Andrographis Paniculata / Chuan Xin Lian

Updated: Nov 16, 2020

The herb that evokes one of the strongest and most powerful emotions for me is Adrographis. It is my favorite herb which I have been using for years both personally and professionally to lessen the duration and degree of symptoms when the first signs of illness arise.


I was first introduced to Andrographis paniculata through my late husband Stan Finkelstien, MD, DC, L.Ac, DAOM, AAIHM, TCM, who was a physician, chiropractor, acupuncturist, and traditional chinese medical doctor. He was board certified in psychiatry, neurology, pain medicine and integrative medicine. We worked together in our private practice for many years. I knew andrographis as Chuan Xin Lian. The herb brings back bittersweet memories. Andrographis is a very bitter pill to swallow but has tremendous, sweet, healing powers that result in restored health and strength as illness subsides after multiple doses.



I liken it to the bittersweet memories that come, when I taste its bitterness and remember the traumatic day of his passing, the disabling feeling that suddenly overcame me and the incredible feelings of the loss of missing my partner, colleague and husband, mingled with all of the sweet and strengthening memories of the day we meet while working together in the hospital, the sacrifice of his residency in neurology/psychiatry and pain medicine, our wonderful marriage, our time in school learning acupuncture and many aspects of chinese herbal medicine, including Chuan Xin Lian, and beginning our integrative practice together when no one else was doing it.


It makes me think about the happiness of the day we were both accepted to the National Institute of Health’s Fellowship Program in Integrative Pain Management and the three months living, working, and studying there. It reminds me of the program we attended together just a month before he passed, “The Science and Clinical Application of Integrative Medicine”. The emotions evoked when I take Andrographis are that of the sadness and bitterness of loss and illness that lays you up in bed after your body is assaulted by invading microbes and the comfort and empowerment of knowing that the pain of illness will eventually pass as strength rebounds and is restored to full health once more. I still remember the initial feeling of panic, not knowing what I would do and feeling lost, only to realize that I too had studied many of the things that he did and taking hold of what I thought I could not control like the invading microbe and fighting it off with the strength and empowerment of what I had already learned.


I now think of andrographis paniculata like a personal family doctors always on-call, waiting to be there when you become ill, to make a house call and help remediate any signs of an illness, so Andrographis is always standing by as my first line of defense when I begin to feel sick in any way. Like Andrographis, things in life can sometimes be very bitter, but in the end there is the potential for healing and the joy and strength that accompanies it.

Clinically, I not only personally have used it with much success but have recommended it to many of my clients, family and friends. It has never let me down and has lived up to its reputation as a potent anti-microbial. It has a horrible bitter taste and comes in many forms. I’ve tried it as a tincture but could not get past the taste so my “go to” form is tablet or a coated pill. I recommend this form for anyone who has never tried herbs, especially andrographis so that they are not immediately discouraged from taking it by its bitterness.


There is a commercial product available that many patients feel more comfortable to purchase called Kold Kare. It is more expensive than Chuan Xin Lian but I continue to use this for many people who are somewhat squeamish about taking an herbal product, especially if they have fears about products from other countries or cultures. It is a good herbal introduction for those who normally would not venture off of the path of Western medicine but are open to health foods or supplements. Once they see how well andrographis works they develop a trust to try other herbal formulas and gain greater respect for the effectiveness of herbalism in general. I know that Andrographis paniculata has saved me many physician visits and many doses of unnecessary antibiotics.


History


Andrographis paniculata, commonly known as the "King of Bitters," is a member of the plant family Acanthaceae. It is a hardy, annual herb which grows erect and is branched reaching up to 3 feet in height. The plant grows in abundance in all of Asia, including China, India, Pakistan, Thailand, Indonesia, and East and West Indies, although China and Thailand are the countries that mainly cultivate it. It grows in deciduous forest areas and in most soil types which makes cultivation very easy.


In China, it has been used by TCM practitioners (Traditional Chinese Medicine) for centuries under the name Chuan Xin Lian and has been used to treat upper respiratory tract infections, fevers, viruses, sore throats, colds and generally to dispel heat and toxins from the body. It is also used in ancient Ayurvedic practice and is found in numerous formulas. In Ayurveda, andrographis is known as Kalamegh in Hindi, which means "dark cloud" or Bhuin Neem, meaning "neem of the ground", because its bitter taste is similar in taste to the neem tree.


In Traditional Chinese medicine, the herb was used to fight off colds and reduce the severity and length of cold/flu symptoms. It has a long history of use in traditional Ayurvedic medicine for both a gastric/ hepatic liver tonic and anti-cancer agent. It is antibacterial, antifungal, antiviral, Vermicidal, cardio and hepatoprotective, Anti-inflammatory, Immune stimulant, hypoglycemic, and choleretic.


