Andrographis

This popular and traditional Ayurvedic Herbal Medicine, known as the ‘King of bitters’ has a strong reputation as a bitter digestive tonic, used especially during convalescence, after infectious illness and also in parasitic infestation. A potent herb that can be applied during and after viral infection.

Andrographis clears toxins and other metabolic by-products from the blood, making it a great herb for skin conditions especially where they are caused by poor detoxification in the liver. These skin conditions are often red, inflammatory, itching and hot. Note: Consulting a herbalist for chronic skin conditions is often most effective. Herbalists are trained to identify the unique causes of such conditions.

It has also been shown to stimulate the immune system, especially white blood cell activity. It can also counter the damaging effects of free radicals due to its ability to detoxify the blood and antioxidant properties (5).

Andrographis is also an excellent choice for treating conditions of the respiratory system. It can be used for both bacterial and viral infections, including the common cold and pharyngotonsillitis and also both prophylactically and in treatment of viral respiratory infections including the common cold and flu (1, 2, 5).

As a bitter digestive there is likely to be additional benefit in the treatment of infections in the gut, including even parasitic infestation. It may help with gallbladder and bilious conditions as it both protects the liver from toxins and stimulates bile production and flow.

It can also be considered for prevention and treatment of urinary tract infections (5).

Since Andrographis is energetically “cold” (meaning it reduces circulatory and heat-generating activity and enhances digestion and detoxification), it may be taken in combination with “warm” herbs (such as ginger and astragalus), especially in a cold, debilitated constitution.

Known as chuan xin lian in traditional Chinese medicine (TCM), Andrographis was traditionally characterised as a bitter (or, in the terminology of TCM, ‘cooling, drying’) remedy. It is used in modern Chinese medicine to eliminate toxins (‘heat’), especially in disorders of the lungs, throat, urinary system, and skin. ‘Heat’ patterns in Chinese medicine involve active inflammation, infection, swelling, and, often, burning pain. 

Examples in which Andrographis showed most benefit include raw sore throats, influenza, bronchitis, lung infections and fever. Andrographis is believed to have particular benefit with ‘damp heat’ patterns affecting excretory functions, particularly those relating to the liver, bile and kidneys, and is used when these were associated with diarrhoea, dysentery, and urinary problems. Externally, Andrographis was used in TCM to treat oozing wounds, sores, carbuncles, scalds, boils, burns, eczema, and snakebites.

In the Western Herbal Medicine approach, Andrographis would be considered ‘cold in the first degree’. An extremely bitter herb that is able to clear heat through liver and through blood detoxification, thus reducing heat and inflammation throughout the body. 

The bitter taste of the herb indicates that choleretic (bile stimulating) claims are likely, and there are traditional applications for liver problems in both Ayurvedic and Chinese Herbal Medicine.

In Ayurveda, the ancient healing system of India, Andrographis was used as a bitter tonic, a remedy against intestinal parasites, and a general stomach tonic. It was said to increase appetite, strengthen digestion, and diminish flatulence, hyperacidity, and biliousness. 

It was also used in the management of many more complex conditions, including diabetes, hepatitis, and general debility.  It was specifically used for feverish stomach complaints in young children and to help weak, convalescing individuals regain appetite and strength after illness.

Kalamegha literally means ‘black cloud’ perhaps attesting to Andrographis being traditionally harvested just before winter. Andrographis is also known as bhunimba meaning ‘Neem of the earth’ referring to its bitter neem-like taste and effects.

Immunity

Andrographis is a wonderful herb used both for viral infections and infestations. In the treatment viral infections, Andrographis works via a direct anti-viral action, whilst enhancing the immune function. 

Andrographis is indicated where there is lowered immunity and acute and chronic infections. It is an immune stimulant rather than solely being anti-bacterial and can be used to reduce symptoms in influenza, upper respiratory tract infections such as common cold, coughs, sinusitis, sore throats, otitis media, and also for urinary infections and vaginitis. 

Andrographis is additionally used to inhibit histamine release (4) which may be useful for use in mild allergies. Due to its antiviral activity, Andrographis may also be therapeutically useful in Herpes simplex and H. Zoster infection (4).

Liver

Andrographis is both a liver protector that also improves liver function. It works by increasing bile flow and offers protection to hepatocytes (liver cells), and with its bitter and cooling qualities, is well suited to liver infections and inflammation. As Andrographis has very effective hepatoprotective as well as anti-viral activity, it should be considered in hepatitis and all forms of sluggish liver where there is a reduced ability to digest fats or alcohol.

