Arjuna

Arjuna (Terminalia arjuna)

1. Identity and Botanical Profile

Botanical name: Terminalia arjuna (Roxb. ex DC.) Wight & Arn. Commonly known as arjuna, it belongs to the family Combretaceae. Vernacular names in Indian languages include white marudah, arjuna, arjunam, kakubha, and kahu. It is also known as Indradru, Partha, and Veeravriksha, and is indigenous to the Indian subcontinent.

Morphology and habitat: Terminalia arjuna is a deciduous tree found throughout India, growing to a height of 60–90 feet. Arjuna is native to India and is typically found near riverbanks or in moist areas, particularly in central and southern India. It is one kind of widely used medicinal plant used in various indigenous systems of medicine, including Ayurveda, Siddha, and Unani.

Plant part used: T. arjuna is used primarily for its bark, while other Terminalia species are primarily used for their fruits. The thick, white-to-pinkish-gray bark has been used in India's native Ayurvedic medicine for over three centuries, primarily as a cardiac tonic. Arjuna's therapeutic value extends beyond heart health, with its bark, leaves, and fruits being utilized in a wide range of treatments due to its potent antioxidant, anti-inflammatory, and antimicrobial activities.

Common forms and preparations: Traditional preparations of arjuna bark include stem bark powder administered in the form of an alcoholic decoction (asava), or given along with clarified butter (ghrita), or along with boiled milk (kshirpak). Modern commercial preparations include powder produced from the grinding and sieving of stem bark, as well as standardized aqueous and ethanolic extracts, capsules, and tablets.

2. Traditional and Historical Use

Renowned for its medicinal properties, T. arjuna has been a staple in Ayurvedic medicine for over 2,500 years, dating back to the Vedic period. It is extensively referenced in ancient Indian medical texts such as the Charaka Samhita, Sushruta Samhita, and Astanga Hridayam.

An Indian physician named Vagbhata has been credited as the first to use this product for heart conditions in the seventh century A.D. Chakradatta, the great ancient physician, recommended it to be given as a decoction of bark with milk or as a ghrita (a preparation with ghee or butter).

The range of conditions for which arjuna bark was traditionally prescribed was broad. In Ayurvedic medicine, it has been used to balance the three "humors": kapha, pitta, and vata. Its bark decoction has been used in the Indian subcontinent for anginal pain, hypertension, congestive heart failure, and dyslipidemia, based on the observations of ancient physicians for centuries. The bark was decocted and used to treat diarrhoea and dysentery, whilst the powdered bark was used for asthma. It was also recommended for poisonings and scorpion stings.

The plant has been widely used across indigenous systems of medicine including Ayurveda, Siddha, and Unani. Traditional Siddha practitioners in South India employed decoctions of Arjuna bark to fight infections; Unani healers used its extracts for dropsy (edema).

The stem bark of Terminalia arjuna is used by Ayurvedic physicians in India for the treatment of various cardiovascular diseases, collectively referred to as hritroga. Milk solids were traditionally combined with T. arjuna phytoconstituents, with the belief that this enhanced absorption and resulted in better effectiveness even at lower doses.

3. Key Constituents and Active Compounds

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), phytosterols, calcium, magnesium, zinc, and copper. The plant also contains arjunilic acid, triterpene glycosides including arjunetosides I, II, III, and IV, arjunine, and arjunetein.

Polyphenols, flavonoids, tannins, triterpenoids, saponins, sterols, and minerals are the major constituents of T. arjuna. Amino acids including tryptophan, tyrosine, histidine, and cysteine are also main ingredients.

