Herbal Monograph
Andrographis
Andrographis paniculata (Burm.f.) Nees
Acanthaceae
Premier immune-stimulating bitter herb for upper respiratory infections, fever, and liver protection
Overview
Plant Description
Andrographis paniculata is an erect, branching annual herb of the Acanthaceae (acanthus) family, typically reaching 30-110 cm (12-43 inches) in height. The stem is slender, dark green, quadrangular (square in cross-section) with longitudinal furrows and wings along the angles, 2-6 mm in diameter, slightly enlarged at the nodes, and glabrous (hairless). The branches are opposite-decussate, spreading. Leaves are simple, opposite, lanceolate to oblong-lanceolate, 2-12 cm long and 1-3 cm wide, with acute or acuminate apex and cuneate (wedge-shaped) base tapering into a short petiole (2-5 mm). The leaf blade is thin, glabrous on both surfaces, dark green above and paler beneath, with an entire (smooth) margin and pinnate venation. The leaves are intensely bitter in taste -- the 'King of Bitters' epithet derives from this characteristic. The inflorescence is a terminal or axillary racemose panicle, lax and spreading, 10-30 cm long. Flowers are small, solitary or in pairs, borne on slender pedicels. The calyx is five-lobed, glandular-pubescent. The corolla is bilabiate (two-lipped), small (approximately 1.2 cm long), white with purple or violet spots and streaks on the lower lip (guide marks for pollinators). Stamens are two, inserted at the throat. The fruit is a linear-oblong capsule, 10-20 mm long and approximately 3 mm wide, compressed, acute at both ends, containing numerous small (approximately 1.5 mm), subquadrate, rugose (wrinkled), yellowish-brown seeds. The entire aerial portion of the plant -- leaves, stems, and to a lesser extent flowers -- is used medicinally, with the leaves containing the highest concentration of the primary bioactive compound andrographolide.
Habitat
Andrographis paniculata grows naturally in a range of tropical and subtropical habitats. It thrives in moist, shady to semi-shady locations in deciduous and semi-evergreen forests, along roadsides, in waste places, and on plains and hillsides. The plant prefers well-drained, moist soils rich in organic matter but is adaptable to a variety of soil types including sandy loam, laterite, and clay soils. It tolerates partial shade and is often found as an understorey herb in forest margins, hedgerows, and disturbed areas. The species occurs from sea level to approximately 1,600 metres elevation. It grows best in warm, humid climates with annual rainfall of 1,000-3,000 mm and temperatures of 25-35 degrees Celsius. The plant is relatively resistant to pests and diseases but is frost-sensitive and does not tolerate prolonged waterlogging.
Distribution
Andrographis paniculata is native to South and Southeast Asia. The center of origin and genetic diversity is considered to be southern India and Sri Lanka. The species has a wide natural and cultivated distribution across the Indian subcontinent (India, Sri Lanka, Bangladesh, Nepal), Southeast Asia (Thailand, Malaysia, Indonesia, Vietnam, Cambodia, Myanmar, Philippines), and southern China (Guangdong, Guangxi, Fujian, Yunnan provinces). It has been introduced and cultivated in the West Indies, Central America, and parts of Africa and the Pacific Islands. The plant is particularly important in the traditional pharmacopoeias of India (Ayurveda, Siddha, Unani), China (TCM), Thailand, Malaysia, Indonesia, and Scandinavian phytomedicine. India and China are the largest producers for the global herbal market. In Scandinavia, Andrographis-based products (particularly the Kan Jang product containing a standardized extract) have been marketed since the 1990s as over-the-counter remedies for upper respiratory infections.
Parts Used
Aerial parts (Herba Andrographidis)
Preferred: Standardized dry extract (tablets or capsules) standardized to andrographolide content; dried herb for decoction in traditional practice
The dried aerial parts -- primarily the leaves and stems harvested during early flowering -- constitute the official pharmacopeial drug (Herba Andrographidis in the WHO monograph). The leaves contain the highest concentration of andrographolide (1.5-3.5% by dry weight in typical commercial material), with stems contributing lower concentrations. This is the part listed in the WHO Monographs on Selected Medicinal Plants (Volume 2), the Chinese Pharmacopoeia (as Chuan Xin Lian), the Indian Pharmacopoeia, and the Thai Herbal Pharmacopoeia. The vast majority of clinical trial evidence is based on standardized extracts of the aerial parts. The extremely bitter taste of the herb makes direct consumption of the raw dried material or decoction challenging for many patients, which is why capsule and tablet preparations are the most common commercial dosage forms.
Leaves (Andrographidis paniculatae folium)
Preferred: Dried leaves for extraction; standardized extract capsules/tablets
The leaves alone are specified in the EMA (European Medicines Agency) monograph as Andrographidis paniculatae folium. Leaves contain the highest concentration of diterpenoid lactones, particularly andrographolide, compared to stems or roots. Fresh leaves are used in some traditional preparations in India and Southeast Asia (e.g., fresh leaf juice mixed with honey for fever). Dried leaves are the primary starting material for most standardized commercial extracts. The EMA Committee on Herbal Medicinal Products (HMPC) assessed the leaf specifically for traditional use in the relief of cold symptoms.
Whole plant (root included)
Preferred: Dried whole plant powder or decoction in traditional formulations
In some Ayurvedic and folk medicine traditions, the whole plant including roots is used, particularly for hepatoprotective and antipyretic indications. The root contains lower levels of andrographolide but has a distinct phytochemical profile including some unique flavonoid glycosides and xanthones. The root is used in certain traditional formulations for liver complaints and dyspepsia. However, root use is less well supported by modern clinical evidence compared to the aerial parts, and the aerial parts are the standardized pharmacopeial drug in all major monograph systems.
Key Constituents
Diterpene lactones (labdane diterpenoids)
The labdane diterpenoid lactones are the primary pharmacologically active and chemically distinctive constituents of Andrographis paniculata, with andrographolide as the predominant and most extensively studied compound. These diterpenoids are responsible for the herb's immunomodulatory, anti-inflammatory, antipyretic, hepatoprotective, and antimicrobial activities. The total diterpenoid lactone content -- particularly andrographolide -- serves as the primary quality marker for raw material and commercial products. Clinical efficacy in upper respiratory tract infections has been correlated with andrographolide dose, with most positive clinical trials using extracts standardized to deliver specific daily doses of andrographolide (typically 48-120 mg/day in divided doses). The intense bitterness of these compounds also mediates the traditional bitter tonic and digestive-stimulating effects of the herb. Diterpenoids are best extracted by hydroalcoholic solvents (ethanol 50-80%) or methanol; aqueous extraction (decoction) is less efficient for these lipophilic compounds, though neoandrographolide and the glycosidic forms are more water-soluble.
Flavonoids
Flavonoids in Andrographis paniculata contribute antioxidant, anti-inflammatory, and potentially hepatoprotective effects. While they are secondary to the diterpenoid lactones as pharmacological markers, the flavonoid fraction may contribute to the overall therapeutic activity of whole-plant or full-spectrum extracts through synergistic effects with andrographolide and related diterpenoids. The antioxidant activity of flavonoids may help protect against oxidative stress associated with inflammation and infection.
Polyphenols and phenolic acids
Polyphenols and phenolic acids are secondary constituents that contribute to the antioxidant capacity and overall pharmacological profile of Andrographis paniculata extracts. While not the primary basis for the herb's therapeutic actions, they contribute to hepatoprotective, anti-inflammatory, and free-radical-scavenging effects, potentially enhancing the activity of the primary diterpenoid lactone constituents.
