My grandfather kept a piece of mulethi in his shirt pocket at all times. Whenever his throat felt scratchy or his stomach burned after a heavy meal, he would chew it slowly, extracting the sweet juice. As children, we loved stealing pieces from his pocket because it tasted like natural candy. “This root has more sweetness than sugar,” he would say, “but the sweetness that heals rather than harms.”

Yashtimadhu, also written Yastimadhu, is the Ayurvedic name for licorice root, commonly called mulethi in Hindi. The Ayurvedic Pharmacopoeia of India identifies Yashti as the dried, unpeeled stolon and root of Glycyrrhiza glabra. Ayurveda values it as a sweet, cooling, nourishing, and Vata-Pitta-pacifying herb, especially for the throat, respiratory tract, gastric burning, weakness, and tissue repair. Its sweetness comes largely from glycyrrhizin, a compound that also explains why licorice must be used with respect: excess or prolonged intake can raise blood pressure, lower potassium, and cause fluid retention in susceptible people.

Ayurvedic Profile and Pharmacology

Classically, Yashtimadhu is a madhura, snigdha, guru, sheeta herb with madhura vipaka. This means it is sweet in taste, unctuous and heavy in quality, cooling in potency, and nourishing after digestion. Under the synonym Madhuka, the Charaka Samhita places it in several therapeutic groups, including Jivaniya, Sandhaniya, Varnya, Kanthya, Snehopaga, Dahaprashamana, Angamardaprashamana, and Shonitasthapana. The Ayurvedic Pharmacopoeia lists its actions as Balya, Cakshushya, Vrishya, Varnya, Vatapittajit, and Raktaprasadana.

Therapeutic Application 1: Gastric Burning, Dyspepsia, and Ulcer-Conscious Support

Yashtimadhu is especially suited to burning, sourness, irritation, and dryness in the upper digestive tract. Its madhura rasa, snigdha guna, and sheeta virya make it a natural Ayurvedic choice for Pitta-type gastric discomfort and Vata-related roughness of the mucosa. In modern herbal practice, licorice root is also used for digestive burning and dyspepsia, while deglycyrrhizinated licorice is used as a demulcent preparation for minor inflammation and burning of the gastrointestinal tract.

• Classical root powder: 2–4 g of Yashtimadhu churna may be used in appropriate cases, preferably under the guidance of a qualified practitioner.
• Digestive tea or decoction: A conservative adult preparation is 1.5–2 g of cut or powdered licorice root in about 150 ml water, taken after meals when suitable.
• DGL tablets: Deglycyrrhizinated licorice is usually taken as a chewable product so it mixes with saliva before reaching the stomach. A common adult range is 380–760 mg before meals or between meals, within the product label and practitioner guidance.
• When ulcers are suspected: Persistent burning, severe abdominal pain, black stools, vomiting blood, unexplained weight loss, anemia, or chronic painkiller use requires medical evaluation. Yashtimadhu can be supportive, but it should not replace diagnosis and appropriate care for peptic ulcer disease.

Therapeutic Application 2: Adrenal-Axis Support and Cortisol Metabolism

Yashtimadhu is sometimes discussed in relation to adrenal recovery because glycyrrhizin is metabolized into compounds that affect cortisol metabolism. The key point is not that licorice forces the adrenal glands to produce more hormones; rather, glycyrrhetinic acid can inhibit 11-beta-hydroxysteroid dehydrogenase, an enzyme involved in converting cortisol to cortisone. This can make cortisol activity last longer in certain tissues, which is why the herb may feel strengthening in selected depletion patterns and why it can also cause mineralocorticoid-like side effects when misused.

In Ayurvedic terms, Yashtimadhu belongs more naturally to presentations of dryness, irritation, hoarseness, weakness, Vata-Pitta depletion, and tissue exhaustion than to heaviness, congestion, edema, or Kapha accumulation. Anyone with diagnosed adrenal disease, unexplained chronic fatigue, faintness, blood-pressure instability, or corticosteroid use should treat this as a practitioner-guided herb rather than a self-prescribed tonic.

Practical use: For ordinary root powder, stay within the 2–4 g classical dose range unless supervised. Avoid combining licorice capsules, licorice tea, mulethi sticks, black licorice candy, and formulas containing Yashtimadhu on the same day, because total glycyrrhizin exposure is what drives many safety concerns.

Therapeutic Application 3: Respiratory and Voice Support

Yashtimadhu is one of Ayurveda’s most beloved herbs for the throat and voice. The Ayurvedic Pharmacopoeia lists Kasa and Svarabheda among its uses, and Charaka’s Kanthya grouping supports its traditional reputation for the throat. Its sweet, cooling, unctuous nature makes it especially fitting for dry cough, throat scratchiness, hoarseness, and vocal strain.

• Dry cough and throat irritation: Yashtimadhu churna may be used within the 2–4 g range with a suitable anupana chosen for the person and season.
• Cough associated with cold: A simple tea can be prepared from about 1.5 g licorice root in 150 ml water, used for short-term respiratory support in appropriate adults.
• Voice strain: Slowly sipping warm Yashtimadhu tea or using a small piece of mulethi root traditionally supports the throat when dryness and roughness are the main features.
• When to seek care: Shortness of breath, fever, thick purulent sputum, chest pain, wheezing, or a cough that persists beyond a short acute episode should be assessed by a healthcare provider.

