Gotu Kola

In western herbal medicine, gotu kola was used mainly as a nervine, depurative, and vulnerary. It was especially useful in connective tissue and skin healing. ^{28Reference 28Bone et al. · 2013Principles and Practice of Phytotherapy (2nd ed.)}.

In Australia, the leaves were consumed from a similar species for arthritis ^{28Reference 28Bone et al. · 2013Principles and Practice of Phytotherapy (2nd ed.)}.

Gotu kola is one of the highly esteemed Rasayana herbs of the Ayurvedic medical system. This means it is used to improve the mind body and spirit in much the same way as a tonic herb from China, or an adaptogenic herb of western herbal medicine.

The Sanskrit name Brahmi means “from Brahma,” who is a central deity in the Hindu pantheon ^{28Reference 28Bone et al. · 2013Principles and Practice of Phytotherapy (2nd ed.)}. This shows the level of distinction gotu kola has in this medical system.

Gotu Kola was used in the traditional Chinese medical system for its ability to clear “damp-heat,” cool the blood, stop bleeding and clear the liver. It was also suggested to brighten the eyes. ^{28Reference 28Bone et al. · 2013Principles and Practice of Phytotherapy (2nd ed.)}.

Many of the medical systems of South Asia used gotu kola for skin conditions and infections ^{28Reference 28Bone et al. · 2013Principles and Practice of Phytotherapy (2nd ed.)}.

This is gotu kola’s strongest human evidence. A standardised total triterpenic fraction (TTFCA/TECA) has been tested in a series of small placebo-controlled and comparative trials in chronic venous insufficiency and venous/diabetic microangiopathy. An early double-blind trial (n=94, 2 months) found TECA at 60–120 mg/day significantly improved leg heaviness, oedema and venous distensibility versus placebo ^{6Reference 6Pointel et al. · 1987RCTTitrated extract of Centella asiatica (TECA) in the treatment of venous insufficiency of the lower limbs — multicentre double-blind randomised trialView study →}. Later randomised, placebo-controlled trials (typically 60 mg twice or thrice daily, 4–8 weeks, n≈40 each) reported significant reductions in capillary filtration rate, ankle oedema, resting flux and microcirculatory symptoms, with improved venoarteriolar response ^{2,3,4,5Reference 2Martínez-Zapata et al. · 2020Meta-analysisPhlebotonics for venous insufficiency — systematic review and meta-analysis (Cochrane)View study →Reference 3Incandela et al. · 2001RCTTreatment of diabetic microangiopathy and edema with total triterpenic fraction of Centella asiatica — placebo-controlled randomised trialView study →Reference 4Cesarone et al. · 2001RCTEffects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy — placebo-controlled randomised trialView study →Reference 5De Sanctis et al. · 2001RCTTreatment of edema and increased capillary filtration in venous hypertension with total triterpenic fraction of Centella asiatica — randomised, placebo-controlled, dose-ranging trialView study →}; a 12-month trial extended benefit to diabetic microangiopathy ^{3Reference 3Incandela et al. · 2001RCTTreatment of diabetic microangiopathy and edema with total triterpenic fraction of Centella asiatica — placebo-controlled randomised trialView study →}. The 2020 Cochrane review of phlebotonics judged the class to moderately reduce oedema and some venous symptoms, listing Centella asiatica among the agents assessed ^{2Reference 2Martínez-Zapata et al. · 2020Meta-analysisPhlebotonics for venous insufficiency — systematic review and meta-analysis (Cochrane)View study →}. The European Medicines Agency accepts Centellae asiaticae herba as a traditional herbal medicine for minor venous circulation symptoms. Honest limits: trials are small, mostly from a single Italian research group, and used a proprietary standardised fraction rather than crude herb.

Gap: trials are small and largely single-group; no large multicentre RCT or hard-outcome (ulcer-healing) data, and results apply to the standardised fraction, not tea or tincture.