Xanthones (primarily in roots)
Xanthones are minor constituents found primarily in the roots. They may contribute to the antimicrobial and hepatoprotective effects of whole-plant preparations but are not the primary therapeutic constituents. Their presence is more relevant to quality control and authentication of root-containing preparations.
Miscellaneous constituents
These miscellaneous constituents make minor but potentially meaningful contributions to the overall pharmacological profile, particularly in whole-herb or aqueous extract preparations. Polysaccharides may contribute to immunostimulatory activity of traditional decoction preparations, complementing the diterpenoid-mediated immune effects.
Herbal Actions
Stimulates and enhances immune response
Andrographis paniculata is one of the most well-documented immune-stimulating herbs in modern phytotherapy. The immune-enhancing effect is mediated primarily through andrographolide and 14-deoxy-11,12-didehydroandrographolide, which enhance both innate and adaptive immune responses. Demonstrated effects include: increased phagocytic activity of macrophages and neutrophils, enhanced natural killer (NK) cell cytotoxicity, stimulation of antibody production (both IgG and IgM), increased cytotoxic T-lymphocyte activity, enhanced production of IL-2 and IFN-gamma (Th1 cytokines), and increased delayed-type hypersensitivity responses. Unlike the bidirectional immunomodulation of some adaptogens, Andrographis acts primarily as an immune stimulant -- enhancing depressed or challenged immune function -- which is the basis for its clinical use in acute upper respiratory infections. Multiple systematic reviews and meta-analyses (Coon & Ernst 2004, Poolsup et al. 2004, Hu et al. 2017) have confirmed clinical efficacy in URI, consistent with immunostimulant activity.
[1, 5, 6, 7, 13]Andrographis is one of the most intensely bitter herbs in worldwide herbal pharmacopoeias, earning its common name 'King of Bitters.' The bitter taste is primarily due to the andrographolide diterpenoid lactones, which activate bitter taste receptors (T2Rs) on the tongue and in the gut epithelium. In herbal energetics, the bitter quality stimulates digestive secretions: saliva, gastric acid, pancreatic enzymes, and bile production. This bitter reflex mechanism underlies the traditional use of Andrographis as a stomachic (appetite and digestive stimulant) and choleretic (bile-flow stimulant) in Ayurveda and Southeast Asian traditional medicine. The bitter action is also considered to contribute to the hepatoprotective effect by promoting healthy bile flow and hepatobiliary function. In Western herbal classification, Andrographis functions as a 'pure bitter' similar to Gentiana lutea, though with additional anti-infective and immune-stimulating properties that distinguish it from simple bitter tonics.
[1, 3, 4]Reduces inflammation
Andrographolide is a potent anti-inflammatory agent acting through multiple molecular mechanisms. The primary mechanism is inhibition of NF-kB activation by forming a covalent adduct with the reduced cysteine residue (Cys62) of the p50 subunit of NF-kB, preventing its DNA binding. This downstream effect suppresses the transcription of pro-inflammatory genes including iNOS, COX-2, TNF-alpha, IL-1beta, IL-6, and adhesion molecules. Additional anti-inflammatory mechanisms include: inhibition of the JAK-STAT signaling pathway, suppression of MAPK (ERK, JNK, p38) phosphorylation, inhibition of phospholipase A2 and lipoxygenase activity, and reduction of reactive oxygen species generation in activated inflammatory cells. In vivo, andrographolide has demonstrated efficacy in multiple animal models of inflammation including carrageenan-induced paw edema, collagen-induced arthritis, LPS-induced acute lung injury, and experimental colitis. The anti-inflammatory potency supports the herb's traditional use in inflammatory conditions and contributes to its clinical efficacy in acute upper respiratory tract infections, where mucosal inflammation underlies symptoms.
[1, 3, 13]Fever reduction is one of the oldest and most widespread traditional indications for Andrographis across all traditions of use (Ayurveda, TCM, Thai medicine, Southeast Asian folk medicine). The antipyretic action has been confirmed in animal models: andrographolide reduces fever in brewer's yeast-induced pyrexia and LPS-induced fever models in rats. The mechanism is attributed to inhibition of pro-inflammatory cytokine production (particularly IL-1beta, TNF-alpha, and IL-6, which act as endogenous pyrogens), inhibition of prostaglandin E2 synthesis (via COX-2 suppression), and central antipyretic effects. The WHO monograph lists fever as one of the traditional medicinal uses supported by clinical data. In practice, the antipyretic effect is moderate and is most relevant in the context of fever associated with acute infections (URI, pharyngitis, enteritis) rather than as a standalone antipyretic.
[1, 3, 13]Protects the liver from damage
Multiple preclinical studies demonstrate hepatoprotective effects of andrographolide and Andrographis paniculata extracts. Andrographolide protects hepatocytes against damage from carbon tetrachloride (CCl4), paracetamol (acetaminophen), galactosamine, thioacetamide, and ethanol in animal models. Mechanisms include: enhancement of hepatic antioxidant enzyme activity (superoxide dismutase, catalase, glutathione peroxidase, glutathione-S-transferase), inhibition of lipid peroxidation, suppression of hepatic stellate cell activation and fibrogenesis, reduction of hepatic inflammatory infiltrate, and promotion of hepatocyte regeneration. Andrographolide also increases bile flow (choleretic effect) and has protective effects against drug-induced cholestasis. In traditional Ayurvedic medicine, Kalmegh is classified as a premier hepatoprotective herb (yakrit-uttejak) and is used for jaundice, liver enlargement, and sluggish liver function. Clinical evidence is limited to small, uncontrolled studies showing improvement in liver enzymes in patients with chronic hepatitis and toxic liver injury.
[1, 3, 13, 14]Kills or inhibits the growth of microorganisms
In vitro and in vivo studies demonstrate broad-spectrum antimicrobial activity. Antibacterial: andrographolide and whole extracts show activity against Staphylococcus aureus, Pseudomonas aeruginosa, Proteus vulgaris, Escherichia coli, Salmonella typhi, and Shigella species, though minimum inhibitory concentrations are generally higher than conventional antibiotics. Antiviral: Andrographis extracts demonstrate activity against influenza A virus, herpes simplex virus, hepatitis B and C viruses, and HIV (in vitro inhibition of HIV-1 replication). In a mouse model of influenza A infection, oral administration of Andrographis extract reduced viral titers and improved survival. The antimicrobial effect is likely contributory rather than primary in clinical efficacy -- the herb's effectiveness in respiratory infections is attributed more to immunostimulation and anti-inflammatory effects than to direct antimicrobial action.
[1, 13]Andrographolide stimulates bile production and bile flow in animal models, consistent with its profound bitter taste and traditional classification as a hepatobiliary tonic. The choleretic effect complements the hepatoprotective action and supports the traditional Ayurvedic use for sluggish digestion, loss of appetite, and liver-gallbladder complaints. In TCM, Chuan Xin Lian is described as clearing heat from the liver and gallbladder, which aligns with the choleretic and hepatoprotective pharmacology.
[1, 3]The WHO monograph lists diarrhoea as a traditional indication for Andrographis. The anti-diarrhoeal effect is attributed to antimicrobial activity against enteric pathogens, anti-inflammatory effects on the intestinal mucosa, and inhibition of intestinal secretion. Animal studies show reduction in castor oil-induced diarrhoea and inhibition of enterotoxin-induced intestinal fluid accumulation. This action is clinically relevant in traditional practice in tropical regions where the plant is used for infectious diarrhoea.
