Arjuna

Ancient Indian physicians used the powdered bark for hritshool (angina) and other heart conditions ^{12Reference 12Dwivedi · 2007ReviewTerminalia arjuna Wight & Arn. — a useful drug for cardiovascular disorders — reviewView study →}. It is given as a cardiac tonic for cardiac debility and in old age to protect the heart.

In Ayurveda the bark is acrid, astringent and tonic. It is also used for high blood pressure, ulcers, fractures, wounds, and skin, gynaecological and urinary complaints ^{24Reference 24Orwa et al. · 2009Terminalia arjuna — Agroforestree Database: a tree reference and selection guide, version 4.0 — species databaseView study →}.

Ayurvedic texts also name arjuna among herbs for disorders of the circulation ^{22Reference 22Pratap Shankar et al. · 2024ObservationalEffectiveness of the herbal drug Terminalia arjuna in chronic venous insufficiency — a prospective observational studyView study →}.

Antioxidant activity is the most consistently shown property of arjuna bark. The bark is rich in tannins, about 16% of an aqueous extract, and flavonoids including luteolin, baicalein, quercetin and oligomeric proanthocyanidins ^{4,10Reference 4Bharani et al. · 2002RCTEfficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate — randomised controlled trialView study →Reference 10Amalraj et al. · 2017ReviewMedicinal properties of Terminalia arjuna (Roxb.) Wight & Arn. — a reviewView study →}.

In the 100-patient heart-failure trial, the extract (750 mg twice daily) preserved red-blood-cell catalase activity compared with placebo ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}. Larger rises in red-cell superoxide dismutase and glutathione appeared only in a post-hoc analysis of patients who improved ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}.

In rats given isoproterenol to injure the heart, a hydroalcoholic bark extract (100–400 mg/kg for 30 days) lowered malondialdehyde and restored glutathione and superoxide dismutase ^{13Reference 13Shukla et al. · 2015AnimalTerminalia arjuna augments cardioprotection via antioxidant and antiapoptotic cascade in isoproterenol-induced cardiotoxicity in rats — animal modelView study →}.

In a double-blind, placebo-controlled crossover trial, 58 men with chronic stable angina took bark extract 500 mg every 8 hours, isosorbide mononitrate 40 mg a day or placebo, for one week each ^{4Reference 4Bharani et al. · 2002RCTEfficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate — randomised controlled trialView study →}. Arjuna reduced angina frequency and nitrate use and improved treadmill exercise measures compared with placebo, with results similar to the nitrate ^{4Reference 4Bharani et al. · 2002RCTEfficacy of Terminalia arjuna in chronic stable angina: a double-blind, placebo-controlled, crossover study comparing Terminalia arjuna with isosorbide mononitrate — randomised controlled trialView study →}.

In an open study of 15 people with stable angina, three months of bark powder halved angina episodes and delayed ST changes on treadmill testing ^{2Reference 2Dwivedi et al. · 1994Clinical trialAntianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease — clinical studyView study →}. It had little effect in five people with unstable angina ^{2Reference 2Dwivedi et al. · 1994Clinical trialAntianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease — clinical studyView study →}. A comparative study of bark powder 500 mg every 8 hours added to standard care after heart attack also improved ejection fraction and reduced left-ventricular mass ^{3Reference 3Dwivedi et al. · 1997Clinical trialBeneficial effects of Terminalia arjuna in coronary artery disease — comparative clinical studyView study →}.

A proprietary arjuna product, Hartone, relieved symptoms in 8 of 10 patients, compared with 7 of 10 on isosorbide mononitrate, in a small open trial ^{9Reference 9Kumar et al. · 1999Safety and efficacy of Hartone in stable angina pectoris — an open comparative trial (Terminalia arjuna–based product)View study →}.

A 2014 systematic review and meta-analysis found the trials to be of poor methodological design, with no significant difference from control in the outcomes it could pool. It concluded the evidence was insufficient to favour or reject arjuna in stable angina ^{7Reference 7Kaur et al. · 2014Meta-analysisTerminalia arjuna in chronic stable angina: systematic review and meta-analysisView study →}.

Gap: trials are small, short, single-centre and methodologically weak; the crossover designs and brief washouts make durable benefit hard to establish.