Over the past decade, it has been confirmed in clinical studies, that Andrographis has a broad range of beneficial pharmacological effects. Although all parts of the plant are used the aerial parts of the plant are the most medicinal. The most active phytochemical in the plant is andrographolide and is contained in the leaves and stems. The leaves are said to contain the highest amount of andrographolide (2.39%) which is the primary medicinal constituent. The seeds and root is also used but contains less of the andrograpolide.


Studies & Research


Research conducted on Andrographis has been robust. There have been many double-blind clinical trials and several placebo controlled double-blind trials as well. There have also been multiple uncontrolled studies as well.


A 10 day, manufacturer-sponsored, three arm clinical trial was conducted by Kan Jang on study with 130 children ages 4 to 11 years who all had uncomplicated respiratory infections.

The study design was sign of sickness, was one of the few compounds to reduce the duration of illness and degree of symptoms. Adjuvant treatment with Kan Jang was significantly more effective than the other two arms of the study. It primarily reduced nasal congestion and secretions and performed better than the other two arms of the study with standard treatment alone or standard treatment with adjuvant treatment of Immunal.

Another double-blind, placebo controlled study conducted between 1997 to 1999 that was published in Phytomedicine in 2002 was conducted by The Swedish Herbal Institute, Göteborg, Sweden by Gabrielian, Shukarian, Goukasova , Chandanian , Panossian , Wikman, and Wagner. Using a standard extract of Kan Jang they looked at the effectiveness of Andrographis paniculata SHA-10 and Eleutherococcus senticosus for the treatment of sinusitis and acute upper respiratory tract infections. There were a total of 200 participants, men and women, aged 15 to 64 years, diagnosed with an upper respiratory tract infection that did not require treatment with antibiotics, were recruited and non-randomized to two arms. There was a subgroup of patients who had been diagnosed with sinusitis underwent a separate statistical analysis: one group with a previous history of sinusitis like symptoms, and the other with no or few previous episodes.


The study was multi-centered at two medical centers in Yerevan, at the Department of Otolaryngology and at the Emergency Ward Department of the Erebuni Hospital. The arm of the study receiving an 85 mg standardized extract of Andrographis paniculata SHA-10 equivalent to 5 mg andrographolide and 10 mg of Eleutherococcus senticosus extract equivalent to 120 mg of the crude drug was called the “Verum” which in Latin means “true” and the other arm was the placebo group receiving pills that looked identical. Both the verum arm and placebo arm were administered 4 tablets, three times a day for 5 days. A physician exam was performed on all participants on the first visit and the last visit. The sinusitis subgroup was determined by an objective clinical evaluation by means of x-ray examination and an ENT exam with fibroscope for suspected sinusitis and was distinguished from patients in each arm. Out of the 200 patients enrolled in the study, 15 did not complete it. Of the 15 patients who did not complete the study, 10 patients in the placebo and 2 in the treatment group dropped out.


The study results, by means of total score analysis, showed a highly significant improvement in the treatment arm with Andrographis and Eleutherococcus (the verum arm) versus the placebo.


The results clearly demonstrated two statistically significant differences (1) a significant

difference between the two groups at visit 1, and visit 2 in symptoms and (2) an extremely low P value for the difference between treatment groups and placebo group, i.e. with respect to the improvement between visit 1 and visit 2 (P < 10–6). The conclusion showed that with treatment with Kan Jang the main symptoms associated with an upper respiratory tract infection (headache, malaise, sore throat, runny nose, et. al.) improved significantly and were also found in the two sinusitis subgroups that showed relief of respiratory symptoms and of the inflammatory symptoms of sinusitis. The study drug was well tolerated.


The last interesting study I wanted to briefly mention was conducted by Zheng, Z.Y. 1982. Pharmacokinetic studies on 3H-andrographolide. Chinese Herbal Med. 13(9):33-36. It was on the pharmacokinetics of Andrographis paniculata. Zheng states that Andrographis, “when consumed, andrographolides appear to accumulate in organs throughout the viscera. In one study, after 48 hours, the concentration of labelled andrographolide was 20.9%, brain; 14.9%, spleen; 11.1%, heart; 10.9%, lung; 8.6%, rectum; 7.9%, kidney; 5.6%, liver; 5.1%, uterus; 5.1%, ovary; and 3.2%, intestine. (6). Absorption and excretion is rapid: 80% is removed within eight hours via the kidney (urine) and G.I. tract. Ninety percent is eliminated within forty-eight hours.” I was unable to find the original study by Zheng but was able to find another study by Niranjan, Tewari and Alok on the biological activities of Kalmegh (andrographis), which confirmed the results of Zheng’s study.