[1, 13]Prevents or slows oxidative damage to cells
Andrographolide and the flavonoid/polyphenol constituents demonstrate moderate antioxidant activity including free radical scavenging (DPPH, superoxide, hydroxyl radicals), enhancement of endogenous antioxidant enzymes (SOD, catalase, GPx), inhibition of lipid peroxidation, and chelation of pro-oxidant metal ions. The antioxidant capacity is secondary to plants with more concentrated polyphenol content but contributes to the hepatoprotective, cytoprotective, and anti-inflammatory effects. The antioxidant activity of andrographolide is considered to operate primarily through upregulation of endogenous antioxidant enzyme systems (Nrf2 pathway activation) rather than direct radical scavenging.
[13]Therapeutic Indications
Immune System
Upper respiratory tract infections (common cold, pharyngitis, tonsillitis)
This is the most thoroughly studied and best-supported clinical indication for Andrographis paniculata. Multiple randomized, double-blind, placebo-controlled clinical trials have demonstrated that Andrographis extracts (alone or in combination with Eleutherococcus senticosus as Kan Jang) significantly reduce the severity and duration of symptoms of uncomplicated upper respiratory tract infections, including nasal congestion, rhinorrhea, sore throat, cough, headache, earache, malaise, and fatigue. Key systematic reviews and meta-analyses: Poolsup et al. (2004) meta-analysis of RCTs found significant benefit in symptom reduction; Coon & Ernst (2004) systematic review of 7 RCTs (n=896) concluded that A. paniculata is superior to placebo for URI symptoms; Hu et al. (2017) comprehensive meta-analysis of 33 RCTs (n=7175) confirmed significant improvement in overall symptoms, cough, and sore throat compared to placebo, usual care, and other herbal therapies. Treatment is most effective when initiated within 24-72 hours of symptom onset and continued for 3-7 days. The EMA has assessed Andrographis leaf for traditional use in relief of symptoms of common cold.
[1, 5, 6, 7, 8, 9]Sinusitis (acute, as adjunctive treatment)
Gabrielian et al. (2002) conducted a double-blind, placebo-controlled study of Kan Jang (Andrographis paniculata fixed combination with Eleutherococcus senticosus) specifically in patients with acute upper respiratory tract infections including sinusitis. The treatment group showed highly significant improvement in total symptom scores compared to placebo. Nasal symptoms, headache, and sinus pressure/pain improved significantly. The combination of immunostimulant, anti-inflammatory, and mild antimicrobial actions provides a rational pharmacological basis for efficacy in sinusitis.
[6, 10]Influenza-like illness (prophylaxis and early treatment)
Hancke et al. (1995) studied Kan Jang for prevention and early treatment of common cold/influenza in a double-blind, placebo-controlled trial, finding significant reduction in incidence and symptom severity. A 2026 mouse model study demonstrated that orally administered A. paniculata extract reduced influenza A viral titers and improved outcomes using a translationally relevant dose. Preliminary evidence supports a preventive role when taken during high-risk periods, though large-scale prevention trials in humans are limited. Clinical benefit appears greatest when treatment is initiated early in the course of illness.
[5, 11]General immune support and infection resistance
Traditional use across Ayurvedic, Chinese, Thai, and Southeast Asian medicine systems for enhancing resistance to infectious diseases, particularly during seasonal epidemics. The immunostimulant pharmacology (enhanced phagocytosis, NK cell activity, antibody production) provides a rational basis for this traditional application. Best suited for short-term immune stimulation during acute infection or periods of heightened infection risk, rather than long-term tonic immunomodulation (for which adaptogens like Astragalus or Reishi are more appropriate).
[1, 3]Hepatobiliary System
Hepatoprotection and liver support (general)
Andrographolide demonstrates robust hepatoprotective activity across multiple preclinical models of liver injury. Protection has been demonstrated against carbon tetrachloride, paracetamol (acetaminophen), galactosamine, thioacetamide, and alcohol-induced hepatotoxicity in animal models. Mechanisms include antioxidant protection (Nrf2 activation, enhanced SOD/catalase/GPx), anti-inflammatory modulation (NF-kB inhibition), inhibition of hepatic stellate cell activation (anti-fibrotic), and promotion of hepatocyte regeneration. In traditional Ayurvedic practice, Kalmegh is one of the most highly regarded hepatoprotective herbs and is used for jaundice, hepatomegaly, and sluggish hepatic function. The choleretic action (bile-flow stimulation) complements hepatocellular protection. Clinical evidence in humans is limited to small, open-label studies reporting improvement in liver enzymes in patients with hepatitis and toxic liver injury, but the preclinical evidence is extensive and consistent.
[1, 3, 13, 14]Chronic viral hepatitis (adjunctive support)
Preclinical studies show that andrographolide inhibits hepatitis B and C virus replication in vitro and demonstrates hepatoprotective effects against virus-induced liver damage. Some small clinical studies from India and China report improvement in liver function markers in chronic hepatitis patients receiving Andrographis preparations alongside standard care. Evidence is preliminary and insufficient to recommend Andrographis as a standalone antiviral therapy for hepatitis. Use as a hepatoprotective adjunct may be considered under practitioner supervision.
[1, 13]Dyspepsia and poor appetite
The profound bitter taste of Andrographis stimulates the bitter reflex pathway, promoting secretion of saliva, gastric acid, pancreatic enzymes, and bile. This supports the traditional Ayurvedic use of Kalmegh as a stomachic (deepaniya -- appetite stimulant) and digestive aid. In Western herbal practice, Andrographis functions as a potent bitter tonic comparable to Gentiana. Indicated for poor appetite, sluggish digestion, and functional dyspepsia, particularly in patterns of hepatobiliary insufficiency. Clinical evidence for this indication is based on traditional authority and pharmacological rationale rather than clinical trials.
[1, 3, 4]Musculoskeletal System
Inflammatory joint conditions (adjunctive)
The potent NF-kB inhibitory activity of andrographolide has generated research interest in rheumatoid arthritis and other inflammatory joint diseases. Preclinical studies demonstrate suppression of collagen-induced arthritis in animal models, with reduced joint inflammation, cartilage destruction, and bone erosion. Andrographolide inhibits the production of matrix metalloproteinases (MMP-1, MMP-3) and pro-inflammatory cytokines (TNF-alpha, IL-1beta, IL-6) implicated in joint destruction. A small pilot clinical trial in rheumatoid arthritis patients suggested improvement in pain scores and inflammatory markers with andrographolide supplementation. Further clinical trials are needed to establish efficacy and optimal dosing.
[13]gastrointestinal
Infectious diarrhoea
One of the traditional indications listed in the WHO monograph. Andrographis is used across South and Southeast Asia for the treatment of acute diarrhoea, particularly bacillary dysentery and diarrhoea caused by enteric infections. The antimicrobial activity against enteric pathogens (Salmonella, Shigella, E. coli), anti-inflammatory effects on intestinal mucosa, and inhibition of intestinal secretion contribute to the anti-diarrhoeal action. Animal studies confirm reduction in intestinal transit rate and fluid accumulation. Clinical evidence is limited to traditional practice reports and small observational studies.
[1, 13]Ulcerative colitis (adjunctive)
A notable clinical trial (Tang et al. 2011) evaluated Andrographis paniculata extract (HMPL-004) versus mesalazine in patients with mild-to-moderate active ulcerative colitis. The andrographis extract at 1800 mg/day was non-inferior to mesalazine 4500 mg/day in inducing clinical response and remission over 8 weeks. The anti-inflammatory mechanism (NF-kB inhibition) and mucosal protective effects provide a rational pharmacological basis. This represents a promising area for further clinical development.
