What Is It, Really?
Sho-saiko-to (SSKT) otherwise known as Minor Bupleurum Combination or Xiao Chai Hu Tang is an ancient herbal preparation used in Asia to treat what the chinese call lesser yang disorders, which includes fevers, the flu, bronchitis, lung infections, pulmonary TB, malaria, jaundice and hepatitis. Here in the 20th century, researchers have produced evidence supporting many of these traditional uses in test tube, animal studies and clinical trials in people — particularly for chronic hepatitis and liver cancer. Recent research also suggests that it may have anti-HIV effects. While traditional Chinese medicinal doctors may treat their patients with their own formulations, SSKT based on the ancient formula of seven medicinal plants is available as a pharmaceutical product in Asian countries.
How Does It Work?
Probably because it is an blend of medicinal plants, SSKT has a wide range of activity in test tube and animal studies that can be broken down into three main categories:
- anti-oxidant/anti-inflammatory effects,
- immune stimulating effects,
- and anti-viral/tumor effects.
As an anti-oxidant/anti-inflammatory: SSKT acts as a free radical scavenger, preserving levels of glutathione in mice livers. It has been shown to protect the liver against a variety of toxins, including chemotherapeutic drugs. It also dramatically reduces oxidative stress in the brains of aging mice. It has also been shown to treat ulcers, diabetes and stomach irritation in rodents.
As an immune-modulator: Again, in in vitro and animal studies SSKT has wide ranging effects on the immune system. It activates macrophages without boosting TNF-alpha; stimulates CTLs (the part of the immune sytem that kills infected or cancerous cells), NK cells and the production of antibodies; boosts G-CSF, and gamma-interferon (and maybe some harmful cytokines too). And it boosts T cells in rats.
Anti-viral/anti-tumor effects: SSKT has been shown to have anti-viral effects against hepatitis B, HTLV and HIV. Extracts from one ingredient, scute seem responsible for most of this activity (although glycyrrhizin, another ingredient also has documented anti-viral effects). Meanwhile, even though some of the herbs in SSKT have anti-cancer effects, as a mix it exhibits much more potent inhibition of cancer cells. It stops cancer cells in mice livers, and colons from proliferating, and may even kill them.
SSKT in PWAs
We don't know whether SSKT helps people with HIV. Both SSKT and some of its ingredients separately have shown activity against the virus in test tube studies. One study showed that doses ranging from 25-100 ug/ml stopped HIV's reverse transcriptase (RT) enzyme in lymphocytes taken from asymptomatic people with HIV; these doses were somewhat less effective in blood drawn from people with symptoms, and had little or no effect against virus from PWAs.
A more recent in vitro study shows that much lower doses than would normally work dramatically suppress the virus when given with AZT. But we don't know whether people with HIV can absorb enough SSKT to have an antiviral effect. Furthermore, the RT enzyme becomes resistant to most drugs aimed at it within months or weeks. We don't know anything about the development of resistance to SSKT.
Studies of SSKT in people with HIV might answer some of these questions. A Japanese study published at the V International AIDS Conference reported CD4 and CD8 cell improvements in 7 out of 13 patients treated with SSKT over six months, but it didn't mention the doses they used. To our knowledge there have been no other studies, other than a rumored underground study in New York, and one just beginning in Australia.
Studies in People With Liver Disease
There have been several studies of SSKT for hepatitis B, although none were well designed. One six month study in 80 people with chronic hep B reported decreases in viral load, antigen and 50% improvements in liver function. Another study in twenty six patients with chronic hep b reported even better results in eleven of the participants treated with SSKT. Seven out of fourteen children with chronic hep B cleared antigen within six months in yet another study of SSKT.
The largest (260 people) and best designed trial of SSKT that we've been able to find evaluated whether the blend could delay or prevent the development of liver cancer in people with cirrhosis. Participants were treated with 7.5 grams a day of SSKT or standard therapy. After 34 months, 17 people on standard therapy developed lesions in their livers compared to just 9 on SSKT.
Some of the ingredients of SSKT (bupleurum, and scute) in combination with a couple of other herbs including astragalus were compared to ritalin in 7 to 14 year old children with attention deficit disorders. The herbal blend was as effective as ritalin, without the toxicity. The children who did the best on the herbal combo got the highest boost in IQ points (10 points to be specific).
Side Effects and Toxicity
Side effects from taking SSKT are very rare. However, there are a few documented cases of SSKT causing lung inflammation in elderly patients.
There are no reports of interactions of SSKT with other drugs, other than studies that show that it reduced the level of liver toxic drugs within the liver. SSKT is often used in Asian countries to protect patients against the toxicity of chemotherapeutic drugs.
No one knows the best dose of SSKT for people with HIV disease. The underground study purportedly used between 6-12 grams a day.
What We Carry
The PWA Health Group imports Sun Ten brand Minor Bupleurum Combination from Taiwan. It is composed of bupleurum, scute, pinellia, fresh Ginger, ginseng, jujube, and glycyrrhizin, according to the ancient formula. It comes in bottles of 120 x 500 mg tablets, which can be dissolved (four at a time) in a cup of hot water and drunk as a tea, before or after meals.