The cure for (some of) what ails you

A Thai traditional herb called fah talai jone has many medical professionals believing there may be a natural solution to some of Covid-19's more basic symptoms, and they're hard at work on the research to prove it

The herbal tea is dark green. The smell is not that appealing. Only a small sip can leave a long-lasting bitterness in your mouth. Fah talai jone, or green chireta, is known for its extreme bitterness. The King of Bitters has been used for the treatment of some sickness like the flu and sore throat for centuries in Asian countries such as Thailand, China and India.

Fah talai jone plants. (Photos by Piyarach Chongcharoen)

Recently, fah talai jone was in the spotlight. The Thai traditional medicinal herb proved that it can kill the novel coronavirus in test-tube experiments conducted by a research team of the Institute of Biological Products, the national control laboratory for biological products of the Department of Medical Sciences under the Ministry of Public Health.

"Fah talai jone can kill and inhibit the virus in vitro," said the Institute of Biological Products Director Dr Supaporn Phoomamorn.

Fah talai jone is a hardy annual shrub. Its height can reach up to 90cm. The leafy plant has small purple or pink flowers. The entire plant of fah talai jone, or andrographis, can be used for traditional medicine. Regarded as a "cold" herb, andrographis is used to reduce body heat due to fever or infections. Modern medical science is also interested in the medicinal herb. Since early 1950, more than 800 scientific research projects about andrographis have been conducted in both the Eastern and Western worlds. Researchers found that the herb can cure other maladies, including rheumatoid arthritis, herpes virus and pneumococcal pneumonia, as well as help improve immune function in HIV-infected people.

The main component of the curing found in fah talai jone is andrographolide, which gives the herb the bitter taste. In the past, people made tea from its leaves to cure some sickness. But the herbal drink is hard to be consumed. At present, the herb is produced in the forms of tablets and capsules with options of ground dried leaves or andrographis extract capsules.

Fah talai jone is available in capsule format.

Since the andrographis can kill some viruses, it led to a question if it can be used for curing Covid-19 patients. The sickness has infected more than 4.2 million people globally and over 3,000 in Thailand since the end of last year.

To find the answer, the Department of Thai Traditional and Alternative Medicine signed an MoU with the Department of Medical Sciences and the Government Pharmaceutical Organisation (GPO) on Feb 25 for a laboratory experiment.

Under the contract, the Institute of Biological Products conducted the test. It used ground dried leaves of andrographis and andrographis extract produced by Thai Herbal Products Company, an affiliate of GPO. The team spent about a week for the research. The result was positive.

"The andrographis compound, which contains one microgram per milligram [mcg/mg] of andrographolide, can kill the Covid-19. We also found that andrographolide can stop the spread of the novel coronavirus after it infects the cells," said Dr Supaporn.

Dr Pramote Stienrut, deputy director of the Department of Thai Traditional and Alternative Medicine. (Photos courtesy of Department of Thai Traditional and Alternative Medicine)

Based on the result, the Department of Thai Traditional and Alternative Medicine will launch a clinical trial project with patients at Bamrasnaradura Infectious Diseases Institute, the first hospital that admits Covid-19 patients.

"We expect to kickstart the clinical trial in the middle of this month," said Dr Pramote Stienrut, Deputy Director of the Department of Thai Traditional and Alternative Medicine (DTTAM), who is in charge of the project.

After the solution of the lab test came around the end of March, DTTAM drafted a project proposal for patient trials. The project is a co-oporation among various parties including Bamrasnaradura Infectious Diseases Institute, the Faculty of Medicine Siriraj Hospital, Chulabhorn Research Institute and GPO. DTTAM funds about 3 million baht for the programme.

The proposal has passed the first review of two ethics committees. One belongs to DTTAM and the other is of Bamrasnaradura Infectious Diseases Institute. Some details were pointed out and revised. At present the proposal is in the process of the second review by the committees.

"The safety of patients is our priority. We have to be sure that there will be no room for risks or errors. We expect the outcome will benefit patients and the traditional medicine as a whole," said Dr Pramote.

The clinical tests of andrographis to fight against the Covid-19 may be new in Thailand, but not in some countries. In China, a clinical trial was conducted by injecting the mixture of 100mg of andrographolide sulfonate, known as Xiyanping injection, and 250ml of normal saline solution to Covid-19 patients. The traditional Chinese medicine is also used together with modern medicines for effective treatment.

