Picrorhiza kurroa Royle ex Benth.

Last updated: 02 Jun 2016

Scientific Name

Picrorhiza kurroa Royle ex Benth. [Unresolved name]

Synonyms

Picrorhiza lindleyana Steud. (unresolved), Valeriana lindleyana Wall. (unresolved), Veronica lindleyana Wall. (unresolved) [1]

Vernacular Name

English Gentian [2]
China Hu huang lian [2]
India Acokarokini, akutam, akutarokini, amakkini (Tamil); katuka-rogani, katukarogani, katukkurohini (Telugu); kutki (Urdu) [3]; katuka, katula, katki, kuru, kutakee, katukarosana, kooren [4]
Tibet Hong-len [2], hong len [5].

Geographical Distributions

Picrorhiza kurroa is found perennially throughout the higher elevations of the Himalayan region particularly from Kashmir to Sikkam. It grows in the cracks of mountain rocks at elevations of 2500 to 4500 meters. [4][6][7]

Botanical Description

P. kurroa is member of the Plantaginaceae family. It is a small herb having usually longer flowering stems than the leaves. The rhizomes are 15-25 cm long and woody. [3]

The leaves are spoon-shaped, almost all at the base with 5-15 cm long, coarsely toothed, and has narrowed to a winged stalk. [3]

The flowers are small, pale or purplish blue, borne in cylindric spikes, and spikes borne on almost leafless erect stems. It measure about 8 mm, 5-lobed to the middle, and with much long stamens. [3]

The fruits are 1.3 cm long. [3]

Cultivation

No documentation.

Chemical Constituent

P. kurroa has been reported to contain iridoid glycosides (e.g. picroside I, picroside II, picroside III, pikuroside, kutkoside and 6-feruloyl catalpol), cucurbitacin glycosides, androsin, and apocynin [8][9]. Other iridoid glycosides reported including kutkoside, minecoside and veronicoside as well as D-mannitol, kutkiol and kutkisterol [4][6][10]

Plant Part Used

Leaves, stems, inflorescenses, rhizomes and roots. [5]

Traditional Use

P. kurroa isidentified as hong len in Tibetan medicine has cooling properties and is used to treat tsha ba diseases. Tsha ba diseases or conditions are the result of warming which can be  due to taking in too many hot foods, participating in too much exercise, wearing too many clothes and sleeping during the day when the weather is hot [5]. However, many factors will affect which specific herb will be used as hong len, or as a cooling agent.  These factors include but are not limited to the age of the patient, the patient’s personality, the patient’s lifestyle and the specific organ system in the patient’s body that is affected [11]. In addition, the patient’s present mental state will also affect the diagnosis and treatment. Only a well-trained Tibetan medical practitioner is capable of making the diagnosis and prescribing treatment [12]

In Ayurvedic medicine, P. kurroa is most often used as a hepatoprotective, promoting health in both the liver and the spleen, specifically in cases of jaundice. It is traditionally used in treatment of snake bites and scorpion stings. In high doses it can act as a mild purgative. P. kurroa is also traditionally indicated to treat many types of fever, anemia and asthma. Due to its antiperiodic activity, P. kurroa is used often used to treat recurring symptoms of periodic illnesses. The plant is classified as having a tikta (bitter) rasa (taste) and has a cooling effect on the body. It pacifies the pitta dosha while stimulating the kapha and vata doshas. [4]

In India, the roots and rhizome of P. kurroa are considered bitter tonic, stomachic, anthelmintic, and cardiotonic and has been used to treat fever and dyspepsia. It also has been included in purgative medicine and can be used to treat scorpion stings. In Ladakh, the P. kurroa root is considered cardiotonic and is used to treat respiratory disease, jaundice, and anemia. [5]

Preclinical Data

Pharmacology

Hepatoprotective activity

In regard to its hepatoprotective properties, P. kurroa is similar to Milk thistle, and may have an effect on liver regeneration. A 1992 study demonstrated stimulation of nucleic acid and protein synthesis in rat liver with oral administration of P. kurroa. The results showed that P. kurroa were comparable to milk thistle.  There have been over 15 studies conducted in laboratory animals regarding the effectiveness of standardised P. kurroa as a tool in liver health. Studies report P. kurroa beneficial for the liver, including viral hepatitis, and exposure to hepatotoxic chemical agents, including alcohol and acetaminophen. [13][14][15][16]

