ISSN: 2349-8889 International Journal for Research in Applied Sciences and Biotechnology Volume-8, Issue-2 (March 2021) www.ijrasb.com https://doi.org/10.31033/ijrasb.8.2.30

Terminalia arjuna: A Potential Ayurvedic Cardio Tonic

Shifali Thakur1, Hemlata Kaurav2 and Gitika Chaudhary3 1Research and Development Department, Shuddhi Ayurveda, Jeena Sikho Life care Pvt. Ltd., Zirakpur Punjab 140603, 2Research and Development Department, Shuddhi Ayurveda, Jeena Sikho Life care Pvt. Ltd., Zirakpur Punjab 140603, INDIA 3Shuddhi Ayurveda, Jeena Sikho Life care Pvt. Ltd., Zirakpur Punjab 140603, INDIA

3Corresponding Author: [email protected]

ABSTRACT cough, excessive perspiration, asthma, ulcer, tumor, Herbal have been a significant source of inflammation, skin and many more [9,10]. According to therapeutic agents to cure human diseases. Plants are being "Atharva Veda" several medicinal plants have been in use for treating various kinds of diseases across the prescribed for the treatment of cardiac diseases like world. arjuna is a widely used herbal since Allium sativum L. (garlic), Cicer arietinum L. ancient times. The ancient indian practitioners utilized the (Bengalgram), Commiphoramukul Engl. (guggul), powdered tree bark of arjuna for the treatment of "hritshool" (angina) and other cardiovascular problems. Curcuma longa L. (turmeric), Eugenia jambolana Terminalia arjuna is regionally called as arjuna which (Jamun), Emblica Officinalis (gooseberry), Ocimum belongs to the family. The plant is utilized as sanctum L. (tulsi), Terminalia arjuna (Arjuna) and a medicine in the various indigenous system like ayurveda, Trigonellafoenum-graecum L. (fenugreek) [11,12]. siddha and unani. Arjunic acid, arjunolic acid, arjungenin, Terminalia arjuna showed the most promising and arjunone, arjunolone and luteolin, gallic acid, ellagic acid, distinct results among all these plants. Terminalia oligomeric proanthocyanidins (opcs), phytosterols are the arjuna, locally known as arjuna. It belongs to the major phytoconstituents of Terminalia arjuna that Combretaceae family. It is an evergreen tree that is possesses many useful biological properties like anti- native to India. The bark stem powder of the Arjuna has microbial, anti-inflammatory, antioxidant, antifeedant, cardio protective, etc. Various clinical evidence of been utilized in the case of "hritshool" i.e. severe pain in Terminalia arjuna and its beneficial effects on the the chest caused by not enough blood supply and other cardiovascular system. The present review is summarizing cardiac ailments by the ancient physicians [13,14]. the phytomedicinal value of Terminalia arjuna in ayurveda Arjunic acid, arjunolic acid, arjungenin, arjunone, and the folk system of medicine. arjunolone and luteolin, gallic acid, ellagic acid, oligomeric proanthocyanidins (OPCs), phytosterols are Keywords- Arjuna, Hritshool, Cardio protective, the major phytoconstituents of Terminalia arjuna Arjunone. [15,16]. Various clinical trials have been done on this plant for cardiovascular diseases including ischaemic heart disease [17], hypertension [18], mitral I. INTRODUCTION regurgitation [19], endothelial dysfunction [20], and heart failure [21]. Several reviews have been describing Medicinal plants play chief role in the health the other effect of "Terminalia arjuna". This review is to care industry. It is also used as a raw material for both compile overall information on various aspects of the traditional drug formulation and modern formulation [1]. Terminalia arjuna plant. The vernacular names and Medicinal plants used in the drug formulation due to taxonomical classification of Terminalia arjuna is their effectiveness, cultural preferences and increasing shown in table no. 1 and table no. 2 respectively. cost of modern medicine [2,3]. Ethno botanical studies [22,23]. are most essential to uncover the past times and current culture about plants in the world and reserving original Table 1: Vernacular Names of Terminalia arjuna knowledge of medicinal plants. Ethno botanical studies were important to recognize the plant uses as food [4], English Arjun human healthcare medicine [5] and veterinary medicine Hindi Arjuna, Arjun [6]. The use of herbal drugs increases from 2.5% to 12% Assamese Arjun in present times. Nanoparticles are derived from Irula Mathi medicinal plants also increased due to their wide Aatumaruthu, Nirmatti, applications in drug industries [7,8]. Numerous medicinal plants have been utilized in the therapeutic Neermaruthu