English: Green chiretta, creat
Hindi: Kalmegh
Sanskrit: Bhunimba

Kalmegh has been used over many centuries as a household remedy specifically for jaundice and fevers, especially the intermittent type. It is a component of over 50% of the multi-ingredient herbal formulations available in India for the treatment of liver ailments and many books on Indian material medical equate the therapeutic applications of the plant with those of chiretta, Sweetie chirata (qv).

Habitat

The herb is found on plains and in forests throughout India, especially the south, and in other tropical Asian countries. It grows abundantly in shady and moist places.

Botanical description

An erect, branched, annual herb with dark green stems, growing up to 1 m in height (Plate 7). Leaves glabrous, about 8 cm long and 2.5 cm broad, lanceolate and pinnate. Flowers are small, whitish or pale pink, with brown or purple blotches, in loose spreading axillary and terminal pannicles. Capsules linear or oblong, containing numerous seeds which are subquadrate and yellowish-brown in colour.

Parts used

Whole plant, leaves and roots.

Traditional and modern use

Kalmegh is used mainly for liver disorders and jaundice. A decoction or infusion of leaves is used in general debility and dyspepsia and a tincture of the root as a tonic, stimulant and aperient. The macerated leaves and juice, together with carminative spices such as cardamom, clove and cinnamon, may be made into pills and prescribed for gripe and other stomach ailments in infants. The leaves and roots also find use as an antispasmodic, febrifuge, stomachic, alterative, anthelmintic anodyne, antiseptic, laxative, astringent, and antipyretic and have been used as an adjunct in the treatment of diabetes, malaria, cholera, dysentery, enteritis, gastritis, pneumonia, pyelonephritis and even rabies. It is also a major constituent of switradilepa, an Ayurvedic preparation which is used to treat vitiligo.

Ethnoveterinary usage

The juice of the stem, and the whole plant, are used to treat diarrhoea, Newcastle disease and respiratory problems in poultry.! The plant, especially the leaves, has been used to treat dhatoora (datura) poisoning, maggots in wounds, worms in the eye and abdomen, liver fluke, glossitis, holes in the hard palate, constipation, tuberculosis, pneumonia, leeches in the nostrils, contagious abortion, retention of placenta, tetanus and scabies.

Major chemical constituents Diterpenes

Andrographolide is the major component, with neoandrographolide, deoxyandrographolide and various derivatives, andrographiside, andropanoside, andrographin and panicolin also present.

Flavonoids

5-Hydroxy-2',7,8-trimethoxy flavone, 2',5¬dihydroxy- 7 ,8-dimethoxyflavone, apigenin-4',7 -dimethylether, 5-hydroxy-7,8¬dimethoxyflavanone and others.4 The roots contain apigenin-7 -4' -di-O-methyl ether and 5-hydroxy-7,8,2',3' -tetramethoxy flavone.

Medicinal and pharmacological activities

Antiviral activity: A dry extract of A. paniculata was shown to have some efficacy in the initial treatment of common cold and sinusitis, decreasing the symptoms and shortening their duration.6.7 Dehydroandrographolide succinic acid monoester inhibited the human immunodeficiency virus (HIV) in vitro. The methanolic extract of the leaves also exhibited activity in HIV-l infected MT-4 cells and suppressed the formation of syncytia in co-cultures of MOLT-4 and MOLT-4/HIV-l cells.

Anthelmintic activity: An alcoholic extract showed in vitro anthelmintic action against human Ascaris lumbricoides.

Antidiarrhoeal activity: The alcoholic extract exhibited significant activity against diarrhoea induced by Escherichia coli enterotoxins in animal models. Andrographolide and neoandrographolide showed activity similar to that of lope amide against E. coli LT and LT/ST enterotoxins and andrographolide was found to be superior against enterotoxin-induced neonatal diarrhoea.

Antimalarial activity: An ethanolic extract, fractions and pure isolated compounds were studied in a 4-day suppressive test against Plasmodium berghei NK 65 in Mastomys natalensis. The ethanolic extract suppressed the level of parasites in a dose-dependent manner and 15 days' administration of neoandrographolide before infection also suppressed parasitaemia.

