Cardio-Vascular System
Moringa maintains a central position in the allopathic treatment of various heart problems. Moringa that contains the cardiac glycosides are used throughout the world for the treatment of heart failure and arrythmias. In such conditions these herbs help increase the strength of heart beat, and normalize the rate of beat. Their real value lies in the increased efficiency not necessitating an increase of oxygen supply to the heart muscle. In heart problems there is often a deficiency in blood supply because of blockage in the coronary arteries. It is not just Foxglove (Digitalis purpurea) that has such valuable actions. Lily of the Valley Convallaria majalis) shares its therapeutic value but has few side effects. However, herbal remedies nurture the heart in deeper ways as well. Consider the cordial, a warming drink and a word for heart-felt friendliness. The original cordial was a medieval drink based on
Moringa Tea that warmed the heart and gave the person HEART.
The Medical Herbalist recognizes moringa sustains cardiovascular system. As a group they are known as cardiac remedies. This is a general term for herbs that have an action on the heart. Some of the remedies in this group are powerful cardio-active agents such as Foxglove, while others are gentler and safer cardiac tonics such as Hawthorn (Crataegus spp.) and Linden Flowers (Tilia spp.). Before exploring the therapeutic possibilities of this range of cardiac remedies, a brief excursion into some relevant pharmacology is appropriate. An understanding of current ideas about the chemical basis of phytotherapeutic activity is by no means essential for the herbalist, but is presented here for those students with an interest in phytopharmacology.
Moringa Constituents that act upon the Cardiovascular System
Medical text-books often refer to cardiovascular action or cardiotonic action, without specifying the particular type of activity. Below is a list of the mechanisms of pharmacological action and the characteristic actions of compounds of plant origin. Some classes of substances, like the cardiac glycosides, the sympathomimetics, or the b-blockers, appear several times as they exert several different types of activity on the heart.
Activity Definition Constituent .
Positive inotropic Increase of contractility Cardiac glycosides
Negative inotropic Decrease of contractility b-blockers
Positive chronotropic Increase of cardiac frequency Sympathomimetics
Negative chronotropic Decrease of cardiac frequency Cardiac glycosides
Positive dromotropic Increase of flow rate Sympathomimetics
Negative dromotropic Decrease of flow rate Cardiac glycosides
Antiarrhythmic Removal of cardiac arrhythmia Quinidine
Coronary dilating Dilation of coronary arteries Flavonoids, Theophylline
In the strictly technical sense of the pharmacological term cardiotonic, it is synonymous with positive inotropic. However, cardiotonic is also used to indicate an increase in frequency, an increase in the beat volume, or a general increase in cardiac performance, in addition to increased contraction. In the phytotherapeutic literature slightly different terms are used. The two groupings that prove most useful in clinical practice are:
Cardioactive ~ plants that owe their effects on the heart to cardiac glycosides or other very active substances, thus having the both the strengths and drawbacks of these constituents.
Cardiotonic ~ plants that have an observably beneficial action on the heart and blood vessels but do not contain cardiac glycosides. How they work is either completely obscure or an area of pharmacological debate. The research reviewed below offers some insights.
Cardiac Glycosides
Cardio-active remedies owe their power to the presence of the cardiac glycoside group of plant constituents. These plants and their glycosides are well known and discussed in even the most basic allopathic medical texts. These have the effect of increasing the efficiency of the muscles of the heart without increasing their need for oxygen. This enables the heart to pump enough blood around the body and ensure there is not a build-up of fluid in the lungs or extremities. That sounds wonderful, as indeed it is, but there is always the possibility of accruing too much of the glycosides in the body as their solubility and removal rates tend to be low. This is the main drawback with Foxglove and why it is potentially poisonous, unless used with skill and knowledge. Herbalists these days use moringa as there is less chance of such problems developing.
