Its potent TTFCA component strengthens veins and reduces ankle swelling 

In last month's cover story, we talked about the beneficial effects of the herb gotu kola on our veins (see "Gotu Kola Promotes Healthy Veins," Life Enhancement,May 2002). Actually, most of the article was about our venous system and what can go wrong with it, and why it's important not to let that happen. Most of us are probably not too familiar with this subject, but we ought to be, because neglecting the health of our veins can have severe consequences. In this article we will focus mainly on recent research studies on the effects of gotu kola on our venous health - after a quick recap of the basics.

Usually we never even think about our veins unless they show their ugly side in the form of varicose veins or hemorrhoids (which are just varicose veins of the anus). These afflictions can be annoying and painful, but their real significance is that they are often symptoms of an underlying (literally) problem: chronic venous insufficiency (CVI) affecting the deep veins - especially in our legs - that we can't see. CVI is a deterioration of vein function, and it's not to be taken lightly.

Swollen Ankles Are a Telltale Symptom of Disease

The primary cause of CVI is venous hypertension, or high blood pressure in the veins (mainly in our legs). And the primary cause of that is a weakening of the connective tissue that constitutes an integral part of the vein walls. As the connective tissue gradually loses its strength, the veins lose their tone. The vein walls become distended, and the one-way valves inside the veins become less efficient at keeping the blood flowing in one direction only (toward the heart). The blood flow becomes sluggish and even stagnant in places, and the blood pressure builds up. This can lead to varicose veins. Worse still, it can lead to blood clots (deep-vein thrombosis), which can be fatal if they break loose and become lodged in the lungs - an event called pulmonary embolism.

In CVI the layer of smooth endothelial cells that forms the inner lining of blood vessels is also damaged, further compromising proper vein function. And characteristically there is damage to the walls of capillaries, particularly in the lower extremities, where venous blood pressure is maximized. Excessive pressure can increase the permeability of the capillaries, allowing fluid and large protein molecules to seep through their walls into the surrounding tissues. The result is edema (swelling), most commonly seen in the ankles. If you have edema of the ankles, it could very well signal a serious problem with your veins (but it could be caused by congestive heart failure, which is also a serious condition, so play it safe and see your doctor).

The treatment group showed major 
improvements in both measures: 
their skin flux had decreased by 
43%, and their capillary filtration 
rate had decreased by 34%.

This kind of capillary damage is called microangiopathy, which means "small vessel disease." Damage to the capillary walls can be caused not just by venous hypertension, however, but by other factors as well, notably diabetes; it is then called diabetic microangiopathy. Either way, a common secondary symptom of such microangiopathies, in addition to the edema, is skin ulceration at the affected areas.

TTFCA Rebuilds Vein Walls

Now for the good news (there's always some good news in the field of nutritional supplements): the symptoms of CVI can be alleviated by an extract of gotu kola (its botanical name is Centella asiatica), especially by a certain portion of the extract called TTFCA, which contains gotu kola's most potent components. TTFCA stands for triterpenic fraction of Centella asiatica. It consists of three chemical compounds of the class known as terpenes: asiaticoside, asiatic acid, and madecassic acid.

A recent supplement issue to the journal Angiology (angiology is the study of blood vessels and lymph vessels) is devoted entirely to research on the benefits of TTFCA in treating certain diseases of the circulatory system, mainly chronic venous hypertension and microangiopathies caused by venous hypertension and diabetes. The striking benefits of TTFCA are attributed largely to its ability to stimulate the growth both of connective tissue in the vein walls and of the endothelial cells that line them.1

TTFCA Slows Capillary Leakage

A research group of biomedical scientists in Italy and England has conducted a number of randomized, placebo-controlled studies investigating the effects of TTFCA in patients suffering from chronic venous hypertension. In one study, 40 patients (men and women, average age 48) with severe venous hypertension were given either placebo or 60 mg of TTFCA twice daily for 8 weeks.2 The purpose was to evaluate the effects of TTFCA on the patients' microcirculation - the blood flow in their capillaries, which are so narrow that blood cells pass through them one at a time. This is where microangiopathies occur, causing edema and skin ulcers.

The treatment group showed 
marked improvement in subjective 
measures of their condition -
edema, pain, restless limbs, etc.

