The Clinical Efficacy and Safety of Tulsi in Humans: A Systematic Review of the Literature

Abstract

Tulsi, also known as holy basil, is indigenous to the Indian continent and highly revered for its medicinal uses within the Ayurvedic and Siddha medical systems. Many in vitro, animal and human studies attest to tulsi having multiple therapeutic actions including adaptogenic, antimicrobial, anti-inflammatory, cardioprotective, and immunomodulatory effects, yet to date there are no systematic reviews of human research on tulsi’s clinical efficacy and safety. We conducted a comprehensive literature review of human studies that reported on a clinical outcome after ingestion of tulsi. We searched for studies published in books, theses, conference proceedings, and electronic databases including Cochrane Library, Google Scholar, Embase, Medline, PubMed, Science Direct, and Indian Medical databases. A total of 24 studies were identified that reported therapeutic effects on metabolic disorders, cardiovascular disease, immunity, and neurocognition. All studies reported favourable clinical outcomes with no studies reporting any significant adverse events. The reviewed studies reinforce traditional uses and suggest tulsi is an effective treatment for lifestyle-related chronic diseases including diabetes, metabolic syndrome, and psychological stress. Further studies are required to explore mechanisms of action, clarify the dosage and dose form, and determine the populations most likely to benefit from tulsi’s therapeutic effects.

Full text

Review Article
The Clinical Efficacy and Safety of Tulsi in Humans:
A Systematic Review of the Literature
Negar Jamshidi and Marc M. Cohen
School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
Correspondence should be addressed to Marc M. Cohen; marc.cohen@rmit.edu.au
Received 21 December 2016; Revised 20 February 2017; Accepted 22 February 2017; Published 16 March 2017
Academic Editor: Daniela Rigano
Copyright ©  Negar Jamshidi and Marc M. Cohen. is is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Tulsi, also known as holy basil, is indigenous to the Indian continent and highly revered for its medicinal uses within the
Ayurvedic and Siddha medical systems. Many in vitro, animal and human studies attest to tulsi having multiple therapeutic actions
including adaptogenic, antimicrobial, anti-inammatory, cardioprotective, and immunomodulatory eects, yet to date there are
no systematic reviews of human research on tulsi’s clinical ecacy and safety. We conducted a comprehensive literature review
of human studies that reported on a clinical outcome aer ingestion of tulsi. We searched for studies published in books, theses,
conference proceedings, and electronic databases including Cochrane Library, Google Scholar, Embase, Medline, PubMed, Science
Direct, and Indian Medical databases. A total of  studies were identied that reported therapeutic eects on metabolic disorders,
cardiovascular disease, immunity, and neurocognition. All studies reported favourable clinical outcomes with no studies reporting
any signicant adverse events. e reviewed studies reinforce traditional uses and suggest tulsi is an eective treatment for lifestyle-
related chronic diseases including diabetes, metabolic syndrome, and psychological stress. Further studies are required to explore
mechanisms of action, clarify the dosage and dose form, and determine the populations most likely to benet from tulsi’s therapeutic
eects.
1. Introduction
Tulsi in Hindi or Tulasi in Sanskrit (holy basil in English)
is a highly revered culinary and medicinal aromatic herb
from the family Lamiaceae that is indigenous to the Indian
subcontinent and been used within Ayurvedic medicine more
than  years. In the Ayurveda system tulsi is oen referred
toasan“ElixirofLife”foritshealingpowersandhasbeen
known to treat many dierent common health conditions. In
the Indian Materia Medica tulsi leaf extracts are described for
treatment of bronchitis, rheumatism, and pyrexia []. Other
reported therapeutic uses include treatment of epilepsy,
asthma or dyspnea, hiccups, cough, skin and haematological
diseases, parasitic infections, neuralgia, headache, wounds,
and inammation [] and oral conditions []. e juice of the
leaves has been applied as a drop for earache [], while the tea
infusion has been used for treatment of gastric and hepatic
disorders []. e roots and stems were also traditionally used
to treat mosquito and snake bites and for malaria [].
