Substances & Homeopatic Remedies

Terminalia arjuna

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The main constituents of this shade and ornamental tree are ellagic acid and arunic acid.
In cases of cirrhosis of the liver the bark has a tonic effect and induces a drug-dependent decrease in heart rate and blood pressure. It is also helpful as an anti-ischemic and cardioprotective agent in ischemic heart disease and hypertension. Levels of triglycerides and cholesterol have been reduced and it has been reported to enhance the synthesis of LDL-apoprotein (apoB). It allegedly possesses protective cardiovascular and hypolipidemic properties. It inhibits the oxidation of LDL and accelerates the turnover of LDL-cholesterol in liver. This increases the expulsion of cholesterol from the body. The hepatic cholesterol biosynthesis suppression by Terminalia arjuna is the mechanism responsible for the recovery of HDL components in hyperlipidemia as well as a major reduction of beta-lipoprotein lipids.

The efficacy of the bark powder in treating congestive cardiac failure (CCF) was the subject of a study that showed a marked improvement in over 40% of the cases. Also observed were CCF due to congenital anomaly of heart and valvular disease being brought under control as well as 4 out of 9 cases of CCF as a result of chronic bronchitis being relieved by the treatment. Symptomatic complaints of essential hypertension viz. giddiness, insomnia, lassitude, headache and a lack of concentration ability were relieved by arjuna. Coagulation, bleeding and prothrombin time can be reduced by oral administration of an aqueous suspension of the bark powder.


Active Constituents
Terminalia's active constituents include tannins, triterpenoid saponins (arjunic acid, arjunolic acid, arjungenin, arjunglycosides), flavonoids (arjunone, arjunolone, luteolin), gallic acid, ellagic acid, oligomeric proanthocyanidins (OPCs), phyto-sterols, calcium, magnesium, zinc, and copper.

Mechanisms of Action
Improvement of cardiac muscle function and subsequent improved pumping activity of the heart seem to be the primary benefits of Terminalia. It is thought that the saponin glycosides might be responsible for the inotropic effects of Terminalia, while the flavonoids and OPCs provide free radical antioxidant activity and vascular strengthening. Unlike Crataegus, Terminalia has not had the extensive studies of its constituents, and this type of study would be beneficial to the understanding of this botanical.

Clinical Studies on Terminalia
An open study of Terminalia's effects on stable and unstable angina revealed a 50 percent reduction of anginal episodes in patients with stable angina (p < 0.01) after three months' treatment. A statistically significant reduction was also noted in systolic blood pressure in these patients (p < 0.05). On treadmill testing, both the time to onset of angina and the time to appearance of ECG ST-T changes were significantly increased in the stable angina group (p < 0.001), indicating an improvement in exercise tolerance (Figure 1). The unstable angina patients in this study did not experience significant reductions in angina or systolic blood pressure. Both groups showed improvements in left ventricular ejection fraction. When these improvements were combined for statistical purposes, the improvements were significant (p < 0.05). Evaluating the overall clinical condition, treadmill testing, and ejection fraction, 66 percent of the stable angina patients and 20 percent of the unstable angina patients improved during three months of therapy.18
 