I reviewed these two studies because as a former clinical medical research nurse, I felt that they were sound in there study design, numbers, inclusion and exclusion criteria, number of sites enrolled and prove that when properly designed clinical trials are conducted with herbs they can show incredible results that parallel or exceed that of synthetic pharmaceutical drugs that have accompanied side effects. It also clearly indicates the need for more clinical trials need to be funded and conducted on herbs and their efficacy.


Ayurvedic and TCM doctors have been treating patients with this herb for over 1,000 years and yet it goes unknown by modern medical practitioners. Andrographis paniculata has been used for over 20 years in Scandinavia as an herbal medicinal product in uncomplicated upper respiratory tract infections and but has rarely been used in the United States and primarily, only in alternative medicinal practices. Studies abound on this herb and are showing potential effectiveness for the treatment of snakebites, insect stings, fever, sore throat, cough, flu, stomachaches, to alleviate the symptoms of the common cold, in treating ulcerative colitis, and new research shows promise for the treatment of rheumatoid arthritis and other inflammatory diseases, for cancers of many kinds and has even shown antiplatelet effects by inhibiting thrombin and platelet activating factor.


Andrographolides, the active constituent has demonstrated anticancer effects. They inhibited IL-6 expression and IL-6-mediated signals in human prostate cancer cells, and suppressed tumor growth. Andrographolides were shown to cause apoptosis of human hepatoma cancer cells and according to Sloan Kettering Cancer Centers Research Department of Integrative Medicine, “andrographolides inhibit HIV-induced dysregulation of cell cycle and increased CD4+ lymphocyte levels in HIV-1 patients.”


There was so much research on this herb that it just can no longer be ignored by the modern medical world. We must adopt use of this herbal therapy and continued research must somehow be funded. I have included a list of all of the clinical research that I read through for additional information on Andrographis. It is very extensive but easily could have been much longer. One can see how Andrographis paniculata can easily be my favorite and most widely used herb in my herbal arsenal of weapons.


Genus: Andrographis


Species: A. paniculata


Family: Acanthaceae


Common Name: Chiretta, King of Bitters, Kalmegh, Creat, Chuan xin lian, Yijianxi, Lanhelian, Indian Echinacea, Kold Kare (American stores)


Energetics: Cooling


Properties: Immune stimulant, alterative, febrifuge, bitter tonic, cholagogue, hepatoprotective, immunostimulant, anti-inflammatory, anthelmintic


Taste: very bitter taste


Degree of Action: 3rd degree


Tissue States: Hot, dry, rid the body of heat


Constituents: Terpenoids, Diterpenoids are distributed in and have been isolated from the aerial parts and roots of this plant, Flavonoids have been isolated from the aerial parts, roots and whole plant. Other medicinal properties isolated from the roots have been xanthones, noriridoids, and curvifloruside. Diterpenoid lactones – andrographoloides (immune stimulating), diterpene glucosides.


Dosage: The standard dose of Andrographis paniculata basic root extract is 2,000 – 6,000 mg. 1–6g/day dried or 5–15ml/day of a 1:5 @ 25% tincture. Andrographis paniculata root extract tends to have 1-2% andrographolide content, by weight, though up to 4% has been reported. Concentrated root extracts can have an andrographolide content of up to 30%. The standard dose for a concentrated extract is 200mg.


Key Uses: For the treatment of cold, flu, upper respiratory tract infections to lessen the duration and symptoms.


Clinical Use: Immune enhancer/stimulant, potent anti-viral, anti-bacterial and anti-microbial, anti-elmintic, upper respiratory infections, fevers, sinus infections, and common cold. Bitter tonic for the digestive system and liver, hepatoprotective and cholagogue. Alterative, anti-inflammatory, Hypoglycemic.


Warnings: According to the Mayo Clinic Book of Alternative Medicine, "Pregnant women shouldn't use andrographis because it could terminate pregnancy." Caution is advised with immunosuppressive medications. Andrographis may prove beneficial as a liver protective when taking tricyclic anti-depressants that may be harmful to the liver.

Potential or Reported Drug-Herb Interactions: According to Sloan Kettering, Andrographis has antioxidant effects and can interfere with chemotherapy drugs. It should also be avoided if taking medications that affect the Cytochrome P450 pathway since Andrographis may make some of these drugs less effective and may increase the risk of side effects of others. If on antihypertensive or anticoagulant drugs, andrographis may have additive hypotensive or anticoagulant effects. Andrographis inhibits CYP1A2, which is involved in metabolizing aminophylline, resulting in increased risk of side effects from the drug.