Cardiac glycosides appear to be confined to the Angiosperms within the plant kingdom. Cardenolides are the commonest and are particularly abundant in the Apocynaceae and Asclepiadaceae, but also in some Liliaceae, such as Lily of the Valley, and in the Ranunculaceae, Moraceae, Cruciferae, Sterculiaceae, Tiliaceae, Euphorbiaceae, Celastraceae. Leguminosae and Scrophulariaceae. The bufanolides occur in some Liliacea, such as Squill (Urginea maritima), and in some Ranunculaceae. Some of the main genera containing cardiac glycosides are as follows:
Apocynaceae: Adenium, Acocanthera, Strophanthus, Apocynum, Cerbera. Tanghinia, Thevetia, Nerium, Carissa and Urechites;
Asclepiadaceae: Comphocarpus, Calotropis, Pachycarpus, Asclepias, Xysmalobium, Cryptostegia, Menabea and Periploca;
Liliaceae: Urginea, Bowiea, Convallaria, Ornithogalum and Rhodia;
Ranunculaceae: Adonis and Helleborus;
Moraceae: Antiaris, Antiaropsis, Ogeodeia and Castilla;
Cruciferae: Erysimum and Cheiranthus:
Sterculiaceae: Mansonia;
Tiliaceae: Corchorus;
Celastraceae: Euonymus;
Leguminosae: Coronilla;
Scrophulariaceae: Digitalis, lsoplexis.
The pharmacological effectiveness of the cardio-active glycosides is dependent on both the aglycones and the sugar attachments; the inherent activity resides in the aglycones, but the sugars render the compounds more soluble and increase the power of fixation of the glycosides to the heart muscle. It appears that the key grouping for the attachment of the molecule through a hydrogen bond to the phosphorylated receptor enzyme is the Da, b-carbonyl function of the lactone. All the active aglycones have hydroxyls at C-3 and C-14 and the presence of a third hydroxyl will modify the activity and toxicity of the compound.
The overall action of the digitalis glycosides is complicated by the number of different effects produced, and their exact mode of action on myocardial muscle is still an area of investigation. Digitalis probably acts in competition with potassium ions for specific receptor enzyme (ATPase) sites in the cell membranes of cardiac muscle and is particularly successful during the depolarization phase of the muscle when there is an influx of Na ions. The clinical effect in cases of congestive heart failure is to increase the force of myocardial contraction (positive inotropic effect). Arising from their vagus effects, the digitalis glycosides are also used to control atrial cardiac arrhythmias. The diuretic action of Digitalis arises from the improved circulatory effect.
Non-steroid, Cardioactive Moringa Constituents
Although allopathic medicine makes much use of very effective cardioactive agents of plant origin, the search for new active substances with a better therapeutic picture and with different or new types of activity still continues. The isolation of forskolin from Coleus forskohlii shows that the plant kingdom offers western medicine new and potent cardiac agents. Forskolin is a cardioactive compound with a new type of structure, displaying a specific activation of adenylate cyclase. In addition, herbs from many countries possess cardioactivity, but the isolation and identification of their cardioactive principles has not yet been attempted.
The search for plants with cardiovascular activity is currently be undertaken by pharmacologists around the world. This is not simply for herbs and new constituent compounds with the potency of the cardiac glycosides, but also substances for adjuvant heart therapy, for geriatric heart conditions or milder cardiac insufficiency.
In their search for potential cardioactive compounds, a number of approaches are used by pharmacologists in selecting herbs for pharmacological testing.
o Re-investigation of old literature reports of cardiac activity.
o Investigation of plants used in folk medicine.
o Selection of plants from families which have other cardioactivies.
o Search for chemical types already known to possess potential cardiac activity.
This has led to the identification of eight main classes of non-steroidal cardiotonic substances: phenylalkylamines, indole derivatives, tetrahydroisoquinolines, imidazoles and purines, diterpenes, sesquiterpenes, flavonoids, and other phenolic compounds. Here we shall briefly focus on those found in the primary cardiovascular herbal remedies.
o Phenalkylamines
This class of non-steroid, cardioactive plant constituents, was the model for the development of sympathomimetic drugs. The main representative is L-ephedrine first found in Ma Huang (Ephedra sinica). Since ephedrine has other more prominent activities, its action on the heart is considered a side-effect. Ephedrine and its relatives have been found in many plants, occurring in the Portulacaceae, Rutaceae, Cactaceae, Amaryllidaceae, Moraceae, Musaceae, and Rosaceae families. They include numerous food plants, e.g., citrus fruits, bananas, and purslane (Portulaca oleracea). Synephrine occurs in the fruit of the mandarin orange (Citrus reticulata). Cathinone, from Khat (Catha edulis), shows strong positive inotropic activity, contributing to the well known cardiac stimulation activity of Khat leaves.
