Andrographis — Andrographis paniculata

Common & Latin Names

Common names: Andrographis, King of Bitters, Indian echinacea, Kalmegh, Green chiretta Latin name: Andrographis paniculata (Burm.f.) Nees Sanskrit: Kalmegh, Bhunimba (“ground neem”) Hindi: Kalmegh TCM name: Chuan Xin Lian (穿心莲) — “Through-the-Heart Lotus” Thai: Fa Thalai Jone

Plant Family & Parts Used

Family: Acanthaceae (acanthus family) Parts used: Aerial parts — leaves and stems. Leaves contain the highest concentration of andrographolides. The whole plant is sometimes used in traditional preparations. Habitat: Native to India and Sri Lanka, widely distributed throughout South and Southeast Asia. Grows in moist, shaded habitats — forest edges, roadsides, and cultivated gardens. An annual herb growing 30-110cm tall with lanceolate leaves and small white-pink flowers.

Traditional Uses

Ayurvedic Medicine

Kalmegh (“dark cloud”) has been used in Ayurveda for centuries as a bitter tonic, febrifuge, and anti-infective. The intensely bitter taste (it is truly one of the bitterest herbs in any pharmacopoeia) reflects its classification as a powerful Pitta-pacifying, blood-purifying, fever-resolving herb.

Traditional Ayurvedic indications:

• Jwara (fever — including malarial fever)
• Kamala (jaundice), liver disorders
• Krimi (intestinal parasites)
• Prameha (urinary disorders, diabetes)
• Kushtha (skin diseases)
• General debility and infectious disease

Traditional Chinese Medicine

Chuan Xin Lian entered TCM relatively recently (not in the classical ancient texts, but widely used in modern Chinese medicine). It is classified as a Clear Heat / Resolve Toxin herb — used for sore throat, upper respiratory infection, urinary tract infection, diarrhea, and snake bite.

Southeast Asian Traditional Medicine

Andrographis is one of the most important medicinal plants in Thailand, Malaysia, Indonesia, and the Philippines. In Thailand, it was adopted as the primary herbal treatment for the common cold by the Thai Ministry of Public Health.

Scandinavian Use

Andrographis (as Kan Jang, a standardized extract combined with Eleutherococcus) became popular in Scandinavia for upper respiratory infections, with significant clinical research conducted in Sweden.

Active Compounds & Pharmacology

Primary Phytochemicals

Andrographolides (diterpenoid lactones):

• Andrographolide: The primary bioactive compound (typically 1-4% of dried aerial parts in quality material). Responsible for the extreme bitterness. Anti-inflammatory, immunomodulatory, anti-cancer, hepatoprotective, antiviral.
• Neoandrographolide: Anti-inflammatory, anti-allergic.
• 14-deoxyandrographolide: Immunostimulatory, anti-malarial.
• 14-deoxy-11,12-didehydroandrographolide: Anti-HIV activity in vitro.

Flavonoids: Including andrographidine A, oroxylin — anti-inflammatory, antioxidant.

Polysaccharides: Immunostimulatory.

Mechanisms of Action

1. NF-kB Inhibition: Andrographolide is a potent NF-kB inhibitor — it covalently binds to reduced cysteine 62 of the p50 subunit, directly blocking NF-kB DNA binding. This is a distinct and highly specific mechanism that suppresses the transcription of inflammatory genes (COX-2, iNOS, TNF-alpha, IL-6, IL-1beta, MMP-9).

2. Immunomodulation: Andrographolide enhances innate immunity (macrophage activation, NK cell cytotoxicity) while modulating adaptive immunity (enhancing Th1 responses, modulating excessive Th2 responses). It also enhances antibody production and lymphocyte proliferation.

3. Antiviral: Andrographolide inhibits viral replication through multiple mechanisms — interference with viral RNA synthesis, inhibition of viral protease activity, and enhancement of host antiviral interferon production. Active against influenza, HIV, hepatitis B, hepatitis C, herpes simplex, and dengue in vitro.

4. Hepatoprotection: Protects hepatocytes from toxic damage (carbon tetrachloride, paracetamol/acetaminophen, galactosamine) through antioxidant, anti-inflammatory, and choleretic mechanisms. Enhances bile flow and supports liver regeneration.

5. Antipyretic: Reduces fever through prostaglandin synthesis inhibition and direct action on thermoregulatory centers in the hypothalamus. This mechanism underlies the traditional “fever-reducing” reputation.