ree types of tulsi are commonly described. Ocimum
tenuiorum (or Ocimum sanctum L.) includes  botanically
and phytochemically distinct cultivars that include Rama or
Sri tulsi (green leaves) and Krishna or Shyama tulsi (purplish
leaves) [, ], while Ocimum gratissimum is a third type
of tulsi known as Vana or wild/forest tulsi (dark green
leaves) [, ]. e dierent tulsi types exhibit vast diversity
in morphology and phytochemical composition including
secondary metabolites, yet they can be distinguished from
other Ocimum species by the colour of their yellow pollen,
high levels of eugenol [], and smaller chromosome number
[]. Despite being distinct species with Ocimum tenuiorum
having six times less DNA than Ocimum gratissimum [],
theyaretraditionallyusedinthesamewaytotreatsimilar
ailments []. For consistency, this review uses the term tulsi
to refer to both Ocimum tenuiorum or Ocimum gratissimum.
Tulsi has been the subject of numerous scientic studies
and its pharmacological and wide range of therapeutic appli-
cations are the subject of more than one hundred publications
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2017, Article ID 9217567, 13 pages
https://doi.org/10.1155/2017/9217567

 Evidence-Based Complementary and Alternative Medicine
duringthelastdecadealone.Numerousinvitroandanimal
studies attest to tulsi leaf having potent pharmacological
actions that include adaptogenic [–], metabolic [–
], immunomodulatory [–], anticancer [–], anti-
inammatory [, ], antioxidant [, ], hepatoprotective
[, ], radioprotective [, ], antimicrobial [–],
and antidiabetic eects [–] that have been extensively
reviewed previously [–].
Preclinical studies have demonstrated that tulsi increases
swimming survival times in mice and prevents stress-induced
ulcers in rats [] with antistress eects comparable to
antidepressant drugs []. Similarly, recent studies report leaf
extracts from ethanolic and aqueous tulsi protects rats from
stress-induced cardiovascular changes [, ]. Studies in
animal models have further shown that the leaf extract of tulsi
possesses anticonvulsant and anxiolytic activities [, ].
Several animal studies conducted over the past y years
report that ingestion of tulsi leaves improves both glucose and
lipid proles in normal and diabetic-induced animal models
[, , –]. Tulsi aqueous leaf extract intramammary
infusion has also showed promising eect on improving the
immune response in bovine models [].
In addition to the extensive literature documenting in
vitro and animal research, studies on the use of tulsi as part of
a polyherbal formulation in humans has been systematically
reviewed []. To date, however, there are no systematic
reviews on the clinical ecacy and safety of tulsi as a single
herbal intervention in humans. e objective of this review
was therefore to summarize and critically appraise human
clinical trials of tulsi in order to assess the current evidence
on tulsi’s clinical ecacy and safety.
2. Methods and Materials
2.1. Search Strategies. Relevant clinical studies were identied
through searching PubMed, Google Scholar, ScienceDirect,
Medline, Embase, Cochrane Library, and Indian Medical
databases. e terms in the title or abstract (MeSH and
free search terms) alone or in combination searched were
“Tulsi”, “Tulasi”, “Holy Basil”, “ocimum sanctum”, “Ocimum
tenuiorum”, “Ocimum gratissimum”, “ocimum”, “Albahaca
Morada” or combined with “clinical trial”, “clinical”, or
“human”.
2.2. Inclusion Criteria. Studies were included if they reported
on a human intervention study that involved ingestion of
any form of tulsi or holy basil (Ocimum sanctum or Ocimum
tenuiorum or Ocimum gratissimum) and at least one clinical
outcome.
2.3. Exclusion Criteria. Studies were excluded if they were
reviews, were nonclinical studies, did not involve human
subjects, did not report a biological outcome, only involved
topical application or only used tulsi at part of a polyherbal
formulation, and did not report on the use of tulsi as a single
herbal intervention.
2.4. Study Selection. All the titles and abstracts were screened
on the basis of the predetermined inclusion and exclusion
criteria described above. e full text of each article was
reviewed to assess suitability of the study with duplications
removed. e search included clinical studies written in the
English language and articles from inception until November
 in the above-mentioned electronic databases. e refer-
ences of selected articles were manually searched to identify
further relevant studies and, where appropriate, study authors
were contacted to request further information.
2.5. Quality Assessment. In order to evaluate the quality
of design and implementation of trials, information was
collected on the study design, randomization, blinding, and
description of participant dropouts and the Jadad scale was
used to assess methodological quality [].