Congestive Heart Failure
Chronic congestive heart failure, with an annual mortality rate of more than 40 percent, can be a difficult condition to treat. Because of Terminalia's effect of increasing cardiac output, Indian researchers conducted a two-phase trial of Terminalia extract treatment in twelve patients with severe refractory heart failure (NYHA Class IV). Either 500 mg Terminalia bark extract or placebo was given every eight hours for two weeks in this double-blind study. All patients continued their drug therapy during the study. These included digoxin, diuretics, angiotensin-converting-enzyme inhibitors, vasodilators, and potassium supplementation. Symptoms of dyspnea, fatigue and edema improved while patients were on Terminalia therapy, and walking tolerance improved as well. All patients had dyspnea at rest or after minimal activity at the start of the trial. Echocardiographically, Terminalia therapy was associated with significant improvements in stroke volume and left ventricular ejection fraction, with decreases in end-diastolic and end-systolic left ventricular volumes compared to placebo. In the second phase of the study, patients from phase I were continued on Terminalia extract for approximately two years. Improvements were noted in the ensuing two to three months, and were maintained throughout the balance of the study. After four months of treatment, nine patients had improved to NYHA Class II and three improved to Class III. This was a significant piece of research, as these patients had not responded to conventional drug therapy, and yet had significant improvements in objective and subjective parameters while taking Terminalia.19
A subsequent study was conducted on 10 patients post myocardial infarction and two patients with ischemic cardiomyopathy, utilizing the same 500 mg every eight hours dosage as above, for three months. Patients were continued on conventional treatments. Significant reductions in angina, left ventricular ejection fraction, and left ventricular mass were noted in the Terminalia group, whereas a control group taking only conventional drugs had decreased angina only. The two patients with cardiomyopathy improved from NYHA Class III to Class I during the study.20
Animal studies suggest Terminalia can reduce blood lipids. Rabbits were made to be hyperlipidemic by feeding them an atherogenic diet. Two groups were given a Terminalia extract orally, and one group was used as a placebo control group. The animals given Terminalia had a significant, dose-related decrease in total and LDL cholesterol, compared to placebo (p < 0.01).21 However, the amounts used (100 mg/kg and 500 mg/kg body weight) were very large, and it remains to be seen if these significant changes will be seen in humans taking relatively smaller oral doses.
In a similar study, rats were fed cholesterol (25 mg/kg body weight) alone or with Terminalia bark powder (100 mg/kg) for 30 days. Terminalia feeding caused a smaller increase in blood lipids and an increase in HDL cholesterol compared to the cholesterol-only group. The study's authors hypothesized that Terminalia's lipid-lowering effects were caused by inhibition of hepatic cholesterol biosynthesis, increased fecal bile acid excretion, and stimulation of receptor-mediated catabolism of LDL cholesterol, effects which mirror the lipid-lowering activity of Crataegus noted above.22
 
Research results:



1)


Screening of 34 Indian medicinal plants for antibacterial properties.

Perumal Samy R, Ignacimuthu S, Sen A.

Entomology Research Institute, Loyola College, Chennai, India.

A total of 34 plant species belonging to 18 different families, selected on the basis of folklore medicinal reports practised by the tribal people of Western Ghats, India, were assayed for antibacterial activity against Escherichia coli, Klebsiella aerogenes, Proteus vulgaris, and Pseudomonas aerogenes (gram-negative bacteria) at 1000-5000 ppm using the disc diffusion method. Of these 16 plants showed activity; among them Cassia fistula, Terminalia arjuna and Vitex negundo showed significant antibacterial activity against the tested bacteria. Our findings confirm the traditional therapeutic claims for these herbs.

2)
Antineoplastic agents 338. The cancer cell growth inhibitory. Constituents of Terminalia arjuna (Combretaceae).

Pettit GR, Hoard MS, Doubek DL, Schmidt JM, Pettit RK, Tackett LP, Chapuis JC.

Cancer Research Institute, Arizona State University, Tempe 85287-1604, USA.

By means of bioassay-guided separation methods, the cancer cell growth inhibitory constituents residing in the bark, stem and leaves of the Mauritius medicinal plant Terminalia arjuna (Combretaceae) were examined. The cancer cell line active components were found to be gallic acid, ethyl gallate, and the flavone luteolin. Only gallic acid was previously known to occur in this plant. Luteolin has a well established record of inhibiting various cancer cell lines and may account for most of the rationale underlying the use of T. arjuna in traditional cancer treatments. Luteolin was also found to exhibit specific activity against the pathogenic bacterium Neisseria gonorrhoeae.

3)
Biochemical contents, their variation and changes in free amino acids during seed germination in Terminalia arjuna.

Srivastava N, Prakash D, Behl HM.

National Botanical Research Institute, Lucknow, India.

The leaves, twigs, stem and bark of T. arjuna were analysed for their protein, phenol, tannin, nitrate, oxalate in addition to vitamin C, anthocyanin and chlorophyll in the leaves. The variation of some of these parameters in the leaves with season and leaf position was also studied. The time course changes in amino acids and protein during seed germination in T. arjuna, showed initial decrease in protein followed by increase at subsequent stages. The seeds contain high level of serine (21.7%) and glutamic acid (22.6%) the later decreased as the germination progressed. After 30 days seeds showed higher amounts of serine (26.0%), valine (2.8%), proline (10.6%), methionine (3.4%), histidine (5.6%) and lysine (7.4%) while threonine, glutamic acid, tyrosine and arginine were in lower amounts than that of initial stage at 0 day.