India Herbs

Scientific Name
Centella asiatica, Hydrocotyle asiatica

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Common Name
Indian pennywort, hydrocotyle, mandukaparni, madecassol, TECA, centelase, tsubo-kusa, luei gong gen, idrocotyle, kaki kuda

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Clinical Summary
Extracts from the leaf and the entire plant are used for a variety of conditions including venous insufficiency, varicose veins, wound healing, scleroderma, and scars. There is a significant amount of in vitro data, but few human studies. Several trials demonstrate a reduction in lower extremity edema with gotu kola as compared to placebo for patients with chronic venous insufficiency (4) (7) (8). It is thought to act on connective tissue, increasing collagen formation and glycosaminoglycan synthesis, and act as an anti-inflammatory. Possible adverse effects include headache, contact dermatitis, pruritus, and elevations in blood glucose. There are no known drug interactions, but gotu kola theoretically may interact with hypoglycemic agents.

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Purported uses
Burns
Cancer treatment
Circulatory disorders
GI disorders
Hypertension
Memory loss
Psoriasis
Scars
Sedation
Varicose veins
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Constituents
Amino Acids: Alanine and serine (major components)
Terpenoids: Triterpenes, asiaticoside, brahmoside and brahminoside (saponin glycosides), aglycones, asiaticentoic acid, centellic acid, centoic acid and madecassic acid
Sesquiterpenes: Caryophyllene, trans-B-farnesene
Volatile Oils: Germacrene D
Alkaloid: Hydrocotylin
Flavones: Quercetin, kaempferol, sesquiterpenes, stigmasterol, and sitosterol
Other Constituents: Vallerine, fatty acids, resin, and tannins

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Mechanism of Action
The triterpenoids are considered to be the active constituents in gotu kola. They seem to be involved in wound healing and decreasing venous pressure in venous insufficiency. The glycoside madecassoside has anti-inflammatory properties, while asiaticoside appears to stimulate wound healing by stimulating collagen and glycosaminoglycan synthesis. The asiaticosides might also elevate blood glucose and cholesterol levels. There is preliminary evidence that gotu kola might be beneficial in Alzheimer’s disease, act as a sedative, and have analgesic properties.

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Herb-Drug Interactions
Hypoglycemics / Insulin: Theoretically gotu kola may interfere with blood glucose levels.
Anti-hyperlipidemics: Theoretically gotu kola may interfere with cholesterol lowering agents.

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Literature Summary and Critique
Bradwejn J, et al. A double-blind placebo-controlled study on the effects of gotu kola on acoustic startle response in healthy subjects. J Clin Psychopharmacol 2000;20:680-4.
An evaluation of the effects of gotu kola on the acoustic startle response (ASR) in humans. Subjects were randomly assigned to receive either a single 12 g orally administered dose of gotu kola (n=20) or placebo (n=20). Gotu kola significantly attenuated the peak ASR amplitude 30 and 60 minutes after treatment.

Pointel JP, et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiology 1987;38:46-50.
Ninety-four patients suffering from venous insufficiency of the lower limbs participated in a multicenter, double-blind placebo-controlled study. After randomization, they were allotted for a treatment period of two months to one of three groups: TECA 120 mg/day, TECA 60 mg/day, or placebo. A significant improvement in the symptoms of heaviness in the lower limbs and edema, as well as in the overall evaluation by the patient, was reported for the TECA groups. The venous distensibility measured by mercury strain gauge plethysmograph at three occlusion pressures was improved for the TECA groups, but aggravated for the placebo group.

Chronic venous insufficiency:
In a randomized, controlled trial, 94 patients with venous insufficiency were assigned to take either (1) 120 mg/day of gotu kola, (2) 60 mg/day of gotu kola, or (3) a placebo pill. After two months, people who were taking gotu kola, regardless of the dose, had an improvement in the symptoms of heaviness and edema (swelling) in their legs compared to people taking the placebo pill. In addition, people taking gotu kola had better venous tone than people taking the placebo.

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References
Newall CA, et al. Herbal Medicines: A Guide for Health-Care Professionals. London: The Pharmaceutical Press; 1996.
DerMarderosian A, editor. The Review of Natural Products. St. Louis: Facts and Comparisons; 1999.
Brinkhaus B, et al. Chemical, pharmacological and clinical profile for the East Asian medical plant Centella asiatica. Phytomedicine 2000;5:427-48.
Pointel JP, et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiology 1987;38:46-50.
Pizzorno JE, et al. Textbook of Natural Medicine, 2nd ed. New York: Churchill Livingston; 1999.
Bradwein J, et al. A double-blind, placebo-controlled study on the effects of gotu kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol 2000;20:680-4.
Cesarone MR, et al. Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology 2001;52(Suppl 2):S15-18.
Cesarone MR, et al. Evaluation of treatment of diabetic microangiopathy with total triterpenic fraction of Centella asiatica: a clinical prospective randomized trial with a microcirculatory model. Angiology 2001;52(Suppl 2):S49-54.

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