The classic traditional use, and the one with the clearest mechanism. In animal wounds, topical asiaticoside raised wound-tissue antioxidants (SOD +35%, catalase +67%, glutathione peroxidase +49%) and cut lipid peroxides, alongside its known collagen and angiogenesis effects ^{16Reference 16Shukla et al. · 1999AnimalAsiaticoside-induced elevation of antioxidant levels in healing wounds — animal (rat) modelView study →}; oral madecassoside accelerated burn-wound closure in mice with increased hydroxyproline (collagen) and reduced inflammatory infiltrate ^{17Reference 17Liu et al. · 2008AnimalMadecassoside isolated from Centella asiatica facilitates burn wound healing in mice — animal modelView study →}. In humans, a 2022 systematic review of four clinical trials found C. asiatica improved wound contraction, granulation and re-epithelialisation, attributing this to stimulation of collagen I, FGF and VEGF plus suppression of IL-1β, IL-6, TNF-α and COX-2 ^{8Reference 8Arribas-López et al. · 2022Systematic reviewA systematic review of the effect of Centella asiatica on wound healingView study →}; a 2023 multicentre RCT (n=60) of a standardised triterpene spray-film improved healing of clean-contaminated acute wounds ^{9Reference 9Changsan et al. · 2023RCTWound healing efficacy of a polymeric spray film containing Centella asiatica leaf extract — multicentre randomised controlled trialView study →}. Effects are best documented for standardised topical preparations.

Gap: most trials are small, use varied standardised topicals, and lack blinding rigour; oral whole-herb wound data are thin.

Anti-inflammatory activity is the mechanistic thread linking the wound, venous and neuroprotective effects, and it is well characterised at the molecular level. In LPS-stimulated macrophages, madecassic acid suppressed nitric oxide, PGE2, TNF-α, IL-1β and IL-6, downregulated iNOS and COX-2, and inhibited NF-κB activation — more potently than madecassoside ^{18Reference 18Won et al. · 2010In vitroAnti-inflammatory effects of madecassic acid via suppression of the NF-κB pathway in LPS-induced macrophages — in vitroView study →}. The same cytokine and COX-2 suppression is reported in the human wound-healing review ^{8Reference 8Arribas-López et al. · 2022Systematic reviewA systematic review of the effect of Centella asiatica on wound healingView study →}. Evidence is overwhelmingly preclinical (cell and animal), but it is consistent and directly explains the clinically observed effects.

Gap: no trial measures inflammatory endpoints in humans taking the herb systemically; the anti-inflammatory case is inferred from cell/animal work plus downstream clinical outcomes.

Oral and topical standardised extracts show modest anti-ageing effects on skin. A 2020 systematic review and network meta-analysis of five double-blind RCTs (172 Asian women) concluded C. asiatica or asiaticoside applied topically for 8–12 weeks improved periocular and lip wrinkles and markedly raised skin hydration, appearing more effective than Pueraria mirifica though possibly less than tretinoin, with fewer adverse events than tretinoin ^{10Reference 10Kongkaew et al. · 2020Meta-analysisEfficacy and safety of Centella asiatica on wrinkles — systematic review and network meta-analysis of randomised controlled trialsView study →}. A 2026 RCT (n=112, 12 weeks) of an oral extract (200 mg/day) reported significant reductions in wrinkle depth and improved hydration and elasticity versus baseline ^{11Reference 11Hur et al. · 2026RCTOral Centella asiatica extract on skin aging parameters in middle-aged women — randomised, double-blind, placebo-controlled trialView study →}. Preparations are proprietary and standardisation varies.

Gap: trials are short, several are industry-linked, and lack of standardisation across products limits generalisation.

Antioxidant activity is one of gotu kola’s most reproducible preclinical properties and underlies several of its other effects. In wound tissue asiaticoside raised SOD, catalase, glutathione peroxidase, vitamin E and ascorbate while cutting lipid peroxidation ^{16Reference 16Shukla et al. · 1999AnimalAsiaticoside-induced elevation of antioxidant levels in healing wounds — animal (rat) modelView study →}; in Alzheimer’s-model mice, water extract activated the NRF2 antioxidant-response pathway and improved mitochondrial antioxidant markers in the hippocampus ^{19,14Reference 19Matthews et al. · 2019AnimalCentella asiatica improves memory and promotes antioxidative NRF2 signaling in 5XFAD mice — animal modelView study →Reference 14Gray et al. · 2018AnimalCentella asiatica attenuates hippocampal mitochondrial dysfunction and improves memory and executive function in β-amyloid overexpressing mice — animal modelView study →}. The 2012 Orhan review catalogues consistent radical-scavenging and lipid-peroxidation-lowering effects across models ^{1Reference 1Orhan · 2012ReviewCentella asiatica (L.) Urban: From traditional medicine to modern medicine with neuroprotective potential — reviewView study →}. Direct human antioxidant-endpoint data are limited, though a 2026 RCT found an oral extract raised macular pigment optical density, a nutrition-responsive ocular antioxidant marker ^{15Reference 15Baek et al. · 2026RCTLong-term supplementation with Centella asiatica extract (CA-HE50) on macular pigment optical density — randomised, double-blind, placebo-controlled trialView study →}.