NeerMarudhu, Aatumaruthu, system as well as a modern medicinal system to treat most diseases like cardiovascular diseases like diabetes, Nirmarutu, Vellamathi 227 This work is under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Manipuri Maiyokpha II. GEOGRAPHICAL DISTRIBUTION Vella Maruda, Vella maruthu, Tamil Kula maruthu, Marutu T. arjuna is distributed throughout Indo-sub- Himalayan regions of , South , Table 2: Taxonomical classification of Terminalia , Delhi and Deccan [26]. The plant is arjuna cultivated near ponds and rivers. It is widely distributed in the forests of Sri-Lanka, Burma and Mauritius [27]. Kingdom Plantae Indian immigrants were introducing Terminalia arjuna Division Magnoliophyta in Mauritius [28]. Class Magnoliopsida Phytochemical Constituents of Terminalia arjuna The bark was known to be the most important Order part of the plant Arjuna from a medicinal point of view. Family Combretaceae Initially, it was recorded that the bark had 34% ash Terminalia content consisting entirely of pure calcium carbonate. The aqueous extract contained 23% calcium salts and Species Terminalia arjuna 16% tannins, whereas the alcoholic extract contained Common Name Arjuna tannins and little coloring matter [29]. Other researches on Arjuna bark also showed the presence of sugar, Botanical description of Terminalia arjuna tannins (12%), coloring matter, a glycoside, and T. arjuna(Figure 1) is a large size deciduous carbonates of calcium, sodium and traces of chloride of plant that belongs to the Combretaceae family. The alkali metals [30]. Ghosh et al., investigated that the length of the plant is up to 100 feet. It has a buttressed glycosides. That was capable of increasing the force of trunk and horizontally spreading branches. The branches contraction of the frog heart. Organic compounds of T. are dropped downwards. The smooth grey bark of the arjuna bark were also prepared using sequential methods plant shows the presence of a single-layered epidermis with some organic solvents such as hexane, benzene, with hair-like projections and few scattered lenticels. chloroform, acetone, dichloromethane, ethyl acetate, Periderm and secondary phloem are present in the old butanol, ethanol, methanol and ether, etc. to isolate bark. Leaves are conical. oblong or elliptic. It measures various phytochemical constituents. The major 10-15cm long and 4-7cm broad. Their upper side is pale constituents of T. arjuna are polyphenols, flavonoids, or dark green and the lower side is pale brown. Petioles tannins, triterpenoids, saponins, sterols and minerals. are arranged with one or two prominent glands at the 1. Terpenoids and glycosides: Arjunin is an oleanane top, immediately below the leaf. The flowers are white triterpenoid and a lactone arjunetin was isolated from the with short axillary spikes. They are bisexual. Each benzene and alcoholic extracts of its bark. Arjunic acid flower consists of 10 stamens and an ovary which is and arjungenin is reported in the bark stem of the plant. disk-clothed with yellow or reddish hair. The calyx is Arjunglucoside I and Arjunglucoside II are two more glabrous. Fruit is 2.5-3.5 cm long, glabrous with 5 hard glycosidesisolated from the bark stem of the plant arjuna angles or wings. The wings lines are oblique and curved [31]. After that a triterpene carboxylic acid, terminic upwards. Fruit is a drupe and is often notched near the acid, and arjunoside III and arjuno-side IV were isolated top, marked with oblique upward curving from the ethyl acetate extract of its root [32]. Terminic striations[24,25]. acid was also isolated from the n-hexane extract of arjuna heartwood. Isolation of terminic acid was a very significant finding since it was for the first time that a lup-20(29)-en derivative was isolated from nature with a hydroxyl free at the rare C-13 position. Anjaneyulu et al., reported the presence of lupine derivative in any Terminalia species. Ali et al., was investigated another oleanane type triterpene, terminoside A isolated from the acetone fraction of the ethanolic extract of stem bark [33]. It was also studied that terminoside A inhibits nitric oxide production and decreases inducible nitric oxide synthase levels in lipopolysaccharide stimulated macrophages [34]. Arjunaphthanoloside is a naphthanolycoside (2,3,6,7,8,9-hexahydroxynaphthaline-2-O-α-L (-) rhamnoside) possessing antioxidant activity that has been isolated from its bark. 2α,19α-dihydroxy-3-oxo- Olean-12-en28-oic acid 28-O-β-D-glucopyranoside has

