Terminalia Arjuna Research Paper

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Terminalia Arjuna Research Paper



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However, its long-term safety still remains to be elucidated. Arjuna is a potential cardioprotective agent belonging to the Combretaceae family. It is an ayurvedic remedy that has been mentioned since vedic period in many ancient Indian medicinal texts including Charaka Samhita, Sushruta Samhita, and Astang Hridayam. It was Vagabhatta who, for the first time, advocated the use of stem bark powder in heart ailments. The bark has been described as an astringent, demulcent, expectorant, cardiotonic, styptic, antidysenteric, urinary astringent, and has shown to be useful in fracture, ulcers, leukorrhea, diabetes, anemia, cardiopathy, and cirrhosis.

They also use fruit paste topically on wounds. Arjuna tree is about ft in height, and is seen along rivers, streams, and dry water bodies throughout the Indo-sub-Himalayan tracts of Uttar Pradesh, southern Bihar, Chota Nagpur, Burma, Madhya Pradesh, Delhi, and Deccan region [ Figure 1 ]. It is also found in the forests of Sri Lanka and Mauritius. It can tolerate half submergence for a few weeks. The outer surface of the bark is smooth, while the inner surface has longitudinal striation and is pinkish in color.

On microscopic examination of the mature bark, a cork consisting of layers of tangentially elongated cells, cells thick phellogen, and phelloderm consisting of tangentially elongated cells are seen. The phloem is broad, consisting of ceratenchyma, phloem parenchyma, phloem fibers, and crystal fibers with rosette crystals of calcium oxalate. Periderm and secondary phloem are present in the old bark. Flowers are white in color and bisexual, arranged in spikes with linear bracteoles [ Figure 4 ].

The lines on wings are oblique and curving upward [ Figure 5 ]. Major chemical constituents of arjuna have been shown in Table 1. Various extracts of the stem bark of arjuna have shown to possess many pharmacological properties including inotropic, anti-ischemic, antioxidant, blood pressure lowering, antiplatelet, hypolipidemic, antiatherogenic, and antihypertrophic. Bark stem of arjuna possesses diuretic, inotropic, and chronotropic properties. It increased the coronary flow in isolated perfused rabbit heart and produced bradycardia. Aqueous and alcoholic bark extract, when given intravenously, intracerebrally, and intravertebrally in dog, resulted in a dose-dependent decrease in blood pressure.

Takahashi et al. This suggested that the hypotensive effect may be mediated by cholinergic mechanisms. It was also suggested that muscarinic or histaminergic mechanisms are not likely to be involved in the hypotension produced. Dried, pulverized bark has been shown to augment endogenous antioxidant compounds of rat heart and prevent oxidative stress associated with ischemic—reperfusion injury of the heart. It was suggested that the alcoholic extract of arjuna in rabbit induces myocardial heat shock protein 72 and augments myocardial endogenous antioxidants which offer cardioprotection against oxidative stress associated with myocardial ischemic—reperfusion injury.

Thus, it can be inferred that there exists a linear correlation between the antioxidant capacity and the total phenolic content of the extracts. In isoprenaline-induced myocardial ischemia MI , arjuna has been found to possess prostaglandin E2-like activity with coronary vasodilatation and hypotension. Further, the bark extract has also shown protective effects against doxorubicin-induced DNA damage and cardiotoxicity. Cardioprotective action of arjuna was comparable to fluvastatin. Arjuna bark extract has a significant prophylactic and therapeutic beneficial effect in protecting heart against catecholamine-induced CHF, possibly through maintaining endogenous antioxidant enzyme activities and inhibiting LPO and cytokine levels.

Recently, Mythili et al. Solvent ether and ethanolic fractions caused a decrease in the plasma levels of lipids in triton as well as in high fat diet HFD fed models of hyperlipidemia in hamsters. When these fractions were tested against the generation of oxygen free radicals, they counteracted the formation of superoxide anions and hydroxyl radicals in nonenzymic test systems. The ethanolic fraction possesses potent antioxidant and hypolipidemic properties compared to other fractions, and this has been substantiated by other studies also.

