Adaptogens are among the most common class of herbal medicines prescribed by herbalists today, and the term is rapidly disseminating into the wider community. Yet, despite the ubiquitous use of adaptogens in clinical practice, there is very little research available which clearly defines the mechanism of action. Although definitions have been proposed, no single definition has been agreed upon by researchers. It appears that the polyvalent action of adaptogens cannot be measured from a conventional pharmacological paradigm of single receptor-based perception of drug action, when adaptogens likely have a multi-targeted action on multiple receptor sites. The multi-target action has been a limiting factor in the progression of clinical trials as the most appropriate method to measure adaptogens remains unknown. Adaptogen is a key concept in Western herbal medicine, with roots spanning more than a century. Bridging the gap between clinical use of this concept and clinical data is long overdue. For this to happen, steps need to be taken to initiate the process of standardisation of the term, as is being seen with other traditional medicine concepts being formalised by the World Health Organization (WHO). This begins with consensus on the definition and a thorough examination of the mechanism of action from a broader pharmacological perspective.

Background Chronic hepatitis C (CHC) is a viral liver disease characterised by oxidative stress and inflammation leading to fibrosis, liver injury, cirrhosis and increased risk of liver cancer and reduced quality of life (QOL). Antioxidant phytonutrients have potential to limit inflammation and reduce co-morbidities associated with CHC. This randomised, placebo-controlled trial investigated the effects of two naturopathic treatments consisting of antioxidant nutrients and herbal medicines against placebo on liver function and QOL in people with CHC.

Methods A randomised, double-blind, placebo-controlled clinical trial was conducted in three Australian teaching hospitals in New South Wales. One hundred and eighteen participants with compensated CHC-related disease were recruited through liver outpatient clinics and randomised to one of three groups: silymarin; silymarin with 13 other antioxidants (SOX); or placebo. Study duration was 48 weeks: 24 weeks on active treatment or placebo, and 24 weeks follow-up post treatment. Outcome measures included alanine aminotransferase (ALT), F₂-isoprostanes (oxidative stress), HCV RNA (viral load), FibroTest (liver damage), and QOL.

Results The use of silymarin with antioxidants (SOX) achieved a higher rate of ALT normalisation (primary outcome) than placebo (P=0.02) or silymarin alone (P=0.003) at week 24. In addition, there was significant improvement in the Hepatitis Quality of Life Questionnaire (HQLQ) Mental Component Summary (MCS) in the SOX group (P=0.002). There were no significant changes in F₂-isoprostanes, HCV RNA or FibroTest.

Conclusions This study has shown that the use of a complex naturopathic herbal and nutritional treatment can normalise ALT and improve QOL in participants with compensated CHC-related disease.

ANZCTR clinical register ACTRN12614000966695

These abstracts are brief summaries of articles in recent issues of medical journals. Articles selected are of a general nature for the information of practitioners of naturopathy and herbal medicine. A dominant theme is often present throughout the journals, which will be reflected in the reviews.

These abstracts are brief summaries of articles which have appeared in recent issues of herbal medicine journals, some of which may be held in the NHAA library.

The AJHNM-based CPE questionnaire system is a voluntary system designed to assist members in the accumulation of NHAA CPE points. Questions are divided into the appropriate subject categories (herbal medicine and medical science) and each question refers to an article in this issue of the Australian Journal of Herbal and Naturopathic Medicine. Points accumulated through completion of these questions should be recorded in the NHAA CPE diary. Each completed question is worth one mark in the relevant category. Your completed CPE diary should be returned with your membership renewal at the end of the calendar year. For further information, please see the NHAA CPE Members’ Manual on the NHAA website www.nhaa.org.au.