The Safety Question: Glycyrrhizin, Blood Pressure, and Potassium

This is where Yashtimadhu’s sweetness becomes a double-edged sword. Glycyrrhizin and its metabolites can inhibit 11-beta-hydroxysteroid dehydrogenase in a way that allows cortisol to act more strongly at mineralocorticoid-sensitive receptors. The result can be sodium and water retention, potassium loss, swelling, high blood pressure, muscle weakness, heart-rhythm disturbance, and, in severe cases, serious cardiovascular complications.

Who Should Avoid Yashtimadhu or Use It Only Under Direct Supervision

Glycyrrhizin-containing licorice is not appropriate for everyone. People with blood-pressure, kidney, liver, heart, electrolyte, pregnancy, or medication-related risks should not treat it as a casual home remedy.

• People with hypertension, including those whose blood pressure is controlled with medication
• People with kidney disease, liver disease, heart disease, heart failure, edema, or rhythm disorders
• Anyone with low potassium or a history of electrolyte imbalance
• People taking diuretics, cardiac glycosides, corticosteroids, stimulant laxatives, or medicines that disturb electrolytes
• People taking antihypertensive medication, because licorice may oppose blood-pressure control
• Pregnant or breastfeeding women, unless specifically guided by a qualified clinician
• Children and adolescents unless guided by a qualified practitioner
• Anyone who develops swelling, headache, muscle weakness, palpitations, or unusual fatigue while using licorice

Safer Options When Glycyrrhizin Is a Concern

When the goal is digestive demulcent support rather than the full systemic action of licorice, DGL is often the safer licorice-based option. It is processed so the finished product contains only a small percentage of the original glycyrrhizic acid, while retaining a soothing role for the gastrointestinal tract.

• DGL: Best suited when the main concern is gastric burning or minor gastrointestinal irritation and blood-pressure safety is important.
• Individualized Ayurvedic substitutes: When licorice is unsuitable, a practitioner may choose other cooling, demulcent, or nourishing herbs based on the person’s dosha pattern, digestion, medications, and diagnosis.
• Medical treatment when required: Red-flag digestive or respiratory symptoms should be evaluated rather than masked with herbs.

My Approach to Safe Use

Yashtimadhu is powerful precisely because it is both soothing and systemically active. My grandfather’s small mulethi stick, used occasionally in the context of a traditional diet and active life, is very different from concentrated capsules taken daily alongside blood-pressure medicines or a low-potassium diet.

1. Confirm whether the product is whole licorice, extract, DGL, candy, tea, or part of a formula.
2. Check blood pressure and review kidney, heart, liver, pregnancy, and medication history before regular use.
3. Keep ordinary root powder within the 2–4 g classical range unless supervised.
4. Avoid stacking multiple sources of licorice on the same day.
5. Use DGL rather than whole licorice when long-term gastric demulcent support is needed and glycyrrhizin is a concern.
6. Stop use and seek medical advice if swelling, headache, palpitations, muscle weakness, or unusual fatigue appears.
7. Reassess persistent digestive symptoms, cough, hoarseness, or fatigue instead of extending licorice use indefinitely.

For broader support around exhaustion and digestive repair, Yashtimadhu belongs inside a complete plan that considers sleep, food timing, agni, bowel habits, stress load, medications, and the person’s constitution. Used wisely, it remains one of Ayurveda’s most graceful sweet roots; used carelessly, that same sweetness can become a source of avoidable harm.

Medical Disclaimer: This article is for educational purposes only and does not constitute medical advice. Yashtimadhu or licorice can interact with medications and may cause hypertension, hypokalemia, edema, and heart-rhythm problems in susceptible people. Consult a qualified Ayurvedic practitioner or healthcare provider before using licorice products, especially if you have high blood pressure, heart disease, kidney disease, liver disease, pregnancy, electrolyte imbalance, or take prescription medicines. Do not exceed recommended dosages or use continuously without professional supervision.

References

1. Ayurvedic Pharmacopoeia of India
2. Charaka Samhita — Shadvirechanashatashritiya Adhyaya
3. Heart (heart.org)
4. E-lactancia (e-lactancia.org)
5. Webprod (webprod.hc-sc.gc.ca)
6. Anti-Helicobacter pylori flavonoids from licorice extract (2002), PubMed
7. Aqueous extracts and polysaccharides from liquorice roots (Glycyrrhiza glabra L.) inhibit adhesion of Helicobacter pylori to human gastric mucosa (2009), PubMed
8. Ema (ema.europa.eu)
9. NCCIH

This is not a claim that Ayurveda treats COVID-19 or any specific infectious disease. It is a pharmacological and classical review of documented mechanisms and traditional usage, presented with their appropriate clinical limits.