2.6. Data Extraction. Eligible studies were reviewed with
the following data extracted and tabulated: () rst author
name and year of publication; () design of the study; ()
Jadad score; () study participants (intervention and control
groups); () extraction method; () duration of intervention;
() tulsi dose and dose form () comparator; () outcome
measure(s) including both primary and secondary, and ()
any adverse event(s).
3. Results
3.1. Study Description. Aer screening  studies, a total of
 articles on tulsi met the inclusion criteria. Four articles
were excluded due to being inaccessible and one article
reported two independent clinical studies, while one clinical
trial was reported in three separate articles. is le a total
of  independent clinical studies to be reviewed. A ow
chart of the systematic search and study selection protocol is
presented in Figure .
e reviewed studies involved a total of  participants
with ages ranging from  to  years old with eight clinical
trials limiting participants to ≥ years old [, , , –
, , ]. Only three clinical trials included  or more
participants [, , ]. e study durations ranged from
 to  weeks and tulsi dosage and frequency varied from
mgtomggivenas–timesperdayastulsileaf
aqueous extract;  mg– mg once or twice per day as
tulsi leaf ethanolic extract;  g to  g per day as the tulsi
whole plant aqueous extract; and  g fresh tulsi leaf aqueous
extract administered as once or four equal doses daily, and as
tincture solution  drops a day were administered as three
equal doses daily.
From the  studies identied only eight included a
placebo[,,,–,,].Fiveoftheincludedtrials
adoptedatwo-armparalleldesign[,,,,],while
four used a cross-over design with one being described in
three dierent papers that reported on two dierent sets of
outcomes [, , ].
Included studies were classied according to three major
clinical domains: metabolic related disorders; immunity; and
neurocognitive function (Tables , , and ). Only two studies
described the type of tulsi (Krishna) used while all other
papers referred to tulsi as Ocimum sanctum [, ] not

Evidence-Based Complementary and Alternative Medicine 
Studies identied through
database search
Searched full text articles
Clinical studies identied
(i) Reviews
(ii) Nonclinical studies
(iii) Nonhuman
(iv) No outcome
(v) Topical application
(vi) Polyherbal formulation
Duplicated records removed
Studies identied through other sources such
as books, thesis, and Indian journals
Total studies identied
Clinical studies included in
Inaccessible records removed
Identical records removed
(n=3)
(n=4)
(n=24)
systematic review
(n=1552)
(n = 156)
(n = 538)
Records excluded
(n=983)
(n=31)
(n = 1014)
(n=1396)
F : Flow chart of systematic search and study selection protocol.
distinguishing between cultivars. Four studies reported on
theuseoftulsialoneandalongwithfood,hypoglycemicdrug,
curryorNeem[,,,].Moststudieslookedatclinical
populations with specic acute or chronic illnesses, such as
viral infection, psychological stress, diabetes, or metabolic
syndrome, with only three studies reporting on the eects of
tulsiinhealthyhumanparticipants[,,].
3.2. Eectiveness and Safety Evaluation. e most common
outcome measurements were related to blood glucose levels
( studies), lipid prole ( studies), blood pressure ( studies),
immune response ( studies), and neurocognitive changes (
studies). Other outcomes included mood ( studies), fatigue
( studies), uric acid levels ( studies), diabetes secondary
symptoms ( study), and sleep ( study). Fieen of the 
included studies reported no adverse events and eight studies
did not describe or refer to any adverse events. Only one study
that used tulsi leaf extract as  mg capsule taken before
mealstwicedailyinobeseadultsreportedtheoccurrence
of occasional nausea.
3.3. Quality Assessment. e studies were classied as either
Randomized Clinical Trial Placebo Controlled (RCT-PC ),
Randomized Clinical Trials with no placebo (RCT ), or
Clinical Trials where no information on randomization or
control was available (CT ). Only three out of  studies,
two of which examined neurocognitive eects [, ] and
onereportedonimmunityaswellascardiovascularchanges
[, ], were rated as high quality with Jadad scores of -
 points, with the remaining studies varying in quality with
Jadad scores ranging from  to  points. e score for each
included study is presented in Tables –.