Class-by-class, the phytochemical roles are described as follows:

• Tannins provide antioxidant and anti-inflammatory benefits, and flavonoids support cardiovascular health through lipid-lowering and cardioprotective effects.
• Glycosides present in T. arjuna offer cardiotonic properties, while triterpenoids, such as ursolic acid, exhibit anticancer and antileishmanial activities.
• Saponins add further immune-boosting and anti-inflammatory effects, and essential minerals complement its overall health benefits.
• Triterpenoids are mainly responsible for cardiovascular properties. Tannins and flavonoids are responsible for its anticancer properties.
• Saponin glycosides in T. arjuna may be responsible for its inotropic effects, while the flavonoids/phenolics may supply antioxidant activity as well as vascular amplification activity, authenticating the multiple activities of this plant for its cardio-protective function.

4. Mechanisms of Action

It has been extensively studied in animal models to demonstrate cardioprotective properties, ranging from positive inotropic effects, hypolipidemic effects, coronary vasodilatory effects, and antioxidant effects to induction of stress protein in the heart.

Antioxidant effects: Triterpenoids derived from arjuna extract, containing arjunolic acid, show cardioprotective activity by boosting the endogenous antioxidant defense system. Both alcoholic and aqueous bark extracts attenuated hydrogen peroxide-mediated reactive oxygen species (ROS) generation in human monocytic (THP-1) cells by promoting catalase (CAT) and glutathione peroxidase (GPx) activities, and by sustaining cellular reducing power.

Anti-inflammatory effects: T. arjuna modulates inflammatory responses by lowering levels of inflammatory cytokines, further supporting cardiac health. It enhances cardiac function by positively influencing calcium handling and myocardial metabolism, which improves contractility.

Anti-apoptotic effects: The herb exhibits anti-apoptotic effects, reducing programmed cell death in cardiac cells during stress conditions like hypoxia, which is facilitated by the regulation of specific signaling pathways.

Vascular effects: Terminalia arjuna has shown significant antihypertensive properties, particularly through its ability to improve vascular health. The bark extract induces relaxation of vascular smooth muscles, leading to vasodilation, which helps reduce both systolic and diastolic blood pressure.

Hypolipidemic effects: The hypolipidemic action is thought to occur through enhanced hepatic clearance of cholesterol, downregulation of lipogenic enzymes, and inhibition of HMG-CoA reductase. Inhibitory effect of alcoholic and aqueous extracts of T. arjuna stem bark was assessed on human 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, lipoprotein lipase (LpL), and lipid peroxidation.

Summary of pleiotropic cardiovascular actions: Evidence from various in vitro, in vivo, and clinical trials reveals the pleiotropic effects of Terminalia arjuna, such as anti-atherogenic, hypotensive, inotropic, anti-inflammatory, anti-thrombotic, and antioxidant actions for the treatment of various cardiovascular disorders.

5. Scientific Evidence by Area of Use

5.1 Congestive Heart Failure (CHF)

The most influential early clinical study of arjuna in heart failure is attributable to Bharani et al. (1995). Twelve patients with refractory chronic congestive heart failure (Class IV NYHA), related to idiopathic dilated cardiomyopathy (10 patients), previous myocardial infarction (1 patient), and peripartum cardiomyopathy (1 patient), received Terminalia arjuna as bark extract (500 mg 8-hourly) or matching placebo for 2 weeks each, separated by a 2-week washout period, in a double-blind crossover design as an adjuvant to maximally tolerable conventional therapy (Phase I). On long-term evaluation in an open design (Phase II), wherein Phase I participants continued T. arjuna in a fixed dosage (500 mg 8-hourly) in addition to flexible diuretic, vasodilator, and digitalis dosage for 20–28 months (mean 24 months) on an outpatient basis, patients showed continued improvement in symptoms, signs, effort tolerance, and NYHA Class, with improvement in quality of life. No significant clinical untoward effect occurred during Terminalia arjuna or placebo therapy.

A subsequent, more rigorously designed trial addressed limitations of the Bharani study. In a double-blind, parallel, randomized, placebo-controlled add-on clinical trial, 100 patients of CHF of New York Heart Association (NYHA) functional class II on standard pharmacotherapy having an echocardiographic left ventricular ejection fraction (LVEF) ≤ 40% were consecutively recruited and randomized 1:1 to arjuna extract 750 mg or matching placebo twice daily.