P. kurroa was evaluated as a hepato-protective agent against ethanol-induced hepatic injury in rats .  There was also an effect on specific alcohol-metabolising enzymes (aldehyde dehydrogenase, 41%; acetaldehyde dehydrogenase, 52%) in rat hepatocytes. The levels of these enzymes were found to be reduced in the cells following alcohol intoxication. [16]

A mixture of the iridoid glycosides, picroside I, and kutkoside has been found to be an efficient liver protectant. Androsin, a phenolic glycoside isolated from P. kurroa, has been attributed with anti-asthmatic properties. [17]

P. kurroa has been reported to reverse acetaminophen and ethynyl estradiol-induced cholestasis, maintaining both bile volume and flow. Milk thistle was tested simultaneously for comparison. Picrorhiza was found to be a more potent choleretic and anticholestatic agent than milk thistle [18]. Ethyl alcohol also produces cholestasis to varying degrees, as indicated by reduction in bile volume, bile salts, and bile acids. P. kurroa treatment has been reported to restore these altered parameters in a dose-dependent manner [19].

Also, the active principles picroside I, catalpol, kutkoside, and kutkoside 1 were tested for the presence of anti-hepatitis B virus surface antigen (anti-HBsAg) like activity in vitro.  A promising anti-HBsAg like activity was noted which differed from the classical viral neutralization. P. kurroa also inhibited purified HBV antigens prepared from healthy HBsAg carriers from binding in vitro. [20]

As an antioxidant for the liver, P. kurroa is reported to protect against changes in liver and brain glutathione metabolism, improving reduced glutathione levels, and decreasing inhibition of glutathione-S-transferase, glutathione reductase, and glutathione peroxidase [21]. The increased levels of lipid peroxidation products in damaged tissues were also reduced along with the recovery of glutathione metabolism. Also, P. kurroa possess the properties of antioxidants that appear to be mediated through activity like that of superoxide dismutase, metal ion chelators, and xanthine oxidase inhibitors [22]P. kurroa does seem to alter cytochrome P-450 enzyme levels. Therefore, caution should be used with medications that are metabolized in the liver [23]. A laboratory study found that picrorhiza decreased the hepatotoxic effects of cadmium [24].

Immunopharmacological activity

P. kurroa reportedly stabilizes mast cells in vivo, further elucidated by a repeated study in vitro in laboratory animals [25][26]. This may prove useful as part of an integrative approach in patients with allergic conditions [27]

Immune system modulation 

The effect of an ethanolic extract of each drug was studied on delayed type, hypersensitivity, humoral responses to sheep red blood cells, skin allograft rejection, and phagocytic activity of the reticuloendothelial system in mice. P. kurroa was found to be a potent immunostimulant of both cell-mediated and humoral immunity. The clinical success in treating vitiligo, a benign autoimmune disease characterized by irregular skin patches without pigmentation, is attributed to the immunomodulating effects of picrorhiza. [28]

Ethanol extract of P. kurroa leaves was reported to stimulate cell mediated and humoral components of the immune system including stimulation of phagocytosis [29]P. kurroa root also has been reported to have antitumour and anticarcinogenic activity in laboratory studies [30].

Anti-inflammatory activity

Apocynin is a constituent of root extracts of P. kurroa and has been reported to possess anti-inflammatory properties in laboratory animals [31]. Apocynin concentration dependently inhibited the formation of thromboxane A2, whereas the release of prostaglandins E2 and F2 alpha was stimulated. Apocynin inhibited arachidonic acid-induced aggregation of bovine platelets, possibly through inhibition of thromboxane formation. Apocynin was found to inhibit neutrophil oxidative burst in vitro without affecting beneficial activities such as chemotaxis, phagocytosis, and intracellular killing of bacteria [32].