6. Anti-diabetic: Enhances insulin sensitivity through AMPK activation, reduces hepatic gluconeogenesis, and protects pancreatic beta cells.

Clinical Evidence

Key Clinical Trials

Saxena, R.C., Singh, R., Kumar, P., et al. (2010). “A randomized double blind placebo controlled clinical evaluation of extract of Andrographis paniculata (KalmCold) in patients with uncomplicated upper respiratory tract infection.” Phytomedicine, 17(3-4), 178-185.

• 223 patients with uncomplicated URTI, andrographis extract (KalmCold) 200mg daily vs placebo for 5 days
• Results: Significant improvement in all symptom categories — nasal discharge, sore throat, sleep disturbance, cough, headache, malaise, earache (all p<0.01). Overall efficacy score significantly higher in andrographis group.
• This is one of the largest and most rigorous andrographis-for-URTI trials.

Coon, J.T., & Ernst, E. (2004). “Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy.” Planta Medica, 70(4), 293-298.

• Systematic review of 7 RCTs (807 patients total)
• Results: Andrographis (alone or in combination) was consistently superior to placebo for URTI symptom reduction. Combined with eleuthero (Kan Jang formulation), the evidence was particularly strong.
• Concluded: “There is encouraging evidence suggesting that A. paniculata may be a safe and efficacious treatment for the relief of symptoms of uncomplicated URTI.”

Poolsup, N., Suthisisang, C., Prathanturarug, S., Asawamekin, A., & Chanchareon, U. (2004). “Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials.” Journal of Clinical Pharmacy and Therapeutics, 29(1), 37-45.

• Systematic review of RCTs confirming efficacy for URTI symptom reduction
• Highlighted the SHA-10 extract (Kan Jang) as having the most robust evidence base

Gabrielian, E.S., Shukarian, A.K., Goukasova, G.I., et al. (2002). “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, 9(7), 589-597.

• 185 patients with URTI, Kan Jang (andrographis + eleuthero) vs placebo for 5 days
• Results: Significant improvements in nasal secretion, sore throat, muscular ache, headache, malaise, cough, and temperature. Overall symptom score 2.1x better in treatment group.

Therapeutic Applications

Conditions

• Upper respiratory tract infections (primary indication — strongest evidence)
• Influenza (treatment and prevention)
• Sinusitis (acute)
• Fever (antipyretic)
• Liver disease (hepatoprotection — hepatitis, toxic liver injury)
• Inflammatory bowel disease (anti-inflammatory)
• Rheumatoid arthritis (NF-kB inhibition — early clinical evidence)
• Type 2 diabetes (adjunctive — AMPK activation)

Dosage Ranges

• Standardized extract (min 10% andrographolides): 200-400mg, 3 times daily during acute illness; lower dose for prevention
• KalmCold standardized extract: 200mg daily (as studied)
• Kan Jang (andrographis + eleuthero): As directed on product (typically 3-6 tablets daily)
• Dried herb powder: 1.5-6g daily (extremely bitter — capsules preferred)
• Tincture (1:5 in 45% alcohol): 3-5mL, 3 times daily
• Timing: Start at first sign of symptoms for maximum efficacy. Continue for 5-7 days.

Safety & Contraindications

Generally Safe at Recommended Doses

Clinical trials report mild, transient side effects — primarily GI complaints (nausea, diarrhea) related to the extreme bitterness and choleretic effect. Safety appears excellent for short-term use (5-10 days).

Contraindications

• Pregnancy: Andrographolide has demonstrated anti-fertility effects in animal studies (impairs implantation, may have abortifacient activity). CONTRAINDICATED in pregnancy.
• Lactation: Insufficient safety data. Avoid.
• Autoimmune conditions: Immune-stimulating effects may theoretically worsen autoimmune conditions.
• Gallbladder disease: Choleretic effect may precipitate biliary colic in patients with gallstones.
• Bleeding disorders: Andrographolide has antiplatelet activity at higher doses.

Drug Interactions

• Anticoagulants/antiplatelets: Additive bleeding risk at therapeutic doses.
• Antihypertensives: Andrographolide may lower blood pressure — additive effect.
• Immunosuppressants: May counteract immunosuppressive therapy.
• Hepatotoxic drugs: While andrographis is hepatoprotective, altered liver metabolism could affect drug levels. Monitor.
• Antidiabetic medications: May enhance hypoglycemic effects.