3.4. Metabolic Disorders. Seventeen clinical trials reported
on metabolic conditions with ten studies reporting on type
 diabetes or metabolic syndrome with measures of blood
glucose, lipids, and blood pressure, yet only one study

 Evidence-Based Complementary and Alternative Medicine
T : Eect of tulsi on metabolic related-disorders in human clinical trials.
Clinical Authors Study design Jadad Participants∗∗ Tulsi Intervention Comparator Outcome Adverse
domain (year) score (age range) extract Duration∗Dosage measure(s) events (s)
Metabolic
disorders
Gandhi et al.
() []
Randomized
controlled
clinical trial
1
 male adults
TDM
(– years)
Tuls i l e a v e s
caps . weeks g/day
before meal
Not
disclosed
Signicant↓postprandial
glucose & fasting blood
glucose
Not
reported
Satapathy et al.
() []
Randomized
parallel group
clinical trial
3
 adults
Obesity
(– years)
Tula s i 1
leaves
caps
weeks
 mg/day
x daily
before meal
Parallel group
no intervention
Improved BMI, lipid prole
(except TC), TG & IR
Mild
nausea
Venkatesan and
Sengupta ()
[]
Clinical trial
controlled
parallel group
0 adults
TDM
Tulsi powder
leaves weeks g/day Curry leaves
tulsi + curry
Signicant↓post-prandial
glucose & fasting blood
Not
reported
Srinivasa
Prasadacharyulu
() []
Clinical study
case report 0 adults
TDM
Fresh tulsi
leaves weeks fresh leaves3
x daily None
Considerable decrease in
blood glucose reaching
near normal levels
None
Ahmad et al.
() []
Randomized
single-blind
parallel group
2
 adults
Gouty
Arthritis
Tincture2
from tulsi  weeks  drops
times/day
Tincture
wild rosemary
 drops ×/day
Signicant reduction in
serum uric acid
Not
reported
Devra et al.
() []
Randomized,
placebo-controlled
clinical trial
1
 adults
MetS
(≥ years)
Aqueous
tulsi Leaves  weeks  mL/×day
before meals
Not
disclosed
Improved lipid prole,
fasting blood glucose,
and BP
Not
reported
Somasundaram
et al. () []
Randomized,
controlled parallel
clinical Trial
1
 adults
TDM
(– years)
Tuls i l e a v e s +
glibenclamide
drug
 weeks
 mg/day tulsi
+mg
Glibenclamide
mg/day
glibenclamide
Signicant ↓fasting blood
&postprandialglucose
reduced HBAc
None
Dineshkumar et
al. () []
Randomized
placebo-controlled
clinical trial
3
 adults
TDM
(– years)
Aqueous
tulsi leaves weeks g/day Water Signicant improvement
in lipid prole None
Kochhar et al.
() []
Randomized,
clinical trial 1
 male adults
TDM/MetS
(– years)
Powder
tulsi leaves  weeks  g/day Neem
neem + tulsi
Improved TDM
symptoms: ↓polydipsia,
↓polyphagia, & BP
Not
reported

Evidence-Based Complementary and Alternative Medicine 
T  : C o n t i n u ed.
Clinical Authors Study design Jadad Participants∗∗ Tulsi Intervention Comparator Outcome Adverse
domain (year) score (age range) extract Duration∗Dosage measure(s) events (s)
Rai et al. ()
[]
Clinical trial
controlled group 1
 adults
TDM/MeS
(– years)
Tuls i
powder
leaves
weeks
g/day
in morning
before meal
None
Improved lipid prole,
blood glucose, glycated
proteins (HbAc) & UA
Not
reported
Agrawal et al.
() []
Randomized,
single-blind,
Placebo-controlled
cross-over
1
 adults
TDM
(– years)
Tuls i
powder
leaves
weeks
(+-day
wash out)
. g/day
in morning
before meal
Spinach
powder
leaves
. g/day
Signicant ↓fasting blood
glucose, post-prandial
glucose and urine glucose
None
Luthy () [] Clinical trial 1 adults
TDM
Whole plant
decoction  weeks  g/day None Reduced blood glucose
in  TDM adults None
Verm a e t a l .
() [] Clinical trial 0
 adults
psychosomatic
(– years)
Powder
whole plant
tulsi
 weeks  g ×/day None Signicant improvement
in lipid prole None
Bhargava et al.,
() []
Clinical study
open label 1
 Female
adults
hypotensive
(– years)
Fresh juice
 tulsi
leaves
 weeks Juice ×/day None Signicant changes,
in Blood pressure
Not
reported
Mondal et al.