The Cytokine Storm: Mechanism and Targets

Under normal immune activation, dendritic cells and macrophages release cytokines that coordinate a measured inflammatory response. In cytokine storm this regulation fails: positive-feedback loops among IL-6, TNF-alpha, and IL-1beta create a self-amplifying cascade that injures healthy tissue, particularly the lung endothelium and vascular system. The principal therapeutic targets identified in the immunological literature include:

• IL-6: the primary driver of the acute-phase response; its receptor is the target of the monoclonal antibody tocilizumab used in severe COVID-19
• TNF-alpha: central to the NF-kB inflammatory pathway; elevated in sepsis, autoimmune conditions, and severe infection
• IL-1beta: activates the NLRP3 inflammasome, triggering pyroptosis and vascular leakage
• IFN-gamma: drives the macrophage activation syndrome associated with haemophagocytic lymphohistiocytosis
• NLRP3 inflammasome: the molecular platform on which IL-1beta maturation depends; an emerging drug target across multiple inflammatory conditions

Guduchi (Tinospora cordifolia): The Most Studied Ayurvedic Immunomodulator

Guduchi (giloy, Tinospora cordifolia) is among the most extensively investigated herbs of the Ayurvedic materia medica. Classical texts give it the name Amrita, “the nectar of immortality,” and Charaka places it among the Vayasthapana (age-sustaining), Trishna-nigrahana (thirst-relieving), and Dahaprashamana (heat-quelling) groups of herbs. Its rasa (taste) is tikta (bitter) and kashaya (astringent), its virya (potency) ushna (heating), and its vipaka (post-digestive effect) madhura (sweet); it is classically regarded as tridoshahara and as a premier Rasayana (rejuvenative) used to rebuild strength and resilience after illness.

Phytochemically, Tinospora contains several chemically distinct classes of constituent, which should not be conflated: isoquinoline-type alkaloids such as berberine, palmatine, and magnoflorine; diterpenoid furanolactones such as columbin and tinosporide; clerodane glycosides such as tinocordiside and cordifolioside; and an immunologically active arabinogalactan polysaccharide. Columbin is a bitter diterpenoid lactone, not an alkaloid, and berberine is a separate isoquinoline alkaloid — the two belong to different chemical families and are not interchangeable names for one compound. Experimental reviews of the plant attribute much of its immunomodulatory activity to the arabinogalactan polysaccharide and report that the herb acts bidirectionally rather than as a simple immunosuppressant: in immunodeficient models it enhances natural-killer-cell activity and macrophage phagocytosis, while in hyperinflammatory models it dampens pro-inflammatory cytokine output. This normalising, bidirectional character is consistent with the classical understanding of Guduchi as a Rasayana rather than a single-target drug.

In classical practice Guduchi is rarely given as a crude alkaloid. It is used as Guduchi Satva (the starch-like aqueous extract), as Samshamani Vati (also called Guduchi Ghana Vati, the solidified decoction), and within compound formulations such as Amritarishta and Guduchyadi Kashaya, classically indicated in Jvara (fever) — particularly Jirna Jvara, the chronic or lingering fever — as well as in Vatarakta and Prameha. These traditional indications align with the herb’s documented anti-inflammatory and immunomodulatory pharmacology, but rigorous human trials specific to cytokine-storm conditions are still lacking, and that gap should not be overstated.

Yashtimadhu (Glycyrrhiza glabra): Glycyrrhizin and HMGB1

Yashtimadhu (licorice root, Glycyrrhiza glabra; also Madhuyashti or Mulethi) is one of the most valued herbs of classical Ayurveda, included in Charaka’s Jivaniya (life-promoting), Kanthya (voice-improving), Varnya (complexion-improving), and Sandhaniya groups. Its rasa is madhura (sweet), its virya sheeta (cooling), and its vipaka madhura, and it is traditionally used as a Rasayana for the respiratory tract and throat. Its principal triterpenoid saponin, glycyrrhizin, has a well-characterised anti-inflammatory profile:

• It binds directly to HMGB1 (high-mobility group box 1 protein) and inhibits its cytokine activity — HMGB1 being a late-phase mediator that sustains inflammation after the initial infectious trigger has been controlled
• It is reported to reduce NLRP3 inflammasome activation, limiting IL-1beta maturation
• It modulates interferon and JAK-STAT signalling in experimental systems
• It inhibits phospholipase A2, reducing arachidonic-acid release and downstream prostaglandin and leukotriene production

Andrographis paniculata (Bhunimba / Kalamegha): The NF-kB and STAT3 Modulator

In Ayurveda Andrographis paniculata is known by the Sanskrit names Bhunimba (“neem of the ground,” for its intense bitterness) and Kalamegha; “Kalmegh” is the common Hindi and Bengali vernacular form rather than the classical Sanskrit or pharmacopoeial name. It is an intensely tikta (bitter) herb used classically as a deepana-pachana (digestion-kindling) agent and as a remedy for fever and liver disorders, especially in Pittaja jvara and in afflictions of the Yakrit (liver). Its primary diterpene lactone, andrographolide, has been studied as an inhibitor of the two transcription factors most central to cytokine-storm amplification, NF-kB and STAT3:

• It forms a covalent adduct with reduced cysteine 62 of the NF-kB p50 subunit, blocking the protein’s binding to DNA and thereby suppressing NF-kB-driven transcription
• It is reported to interfere with STAT3 activation, the pathway through which IL-6 propagates its inflammatory signal
• In cell-culture models it reduces replication of several respiratory viruses, an effect attributed in part to interference with viral protease activity

Andrographis has been evaluated in human trials for uncomplicated upper-respiratory-tract infection, where it has shown modest symptomatic benefit. Claims of dramatic benefit in COVID-19, however, are not supported by reliable randomised evidence; existing trials of standardised andrographolide doses have not demonstrated a consistent, clinically meaningful advantage, and the herb should not be presented as a proven antiviral therapy.