RESEARCH REFERENCES


Burgos R.A., Hancke J.L., Bertoglio J. C. Aguirre V., Arriagada S., Calvo M., Cáceres D. D., “Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial”, Clin Rheumatol (2009) 28:931–946 DOI 10.1007/s10067-009-1180-5


Calabrese C, Berman SH, Babish JG, et al. A phase I trial of andrographolide in HIV positive patients and normal volunteers. Phytother Res 2000; 14(5):333-338. PMID: 10925397


Chao W-W, Lin B-F. Isolation and identification of bioactive compounds in Andrographis paniculata (Chuanxinlian). Chinese Medicine. 2010; 5:17. doi: 10.1186/1749-8546-5-17.


Cheung HY , Cheung SH , Li J , Cheung CS , Lai WP , Fong WF , Leung FM, “Andrographolide isolated from Andrographis paniculata induces cell cycle arrest and mitochondrial-mediated apoptosis in human leukemic HL-60 cells.”, Planta Medica [2005, 71(12):1106-1111],Department of Biology and Chemistry, City University of Hong Kong, Hong Kong SAR, China.,Type: Journal Article, Research Support, Non-U.S. Gov't - bhhonyun@cityu.edu.hk, PMID: 16395645 DOI: 10.1055/s-2005-873128


Del Poeta G1, Bruno A, Del Principe MI, Venditti A, Maurillo L, Buccisano F, Stasi R, Neri B, Luciano F, Siniscalchi A, de Fabritiis P, Amadori S.” Deregulation of the mitochondrial apoptotic machinery and development of molecular targeted drugs in acute myeloid leukemia”. Curr Cancer Drug Targets. 2008 May;8(3):207-22. PMID: 18473734 http://www.ncbi.nlm.nih.gov/pubmed/18473734


Gabrielian ES, et al, A double blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang in the treatment of acute upper respiratory tract infections including sinusitis . Phytomedicine. (2002) Oct; 9 (7):589-97. PMID: 12487322 DOI: 10.1078/094471102321616391


Liu JP, Manheimer E, Yang M. Herbal medicines for treating HIV infection and AIDS. (Protocol) The Cochrane Database of Systematic Reviews , Issue . Art. No.: CD003937. DOI: 10.1002/14651858.CD003937


Melchior J, et al Double-blind, placebo-controlled pilot and phase III study of activity of standardized Andrographis paniculata Herba Nees extract fixed combination (Kan jang) in the treatment of uncomplicated upper-respiratory tract infection . Phytomedicine. (2000) PMID: 11081985 DOI: 10.1016/S0944-7113(00)80053-7


Niranjan, Abhishek, S. K. Tewari, and Alok Lehri. "Biological activities of Kalmegh (Andrographis paniculata Nees) and its active principles-A review." Indian Journal of Natural Products and Resources 1.2 (2010): 125-135.

Okhuarobo A, Falodun JE, Erharuyi O, Imieje V, Falodun A, Langer P.” Harnessing the medicinal properties of Andrographis paniculata for diseases and beyond: a review of its phytochemistry and pharmacology”. Asian Pacific Journal of Tropical Disease. 2014; 4(3):213-222. DOI: 10.1016/S2222-1808(14)60509-0.


Spasov AA, Ostrovskij OV, Chernikov MV, Wikman G. Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytother Res 2004; 18(1):47-53 PMID: 14750201 DOI: 10.1002/ptr.1359


Wen-Wan Chao, Yueh-Hsiung Kuo, Bi-Fong Lin, “Anti-inflammatory Activity of New Compounds from Andrographis paniculata by NF-κB Transactivation Inhibition”, J. Agric. Food Chem., 2010, 58 (4), pp 2505–2512 DOI: 10.1021/jf903629j


Yi-Hua Lai, Sung-Liang Yu, Hsuan-Yu Chen,Chi-Chung Wang, Huei-Wen Chen, Jeremy J.W., “The HLJ1-targeting drug screening identified Chinese herb andrographolide that can suppress tumour growth and invasion in non-small-cell lung cancer” Carcinogenesis vol. 34 no.5 pp.1069–1080, 2013 PMID: 23306212 DOI:10.1093/carcin/bgt005 Advance Access publication January 9, 2013


Zheng, Z.Y. 1982. Pharmacokinetic studies on 3H-andrographolide. Chinese Herbal Med. 13(9):33-36.


REFERENCES:

http://www.altcancer.com/andcan.htm#note6 https://examine.com/supplements/andrographis-paniculata/


RESOURCES

Mayo Clinic Book of Alternative Medicine (second ed.). 2010. p. 47. PubMed


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