Used as a decoction, extract and tincture.

The 1997 Commission E on Phytotherapy and Herbal Substances of the German Federal Institute for Drugs recommends Milk Thistle ripe seed: 'The drug contains silibinin, silydianin, and silychristin. Uses: Crude drug: Dyspeptic complaints. Formulations [an extract standardized to at least 70 percent silymarin, the collective name for the three compounds listed]: Toxic liver damage; for supportive treatment in chronic inflammatory liver disease and hepatic cirrhosis.'

'Average daily dose of drug: 12 - 15 g; Formulations equivalent to 200 - 400 mg of silymarin, calculated as silibinin. Mode of Administration: Powdered drug for making infusions and other galenical formulations to be taken by mouth.'

'Actions: Silymarin acts as an antagonist in many experimental liver-damage models: phalloidin and -amanitin (death-cap toxins), lanthanides, carbon tetrachloride, galactosamine, thioacetamide, and the hepatotoxic virus FV3 of cold-blooded vertebrates. The therapeutic activity of silymarin is based on two sites or mechanisms of action: (a) it alters the structure of the outer cell membrane of the hepatocytes in such a way as to prevent penetration of the liver toxin into the interior of the cell; (b) it stimulates the action of nucleolar polymerase A, resulting in an increase in ribosomal protein synthesis, and thus stimulates the regenerative ability of the liver and the formation of new hepatocytes.'

Milk thistle is believed to protect the cells of the liver by blocking the entrance of harmful toxins and helping to remove these toxins from the liver cells. Milk thistle seeds contain a bioflavonoid complex known as silymarin. As with other bioflavonoids, silymarin is a powerful antioxidant. Milk thistle also regenerates injured liver cells.

Milk thistle extract is most commonly recommended to counteract the harmful actions of alcohol on the liver. Long-term placebo-controlled, double blind studies have shown milk thistle extracts to be effective in patients with liver cirrhosis, chronic hepatitis, and even diabetes due to cirrhosis. Milk thistle alters bile makeup, thereby potentially reducing risk of gallstones.

Since silymarin is not very soluble in water, a strong boiled decoction of the ground seeds is most effective, rather than a weak infusion (tea). More effective yet is the standardized extract.

A recent case report of chronic infection by hepatitis B virus and hepatitis C virus demonstrated potential efficacy of treatment with milk thistle (10 g ground-up seeds in oatmeal with standardized (70%) milk thistle extract capsules three times daily) in combination with another herb known for its hepatoprotectant activity, Phyllanthus amarus (200 mg, three times daily).

Grieve's classic 'A Modern Herbal': 'The seeds of this plant are used nowadays for the same purpose as Blessed Thistle, and on this point John Evelyn wrote: 'Disarmed of its prickles and boiled, it is worthy of esteem, and thought to be a great breeder of milk and proper diet for women who are nurses.'

'It is in popular use in Germany for curing jaundice and kindred biliary derangements. It also acts as a demulcent in catarrh and pleurisy.'

'Culpepper considered the Milk Thistle to be as efficient as Carduus benedictus for agues, and preventing and curing the infection of the plague, and also for removal of obstructions of the liver and spleen.'

'He recommends the infusion of the fresh root and seeds, not only as good against jaundice, also for breaking and expelling stone and being good for dropsy when taken internally…'

King's 1898 Dispensatory: 'Carduus marianus is an old remedy, which had nearly passed out of use and has more recently been revived. Rademacher valued the seeds in hemorrhages associated with splenic or hepatic disorders. That it influences the parts supplied by the coeliac axis, particularly the distribution of the hepatic and splenic arteries, especially the latter, seems well established.'

'Congestive conditions of the splenic circulation are those most benefited by it. To a lesser extent, the whole venous apparatus is influenced by this drug, giving power to the veins, and preventing varicoses and other dilatations.... Dull, aching, splenic pain passing up under the left scapula, and associated with pronounced general debility and despondency is the indication for its use. It controls splenic pain even where no enlargement can be detected, and it is the remedy for hypertrophy of the spleen when non-malarial in character.'

'Congestion of the liver, spleen and kidneys is relieved by its use. Bilious states, with stitches in the side and pain in the abdomen, hard and tender right hypochondrium, gall stones, jaundice, hepatic pain and swelling, vomiting of pregnancy, and leucocythemia, are conditions in which it is reported useful. Amenorrhoea, with wrong of the portal circulation, melaena, hemoptysis, and uterine hemorrhage, have all been successfully treated with it.... A strong tincture (seed, viii to alcohol Oj), or the homoeopathic mother tincture, in doses of from 1 to 20 drops.'

http://www.herbmed.org/Herbs/Herb120.htm:

Clinical Trials

120 mg silybin equivalents to 9 cholecystectomy patients found that biliary silybin concentrations were several-fold lower than those observed after intake of silipide Schandalik 1992

6 months of silymarin to cirrhotic patients normalized the originally low T cell percentage and the originally high CD8+ cell [Article in Hungarian] Deak 1990

60 patients treated with silymarin and amino-imidazol-carboxamid-phosphate had normalized levels of liver enzymes and other parameters Lang 1990

6 months of 420 mg/d silymarin, in a double blind study of cirrhotic patients, restored the diminished superoxide dismutase activity of erythrocytes and lymphocytes [Article in Hungarian] Muzes 1990

A 6 month double blind clinical trial with 36 patients showed normalization of serum bilirubin, aspartate aminotransferase and alanin-aminotransferase [Article in Hungarian] Feher 1989

4-year survival rate was 58% in treatment group (140 mg silymarin 3 times daily) vs. 39% in placebo group in a double blind study of 170 cirrhosis patients Ferenci 1989

14 type-II hyperlipidaemic outpatients treated with 420 mg Legalon daily for three months had decreased cholesterol and apolipoprotein Somogyi 1989

Liver function tests and the platelet counts improved for 30 workers exposed to organic solvents taking Legalon compared with the 19 left without treatment Szilard 1988

Legalon showd benefit in a double-blind trial with 180 hepatitis patients for 40 days Tanasescu 1988

Legalon to 24 liver disease patients had good effect on thymol test, SGOT, gamma-globulins, immunoglobulin G, blood bilirubin without affecting subjective symptoms [Article in Bulgarian] Brailski 1986

Decreased S-SGPT (S-ALAT) and S-SGOT (S-ASAT) was found in a 4 week placebo controlled trial of 106 liver patients Salmi 1982

A randomized double-blind study about the therapy of the cirrhosis of the liver shows a significant higher surviving rate of the alcoholic cirrhosis in the group treated with Silymarin [Article in German] Benda 1980

Silymarin, 2 x 70 mg 3 times daily, to 28 viral hepatitis patients showed beneficial influence on the characteristicly increased serum levels of bilirubin, GOT and GPT compared with 29 in the placebo group [Article in German] Magliulo 1978