Figure 1: Terminalia arjuna been detected from its root [35]. Alam et al., was 228 This work is under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

ISSN: 2349-8889 International Journal for Research in Applied Sciences and Biotechnology Volume-8, Issue-2 (March 2021) www.ijrasb.com https://doi.org/10.31033/ijrasb.8.2.30 isolated glycosides that is Termiarjunoside I and II from 3. Tannins: Numbers of tannins have been extracted the ethanolic extract of TA bark [36]. Wang et al., was from the bark of Terminalia arjuna. Some of the well- also isolated Arjunglucoside IV and V, Arjunasides A-E known hydrolyzable tannins from the bark are were isolated from the ethanolic extract of the stem bark pyrocatechols, punicallin, punicalagin, terchebulin, of T. arjuna. Some major chemical structure of T. arjuna terflavin C, castalagin, casuariin and casuarnin. Lin et is shown in figure 2. al. was isolated twenty types of tannins and related type 2. Flavonoids / Flavones: A very high level of of compounds from its bark. Tannins are basically used flavonoidspresents inTerminalia arjuna bark compared for enhance the synthesis of nitric oxide and relax to another commonly used plant item. Flavonoids vascular segments precontracted with norepinephrine isolated from its bark are arjunoline, flavones, bicalein, [38]. Takakashi et al., was reported that tannins isolated quercetin, kempferol and pelorgonidin. Sharma et. Al., from arjuna are possessing hypotensive action [39]. It was reported that the chemical and spectroscopic also speculated that tannins may be responsible for their structure of arjunolone was established as 6,4, - astringent, wound healing and anti-microbial activity dihydroxy-7-methoxy flavone and that of bicalein as [40]. 5,6,7- trihydroxy flavone [37]. Luteolin is a significant 4. Minerals: Dwivedi et el., was reported that the bark compound possessing antimutagenic and antibacterial contains large amounts of magnesium (4000 µg/g), properties. calcium (3133 µg/g), zinc (119 µg/g), copper (19 µg/g) and silica [41].

