Andrographis is commonly found in many herbal ‘immune’ formulas throughout Australia. The TGA permits supplements containing the herb to mention benefits such as ‘support healthy immune system function’, and  ‘relieve symptoms of common colds and flu’. And many of these products refer to the herb defending, shielding or protecting the immune system in their names and marketing.

Is this reputation warranted? Well, yes… Andrographis has a long history of supporting immune function via its use in traditional Chinese medicine (TCM), Ayurvedic medicine, and healing practices throughout Asia.[1] In addition to traditional use, many research groups have concluded positive results against colds, flus and respiratory infections, including COVID-19.[2][3][4][5][6]

But is there more to this herb than just an ability to support immune function? Can it positively impact other human body systems and health conditions? And how can we safely utilise this ancient medicinal herb? Let’s find out!

 Figure 1. Andrographis paniculata

A variety of traditional uses

Andrographis has been used for centuries throughout Asia for the treatment of various ailments.       Table 1. Medicinal uses of Andrographis paniculata[7][8][9][10][11][12]

Gut health: While this herb is known by at least 35 different names in a variety of Asian languages[13], it is also known by the moniker ‘King of Bitters’, due to its strong elemental taste. Bitter herbs stimulate bitter receptors throughout the digestive tract and trigger enhanced digestion via increased output of saliva, stomach acid, bile, and others digestive enzymes. All of these digestive juices help the gut break food down, allowing for better absorption of nutrients. Many of us have heard the old saying “you are what you eat”, but its less-well known modification by gut health experts: “you are what you absorb”, talks to the importance of proper digestion and absorption. Bitter herbs certainly help in this regard, and of the many bitters used by herbal medicine practitioners, andrographis is lauded as the ‘King’!

Indeed, recent research has looked to explore this characteristic, aiming to confirm protective effects of andrographis and its constituents on the gastrointestinal tract. Animal studies have shown that andrographolide, one of the herbs main chemical constituents, alleviates pathological damage leading to stomach ulcers caused by ethanol and non-steroidal anti-inflammatory drugs (NSAIDs).[14][15][16]

Andrographolide and its derivatives have also shown similar benefits in animal models of ulcerative colitis (UC), dramatically reducing disease activity and mortality,[17] backing up previous trials reporting protective effects in UC.[18][19][20] In addition to these, a human trial compared andrographis extract to the conventional UC medication mesalazine for 8 weeks.[21] Results indicated comparable symptom reduction: 56% reduction for andrographis vs 59% reduction with mesalazine. Furthermore, a minimum of 25% mucosal healing (observed through colonoscopy) was achieved in 53% of the andrographis group vs 40% in the mesalazine group.

Anti-inflammatory activity: Related to the above-mentioned gut health aspects are the herb’s anti-inflammatory effects. Several chemical constituents, including andrographolide, suppress the release of inflammatory cytokines including TNF-α as well as interleukins and interferons, stimulated by influenza virus.[22] They inhibit a signalling pathway, which is crucial to the initiation of inflammatory processes throughout the body. They also downregulate another inflammatory pathway, responsible for hundreds of interferon-stimulated genes. This pathway also plays a critical role in the initiation of inflammation in the lungs.[23][24]

A diverse human cell-based study sought to examine the effects of andrographis leaves on lipopolysaccharide-induced inflammatory markers including nitric oxide, prostaglandin E2, interleukin-1β, interleukin-6, leukotriene B4 and thromboxane B2.[25] The authors concluded that andrographis attenuates inflammation by inhibiting pro-inflammatory, inflammatory, and allergic mediators.

And a randomized placebo-controlled clinical trial performed on rheumatoid arthritis (RA) patients with active disease, administered an andrographis extract 3 times daily for 14 weeks.[26] The results revealed that andrographis was effective in relieving RA symptoms, as well as reducing rheumatoid factor. What’s more, the authors reported the treatment had a good safety profile.