The Classical Formula Approach: Sudarshana Churna

Classical Ayurveda rarely treats Jvara (fever) with a single herb. Instead it relies on compound formulas (yoga) in which many bitter, deepana-pachana herbs are combined to digest Ama (undigested metabolic residue) and rebalance the doshas. Sudarshana Churna (in its larger form Mahasudarshana Churna), described in classical compendia such as the Bhaishajya Ratnavali, is among the most widely used Ayurvedic antipyretic formulas. Built around the intensely bitter Kiratatikta (Swertia chirata) together with Guduchi and a large number of supporting herbs, it is classically indicated in Vishama Jvara — the irregular, recurrent, and intermittent fevers that include malaria-like and chronic febrile patterns.

A related and frequently cited Tamil formula, Nilavembu Kudineer, is used for similar febrile and inflammatory conditions, but it belongs to the Siddha system — a distinct classical tradition of South India — and does not appear in the Ayurvedic classical texts or the Ayurvedic Pharmacopoeia of India; it should therefore not be described as an Ayurvedic formula. Within Ayurveda itself, the rationale for multi-herb antipyretics is the principle of synergy: bitter herbs such as Kiratatikta and Guduchi supply the central febrifuge and Ama-digesting action; aromatic and pungent additions such as dry ginger (Shunthi) and the Trikatu group act as deepana and as anupana that aid absorption; and the whole is held to function as a balanced pharmacological ensemble rather than as a single isolated molecule.

Safety Considerations for Cytokine-Modulating Herbs

Enthusiasm for cytokine-modulating herbs must be matched by explicit safety awareness, because several of these plants carry genuine risks at therapeutic doses:

• Yashtimadhu: glycyrrhizin raises blood pressure through mineralocorticoid-like activity and can cause hypokalaemia and fluid retention. It is contraindicated in uncontrolled hypertension and should not be taken at high doses for more than four to six weeks without medical supervision.
• Andrographis: animal studies suggest it may reduce sperm parameters at high doses, so it is best avoided by men actively trying to conceive; it may also potentiate anticoagulant and antiplatelet medicines.
• Guduchi: published case series have linked some commercial Tinospora cordifolia preparations to herb-induced liver injury, including an autoimmune-pattern hepatitis. Correct botanical identification and quality-verified sources are essential, and unexplained jaundice warrants stopping the herb and seeking medical care.
• Curcumin (Haridra): can inhibit platelet aggregation, warranting caution with anticoagulants, and inhibits CYP3A4, potentially altering the levels of many prescription medicines.

For anyone receiving immunosuppressive therapy for autoimmune disease or organ transplantation, cytokine-modulating herbs require careful medical supervision, because their effects on immune regulation may interact unpredictably with pharmaceutical immunosuppressants.

The immunological themes here connect to the broader Ayurvedic anti-inflammatory framework covered in the Ayurvedic anti-inflammatory diet. For further pharmacological context, the herb-drug interactions safety guide provides essential reference for herb-medication combinations.

This is a pharmacological and classical review for educational purposes only. None of the herbs or formulas described here should be used as a first-line treatment for COVID-19, sepsis, or any acute inflammatory condition requiring urgent medical care. Always consult a qualified healthcare provider and a registered Ayurvedic practitioner before using cytokine-modulating herbs, particularly if you take immunosuppressants, anticoagulants, or antiviral medicines.

References

1. Nejm (nejm.org)
2. Tinospora cordifolia (Willd.) Hook. f. and Thoms. (Guduchi) – validation of the Ayurvedic pharmacology through experimental and clinical studies (2010), PubMed Central
3. Glycyrrhizin binds to high-mobility group box 1 protein and inhibits its cytokine activities (2007), PubMed
4. Andrographolide attenuates inflammation by inhibition of NF-kappa B activation through covalent modification of reduced cysteine 62 of p50 (2004), PubMed
5. Profiling Inflammatory Biomarkers following Curcumin Supplementation: An Umbrella Meta-Analysis of Randomized Clinical Trials (2023), PubMed Central
6. NCBI

Herbs described as “phytoestrogenic” are often promoted as natural alternatives to menopausal hormone therapy, but the term can mislead. A plant constituent may bind an estrogen receptor in a laboratory assay without reproducing estradiol’s clinical effects, and powders, decoctions, fermented medicines, and concentrated extracts may differ greatly. Among the Ayurvedic drugs discussed for menopause, Shatavari has the most direct human evidence, although it remains short-term and product-specific. Yashtimadhu has limited hot-flash evidence but important glycyrrhizin-related risks. Ashoka and Vidarikanda have verified Ayurvedic uses but no convincing standalone evidence for menopausal vasomotor symptoms.