Digestion

Andrographis is an excellent herb of choice where there is a complete loss of appetite.

Andrographis was used historically in bacillary dysentery and enteritis. And including gut infections with parasites, protozoa and fungi. When Andrographis is combined with warming aromatic herbs such as Cardamom (Elettaria cardamomum) and Cinnamon (Cinnamon zeylanicum) it can stimulate the appetite and reduce excess mucus.

There are many digestive applications of this herb, particularly where poor liver function leads to poor assimilation of nutrients (due to low bile derived enzymatic activity). Poor liver function may also be a cause for haemorrhoids, Andrographis both improves the liver detoxification and acts as a mild laxative, making it a good option for ongoing haemorrhoids (5)

Andrographis is indicated for parasitic infections, particularly Ascaris lumbracoides (large roundworm) (4, 5). It is also a herb that may be of use against bacterial hepatitis, E.Coli and other bacillary dysentery (4).

Skin

Hot, inflammatory skin conditions such as sores and eczema can be effectively treated with Andrographis. It can also be used externally as a wash or in a cream where there are signs of infection.

Other

Andrographis has a antioxidant cell protective properties, countering the damaging effects of free radicals. Several texts also refer to this herb for conjunctive treatment for malaria, snakebite and leptospirosis (6). 

Note: These are serious conditions which require conventional medicines such as antibiotics. Herbal medicines for treatment of such serious infections can be used to support in both treatment and recovery but are not advised to be used alone.

Andrographis is becoming more recognised for its anti-inflammatory and antioxidant properties. A herb that is a subject of much interest among the scientific community, particularly in the branch of pharmacology that is concerned with the search for ‘new drugs’. Therefore much of the available research on Andrographis focuses on isolated compounds extracted from the plant, mainly its diterpenes and flavonoids. 

Immune system

In a systematic review of research carried out to evaluate the effects of one of Andrographis’s active compounds, a paper summarises the various experimental and clinical pharmacological activities of andrographolide. This review concludes that the andrographolide compound is antioxidant, anti-inflammatory, anticancer, antimicrobial and parasitic, hepatoprotective, antihyperglycemic, and antihypoglycemic. Evidence from clinical studies also suggests that andrographolide reduces symptoms of HIV, uncomplicated upper respiratory tract infections, including sinusitis and the common cold, and rheumatoid arthritis (8, 9).

In another study to investigate the physiological effects of short-term multiple dose administration in healthy Thai subjects for the treatment of the common cold and uncomplicated upper respiratory tract infections. A standardized A. paniculata crude powder (4 capsules of 1.4 g of A. paniculata, 3 times per day, 8 h intervals) was used for 3 consecutive days. The results showed positive modulation of white blood cells and absolute neutrophil count in the blood and a reduction of plasma alkaline phosphatase (11).

COVID 19

The government of Thailand approved a pilot study for the use of Andrographis in the treatment of early symptoms based on numerous findings for its use in reducing the severity of COVID-19. Initially, the treatment is being made available at five state-owned hospitals in Thailand, on a voluntary basis for people between 18-60 years old with the active virus, to be given to patients within 72 hours of symptom onset (15).

An in vitro study was carried out on legitimate model human lung epithelial cells, Calu-3, using an optimised high-content imaging platform and the plaque assay for viral output to determine the anti-SARS-CoV-2 activity of Andrographis paniculata extract and its major component, andrographolide. 

SARS-CoV-2 was able to reach the maximal infectivity of 95% in Calu-3 cells. Post infection treatment of A. paniculata and andrographolide in SARS-CoV-2-infected Calu-3 cells significantly inhibited the production of infectious virions. These promising results provided experimental evidence in favour of A. paniculata and andrographolide for further development as a monotherapy or in combination with other effective drugs against SARS-CoV-2 infection (14).

Respiratory system

A systematic review of two reviews and eight clinical trials concluded that there was qualified evidence that andrographis was useful in the treatment of upper respiratory tract infections (1).

A later systematic review and meta-analysis again concluded that subject to methodological inconsistencies andrographis appears beneficial and safe for relieving acute respiratory tract infection symptoms and shortening time to symptom resolution (2).

