Andrographis

Common names: Chiretta, Chuan xin lian, Kalmegh, Kirata

Botanical name: Andrographis paniculata

Parts used and where grown

Andrographis originated in the plains of India, and it also grows in China. The leaves and flowers are used medicinally.

Andrographis has been used in connection with the following conditions (refer to the individual health concern for complete information):

Science Ratings	Health Concerns
	Common cold Immune function Infection
	Dysentery
	HIV infection Indigestion Viral hepatitis
Reliable and relatively consistent scientific data showing a substantial health benefit. Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit. For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

Historical or traditional use (may or may not be supported by scientific studies)

Andrographis has long been used in traditional Indian and Chinese herbal medicine. The most common reported uses were for digestive problems (as is the case with most non-toxic bitter herbs such as andrographis), snakebite, and infections ranging from malaria to dysentery.¹ ² Interestingly, some of these uses have been validated by modern scientific research. Although the roots were sometimes used in traditional medicine, the leaves and flowers are now more commonly used.

Active constituents

The major constituents in andrographis are diterpene lactones known as andrographolides. These bitter constituents are believed to have immune-stimulating, anti-inflammatory, fertility-decreasing, liver-protective, and bile secretion-stimulating actions.³ Though some older studies suggested andrographis was antibacterial, modern research has been unable to confirm this finding.⁴

Several double-blind clinical trials have found that andrographis can help reduce symptom severity in people with common colds.⁵ ⁶ ⁷ ⁸ ⁹ Though the earliest clinical trial among these showed modest benefits, later studies have tended to be more supportive. Standardised andrographis extract combined with eleuthero (Siberian ginseng), known as Kan jang, has also been shown in a double-blind clinical trial to reduce symptoms of the common cold.¹⁰

A preliminary uncontrolled study using isolated andrographolide found that while it tended to decrease viral load and increase CD4 lymphocyte levels in people with HIV infection, at the amount used, the preparation led to side effects, including headache, fatigue, a bitter/metallic taste in the mouth, and elevated liver enzymes (which returned to normal after the medication was stopped).¹¹ It is unknown whether the andrographolides used in this study directly killed HIV or had an immune-strengthening effect.

Andrographis has proven helpful in combination with antibiotics for people with dysentery, a severe form of diarrhoea.¹² It has also shown preliminary benefit for people with chronic viral hepatitis.¹³

How much is usually taken?

Andrographis is generally available as capsules with dried herb or as standardised extracts (containing 11.2 mg andrographolides per 200 mg of extract). For dried herb, 500–3,000 mg are taken three times per day. In clinical trials, 100 mg of a standardised extract were taken two times per day to treat the common cold.¹⁴ For indigestion, andrographis may be taken as a tea. Use 1 teaspoon (5 grams) of the herb for each cup (250 ml) of hot water. Allow the mixture to stand for 10–15 minutes before drinking (sip before meals).

Are there any side effects or interactions?

Some people develop intestinal upset when taking andrographis. If this occurs, reduce the amount taken or take it with meals. Headache, fatigue, a bitter/metallic taste, and elevated liver enzymes were reported in one trial with HIV-infected people taking high doses of isolated andrographolides.¹⁵ This has not been reported in people using whole andrographis or standardised extracts at the amounts recommended above. As with all bitter herbs, andrographis may aggravate ulcers and heartburn. The safety of andrographis during pregnancy and breast-feeding is unknown.

At the time of writing, there were no well-known drug interactions with andrographis.

References
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1. Nadkarni AK, Nadkarni KM. Indian Materia Medica vol 1. Bombay: Popular Prakashan, 1976, 101–3.

2. Bensky D, Gamble A, Kaptchuk T. Chinese Herbal Medicine Materia Medica Revised Edition. Seattle: Eastland Press, 1993, 95.

3. Bone K. The story of Andrographis paniculata, a new “immune system” herb. Nutrition & Healing 1998;Sept:3, 4, 8, 9 [review].

4. Leelarasamee A, Trakulsomboon S, Sittisomwong N. Undetectable anti-bacterial activity of Andrographis paniculata (Burma) Wall. ex ness. J Med Assoc Thai 1990;73:299–304.

5. Thamlikitkul V, Dechatiwongse T, Theerapong S, et al. Efficacy of Andrographis paniculata, Nees for pharyngotonsillitis in adults. J Med Assoc Thai 1991;74:437–42.

6. Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold–a pilot trial. Phytomedicine 1996;3:314–8.

7. Hancke J, Burgos R, Caceres D, Wikman G. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in recovery from common colds. Phytother Res 1995;9:559–62.

8. Cáceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to assess the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine 1999;6:217–23.

9. Caceres DD, Hancke JL, Burgos RA, et al. Use of visual analogue scale measurements (VAS) to asses the effectiveness of standardized Andrographis paniculata extract SHA-10 in reducing the symptoms of common cold. A randomized double blind-placebo study. Phytomedicine 1999;6:217–23.

10. Melchior J, Spasov AA, Ostrovskij OV, et al. Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Ness extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection. Phytomedicine 2000;7:341–50.

11. Calabrese C, Berman SH, Babish JG, et al. A phase I trail of andrographolide in HIV positive patients and normal volunteers. Phytother Res 2000;14:333–8.

12. Thanagkul B, Chaichantipayut C. Double-blind study of Andrographis paniculata Nees and tetracycline in acute diarrhea and bacillary dysentery. Ramathibodi Med J 1985;8:57–61.

13. Chaturvedi GN, Tomar GS, Tiwari SK, Singh KP. Clinical studies on kalmegh (Andrographis paniculata) in infective hepatitis. J Int Inst Ayurveda 1983;2:208–11.

14. Bone K. The story of Andrographis paniculata, a new “immune system” herb. Nutrition & Healing 1998;September:3, 4, 8, 9 [review].

15. Calabrese C, Berman SH, Babish JG, et al. A phase I trail of andrographolide in HIV positive patients and normal volunteers. Phytother Res 2000;14:333–8.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.