Evidence characterization: Data for Terminalia arjuna are limited to a single product formulation evaluated in a small number of subjects. Additional well-controlled comparative trials are needed, and safety profiles must be established before its use can be recommended.

5.2 Chronic Stable Angina (Coronary Artery Disease)

The first recorded clinical study showing efficacy of Terminalia arjuna in cardiovascular diseases was carried out in the early 20th century. Terminalia arjuna has been clinically tested in a number of cardiovascular conditions including ischemic heart disease, hypertension, mitral regurgitation, endothelial dysfunction, and heart failure. Nine clinical studies have been conducted to study the effects of Terminalia arjuna in patients with angina alone.

A key open-label trial demonstrated a 50% reduction in angina episodes along with a significant delay in the time to the onset of angina on the treadmill test (TMT) and appearance of ST–T changes in ECG after arjuna therapy was administered in stable angina patients.

An earlier study administered 500 mg of bark powder twice daily to 25 coronary artery disease (CAD) patients for 3 months. A reduction in the grade of positivity of the 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.

A double-blind, placebo-controlled crossover study by Bharani et al. (2002) compared arjuna with isosorbide mononitrate. Participants received either Terminalia arjuna bark extract (500 mg every 8 hours), isosorbide mononitrate (40 mg/day), or placebo for one week each in a crossover design. Key findings included a significant decrease in angina frequency during arjuna treatment vs. placebo, reduced need for sublingual isosorbide dinitrate, and improved treadmill exercise test parameters (time to onset of angina and ST-segment depression), with no significant difference between arjuna and isosorbide mononitrate in any parameter. The short treatment duration (one week per arm) and exclusively male cohort limit the generalizability of these results.

A pharmacovigilance study examining long-term safety as adjunct therapy reported: a total of 35 patients of chronic CAD were enrolled to receive arjuna bark extract powder (500 mg three times daily) along with conventional drugs. The control group (35 patients) received conventional drugs alone. Arjuna has been in use for long and is considered to be effective for angina with no major side effects in short-term studies.

A 2014 systematic review and meta-analysis specifically addressed angina: studies were found to be of poor methodological design. Though various pharmacological studies and clinical trials support its benefit in cardiovascular disease as per traditional use, new clinical trials using more rigorous state-of-the-art technology and in a larger population setup are warranted to assess the traditional putative efficacy of Terminalia arjuna.

Though it has been found quite useful in angina pectoris, mild hypertension, and dyslipidemia, its exact role in primary/secondary coronary prevention is yet to be explored.

5.3 Dyslipidemia and Atherosclerosis

Animal experiments have demonstrated that arjuna bark powder/extract reduces the total cholesterol (TC) and triglyceride (TG) levels. On comparing the hypolipidemic property of the bark in different solvent fractions (petroleum ether, solvent ether, ethanol, and water) in hyperlipidemic rats, it was observed that only the ethanolic fraction exerted significant lipid-lowering effect.

In a rabbit model of atherosclerosis, twenty New Zealand rabbits were randomly divided into five groups; the treatment groups received a high cholesterol diet supplemented with atorvastatin (10 mg/kg body weight) or T. arjuna ethanolic fraction (100 and 200 mg/kg body weight). Results showed that T. arjuna significantly decreased TC, LDL, and TG levels, increased HDL, and lessened atherosclerotic lesions in the aorta (P < .05). Hence T. arjuna extract can effectively prevent the progress of atherosclerosis, likely due to the effect on serum lipoproteins and its antioxidant and anti-inflammatory properties.

Evidence characterization: Evidence for lipid-lowering in humans specifically remains primarily extrapolated from animal models and preliminary human cardiovascular trials. Dedicated, well-controlled human hypolipidemia trials are limited.

