case history, make a diagnosis and
decide on the actions required before choosing
the herbs. While St Mary's Thistle is often
helpful, it is not appropriate in all circumstances.
See Kerry Bone's article on "Western Herbal
Therapeutics" in this edition.
Mr Nicholas Burgess
DH, MNHAA
Nick Burgess is a medical herbalist and has been
in practice for over ten years. He has lectured at
Sydney's most prominent natural therapies
colleges since 1985 and is a frequent guest
speaker at seminars both in Australia and
overseas. He is currently Vice-President of the
National Herbalists Association of Australia and
has been on the Board of Directors for six years.
For professional use only. Not for Public Distribution.