Figure 2: Major chemical constituents of Terminalia arjuna

Folk View treating heart diseases [46]. The mixture of bark powder The bark of T. arjuna has been described as a with rice-washed water was used to treat blood in urine cardiotonic, styptic, anti-dysenteric, urinary astringent. by Tribal living in Sundargarh District, Orissa. Chakradatta et al., prescribed the Powdered bark with Malkangiri tribal people chewed the fresh bark and milk for cardiac problems [42]. The decoction of the swallow the juice as an antacid [47]. T. arjuna is also bark is utilized as a wash in ulcers [43] The ashes of the utilized as a hypolipidemic, anticoagulant, antiviral, bark are recommended for snakebite and scorpion sting. antifungal, antibacterial and hypocholesterolemic agent Kritikar et al., was investigated that fruits of Arjuna are [48]. utilized as a tonic and deobstruent [44]. The powder of Ayurvedic View stem bark of arjuna with boiled water was inhaled to This medicinal plant is being in use since Vedic cure headaches and to kill worms in teeth. In Tamil period. In Ayurvedic literature, the plant is known with Nadu, the Fruit paste of the plant is used on wounds synonyms of Arjun, the Hero of the great epic, topically [45]. Malabar tribe of Kerala was utilized leaf Mahabharata. The plant Arjuna has been mentioned in juice for the treatment of earache and bark powder for many ancient Indian Medicinal literature including 229 This work is under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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Charaka Samhita, Sushruta Samhita, and Astang [59,60,61]. The major disadvantages associated with adulteration are deterioration and degradation of drugs. Hridayam. Vegabhatta (वा嵍भट) was the first person who Adulteration also increases the cost of drugs and used the stem bark powder of Arjuna for heart ailments. produces adverse effects instead of showing actual In Ayurveda, it is mentioned as Hridya (Cardiac tonic). biological effect [62]. The bark powder of Arjuna is given for the treatment of kshata (injury or wound), kshaya (emitiated condition), visha (poison), raktavikara (as a styptic), medaroga III. REPORTED STUDIES OF (diabetic issues), prameha (urinary disorders), vrana TERMANALIA ARJUNA (ulcer/wound), etc [49] Rasa panchak of the T. arjuna [50] is shown in the table no. 3. Various experimental and clinical studies were conducted on T. arjuna plant to demonstrate its Table 3: Rasa Panchak of Terminalia arjuna pharmacological and therapeutically properties. Some of the reported studies of Arjuna plant are shown below. A Sanskrit/ English Sanskrit/ English brief view of reported pharmacological studies in shown Rasa/Taste Kashaya/Astringent in table no. 4. Veerya/ Potency Sheeta/Cooling Antimicrobial Activity The flavonoids isolated from the bark of T. Laghu, Rukash/ Small, Guna/Physical Properties arjuna were analysed to possess antimicrobial activity. Dry The study was investigated that the bark of T. arjuna for Vipaka/ Metabolic Katu/Biiter some bioactive compounds. Both bound and free Properties flavonoids showed activity against all the pathogens. The maximum inhibitory effect was observed against Karma/Action and Properties of T. arjuna[51,52] Agrobacterium tumefacient and Bacillus subtilis by both 1. Mutrvahsansthan (मुत्रवहंसंथान): It is useful in the flavonoids [63]. diabetes. It helps in reducing painful micturition. Reported studies showed the antimicrobial potential of T. arjuna leaves and bark extracts against 2. Prajanansansthan (प्रजननसंथान ): The decoction of various pathogens like Staphylococcus aureus, Arjuna bark and white sandalwood is given to increase Acinetobacter sp., Proteus mirabilis, Escherichia coli, the sperm count in male. In female, it is given in Pseudomonas aeruginosa and Candida albicans, menstrual pain and Leukorrhea. pathogens causing ear infections [64]. Organic extract of 3. Tawcha (तवचा): It is also given in Itching and other T. arjuna bark showed a greater inhibition zone than the skin problems. herbal drops for the treatment of bacterial ear infection 4. Taapkarm (तापकमम): It is also given in severe fever. especially S. aureus. Anti-inflammatory Activity 5. Shatamikaran (सातममकर्म): It is used in improving As per Ayurvedic standard, theformulatiom of overall strength in the human body. The bark decoction arjuna ksheerapaka was prepared in cow milk and of Arjuna with milk is given for ossification. compared with standard hydroalcoholic decoction of T. Some herbal formulation of Arjuna arjuna. The extracts were analysed for gross  Kakubhadichuran phytoconstituents level and their antioxidant activity was  Arjunaristh assayed by DPPH free radical scavenging activity and  Arjunghrith inhibition of lipid peroxidation. The total extraction Modern View yield of Arjun Ksheera Paka was two times higher than The primary issue which is faced by the global hydroalcoholic extract. This implies that the herbal drug industry in today's scenario is the practice of phytoconstituents in Arjun Ksheera Paka were diluted by making these drugs adulterated. This is the reason a factor of 0.5. From the reported study it was found that behind the lost faith of people in these herbal drugs the antioxidant activity of the hydro alcoholic extract nowadays [53,54,55,56,57,58]. Adulteration can be was also higher compared to Arjun Ksheera Paka [65]. either intentional or unintentional. In today's time, Singh et al., studied the anti-inflammatory intentional adulteration is practiced in many different activity of leaves of T. arjuna in the Wister albino rat ways like by substituting standard commercial variety, models. The dried and crushed leaves of Arjuna were by substituting superficially similar but inferior drugs, mixed with petroleum ether and then extracted with by substituting artificially manufactured drugs, the methanol. The methanol extract at the doses of substitution of exhausted drugs and by substituting toxic 100mg/kg and 200mg/kg body weight was subjected to materials. These practices ultimately degrade the quality the animal models for evaluation of anti-inflammatory of the original drugs. The herbal plant vendors use these activities. The acute anti-inflammatory activity was adulteration techniques so smartly that these remain evaluated by carrageenan, histamine and dextran- undetectable until and unless examination on a induced paw oedema in Wister albino rats. Aspirin and microscopic level and chemical level is implied indomethacin were the drugs referred for anti- 230 This work is under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