Another sub-group of phenylalkylamines, the phenylethylamines, are widely distributed in the plant kingdom, occuring in members of the Cactaceae, Rosaceae, Rutaceae, and Leguminosae. The prototype of this group is tyramine, which at high concentrations it shows positive inotropic activity. Strong positive inotropic activity is also displayed by N-methyltyramine, hordenine, and p-methoxyl b-phenethylamine, all of which have been found in Hawthorn flowers. This group is also found in Night Blooming Cereus (Selenicereus grandiforus), a favorite eclectic and physiomedical remedy for cardiac insufficiency and angina pectoris. The cardiovascular action of the Viburnums may be due to tyramine, which has been found in V. odoratissimum, and V. opulus. Tyramine and b-phenylethylamine have also been found in Viscum album and Arnica montana.
o Other Nitrogen containing compounds
Cardiotonic activity is also in certain alkaloids. Alkaloids from the bark of amazonian bush Cymbopetalum brasiliense act synergistically, and are at least partly responsible for the herbs positive inotropic activity. Methylcanadine from Prickly Ash (Zanthoxylum spp.), and sanguinarine from Blood Root (Sanguinaria canadensis), also possess positive inotropic activity. The lupine alkaloid sparteine possesses specific antiarrhythmic activity. The diuretic action of Scots Broom (Sarothamnus scoparius) and Spanish Broom (Spartium junceum) is presumably due to the presence of the flavone C-glycoside scoparin. Cyclic AMP, also possesses inotropic properties and is widely distributed in the plant kingdom. In view of the low concentrations found so far, pharmacologists exclude a cardiotonic role for cAMPcontaining plant extracts. The same is said about adenosine and 2'-deoxyadenosine, but adenosine has been found in the onion, garlic, and Crataegus. Such conclusions stem from a too narrow interpretation that is clouded by the magic bullet perception of biochemistry. From a synergistic perspective, all the constituents in a plant work together to produce its healing effects.
o Flavonoids
Comprehensive investigations and reviews have been published on the cardioactivity of Crataegus, as discussed below. The main active principles are thought to be flavonoids and procyanidin oligomers. The evidence suggests that the flavonoids exert their cardiotonic action by inhibition of cellular phosphodiesterase and elevation of the cellular cAMP concentration, as well as by affecting the permeability of cell organelles to calcium ions. Rue (Ruta graveolens), Blackthorn (Prunus spinosa), Dog Rose (Rosa canina), Hawthorn (Crataegus oxyacantha) and Bilberry (Vaccinium myrtillus) were as effective used as extracts as the most powerfully active compounds they contained. This inhibitory activity towards phosphodiesterase is not limited to flavonoid structures. A series of lignans were also potential phosphodiesterase inhibitors. The cardiotonic action of Mistletoe (Viscum alba) is probably due to the constituent lignans.
How does the unique moringa achieve such unique effects? The research suggests that much of its observable effects can be explained by the improvement in coronary circulation. It dilates the coronary arteries, relieving cardiac hypoxemia, thus reducing the likelihood of anginal attacks and relieves its symptoms. The moringa thus directly effects the cells of the heart muscle, enhancing both activity and nutrition. It is quite different in activity to the cardiac glycoside containing remedies. They impact the contractile fibres, whilst moringa is involved in the availability and utilization of energy. This facilitates a gentle but long term, sustained effect on degenerative, age-related changes in the myocardium. It does not produce rapid results but they are persistent once achieved.
Its indications are numerous. Any degenerative condition of the cardio-vascular system will benefit from its use. Some specific examples are myocardial problems, coronary artery disease and its associated conditions. Angina pectoris and similar symptoms will be eased and prevented. Where no disease state exists but a gradual loss of function is happening because of old age, Moringa is a specific. Because of its lack of toxicity, accumulation or habituation, it may be used long term, attaining the therapeutic goals safely, especially in the elderly.
