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Background and Rationale Andrographis paniculata is an herb that has a
Influenza or çflué and the common cold are both long history of use in Ayurvedic medicine and tradi-
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respiratory diseases but they are caused by different tional Chinese medicine. In India, A. paniculata is
viruses. Even though the symptoms of influenza and useful in liver disorders, jaundice, dysentery, cholera,
the common cold are similar and sometimes difficult diabetes, influenza, bronchitis, hemorrhoids and gon-
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to tell apart, influenza is generally much worse than orrhea. According to the Pharmacopoeia of the
the common cold. Symptoms such as fever, body Peopleûs Republic of China, this herb is indicated for
aches, extreme tiredness, and dry cough are more influenza with fever, sore throat, ulcers in the mouth
common and intense in influenza. Generally, these or on the tongue, acute or chronic cough, colitis, dys-
symptoms will improve within 5 days after a person entery, urinary tract infection with difficult or painful
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becomes ill; patients should recover and become nor- urination, carbuncles, sores, and venomous snakebite.
mal within 7-14 days. However, in the elderly, chil- In Thailand, A. paniculata is officially listed in the
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dren, or patients with other chronic diseases or weak- Thai Herbal Pharmacopoeia and it was included in
ened immune system, the flu may cause severe ill- the National List of Essential Drugs (Herbal Medici-
ness and life-threatening complications such as bron- nal Products) for the relief of the symptoms of the
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chitis or pneumonia. common cold and non-infectious diarrhea. Similarly,
In Thailand, influenza can be found throughout WHO also selected this herb for the prophylaxis and
the year but the incidence is highest during the rainy symptomatic treatment of upper respiratory infections,
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season (June-September). The numbers of reported such as the common cold and uncomplicated sinusi-
cases of influenza appears to have decreased during tis, bronchitis and pharyngotonsillitis, lower urinary
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the past 6 years, from more than 39,000 cases during tract infections and acute diarrhoea. Various kinds
the period 2001-2002 to over 19,000 cases in the pe- of lactones, e.g., andrographolide, neoandrographolide,
riod 2004-2005; in 2006 the reported cases of influ- deoxyandrographolide and deoxy-didehydroandro-
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enza totaled 16,146. In 2004, it was calculated that grapholide, are the active principles of A. paniculata.
the economic cost of seasonal influenza in Thailand According to the standard specification of A.
ranged from about 928 million to 2,360 million baht. paniculata in the Thai Herbal Pharmacopoeia, the
Of this amount, the cost of medical care accounted aerial part of the herb must contain not less than 6
for 384 million-842 million baht; transportation 80 mil- percent of the total lactones calculated as andro-
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lion-300 million baht; and productivity losses 464 mil- grapholide . In vitro studies and in vivo studies in
lion-1,230 million baht. Overall, the economic cost of experimental animals have shown that extracts of this
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seasonal influenza was about 992-2,417 baht per case. herb and/or its latones possess various pharmaco-
The treatment of influenza is generally symp- logical activities, e.g., anti-inflammatory, antipyretic,
tomatic. Patients are advised to take some rest, immonomodulatory, antioxidant, and antidiarrheal
drink a lot of fluid, and use paracetamol to reduce activities, which could account for its therapeutic ef-
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fever and relieve muscle ache. An antitussive, ex- ficacy.
pectorant, nasal decongestant may also be taken, if There are several clinical reports on the efficacy
necessary. Currently, antiviral agents, e.g., oseltamivir, of A. paniculata in patients with upper respiratory
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amantadine or rimantadine, can relieve the symp- tract infection. The first report was a multi-cen-
toms of influenza and help patients to recover sooner, ter study, conducted in Thailand by Thamlikitkul et
but the medication must be taken within 48 hours al., which showed that A. paniculata at the dose of 6
after the symptoms first develop. For persons in the g per day in 4 divided doses was effective for the
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high-risk group, influenza can be fatal; thus, flu vac- relief of fever and pharyngotonsillitis. Standardized
cine should be administered as a preventive mea- extract of A. paniculata was later found to be effec-
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sure. tive for relieving the intensity of the symptoms of the