() []
Randomized,
double-blind,
placebo-controlled
cross-over
leaves
5
 healthy
adults
(– years)
Ethanolic
tulsi
weeks
(+-week
wash-out)
 mg/day
before food
 mg/day
sucrose
Reduction in lipid prole,
in  participants None
Sarvaiya ()
[]
Randomized
placebo controlled
cross-over
1
 adults,
hypertension
(– years)
Fresh Juice
% tulsi
 days
(+-day
wash-out)
 mL/day
Green colored
water  mL/day
before meal
Signicant ↓blood pressure None
Sarvaiya ()
[]
Randomized
placebo-controlled 1
 adults,
hypertension
(– years)
Fresh Juice
% tulsi  days
 mL
timesaday
before meals
Green-colored
water
 mL ×/day
Signicant ↓blood pressure
(lowered by %) None
BMI = body mass index measured by weight (kg)/height (m2); BP = blood pressure; HbAC = glycosylated haemoglobin; IR = insulin resistance; MetS = metabolic syndrome; TDM = type  diabetes mellitus; TC
= total cholesterol, TG = triglycerides; UA = uric acid.
∗Intervention duration is the time the intervention was administered excluding any washout periods.
∗∗Participants who completed the study are listed excluding any drop-outs.
1Tul asi Ta bl e ts are product of Himalaya Herbal Healthcare Pharmaceutical Company in India.
2Tincture is a product of BM private limited.
3e quantity of tulsi fresh leaves was not specied; “handful” of leaves was given to each patient.

 Evidence-Based Complementary and Alternative Medicine
T : Eect of tulsi on immune system and viral infections in human clinical trials.
Clinical
domain
Authors
(year) Study design Jadad
score
Participants∗∗
(age range)
Tuls i
extract
Intervention Comparator Outcome
measure(s)
Adverse
events (s)
Duration∗Dosage
Immunomodulation
Venu Pra s a d
() []
Randomized,
placebo-controlled
clinical trial
3
 healthy
adults
(– years)
Ethanolic
tulsi leaves
in Bar‡weeks bar×/day
( mg tulsi)
Not described
“control bar”
↑physical performance
↓fatigue and CK levels
less increase in lactic acid
None
Mondal†et al.
() []
Randomized,
double-blind,
placebo-controlled
cross-over
5
 healthy
adults
(– years)
Ethanolic
tulsi leaves
weeks
(+ weeks
wash out)
 mg/day Cellulose
 mg/day
Increased cytokine level,
interferon-Υ,&
interleukin-
None
Sharma ()
[] Open clinical trial 1 adults,
asthma
Aqueous
tulsi leaves
tablets
week mg×/day None Relief within  days,
improved vital capacity None
Viral infections
Rajalakshmi et
al. () [] Clinical trial 0
 cases,
viral hepatitis
(– years)
Aqueous
extract fresh
tulsi leaves
weeksfor
mild cases
weeksfor
Severe cases
 g daily None Symptoms all improved
within  weeks None
Das et al. ()
[]
Randomized
clinical trial
parallel-controlled
1
 adults,
viral
encephalitis
Aqueous
extract fresh
tulsi leaves
weeks . g
times/day
 mg/day
dexamethasone
treated group
Increased survival rate
compared to steroid
Not
reported
CK = creatine kinase; TPE = tropical pulmonary eosinophilia.
∗Intervention duration included wash-out periods where applicable until study was completed.
∗∗Participants include both control and intervention groups completing the study and excluded any drop-outs.
†Same results as previously published (Mondal et al., ).
‡Tulsi enriched bar: each  g bar contained oats, resin, peanuts, skimmed milk powder, sugar, and honey and .%ethanolic tulsi.

Evidence-Based Complementary and Alternative Medicine 
T : erapeutic eects of tulsi on cognitive function, mood, and stress in human clinical trials.
Clinical Authors Study design Jadad Participants∗∗ Tulsi Intervention Comparator Outcome Adverse
domain (year) score (age range) extract Duration∗Dosage measure(s) events (s)
Neurocognition
Sampath et al.