Gap: antioxidant effects are demonstrated almost entirely in vitro and in animals; systemic antioxidant benefit in humans is largely inferred.

Anxiolytic use has one rigorous acute human trial and several weaker ones. In a double-blind, placebo-controlled study (n=40), a single 12 g oral dose of gotu kola significantly attenuated the acoustic startle response 30–60 minutes after dosing — a validated marker of anxiety — without affecting mood, heart rate or blood pressure ^{12Reference 12Bradwejn et al. · 2000RCTA double-blind, placebo-controlled study on the effects of Gotu Kola on acoustic startle response in healthy subjects — randomised trialView study →}. A small open-label study in generalised anxiety disorder (n=33, 500 mg twice daily, 60 days) reported reduced anxiety, stress and depression scores ^{13Reference 13Jana et al. · 2010Clinical trialA clinical study on the management of generalized anxiety disorder with Centella asiatica — clinical trialView study →}, and the 2017 cognition/mood meta-analysis found C. asiatica improved alertness and reduced anger acutely ^{7Reference 7Puttarak et al. · 2017Meta-analysisEffects of Centella asiatica on cognitive function and mood — systematic review and meta-analysisView study →}. A 2026 scoping review of mood disorders found only three small human studies (n=91 total) and judged the evidence too limited for meta-analysis ^{20Reference 20Pedregosa et al. · 2026ReviewTherapeutic potential of Gotu Kola, phosphatidylcholine and taurine in mood disorders — systematic scoping reviewView study →}.

Gap: the strongest data are acute and single-dose; no adequately powered RCT tests sustained treatment of a diagnosed anxiety disorder.

Preclinical neuroprotection is a rich, active research area, particularly for Alzheimer’s disease. Water extract of C. asiatica improved memory and executive function in β-amyloid-overexpressing (5xFAD/Tg2576) mice, attenuated hippocampal mitochondrial dysfunction, reduced oxidative stress and activated NRF2-regulated antioxidant genes ^{19,14Reference 19Matthews et al. · 2019AnimalCentella asiatica improves memory and promotes antioxidative NRF2 signaling in 5XFAD mice — animal modelView study →Reference 14Gray et al. · 2018AnimalCentella asiatica attenuates hippocampal mitochondrial dysfunction and improves memory and executive function in β-amyloid overexpressing mice — animal modelView study →}. Asiatic acid shows neuroprotective activity across models of cerebral ischaemia, spinal cord injury, epilepsy and neurodegeneration, acting through anti-inflammatory and antioxidant signalling ^{21Reference 21Ding et al. · 2023ReviewNeuroprotective mechanisms of asiatic acid — reviewView study →}. The 2012 review attributes the herb’s brain effects to acetylcholinesterase and tyrosinase inhibition, reduced lipid peroxidation, dendritic arborisation and increased Na⁺/K⁺-ATPase activity ^{1Reference 1Orhan · 2012ReviewCentella asiatica (L.) Urban: From traditional medicine to modern medicine with neuroprotective potential — reviewView study →}. All of this remains preclinical.

Gap: no human neuroprotection trial exists; the case rests entirely on rodent and cell models, with human pharmacokinetics showing the parent glycosides are poorly absorbed ^{22,23Reference 22Songvut et al. · 2019Clinical trialSafety and pharmacokinetics of standardized extract of Centella asiatica (ECa 233) capsules in healthy volunteers — phase 1 clinical trialView study →Reference 23Songvut et al. · 2021Clinical trialPharmacokinetics and metabolomics of an orally modified formula of standardized Centella asiatica extract in healthy volunteers — clinical trialView study →}.

Despite its “brain tonic” reputation, controlled human data do not support cognitive enhancement. The 2017 systematic review and meta-analysis (five RCTs of C. asiatica alone plus six of C. asiatica-containing products) found no significant difference from placebo in any cognitive domain; the only positive effects were improved alertness and reduced anger acutely ^{7Reference 7Puttarak et al. · 2017Meta-analysisEffects of Centella asiatica on cognitive function and mood — systematic review and meta-analysisView study →}. The most cited positive trial (n=28 healthy elderly, 2 months) found working-memory gains only at the highest dose (750 mg/day), not lower doses ^{24Reference 24Wattanathorn et al. · 2008RCTPositive modulation of cognition and mood in the healthy elderly following Centella asiatica — randomised, placebo-controlled trialView study →}. The gap between strong animal data and null human cognition results is the central tension in the herb’s modern profile.