[13]Respiratory System
Pharyngitis and sore throat
Sore throat symptom reduction is one of the most consistently demonstrated clinical effects of Andrographis. In the Hu et al. (2017) meta-analysis, sore throat symptom scores improved significantly with Andrographis compared to placebo and usual care. The combined immunostimulant, anti-inflammatory, and mild analgesic effects contribute to rapid symptomatic relief. Most clinical trials demonstrating efficacy used standardized extracts delivering 48-120 mg andrographolide daily for 3-7 days.
[5, 6, 9]Cough (associated with URI)
Cough symptom reduction was demonstrated in the Hu et al. (2017) meta-analysis, with Andrographis shortening cough duration compared to usual care. Hancke et al. (1995) and Caceres et al. (1999) also reported significant improvement in cough scores with Kan Jang treatment. The anti-inflammatory and immunomodulatory effects likely contribute to reduced airway inflammation and faster resolution of infection-related cough.
[5, 8, 11]Fever (associated with URI and acute infections)
Traditional antipyretic use across all systems of medicine. Animal studies confirm the antipyretic action. Clinical improvement in fever as part of the URI symptom complex has been reported in several trials, though fever is rarely the primary outcome measure in modern studies. Used traditionally in India and Southeast Asia as a first-line herbal remedy for fever of various origins.
[1, 13]Cardiovascular System
Antiplatelet and cardioprotective support
Andrographolide inhibits platelet aggregation induced by thrombin, ADP, collagen, arachidonic acid, epinephrine, and platelet activating factor (PAF) in vitro and in animal models. The antiplatelet mechanism involves inhibition of extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation and thromboxane A2 receptor signaling. This antiplatelet effect is pharmacologically significant and is the basis for the drug interaction caution with anticoagulant and antiplatelet medications. While not a primary cardiovascular herb, the antiplatelet and anti-inflammatory properties provide theoretical cardioprotective benefit.
[13]Energetics
Temperature
cold
Moisture
dry
Taste
Tissue States
hot/excitation, damp/stagnation
In traditional Ayurvedic classification, Andrographis (Kalmegh) is described as having tikta (bitter) and katu (pungent) rasa (taste), with laghu (light) and ruksha (dry) guna (qualities), and a cooling virya (potency). Its vipaka (post-digestive effect) is katu (pungent). It is said to pacify Kapha and Pitta doshas while potentially aggravating Vata in excess due to its cold and dry qualities. In traditional Chinese medicine, Chuan Xin Lian is classified as bitter (ku) and cold (han), entering the Lung, Stomach, Large Intestine, and Small Intestine channels. Its action of 'clearing heat and resolving toxins' (qing re jie du) corresponds to its anti-inflammatory, antimicrobial, and antipyretic pharmacology. The TCM actions include clearing damp-heat from the Lower Jiao, cooling blood, and reducing swelling. In Western herbal energetics, Andrographis is considered strongly cold and dry -- a classic 'cooling bitter' herb. It addresses hot/excited tissue states (acute inflammation, fever, infection with heat signs) and damp/stagnant tissue states (sluggish liver, congested digestion, phlegm). Due to its pronounced cold energy, it is traditionally combined with warming herbs such as dried ginger (Zingiber officinale), long pepper (Piper longum), or Astragalus membranaceus to moderate its cold quality and improve digestive tolerability, especially in constitutionally cold or Vata-dominant individuals. Prolonged use in cold, deficient constitutions without warming support is discouraged in Ayurvedic tradition. CAVEAT: Herbal energetics are interpretive frameworks within Ayurveda, TCM, and Western herbalism, not standardized across all practitioners.
Traditional Uses
Ayurvedic medicine (Kalmegh / Bhunimba)
- Premier hepatoprotective herb (yakrit-uttejak), used for jaundice, hepatomegaly, and sluggish liver function
- Febrifuge (jvarahara) for fevers of various origins, including malarial, typhoid, and intermittent fevers
- Bitter digestive tonic (deepaniya) for loss of appetite, dyspepsia, and sluggish digestion
- Blood purifier (raktashodhak) for skin diseases, boils, and acne associated with blood toxicity
- Anti-helminthic (krimighna) for intestinal parasites and worms
- Treatment of diarrhoea and dysentery (atisara and pravahika)
- General debility and convalescence following febrile illness
"In the Ayurvedic pharmacopoeia, Kalmegh (Andrographis paniculata) is classified under tikta rasa (bitter taste) herbs with a cooling virya. The Bhavaprakash Nighantu, a major 16th-century Ayurvedic materia medica text, describes Kalmegh as 'bhunimba' (neem of the ground) due to its extreme bitterness comparable to Azadirachta indica (neem). It is indicated for conditions of excess Pitta (heat/inflammation) and Kapha (congestion/stagnation). Primary traditional actions include deepaniya (appetite-stimulating), jvarahara (fever-reducing), yakrit-uttejak (liver-stimulating), raktashodhak (blood-purifying), and krimighna (anti-helminthic). It is traditionally administered as svarasa (fresh juice), churna (powder), or kvatha (decoction), often combined with warming herbs like ginger or long pepper (Trikatu) to counterbalance its cold energy."
Traditional Chinese medicine (Chuan Xin Lian / Chuan Xin Lian)
- Clearing heat and resolving toxins (qing re jie du) for acute febrile diseases and toxic sores
- Treating lung heat patterns: sore throat, cough with yellow phlegm, and acute bronchitis
- Clearing damp-heat from the Lower Jiao: treating urinary tract infections and dysentery
- Treating acute gastroenteritis, bacillary dysentery, and infectious diarrhoea
- Snake bite and venomous insect stings (external and internal application)
- Boils, carbuncles, and suppurative skin infections (clearing heat-toxin)
- Mouth ulcers and pharyngitis
"In the Chinese Materia Medica, Chuan Xin Lian (literally 'threading-the-heart lotus,' referring to its extreme bitterness that 'penetrates the heart') is classified as a heat-clearing and toxin-resolving herb (qing re jie du yao). Its properties are described as bitter (ku) and cold (han), entering the Lung (Fei), Stomach (Wei), Large Intestine (Da Chang), and Small Intestine (Xiao Chang) channels. The Chinese Pharmacopoeia includes Chuan Xin Lian as an official monograph. It appears in several classical and modern formulas including Chuan Xin Lian Pian (Andrographis tablets), a widely used over-the-counter remedy in China for sore throat, fever, and respiratory infections. Injectable preparations (Chuan Xin Lian Injection) have been used in Chinese hospital settings for severe infections, though injectable forms have been associated with adverse reactions including anaphylaxis and are not recommended in Western phytotherapy."
[1]
Thai traditional medicine (Fah Talai Jone)
- Treatment of sore throat, cough, and fever associated with upper respiratory infections
- Anti-diarrhoeal remedy for infectious diarrhoea and dysentery
- General antipyretic and anti-infective for acute febrile illnesses
- Treatment of skin infections and wounds (topical application of paste)
- Used during monsoon season as a prophylactic against common tropical infections
"Andrographis paniculata, known as Fah Talai Jone in Thai, is one of the most important medicinal plants in the Thai Herbal Pharmacopoeia and is included in the Thai National List of Essential Medicines as an herbal medicinal product. It is particularly prominent in Thai traditional medicine for the treatment of upper respiratory tract infections and diarrhoeal diseases. During the COVID-19 pandemic in 2020-2021, the Thai government promoted Andrographis paniculata as an adjunctive treatment for mild COVID-19 cases, reflecting its deep integration into the Thai national healthcare system. The Thai Herbal Pharmacopoeia specifies standardization of Andrographis products to andrographolide content."