() []
Randomized,
double-blind,
placebo controlled
clinical trial
5
 healthy
adults
(– years)
Ethanolic
tulsi leaves
capsules
weeks  mg/day
before meals
Cellulose
capsules
Cognitive exibility,
attention, Improved
working memory
only aer day 
None
Saxena et al.
() []
Randomized,
double-blind,
placebo-controlled
4
 adults,
stress
(– years)
OCIBEST†
whole plant
capsules
weeks
 mg
times/day
aer meals
Cellulose
capsules
Reduction in stress
related symptoms:
fatigue, sleep and
sexual problems
None
Verm a ‡et al.
() [] Clinical trial 0
 adults,
psychosomatic
(– years)
powder
whole plant
tulsi
 weeks  g ×/day None
Reduced anxiety
signicantly lowered
biological age score
None
Bhattacharyya et
al. () [] Clinical trial 1
 adults
with GAD
(– years)
Ethanolic
tulsi leaves
capsules
weeks
 mg
x daily
aer meals
None
Self-reported
questionnaire,
↓anxiety, stress, &
depression
None
GAD = generalized anxiety disorder.
∗Intervention duration is the time the intervention was administered excluding any washout periods.
∗∗Participants include both control and intervention groups completing the study and excluded any drop-outs.
†OCIBEST is product of natural remedies and contains tulsi whole plant.
‡Authors also reported ndings from glucose and lipid prole for  of the participants and found lipid prole signicantly improved.

 Evidence-Based Complementary and Alternative Medicine
reported on the clinical symptoms associated with type 
diabetes such as polydipsia, polyphagia, polyuria, sweating,
fatigue, burning feet, itching, and headache []. In addition
one study reported on obesity [] and two studies on uric
acid changes in participants with gouty arthritis [, ].
Six of the identied trials on metabolic conditions were
randomized clinical trials with placebo controls [, , ,
, ]. In addition, eight studies were of – weeks duration
[,,,,–],threewereof–weeks[,,],
and six were of - weeks [–, , , ]. When the
duration of the tulsi intervention was increased from -
weeks [, ] to - weeks there was a more dramatic
reduction in fasting blood glucose (FBG) and postprandial
glucose (PPG) compared to controls [, ]. In particular,
HbAc (.%) signicantly decreased when tulsi was added
as adjunct therapy to hypoglycemic medication compared to
drug medication alone [].
e earliest clinical trial conducted in  with 
patients with type  diabetes reported that over a period of
 weeks, a  g decoction of whole Krishna tulsi plant led
to a gradual improvement in fasting blood glucose in  out
of  patients []. ree decades later, the rst randomized
placebo-controlled clinical trial reported daily ingestion of
. g of tulsi leaves led to signicant improvements of FBG,
PPG, and urine glucose in type  diabetes patients aer 
weeks []. In addition, Rai et al. reported that  weeks of sup-
plementation with tulsi powder signicantly lowered blood
glucose and glycated proteins, reduced uric acid levels, and
improved lipid proles in participants with type  diabetes
[]. In comparable trials with longer durations, FBG and
PPG improved by .–. and .–. folds, respectively, while
HbAc improved . and . fold aer - weeks [, ].
Similarly, lipid prole was improved signicantly in MetS and
diabetes participants in three clinical trials [, , ] with
a separate clinical trial reporting signicant improvement in
lipid prole in obese participants [] and a further study
reporting improved lipid levels in healthy subjects [].
Afurther-weekstudyoftypediabetespatients
reported greater improvement in both blood glucose and
HbAc levels when  mg of tulsi leaf extract was adminis-
tered along with the antidiabetic drug glibenclamide, com-
pared to drug treatment alone []. Similarly, a controlled
trial of patients with diabetes found that consumption of  g
of tulsi powdered leaves, either alone or combined with curry
leaves, led to signicant improvement in blood sugars aer
two weeks []. In a further -week randomized trial in
diabetic patients,  g of tulsi leaf extract alone or combined
with neem leaf extract produced marked reduction in dia-
betic symptoms with greatest eect noted for the combination
[].