ISSN: 2349-8889 International Journal for Research in Applied Sciences and Biotechnology Volume-8, Issue-2 (March 2021) www.ijrasb.com https://doi.org/10.31033/ijrasb.8.2.30 inflammatory studies. Results showed that the methanol concluded from the results that T. arjuna extracts were a extract of the leaves of T. arjuna possessed significant good source of natural antioxidants [72]. anti-inflammatory activities in the tested models [66,67] Reported study revealed the antioxidant and 3. Cardiovascular Activity anthelmintic activity of T. arjuna bark extracts. The Pawar et al., conducted a study on male Wister analysis for an inorganic component in the sample rats. Doxorubicin (Dox)- induced in the models for the indicated the presence of Cd, Mn, Cu, Ni, Pb, Zn, K and cardiotoxicity. T. arjuna was given orally to Wister rats Na. The crude extracts of T. arjuna stem bark indicates at different doses (0.42mg/kg, 0.85mg/kg, 1.7 mg/kg, 3.4 the presence of flavonoids, glycosides, triterpenoids, mg/kg and 6.8 mg/kg for 6 days/week. The result saponins and tannins in the crude ethanolic extract. From showed that there was a significant reduction in the analysis, it was found that the phenolic and flavonoid myocardial superoxide dismutase (38.94%) and reduced contents were high in TAEE compared to other extracts glutathione (23.84%) in animals treated with Dox. [73]. Mitochondrial swelling, Z-band disarray, focal dilatation The in-vitro model of Cu2+ ascorbate-induced of smooth endoplasmic reticulum and lipid inclusions stress in goat red blood was analysed for the revealed in the Dox-treated animals under the Electron investigation. Aqueous extract of T. arjuna bark reduced microscopy, whereas results showed that the butanoic the level of lipid peroxidation, increased the reduced fraction of T. arjuna bark has protective effects against glutathione content and decreased the protein carbonyl Dox-induced cardiotoxicity [68]. content in Cu2+ ascorbate treated RBCs. The aqueous The research was recorded to find the effect of extract of Arjuna bark has also protected the activities of different dosage of T.arjuna bark powder serum antioxidant enzymes, catalase and superoxide dismutase biochemistry of broilers chicks. A total of 72-day old (SOD) [74]. chicks were used in this study. Four dosage of arjuna Repellent and antifeedant activities bark powder at the rate of .00%, .50%, .75% and 1% As per the reported study, Saracaasoca and T. were given into the basal diet for five weeks. The arjuna bark extract controlled Sitophilus oryzae and administration of dosage for all groups lasted for 35 found to possessed antifeedant activity. The repellent days. It was observed that T. arjuna bark powder activity against S. oryzae adults was more significant in methanol extract of T. arjuna bark as compared with lowered the total cholesterol, triglycerides and LDL [69]. Saracaasoca bark extract. Hence, S asoca and T. arjuna 4. Antioxidant Activity could be recognized as an ideal grain protectant from the The research was conducted for hypolipidaemic point of view of seed viability and safety to mammals and antioxidative properties of T. arjuna added vanilla [75]. chocolate dairy milk. It was investigated in high Aortic Prostaglandins cholesterol-fed Wister rats for 60 days. It was found that As per the reported study, the effect of bioactive compounds present in the encapsulated T. Terminalia arjuna bark on prostaglandins was studied in arjunashowed antioxidant property and released in the rabbits subjected to isoproterenol-induced myocardial intestine and show their effects [70]. ischemia. Initially, Rabbits were divided into two One more study on the alcoholic extract of stem groups. First group was administrated with 500mg T. bark of T. arjuna was investigated for antioxidant and arjuna bark powder twice daily by oral gavage for 90 antimutagenic activity. The alcoholic extract has shown days and another group was put on placebo along with potent antioxidant activity with EC50 of the standard drug. After that they were subjected to 2.4km91±0.160, 50.110±0.150 & 71.00±0.250 in DPPH isoproterenol infusion to induce myocardial ischemia. assay, superoxide radical scavenging activity lipid Myocardial ischemia was confirmed by peroxidation assay in comparison with ascorbic acid electrocardiographic and cardiac injury enzyme changes. with ED50 of 2.471±0.140, 40.500±0.390 & In the end, the rabbits were sacrificed and aortic rings 63.00±0.360 respectively. In the micronucleus test, T. bioassayed for the PGE2 activity. It was found that arjuna showed a potential reduction in the percentage of aortic prostaglandin E2 like activity was enhanced in micronucleus in both polychromatic erythrocytes and a rabbits who were administered T. arjuna compared to significant reduction in the P/N ratio [71]. those who were on placebo [76]. Seth et al., was determined the antioxidant Anti-Lipidemic Activity activity and free radical scavenging capacity of T. A study was conducted on the rabbits fed on arjuna. The extracts of arjuna were ranged from 6.66- high cholesterol diet to check the antilipidemic activity 19.09g/100g (w/w) on a dry weight basis. The result of T. arjuna. It was found from the study that T. arjuna showed that T. arjuna extracts contained a good amount bark powder reduced the total cholesterol in the rabbits of TPC (6.02-19.09g/100g, as gallic acid equivalent), [77]. These findings were further confirmed by Pathak TFC (1.75-5.96g/100g) as catechin equivalent and and Khanna in a research [78]. DPPH radical scavenging activity was (IC50 2.71-7.68 In another experimental study, ethanolic extract µg/ml), inhibition of peroxidation was (64.79-71.43%) of T. arjuna was given in doses of 100 and 500mg /kg to and reducing power was (0.001-1.584 mg/ml). It can be the hypercholesterolaemic rabbits. It was found that T.