In addition to this, they also found that recipes Arjuna Omelette and Arjuna En Upma incorporating arjuna bark showed good acceptability, meriting their inclusion in the daily diet of the people needing long-term intervention for elevated lipids and oxidative stress levels. The hypolipidemic action is thought to be mediated through increased hepatic clearance of cholesterol, down-regulation of lipogenic enzymes, and inhibition of HMG-CoA reductase.

The authors observed that the mean anginal frequency decreased significantly, along with a significant decrease in systolic blood pressure SBP , improvement in ECG changes, and reduction in plasma cortisol and serum cholesterol levels. Later, in a study, mg of bark powder was administered twice daily to 25 coronary artery disease CAD patients for 3 months. A reduction in the grade of positivity of treadmill test TMT response was observed in six patients, in addition to improvement in exercise tolerance and a reduction in the frequency of anginal attacks and use of sublingual nitrates.

Significant lowering of SBP and body mass index, with a marginal improvement in left ventricular ejection fraction LVEF and a slight increase in high density lipoprotein HDL levels were also observed. In unstable angina patients, there was an insignificant reduction in anginal frequency. These results suggest that monotherapy with arjuna is fairly effective in patients with stable angina, but has a limited role in unstable angina.

In yet another study, mg of bark powder was administered 8 hourly to 10 patients of post-myocardial infarction angina and 2 patients of ischemic cardiomyopathy for a period of 3 months. These patients were compared with matched patients of post-myocardial infarction angina receiving only conventional treatment. Significant reduction in anginal frequency, improvement in LVEF from The efficacy of Hartone an herbal product containing arjuna was studied in 10 stable angina patients. The results were compared with those of 10 patients of stable angina on 20 mg of isosorbide mononitrate ISMN administered twice daily. In addition, arjuna was better tolerated than ISMN. It was found that arjuna therapy was associated with a significant decrease in the frequency of angina and the need for isosorbide dinitrate.

No significant differences were observed in the above parameters when arjuna and ISMN therapies were compared. In one of the earliest studies, 10 patients with CHF received 4 g of arjuna bark powder twice daily for 1 month. The researchers observed improvement in the functional class, breathlessness, and overall well-being with significant diuresis, and a fall in both systolic and diastolic blood pressure. Subsequently, the effect of bark extract mg 8 hourly was studied in a double-blind placebo-controlled two-phase trial comprising 12 patients with refractory CHF. In the first phase, arjuna was administered for a period of 2 weeks.

A decrease in echo-left ventricular end-diastolic and end-systolic volume indices, an increase in left ventricular stroke volume index, and an increase in LVEF were recorded suggesting improvement. On long-term evaluation months , in addition to continued improvement in symptoms and signs, they also reported an improvement in quality of life. A study done with abana herbal formulation containing arjuna in hypertensive individuals revealed an improvement in cardiac function as indicated by an increase in ejection fraction and a significant reduction of the SBP, echocardiographic left ventricular internal diameter, posterior wall thickness, and interventricular septal thickness.

Recently, arjuna has also been shown useful in improving cardiovascular endurance and in lowering SBP in normal healthy subjects. Efficacy of arjuna in decompensated rheumatic heart disease was studied in a double-blind study in which 30 patients of rheumatic valvular heart disease with CHF were administered mg arjuna thrice daily. The results revealed a significant improvement in LVEF, exercise duration, and significant reduction in heart size.

In a randomized, double-blind, placebo-controlled study done in patients with ischemic mitral regurgitation IMR following acute myocardial infarction, arjuna was found to significantly decrease IMR and anginal frequency. The bark extract has been found to decrease platelet activation and possess antithrombotic properties in vitro in 20 patients of angiographically proven CAD and 20 age- and sex-matched controls. The possible mechanism could be by desensitizing platelets by competing with platelet receptor or by interfering with signal transduction. In another recent randomized, double-blind, parallel-group, placebo-controlled study in patients with type 2 diabetes mellitus, mg of arjuna administered thrice daily resulted in a significant increase in mean cardiac output from 4.