5.4 Hypertension

Experimental studies have revealed its bark exerting significant inotropic and hypotensive effect, increasing coronary artery flow and protecting the myocardium against ischemic damage. It has also been detected to have mild diuretic, antithrombotic, prostaglandin E2-enhancing, and hypolipidaemic activity. Human clinical data on arjuna in isolated hypertension are limited, and evidence is primarily derived from cardiovascular disease trials where blood pressure was a secondary endpoint.

5.5 Endothelial Function

Clinical testing in endothelial dysfunction has been reported, including a study (Bharani et al., 2004, Indian Heart Journal) that examined arjuna's capacity to reverse impaired endothelial function in chronic smokers. Mechanistically, the alcoholic extract of arjuna bark (TAAE) was highly effective at attenuating proinflammatory gene transcripts in human monocytic (THP-1) cells and human aortic endothelial cells (HAECs), whereas the response to the aqueous extract depended on the type of transcript and cell type.

5.6 Ischemic Mitral Regurgitation

A number of clinical studies have reported beneficial effects of T. arjuna in patients of chronic stable angina, endothelial dysfunction, heart failure, and even ischemic mitral regurgitation. Dwivedi et al. (2005, International Journal of Cardiology) documented its role in ischemic mitral regurgitation; however, this represents a small-scale clinical observation with limited confirmatory evidence.

5.7 Antimicrobial and Periodontal Effects

Active substances such as ethyl gallate, gallic acid, arjunolic acid, ellagic acid, and flavones are extracted from the plant's leaves, bark, and fruits and tested for their potential to fight periodontal bacteria. Beyond heart health, it is gaining attention for applications in oral health, particularly periodontal therapy, due to its anti-inflammatory and wound-healing properties. Its flavonoids and tannins have demonstrated effectiveness in managing bacteria and inflammation in periodontal pockets.

Evidence characterization: Antimicrobial evidence in periodontal disease is predominantly in vitro or based on small clinical applications. It is preliminary and not yet supported by large randomized controlled trials.

5.8 Antimutagenic Activity

It has also been found to be antibacterial and antimutagenic. The alcoholic extract of the stem bark of T. arjuna (ALTA) has shown potent antioxidant activity with EC50 in DPPH assay, superoxide radical scavenging activity, and lipid peroxidation assay. In the micronucleus test, ALTA showed significant reduction in the percentage of micronuclei in both polychromatic and normochromatic erythrocytes. These findings are from animal and in vitro studies; no dedicated human clinical trials on antimutagenic endpoints have been conducted.

5.9 Cardiotoxicity Protection (Doxorubicin Model)

Investigators examined the effects of a butanolic fraction of T. arjuna bark on doxorubicin (Dox)-induced cardiotoxicity using an in vivo study with male Wistar rats, and found that T. arjuna bark has protective effects against Dox-induced cardiotoxicity and may have potential as a cardioprotective agent. This evidence is preclinical only.

6. Body Systems and Health Areas Associated with Arjuna

• Cardiovascular system: The plant has been reported to contain phytochemical constituents that exhibit various pharmacological activities including antimicrobial, anticancer, cardioprotective, antifungal, antidiabetic, antioxidant, anti-inflammatory, hypolipidemic, anthelmintic, insecticidal, wound healing, antiacne, and gastroprotective effects.
• Hepatic system: It has been reported to possess hepatoprotective properties.
• Immune and inflammatory pathways: Multiple in vitro and animal studies document modulation of pro-inflammatory cytokines and antioxidant enzyme systems.
• Oral/periodontal system: Emerging area of research as noted in recent PMC publications.
• Metabolic system: Preclinical evidence exists for antidiabetic and lipid-lowering effects; robust human evidence is lacking.

7. Dosage Forms and Dosages Reported in Studies

Clinical studies — cardiovascular:

• T. arjuna bark extract 500 mg every 8 hours (reported treatment durations: 1 to 2 weeks) has been used in clinical studies evaluating effects on cardiovascular disorders.
• In a double-blind, randomized, placebo-controlled trial, 100 patients of CHF were randomized 1:1 to arjuna extract 750 mg or matching placebo twice daily.
• In a pharmacovigilance study, 35 patients of chronic CAD were enrolled to receive arjuna bark extract powder at 500 mg three times daily along with conventional drugs.
• In a separate study, 500 mg of bark powder was administered twice daily to 25 coronary artery disease patients for 3 months.