Musculoskeletal system

A randomised, double-blind, placebo-controlled study was conducted to assess the efficacy of a standardized dried extract of andrographis called ParActin®  which is standardized to 150mg of andrographolide per 300mg dose. Patients were given 300 and 600 mg daily for pain reduction in patients with knee osteoarthritis. The study concluded that both 300 and 600 mg/day dosages were found to be effective and safe in reducing pain, joint stiffness and physical function. Whilst also demonstrating significantly improvements in the SF-36 quality of life questionnaire and a fatigue scale, in individuals suffering from mild to moderate knee osteoarthritis (10).

Digestive system

A randomised, double-blind, placebo-controlled trial evaluated the efficacy of A. paniculata extract in 224 adults with mild-to-moderate ulcerative colitis. Patients were randomised to A. paniculata extract (HMPL-004) 1,200 mg or 1,800 mg daily or placebo for 8 weeks. This study shoes that patients with mild to moderate active ulcerative colitis treated with A. paniculata extract at a dose of 1,800 mg daily were more likely to achieve clinical response than those receiving placebo (12).

Nervous system

In a study investigating the effect of A. paniculata on relapse rate and fatigue in relapsing-remitting MS (RRMS) patients receiving interferon beta. Using 170 mg of A. paniculata dried extract tablet, twenty-five patients were enrolled, and twenty-two patients were ultimately analysed and randomised to the active or placebo group. This study found that A. paniculata significantly reduces fatigue in patients with RRMS receiving interferon beta in comparison to placebo and only interferon beta treatment (13).

Kidneys

In acute pyelonephritis, the results were reported to be similar to those obtained with nitrofurantoin (antibiotic), but with fewer adverse effects. Intra-arterial or retrograde intravenous injections of Andrographis were reportedly effective in thromboangiitis obliterans, especially of “heat toxic type.” Ten cases of viper bites were reportedly cured in 3-5 days by a compound formula that had A. paniculata as the chief active component (6).

The government of Thailand approved trials using for Andrographis to treat COVID-19 after it was shown to be effective for prison inmates that had mild or asymptomatic cases. The government claims that out of 11,800 inmates who took it to treat coronavirus, 99.02% recovered.

Native to India and Sri Lanka. Its distribution is recorded in India, Sri Lanka, Malay Peninsula, China and Thailand. In India it occurs through out in the plains and also in forests as undergrowth.

According to the ENVIS database under Red Listed Medicinal Plan species, Andrographis is classed as low risk/ ‘Least Concern’ (7).

Herbal Medicines are often extremely safe to take, however it is important to supply herbal medicines from a reputed supplier. Sometimes herbs bought from unreputable sources are contaminated, adulterated or substituted with incorrect plant matter.

Some important markers for quality to look for would be to look for certified organic labelling, ensuring that the correct scientific / botanical name is used and that suppliers states clearly the source of ingredients used in the product. 

A supplier should also be able to tell you where the herbs have come from. There is more space for contamination and adulteration where supply chain is unknown.

Native to India, the plant prefers a hot, humid climate with plenty of sun. 

1. Prepare a bed for andrographis in the late spring, after the last frost has passed. The plant will grow in all soil conditions as long as enough moisture is present. Aerate the soil by breaking up clumps and removing large rocks, then mixing in 3- to 4-inch layer of organic compost.
2. Soak the andrographis seeds overnight. Sow the seeds approximately 2 inches deep and 6 to 8 inches apart. Water gently and keep the soil evenly moist until the seedlings have germinated in approximately five to seven days.
3. Spread a 2- to 3-inch layer of organic mulch around the seedlings, being careful not to cover the plants.
4. Thin out to 12 to 18 inches apart when the plants are established, removing the weakest seedlings.
5. Taper off watering once the sprouts appear, water when the top of the soil begins to dry out.

Andrographis reaches 1 to 3 feet in height when mature. Flowers appear approximately three to five months after planting.

