Extract standardized to triterpenes depending on the product.
Improves symptoms of heavy legs and edema.
View the study (systematic review) →⏱ 3 min read
Centella asiatica, also called gotu kola or brahmi (a name it confusingly shares with Bacopa monnieri), is an aquatic plant with small leaves and a long tradition in Ayurvedic and traditional Chinese medicine, where it has been used for millennia for wound healing, peripheral circulation, and mental longevity; the last fifty years of pharmacological research have confirmed a real clinical profile based on saponin triterpenes that stimulate collagen synthesis and modulate the microcirculation.
The most studied active principles are asiaticoside, madecassoside, asiatic acid, and madecassic acid, collectively known as the total triterpenic fraction of Centella asiatica (TTFCA), a standardized mixture used in European clinical products (Centellase, Madecassol) with formal indications for chronic venous insufficiency, wound healing, and microvascular circulatory disorders.
The indication with the strongest clinical support is chronic venous insufficiency of the lower limbs: several meta-analyses have shown significant improvements in symptoms (leg heaviness, end-of-day swelling, night cramps) and in objective markers (edema measured by plethysmography, venous distensibility) with doses of 60 to 180 milligrams daily of TTFCA for 4 to 12 weeks.
The mechanism combines increased synthesis of type I collagen in the venous wall (which improves the structural integrity of weakened veins), modulation of capillary permeability (which reduces the edema associated with venous stasis), and an anti-inflammatory effect on the microvascular endothelium; this multimodal profile explains why the clinical response is more sustained than that of generic pharmacological venotonics.
Topically, Centella asiatica is one of the few plant extracts with clinical evidence for accelerating wound healing: several studies have shown improvements in the speed of epithelialization and in the quality of the final scar (less hypertrophy, lower risk of keloids) when applied in standardized creams to surgical wounds, superficial burns, and chronic ulcers.
In cosmetic dermatology, standardized extracts are used in anti-wrinkle and anti-stretch-mark creams with some clinical support, especially in postpartum women to reduce the incidence of abdominal stretch marks if applied from the start of pregnancy, a curious indication with several small but consistent trials.
In subclinical anxiety and mild sleep disorders, several small trials have shown modest improvements with doses of 500-1,000 milligrams daily for several weeks; the subjective effect is reminiscent of Bacopa monnieri or chamomile, without sedation and with very favorable tolerability, although the evidence is less robust than for venous insufficiency.
In mild cognitive impairment and normal aging, some studies have shown modest improvements in working memory, attention, and overall well-being; the mechanism may be related to improved cerebral blood flow associated with its effects on the microcirculation and to its modulation of monoaminergic neurotransmitters.
The doses studied range from 60 to 1,000 milligrams daily depending on the indication and format: 60-180 mg/day of TTFCA for venous insufficiency, 500-1,000 mg/day of standardized extract for anxiety or cognition; topically, creams with 0.5-2 percent extract applied twice a day; standardized products (especially European ones with TTFCA) have the most clinical support.
Generally well tolerated orally over short periods; the most frequent adverse effects are mild digestive discomfort; rare cases of liver toxicity have been described with prolonged use at high doses, which makes it prudent to limit continued use to periods of 6 to 8 weeks separated by breaks; it is contraindicated in pregnancy and breastfeeding because of limited data, and caution is advised in people with preexisting liver disease.
Information, not medical advice. Scientific evidence reflects the quality of the studies.