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ISSN: 2349-8889 International Journal for Research in Applied Sciences and Biotechnology Volume-8, Issue-2 (March 2021) www.ijrasb.com https://doi.org/10.31033/ijrasb.8.2.30 arjuna was significantly reduced the total LDL later, in another study, the extract isolated from the bark cholesterol and HDL respectively. Ram et al., was of Terminalia arjuna was administered to a patient with investigated that the decoction of T. arjuna plant did not congestive heart failure (CHF), essential hypertension affect the liver and renal functions when tested and cirrhosis of the liver. Clinical improvement was biochemically [79]. noted in 42%, 62% and 40% of these patients [86]. Anti-diabetic activity Through improvement in CHF substantiated earlier A study was conducted for the antidiabetic claims of its cardiotonic property, there could be some activity of aqueous stem bark extract of T. arjuna. other mechanism of action, as its putative diuretic action Antidiabetic bioassay was analysed through estimation or effect of some specific tannin and effective results of blood counts, total cellular (i.e. proteins) and free were reported in cases of essential hypertension and hemoglobin content in diabetic blood plasma and also cirrhosis would not be overriding. It is also efficient in determined its haemolytic activity in human whole decompensated rheumatic heart disease. It was blood. The results revealed that the aqueous stem bark of subsequently investigated in a double-blind study. The T. arjuna have antidiabetic activity and also enhances extract isolated from arjuna plant was tested against the granulocyte count and decrease in free hemoglobin thirty patients of rheumatic valvular heart disease with content including total cellular content in diabetic human CHF thrice a day. Results showed a significant whole blood and plasma samples [80]. improvement in left ventricular ejection fraction was Anti-cancer activity noted in these cases [87]. As per the reported study T. arjuna possess Anti-ischemic activities anti-cancer activity. A, pestalotiopsis was isolated from The efficiency of Terminalia arjuna therapy in T. arjuna leaves and was screened for the production of ischemic stroke and ischemic heart diseases has been taxol (anticancer drug). Pestalotiopsisis an endophytic studied by several groups of researchers. In a study, 20g fungus. A sufficient amount of taxol 211.1 µg/litre was bark stem powder was administered in three divided produced by a fungus. The fungal taxol extracted from doses to patients of angina and thrombotic stroke [88]. an organic extract of the fungal culture had strong Functional improvement in motor power along with an cytotoxic activity towards BT220, H116, Int 407, HL increase in prothrombin time was noted in these cases. 251 and HLK 210 human cancer cells in vitro when One more study from the same group using an alcoholic tested by apoptosis assay [81]. decoction of the bark in patients with ischemic heart Antimutagenic Activity disease. It was found that the frequency of angina The antimutagenic property of T. arjuna has episodes decreased and increase globulin lysis time. also been reported by Pettit. It was observed that some One more clinical study involving a herbo- patients with coronary artery disease may benefit from mineral preparation which was containing Terminalia T. arjuna. It may also be having some kind of associated arjuna 30mg per tablet, known as abana, was found to malignant lesion [82,83,84]. have antithrombotic activity [89]. This drug could significantly inhibit platelet adhesion and ADP and IV. CLINICAL STUDIES adrenaline-induced platelet aggregation. Lipoprotein Lowering Effects Diuretic/ Decongestive effects The effect was examined in an open label pilot The first reported clinical study was done study in CAD patients. Result showed a significant cardiovascular patients in the early 20th century and the decrease in Lp (a) level fell significantly by 3 months of drug was found to be cardio tonic [85]. Almost 40 years adjuvant Terminalia arjuna therapy [90,91].