1. Kligler B, Ulbricht C, Basch E, Kirkwood CD, et al (2006), Andrographis paniculata for the treatment of upper respiratory infection: a systematic review by the natural standard research collaboration. Explore (NY).;2(1): 25-9.
2. Hu XY, Wu RH, Logue M, et al. (2017) Andrographis paniculata (Chuān Xīn Lián) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One. 12(8): e0181780.
3. Pole, S. (2013). Ayurvedic medicine : the principles of traditional practice. London ; Philadelphia: Singing Dragon, Cop.
4. Menzies-Trull, C. (2013). Herbal medicine keys to physiomedicalism including pharmacopoeia. Newcastle: Faculty Of Physiomedical Herbal Medicine (Fphm).
5. Bone, K. and Mills, S. (2013). Principles and practice of phytotherapy modern herbal medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier.
6. Chang HM, But PPH. Pharmacology and Applications of Chinese Materia Medica. English translation by Shem Chang-Shing
7. Yeung, Sih Cheng-Yao and Lai-Ling Wang (Chinese Medicinal Material Research Centre, The Chinese University of Hong Kong), Singapore: World Scientific Publishing Co. Pte. Ltd; 1987;2:918-928.
8. Environmental Information System (n.d.). Red Listed Medicinal Plants species. [online] Available at: http://envis.frlht.org/junclist.php?txtbtname=&gesp=181%7CAndrographis+paniculata+(BURM.F.)WALLICH+EX+NEES.
9. Jayakumar, T., Hsieh, C.-Y., Lee, J.-J. and Sheu, J.-R. (2013). Experimental and Clinical Pharmacology ofAndrographis paniculataand Its Major Bioactive Phytoconstituent Andrographolide. Evidence-Based Complementary and Alternative Medicine, 2013, pp.1–16. doi:10.1155/2013/846740.
10. Chao, W.-W. and Lin, B.-F. (2010). Isolation and identification of bioactive compounds in Andrographis paniculata (Chuanxinlian). Chinese Medicine, 5(1), p.17. doi:10.1186/1749-8546-5-17.
11. Hancke, J.L., Srivastav, S., Cáceres, D.D. and Burgos, R.A. (2019). A double‐blind, randomized, placebo‐controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. Phytotherapy Research, 33(5), pp.1469–1479. doi:10.1002/ptr.6339.
12. Suriyo, T., Pholphana, N., Ungtrakul, T., Rangkadilok, N., Panomvana, D., Thiantanawat, A., Pongpun, W. and Satayavivad, J. (2017). Clinical Parameters following Multiple Oral Dose Administration of a Standardized Andrographis paniculata Capsule in Healthy Thai Subjects. Planta Medica, 83(09), pp.778–789. doi:10.1055/s-0043-104382.
13. Sandborn, W.J., Targan, S.R., Byers, V.S., Rutty, D.A., Mu, H., Zhang, X. and Tang, T. (2013). Andrographis paniculata Extract (HMPL-004) for Active Ulcerative Colitis. American Journal of Gastroenterology, 108(1), pp.90–98. doi:10.1038/ajg.2012.340.
14. Bertoglio, J.C., Baumgartner, M., Palma, R., Ciampi, E.Carcamo, C., Cáceres, D.D., Acosta-Jamett, G., Hancke, J.L. and Burgos, R.A. (2016). Andrographis paniculata decreases fatigue in patients with relapsing-remitting multiple sclerosis: a 12-month double-blind placebo-controlled pilot study. BMC Neurology, 16(1). doi:10.1186/s12883-016-0595-2.
15. Sa-ngiamsuntorn, K., Suksatu, A., Pewkliang, Y., Thongsri, P., Kanjanasirirat, P., Manopwisedjaroen, S., Charoensutthivarakul, S., Wongtrakoongate, P., Pitiporn, S., Chaopreecha, J., Kongsomros, S., Jearawuttanakul, K., Wannalo, W., Khemawoot, P., Chutipongtanate, S., Borwornpinyo, S., Thitithanyanont, A. and Hongeng, S. (2021). Anti-SARS-CoV-2 Activity of Andrographis paniculata Extract and Its Major Component Andrographolide in Human Lung Epithelial Cells and Cytotoxicity Evaluation in Major Organ Cell Representatives. Journal of Natural Products, [online] 84(4), pp.1261–1270. doi:10.1021/acs.jnatprod.0c01324.
16. www.herbalgram.org. (n.d.). Thailand Approves Asian Herb Andrographis to Treat COVID-19 – American Botanical Council. [online] Available at: https://www.herbalgram.org/resources/herbalegram/volumes/volume-18/issue-1-january-2021/thailand-approves-asian-herb-andrographis-to-treat-covid-19/thailand-approves-asian-herb-andrographis-to-treat-covid-19/.