Asian Herb “Green Chiretta” treats Covid-19 in Thailand

Green Chiretta (Andrographis paniculata) or locally known as “Fah Talai Jone”, is the medicinal Herb that has become more widespread during the COVID-19 crisis. In late December 2020, the Ministry of Public Health of Thailand approved a pilot study of the consumption of this Southern Asian Herb to treat the early symptoms and reduce the severity of the COVID-19 situation in the country. Initially, the treatment was available at five state-owned hospitals on a voluntary basis for people within 18 to 60 years old with minor COVID-19 symptoms.

It was reportedly given to patients within 72 hours of symptom onset. This approval comes amid an escalation of COVID-19 infections in the country. As of 28th January 2021, the country had 16,221 cases of COVID-19 in a total population of about 70 million.

“Fah Talai Jone”—literally means “the king of bitters”. This is a small annual Plant. In India’s traditional holistic medical system of Ayurveda, the Plant’s dried leaves and shoots are consumed for cough, bronchitis, diarrhoea, dyspepsia (indigestion), inflammation, fever, and skin diseases. In traditional Chinese medicine, the Plant has been applied to treat the inflammatory diseases of the colon, cough, fever, dysentery, influenza, and sore throat. Modern studies have focused on Green Chiretta’s potential benefits for respiratory and digestive conditions.

Recent studies about Green Chiretta

In late June of 2020, The Nation Thailand announced that phase 1 of the Thai research initiative on Green Chiretta for COVID-19 had started at two hospitals in Thailand. In this preceding trial, patients received the Plant extracted capsules if they were verified to be infected with COVID-19 and had mild to moderate symptoms, including coughing and fever, lasting no more than 72 hours. Six volunteers reportedly received 60 mg, or the normal dose of Green Chiretta extract capsules, three times per day, while another six volunteers received 100 mg, or five times the normal dose, three times per day.

The Department of Thai Traditional and Alternative Medicine signed a Memorandum of understanding (MoU) with the Department of Medical Sciences and the Government Pharmaceutical Organisation (GPO) on 25th February for a laboratory experiment. Under the contract, the Institute of Biological Products conducted the test. They put the ground dried leaves and the Plant extraction in the capsule.

In late August of 2020, the research team reported that the lower dose of Green Chiretta showed benefits in the initial trial, especially for coughing. Within three days, both cough volume and overall symptom severity reportedly reduced significantly. After five days, other symptoms improved too, and real-time polymerase chain reaction (PCR) tests showed negative for the COVID-19 virus in two patients. After three weeks, real-time PCR tests were negative in all six subjects, but the authors reminded that additional studies were needed to confirm the results.

In a study published in November 2020, researchers selected 122 Thai natural products among these 114 medicinal Plant extracts and eight purified compounds for activity against SARS-CoV-2, the virus that causes COVID-19. Among six selected volunteers, Green Chiretta extract had moderate inhibitory activity against the virus in cell cultures, while the purified compound, andrographolide, demonstrated 99.9% inhibitory activity against the virus in cell cultures.

In late December, when the Green Chiratta extract was approved for the further pilot study, the Thai government reportedly declared that this medicinal Plant could be used as an effective, safe, less costly treatment alternative for COVID-19 patients. Even Bloomberg reported that Green Chiretta could reduce inflammation.

Another vitro research paper from Thailand published in December 2020 revealed that a 95% ethanol extract of Green Chiretta significantly inhibited the production of SARS-CoV-2 in a human lung cell model. The Green Chiretta material met the criteria of the Thai Herbal Pharmacopoeia, and the Plant powder was made into an extract using 95% ethanol at a 4:1 ratio. It is still not clear if these two studies played a role in the government’s approval of Green Chiretta for COVID-19 patients.

Other Benefits of Green Chiretta

Previous studies have found that Green Chiretta may have benefits for other viral infections. A 2004 study which involved 133 children with the common cold compared a preparation of echinacea (Echinacea Purpurea) in combination with standard conventional medical treatment, a preparation containing Green Chiretta in comparison with standard treatment, and standard treatment only. All three groups experienced developments in upper respiratory symptoms, but the children who received the preparation containing Green Chiretta recovered from symptoms significantly faster than children in the two other groups.

