Picrorhiza

James Meschino DC, MS, ROHP

General Features
Picrorhiza is a perennial plant, whose roots and rhizomes have been used for thousands of years in Indian traditional medicine.  It grows high in the Himalayan mountains. ^1,2     Picrorhiza’s most important use is in the treatment and prevention of liver conditions, whereby many of its protective influences appear to be similar to those exhibited by the herb milk thistle (see milk thistle in this document). ² It may also benefit asthma sufferers, and patients with rheumatoid arthritis or a skin condition known as vitiligo. ^1,2 There have a limited number of double-blind, placebo-controlled trials performed with Picrorhiza, but several open trials have provided preliminary evidence to support the positive outcomes revealed by animal and test tube studies.  As such, it is difficult to make definitive statements about its clinical use, although its long history of use in Indian traditional medicine and recently performed clinical trials indicate that it is very non toxic and is associated with only occasional mild side effects.  ^1,2

Principle Active Constituents
Iridoid Glycosides, including glycoside picroside-1, kutkoside, androsin, and apocynin. ²   A standardized preparation from roots of picrorhiza, which have been tested in preclinical studies, is a mixture of iridoid glycosides containing at least 60% picroside-1, and kutkoside in the proportion 1:1.5, and is known as Picroliv (Sabinsa Corporation). ³

Clinical Application and Mechanism of Action
Liver Health
Animal and laboratory studies strongly suggest that Picrorhiza may protect liver cells via four physiological mechanisms:

1. Picrorhiza extract stimulates growth of and regeneration of damaged liver tissues in a similar manner to the silymarin flavonoid from milk thistle. ⁴
2. Picroriza extract may be able to protect the liver from viral hepatitis infection and dose-dependent toxic agents such as alcohol and acetaminophen. ^5,6,7,8   Rat liver was shown to be protected against the damaging effects of thioacetamide, galactosamine and carbon tetrachloride, when treated concurrently with Picrorhiza extract, under experimental conditions. ⁵   Mice injected with carbon tetrachloride showed significantly less liver damage upon concurrent treatment with picrorhiza, and rats subjected to daily high intake of alcohol ingestion developed significantly less liver damage than animals given the same amount of alcohol without concurrent intake of pirorhiza extract.  ^6,8
3. Picrorhiza extract may produce anti-inflammatory effects, helping to contain liver damage.²
4. Picrorhiza extract has been shown to act as an antioxidant in the liver, reducing liver cell damage from uncontrolled propagation of free radicals. ⁹   It may also help liver cells restore their intracellular glutathione stores after injury from infection of free radical insult.  Glutathione is an extremely important intracellular antioxidant in liver cells and directly participates in the detoxification of many potentially dangerous chemicals that are filtered through the liver each minute of our lives.  ⁹

Human Studies

2. Viral Hepatitis

• In a study of 37 patients with chonic viral hepatitis B, who received picrohriza extract and 23 patients with chronic viral hepatitis B, who received the placebo, 59% of those treated with picrohriza extract showed no sign of the viral antigen 15 to 20 days after the course of treatment. In the placebo group, only one subject demonstrated this outcome.  The treatment group received a dose of 200 mg of Picrorhiza extract daily for 30 days. ¹⁰
• A second clinical trail demonstrated that Picrorhiza extract, plus a variety of minerals, was also successful in treating a series of cases of acute viral hepatitis, in a study performed in India, and a number of similar reports have appeared in Indian medical literature over the years. ^1,11
• In a randomized, double-blind placebo controlled trial in patients diagnosed with acute viral hepatitis (HBsAG negative). Patients receiving 375 mg of Picrorhiza root powder, three times per day for 2 weeks (n= 15) demonstrated significantly lower blood levels of the liver enzymes known as SGOT, SGPT as well as bilirubin, compard to the placebo group (n= 18). In the Picrorhiza treatment group, bilirubin levels returned to normal values in 27.44 days, on average, compared to 75.9 days in the group given the placebo.  ⁷

3. Asthma

• Two preliminary trials indicate that picorhiza may improve breathing ability in asthma patients and reduce the severity of the condition. ^12,13   This may be related to the ablitiy of picrorohiza extract to reduce inflammation in the lungs and related air passageways.  ¹⁴   However, a double-blind follow-up study failed to show a benefit in asthmatic sufferers.  ¹⁵

4. Rheumatoid Arthritis

• Animal studies indicate that Picrorhiza extract can decrease joint inflammation. ¹⁶   A single open trial suggested that Picrorhiza extract may reduce symptoms of rheumatoid arthritis to a limited degree. ¹⁷