Using sophisticated techniques, the researchers measured the "skin flux," or rate of fluid flow (mostly blood) within the tissue near the surface of the skin, at the ankle - in venous hypertension, skin flux increases beyond the normal range. They also measured the rate of capillary filtration, which is leakage from the capillaries. The latter measurement was made under carefully controlled conditions in which, after lying supine (on the back) for 30 minutes, the patient stands up and holds onto a frame to prevent any bodily motion. Under the sudden influence of gravity, the blood pressure in the patient's ankles quickly builds up, causing the diseased capillaries to stretch and leak fluid and proteins. The ankles swell, and the rate of swelling is a measure of the severity of the patient's condition.

At the outset of the study, there were no significant differences between the treatment group and the control (placebo) group in these two measures of their condition. At the end of the study, the control group showed no changes in their condition. The treatment group, however, showed major improvements in both measures: their skin flux had decreased by 43%, and their capillary filtration rate had decreased by 34%.

Patients with CVI Feel Better Too

Furthermore, the treatment group showed marked improvement in subjective measures of their condition, based on a rating system for the signs and symptoms of the disease. For each of five symptoms - edema, pain, restless limbs, subjective swelling (i.e., the sensation of swelling, as distinct from the actual swelling), and skin alterations/redness - the patients gave themselves a score of 0, 1, or 2, depending on the severity of the symptom. The most severe cases could thus have a composite score as high as 10 (5 x 2). At the outset of the study, the overall average score was 9.5 (really bad!), but after 8 weeks it had dropped to 4.5, a 53% improvement. No side effects of the treatment were noted.

The lab results were mirrored in 
the patients' subjective evaluations 
of their symptoms: Group B showed 
a 71% reduction, and Group C 
showed a whopping 94% reduction.

The authors concluded that ". . . this study indicates that oral treatment with TTFCA is effective in improving the microcirculation in limbs with chronic venous hypertension and venous microangiopathy characterized by high skin flux and high rate of ankle swelling in the perimalleolar [ankle] region."

Relief for Edema

Gotu kola (Centella asiatica), the source of TTFCA.

Other studies performed by the same research group, using a variety of measuring techniques and varying patient groups, produced consistently similar conclusions. In a 4-week trial, e.g., 50 patients (men and women, average age 43) with CVI and edema were given either placebo or 60 mg of TTFCA twice daily.3 Again there were no side effects. As in the previous study, the control group showed no improvement, but the treatment group did: there was a 34% reduction in the capillary filtration rate using one measuring technique, and a 48% reduction using another technique. (An important aspect of this series of studies was not only to measure the effects of TTFCA but also to evaluate different measurement techniques for disease processes that are inherently difficult to measure.)

TTFCA Combats Vasodilation

Another group of patients (40 men and women, average age 41) with severe venous hypertension and edema were evaluated for the effects of TTFCA (60 mg twice daily for 6 weeks) on their microcirculation and edema.4 After the treatment, their skin flux had decreased (improved) by 29%, and their venoarteriolar response - another measure of microcirculatory function, when the patient rises from a supine to a standing position - had increased (improved) by 52%. Their leg volume, a measure of edema, decreased by 1.3%, which may not sound like much but is regarded by the authors as clinically important.

Furthermore, transcutaneous (through-the-skin) measurements of the patients' oxygen and carbon dioxide levels showed a significant increase (+7.2%) in the former and a significant decrease (-9.6%) in the latter. These changes are considered beneficial, particularly because carbon dioxide is a powerful vasodilator - a substance that causes blood vessels to dilate - and further dilation of the already enlarged capillaries in venous hypertension and microangiopathy simply makes a bad situation that much worse.

Higher Amount of TTFCA Yields Better Results

In yet another study, 62 individuals (men and women, average age 44) were evaluated over a 4-week period; 10 were healthy, and 52 had venous hypertension.5 They were divided into four groups: Group A (20 patients) was treated with 60 mg of TTFCA thrice daily; Group B (20 patients) received 30 mg of TTFCA thrice daily; Group C (12 patients) received placebo thrice daily; and Group D (the 10 normal individuals) received the same treatment as Group A.

Seldom do research results point 
so clearly and unambiguously to 
the safety and efficacy of a 
nutritional supplement as in 
the case of TTFCA.

