Phyllanthus amarus, Phyllanthus niruri, Phyllanthus urinaria
Tropical plants in the genus Phyllanthus have a long history of use in Ayurvedic medicine ( the traditional medicine of India) for the treatment of hepatitis, kidney and bladder problems, intestinal parasites, and diabetes. The most studied species is Phyllanthus amarus.
Hepatitis B is a two-stage illness. Its has an acute phase which causes jaundice, severe fatigue, and other symptoms. These symptoms usually resolve in a month or so; however, the infection may then become chronic. Long-term infection with hepatitis B can spread the disease to other people and can also lead to liver injury or liver cancer.
P. amarus has undergone considerable evaluation as a as a treatment for chronic hepatitis B, and a bit of study for acute hepatitis. However, the results have not been promising. The current consensus is that the herb is not helpful for hepatitis. P. urinaria also appears to be ineffective.
Despite numerous test tube and animal studies showing efficacy against the hepatitis B virus,2 P. amarus has generally not done well in human trials.
Only one study clearly found benefits, and it was seriously flawed. In this 30-day double-blind, placebo-controlled trial of 60 people with chronic hepatitis B, treatment with phyllanthus (200 mg 3 times daily) dramatically increased the odds of full recovery.3 In the treated group, almost 60% were hepatitis B–negative at follow-up, as compared to only 4% in the placebo group.
However, the high drop-out rate in the placebo group significantly reduces the reliability of the results. Furthermore, multiple follow-up studies attempting to reproduce these findings have not found any benefits 4–11
Another double-blind, placebo-controlled trial enrolled 57 people with acute hepatitis B to see whether treatment with P. amarus (300 mg 3 times daily for 1 week) could improve speed of recovery.12 The results showed no benefit. However, because acute hepatitis B usually lasts a month or more, the duration of treatment in this study was oddly short.
One highly preliminary study suggested that P. urinaria, a related species, might be more effective against hepatitis than other species of phyllanthus.13 However, a subsequent double-blind, placebo-controlled study designed to test this hypothesis failed to find benefit.1
The usual dose of P. amarus used in studies is 600 to 900 mg daily.
There are no indications that P. amarus is toxic when used at recommended doses, but comprehensive safety studies have not been performed.14 In double-blind studies, significant side effects have not been reported. Safety in pregnant or nursing women, or individuals with severe liver or kidney disease, has not been established.
1. Chan HL, Sung JJ, Fong WF, et al. Double-blinded placebo-controlled study of Phyllanthus urinaris for the treatment of chronic hepatitis B. Aliment Pharmacol Ther. 2003;18:339-45.
2. Calixto JB, Santos AR, Cechinel Filho V, et al. A review of the plants of the genus Phyllanthus: their chemistry, pharmacology, and therapeutic potential. Med Res Rev. 1998;18:225–258.
3. Thyagarajan SP, Subramanian S, Thirunalasundar T, et al. Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet. 1988;2:764–766.
4. Berk L, de Man RA, Schalm SW, et al. Beneficial effects of Phyllanthus amarus for chronic hepatitis B, not confirmed. J Hepatol. 1991;12:405–406.
5. Calixto JB, Santos AR, Cechinel Filho V, et al. A review of the plants of the genus Phyllanthus: their chemistry, pharmacology, and therapeutic potential. Med Res Rev. 1998;18:225–258.
6. Leelarasamee A, Trakulsomboon S, Maunwongyathi P, et al. Failure of Phyllanthus amarus to eradicate hepatitis B surface antigen from symptomless carriers. Lancet. 1990;335:1600–1601.
7. Thyagarajan SP, Jayaram S, Valliammai T, et al. Phyllanthus amarus and hepatitis B. Lancet. 1990;336:949–950.
8. Thamlikitkul V, Wasuwat S, Kanchanapee P. Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers. J Med Assoc Thai. 1991;74:381–385.
9. Berk L, de Man RA, Schalm SW, et al. Beneficial effects of Phyllanthus amarus for chronic hepatitis B, not confirmed. J Hepatol. 1991;12:405–406.
10. Doshi JC, Vaidya AB, Antarkar DS, et al. A two-stage clinical trial of Phyllanthus amarus in hepatitis B carriers: failure to eradicate the surface antigen. Indian J Gastroenterol. 1994;13:7–8.
11. Milne A, Hopkirk N, Lucas CR, et al. Failure of New Zealand hepatitis B carriers to respond to Phyllanthus amarus. N Z Med J. 1994;107:243.
12. Narendranathan M, Remla A, Mini PC, et al. A trial of Phyllanthus amarus in acute viral hepatitis. Trop Gastroenterol. 1999;20:164–166.
13. Wang M, Cheng H, Li Y, et al. Herbs of the genus phyllanthus in the treatment of chronic hepatitis B: observation with three preparations from different geographic sites. J Lab Clin Med. 1995;126:350–352.
14. Thyagarajan SP, Subramanian S, Thirunalasundar T, et al. Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet. 1988;2:764–766.
Last reviewed September 2014 by EBSCO CAM Review Board
Last Updated: 9/18/2014
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