5. Vitiligo

• Picrorhiza extract appears to modulate the immune system in such a way as to produce a beneficial effect on the benign skin condition called vitiligo, which has been shown to result from a hyperactive immune system. Vitiligo is characterized by irregular, pigment-free skin patches.  ¹⁸  In a preliminary trial, Picrorhiza extract, in combination with the drug methoxsalen, was shown to hasten recovery from vitiligo faster than the combination of methoxsalen and sun exposure alone.  ¹⁹

Dosage and Standardized Grade
Therapeutic Dose For Above Conditions – 250 – 350 mg, twice or three times daily (standardized to 4% – 10% kutkin content) ²

Adverse Side Effects, Toxicity and Contraindications

Picrorhiza extract is considered very safe and only mild and infrequent side effects are associated with its use, which include loose stools and colic.  ^1,11

Drug-Nutrient Interactions

1. Diabetic Hypoglycemic Drugs – animal studies indicate that Picrorhiza may affect blood sugar, which may alter the dose requirement of diabetic hypoglycemic medications. Thus, proper patient monitoring is advised.  ²⁰
2. Anticoagulant Drugs (warfarin, coumadin, aspirin etc.) – as picrorihza has been shown in animal studies to inhibit platelet aggregation to some degree, it may potentiate the action of other anticoagulant drugs. Thus, proper patient monitoring is advised with respect to prothrombin time (INR).  ¹⁴
3. Immunosuppressive Medications – experimental studies indicate that Picrorhiza may stimulate the immune system and thus, may counter the effects of immunosuppressive drugs. ^18,21

1. Healthnotes, Inc. 2001. healthnotes.com: Picrorhiza
2. Dietary Supplement Information Bureau. content.intramedicine.com: Picrorhiza
3. Sabinsa Corporation product Manual: Picroliv
4. Singh V, et al. Effect of picroliv on protein and nucleic acid synthesis. Indian J Exp Biol Jan1992;30(1):68-9
5. Visen PK, et al. Curative effect of picroliv on primary cultured rat hepatocytes against different hepatotoxins: an in vitro study. J Pharmacol Toxicol Methods Oct1998;40(3):173-9
6. Santra A et al. Prevention of carbon tetrachloride-induced hepatic injury in mice by picrorhiza kurrooa. An in vitro study. J Pharmacol Toxicol Methods Oct1998;40(3):173-9
7. Vaidya AB, et al. Picrorhiza kurroa (Kutaki) Royle ex Benth as a hepatoprotective agent—Experimental and clinical studies. J postgrad Med Dec1996;42(4):105-8
8. Rastogi R, et al. Picroliv protects against alcohol-induced chronic hepatotoxicity in rats. Planta Med Jun 1996;62(3):283-5
9. Chander R, et al. Effect of picroliv on glutathione metabolism in liver and brain of mastomys natalensis infected with plasmodium berghei. Indian J Exp Biol Aug1992;30(8):711-4
10. Thygarajan SP, et al. Effect of Phyllanthus amcrus on chronic carriers of hepatitis B virus. The Lancet 1988 Oct1:764-6
11. Chaturvedi GN, Singh RH. Jaundice of infectious hepatitis and its treatment with an indigenous drug. Picrorhiza kurrooa [sic]. J Res Ind Med 1966;1:1-13
12. Rajaram D. A preliminary clinical trial of Picrorrhiza kurroa in brochial asthma. Indian J Pharmacol 1975;7:95-6
13. Shan BK, Kamat SR, Sheth UK. Preliminary report of use of Picrorrhiza kurroa root in bronchial asthma. J Postgrad Med 1977;23:118-20
14. Dorsch W et al. Antiasthmatic effectgs of picrorhiza kurroa: Androsin prevents allergen- and PAF-induced brochial obstruction in guinea pigs. Int Arch Allergy Appl Immunol 1991;95(2-3):128-33
15. Doshi VB, Shetye VM, Mahashur AA, Kamat SR. Picrorrhiza kurroa in bronchial asthma. J Postgrad Med 1983;29:89-95
16. Hart BA, Simons JM, Knaan-Shanzer S, et al. Antiarthritic activity of the newly developed neutrophil oxidative burst antagonist apocynin. Free Rad Biol Med 1990;9:127–31
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18. Atal CK, et al. Immunomodulating agents of plant origin I:Preliminary Screening. J Ethnopharmacol Nov1986;18(2):133-41
19. Bedi KL, Zutshi U, Chopra CL, Amla V. Picrorhiza kurroa, an Ayurvedic herb, may potentiate photochemotherapy in vitiligo. J Ethnopharmacol 1989;27:347–52
20. Joy KL, et al. Anti-diabetic activity of picrorrhiza kurroa extract. J Ethnopharmacology Nov1999;67(2):143-8
21. Sharma ML, et al. Immunostimulatory activity of picrorhiza kurroa leaf extract. J Ethnopharmacol Feb1994;41(3):185-92