[1]
Scandinavian phytomedicine (Kan Jang product)
- Treatment and prevention of common cold and upper respiratory tract infections
- Relief of cold symptoms including sore throat, rhinitis, headache, and fatigue
- Used as a fixed combination with Eleutherococcus senticosus (Siberian ginseng) for enhanced efficacy
- Adjunctive treatment of sinusitis
"Andrographis entered Scandinavian herbal medicine in the 1990s through the introduction of Kan Jang, a fixed-combination product developed by the Swedish Herbal Institute containing a standardized Andrographis paniculata extract (SHA-10) and Eleutherococcus senticosus extract (SHE-3). Kan Jang became the subject of multiple well-designed clinical trials conducted in Sweden, Chile, and Armenia, establishing the evidence base for Andrographis use in upper respiratory infections in Western medical practice. The product has been marketed in Scandinavia and other European countries as an over-the-counter remedy for cold symptoms. The clinical trial program for Kan Jang was pioneered by Alexander Panossian and colleagues, and the product represents one of the most thoroughly investigated proprietary herbal combinations for respiratory infections in the world."
Malaysian and Indonesian traditional medicine (Hempedu Bumi / Sambiloto)
- Treatment of fever, malaria, and tropical infections
- Bitter tonic for diabetes and blood sugar regulation
- Treatment of skin diseases and poisonous bites
- Anti-helminthic for intestinal parasites
- General tonic for debility and convalescence
- Used as 'Hempedu Bumi' (bile of the earth) in Malay folk medicine, reflecting its intense bitterness
"In Malaysia and Indonesia, Andrographis paniculata is known as Hempedu Bumi ('bile of the earth' in Malay) or Sambiloto (Javanese/Indonesian), reflecting its extreme bitterness. It is widely used in traditional Malay, Javanese, and Indonesian medicine (Jamu) for fever, infections, liver complaints, and as a general bitter tonic. The herb is frequently consumed as a fresh leaf decoction or dried powder. In Indonesia, Sambiloto is included in the Indonesian Materia Medica and is one of the most commonly sold traditional herbal remedies. Its use for diabetes and blood sugar regulation in Southeast Asian folk medicine has stimulated modern research into anti-diabetic properties."
[1]
Modern Research
Systematic review and meta-analysis of Andrographis for acute respiratory tract infections (comprehensive)
Comprehensive systematic review and meta-analysis of 33 randomized controlled trials (n=7175) evaluating Andrographis paniculata preparations for symptomatic relief of acute respiratory tract infections in adults and children.
Findings: A. paniculata (alone or combined with usual care) significantly improved overall symptoms of acute respiratory tract infections compared to placebo, usual care, and other herbal therapies. Significant improvements were demonstrated for cough (reduced severity and duration) and sore throat. A. paniculata shortened duration of cough, sore throat, and sick leave/time to symptom resolution compared to usual care. No major adverse events were reported. Minor adverse events were mainly gastrointestinal (nausea, diarrhoea, distaste/metallic taste) and were mild and self-limiting. The evidence was judged moderate to high quality for the primary outcomes.
Limitations: Substantial heterogeneity in preparations, doses, and outcome measures across trials. Many studies conducted in single countries (Sweden, Chile, China, Thailand, India). Risk of publication bias for positive results from traditional-medicine-supporting countries. Some included studies had moderate risk of bias. Different Andrographis preparations (monopreparations vs. Kan Jang combination) were pooled in some analyses.
[5]
Systematic review of safety and efficacy in upper respiratory tract infections (Coon & Ernst 2004)
Systematic review of seven double-blind, controlled trials (n=896) evaluating Andrographis paniculata in the treatment of upper respiratory tract infections, conducted by Peninsula Medical School, Universities of Exeter and Plymouth.
Findings: Collectively, the data suggest that A. paniculata is superior to placebo in alleviating the subjective symptoms of uncomplicated upper respiratory tract infection. There was also preliminary evidence of a preventive effect when used prophylactically during cold season. Adverse events were generally mild and infrequent, with the herb demonstrating a favorable safety profile. The authors concluded that A. paniculata may be a safe and efficacious treatment for the relief of symptoms of uncomplicated URTI.
Limitations: Limited to seven trials available at the time of review. Several included studies were of moderate methodological quality. Heterogeneity in preparations (Kan Jang combination vs. monopreparations) and dosing regimens. Most studies were of short duration (5-14 days). The preventive evidence was based on a single trial.
[6]
Meta-analysis of Andrographis in symptomatic treatment of uncomplicated URTI (Poolsup et al. 2004)
Systematic review and statistical meta-analysis of randomized controlled trials evaluating Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection.
Findings: Four RCTs met inclusion criteria (total n=433 in three trials included in statistical analysis). Pooled analysis confirmed that Andrographis paniculata was significantly more effective than placebo in reducing overall symptom severity of URI. The odds ratio for symptom improvement was statistically significant. The analysis supported the clinical utility of Andrographis preparations for short-term symptomatic treatment of uncomplicated URTI.
Limitations: Small number of trials meeting strict inclusion criteria. Limited total sample size for meta-analysis. Included studies used different Andrographis preparations and dosing regimens. Short-term outcomes only.
[7]
Kan Jang in acute URTI including sinusitis (Gabrielian et al. 2002)
Double-blind, placebo-controlled study of Andrographis paniculata fixed combination Kan Jang (SHA-10 extract of A. paniculata with SHE-3 extract of Eleutherococcus senticosus) in the treatment of acute upper respiratory tract infections including sinusitis.
Findings: The Kan Jang treatment group showed highly significant improvement in total symptom scores compared to placebo. Specific symptoms including nasal congestion, rhinorrhoea, sore throat, headache, and general malaise improved significantly. Patients with sinusitis symptoms showed significant improvement in sinus-related symptoms (facial pain/pressure, nasal discharge quality). The treatment was well tolerated with no significant adverse events.
Limitations: Single study with moderate sample size. Fixed combination product (Kan Jang) prevents attribution of effects to Andrographis alone vs. the Eleutherococcus component. Short treatment duration. Sinusitis diagnosis was clinical rather than imaging-confirmed.
[10]
KalmCold -- standardized Andrographis extract for URTI (Saxena et al. 2010)
Randomized, double-blind, placebo-controlled clinical evaluation of KalmCold (standardized extract of Andrographis paniculata) in patients with uncomplicated upper respiratory tract infection.
Findings: KalmCold (200 mg daily andrographolide equivalents) was significantly more effective than placebo in reducing the severity of URI symptoms. The overall efficacy of KalmCold over placebo was 52.7% (2.1 times higher). Significant improvements were observed in nasal congestion, sleep disturbance, sore throat, and general malaise. Treatment was initiated within 72 hours of symptom onset and continued for 5 days. The extract was well tolerated with adverse events comparable to placebo.
Limitations: Single-center study. Moderate sample size. Specific proprietary extract (KalmCold); results may not generalize to all Andrographis preparations. Five-day treatment duration only.
[9]
Kan Jang for treatment and prevention of common cold (Caceres et al. 1999)
Double-blind, placebo-controlled pilot and Phase III study evaluating the activity of standardized Andrographis paniculata extract fixed combination (Kan Jang) in the treatment of uncomplicated upper respiratory tract infection, conducted in Chile.
Findings: Treatment with A. paniculata extract SHA-10 (as Kan Jang) significantly reduced the intensity of symptoms including tiredness (OR=1.28), sleeplessness (OR=1.71), sore throat (OR=2.30), and nasal secretion (OR=2.51) compared to placebo. A duration-dependent effect was observed, with 4-day treatment showing significantly greater symptom reduction than 2-day treatment. The results supported the clinical efficacy of Kan Jang for symptomatic treatment of uncomplicated URTI.