Arjuna also caused significant inhibition of platelet aggregation. In a study on 21 patients with coronary heart disease administered 1 g of bark powder twice daily with milk for 4 months, the patients showed improvement in lipid profile. In addition to this, patients got symptomatic relief after 1 month of treatment. Antioxidant effect of bark powder mg has been demonstrated to be comparable to vitamin E IU in a randomized, controlled, open trial done in patients with coronary heart disease.

The hypocholesterolemic effect was attributed to the soluble fibers and sitostanol content, while the antioxidant effect was attributed to the flavonoids. In a prospective cohort study, dyslipidemic patients received arjuna powder 5 g, BD for 3 weeks followed by Arogyavardhini Vati mg, BD for 4 weeks. A significant reduction in lipoprotein a levels amounting to In a double-blind, placebo-controlled, cross-over study involving 18 healthy male smokers and an equal number of age-matched non-smoker controls, it was observed that the hydroalcoholic extract of bark when given for 2 weeks led to significant regression of the endothelial abnormality amongst smokers. In a recent study done to investigate the in vitro thrombolytic and membrane-stabilizing action of four Bangladeshi medicinal plants including arjuna , the methanol extract was found to possess significant thrombolytic activity It also significantly inhibited the hemolysis of RBCs in both hypotonic solution and heat-induced conditions.

This showed that it has moderate thrombolytic activity; however, more research is needed to isolate the secondary metabolites responsible for the activity. Not much data is available to comment on the effect of arjuna on cytochrome P CYP enzyme. Results from a recent in vitro study indicate that arjuna extracts contain constituents that can potently inhibit the activity of CYP1A.

Mild side effects like nausea, gastritis, headache, bodyache, constipation, and insomnia have been reported. No hematological, renal, or metabolic toxicity has been reported even after more than 24 months of its administration. Thus, high amounts of the plant extract should not be consumed, as it may induce hepatotoxicity as well as hypothyroidism. The eternal interest in medicinal plants has led to the discovery of new chemical constituents and pharmacological actions of arjuna. Its efficacy as an anti-ischemic agent, a potent antioxidant, and an antiatherogenic agent has been amply demonstrated in various experimental and clinical studies.

However, major lacunae of these studies include the lack of phytochemical standardization of the extract, bioavailability studies, and well-designed studies to evaluate its long-term toxicity effects. Increasing the awareness regarding its medicinal usage can give a direction to the physicians to respond to the challenges in treating cardiovascular diseases. National Center for Biotechnology Information , U. J Tradit Complement Med. Shridhar Dwivedi 1 and Deepti Chopra 2. Author information Copyright and License information Disclaimer. Correspondence to: Dr. This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.

This article has been cited by other articles in PMC. Abstract Terminalia arjuna , commonly known as arjuna , belongs to the family of Combretaceae. Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Table 1 Major chemical constituents of arjuna. Antioxidant and cardioprotective effect Dried, pulverized bark has been shown to augment endogenous antioxidant compounds of rat heart and prevent oxidative stress associated with ischemic—reperfusion injury of the heart.

Rheumatic heart disease Efficacy of arjuna in decompensated rheumatic heart disease was studied in a double-blind study in which 30 patients of rheumatic valvular heart disease with CHF were administered mg arjuna thrice daily. Ischemic mitral regurgitation In a randomized, double-blind, placebo-controlled study done in patients with ischemic mitral regurgitation IMR following acute myocardial infarction, arjuna was found to significantly decrease IMR and anginal frequency. Platelet aggregation The bark extract has been found to decrease platelet activation and possess antithrombotic properties in vitro in 20 patients of angiographically proven CAD and 20 age- and sex-matched controls. Lipoprotein a A significant reduction in lipoprotein a levels amounting to Endothelial dysfunction In a double-blind, placebo-controlled, cross-over study involving 18 healthy male smokers and an equal number of age-matched non-smoker controls, it was observed that the hydroalcoholic extract of bark when given for 2 weeks led to significant regression of the endothelial abnormality amongst smokers.