Gap: the human meta-analysis is null for cognition; positive signals are limited to one dose in one small trial, and no large confirmatory RCT exists.

Liver-protective claims rest on animal and cell models and are complicated by safety data pointing the other way. C. asiatica juice altered oncogene expression (c-myc, c-fos, c-erbB2) and induced apoptosis in hepatocellular carcinoma cells in vitro ^{25Reference 25Hussin et al. · 2014In vitroCentella asiatica juice effects on DNA damage, apoptosis and gene expression in hepatocellular carcinoma — in vitroView study →}, and madecassoside prevented LPS/D-galactosamine-induced acute liver failure in mice by suppressing inflammation ^{26Reference 26Wang et al. · 2018AnimalMadecassoside prevents acute liver failure in LPS/D-GalN-induced mice — animal modelView study →}. However, C. asiatica is among the more frequently reported herbal causes of drug-induced liver injury in pharmacovigilance reviews ^{27Reference 27Santos et al. · 2021Systematic reviewProfile of herbal and dietary supplement-induced liver injury in Latin America — systematic reviewView study →} — so any hepatoprotective framing must be weighed against documented idiosyncratic hepatotoxicity.

Gap: no human hepatoprotective data; the preclinical signal is directly contradicted by real-world hepatotoxicity case series, making net liver effect uncertain.

Gotu kola is well tolerated in the short-to-medium-term clinical trials conducted to date, with the standardised triterpene fraction reporting no significant adverse effects over 4 weeks to 12 months ^{3,4,5Reference 3Incandela et al. · 2001RCTTreatment of diabetic microangiopathy and edema with total triterpenic fraction of Centella asiatica — placebo-controlled randomised trialView study →Reference 4Cesarone et al. · 2001RCTEffects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy — placebo-controlled randomised trialView study →Reference 5De Sanctis et al. · 2001RCTTreatment of edema and increased capillary filtration in venous hypertension with total triterpenic fraction of Centella asiatica — randomised, placebo-controlled, dose-ranging trialView study →}. The most consistent adverse signal is allergic contact dermatitis from topical use — an Apiaceae-family reaction, uncommon but genuine, and relevant to people sensitised to related plants ^{10Reference 10Kongkaew et al. · 2020Meta-analysisEfficacy and safety of Centella asiatica on wrinkles — systematic review and network meta-analysis of randomised controlled trialsView study →}.

The more serious concern is idiosyncratic hepatotoxicity: Centella asiatica is among the more frequently implicated herbal supplements in drug-induced liver injury case series, typically hepatocellular and predominantly in women, so it should be avoided by people with liver disease and stopped if signs of liver injury appear ^{27Reference 27Santos et al. · 2021Systematic reviewProfile of herbal and dietary supplement-induced liver injury in Latin America — systematic reviewView study →}. Because oral use may lower blood glucose, caution is warranted alongside antidiabetic medication ^{1Reference 1Orhan · 2012ReviewCentella asiatica (L.) Urban: From traditional medicine to modern medicine with neuroprotective potential — reviewView study →} — note this is the opposite direction to older warnings about raising blood sugar. Human pharmacokinetic work shows the parent glycosides (asiaticoside, madecassoside) are poorly absorbed and act via their acid metabolites, which is why extract standardisation and preparation matter ^{22,23Reference 22Songvut et al. · 2019Clinical trialSafety and pharmacokinetics of standardized extract of Centella asiatica (ECa 233) capsules in healthy volunteers — phase 1 clinical trialView study →Reference 23Songvut et al. · 2021Clinical trialPharmacokinetics and metabolomics of an orally modified formula of standardized Centella asiatica extract in healthy volunteers — clinical trialView study →}.

Scope note: no dedicated human drug-interaction or CYP450 study was identified. The glucose-lowering interaction is plausible (and one diabetes RCT co-administered antidiabetic drugs) and additive hepatotoxicity with other hepatotoxic agents is inferred, not tested — treat interactions as not adequately assessed rather than absent.