Limitations: Conducted in a single geographic location (Chile). Fixed combination product. Duration comparison was not a pre-specified primary analysis in the pilot phase.
[8]
Kan Jang for prevention of common cold (Hancke et al. 1995)
Double-blind, placebo-controlled trial evaluating Kan Jang for prevention and early treatment of common cold in Chilean students during winter cold season.
Findings: Prophylactic administration of Kan Jang during winter months significantly reduced the incidence of common cold compared to placebo. In those who did develop cold symptoms, the treatment group had less severe symptoms and faster resolution. This study provided early evidence for both preventive and therapeutic applications of the Andrographis combination product.
Limitations: Early study with smaller sample size. Student population may not be generalizable. Combination product prevents attribution to Andrographis alone. Single-season observation.
[11]
Controlled clinical study of Andrographis for common cold (Melchior et al. 2000)
Controlled clinical study evaluating standardized Andrographis paniculata extract in the treatment of common cold, conducted in Sweden.
Findings: Andrographis paniculata extract significantly reduced the severity of cold symptoms compared to placebo. Sore throat, nasal symptoms, and overall intensity of illness were significantly improved. The treatment was well tolerated. This study contributed important evidence for the monopreparation (Andrographis alone, without Eleutherococcus) in URI treatment.
Limitations: Pilot study design with moderate sample size. Single preparation tested. Swedish population.
[12]
Comprehensive pharmacological review of Andrographis and andrographolide
Comprehensive review of experimental and clinical pharmacology of Andrographis paniculata and its major bioactive phytoconstituent andrographolide, published in Evidence-Based Complementary and Alternative Medicine.
Findings: Documented diverse pharmacological activities of andrographolide including: anti-inflammatory (NF-kB inhibition, COX-2 and iNOS suppression), immunomodulatory (enhancement of CD4+ T-cell, NK cell, and macrophage activity), anti-cancer (induction of apoptosis, cell cycle arrest, inhibition of angiogenesis and metastasis in multiple cancer cell lines), hepatoprotective (protection against CCl4, paracetamol, galactosamine, and alcohol-induced liver injury), anti-diabetic (alpha-glucosidase inhibition, insulin sensitization), anti-infective (antibacterial, antiviral, anti-malarial), and cardiovascular (antiplatelet, anti-atherosclerotic). Controlled clinical trials confirmed efficacy for uncomplicated URTI and preliminary evidence for ulcerative colitis, rheumatoid arthritis, and HIV symptom management. The herb was found to be extremely nontoxic even at high doses in animal studies.
Limitations: Narrative review; not a formal systematic review with meta-analysis. Integrates heterogeneous study types (in vitro, in vivo, clinical). Many pharmacological activities demonstrated only in preclinical models.
[13]
Hepatoprotective activity of andrographolide
Study investigating the hepatoprotective activity of andrographolide isolated from Andrographis paniculata against galactosamine and paracetamol (acetaminophen)-induced hepatotoxicity in rats.
Findings: Andrographolide showed significant hepatoprotective activity, with complete normalization of toxin-induced increases in biochemical parameters (ALT, AST, ALP, bilirubin) and significant amelioration of histopathological changes in liver tissue. The hepatoprotective dose was comparable to silymarin (milk thistle extract), a well-established hepatoprotective reference compound. These findings provided pharmacological validation for the traditional Ayurvedic use of Kalmegh as a liver-protective herb.
Limitations: Animal study (rats). Single acute toxicity model. The dose of andrographolide used may not directly translate to clinical dosing. Silymarin comparison was helpful but different preparations may yield different results.
[14]
Safety of Andrographis paniculata: systematic review and meta-analysis of adverse effects
Systematic review and meta-analysis comparing adverse effects of andrographolide derivative medications versus herbal preparations of Andrographis paniculata in clinical studies.
Findings: The review included 262 studies (125 RCTs, 23 non-randomized controlled trials, 6 case series, 108 case reports). Adverse drug reactions of andrographolide derivative medications (particularly injectable forms used in Chinese hospitals) were few but could be life-threatening, mainly gastrointestinal reactions, skin and subcutaneous tissue disorders, and anaphylaxis. Herbal preparations of Andrographis paniculata (oral tablets, capsules, decoctions) were found to be essentially safe, with adverse effects limited to mild gastrointestinal symptoms (nausea, diarrhoea, metallic/bitter taste, abdominal discomfort) at rates comparable to or slightly higher than placebo. The critical distinction was that injectable andrographolide derivative preparations (used in Chinese hospital medicine) carried significantly higher risk of serious adverse reactions than oral herbal preparations.
Limitations: Heterogeneity of included study types and preparations. Many case reports of serious reactions involved injectable preparations not used in Western herbal practice. Variable reporting quality across studies. Publication bias possible.
[15]
Preparations & Dosage
Standardized Extract
Strength: Typical DER (drug-extract ratio) 4:1 to 10:1 depending on manufacturer. Standardized to 10-30% andrographolides (calculated as andrographolide). Kan Jang: each tablet contains SHA-10 extract (85 mg dry extract from A. paniculata leaf, standardized to 5.25 mg andrographolide per tablet).
Commercially prepared standardized dry extracts of Andrographis paniculata aerial parts or leaves, typically manufactured by hydroalcoholic extraction and standardized to a specified andrographolide content (commonly 10-30% andrographolide by weight). Clinical trial preparations include: Kan Jang (SHA-10 extract of A. paniculata with SHE-3 extract of Eleutherococcus senticosus, standardized to 4-5.6 mg andrographolide per tablet), KalmCold (standardized to andrographolide content), and HMPL-004 (used in ulcerative colitis trials). Tablets or capsules containing the standardized extract are the most extensively studied and evidence-based preparation form.
Standardized extract: 300-600 mg of extract standardized to contain 10-30% andrographolides, taken 2-3 times daily (total daily andrographolide dose of approximately 48-120 mg). Kan Jang: 4-6 tablets daily (each containing SHA-10 extract standardized to 4-5.6 mg andrographolide). KalmCold: as per manufacturer guidelines, approximately 200 mg andrographolide equivalents per day. For acute URI: begin treatment within 24-72 hours of symptom onset and continue for 3-7 days.
Two to three times daily, preferably with meals to reduce gastrointestinal discomfort from bitterness
For acute URI: 3-10 days (most clinical trials used 5-7 day courses). For hepatoprotective use: up to 8 weeks. Not traditionally recommended for long-term continuous use due to cold energetics; use for specific indications with defined treatment courses.
Limited pediatric dosing data. One study (Spasov et al. 2004) used Kan Jang in children 4-11 years at reduced dose. Children over 12: half adult dose under practitioner guidance. Not recommended for children under 4 years.
Standardized extracts are the most evidence-based preparation form and the basis for the majority of positive clinical trial data. The distinction between preparations standardized to 'andrographolide' versus 'total andrographolides' (which includes other diterpenoid lactones) is important for accurate dosing. Kan Jang is the best-studied proprietary preparation with the largest body of clinical trial evidence, including multiple double-blind, placebo-controlled trials. When selecting commercial products, look for extract standardization to andrographolide content, third-party testing, and clearly stated dosage in terms of andrographolide per serving. Whole-herb preparations (crude powder capsules) are less reliably dosed and may have lower bioavailability than concentrated standardized extracts.
Tincture
Strength: 1:5, 45-60% ethanol (dried aerial parts). Fresh plant tincture: 1:2, 60-70% ethanol.