Phytoestrogens: Mechanism and Limits

Phytoestrogens are plant-derived compounds capable of interacting with estrogen-related pathways. Human estrogen receptors include ERalpha and ERbeta. In competition-binding experiments, Kuiper and colleagues found that several phytoestrogens, including genistein, coumestrol, apigenin, naringenin, and kaempferol, bound more strongly to ERbeta than ERalpha, although most had much lower affinity than estradiol.

Preferential ERbeta binding is not proof of benefit or safety. Effects depend on concentration, metabolism, tissue, receptor balance, and whether a compound acts as an agonist, partial agonist, or antagonist. It is therefore inaccurate to present ERalpha as simply harmful and ERbeta as uniformly protective.

A 2006 meta-analysis by Trock and colleagues pooled 18 epidemiological studies of soy exposure and breast-cancer risk: 12 case-control studies and six cohort or nested case-control studies. High versus low soy intake showed a modest inverse association overall (OR 0.86, 95% CI 0.75-0.99), while the Asian-country subgroup was not statistically significant (OR 0.89, 95% CI 0.71-1.12). The authors noted heterogeneous exposure assessment, possible confounding, and no clear dose-response. These dietary-soy findings cannot be transferred directly to concentrated Ayurvedic extracts or used as proof of safety during cancer treatment.

• Isoflavones include genistein, daidzein, and puerarin.
• Licorice flavonoids include glabridin and liquiritigenin.
• Steroidal saponins include shatavarins from Asparagus racemosus.

Shatavari (Asparagus racemosus)

The Ayurvedic Pharmacopoeia of India identifies Shatavari as the tuberous root of Asparagus racemosus Willd. Its profile is madhura and tikta rasa, snigdha and guru guna, shita virya, and madhura vipaka. Listed actions include vrishya, balya, medhya, rasayana, Pittahara, Vatahara, stanyakara, and hridya. These Ayurvedic classifications should not be translated automatically into claims that Shatavari replaces estrogen or “balances hormones.”

The API lists sugar, glycosides, saponin, and sitosterol among its constituents and gives 3-6 g as the dose of the crude drug. It names preparations including Shatavari Ghrita and Shatavari Kalpa. Shatavarins are steroidal saponins used to characterize modern extracts, but their concentration varies. A crude-root dose cannot be converted directly into an extract dose without the extraction ratio and chemical specification.

Clinical Evidence

A 2024 double-blind, multicentre, randomized placebo-controlled trial enrolled 70 women and tested a proprietary Shatavari root extract at 250 mg twice daily for 60 days. The authors reported greater improvement in several menopausal symptoms and quality-of-life measures than with placebo, with no significant adverse events recorded. The sample and follow-up were limited, and the result applies only to the tested product.

A 2025 randomized, double-blind, placebo-controlled study randomized 80 perimenopausal women to a standardized Shatavari root extract at 300 mg once daily or placebo for eight weeks; 73 completed the study per protocol. The investigators reported greater improvement in Menopause Rating Scale and hot-flash measures, without reported adverse events or short-term deterioration in measured liver and kidney variables.

The 2025 trial was single-centre, short, and excluded women with breast or cervical carcinoma. Ixoreal Biomed supplied the study products, while the article reported no specific research grant and no author conflicts. Calling it simply “manufacturer-sponsored” therefore exceeds the published disclosure. Neither trial establishes long-term, endometrial, cardiovascular, comparative, or cancer-specific safety.

Dosing and Formulation

There is no verified universal Shatavari-extract range of 300 mg-2 g daily. The API dose concerns crude root, whereas trials used defined proprietary extracts. Products with different extraction ratios or marker profiles are not milligram-for-milligram equivalents.

Yashtimadhu (Glycyrrhiza glabra)

The API identifies Yashti or Yashtimadhu as the dried, unpeeled stolon and root of Glycyrrhiza glabra Linn. Its profile is madhura rasa, guru and snigdha guna, shita virya, and madhura vipaka. Listed actions include Vatapittajit, raktaprasadana, balya, varnya, vrishya, and cakshushya. The API gives 2-4 g of powdered drug and lists uses including kasa, svarabheda, kshaya, vrana, and Vatarakta; menopause is not a specific pharmacopoeial indication.

Licorice contains glycyrrhizin and multiple flavonoids. In a human breast-cancer cell model, glabridin showed estrogen-receptor-dependent growth-promoting activity at lower concentrations and receptor-independent antiproliferative activity at higher concentrations. Liquiritigenin showed relative ERbeta selectivity experimentally. These studies suggest mechanisms but do not establish cancer safety or clinical benefit from whole licorice root.

Hot Flashes and Safety

A double-blind placebo-controlled trial by Nahidi and colleagues enrolled 90 postmenopausal women. Participants received three capsules daily, each containing 330 mg of the tested licorice preparation or placebo, for eight weeks, followed by four weeks of observation. The investigators reported reduced hot-flash frequency and severity followed by recurrence after treatment ended. This modest trial of one preparation does not establish a universal dose.