Antioxidant: Andrographis has also shown potent antioxidant properties in a variety of research models.[27] Andrographolide blocks hyperglycemia-triggered reactive oxygen species (ROS) and ameliorates diabetic cardiomyopathy in mice by augmenting Nrf2 expression.[28] The NrF2 protein regulates expression of antioxidant enzymes which protect us against oxidative stress.[29]

Andrographolide-induced Nrf2 expression modulated enzymes in the glutathione antioxidant system and led to enhanced redox status of human liver cell lines.[30] The authors claimed that andrographolide may play a crucial role in modulating antioxidant defenses in oxidative stress-induced diseases such as diabetes.

Furthermore, andrographolide has also demonstrated strong antioxidant effects in cardiovascular[31] and respiratory[32][33] diseases, as well as in arthritis.[34]

Safe use of andrographis

So, as we can see, andrographis is quite a versatile herb! Prized by traditional healers for centuries, modern researchers are now discovering its power through scientific trials. But, as with all medicines, herbal and pharmaceutical, andrographis should be used with care. A 2020 systematic review and meta-analysis of oral monotherapy andrographis, found that although serious adverse events (AEs) were very rare, the incidence of non-serious AEs was common.[35] The authors stated that although the herb was generally safe, prospective users should be thoroughly advised and closely monitored for common AEs.

Safety guidelines associated with andrographis:

• Andrographis is not recommended for children
• Andrographis is not recommended for pregnant or lactating women
• If you have an autoimmune condition speak to your health practitioner before using andrographis
• If you take pharmaceutical medications seek your health practitioner’s advice on whether andrographis is safe to take alongside your medications
• Always read the label and follow the directions for use. Ensure you read the warnings on products before purchase
• If you have allergies or have experienced one or more anaphylactic reactions, speak to your health practitioner on whether andrographis is right for you

If you’re not under the guidance of a health practitioner, but are curious about trying andrographis, speak to your local doctor, pharmacist or naturopath before taking this herb. Professional guidance and informed decision-making best supports your health.

If andrographis does become part of your health regime, rest in the knowledge that you’re taking an ancient medicinal herb that has been carefully cultivated and utilised with wisdom by the traditional healers of many lands,  for centuries.

[1] Hossain MS, Urbi Z, Sule A, Rahman KH. Andrographis paniculata (Burm. f.) Wall. ex Nees: a review of ethnobotany, phytochemistry, and pharmacology. The Scientific World Journal. 2014;2014(1):274905.

[2] Saxena RC, Singh R, Kumar P, Yadav SC, Negi MP, 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 Mar;17(3-4):178-85. doi: 10.1016/j.phymed.2009.12.001. Epub 2010 Jan 25. PMID: 20092985.

[3] Hu X-Y, Wu R-H, Logue M, Blondel C, Lai LYW, Stuart B, et al. (2017) Andrographis paniculata (Chuān Xīn Lian) for symptomatic relief of acute respiratory tract infections in adults and children: A systematic review and meta-analysis. PLoS ONE 12(8): e0181780. https://doi.org/10.1371/journal.pone.0181780

[4] Canessa C. Andrographis paniculata (Burm. f.)(Nees) and Infection A Critical Review to assess the efficacy of Andrographis paniculata (Burm. f.)(Nees) in the prevention and treatment of infections.

[5] Shanker K, Rangnekar H, Wele A, Soni P, Gaikwad P, Pal A, Bawankule DU, Chanda D. A randomized controlled pilot study of add-on therapy of CIM-MEG19 (standardized Andrographis paniculata formulation) in mild to moderate COVID-19. Phytomedicine Plus. 2023 Feb 1;3(1):100398.

[6] Benjaponpitak A, Sawaengtham T, Thaneerat T, Wanaratna K, Chotsiri P, Rungsawang C, Bhubhanil S, Charoensuk S, Benjaponpitak S, Lapmanee S, Sirinavin S. Effect of Andrographis paniculata treatment for patients with early-stage COVID-19 on the prevention of pneumonia: A retrospective cohort study. medRxiv. 2023 Mar 18:2023-03.