Use dried aerial parts (leaves and stems), finely chopped or coarsely powdered. Standard maceration: 1:5 ratio in 45-60% ethanol. Macerate for 2-4 weeks with daily agitation. Press and filter. The higher alcohol content (45-60%) is necessary for effective extraction of lipophilic diterpenoid lactones (andrographolides). Fresh plant tincture: 1:2 ratio in 60-70% ethanol can also be prepared from freshly harvested aerial parts.
2-5 mL (40-100 drops) three times daily for acute conditions. For acute URI: use higher end of dose range (4-5 mL three times daily) for 5-7 days.
Three times daily for acute conditions; twice daily for maintenance/tonic use
Acute conditions: 5-10 days. Not recommended for continuous use beyond 2-3 weeks without practitioner guidance.
Not recommended for children due to alcohol content and intense bitter taste. Use standardized extract capsules or tablets instead.
Tincture is a traditional Western herbal preparation method. The hydroalcoholic solvent system extracts both the lipophilic diterpenoid lactones and water-soluble glycosides. The tincture is extremely bitter -- this bitterness is a quality indicator confirming adequate andrographolide extraction. The intense bitter taste is the main compliance-limiting factor for tincture use. Taking the tincture in a small amount of water or juice, followed by a palate-cleansing drink, can improve tolerability. In professional herbal practice, Andrographis tincture is often combined with other immune-supporting tinctures (Echinacea, Elderberry, Eleutherococcus) to create combination cold-and-flu formulas.
Decoction
Strength: 3-6 g dried herb per 300-400 mL water; Ayurvedic kashaya prepared by volume reduction to 1:4
Use dried aerial parts (leaves and stems), coarsely chopped. Add 3-6 g of dried herb to 300-400 mL of cold water. Bring to a boil, then reduce to a gentle simmer for 10-15 minutes. Strain and drink. The decoction will be intensely bitter. In Ayurvedic practice, a stronger decoction (kashaya) is prepared by boiling until the liquid is reduced to one-quarter of the original volume.
3-6 g dried aerial parts per day, prepared as decoction and taken in 2-3 divided doses. Ayurvedic kashaya: 50-100 mL of concentrated decoction, 2-3 times daily.
Two to three times daily
Acute conditions: 3-7 days. Liver support and digestive use: up to 2-3 weeks.
Not generally recommended for children due to extremely bitter taste. For older children: half adult dose under practitioner guidance.
Decoction is the traditional preparation method in Ayurvedic, Chinese, Thai, and Southeast Asian medicine. Water-based extraction is less efficient for the lipophilic andrographolide compared to alcoholic extraction, but captures water-soluble constituents including neoandrographolide, andrographiside, polysaccharides, and flavonoid glycosides. The resulting decoction is extraordinarily bitter -- this bitterness is therapeutic (bitter tonic effect) but is the primary barrier to patient compliance. Traditional methods to improve palatability include adding honey, jaggery (unrefined sugar), or combining with aromatic spices. In TCM, Chuan Xin Lian is often combined with other heat-clearing herbs (Lonicera japonica, Forsythia suspensa, Isatis tinctoria) in compound formulas rather than used as a single-herb decoction.
[1]
Capsule / Powder
Strength: Crude powder: 500 mg per capsule. Standardized extract capsules: vary by manufacturer, typically 4:1 to 10:1 extract ratio, standardized to 10-30% andrographolides.
Dried aerial parts, finely powdered (ground to pass through a 60-80 mesh sieve), filled into vegetarian or gelatin capsules. Alternatively, spray-dried or freeze-dried standardized extract powder encapsulated. The powdered herb or extract should meet pharmacopeial specifications for andrographolide content (minimum 1.0% total lactones for crude herb per WHO standards).
Crude powdered herb: 1.5-4 g daily in divided doses (3-8 capsules of 500 mg). Concentrated extract capsules: follow manufacturer guidelines for andrographolide standardization, typically 300-600 mg extract 2-3 times daily.
2-3 times daily, taken with meals to reduce gastric irritation
Acute conditions: 5-10 days. Hepatoprotective: up to 4-8 weeks. Not recommended for continuous long-term use without clinical indication.
Not well-established for young children. Adolescents: half adult dose under practitioner supervision.
Capsules are the most practical dosage form for most patients, bypassing the extremely bitter taste that limits compliance with tincture and decoction preparations. The encapsulated form allows precise dosing and is the standard delivery method for most commercial Andrographis supplements. Important quality considerations: products should specify whether they contain crude herb powder or concentrated extract; the plant part used (leaf vs. whole herb); the andrographolide or total andrographolide content per serving; and ideally third-party testing results. Crude herb powder capsules may have lower bioavailability than concentrated extracts due to the intact plant cell matrix.
Fresh Juice / Expressed Juice
Strength: Fresh juice (svarasa); no extraction ratio applicable
In Ayurvedic practice, the fresh juice (svarasa) of Andrographis is considered the most potent preparation form. Fresh aerial parts (leaves and tender stems) are washed, crushed in a mortar or juiced, and the expressed juice is consumed immediately, typically mixed with honey or warm water to partially mask the intense bitterness.
5-15 mL fresh juice, 2-3 times daily
Two to three times daily, on an empty stomach in traditional practice
Acute febrile illness: 3-7 days. Not for long-term continuous use.
Not recommended for children due to extremely bitter taste
Fresh juice is the traditional Ayurvedic first-line preparation for acute conditions, particularly fever and liver complaints. It is considered the most bioavailable form as it delivers the full complement of fresh plant constituents without the losses associated with drying, extraction, or storage. However, the intense bitterness makes compliance very challenging. This preparation is most practical where fresh plants are available (tropical India, Southeast Asia) and is rarely used in Western practice. Fresh leaf juice mixed with honey for fever is a common folk remedy across India and Southeast Asia.
[1]
Safety & Interactions
Class 2b
Not to be used during lactation (AHPA Botanical Safety Handbook)
Contraindications
Andrographis paniculata is contraindicated in pregnancy (AHPA Class 2b). Animal studies have demonstrated anti-fertility and potential abortifacient effects. In mice, daily administration of Andrographis extract prevented pregnancy in all treated animals. The WHO monograph specifically states that Herba Andrographidis should not be used during pregnancy due to potential antagonism with endogenous progesterone and evidence of anti-implantation and abortifacient activity in animal models. These concerns are based on multiple animal studies showing interference with early pregnancy maintenance, anti-progestational effects, and disruption of embryo implantation. Human data is insufficient to characterize the risk, but the consistent animal evidence warrants absolute avoidance during pregnancy.
Allergic reactions to Andrographis paniculata preparations have been documented, including urticaria, pruritus, and in rare cases anaphylaxis. Anaphylactic reactions have been reported primarily with injectable andrographolide derivative preparations used in Chinese hospital settings, but oral preparations can also cause allergic reactions in sensitized individuals. Patients with a history of allergic reaction to any Andrographis-containing product should not use the herb. Cross-reactivity with other Acanthaceae family plants is theoretically possible but not well documented.
Andrographolide inhibits platelet aggregation through multiple mechanisms, including inhibition of thrombin-induced and collagen-induced platelet activation. While clinically significant bleeding from oral Andrographis supplementation alone has not been confirmed in clinical trials, the theoretical risk warrants discontinuation 1-2 weeks before elective surgery. This is a precautionary recommendation consistent with guidelines for herbs with demonstrated antiplatelet pharmacology.