Energetics

TCM Classification

• Temperature: Cold
• Flavor: Bitter
• Meridian entry: Lung, Stomach, Large Intestine, Small Intestine
• Actions: Clears Heat, resolves Toxin, cools Blood, reduces swelling
• TCM pattern correspondence: Heat-Toxin accumulation (acute infections with fever, inflammation, sore throat, suppurative conditions). Damp-Heat in the Lower Jiao (urinary tract infections, dysentery).

Ayurvedic Classification

• Rasa: Tikta (bitter — intensely so)
• Virya: Shita (cooling — strongly)
• Vipaka: Katu (pungent)
• Dosha effects: Strongly pacifies Pitta and Kapha. May aggravate Vata in excess (cold, bitter, drying). Best used short-term for acute Pitta conditions.
• Prabhava: Jvarahara (fever-destroying), Raktashodhaka (blood-purifying)

Functional Medicine Integration

Acute Immune Protocol

Andrographis is the “herbal antibiotic” in FM acute infection protocols — though its mechanism is antiviral and immunostimulatory rather than truly antibiotic. For upper respiratory infections, andrographis at 200-400mg standardized extract TID provides rapid symptom relief. Combine with elderberry (antiviral), zinc (immune support), and vitamin C for a comprehensive acute protocol.

Hepatoprotection Protocol

Andrographolide’s hepatoprotective effects make it relevant alongside milk thistle and schisandra in liver support protocols, particularly when liver stress coexists with infectious or inflammatory conditions.

Gut Inflammation Protocol

NF-kB inhibition and anti-inflammatory effects position andrographis as an adjunct in inflammatory bowel disease protocols. The bitter taste also stimulates digestive secretions — bile flow, digestive enzymes, gastric acid — which benefits digestive function broadly.

Fever Management

Andrographis is the FM equivalent of an herbal antipyretic — reducing fever through prostaglandin modulation while simultaneously enhancing immune function. Unlike acetaminophen (which suppresses immune function), andrographis cools the fever while helping the body fight the infection.

Four Directions Connection

Primary Direction: Serpent (South — Physical Body)

Andrographis is the Serpent’s fire-quencher — the herb that reduces the excessive heat of infection while mobilizing the body’s defenses. The Serpent is the immune instinct, the body’s ancient capacity to recognize and fight invaders. Andrographis amplifies this instinct while cooling the collateral damage of inflammation. Its extreme bitterness is itself the Serpent’s medicine — in traditional understanding, bitter taste is the taste that enters the blood and purifies it, the taste that the body resists but needs.

Secondary Direction: Jaguar (West — Emotional Healing)

The association of fever and infection with vulnerability and surrender connects to the Jaguar’s domain. Illness forces us into the cave — into rest, into stillness, into the darkness of the body’s healing process. Andrographis supports the body through that descent.

References

1. Saxena, R.C., et al. (2010). A randomized double blind placebo controlled clinical evaluation of Andrographis paniculata (KalmCold) in patients with URTI. Phytomedicine, 17(3-4), 178-185.

2. Coon, J.T., & Ernst, E. (2004). Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review. Planta Medica, 70(4), 293-298.

3. Poolsup, N., et al. (2004). Andrographis paniculata in the symptomatic treatment of uncomplicated URTI. Journal of Clinical Pharmacy and Therapeutics, 29(1), 37-45.

4. Gabrielian, E.S., et al. (2002). A double blind, placebo-controlled study of Kan Jang in acute URTI including sinusitis. Phytomedicine, 9(7), 589-597.

5. Okhuarobo, A., Falodun, J.E., Erharuyi, O., et al. (2014). Harnessing the medicinal properties of Andrographis paniculata for diseases and beyond: a review. Asian Pacific Journal of Tropical Disease, 4(3), 213-222.

6. Jayakumar, T., Hsieh, C.Y., Lee, J.J., & Sheu, J.R. (2013). Experimental and Clinical Pharmacology of Andrographis paniculata and Its Major Bioactive Phytoconstituent Andrographolide. Evidence-Based Complementary and Alternative Medicine, 2013, 846740.

7. Hu, X.Y., Wu, R.H., Logue, M., et al. (2017). Andrographis paniculata (Chuan Xin Lian) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS One, 12(8), e0181780.