Table 4: Reported pharmacological properties of Terminalia arjuna

S. No. Extract Method Property Reference Agrobacterium 1 Flavonoids tumifacians/ Bacillus Anti-microbial 63 subtilis 2 Methanol Extract Wister Albino Rat Anti-inflammatory 66,67 Male Wister Rats 3 a. Bark Powder Extract Cardiovascular Activity 68

4 Bark Powder Extract Chicks Cardiovascular Activity 69 5 Alcoholic Extract Wister rats Anti-oxidant 70,71,72 6 Aqueous Extract In-vitro model Anti-oxidant 73 7 Methanol Extract Rats Anti-feedant 74 8 Bark powder Rabbits Aortic Prostaglandins 75

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9 Bark powder Rabbits Anti-lipidemic 76,77 Cholesterolaemic 10 Ethanolic Extract Anti-lipidemic 78 Rabbits In vitro study on Human 11 Aqueous Stem Bark Anti-diabetic 80 whole blood & plasma In-vitro study on BT220, H116, Int 407, HL 251 12 Taxol Extracts Anti-cancer 81 and HLK 210 human cancer cells 13 Bark Extract CHF Patient Diuretic 86 Patient of Angina & 14 Bark stem Powder Anti-ischemic 89 Thrombin Stroke 15 Bark Powder CAD Patient Anti-ischemic 89