[7] Chopra RN. Glossary of Indian Medicinal Plants.

[8] Jarukamjorn K, Kondo S, Chatuphonprasert W, Sakuma T, Kawasaki Y, Nemoto N. Gender-associated modulation of inducible CYP1A1 expression by andrographolide in mouse liver. European Journal of Pharmaceutical Sciences. 2010 Mar 18;39(5):394-401.

[9] Saxena S, Jain DC, Bhakuni RS, Sharma RP. Chemistry and pharmacology of Andrographis species. Indian drugs. 1998;35(8):458-67.

[10] Perry LM, Metzger J. Medicinal plants of East and Southeast Asia: attributed properties and uses. 1980.

[11] Panossian A, Davtyan T, Gukassyan N, Gukasova G, Mamikonyan G, Gabrielian E, Wikman G. Effect of andrographolide and Kan Jang–fixed combination of extract SHA-10 and extract SHE-3–on proliferation of human lymphocytes, production of cytokines and immune activation markers in the whole blood cells culture. Phytomedicine. 2002 Jan 1;9(7):598-605.

[12] 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. Journal of Clinical Pharmacy and Therapeutics. 2004 Feb;29(1):37-45.

[13] Hossain MS, Urbi Z, Sule A, Rahman KH. Andrographis paniculata (Burm. f.) Wall. ex Nees: a review of ethnobotany, phytochemistry, and pharmacology. The Scientific World Journal. 2014;2014(1):274905.

[14] Saranya P, Geetha A, Selvamathy SN. A biochemical study on the gastroprotective effect of andrographolide in rats induced with gastric ulcer. Indian journal of pharmaceutical sciences. 2011 Sep;73(5):550.

[15] Yao H, Wu Z, Xu Y, Xu H, Lou G, Jiang Q, Fan W, Liu W, Zheng C, Gao Y, Wang Y. Andrographolide attenuates imbalance of gastric vascular homeostasis induced by ethanol through glycolysis pathway. Scientific Reports. 2019 Mar 21;9(1):4968.

[16] Liu YH, Zhang ZB, Zheng YF, Chen HM, Yu XT, Chen XY, Zhang X, Xie JH, Su ZQ, Feng XX, Zeng HF. Gastroprotective effect of andrographolide sodium bisulfite against indomethacin-induced gastric ulceration in rats. International immunopharmacology. 2015 Jun 1;26(2):384-91.

[17] Zhang L, Cao N, Wang Y, Wang Y, Wu C, Cheng X, Wang C. Improvement of oxazolone-induced ulcerative colitis in rats using andrographolide. Molecules. 2019 Dec 24;25(1):76.

[18] Jing M, Wang Y, Xu L. Andrographolide Derivative AL‐1 Ameliorates Dextran Sodium Sulfate‐Induced Murine Colitis by Inhibiting NF‐κB and MAPK Signaling Pathways. Oxidative Medicine and Cellular Longevity. 2019;2019(1):6138723.

[19] Yang Y, Yan H, Jing M, Zhang Z, Zhang G, Sun Y, Shan L, Yu P, Wang Y, Xu L. Andrographolide derivative AL-1 ameliorates TNBS-induced colitis in mice: involvement of NF-кB and PPAR-γ signaling pathways. Scientific Reports. 2016 Jul 20;6(1):29716.

[20] Kim N, Lertnimitphun P, Jiang Y, Tan H, Zhou H, Lu Y, Xu H. Andrographolide inhibits inflammatory responses in LPS-stimulated macrophages and murine acute colitis through activating AMPK. Biochemical Pharmacology. 2019 Dec 1;170:113646.

[21] Tang T, Targan SR, Li ZS, Xu C, Byers VS, Sandborn WJ. Randomised clinical trial: herbal extract HMPL‐004 in active ulcerative colitis–a double‐blind comparison with sustained release mesalazine. Alimentary pharmacology & therapeutics. 2011 Jan;33(2):194-202.