In rats given isoproterenol to model heart attack, a hydroalcoholic bark extract limited biochemical and apoptotic damage ^{13Reference 13Shukla et al. · 2015AnimalTerminalia arjuna augments cardioprotection via antioxidant and antiapoptotic cascade in isoproterenol-induced cardiotoxicity in rats — animal modelView study →}. In isoproterenol-induced cardiac hypertrophy, a standardised aqueous extract reversed fetal-gene markers and largely restored the heart’s protein and gene-expression profile ^{14,15Reference 14Kumar et al. · 2017AnimalProteomic analysis of the protective effects of aqueous bark extract of Terminalia arjuna on isoproterenol-induced cardiac hypertrophy in rats — animal modelView study →Reference 15Kumar et al. · 2019AnimalTranscriptomic validation of the protective effects of aqueous bark extract of Terminalia arjuna against isoproterenol-induced cardiac hypertrophy — animal modelView study →}.

Arjunolic acid acts as a PPAR-α agonist. In hypertrophied hearts it reduced collagen build-up by blocking TAK1 in the non-canonical TGF-β pathway ^{16Reference 16Bansal et al. · 2017In vitroArjunolic acid, a peroxisome proliferator-activated receptor α agonist, regresses cardiac fibrosis by inhibiting non-canonical TGF-β signalling — in vitro/animal mechanistic studyView study →}.

An early double-blind crossover trial in 12 patients with severe refractory (NYHA IV) heart failure gave bark extract 500 mg every 8 hours or placebo for two weeks each, alongside maximal conventional therapy ^{1Reference 1Bharani et al. · 1995RCTSalutary effect of Terminalia Arjuna in patients with severe refractory heart failure — randomised double-blind crossover trialView study →}. On arjuna, symptoms and NYHA class improved and ejection fraction rose from 30% to 35% ^{1Reference 1Bharani et al. · 1995RCTSalutary effect of Terminalia Arjuna in patients with severe refractory heart failure — randomised double-blind crossover trialView study →}.

A 100-patient, double-blind, placebo-controlled add-on trial of standardised water extract (750 mg twice daily) enrolled people with NYHA class II heart failure and an ejection fraction of 40% or less ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}. After 12 weeks ejection fraction did not change compared with placebo (24.3% vs 25.5%) ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}.

Of the secondary outcomes, only red-cell catalase differed from placebo ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}. Walking distance, antioxidant enzymes and quality-of-life scores improved more on arjuna only in a post-hoc analysis of patients who improved ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}.

A 2026 meta-analysis of nine trials (537 patients) found a significant reduction in left-ventricular mass (mean difference −44.32) and a rise in HDL ^{20Reference 20Kumar et al. · 2026Meta-analysisEvaluation of the therapeutic potential and safety of Terminalia arjuna in heart failure management — a systematic review and meta-analysis of randomised controlled trialsView study →}. Ejection fraction improved slightly but not significantly, and blood pressure and other blood fats did not change ^{20Reference 20Kumar et al. · 2026Meta-analysisEvaluation of the therapeutic potential and safety of Terminalia arjuna in heart failure management — a systematic review and meta-analysis of randomised controlled trialsView study →}.

Gap: the best-powered single trial did not improve the primary cardiac endpoint, and the pooled ejection-fraction effect remains non-significant.

In a double-blind, placebo-controlled crossover trial, 18 healthy male smokers took bark extract 500 mg every 8 hours or placebo for two weeks each ^{5Reference 5Bharani et al. · 2004RCTTerminalia arjuna reverses impaired endothelial function in chronic smokers — randomised double-blind crossover trialView study →}. At the start their flow-mediated dilation was impaired compared with non-smokers (4.71% vs 11.75%) ^{5Reference 5Bharani et al. · 2004RCTTerminalia arjuna reverses impaired endothelial function in chronic smokers — randomised double-blind crossover trialView study →}.

Flow-mediated dilation improved on arjuna but not on placebo (9.31% vs 5.17%) ^{5Reference 5Bharani et al. · 2004RCTTerminalia arjuna reverses impaired endothelial function in chronic smokers — randomised double-blind crossover trialView study →}. Nitroglycerine-mediated dilation was normal in smokers, so the effect was specific to the endothelium ^{5Reference 5Bharani et al. · 2004RCTTerminalia arjuna reverses impaired endothelial function in chronic smokers — randomised double-blind crossover trialView study →}.

Gap: one small, short study in young healthy smokers using crude extract — not replicated, and not extended to patients with established vascular disease.

Early Indian trials recorded lipid changes alongside angina relief, including a slight rise in HDL ^{2Reference 2Dwivedi et al. · 1994Clinical trialAntianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease — clinical studyView study →}. In one case report, lipoprotein(a) fell by about 25% after bark powder in a man with metabolic syndrome and beta-thalassaemia ^{11Reference 11Dwivedi et al. · 2007Case reportBeta-thalassemia, hyperlipoproteinemia(a), and metabolic syndrome — its low-cost holistic therapy (Terminalia arjuna case report)View study →}.

