Tehran University of Medical Sciences Traditional and Integrative Medicine 2476-5104 11 3 2026 10 01 2644 2644 Sukree Kade Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Phornnapa Charoenkij Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Titchaphorn Palo Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Suthathip Mahajaroensiri Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Nalinthika Nathananwanit Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Suveerawan Limsuvan Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Suksalin Booranasubkajorn Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Pravit Akarasereenont Center of Applied Thai Traditional Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand AND Department of Pharmacology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand AND Siriraj Metabolomics and Phenomics Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700 Thailand Chairat Permpikul Faculty of Medicine Siriraj Hospital, Mahidol University 2026 02 06 2026 02 27 This study presents a secondary mechanistic analysis of archived plasma samples from a previously published randomized, double-blind controlled trial comparing Andrographis paniculata (Burm.f.) Wall. ex Nees (AP) and Favipiravir (FV) in patients with mild coronavirus disease 2019 (COVID-19). Plasma samples collected at baseline (Day 0) and post-treatment follow-up (Day 10) were analyzed for inflammatory cytokines using multiplex immunoassays and for metabolic alterations using untargeted liquid chromatography–quadrupole time-of-flight mass spectrometry (LC–QTOF–MS). Exploratory associations between immunometabolic changes and Thai traditional medicine constitutional types—birth and present Dhatu Chao Ruean (bDCR and pDCR)—were also evaluated. Both treatment groups demonstrated reductions over time in several inflammatory cytokines. However, after false discovery rate (FDR) correction, no statistically significant between-group differences were observed. Untargeted metabolomic profiling suggested alterations in pathways related to alpha-linolenic acid and arachidonic acid metabolism in the AP group. Metabolite annotations were assigned at Metabolomics Standards Initiative (MSI) Level 2 and should therefore be interpreted as putative and hypothesis-generating. Associations between Dhatu classifications and biomarker changes were limited and exploratory, with no consistent correlation patterns identified. In conclusion, this secondary analysis provides exploratory insights into immunometabolic changes following AP and FV treatment in mild COVID-19. The findings suggest potential lipid-mediator pathway modulation but require confirmation through targeted metabolomic approaches and adequately powered studies. https://jtim.tums.ac.ir/index.php/jtim/article/view/2644