Antiplatelet aggregation activity: The crude extract of Andrographis paniculata inhibited platelet aggregation, being more potent than ligustrazine and persantin in vitro. Efficient absorption of the extract was assumed since rapid effects were observed in vivo, suggesting a potential use in the treatment of thrombotic diseases. A study carried out on 63 patients with cardiac and cerebral vascular diseases, where the extract was administered and observations made after 3 hours and/or 1 week, found ADP-induced aggregation to be significantly delayed. The release of both dense and a granules from platelets was inhibited and a dilation of the canalicular system observed; the mechanism of action was attributed to a rise in the platelet cAMP level. Similar results were observed with an N administered flavone extract of the roots, where development of thrombi and myocardial infarction were prevented.

Antipyretic activity: Oral administration of the juice of Andrographis paniculata normalised induced pyrexia conditions in experimental rats. ,. This activity was shown to be due in part to the ability of andrographolide to inhibit tumour necrosis factor (TNF)-a- induced intercellular adhesion molecule-1 (ICAM-1) and endothelial-monocyte adhesion.

Antiatherosclerotic activity: A. paniculata alleviated atherosclerotic artery stenosis induced by both de-endothelialisation and a high cholesterol diet, as well as lowering the restenosis rate after experimental angioplasty.

Cardiovascular activity: Polar extracts of A. paniculata produced a significant fall in the mean arterial blood pressure of anaesthetised rats. The most active n-butanol fraction appeared to act through a-receptors, autonomic ganglion and histaminergic receptors.

Induction of cell differentiation: The methanolic extract of the aerial parts exhibited potent cell differentiation, inducing activity on mouse myeloid leukaemia cells.

Hepatoprotective activity: Significant, dose¬dependent protection by andrographolide was observed using an in vitro preparation of isolated rat hepatocytes and both andrographiside and neoandrographolide exhibited a protective action equal to that of silymarin in liver damage induced by carbon tetrachloride or tert-butylhydroperoxide in mice. Andrographolide was also effective in an in vivo system against galactosamine and paracetamol-induced hepatotoxicity in rats, The ethanolic extract of the plant, and andrographolide and neoandrographolideat a dose of 6 mg/kg/day for 2 weeks, protected against hepatic damage induced by Plasmodium berghei K -173 in Mastomys natalensis. All reduced the levels of serum lipoprotein- X, alkaline phosphatase, GOT, GPT and bilirubin, as well as lipid peroxidation products, and facilitated the recovery of superoxide dismutase and glycogen in the liver. An aqueous extract of kalmegh also improved biliary flow in rats, increased liver weight and decreased the duration of action of hexabarbital in hepatotoxicity induced by CCl4, tetracycline and isoniazide. Clinically, a decoction of the plant administered to patients with infectious hepatitis produced significant symptomatic relief, with a marked decrease in serum bilirubin, thymol turbidity, alkaline phosphatase, SGOT, SGPT and serum globulin fraction of protein. Eighty percent of ' the patients experienced symptomatic relief' and 20% showed some improvement.

Hypoglycaemic activity : : A water extract prevented hyperglycaemia induced by oral administration of glucose, possibly by preventing the absorption of glucose from the gut.

Hypotensive activity: The aqueous extract exhibited a dose-dependent, hypotensive effect on the systolic blood pressure of spontaneously hypertensive rats, thought to be due to reducing circulating angiotensin-converting enzyme (ACE) as well as reducing free radical levels in the kidneys.

lmmunomodulator activity: The ethanolic extract and some isolated compounds induced significant stimulation of antibody and delayed-type hypersensitivity response to sheep RBC in mice. The non-specific immune response was also stimulated.

Filaricidal activity: An aqueous decoction of the leaves killed the microfilaria of Dipetalonema reconditum in 40 minutes in vitro and subcutaneous injections in infected dogs reduced the level of microfilariae in blood by more than 85%.