Does it work?

Can Andrographis cure the common cold?

BACKGROUND

The cold and flu season brings a never-ending search for remedies that really relieve. With the need to avoid inappropriate prescribing of antibiotics, many are looking to natural remedies. One herb that has generated interest across Europe is Andrographis paniculata, also called Kalmegh. This Asian herb is extremely bitter, leading to names in various languages that literally mean “king of bitters” or “bile of the earth”. The plant is widely grown across southern Asia where it is used in many medicinal preparations. Traditionally it has most commonly been used for conditions like digestive problems, jaundice and various infections.

Widespread use of Andrographis for fevers and infections has led to considerable scientific interest in the herb from Indian and Chinese researchers. Numerous different compounds have been isolated which have biological effects in animals and humans. Interestingly, it is not very active against bacteria and viruses, with most research suggesting it acts by stimulating the immune system. The most widely tested remedy was developed by the Swedish Herbal Institute and is called Kan Jang, a standardised extract of Andrographis.

EVIDENCE FROM STUDIES

At least eight controlled trials have been published on Andrographis for the treatment of cold and flu, known medically as an upper respiratory infection (URI). Almost all of these used Kan Jang with its manufacturer collaborating in the studies. While this is often how research gets funded, independent confirmation of the results would be helpful.

Of the eight studies, seven found that people did better while taking Andrographis than with placebo. However, the improvements were rated as “small” in five of the studies, and “moderate” in two. A very small difference was sometimes detected between the two groups after two days, with the biggest differences occurring after four to five days. Very few studies lasted longer than this, but in one the symptoms were the same again in both groups at day seven. While most of the studies were relatively large, many of them had at least one important weakness, such as not being randomised or not using a placebo group. In a few cases, people received Siberian ginseng in addition to Andrographis.

Only one study has been published on the use of Andrographis to prevent URI. In this, people were randomly assigned to take 200mg Kan Jang daily or placebo. The two groups did not differ during the first two months, but in the third month those taking Andrographis had significantly few URIs.

PROBLEMATIC ASPECTS

Most adverse effects are mild and short-lasting, including headache, fatigue, diarrhoea and nausea. However, a number of allergic reactions have occurred, one of which led to anaphylactic shock and death. Care is therefore needed by those who tend to be allergic to plants. Most of the studies to date have lasted only several days, so there is no information about potential problems from long-term use of Andrographis.

RECOMMENDATIONS

Overall, there is a small but growing body of evidence showing that Andrographis does help reduce the severity of colds and flu, but not cure them completely. Also, the duration of the symptoms was not shortened.

The evidence on using the herb to prevent colds and flu is much weaker. Although the one study conducted on this found benefits after three months, more research is needed to confirm this result. Given the less than ideal design of many of the studies, further research is needed. However, the results to date show that Andrographis may bring some people welcome relief.

Dónal O'Mathúna has a PhD in pharmacy, researching herbal remedies, and an MA in bioethics, and is a senior lecturer in the School of Nursing, Dublin City University. He is author of Alternative Medicine: The Christian Handbook, Updated and Expanded Edition, Zondervan, 2007