Sho-saiko-to

Related Terms

Apiaceae (family), bei chai hu, beichaihu, bupleuran 2IIc, Bupleurum chinese D.C., Bupleurum exaltatum, Bupleurum falcatum, Bupleurum falcatum L. var. scorzonerifolium, Bupleurum fruticosum L., Bupleurum ginghausenii, Bupleurum longifolium, Bupleurum multinerve, Bupleurum octoradiatum, bupleuri radix (Latin), bupleuri radix saponins, Bupleurum root, Bupleurum rotundifolium L., Bupleurum scorzonerifolium Willd, Bupleurum stewartianum, chaifu, chaihu (Chinese), chai hu, chai hu chaiku-saiko, Chinese thoroughwax root, echinocystic acid 3-O-sulfate, hare's ear root (English), He Jie Decoction, hydroxysaikosaponins, isochaihulactone, juk-siho, kara-saiko, Minor Bupleurum Decoction, mishima-saiko, nanchaihu, northern Chinese thorowax root, phenylpropanoids, radix bupleur, saiko (Japanese), saikospanonins, segl-hareore (Danish), shi ho, sho-saiko-to, shoku-saiko, shrubby hare's-ear, sickle-leaf hare's-ear, siho (Korean), thorowax, thoroughwax, TJ-9, triterpene saponins, Umbelliferae (family), wa-saiko, xiao chai hu tang, yamasaiko.

Background

Bupleurum (Bupleurum falcatum, Bupleurum fruticescens) has been widely used for over 2,000 years in Asia and is used today in Japan and China for hepatitis, cirrhosis, and other conditions associated with inflammation. Other traditional uses that are not supported by human scientific studies include the treatment of deafness, dizziness, diabetes, wounds, and vomiting. Bupleurum's root is an important ingredient in xiao-chai-hu-tan/sho-saiko-to, also known as Minor Bupleurum Decoction, a combination of nine herbs, including ginseng, ginger, and licorice, which is used in traditional Chinese and Japanese herbal medicine for hepatitis and cirrhosis.
Clinical studies have suggested that this combination may be effective in the treatment of hepatitis B and in the prevention of hepatocellular carcinoma. The mixture has also shown some promise as a liver-protecting agent and as an adjuvant in the treatment of HIV infection. The effect of Bupleurum is inseparable from the effects of the other ingredients in xiao-chai-hu-tan/sho-saiko-to, and thus it is difficult to make any firm conclusions based on studies of this combination product. However, because there is some promising early clinical evidence of efficacy for these formulae in the treatment and prevention of hepatitis-associated liver disease, a number of the studies of the combination preparations are included in this review.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


An herbal combination formula containing Bupleurum has been used as a treatment for children with minimal brain dysfunction. Early study is inconclusive, and additional study is needed to make a firm recommendation.

 C


An herbal combination formula containing Bupleurum has been used as a treatment for children with minimal brain dysfunction. Early study is inconclusive, and additional study is needed to make a firm recommendation.

 C


Chinese studies have suggested that Bupleurum may be helpful for reducing fever. However, additional study is needed to draw a firm conclusion about safety and effectiveness. In traditional Chinese medicine, Bupleurum is often used in combination with other herbs.

 C


Chinese studies have suggested that Bupleurum may be helpful for reducing fever. However, additional study is needed to draw a firm conclusion about safety and effectiveness. In traditional Chinese medicine, Bupleurum is often used in combination with other herbs.

 C


Traditional use from China, as well preliminary human study, seems to suggest that Bupleurum and/or herbal combination formulas containing Bupleurum may be helpful in the treatment of chronic hepatitis. Further research is warranted to draw a firm recommendation.

 C


Traditional use from China, as well preliminary human study, seems to suggest that Bupleurum and/or herbal combination formulas containing Bupleurum may be helpful in the treatment of chronic hepatitis. Further research is warranted to draw a firm recommendation.

 C


Hepatocellular carcinoma (HCC) arises predominantly in patients with cirrhosis, both hepatitis-associated and non-hepatitis associated. Sho-saiko-to, the Japanese version of the classical Bupleurum-based formula, has been examined for a possible role in preventing the development of HCC in patients with cirrhosis. Early study suggests that this formula may help prevent progression to HCC in patients with cirrhosis, although more study is needed for a strong recommendation.

 C


Hepatocellular carcinoma (HCC) arises predominantly in patients with cirrhosis, both hepatitis-associated and non-hepatitis associated. Sho-saiko-to, the Japanese version of the classical Bupleurum-based formula, has been examined for a possible role in preventing the development of HCC in patients with cirrhosis. Early study suggests that this formula may help prevent progression to HCC in patients with cirrhosis, although more study is needed for a strong recommendation.

 C


Primary thrombocytopenic purpura may respond in some cases to treatment with Bupleurum-containing herbal formulas. However, currently there is insufficient available evidence for or against the use of Bupleurum for this indication.

 C


Primary thrombocytopenic purpura may respond in some cases to treatment with Bupleurum-containing herbal formulas. However, currently there is insufficient available evidence for or against the use of Bupleurum for this indication.

 C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

Dosing

Adults (18 years and older)
There is no proven safe or effective dose for Bupleurum. Bupleurum is typically taken in combination formulas with other herbs, and has not been well studied alone. Traditionally, 1.5-9 grams of Bupleurum root have been used per day. Also, 1.5-3 milliliters of a fluid extract have been used daily. For hepatitis, doses of 5.4 grams of combination therapy sho-saiko-to daily have been studied for 12 weeks. For prevention of hepatocellular carcinoma, sho-saiko-to has been administered at a dose of 7.5 grams daily in combination with conventional treatment.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Interactions

Interactions with Drugs
Bupleurum may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin?) or heparin, anti-platelet drugs such as clopidogrel (Plavix?), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin?, Advil?) or naproxen (Naprosyn?, Aleve?).
Saikosaponins, constituents of Bupleurum, may increase blood sugar levels. Caution is advised when using medications that may alter blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
Bupleurum may stimulate the adrenals and may decrease the effects of antihypertensives (drugs for high blood pressure). Patients taking blood pressure medications, including beta-blockers or ACE inhibitors, should use cautiously.
Although not well-studied in humans, Bupleurum may reduce cholesterol levels. Caution is advised in patients taking cholesterol-lowering agents.
Due to the possibility of adrenal stimulation, Bupleurum may decrease the effects of diuretics or increase the effects of corticosteroids (steroids).
Bupleurum may have immune inhibitory effects and might additively or synergistically enhance immunosuppressant effects.
Sho-saiko-to, a combination herbal formula that contains Bupleurum, was found to enhance the anti-HIV-1 activity of lamivudine in laboratory study. Consult a qualified healthcare professional, including a pharmacist, before combining Bupleurum or combination formulas containing Bupleurum with antiviral or hepatitis B agents.
Bupleurum may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan?) or diazepam (Valium?), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. The use of Bupleurum in combination with alcohol might additively or synergistically enhance sedation. Caution is advised while driving or operating machinery.
In theory, Bupleurum may interact with medications metabolized by the liver. There are mixed reports of Bupleurum acting as both a protective agent for the liver, and also an agent that has toxic effects on the liver. Additionally, combination products containing Bupleurum may interact with any medication taken by mouth and may alter the way medications are absorbed in the body.
Although human evidence is lacking, Bupleurum may also interact with Alzheimer's disease medications, antibiotics, anticancer medications, or HIV medications (antiretrovirals). Consult with a qualified healthcare professional, including a pharmacist, to check for interactions.

Attribution

This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

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