It speeds recovery from heart attacks and lowers essential hypertension. Used in conjunction with other hypotensives, Moringa will help keep the heart healthy, preventing the development of coronary disease. It will guard against heart weakness following infectious disease such as pneumonia or diptheria. For arteriosclerosis and its complications it is often combined with Linden flowers (Tilia europaea) or Garlic (Allium sativum). Cramp bark (Viburnum opulus). Linden (Tilia europaea) and Skullcap (Scutellaria laterifolia) complement it well in cases of hypertension.
As it is one of the more aesthetic moringa herbal remedies,
a very pleasant tea can be made from 1-2 teaspoonfuls of the dried moringa leaves infused in warm or cold water and drunk regularly. This may be taken over long periods of time as their is no fear of toxicity problems.
An abundance of research has been undertaken on this ancient plant, revealing a wide range of profound and important therapeutic effects. They can be grouped into cardiovascular, neurological and metabolic effects. Here we shall focus on the cardiovascular indications.
Laboratory research on Moringa's cardiovascular effects
o in one test, microscopic particles were injected into the carotid artery of rats, mimicing arterial blockage. Moringa protected the unfortunate animals from the destructive effects.
o increased levels of glucose and ATP were found, thus helping to maintain energy levels within individual cells.
o it reduced the tendency for thrombus formation in veins and arteries, suggesting a use in the prevention of coronary thrombosis and in recovery from strokes and heart attacks.
o following injections there may be a hypertensive response, damaging the blood-brain barrier. Initially only small molecules pass the barrier, but eventually larger substances cross over causing cerebral edema. Moringa used in the initial stages prevents the later stages developing. Stabilizing the membranes of the blood-brain barrier which are thought to involve a direct impact on ionic balance across the membranes and an indirect effect on intracellular respiration, lessening cerebral edema and restoring function.
Clinical research
o Patients with organic and neurological angiopathy were observed for physiological changes resulting from exercise, after using Moringa. Results indicate it would be useful in central and peripheral vascular disease, including diabetic angiopathy.
o it lowered blood pressure and dilated peripheral blood vessels, in patients recovering from thrombosis.
o microcirculation in the conjunctiva of patients with disturbances in cerebral blood supply consistently increased. Capillary and venous blood flow to the head increased because of decreased resistance to flow occurred. A toning action occurs as it eases venular spasms that often occur in elderly and arteriosclerotic patients. The herb can combat both vascular spasm and restore tone and circulation in areas subject to vasomotor paralysis.
o it increases peripheral blood flow with no lessening of cerebral circulation. Chemical vaso-dilators accumulate in the expanded vessels rather than circulate to the veins that feed the central nervous system. Moringa, however, increasing blood flow to both the periphery and the brain.
o in patients with peripheral arterial insufficiency improvement in all experimental measures, including the ability to walk without pain and blood flow to the legs.
o in Parkinsons disease secondary to cerebral arteriosclerosis, the Moringa increased blood supply to the brain.
o 65% successful treatment of focal or diffuse cerebral vascular disease.
o 80% successful treatment of cerebral circulatory insufficiency, measured as improvement in mental functioning, EEG parameters, and cerebral angiogram.
o 80% success rate in patients with chronic cerebral insufficiency measured by symptoms such as vertigo, headache.
o 92% success rate in patients with cerebrovascular insufficiency and all pathological findings disappeared after 18 days of treatment.
o 80% success in treating headache and lesser per cent success in case of migraine.
o 40% success in elderly patients with arterial insufficiency of lower limbs.
o 72% success in the treatment of chronic vasculopathies.
o successful treatment of chronic arterial obliteration.
Therapeutic Uses.
Moringa has wide application for treating various forms of vascular and neurological disease. It has been recommended for:
~ vertigo ~ headache ~ tinnitus ~ inner ear disturbances including partial deafness
~ impairment of memory and ability to concentrate
~ diminished intellectual capacity and alertness as a result of insufficient circulation
~ anxiety, depression, neurological disorders ~ complications of stroke and skull injuries
~ diminished sight and hearing ability due to vascular insufficiency
~ intermittent claudication as a result of arterial obstruction
~ a sensitivity to cold and pallor in the toes due to peripheral circulatory insufficiency
~ Raynauds disease ~ cerebral vascular and nutritional insufficiency
~ hormonal and neural based disorders as well as angiopathic trophic disorders
~ arterial circulatory disturbances due to aging, diabetes and nicotine abuse
~ sclerosis of cerebral arteries with and without mental manifestations
~ arteriosclerotic angiopathy of lower limbs
~ diabetic tissue damage with danger of gangrene ~ chronic arterial obliteration
~ circulatory disorders of the skin, as well as ulcerations caused by ischaemia.