A 2017 systematic review paper which included 33 randomized, controlled trials suggested that Green Chireatta may have benefits against Acute Respiratory Tract Infections (ARTIs). Green Chiretta improved cough and sore throat, significantly improved overall symptoms of ARTIs compared to placebo and other herbal remedies.

Green Chiretta is the main ingredient of the multi-herb formula famously known as Nilavembu Kudineer, which is practised in Siddha Medicine System of India, which also includes many other  medicinal Plants. Traditionally, this combination of Plants has been applied to treat arthralgia (joint pain), arthritis, gastric ulcers, fever, general debility, jaundice, and inflammation. In a 2018 study, an ethanolic extract of Nilavembu Kudineer provided stability and protection against chikungunya virus (an alphavirus) and dengue virus (a flavivirus) during active infection and helped prevent viral infection in cell cultures that were pre-treated with this holistic formula.

Conclusion

In Thailand, Green Chiretta has been registered as a universal home remedy, and can be sold over-the-counter to allow people to have easy access. While Thailand has also been investing in revolutionary coronavirus vaccines, the government also has been investing in traditional medicinal Plant-based remedies too, and people all over the country are accepting this initiation wholeheartedly as they have been familiar with such holistic medicinal traditions.

References

1. Kanjanasirirat, P., Suksatu, A., Manopwisedjaroen, S., et al. (2020). High-content screening of Thai medicinal Plants reveals Boesenbergia rotunda extract and its component Panduratin A as anti-SARS-CoV-2 agents. Scientific reports, [online] Volume, 10(1), p. 19963. Available at: https://doi.org/10.1038/s41598-020-77003-3 [Accessed 17th October 2021].
2. Karnjanatawe K. (2020). The cure for (some of) what ails you. [online] Available at: www.bangkokpost.com/life/social-and-lifestyle/1917212/the-cure-for-some-of-what-ails-you. [Accessed 17th October 2021].
3. Li, F., Li, H., Luo, S., Ran, Y., Xie, X., Wang, Y., Zheng, M., Wang, M., Zhao, Z., & Li, X. (2018). Evaluation of the effect of andrographolide and methotrexate combined therapy in complete Freund’s adjuvant induced arthritis with reduced hepatotoxicity. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, [online] Volume, 106, p. 637–645. Available at: https://doi.org/10.1016/j.biopha.2018.07.001 [Accessed 17th October 2021].
4. Sa-ngiamsuntorn K, Suksatu A, Pewkliang Y, et al. (2020). Anti-SARS-CoV-2 activity of Andrographis paniculata extract and its major component andrographolide in human lung epithelial cells and cytotoxicity evaluation in major organ cell representatives. [online] Available at: https://doi.org/10.1101/2020.12.08.415836 [Accessed 17th October 2021].
5. Spasov, A. A., Ostrovskij, O. V., Chernikov, M. V., & Wikman, G. (2004). Comparative controlled study of Andrographis paniculata fixed combination, Kan Jang and an Echinacea preparation as adjuvant, in the treatment of uncomplicated respiratory disease in children. Phytotherapy research, [online] Volume, 18(1), p. 47–53. Available at: https://doi.org/10.1002/ptr.1359 [Accessed 17th October 2021].
6. The Nation Thailand. (2020). Trials are underway to test the efficacy of Andrographis paniculata extract for Covid-19. [online] Available at: www.nationthailand.com/news/30393547. Accessed 17th October 2021].
7. The Nation Thailand. (2020). Two hospitals are ready to trial traditional Thai medicine in treating Covid-19. [online] Available at: www.nationthailand.com/news/30390444. [Accessed 17th October 2021]
8. Yuvejwattana S. (2020). Thailand clears use of herbal medicine for Covid-19 treatment. [online] Available at: www.bloomberg.com/news/articles/2020-12-30/thailand-clears-use-of-herbal-medicine-for-covid-19-treatment. [Accessed 17th October 2021].
9. Zhang, G., Jiang, C., Xie, N., Xu, Y., Liu, L., & Liu, N. (2019). Treatment with andrographolide sulfonate provides additional benefits to imipenem in a mouse model of Klebsiella pneumoniae pneumonia. Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, [online] Volume, 117, p. 109065. Available at: https://doi.org/10.1016/j.biopha.2019.109065 [Accessed 17th October 2021].