Animal work describes a lipid-lowering action of the bark ^{12Reference 12Dwivedi · 2007ReviewTerminalia arjuna Wight & Arn. — a useful drug for cardiovascular disorders — reviewView study →}. A 2010 systematic review of 53 herbal trials for high cholesterol did not include arjuna among the effective products ^{18Reference 18Hasani-Ranjbar et al. · 2010Systematic reviewThe efficacy and safety of herbal medicines used in the treatment of hyperlipidaemia — a systematic reviewView study →}. The 2026 heart-failure meta-analysis found HDL rose, while LDL and triglycerides did not change ^{20Reference 20Kumar et al. · 2026Meta-analysisEvaluation of the therapeutic potential and safety of Terminalia arjuna in heart failure management — a systematic review and meta-analysis of randomised controlled trialsView study →}.

Gap: human lipid evidence is incidental, uncontrolled or anecdotal, and the one pooled dataset shows no LDL or triglyceride effect; no dedicated, adequately powered lipid-lowering RCT exists.

Arjuna is used traditionally for high blood pressure, and animal studies describe a hypotensive effect and increased coronary blood flow ^{12Reference 12Dwivedi · 2007ReviewTerminalia arjuna Wight & Arn. — a useful drug for cardiovascular disorders — reviewView study →}. In rats with pulmonary hypertension, an aqueous bark extract prevented right-ventricular hypertrophy and the rise in right-ventricular pressure and reduced lung oxidative stress ^{17Reference 17Meghwani et al. · 2017AnimalBeneficial effects of aqueous extract of stem bark of Terminalia arjuna in experimental pulmonary hypertension — animal modelView study →}.

In one open angina study, bark powder lowered systolic blood pressure ^{2Reference 2Dwivedi et al. · 1994Clinical trialAntianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease — clinical studyView study →}. No human trial has made blood pressure its primary outcome, and the 2026 meta-analysis found no significant change in blood pressure ^{20Reference 20Kumar et al. · 2026Meta-analysisEvaluation of the therapeutic potential and safety of Terminalia arjuna in heart failure management — a systematic review and meta-analysis of randomised controlled trialsView study →}.

Gap: no human RCT targets blood pressure as a primary outcome, and pooled human data show no BP effect.

Tolerance. The 100-patient heart-failure trial found the extract well tolerated over 12 weeks ^{8Reference 8Maulik et al. · 2016RCTClinical efficacy of water extract of stem bark of Terminalia arjuna in patients of chronic heart failure — a double-blind, randomised controlled trialView study →}. At 1–2 g a day, side effects are limited to occasional headache, mild gastritis and constipation ^{10Reference 10Amalraj et al. · 2017ReviewMedicinal properties of Terminalia arjuna (Roxb.) Wight & Arn. — a reviewView study →}. Trials of up to three months found no effect on liver, kidney or blood tests ^{2,3,9Reference 2Dwivedi et al. · 1994Clinical trialAntianginal and cardioprotective effects of Terminalia arjuna, an indigenous drug, in coronary artery disease — clinical studyView study →Reference 3Dwivedi et al. · 1997Clinical trialBeneficial effects of Terminalia arjuna in coronary artery disease — comparative clinical studyView study →Reference 9Kumar et al. · 1999Safety and efficacy of Hartone in stable angina pectoris — an open comparative trial (Terminalia arjuna–based product)View study →}.

Drug interactions. No formal interaction study has been done. The bark has inotropic and blood-pressure-lowering effects in animals ^{12Reference 12Dwivedi · 2007ReviewTerminalia arjuna Wight & Arn. — a useful drug for cardiovascular disorders — reviewView study →}, so it may add to cardiac, antihypertensive and anticoagulant drugs. Use it under medical supervision in established heart disease or alongside such medicines.

Thyroid and liver. In rats, a bark extract lowered thyroid hormone levels, and the authors proposed this as part of its heart-protective action ^{21Reference 21Parmar et al. · 2006AnimalCardio-protective role of Terminalia arjuna bark extract is possibly mediated through alterations in thyroid hormones — animal modelView study →}. In healthy rats it also raised liver lipid peroxidation, and the authors advised against high intakes because of possible hypothyroidism and liver toxicity ^{21Reference 21Parmar et al. · 2006AnimalCardio-protective role of Terminalia arjuna bark extract is possibly mediated through alterations in thyroid hormones — animal modelView study →}. No human thyroid measurements have been reported. Anyone taking thyroid medication or being monitored for thyroid disease should use arjuna with care.

Animal toxicology. Formal toxicology studies in animals are lacking ^{12Reference 12Dwivedi · 2007ReviewTerminalia arjuna Wight & Arn. — a useful drug for cardiovascular disorders — reviewView study →}.