Repeated or excessive glycyrrhizin exposure can cause sodium and water retention, potassium loss, hypertension, oedema, muscle weakness, and cardiac-rhythm disturbances. Risk is greater in susceptible people, including those with hypertension or heart or kidney conditions, and licorice can interact with medicines. Deglycyrrhizinated licorice was not tested in the hot-flash trial, and informal “cyclic dosing” has not been validated as a safeguard. The original recommendation of 1-2 g of standardized extract daily is therefore unsupported.

Ashoka (Saraca asoca)

The API identifies Ashoka as the dried stem bark of Saraca asoca. Its profile is kashaya and tikta rasa, laghu and ruksha guna, shita virya, and katu vipaka. Listed actions include grahi, varnya, hridya, shothahara, and vishaghna. The API names asrigdara among its uses, lists Ashokarishta and Ashokaghrita as formulations, and gives 20-30 g of bark for decoction.

Asrigdara is associated with abnormal or excessive uterine bleeding, supporting Ashoka’s authentic place in Ayurvedic gynecology but not proving benefit for hot flashes. A genuine 2023 Journal of Ethnopharmacology review documents the plant’s history, chemistry, and experimental pharmacology, but does not provide robust randomized menopause evidence. Ashokarishta is multi-ingredient, so its effects cannot be assigned to Ashoka alone. New heavy, prolonged, or postmenopausal bleeding requires medical evaluation.

Vidarikanda (Pueraria tuberosa)

The API identifies Vidari or Vidarikanda as the dried tuberous root of Pueraria tuberosa DC. Its profile is madhura rasa, snigdha and guru guna, shita virya, and madhura vipaka. Listed actions include Vatahara, Pittahara, stanyada, mutrala, jivaniya, rasayana, brimhana, varnya, and balya. The API gives 3-6 g as the powdered-drug dose.

Pueraria tuberosa is not interchangeable with Pueraria lobata or Pueraria mirifica. Modern reviews report puerarin, daidzein, and genistein in studied P. tuberosa material, so the claim that puerarin occurs only in P. lobata is incorrect. The available review is dominated by laboratory and animal research and does not establish relief of menopausal hot flashes in controlled human trials. Vidarikanda’s verified nourishing and restorative actions should not be upgraded into a clinically proven phytoestrogen claim.

Hormone-Sensitive Conditions and Monitoring

Women with a personal history of estrogen-receptor-positive breast cancer, endometrial cancer, ovarian cancer, atypical endometrial hyperplasia, or another hormone-sensitive condition require particular caution. The cited Shatavari trials were not designed to determine cancer recurrence, long-term endometrial safety, or compatibility with oncology treatment, and the 2025 study excluded women with breast or cervical carcinoma.

Absence of harm in short trials that excluded such patients is not evidence of safety for cancer survivors. Product-specific interactions with tamoxifen or aromatase inhibitors should not be asserted without clinical evidence, but the exact product should be reviewed with an oncologist. No evidence establishes routine pelvic ultrasound after exactly 12 months of herb use; evaluation should be individualized. Unexpected or postmenopausal bleeding warrants prompt medical assessment.

Evidence Quality and Practical Use

Shatavari has more than one randomized menopause trial, but evidence remains preliminary because products, doses, populations, and outcomes differ and follow-up is short. Yashtimadhu has one modest hot-flash trial and a clear glycyrrhizin-related safety limitation. Ashoka and Vidarikanda have verified Ayurvedic roles, not robust standalone menopause trials. Pharmacopoeial evidence documents identity, Ayurvedic properties, traditional uses, and crude-drug doses; a clinical trial evaluates one defined product for selected outcomes. These forms of evidence should not be conflated.

1. Use authenticated products with botanical identity, plant part, extraction details, and contaminant testing.
2. Match dose to preparation; API crude-drug doses and proprietary extract doses are not interchangeable.
3. Treat Shatavari evidence as promising, not conclusive, especially for long-term or cancer-related safety.
4. Avoid casual prolonged Yashtimadhu use and review blood pressure, kidney and cardiac history, electrolyte risk, and medicines.
5. Do not stop prescribed hormone or oncology treatment because of an herbal claim.

Standardized Shatavari extracts currently have the clearest direct evidence among the herbs reviewed, but the findings remain product-specific. Yashtimadhu may reduce hot flashes in some women, yet its safety limitations prevent a universal recommendation. Ashoka and Vidarikanda are genuine Ayurvedic medicines whose traditional roles should not be converted into unsupported menopause claims.

This article is educational and does not constitute medical advice. Menopausal symptoms, abnormal uterine bleeding, and decisions about hormone therapy or herbal treatment should be reviewed with a qualified healthcare provider. Ayurvedic medicines should be selected under the supervision of a trained Ayurvedic practitioner. Anyone with a personal history of hormone-sensitive cancer should consult an oncologist before using a phytoestrogenic supplement.

