Centella Centella asiatica (L.) Urb.

Synonyms: Hydrocotyle asiatica L.; Trisanthus cochinchinensis Lour.; and others

Family: Apiaceae (Umbelliferae)
Other common names: Asiatic pennywort; gotu kola; hydrocotyle; Indian penny-
wort; Indian water navelwort
Drug name: Centellae herba
Botanical drug used: Dried, fragmented aerial parts

Indications/uses: Centella is now mainly used for symptoms of chronic venous

insufficiency (CVI), including varicose veins, varicose ulcers, diabetic and airline
flight microangiopathy. The herb is also used to aid wound healing and treat skin
conditions such as burns, scarring, eczema and psoriasis, as a topical application
and oral tablets. It is used in cosmetic preparations to reduce the signs of skin
ageing. Centella is also taken orally to relieve anxiety and improve cognition. It
has traditionally been used for many other conditions including diarrhoea, fever
and amenorrhoea.
Evidence: The clinical evidence for use in CVI and some skin conditions is
good, and several licensed preparations containing standardised Centella extract
are available. These include creams and powders for cutaneous use, and tablets
containing the total triterpenic fraction of the extract. For other indications, the
evidence is weak.
Safety: Generally safe at recommended doses, but avoid in pregnancy and
breastfeeding. Allergic reactions have been reported after topical application.

Main chemical compounds: The dried aerial parts should contain a minimum
of 6% of total triterpenoid derivatives, based on Asiatic acid and madecassic acid
and their derivatives, and include asiaticoside B, asiaticoside A (=madecassoside),
braminoside, brahmoside, brahminoside, thankuniside isothankuniside. In addi-
tion to about 0.1% essential oil composed of β-caryophyllene, trans-p-farnesene
and germacrene, C. asiatica contains a wide range of other substances
including carotenoids and flavonoids (EMA 2012; Orhan 2012, Ghedira and
Goetz 2013).

Phytopharmacy: An evidence-based guide to herbal medicinal products, First Edition.

Sarah E. Edwards, Inês da Costa Rocha, Elizabeth M. Williamson and Michael Heinrich.
© 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd.
92 Phytopharmacy

Clinical Evidence: A systematic review of the efficacy of C. asiatica for improve-

ment of the signs and symptoms of CVI, including varicose veins, found eight
studies which met the inclusion criteria. It concluded that the herb significantly
improved microcirculatory parameters, such as rate of ankle swelling and veno-
arteriolar response (Chong and Aziz 2013; EMA 2010). Small clinical studies have
also found a potential use in scar management and prevention of diabetic and
airline flight microangiopathy (Anon. 2007; EMA 2010).
Human studies have shown that oral administration of Centella extract can pro-
duce an enhancement of mood and a reduction in anxiety, and also an improvement
in measures of cognition (Anon. 2007; EMA 2010). For other indications, the evi-
dence is very weak.
Pre-clinical evidence and mechanisms of action: The properties of Centella
have been investigated widely in animal and cell-based studies. Most of the exper-
imental work has been carried out using the triterpene fraction or asiaticoside,
or extracts standardised to the triterpene content. The mechanisms behind the
wound-healing effects include enhancing microcirculation and collagen synthesis,
and stimulation of epithelisation and angiogenesis. Raised levels of monocyte
chemoattractant protein-1 (MCP-1) in keratinocytes have been found following
Centella administration, and increased vascular endothelial growth factor (VEGF)
and interleukin (IL)-1β levels have been found in burn wound exudates. This
suggests that the enhancement of burn wound healing might be due to the promo-
tion of angiogenesis during wound repair as a result of the stimulation of VEGF
production. These mechanisms are also relevant in the treatment of chronic venous
sufficiency.
The extract has anticholinesterase, neuroprotective and antioxidant effects, sup-
porting its use in cognitive and depressive disorders. A GABA-stimulating effect has
been shown, and after orally administered leaf extract, an improvement in recovery
with increased axonal regeneration following nerve damage and neuronal dendritic
growth stimulation have been observed in brain areas involved in memory and learn-
ing processes. It has been suggested that the ERK/RSK signalling pathway mediates
central effects. Centella extract decreases β-amyloid levels, reduces lipid peroxida-
tion and protects against DNA damage in an animal model of Alzheimer’s disease
(EMA 2010; Orhan 2012).
Interactions with other drugs: No clinically significant interactions have been
recorded (Williamson et al. 2013). Caution should be advised in patients taking
other sedative preparations in case of additive effects, but no clinical cases have
been reported (EMA 2010).
Contraindications: Allergy to plants of the Apiaceae. Centella should be avoided
during pregnancy, due to its reported emmenagogue action (Anon. 2007).
Adverse effects: The tolerability of oral C. asiatica preparations is generally good
and Centella has no reported toxicity in recommended doses. Contact dermatitis has
been reported on a few occasions using topical preparations, and gastric complaints
and nausea have occasionally been seen following oral administration. High doses
are said to have sedative properties (EMA 2010).
Dosage: 0.6 g dried herb as an infusion, tincture or extract, up to four times daily.
For products, use according to manufacturers’ instructions. Tablets containing a
 Centella 93

total triterpenic fraction of the extract (oral dose of 60–120 mg daily), and for exter-
nal use, creams containing 1% extract and powders with 2% extract, are available
(EMA 2010).
General plant information: Centella is found in most tropical and subtropical
countries growing in swampy areas, including parts of India, Pakistan, Sri Lanka,
Madagascar, South Africa, the South Pacific and Eastern Europe. It has a long his-
tory of use, dating back to ancient Chinese and Ayurvedic literature. In traditional
Chinese medicine it is known as Leigonggen, and in Ayurveda, as Mandukparni,
where it is one of the main herbs for revitalising the nervous system and has been
used to treat emotional disorders such as depression. The leaves are edible and
widely used in beverages, salads and curries throughout South and Southeast Asia.
It is sometimes also called ‘Brahmi’ (see Bacopa monnieri (L.) Wettst.), p. 69.

References
The primary literature for Centella is extensive; this is a selection of good recent reviews,
which include many referenced individual studies. The EMA assessment is particularly
comprehensive.
Anonymous. (2007) Centella asiatica. Monograph. Alternative Medicine Review 12(1): 69–72.
Chong NJ, Aziz Z. (2013) A Systematic Review of the Efficacy of Centella asiatica for Improve-
ment of the signs and symptoms of chronic venous insufficiency. Evidence Based Comple-
mentary and Alternative Medicine 2013: 627182.
Ghedira K, Goetz P. (2013) Hydrocotyle: Centella asiatica (L.) Urban (Apiaceae). Phytother-
apie 11(5): 310–315.
EMA. (2010) Assessment report on Centella asiatica (L.) Urban, herba. European Medicines
Agency. http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/herbal/medicines
/herbal_med_000046.jsp&mid=WC0b01ac058001fa1d.
Orhan IE. (2012) Centella asiatica (L.) Urban: from traditional medicine to modern medicine
with neuroprotective potential. Evidence Based Complementary and Alternative Medicine
2012: 946259.
Williamson EM, Driver S, Baxter K. (Eds.) (2013) Stockley’s Herbal Medicines Interactions.
2nd Edition. Pharmaceutical Press, London, UK.