Toxicity and Side Effects consumed in Northwestern Tuscany, Italy. J The optimum dose in patients with CAD is 1- Ethnobiol, 21(1), 89-104. 2g/day in various clinical studies. At this dosage, it is [5] Kim, H., & Song, M. J. (2013). Ethnomedicinal well tolerated and has fewer side effects. No practices for treating liver disorders of local haematological, metabolic, renal and hepatic toxicity has communities in the southern regions of Korea. Evidence- been reported in more than 24 months of its Based Complementary and Alternative Medicine, 2013.. administration [92,93,94]. [6] Upadhyay, B., Singh, K. P., & Kumar, A. (2011). Ethno-veterinary uses and informants consensus factor V. CONCLUSION of medicinal plants of Sariska region, , India. Journal of Ethnopharmacology, 133(1), 14-25. Terminalia arjuna is one of the sacred plant of [7] Stickel F, Schuppan D. (2013) Herbal medicine in the world. This medicinal plant is most commonly used the treatment of liver diseases. Dig Liver in all the traditional systems of medicine like Ayurveda, Dis.39:293e304. Siddha, Yanani and Folk system. Terminalia arjuna is [8] Gopinath, K., Venkatesh, K. S., Ilangovan, R., mostly utilized for the treatment of cardiac diseases. Sankaranarayanan, K., &Arumugam, A. (2013). Green Arjuna is a rich source of various phytochemicals like synthesis of gold nanoparticles from leaf extract of arjunic acid, arjunolic acid, arjungenin, arjunone, Terminalia arjuna, for the enhanced mitotic cell division arjunolone and luteolin, gallic acid, ellagic acid, and pollen germination activity. Industrial crops and oligomeric proanthocyanidins that possesses a wide products, 50, 737-742. range of therapeutic properties. But the characteristic [9] Yallappa S, Manjanna J, Sindhe MA, Satyanarayan property of Terminalia arjuna is its significant potential ND, Pramod SN, Nagaraja K. (2013). Microwave for treating cardiovascular diseases. Various clinical assisted rapid synthesis and biological evaluation of studies have been done on the Terminalia arjuna plant. stable copper nanoparticles using T. arjuna bark extract. This review gives an important view mainly on SpectrochimActa A.110: 108e115. therapeutic uses, traditional uses, phytochemical [10] Edison, T. J. I., &Sethuraman, M. G. (2012). compounds, and various clinical studies on the Instant green synthesis of silver nanoparticles using Terminalia arjuna plant. Terminalia chebula fruit extract and evaluation of their catalytic activity on reduction of methylene REFERENCES blue. Process Biochemistry, 47(9), 1351-1357. [11] Dwivedi, S. (1996). Putative uses of Indian cardiovascular friendly plants in preventive [1] WHO. World Health Organization (2002), cardiology. Ann Natl Acad Med Sci, 32(3&4), 159-175. Traditional Medicine Strategy Report, Document [12] Shatvalekar, S. (1943)Atharva Veda Samhita, 1st [2] Heinrich, M. (2000). Ethnobotany and its role in ed. Balsad, , India. p. 25. drug development. Phytotherapy Research: An [13] Chopra, R. N., & Chopra, I. C. (1994). Indigenous International Journal Devoted to Pharmacological and drugs of India. Academic publishers. Toxicological Evaluation of Natural Product [14] Miller, A. L. (1998). Botanical influences on Derivatives, 14(7), 479-488. cardiovascular disease. Alternative medicine review: a [3] Tabuti, J. R., Lye, K. A., & Dhillion, S. S. (2003). journal of clinical therapeutic, 3(6), 422-431. Traditional herbal drugs of Bulamogi, Uganda: plants, [15] Bone, K. (1996). Clinical applications of use and administration. Journal of Ayurvedic and Chinese herbs. Monographs for the ethnopharmacology, 88(1), 19-44. Western Herbal Practitioner. Australia: Phytotherapy, [4] Pieroni, A. N. D. R. E. A. (2001). Evaluation of the 137-41. cultural significance of wild food botanicals traditionally 233 This work is under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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