Measurements of capillary filtration rate produced significant improvements in Groups A (180 mg/day of TTFCA) and B (90 mg/day of TTFCA), namely, by 39% and 17%, respectively. Thus, the higher amount of TTFCA gave dramatically better results. The control group showed no change, as usual, and the healthy individuals showed no significant change. Measurements of ankle circumference showed small but significant decreases in Group A (3.0%) and Group B (2.3%). In the subjective evaluation of four signs and symptoms (swelling sensation, restless limbs, pain/cramps, and tiredness), Group A had an impressive reduction (improvement) of 40%, and Group B had a reduction of 21% (again showing that the higher amount of TTFCA was better).

TTFCA Produces Improvement in All Measures

Finally, the researchers applied a battery of techniques collectively called a microcirculatory model to a group of 89 patients (men and women, average age 39) with venous hypertensive microangiopathy.6 The patients were divided into three groups: for 8 weeks, Group A received placebo; Group B received 30 mg of TTFCA twice daily; and Group C received 60 mg of TTFCA twice daily.

Measurements of numerous quantities associated with the disease confirmed, yet again, the clear pattern running through these studies:

  • Significant, often dramatic improvements in all measured functions in the treatment groups
  • Improvements in a dose-dependent manner, i.e., the benefits rose in proportion to the amount of TTFCA used
  • No changes in the control group - meaning that the improvements in the treatment group were "pure," and not caused to any degree by the placebo effect
  • No side effects

The positive results in the laboratory tests were mirrored, again, in the patients' subjective evaluations of their symptoms (pain, tired or heavy legs, edema, muscle cramps, and degenerative skin changes): Group B showed a 71% reduction, and Group C showed a whopping 94% reduction.

The authors summarized their results by saying,

In conclusion, TTFCA is useful for the treatment of venous hypertensive microangiopathy. Furthermore, because of its action on the vein wall, TTFCA can prevent the progression of the disease. As higher dosages (120 mg/day) are tolerated as well as lower dosages (60 mg/day) but provide a significantly better result on both symptoms and microcirculatory parameters, dosage regimens higher than standard can be considered.

Seldom do research results point so clearly and unambiguously to the safety and efficacy of a nutritional supplement as in the case of TTFCA. By Mother Nature's good grace, this remarkable substance has the power to promote healthy vein function in veins that have been damaged by disease and to prevent the disease from progressing. If you have symptoms of chronic venous insufficiency, or if you believe you may be at risk for it, you would be wise to try TTFCA today and see if doesn't help you as it has helped so many others already.


  1. Incandela L, Cesarone MR, Cacchio M, De Sanctis MT, Santavenere C, D'Auro MG, Bucci M, Belcaro G. Total triterpenic fraction of Centella asiatica in chronic venous insufficiency and in high-perfusion microangiopathy. Angiology 2001 Oct.;52 Suppl 2:S9-13.
  2. Cesarone MR, Belcaro G, De Sanctis MT, et al. Effects of the total triterpenic fraction of Centella asiatica in venous hypertensive microangiopathy: a prospective, placebo-controlled, randomized trial. Angiology 2001 Oct;52 Suppl 2:S15-8.
  3. Belcaro G, Rulo A, Cesarone MR, et al. Capillary filtration in venous hypertension: evaluation with the vacuum suction chamber device and strain-gauge plethysmography. Angiology 2001 Oct;52 Suppl 2:S39-43.
  4. Cesarone MR, Belcaro G, Rulo A, et al. Microcirculatory effects of total triterpenic fraction of Centella asiatica in chronic venous hypertension: measurement by laser doppler, tcPO2-CO2, and leg volumetry. Angiology 2001 Oct;52 Suppl 2:S45-8.
  5. De Sanctis MT, Belcaro G, Incandela L, et al. Treatment of edema and increased capillary filtration in venous hypertension with total triterpenic fraction of Centella asiatica: a clinical, prospective, placebo-controlled, randomized, dose-ranging trial. Angiology 2001 Oct;52 Suppl 2:S55-9.
  6. Incandela L, Belcaro G, De Sanctis MT, et al. Total triterpenic fraction of Centella asiatica in the treatment of venous hypertension: a clinical, prospective, randomized trial using a combined microcirculatory model. Angiology 2001 Oct;52 Suppl 2:S61-7.