Six trials reported on the eect of tulsi on individual
features of metabolic syndrome [, –]. Two studies
reported signicant improvement of blood pressure in hyper-
tensive participants given  mL of fresh tulsi leaf juice once
dailyormLtwiceadayforanddays,respectively
[], with a further study reporting normalisation of blood
pressure in hypotensive adult females []. Yet another study
reported improvement in serum lipids with no dierence in
blood pressure in healthy adults administered  mg per
day of tulsi leaf ethanolic extract for  weeks []. A further
study reported improved lipid proles in older adults (–
years) with psychosomatic symptoms aer administration
of  g of whole plant tulsi extract twice daily for  weeks
[]. A more recent study also reported improvement in lipid
proles, as well as BMI of obese participants administered
 mg capsules of tulsi leaf extract twice daily for  weeks
[].
3.5. Immunomodulation and Inammation. Enhanced im-
mune response was reported in ve clinical studies [–]. A
small randomized double-blind, and placebo-controlled trial
found increased immune response with increased Natural
Killer (NK) and T-helper cells in healthy adult participants
compared to placebo volunteers aer  weeks of  mg
or ethanolic tulsi leaf extract daily taken before food [].
Another -week controlled randomized study in which
young adult volunteers were provided with nutrition bars
fortied with  g of ethanolic tulsi leaf extract found that
compared to control participants, the intervention group
had signicantly improved VO2max, less fatigue, reduced
Creatine Kinase, and improved immune response to viral
infection as indicated by reduced load of human herpesvirus
insaliva[].
Two clinical trials studied the eect of daily adminis-
tration of  g of an aqueous extract of fresh tulsi leaves in
patients with acute viral infections, with a study on patients
with acute viral encephalitis reporting increased survival
aer  weeks in the tulsi group compared to a group given
dexamethasone and a study on viral hepatitis reporting
symptomatic improvement aer  weeks [, ]. A further
study of asthmatic patients found that  mg of dried tulsi
leaves taken three times daily improved vital capacity and
provided relief of asthmatic symptoms within  days [].
3.6. Neurocognitive Eect. e four studies that reported on
neurocognitive eects all showed signicant improvements
in mood and/or cognitive function regardless of age, gen-
der, formulation, dose, or quality of the study [, –].
Cognition function was assessed in a randomized, placebo-
controlled, clinical trial that demonstrated an improvement
in cognitive exibility, short-term memory, and attention in
 healthy young adults (– years) following treatment
with  mg daily tulsi for  weeks []. However, the
cognitive eects of tulsi were only signicant aer the rst
two weeks compared to the placebo, with no signicant
dierence found in stress levels. is is in contrast to three
clinical studies that reported signicant reduction in anxiety
and stress levels with higher doses of tulsi given over a longer
time period [, , ]. e positive eect of tulsi on mood
was demonstrated in three studies, with two studies reporting
reductions of .%–% in overall stress-related symptoms
in patients with psychosomatic problems compared to a
control group [, ].
4. Discussion
Despite a long history of traditional use and widespread
availability, relatively few human intervention studies have

Evidence-Based Complementary and Alternative Medicine 
been conducted on the eectiveness of tulsi for clinical con-
ditions and this is the rst comprehensive literature review of
published human research on the ingestion of tulsi as a single
herbal intervention. e studies identied in this review
could be classied according to three main clinical domains
including metabolic disorders ( studies), neurocognitive or
mood conditions ( studies), and immunity and infections
( studies), which are all extremely relevant to the growing
world-wide epidemic of lifestyle-related chronic disease. e
nding that the reviewed studies reported favourable clinical
eects across these domains suggests that tulsi may indeed be
an eective adaptogen that has a role in helping to address the
psychological, physiological, immunological, and metabolic
stresses of modern living.
It is interesting that tulsi has important clinical eects
across diverse therapeutic domains, all of which may have
inammation as an underlying factor. e anti-inammatory
eects of tulsi have been previously documented in many in
vitro and in vivo studies [, –], and it is likely that tulsi
has multiple bioactive secondary metabolites that act alone
or synergistically to inhibit inammatory pathways. ere
is also evidence to suggest that tulsi may be useful as an
adjuncttopharmacotherapyandnutritioninthetreatmentof
metabolic disorders thereby reducing the need for high doses
of drugs, which may have adverse eects. e clinical eects
demonstrated in the reviewed studies suggest tulsi may have
an important role in addressing other inammatory disorders
and that the Ayurvedic tradition of consuming tulsi on a daily
basis may be an eective lifestyle measure to address many
modern chronic diseases.