Thrombotic condition In a recent study done to investigate the in vitro thrombolytic and membrane-stabilizing action of four Bangladeshi medicinal plants including arjuna , the methanol extract was found to possess significant thrombolytic activity Chopra's Indigenous Drugs of India. Terminalia arjuna W and A Combretaceae pp. Terminalia arjuna a sacred medicinal plant: Phytochemical and pharmacological profile. Phytochem Rev. J Ethnobilol Ethnomed. Yesodharan K, Sujana KA. Indian J Tradit Knowledge. Meet the criteria for probable AD 2. Histopathological evidence obtained by necropsy and biopsy. When talking about neuroimaging, its role in the diagnosis and treatment of AD and other degenerative dementias is still fundamentally reduced to discarding other slowly progressive brain injuries that could cause dementia, like tumours in the frontal or temporal lobe or vascular accumulative lesions.

However, a new and more positive panorama is foreseen for neuroimaging and the management of this disease and related disorders. Eucalyptol depresses CNS and shows antinociceptive property, it enhances blood circulation, causes vasodilation and also bronchodilation. Drug is important in human life as it helps relieved pain and act for cure and treatment Mandal, like opioid.

Chronic and severe pain used opioid as pain management. The use of opioids is associated with rewarding effect that typical of drugs have considerable abuse liability thus patients who are prescribed with opioids might have difficulty to stop the use of prescription opioids even though it is not abuse or misuse of opioids Crofford, Currently, pain medication for chronic and severe pain like cancer and chronic musculoskeletal pain use morphine as its pain management. Morphine is an example of opioid which shows to give positive effects by reducing pain. Understanding the effects of concussions on brain activity is key to developing assessments and preventing future injury. Current assessments rely on symptom inventories or other clinical measures that are lacking in accuracy.

With further research, brain imaging techniques like EEG could be used to evaluate concussions. Temporal lobe epilepsy is known to being resistant to medication, which is why current research is investigating how G- proteins can become activated by the mu opioid receptor selective peptide DAMGO and nociception Temp Lobe G. Another aspect examined is the binding to mu and nociception NOP receptors and adenylyl cyclase AC in the neocortex, which is the region of the brain associated with temporal lobe epilepsy Temp. By comparing the levels of [3H]DAMGO binding and stimulation, it was concluded that epileptics with temporal lobe seizure were found to have changes in the mu opioid and NOP receptor binding and, also, the downstream receptors were found to have alterations in their signal transduction mechanisms.

Effect of Terminalia arjuna bark extract on transient focal cerebral ischemia induced neural damage and behaviour deficits in Sprague dawley rats Stroke is a global socio-economic disease and places a huge burden on patients, families and wider society Warlow et al. Age related risk for stroke becomes higher in India like developed countries with increasing average lifespan of the individual Donnan et al. It possesses various activities like Antitumour, wound healing, anti-inflammatory, hypolipidemic, hypotensive, antioxidant, anti-coagulant, anti-platelet aggregation, and vascular strengthening properties. These activities exerts hepatoprotection, renalprotection, Cardioprotection and neuroprotection in various experimental studies.

Since most of the risk factors was common, the individuals having cardiovascular diseases are having high risk for stroke occurrence. Terminalia arjuna has been proven to be beneficial for cardiovascular diseases in Ayurvedic system, however its effect on cerebrovascular diseases were not clearly understood. The aim of the present study is to analyse the efficacy of Terminalia arjuna on neural damage and behavioural deficits following cerebral ischemia.

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