The ability of P. kurroa to heal indomethacin-induced gastric ulcers in mice was compared to a standard drug therapy.  The herb was found to heal the ulcers after three days of treatment post assault by increasing mucus secretions, reducing oxidative stress, and augmenting expressions of cyclooxygenase enzymes. [33]

Antidiabetic activity 

An extract of P. kurroa was found to lower blood glucose in laboratory animals. Chronic administration of the extract significantly reduced blood sugar in alloxan-induced diabetic rats for 10 days. The extract was also found to reduce the increased blood urea nitrogen and serum lipid peroxides in alloxan-induced diabetic animals and to inhibit the body weight reduction and leukopenia induced by alloxan administration. Further study is required to determine benefits to diabetics. [34]

Hypoxia protective activity

P. kurroa has been reported to protect cells and regulate gene expression during hypoxia and/or re-oxygenation. Picrorhiza reduced the cellular damage caused by hypoxia as revealed by a significant reduction in LDH release compared to untreated controls. These findings suggest that picrorhiza may act as a protective agent against hypoxia and/or re-oxygenation induced injuries by a novel signal transduction pathway to the cells. [35]

Hypolipidaemic activity

A laboratory animal study found that P. kurroa decreased total cholesterol, LDL and triglycerides in hyperlipidemic rats. [24]

Toxicity

No documentation.

Clinical Data

Clinical findings

Antihepatoprotective activity

In a randomised, double-blind placebo controlled trial in patients diagnosed to have acute viral hepatitis (HBsAg negative), P. kurroa root powder, 375mg three times a day, was given for two weeks . P. kurroa was reported to significantly decrease lab values of bilirubin, SGOT, and SGPT as compared to placebo. The time in days required for total serum bilirubin to drop to an average value of 2.5mg% was 75.9 days in placebo compared to 27.44 days in the P. kurroa group [36]. Also, the active principles picroside I, catalpol, kutkoside, and kutkoside 1 were tested for the presence of antihepatitis B virus surface antigen (anti-HBsAg) like activity in vitro . A promising anti-HBsAg like activity was noted which differed from the classical viral neutralisation. P. kurroa also inhibited purified HBV antigens prepared from healthy HBsAg carriers from binding in vitro [37]. Picrorhiza has also been used in India with success for the treatment of vitiligo. Patients undergoing photochemotherapy for the treatment showed improved of the liver function [38].

Antiashmatic activity

Several studies have reported benefit in patients with asthma when using P. kurroa. In a randomised crossover study using laboratory animals, administration of isolated androsin orally or by inhalation prevented bronchial obstruction induced by the inhalation of allergens, platelet activity factors (PAF), histamine, and acetylcholine [39]. It was concluded in this study that asthmatic reactions due to histamine and acetylcholine were not altered by P. kurroa, suggesting that androsin is not a broncholytic agent, but prevents bronchial obstruction. It is suggested that androsin may act by depressing the activity of PAF, which plays a major role in the pathogenesis of bronchial asthma. PAF has been reported to provoke long-term inflammatory responses in the lungs, leading to bronchial hyper-reactivity and subsequent bronchial obstruction. Additionally, histamine release from human polymorphonuclear leucocytes, in vitro, has been reported inhibited by some compounds from P. kurroa that have yet to be identified [40]

A one-year clinical study of 20 patients (ages 14-60 years), two with perennial asthma, others with seasonal asthma, was conducted using P. kurroa as a therapeutic agent. The degree of clinical improvement in the patients was measured in terms of reduction in the use of bronchodilators, as evident from the results of pulmonary function tests at regular intervals. The patients had experienced asthma symptoms ranging from five to twenty years. The peak expiratory flow rate (PEFR) was monitored and reported sustained increases for up to twelve months of treatment with P. kurroa. The frequency and severity of asthmatic attacks reduced significantly as treatment progressed. A reduction in bronchodilator use was also observed. One observation of interest is that individuals having specific food allergies developed tolerance to these allergens during the period of treatment, probably due in part to the mast cell stabilisation properties of P. kurroa. [41] 

A double-blind, crossover trial with placebo failed to demonstrate significant results, although there was a trend toward improvement in symptoms of asthma. Study design and high dropout rate in this trial may have contributed to the poor results. [42]

Precautions

No documentation.

Interaction & Depletion

No documentation.

Contraindications

No documentation.

Dosage

Dosage Range

No documentation.

Most Common Dosage

1-1.5 g powdered as tonic, 3-3.5g powdered as antiperiodic. [4]

Standardisation

No documentation.

Poisonous Management

No documentation.

Line drawing

No documentation.

References

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  3. Flowers of India. Kutki. [homepage on the Internet]. No date [cited 2016 Jun 09]. Available from: http://www.flowersofindia.net/catalog/slides/Kutki.html
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