References

1. Interaction of estrogenic chemicals and phytoestrogens with estrogen receptor beta (1998), PubMed
2. Meta-analysis of soy intake and breast cancer risk (2006), PubMed
3. Academic (academic.oup.com)
4. Ia800501 (ia800501.us.archive.org)
5. Efficacy and Safety of Shatavari Root Extract for the Management of Menopausal Symptoms: A Double-Blind, Multicenter, Randomized Controlled Trial (2024), PubMed Central
6. Efficacy and Safety of Shatavari (Asparagus racemosus) Root Extract for Perimenopause: Randomized, Double-Blind, Placebo-Controlled Study (2025), PubMed Central
7. Estrogenic and antiproliferative properties of glabridin from licorice in human breast cancer cells (2000), PubMed
8. Liquiritigenin is a plant-derived highly selective estrogen receptor beta agonist (2008), PubMed
9. Effects of licorice on relief and recurrence of menopausal hot flashes (2012), PubMed Central
10. NCCIH
11. A comprehensive review on Saraca asoca (Fabaceae) – Historical perspective, traditional uses, biological activities, and conservation (2023), PubMed
12. Pueraria tuberosa: A Review on Traditional Uses, Pharmacology, and Phytochemistry (2020), PubMed Central
13. ACOG

Carbenoxolone and the Modern Ulcer Story

Interest in licorice for peptic ulcers led to the development of carbenoxolone, a semisynthetic derivative of glycyrrhetinic acid. Controlled studies published during the 1960s and 1970s reported faster healing of gastric ulcers with carbenoxolone. A 1968 paper in Gut, for example, examined carbenoxolone treatment and the antagonistic effect of spironolactone. These trials helped establish that a licorice-derived compound could influence ulcer healing, but carbenoxolone was a specific pharmaceutical agent rather than ordinary Yashtimadhu powder or DGL.

Carbenoxolone also produced mineralocorticoid-like adverse effects, including sodium and fluid retention, potassium loss, hypertension, and oedema. Its history therefore illustrates both the pharmacological activity of licorice constituents and the danger of assuming that a natural source guarantees gentle action. It does not provide direct proof that contemporary whole-root supplements or DGL reliably heal ulcers.

DGL vs. Whole Root: A Necessary Distinction

Glycyrrhizin-containing licorice and DGL should be evaluated as different preparations. Glycyrrhizin is converted to glycyrrhetinic acid, which can inhibit 11-beta-hydroxysteroid dehydrogenase type 2. This permits cortisol to exert stronger mineralocorticoid effects and may cause sodium retention, potassium depletion, raised blood pressure, oedema, muscle weakness, and cardiac rhythm disturbances. Individual susceptibility varies, and serious reactions have occurred at lower intakes in vulnerable people.

DGL is processed specifically to reduce this risk. Health Canada’s current monograph requires a finished DGL product to contain no more than 3% of the glycyrrhizic acid originally present in the source material. It recognizes chewable DGL as a demulcent for minor gastrointestinal inflammation and for abdominal pain or burning in the stomach. This regulatory indication should not be interpreted as approval for healing peptic ulcers, eradicating H. pylori, or treating complicated reflux disease.

The European Medicines Agency’s assessment of oral DGL trials did not support a well-established medicinal use for gastric or duodenal ulcer treatment. DGL may still provide short-term soothing relief in selected people with minor burning or dyspeptic discomfort, but persistent, recurrent, nocturnal, bleeding-associated, or unexplained symptoms require medical assessment.

Yashtimadhu and H. pylori

H. pylori is an important cause of peptic ulcer disease and requires a validated eradication regimen followed by confirmation that the infection has cleared. Licorice constituents have demonstrated activity against the organism in laboratory investigations, and one randomized Iranian trial published in 2016 enrolled 120 patients and compared clarithromycin-based triple therapy with the same regimen plus licorice. Reported eradication was 83.3% in the licorice group and 62.5% in the control group.

That trial supports further evaluation of licorice as an adjunct, not as stand-alone treatment. It used a clarithromycin-based regimen that should not now be selected empirically where susceptibility is unknown. The 2024 American College of Gastroenterology guideline recommends 14-day optimized bismuth quadruple therapy as a preferred regimen for many treatment-naive patients and advises against PPI-clarithromycin triple therapy unless clarithromycin sensitivity has been demonstrated. Eradication should be confirmed after treatment with an appropriate breath, stool, or biopsy-based test.

Yashtimadhu, PPIs, and Standard Gastric Care

Proton pump inhibitors remain established medicines for acid suppression in peptic ulcer disease, erosive oesophagitis, and other defined acid-related disorders. They act differently from licorice preparations, and the two should not be presented as direct substitutes. Management also depends on the diagnosis: an H. pylori-positive ulcer requires eradication therapy, a medicine-induced ulcer requires review of the offending medicine, and alarm symptoms may require endoscopy or other investigation.

Yashtimadhu or DGL may be considered only as complementary symptom support when a qualified clinician judges it appropriate. They should not delay investigation of black stools, vomiting blood, progressive difficulty swallowing, persistent vomiting, anaemia, unintended weight loss, severe abdominal pain, or recurrent symptoms. Prescribed PPIs should not be stopped or stepped down solely because an herbal product has been started.