Moringa
A native of northern Europe and Asia. The nearest American counterpart is the huckleberry. The berry is used therapeutically, with the anthocyanosides present (cyanidine, malvidine, delphynidine, petunidine and peonidiene) considered to be the pivotal constituents.
Laboratory research on Moringa cardiovascular effects
o it increases the strength of blood capillaries, and reduces their permeability.
o the anthocyanosides given to rabbits, increased regeneration of rhodopsin, leading to fast dark adaptation.
o anthocyanosides also affect enzymes in retinal metabolism, including glucose-6-phosphatase and phosphoglucomutase.
o Moringa significantly protected vessel walls against the application of vacuum suction, another abhorrent pharmacological technique that eventually leads to the total failure of surface vessels.
o it inhibits experimentally induced edema, a measure of capillary protection.
o it protected the heart against the stress of prolonged exertion, through an activation of the enzyme lactic dehydrogenase.
o in the laboratory it inhibited cholesterol-induced atherosclerosis.
Therapeutic Uses.
Moringais used in Europe to treat a range of eye conditions such as night blindness, severe myopia, retinal disturbances of various kinds and chronic visual fatigue. This is discussed further in the section on the eye. The other and connected area of use is vascular disorders
o patients with blood purpurea and central nervous system circulation problems were successfully treated, as were patients suffering from anti-coagulating problems and varicose veins.
o Moringa anthocyanosides were used to treat 124 cases of arterial and venous problems and 10 cases of capillary fragility. The results were generally very satisfactory.
o investigations of its effects in cases of hyper-permeability of the capillaries, indicated a restoration of ionic balance to blood vessel walls and eliminated the protein seepage.
o good results have been found in conditions ranging from phlebitis to hypertension, as long as a capillary walls pathology was involved.
o it can in cases of some breakdown of capillaries in the kidney glomerulus. This may result from numerous conditions, including infection, traumatic injury, cancer and various vascular diseases. The major clinical sign is hematuria, and patients may gain a significant improvement while using bilberry if used early enough in the disease process.
o it stimulates peripheral circulation.
o disorders of the vessels in the conjunctiva of diabetics are helped.
o it has been used in the management of retinal hemorrhage during prolonged anticoagulant therapy.
o Moringa can be of benefit for varicose veins and related conditions, anywhere a vascular astringent is indicated.
o as a safe anti-coagulation in the treatment or possible prevention of thrombosis.
o for the treatment, and relief of, capillary rigidity and permeability-related pathologies such as hypertension, advanced diabetes, arteriosclerosis, purpurea or hemorrhages, brain circulation disorders, kidney hematuria, bleeding gums, etc.
Moringa can act as a vasoconstrictor and anti-inflammatory
Therapeutic Uses.
o external and internal hemorrhoids, hemorrhoidal bleeding, inflamed and bleeding hemorrhoids, inflammation and bleeding of the vicinity around the rectum, before and after the surgical removal of hemorrhoidal knots, proctitis, pruritus ani and anal fissures. It decreases inflammation and pain, also strengthening the capillaries.
o Circulation disorders of the legs improve both subjectively and objectively. The heaviness in the legs symptom, varicose veins, varicose ulcers, phlebitis resulting from insufficient circulation, and associated symptoms, respond well.
o It has been used to accelerate post-operative recovery, especially where there was prolonged and heavy bleeding, or when anti-coagulant therapy was being administered, or in patients suffering from phlebitis.
o post thrombotic syndrome, venous circulatory disturbances such as chilblains, peripheral circulatory edema, varicophlebitis, pregnancy- related varicose veins, varicose ulcers, and postoperative venous disorders.
o retinal hemorrhages and diabetic retinopathy.
