Comprehensive Guide to Gotu Kola (Centella asiatica)

Gotu Kola Dr. James Meschino DC, MS, ND
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General Features
Gotu Kola grows in tropical, swampy areas in various countries in the Middle East, the south of Africa, Eastern Europe, and Central Asia. The roots and leaves are used medicinally. 15,16 There is good supporting evidence that Gotu Kola, like Horsechestnut and Grape Seed Extract, is an effective intervention for chronic venous insufficiency when taken orally. It has also shown a positive effect in preventing keloid scar formation if taken prior to surgery, and it may be helpful in the treatment of enlarged scars. Applied topically, Gotu Kola has been shown to be effective in the treatment of burns and wounds, 1,17 although some experimental evidence suggests that it may be carcinogenic to skin cells when applied in this topical form
Principle Active Constituents

The primary active constituents are saponins (triterpenoids), which include asiaticoside, madecassoside, and madasiatic acid. These saponins, unique to Gotu Kola, have been shown to prevent excess scar formation by inhibiting the over-production of collagen at the wound site. The same constituents are also associated with promoting wound healing and they have been shown to increase the cement substance (ground substance or glycosaminoglycans) between cells and collagen fibers, forming a more effective seal in cases of chronic venous insufficiency and possibly other blood vessel leakage conditions

Clinical Application and Mechanism of Action
1. Chronic Venous Insufficiency and Varicose Veins
There is significant evidence for the use of Gotu Kola in the treatment of varicose veins and venous insufficiency. 17 At least four well designed clinical trials (a mix of placebo controlled, double blind and one open trial) have provided convincing evidence that Gotu Kola Extract (standardized grade) is able to improve vein function, reduce leg swelling and heaviness, and improve pain and discomfort, in a large percentage of these cases compared to the placebo groups. Moreover, two of the studies demonstrated a dose-dependent relationship, in that a higher dosage resulted in greater improvement than the lower dosage. 19, 20,21,22 A 1992 review of Gotu Kola studies (published in Minerva Cardioangiol), concluded that when taken orally, using a standardized grade extract, it provides a dose-related improvement in venous insufficiency symptoms, reducing foot swelling, ankle edema, and fluid leakage from veins. 23
Studies suggest that Gotu Kola Extract may improve structure and function of connective tissue in the body, helping to strengthen veins and possibly reducing symptoms of other connective tissue disorders, such as scleroderma and dermatitis. 24
2. Increases Formation of Glycosaminoglycans.1
By increasing the synthesis of glycosaminoglycans, Gotu Kola Extract may further strengthen the walls of veins and other blood vessels, in addition to its above noted effects on the collagen protein of connective tissue.
3. Keloids and Other Connective Tissue Abnormalities
There are numerous clinical reports and preliminary studies that suggest that Gotu Kola Extract can be useful in the treatment of keloid scars, anal fissures, periodontal disease, scleroderma, cellulite, and liver cirrhosis. 24,25 Experimental evidence has shown that the saponin constituents of Gotu Kola are able to stimulate the maturation of the scar by production of type I collagen, with a resulting decrease in the inflammatory reaction and myofibrinoblast production. 26 The net result is a scar that is less thick, more fine in its appearnce, and more visually acceptable in the mind of patients. Some authorities promote the use of Gotu Kola as part of a scar and keloid management program.26 Overall, there is a growing body of evidence that suggest that Gotu Kola Extract is an appropriate intervention for cellulite, keloid prevention and management, and may be useful in the treatment of a variety of connective tissue disorders. 2,3,4,5,6,7,8,9,10,11,12,13,17
For the prevention of keloid scars, Gotu Kola Extract is usually taken for 3 months prior to surgery, and for another 3 months afterwards. 17
4. Topical Application in Wound Healing and Burn Management
Animal studies demonstrate that a Gotu Kola Purified Extract, containing high concentrations of asiaticoside, can enhance wound healing. 17 One preliminary trial in human subjects showed that Gota Kola Extract helped the healing of infected wounds (unless they had reached the bone level). 27 A significant number of studies originating in France have also shown that the topical application of Gotu Kola Extract can help heal various types of wounds.
Dosage and Standardized Grade
Standardized Extracts of Gotu Kola contain up to 100% total triterpenoid content, usually broken down in the following percentages: asiatic acid (29-30%), asiaticoside (40%), madecassic acid (29-30%), and madecassoside (1-2%).
For most conditions, including venous insufficiency, varicose veins, keloid or scar prevention or treatment, and treatment of other connective tissue disorders (e.g scleroderma) the usual oral dosage is 60 mg, twice per day.
Adverse Side Effects, Toxicity and Contraindications
Gotu Kola has been shown to be very non-toxic when taken orally. It rarely causes any side effects other than the occasional allergic skin rash. Topical applications may cause contact dermatitis1 and as noted earlier experimental studies on animals suggest that the topical application may act as a carcinogen to skin cells.

Drug-Nutrient Interactions
There are no well-known drug-nutrient interactions for Gotu Kola
Pregnancy and Lactation
During pregnancy and lactation, the only supplements that are considered safe include standard prenatal vitamin and mineral supplements. All other supplements or dose alterations may pose a threat to the developing fetus and there is generally insufficient evidence at this time to determine an absolute level of safety for most dietary supplements other than a prenatal supplement. Any supplementation practices beyond a prenatal supplement should involve the cooperation of the attending physician (e.g., magnesium and the treatment of preeclampsia.)