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Warfarin, heparin, and other anticoagulants (Anticoagulants) | moderate | Andrographolide inhibits platelet aggregation through inhibition of thrombin, collagen, ADP, and PAF-induced platelet activation, and suppression of ERK1/2 phosphorylation in platelets. Combined use with anticoagulants could theoretically increase bleeding risk through additive anticoagulant and antiplatelet effects. |
| Aspirin, clopidogrel, and other antiplatelet agents (Antiplatelet agents) | moderate | Additive antiplatelet effect through complementary inhibition of platelet aggregation pathways. Andrographolide inhibits platelet activation through different molecular targets than aspirin (COX-1) or clopidogrel (P2Y12), creating potential for synergistic or additive antiplatelet effects. |
| Antihypertensive medications (ACE inhibitors, ARBs, calcium channel blockers, beta-blockers, diuretics) (Antihypertensives) | minor | Andrographis has demonstrated mild hypotensive effects in healthy subjects and in animal studies. The mechanism may involve vasodilatory action and calcium channel modulation. Additive blood pressure-lowering is theoretically possible. |
| Cyclosporine, tacrolimus, mycophenolate, and other immunosuppressants (Immunosuppressants) | moderate | Andrographis stimulates immune function, including enhanced T-cell activity, NK cell cytotoxicity, and macrophage phagocytosis. This immunostimulant activity could theoretically counteract the effects of immunosuppressive medications used in organ transplant recipients and autoimmune disease patients. |
| Aminophylline and theophylline (Methylxanthine bronchodilators) | moderate | Andrographis paniculata has been shown to inhibit cytochrome P450 1A2 (CYP1A2) in animal studies. Theophylline and aminophylline are metabolized by CYP1A2. Inhibition of this enzyme could reduce clearance and increase plasma levels of these drugs, potentially increasing risk of theophylline toxicity. |
| 5-Fluorouracil and potentially other chemotherapy agents (Antineoplastic agents) | theoretical | In vitro studies in HepG2 cells showed that Andrographis paniculata extracts can modulate cytochrome P450 enzyme expression, potentially altering the metabolism of chemotherapeutic agents. The clinical relevance is uncertain but warrants caution. |
Pregnancy & Lactation
Pregnancy
unsafe
Lactation
insufficient data
Andrographis paniculata is CONTRAINDICATED in pregnancy (AHPA Class 2b). Multiple animal studies have demonstrated anti-fertility, anti-implantation, and potential abortifacient effects. In mice, daily oral administration of Andrographis extract at therapeutic dose equivalents prevented pregnancy in all treated animals over a 6-week study period. The WHO monograph explicitly states that Herba Andrographidis should not be used during pregnancy due to potential antagonism with endogenous progesterone. Potential anti-progestational effects and interference with early pregnancy maintenance have been documented. There are no controlled studies in pregnant women. Women of reproductive age should be counseled about the anti-fertility effects. For lactation: no data on excretion into breast milk. The bitter compounds may theoretically alter milk taste. Due to insufficient safety data, avoidance during breastfeeding is recommended as a precautionary measure unless specifically recommended by a qualified practitioner.
Adverse Effects
References
Monograph Sources
- [1] World Health Organization. Herba Andrographidis. In: WHO Monographs on Selected Medicinal Plants, Volume 2. World Health Organization, Geneva (2002)
- [2] European Medicines Agency, Committee on Herbal Medicinal Products (HMPC). Assessment report on Andrographis paniculata Nees, folium. European Medicines Agency, London (2014)
- [3] Bone K, Mills S. Andrographis. In: Principles and Practice of Phytotherapy: Modern Herbal Medicine, 2nd edition. Churchill Livingstone/Elsevier (2013) : Andrographis monograph chapter
- [4] Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press, Rochester, VT (2003)
Clinical Studies
- [5] Hu XY, Wu RH, Logue M, Blondel C, Lai LYW, Stuart B, Flower A, Fei YT, Moore M, Shepherd J, Liu JP, Lewith G. 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 (2017) ; 12 : e0181780 . DOI: 10.1371/journal.pone.0181780 . PMID: 28783743
- [6] Coon JT, Ernst E. Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. Planta Med (2004) ; 70 : 293-298 . DOI: 10.1055/s-2004-818938 . PMID: 15095142
- [7] Poolsup N, Suthisisang C, Prathanturarug S, Asawamekin A, Chanchareon U. Andrographis paniculata in the symptomatic treatment of uncomplicated upper respiratory tract infection: systematic review of randomized controlled trials. J Clin Pharm Ther (2004) ; 29 : 37-45 . DOI: 10.1046/j.1365-2710.2003.00534.x . PMID: 14748896
- [8] Caceres DD, Hancke JL, Burgos RA, Sandberg F, Wikman GK. 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 : 217-223 . DOI: 10.1016/S0944-7113(99)80012-9 . PMID: 10511854
- [9] Saxena RC, Singh R, Kumar P, Yadav SC, Negi MPS, Saxena VS, Joshua AJ, Vijayabalaji V, Goudar KS, Venkateshwarlu K, Amit A. A randomized double blind placebo controlled clinical evaluation of extract of Andrographis paniculata (KalmCold) in patients with uncomplicated upper respiratory tract infection. Phytomedicine (2010) ; 17 : 178-185 . DOI: 10.1016/j.phymed.2009.12.001 . PMID: 20092985
- [10] Gabrielian ES, Shukarian AK, Goukasova GI, Chandanian GL, Panossian AG, Wikman G, Wagner H. 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) ; 9 : 589-597 . DOI: 10.1078/094471102321616391 . PMID: 12487322
- [11] Hancke JL, Burgos RA, Caceres DD, Wikman G. A double-blind study with a new monodrug Kan Jang: decrease of symptoms and improvement in the recovery from common colds. Phytother Res (1995) ; 9 : 559-562 . DOI: 10.1002/ptr.2650090804
- [12] Melchior J, Palm S, Wikman G. Controlled clinical study of standardized Andrographis paniculata extract in common cold -- a pilot trial. Phytomedicine (2000) ; 7 : 341-350 . DOI: 10.1016/S0944-7113(00)80053-7 . PMID: 11081985
Traditional Texts
- [13] Jayakumar T, Hsieh CY, Lee JJ, Sheu JR. Experimental and Clinical Pharmacology of Andrographis paniculata and Its Major Bioactive Phytoconstituent Andrographolide. Evid Based Complement Alternat Med (2013) ; 2013 : 846740 . DOI: 10.1155/2013/846740 . PMID: 23634174
- [14] Handa SS, Sharma A. Hepatoprotective activity of andrographolide against galactosamine and paracetamol intoxication in rats. Indian J Med Res (1990) ; 92 : 284-292 . PMID: 2228075
- [15] Panossian A, Brendler T. Adverse Effects of Andrographolide Derivative Medications Compared to the Safe Use of Herbal Preparations of Andrographis paniculata: Results of a Systematic Review and Meta-Analysis of Clinical Studies. Front Pharmacol (2022) ; 13 : 773282 . DOI: 10.3389/fphar.2022.773282 . PMID: 35250555
Pharmacopeias & Reviews
- [16] World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 2. World Health Organization, Geneva (2002)
- [17] Indian Pharmacopoeia Commission. Indian Pharmacopoeia: Andrographis paniculata monograph. Indian Pharmacopoeia Commission, Ghaziabad (2014)
- [18] National Pharmacopoeia Committee of China. Pharmacopoeia of the People's Republic of China, Volume I: Chuan Xin Lian (Andrographis Herba). China Medical Science Press, Beijing (2020)
- [19] Department of Medical Sciences, Ministry of Public Health, Thailand. Thai Herbal Pharmacopoeia: Andrographis paniculata. Department of Medical Sciences, Nonthaburi, Thailand (2019)
Last updated: 2026-03-02 | Status: review
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