e most commonly used part of the tulsi plant is the
leaf (dried or fresh), which is known to contain several
bioactive compounds including eugenol, ursolic acid, 𝛽-
caryophyllene, linalool, and ,-cineole [–]. Eugenol has
been found to be the major bioactive metabolite common to
all three tulsi varieties with varying amounts in each cultivar
[, ] and it has recently been suggested to act via dual
cellular mechanisms to lower blood glucose levels. ese
include competitively preventing the binding of glucose to
serum albumin and inhibiting the conversion of complex
carbohydrate to glucose []. However, while eugenol has
beenshowntobebioactive,thephytochemicalcomposition
of tulsi is very complex and varies depending on dierent
conditions [–] and there are many other potential
active secondary metabolites such as other phenylpropanoids
(methyl eugenol, rosmarinic acid), monoterpenes (ocimene),
and sesquiterpenes (germacrene) that could alone or syner-
gistically produce therapeutic benets [].
All reviewed studies reported favourable clinical eects
with minimal or no side eects irrespective of dose, formu-
lation, or the age or gender of participants, with only one
clinical trial reporting transient mild nausea []. As the
longeststudywasonlyweeks,thefailuretoreportany
adverseeectsdoesnotprecludethepresenceofanylong
term side eects; however, the long traditional history of
regulartulsiusesuggestsanyseriouslongtermeectsare
unlikely and that daily ingestion of tulsi is safe. Furthermore,
the results of this review are consistent with previous evidence
for the clinical ecacy and safety of tulsi, which includes
multiple in vitro and in vivo studies and many human clinical
trials in addition to traditional use.
4.1. Limitations and Scope. is review, which comprehen-
sively reviewed all human clinical trials published in English
language on ingestion of tulsi as a single herb, has many limi-
tations. While the review included  studies and minimized
bias by using a systematic and independent search strategy
without limiting publication year or study design, we cannot
be certain that all studies were located; this is especially due
tothefactthatalmostallstudieswereconductedinIndiaand
published in local journals, some of which are very dicult
to access or search. ere may also be unpublished studies
that report negative outcomes []. Furthermore, while the
reviewed studies were consistent in reporting positive eects
of tulsi in humans, only  out of  can be considered
high quality studies with all but three failing to include a
double-blind strategy. Tulsi’s therapeutic eects may have
therefore been overestimated and while the ecacy of tulsi
was reported across a wide range of formulations and doses,
many studies also failed to provide details of the cultivar,
dosage form, or specic dosage or quality control measures
of the tulsi used.
is review suggests that tulsi is an example of the
Ayurvedic holistic lifestyle approach to health and appears
to provide a vast array of health benets that oers solutions
to many modern day health problems. While the reviewed
studies could be classied into three major therapeutic
domains, there is insucient evidence for any specic tulsi
formulation to assist in any one condition. More rigorous
studies with larger sample sizes and longer durations and
standardised formulations are therefore needed before spe-
cic recommendations can be made for the treatment of
any specic disease. is review further highlights the need
to investigate and determine unique signature compounds
specic to each of the three tulsi varieties, to not only identify
the bioactive metabolites that may synergistically interact, but
also shed light on the underlying mechanism of action on
metabolic and inammatory pathways.
5. Conclusion
Despite the lack of large-scale or long term clinical trials
on the eect of tulsi in humans, the ndings from 
human studies published to date suggest that the tulsi is
a safe herbal intervention that may assist in normalising
glucose, blood pressure and lipid proles, and dealing with
psychological and immunological stress. Furthermore, these
studies indicate the daily addition of tulsi to the diet and/or as
adjunct to drug therapy can potentially assist in prevention or
reduction of various health conditions and warrants further
clinical evaluation.
Conflicts of Interest
Professor Marc M. Cohen receives remuneration as a con-
sultantandadvisortoOrganicIndiaPty.Ltd.,whichisa
company that manufactures and distributes tulsi products.

 Evidence-Based Complementary and Alternative Medicine
is article is the independent work of the authors and
OrganicIndiadidnothaveinputintothearticle’scontentor
thedecisiontopublishit.
Acknowledgments
Negar Jamshidi is a Ph.D. student supported by an RMIT
University Scholarship.
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