"In Thailand, we will give patients only fah talai jone extract so that we know if the patients are cured because of the herb or not," he said.

The clinical trial will apply to two groups of patients. During the first phase, the first six patients will be selected by doctors of Bamrasnaradura Infectious Diseases Institute and based on patients' will to participate in the clinical test.

The patients are limited to those who have mild symptoms of the Covid-19 such as fever, coughing or the sickness that occurs at upper respiratory tract infections. They must not have underlying medical conditions such as chronic lung disease, serious heart conditions, high blood pressure, diabetes or liver disease.

The first group of patients will receive andrographis extract that has 60mg of andrographolide three times a day, or 180mg a day, about three times a higher dose than treatment of the common flu. Every day, the patients' condition will be evaluated. If the condition is better, they will take andrographis extract until the symptoms are gone and not more than five days.

If the condition is worse or does not have a sign of improvement, the patients will be treated with modern medicine immediately, said Dr Pramote.

The second group is another six patients. The test will be conducted if the result of the first group is not yet solid. Patients in the second group will receive andrographolide 100mg three times a day or a total of 300mg per day for five days. The amount of andrographolide consumption will be five times higher than the treatment of flu.

Dr Supaporn Phoomamorn, director of the Institute of Biological Products. (Department of Medical Sciences)

"The amount of andrographolide that we will apply for patients is proven by research in other countries that it is safe to use by humans," he noted.

The clinical trial project is expected to finish within July. However, it depends on the condition if DTTAM can find enough patients who volunteer for the test.

"It is good news that the number of people who are infected with the Covid-19 reduces. On another hand, it will be a challenge for us to find participants," he noted.

Although fah talai jone has benefits, people who are in good health are not recommended to take andrographis capsules regularly.

"Fah talai jone can't protect you from being infected by Covid-19. Do not take fah talai jone if you are not sick," he said. The lab test of the Institute of Biological Products of the Department of Medical Sciences has already proved the point.

"If you feel unwell and have a high fever, coughing or head and body aching, you can have fah talai jone to cure the illness," he said.

The recommendation is to take four andrographis capsules four times a day. For andrographis extract capsules, there are two choices of 10mg and 20mg andrographolide. The recommendation is to take two capsules of 10mg andrographolide or one capsule of 20mg andrographolide three times a day. The total of andrographolide for both andrographis and andrographis extract capsules is 60mg a day.

If the sickness can't be cured within a couple of days, they should see a doctor, he said. Another caution is not to take fah talai jone with some medicines such as warfarin, aspirin, clopidogrel and pills that reduce high blood pressure.

Fah talai jone is a medicinal herb that must be used with caution, he said, adding that although there are some other herbs or Thai traditional herbal formulas that can cure sickness caused by viruses, DTTAM selected fah talai jone because it is widely used. Besides, many researchers have studied the herb so far. The herb is also listed in the National List of Essential Medicines so it is accessible for patients nationwide. In addition, the plant can be grown locally so there will not be a problem of a supply shortage.

"We are confident in the effectiveness of the use of fah talai jone against Covid-19. We expect the positive result of this clinical trial; otherwise we would not conduct any test on patients," said Dr Pramote.


For milder cases

Fah talai jone is not the only choice to cure mild symptoms of Covid-19, according to Prof Dr Surapong Wongyai of the College of Oriental Medicine of Rangsit University.

About 20% of people who are infected by Covid-19 have signs of sickness from the common cold to more severe diseases while the remaining 80% do not show any illness, he said in an online forum about fah talai jone recently organised via a Facebook Page of Agricultural Research Development Agency.

Those who have mild symptoms like fever and coughing can try herbal medicines. Fah talai jone can be one of the choices but it can cause side effects such as lowering blood pressure and can cause muscle weakness. Pregnant women are not recommended to use the herb.

An alternative is to use traditional herbal formulas, he said.

Based on Takasila Scripture, traditional Thai medicine classifies 11 types of fevers that can cause 77 sicknesses. For mild symptoms of the Covid-19, he recommended using three formulas for treatment.

First is ya ha rak or benjalokawichien, which is an antipyretic drug. Next is to take chantaleela for relieving fever and inflammation. The last step is to use chantaharuthai to boost the immune system. The traditional remedies are also available in capsules.