[22] Verweij MC, Wellish M, Whitmer T, Malouli D, Lapel M, Jonjić S, Haas JG, DeFilippis VR, Mahalingam R, Früh K. Varicella viruses inhibit interferon-stimulated JAK-STAT signaling through multiple mechanisms. PLoS pathogens. 2015 May 14;11(5):e1004901.

[23] Cai W, Chen S, Li Y, Zhang A, Zhou H, Chen H, Jin M. 14-Deoxy-11, 12-didehydroandrographolide attenuates excessive inflammatory responses and protects mice lethally challenged with highly pathogenic A (H5N1) influenza viruses. Antiviral research. 2016 Sep 1;133:95-105.

[24] Ding Y, Chen L, Wu W, Yang J, Yang Z, Liu S. Andrographolide inhibits influenza A virus-induced inflammation in a murine model through NF-κB and JAK-STAT signaling pathway. Microbes and infection. 2017 Dec 1;19(12):605-15.

[25] Chandrasekaran CV, Gupta A, Agarwal A. Effect of an extract of Andrographis paniculata leaves on inflammatory and allergic mediators in vitro. Journal of ethnopharmacology. 2010 May 27;129(2):203-7.

[26] Burgos RA, Hancke JL, Bertoglio JC, Aguirre V, Arriagada S, Calvo M, Cáceres DD. Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. Clinical rheumatology. 2009 Aug;28:931-46.

[27] Mussard E, Cesaro A, Lespessailles E, Legrain B, Berteina-Raboin S, Toumi H. Andrographolide, a natural antioxidant: An update. Antioxidants. 2019 Nov 20;8(12):571.

[28] Liang E, Liu X, Du Z, Yang R, Zhao Y. Andrographolide Ameliorates Diabetic Cardiomyopathy in Mice by Blockage of Oxidative Damage and NF‐κB‐Mediated Inflammation. Oxidative Medicine and Cellular Longevity. 2018;2018(1):9086747.

[29] Ngo V, Duennwald ML. Nrf2 and oxidative stress: A general overview of mechanisms and implications in human disease. Antioxidants. 2022 Nov 27;11(12):2345.

[30] Khole S, Mittal S, Jagadish N, Ghosh D, Gadgil V, Sinkar V, Ghaskadbi S. Andrographolide enhances redox status of liver cells by regulating microRNA expression. Free Radical Biology and Medicine. 2019 Jan 1;130:397-407.

[31] Wu T, Peng Y, Yan S, Li N, Chen Y, Lan T. Andrographolide ameliorates atherosclerosis by suppressing pro-inflammation and ROS generation-mediated foam cell formation. Inflammation. 2018 Oct;41:1681-9.

[32] Peng S, Gao J, Liu W, Jiang C, Yang X, Sun Y, Guo W, Xu Q. Andrographolide ameliorates OVA-induced lung injury in mice by suppressing ROS-mediated NF-κB signaling and NLRP3 inflammasome activation. Oncotarget. 2016 Dec 12;7(49):80262.

[33] Yin JN, Li YN, Gao Y, Li SB, Li JD. Andrographolide plays an important role in bleomycin-induced pulmonary fibrosis treatment. International Journal of Clinical and Experimental Medicine. 2015;8(8):12374.

[34] Luo S, Li H, Liu J, Xie X, Wan Z, Wang Y, Zhao Z, Wu X, Li X, Yang M, Li X. Andrographolide ameliorates oxidative stress, inflammation and histological outcome in complete Freund’s adjuvant-induced arthritis. Chemico-biological interactions. 2020 Mar 1;319:108984.

[35] Worakunphanich W, Thavorncharoensap M, Youngkong S, Thadanipon K, Thakkinstian A. Safety of Andrographis paniculata: A systematic review and meta‐analysis. Pharmacoepidemiology and Drug Safety. 2021 Jun;30(6):727-39.