Traditional/classical forms: The stem bark powder is administered traditionally in the form of an alcoholic decoction (asava), or given along with clarified butter (ghrita), or along with boiled milk (kshirpak).

Note on standardization: There is a paucity of data regarding the exact molecular mechanism of its action, appropriate form of drug administration, whether whole crude drug or aqueous or alcoholic extract should be used, toxicological studies, and its interaction with other drugs. Minimal side effects of arjuna have been reported when used at standard doses of 1–2 grams daily.

8. Safety Considerations and Drug Interactions

8.1 General Tolerability

So far, no serious side effects have been reported with arjuna therapy. However, its long-term safety still remains to be elucidated. No hematological, renal, or metabolic toxicity has been reported even after more than 24 months of administration.

Evidence suggests extracts of T. arjuna are well tolerated. Adverse reactions similar to those with placebo (constipation, headache, abdominal discomfort, body ache) were described in one clinical trial, while mild gastritis was noted in another.

8.2 Gastrointestinal Effects

Terminalia arjuna is generally considered safe for medicinal use; however, the most commonly observed adverse effects include gastrointestinal disturbances, such as diarrhea, nausea, and abdominal pain.

8.3 Hepatotoxicity Signal (Animal Data)

Animal data noted that administration of arjuna resulted in reduction of thyroid hormone concentration in euthyroid animals, whereas hepatic lipid peroxidation was increased. Thus, high amounts of the plant extract should not be consumed, as it may induce hepatotoxicity as well as hypothyroidism. However, results from a recent acute and oral toxicological study in animals showed that administration of ethanolic extract at a limit dose of 2000 mg/kg orally did not produce any kind of toxicity or death in animals.

Important context: These hepatotoxicity signals derive from animal studies only. No hematological, renal, or metabolic toxicity has been reported even after more than 24 months of its administration in human studies.

8.4 Antiplatelet and Anticoagulant Interaction

Potentiation of the anticoagulant effect of warfarin and other anticoagulants might be expected because T. arjuna bark extract exhibits antiplatelet and anticoagulant action similar to that of aspirin. Caution is warranted for people who are at risk of bleeding or who are taking blood-thinning medications because arjuna may inhibit platelet aggregation. However, this is largely theoretical and not based on direct evidence of harm.

Terminalia arjuna might slow blood clotting, which might increase the risk of bruising and bleeding in people with bleeding disorders. Terminalia arjuna might increase the risk of bleeding during surgery. Stopping it at least 2 weeks before a scheduled surgery has been advised.

8.5 Cytochrome P450 Enzyme Interactions

Enzyme kinetics studies suggested that the extracts of arjuna showed reversible non-competitive inhibition of all three enzymes in human liver microsomes. Findings suggest strongly that arjuna extracts significantly inhibit the activity of CYP3A4, CYP2D6, and CYP2C9 enzymes, which is likely to cause clinically significant drug–drug interactions mediated via inhibition of the major CYP isozymes.

Based on these observations, in vitro inhibition of CYP3A4, CYP2D6, and CYP2C9 enzymes in human liver microsomes by extracts of T. arjuna suggests that there is a possibility of T. arjuna leading to clinically significant pharmacokinetic interactions, since CYP3A4, CYP2D6, and CYP2C9 are the main enzymes involved in the metabolism of most drugs. Evidence from the assessment of drug interactions from arjuna is currently limited, and the available information is sourced from in vitro or animal studies.