References:Pregnancy and Lactation
1. Encyclopedia of Nutritional Supplements. Murray M. Prima Publishing 1998.
2. Reavley NM. The New Encyclopedia of Vitamins, Minerals, Supplements, and Herbs. Evans and Company Inc. 1998.
3. The Healing Power of Herbs (2nd edition). Murray M. Prima Publishing 1995.
4. Boon H and Smith M. Health Care Professional Training Program in Complementary Medicine. Institute of Applied Complementary Medicine Inc. 1997.
References
1. Bourguigon D, Study of the Action of Titrated Extract of Centella Asiatica, Gaz Med Fr 82, 1975, 4579-4583.
2. Bonnett GF, Treatment of Localized Cellulitis with Asiaticoside Madecassol, Prog Med 102, 1974, 109-110.
3. Grosshans E and Keller F, Cellulite: Reality or Imposter?, J Med Strasbourg 14, 1983, 563-567.
4. Keller F and Grosshans E, Cellulities: Reality or Fraud? Med Hyg 41, 1983, 1513-1518.
5. Tenailleau A, On 80 Cases of Cellulities Treated with the Standard Extract of Centella Asiatica, Quest Med 31, 1978, 919-924.
6. Carraro Pereira I, Treatment of Cellulitis with Centella Asiatica, Folha Med 79, 1979, 401-404.
7. Guarnerio F, et.al., Treatment of Hemorrhoids with Centella Asiatica, G Ital Angiol 6, 1986, 46-52.
8. Benedicenti A, Galli D, and Merlini A, The Clinical Therapy of Periodontal Disease: The Use of Potassium Hydroxide and the Water-Alcohol Extract of Centella Asiatica in Combination with Laser Therapy in the Treatment of Severe Periodontal Disease, Parodontol Stomatol 24, 1985, 11-26.
9. Castellani C, et.al., Asiaticoside and Cicatrization of Episiotomies, Bull Fed Soc Gynecol Obstet 18, 1966, 184-186.
10. Collonna d’Istria J, Research on the Healing Action of Madecassol in Cervical and Laryngeal Surgery After Ionizing Radiations, J Fr Otorhinolaryngol 19, 1970, 507-510.
11. O’Keeffe P, A Trial of Asiatiocoside on Skin Graft Donor Areas, Br J Plast Surg 27, 1974, 194-195.
12. Pignataro O and Teatini GP, Clinical Research on the Cicatrizing Action of Madecassol in Comparison of Oropharyngeal Mucosa, Minerva Med 56, 1965, 2683-2686.
13. Rui R, et.al., Clinical Study of Madecassol in Otorhinogoly, J Med Lyon 47, 1966, 693-706.
14. Sevin P, Some Observations on the Use of Asiaticoside (Madecassol) in General Surgery, Prog Med (France) 90, 1962, 23-24.
15. Murray MT, The Healing Power of Herbs (2nd edition), Prima Publishing.
16. Healthnotes, Inc. 2001.www.healthnotes.com: Gotu Kola.
17. Natural Products Encyclopedia. www.consumerslab.com: Gotu Kola
18. Laerum OD, Iversen OH. Reticuloses and epidermal tumors in hairless mice after topical skin application sof cantharidin and asiaticoside. Cancer Res 1972;32:1463-9
19. Belcaro GV, Grimaldi R, Guildi G. Imrovement of capillary permeability in patients with venous hypertension after treatment with TTFCA. Angiology 1990;41:533-40
20. Belcaro FV, Rulo A, Grimaldi R. Capillary filtration and ankle edema in patients with venous hypertension treated with TTFCA. Angiology 1990;41:12-8
21. Cesarone MR, Laurora G, De Sactis MT et al. The microcirculatory activity of Centella asiatica in venous insufficiency. A double-blind study [translated from Italian]. Minerva Cardioangiol 1994;42:299-304
22. Pointel JP, Boccalon H, Cloarec M et al. Titrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs. Angiology 1987;38:46-50
23. Cesarone MR, Laurora G, De Sanctis MT et al. Activity of Centella asiatica in venous insufficiency [in Italian: English abstract]. Minerva Cardioangiol 1992; 40:137-43
24. Kartnig T. Clinical applications of Centella asiatica (L.) Urb. Herbs Spices Med Plants 1988;3:145-73
25. Bosse JP, Papillon J, Frenette G et al. Clinical study of a new antikeloid agent. Ann Plat Surg 1979;3:13-21
26. Widegerow AD, Chait LA, Stals R, et al. New innovations in scar management. Aesthetic Plast Surgery. 2000;24 (3):277-34.
27. Morisset R, Cote NG, Panisset JC et al. Evaluation of the healing activity of hydrocotyle tincture in the treatment of wounds. Phytother Res 1987;1:117-21
28. Kartnig T. Clinical application sof Centella asiatica 9L) Urb. In Herbs, Spices and Medicinal Plants: Recent Advances in Botany, Horticulture and Pharmacology, vol.3 Craker LE, Simon JE (eds.) Oryx Press Phoenix, AZ 1986:145-73