Dosage, Duration, and Safety Limits

The Ayurvedic Pharmacopoeia of India gives 2–4 g of Yashti powder as the pharmacopoeial dose. This is a monograph dose, not a universal self-treatment instruction: glycyrrhizin content varies, the patient’s constitution and diagnosis matter, and risk rises with prolonged or excessive exposure. The European Medicines Agency treats glycyrrhizin-containing licorice as a short-term preparation and notes important cardiovascular and electrolyte hazards with chronic use.

DGL dosing

Health Canada’s oral DGL monograph lists an adult single dose of 380–1520 mg, taken three times daily, with the product chewed between meals or about 20 minutes before meals. Commercial extracts differ in concentration and excipients, so the labelled amount and glycyrrhizic-acid specification should be checked rather than transferring a dose from one product to another. Symptoms that persist or worsen should be assessed by a healthcare professional.

People who should avoid whole-root licorice

Glycyrrhizin-containing Yashtimadhu is unsuitable for several groups because it can disturb blood pressure, fluid balance, and potassium. Medicinal use should be avoided during pregnancy and lactation and in children unless specifically directed by a suitably qualified clinician.

• People with hypertension, hypokalaemia, kidney disease, cardiovascular disease, heart failure, or significant oedema
• People with liver disease, especially when fluid retention or electrolyte disturbance is present
• People taking thiazide or loop diuretics, cardiac glycosides such as digoxin, corticosteroids, stimulant laxatives, or medicines that can worsen potassium loss
• People taking antihypertensive treatment, because licorice may oppose blood-pressure control

DGL has a lower glycyrrhizin-related risk, but “deglycyrrhizinated” should not be treated as a guarantee that every product is identical or interaction-free. Anyone using prescription medicines, particularly for the heart, kidneys, blood pressure, or fluid balance, should show the exact product label to a physician or pharmacist.

The Ayurvedic Pharmacological Profile

The Ayurvedic Pharmacopoeia of India records a clear dravyaguna profile for Yashti. These attributes describe the drug within Ayurvedic pharmacology and should be applied through assessment of dosha, agni, tissue state, disease stage, associated symptoms, and the chosen anupana.

• Rasa (taste): Madhura
• Guna (qualities): Guru and Snigdha
• Virya (potency): Shita
• Vipaka (post-digestive effect): Madhura
• Karma: Balya, Chakshushya, Vrishya, Varnya, Vatapittajit, and Raktaprasadana

The same monograph lists Kasa, Kshaya, Svarabheda, Vatarakta, and Vrana among its therapeutic uses, and names preparations including Eladi Gutika, Yashtimadhuka Taila, and Madhuyashtyadi Taila. Its explicit designation as Vatapittajit, together with Madhura rasa, Snigdha guna, and Shita virya, explains why Ayurvedic physicians may select it when soothing, nourishing, or Pitta-moderating actions are desired. It should nevertheless be prescribed according to the complete clinical picture rather than equated mechanically with an antacid or PPI.

Yashtimadhu may appear in individualized digestive prescriptions with other herbs, but no single pairing or milk-based recipe is universally appropriate for hyperacidity. Formula choice, processing, dose, and vehicle depend on diagnosis and tolerance. Broader dietary and constitutional context is discussed in our Pitta management article, while our Triphala guide describes a different classical approach to bowel and digestive support.

A Practical Summary

Yashtimadhu is a pharmacologically active Ayurvedic drug, not merely a sweet soothing tea. Whole-root preparations retain glycyrrhizin and therefore carry meaningful risks involving potassium, blood pressure, fluid retention, and cardiac rhythm. DGL reduces this particular hazard and has a recognized demulcent role for minor gastrointestinal irritation and burning, but it is not an established ulcer-healing medicine.

For peptic ulcers, significant GERD, or suspected H. pylori, diagnosis and standard treatment remain primary. Licorice should not replace eradication antibiotics, prescribed acid suppression, endoscopic evaluation, or investigation of alarm symptoms. Its most defensible place is carefully selected, short-term complementary use with attention to the exact preparation, dose, medical history, and concurrent medicines. For another evidence-focused herbal profile, see our Ashwagandha research review.

This article is educational and is not medical advice. Do not stop or alter prescribed gastric medicines without consulting a gastroenterologist or other qualified healthcare provider. Whole-root Yashtimadhu has clinically important contraindications and interactions; DGL should also be reviewed with a healthcare professional when symptoms persist, pregnancy is possible, or prescription medicines are being used.

References

1. Ayurvedic Pharmacopoeia of India
2. Treatment of gastric ulcer with carbenoxolone: antagonistic effect of spironolactone (1968), PubMed
3. Carbenoxolone: a review of its pharmacological properties and therapeutic efficacy in peptic ulcer disease (1976), PubMed
4. Ema (ema.europa.eu)
5. NCCIH
6. Webprod (webprod.hc-sc.gc.ca)
7. To evaluate of the effect of adding licorice to the standard treatment regimen of Helicobacter pylori (2016), PubMed
8. American College of Gastroenterology
9. Ema (ema.europa.eu)