8.6 Cardiac Drug Interactions

The bark of Terminalia arjuna contains chemicals that might stimulate the heart. It might also have effects that lower cholesterol and blood pressure. Co-administration with other cardiovascular agents — antihypertensives, cardiac glycosides, or antiarrhythmic drugs — requires caution in the absence of human pharmacokinetic interaction data, given documented inotropic and hypotensive activity.

8.7 Pregnancy and Lactation

There is not enough reliable information to know if Terminalia arjuna is safe to use when pregnant or breast-feeding; the safe-side approach is to avoid use. There is a lack of reliable and sufficient safety data regarding Arjuna's use during pregnancy or breastfeeding, so it is generally advised to avoid it to prevent potential risks.

8.8 Overall Evidence Quality and Research Gaps

Both clinical and preclinical studies clearly indicate possible therapeutic potential of Terminalia arjuna bark in a wide range of cardiovascular diseases. Many of these studies are randomized, double-blind, and placebo-controlled. However, there are some striking shortcomings in most of these studies which need to be addressed in future studies. These shortcomings include insufficient details regarding the source of Terminalia arjuna, botanical identification, method of extract preparation, and standardization.

Research on terminalia has been going on since the 1930s, but studies have provided mixed results. Its role, if any, in heart disease still remains uncertain.

References

• Terminalia arjuna — PubMed (PMID 10608917)
• Revisiting Terminalia arjuna – An Ancient Cardiovascular Drug — PMC
• Revisiting Terminalia arjuna — An Ancient Cardiovascular Drug — PubMed (PMID 25379463)
• Salutary effect of Terminalia Arjuna in patients with severe refractory heart failure — PubMed (Bharani et al., 1995, PMID 7649665)
• Clinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure: a double-blind, randomized controlled trial — ScienceDirect
• Terminalia arjuna in coronary artery disease: Ethnopharmacology, pre-clinical, clinical & safety evaluation — ScienceDirect
• Terminalia arjuna in Chronic Stable Angina: Systematic Review and Meta-Analysis — PMC
• Terminalia arjuna in chronic stable angina: systematic review and meta-analysis — DARE / NCBI Bookshelf
• Terminalia arjuna in cardiovascular diseases: making the transition from traditional to modern medicine in India — PubMed (PMID 20874682)
• Antianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease — PubMed (PMID 7741874)
• Role of Terminalia arjuna Wight and Arn. in the treatment of chronic coronary artery disease from pharmacovigilance point of view — PMC
• Terminalia arjuna, a Cardioprotective Herbal Medicine — Relevancy in the Modern Era of Pharmaceuticals and Green Nanomedicine — PMC
• Terminalia arjuna: An overview of its magical properties — PMC
• Medicinal properties of Terminalia arjuna (Roxb.) Wight & Arn.: A review — ScienceDirect (Journal of Traditional and Complementary Medicine, 2016)
• Analysis of phytochemical profile of Terminalia arjuna bark extract with antioxidative and antimicrobial properties — PMC
• Stem-bark of Terminalia arjuna attenuates human monocytic (THP-1) and aortic endothelial cell activation — ScienceDirect
• Anti-Atherogenic Activity of Ethanolic Fraction of Terminalia arjuna Bark on Hypercholesterolemic Rabbits — PMC
• In vitro modulatory effects of Terminalia arjuna, arjunic acid, arjunetin and arjungenin on CYP3A4, CYP2D6 and CYP2C9 enzyme activity in human liver microsomes — PMC
• Antimicrobial and anti-inflammatory activity of Terminalia arjuna — PMC
• Terminalia arjuna — ScienceDirect Topics Overview
• Terminalia Uses, Benefits & Dosage — Drugs.com Natural Product monograph
• Terminalia arjuna benefits, dosage, and side effects — Examine.com
• Terminalia arjuna a sacred medicinal plant: phytochemical and pharmacological profile — Phytochemistry Reviews, Springer
• Nutritional Composition, Phytochemical Profile, Extraction Methods of Bioactive Components, and Health Benefits of Terminalia Arjuna Bark — eFood, Wiley (2025)