CARDIOVASCULAR PHYTOTHERAPY

Pharmacy Study Program

Binawan University
Lecture Outcome

Students are able to know and explain cardiovascular phytotherapy which

includes hypertension, angina, hyperlipidemia and varicose veins
 Cardiac System Medicine
synthetic drug Treatment using plants
• Generally, heart system • usually less specific
disorders are treated with • because it can affect several
specific patented chemical molecular targets,
drugs and almost all of them are
synthetic drugs. • but this treatment can help
complex health disorders,
• These treatments are usually
very good but often cause • such as disorders of the heart
unexpected side effects. and circulatory system which is
usually not known where it is
located.
 HEART FUNCTION

the main thing is to pump blood throughout the body.

▰ As a means of transportation in the body, blood is in

charge of carrying nutrients and oxygen needed by
the body's organs, as well as transporting waste
substances
 HEART SYSTEM

▰ Small blood circulation

blood circulation that starts from
heart (right ventricle) through the pulmonary arteries to
the lungs, then through the pulmonary veins back to the
heart (left atrium).
▰ Big blood circulation
blood circulation from the heart (left ventricle) through
the aorta to the rest of the body, then through the vena
cava back to the heart (right atrium).
DISORDERS IN THE HEART SYSTEM

Atherosclero Blood
Heart
sis Circulation
 Cardiovascular System Disorders Phytotherapy

Essential Angina Hyperlipidemia Varicose

hypertension Veins
 ESSENTIAL HYPERTENSION

❑ Hypertension with no identifiable cause

Risk factors for coronary heart
disease: need to be treated ❑ 90% cases of hypertension
even if the level is mild

Phytotherapy aims to reduce

blood pressure gradually

Not recommended for severe

hypertension (>180/110) and
accelerated hypertension
Alli sativi bulbi

• Other names : Garlic .

• Name of plant of origin : Allium sativum .
• Family : Liliaceae .
• Main nutritious substances : Essential oil
• containing; dialildisulfide 60% allylpropyl disulfide
6%, alliin
• Usage: Anticholesterol, hypertension, heart disease
• Description: Characteristic odor, slightly spicy taste
Clinical trial
Clinical trials show inhibition of platelet clumping, which is seen by increasing
bleeding and blood clotting time and increasing fibrinolytic activity

Hypercholesterolemia, which was treated with garlic maceration oil for 3

months, showed a significant decrease in platelet adhesion and aggregation.
Rauwoulfiae Radix

• Latin name: Rauwoulfia serpentina

• Other names: pandak pule
• Family: Apocynacae
• widely used in the drug industry.
• Spread in: India, Myanmar, Thailand,
and Indonesia (especially Java).
Plant content

Pule pandak root contains more than 60 indole alkaloid compounds (0.7-2.4%),
such as reserpine, ajmaline, ajmalicin, reserpinin, alstonin, yohimbine, and
resinamine. Other content is photosterol, fatty acids, unsaturated alcohol,
and sugar.
The main alkaloid content of Rauwolfia serpentine, reserpine, can be an
antihypertensive drug. Its roots have been used in India for a long time,
especially for hypertension. This plant is also used as a sedative and
hypnotic.
Interaction
May cause disorders of the cardiovascular system, eg bricardia, arrhythmias
when used concomitantly with digitalis and quinidine

Dose
Consumed in powder form as much as 200 mg a day, within 1-2 weeks and
followed by a dose of 50-300 mg daily. Dosage adjusted to the content of
alkaloids. In the elderly age group, lower doses are used and are usually divided
into 2 times a day

Side effects
Feelings of restlessness, insomnia, edema, diarrhea, nausea, and vomiting.
Long-term use with high doses can cause tremors like Parkinson's sufferers.
Sizygium polyantha

Latin name
Syzygium polyanthum,

Myrtaceae tribe.
Bay leaves have long been known as a cooking
spice.

In its development, bay leaves are also

used as ingredients for traditional
medicine.
Plant content
Bay leaves (Sizygium polyantha) have been studied to contain flavonoids
that can show antioxidants. In addition, the content of essential oils (citral,
eugenol) which has a function in lowering blood pressure levels. The
essential oil content in bay leaves is 0.05% which is antibacterial and has
a savory aroma.
Indication
Antihypertensive, Reduces dyslipidemia, especially hypertriglyceridemia.
Lowering LDL levels, Potential to reduce uric acid levels.

Dose
Bay leaf extract dissolved in water solvent which was tested on male mice in
vivo was able to reduce the average blood pressure (Azlini et al., 2011).
Another study stated the ability of water extract and methanol extract at a
dose of 20-100 mg/KgBB in lowering blood pressure. The ability to lower
blood pressure is dose-dependent.
.

Pegagan
Latin Name : Centella asiatica L. Urban
Family Name : Apiaceae
Part Used : All parts of the plant
Chemical content
the chemical content in the gotu kola herb, including triterpene
compounds (asiatic acid, madasiat acid, madekasat acid, and
others). Glycoside compounds, saponin compounds,
flavonoids, and alkaloids.

Dose
oral administration of 0.33-0.68 grams. Three times a day.
Antihypertensive effect

The gotu kola plant has been empirically used for the treatment of
hypertension. A new study on the effect of gotu kola infusion on normal blood
pressure in adult women was conducted by Shirley (2006) from Maranatha
University, Bandung. The results showed that gotu kola infusion could lower
the blood pressure of 12 medical students at Maranatha University who had
normal blood pressure. Blood pressure measurements were taken before and
after drinking 3 grams of gotu kola infusion in 100 cc. Volunteer blood
pressure value after drinking gotu kola infusion was 98.33/62.83 mmHg. The
blood pressure value before taking the infusion was 106.83/67.5 mmHg.
 Curcuma Domesticae Rhizoma

Simplisia curcuma domesticae rhizoma (turmeric rhizome) in the form of dried rhizomes
derived from the Curcuma domestica Valenton plant. (synonym: C. longa L.),
Zingeberaceae family
The main content in turmeric rhizome is
curcuminoids: a mixture of curcumin,
desmethoxycurcumin, and
bidesmethoxycurcumin.
In addition, turmeric rhizome simplicia also
contains essential oils (about 3-5%): in the form
of ketone sesquiterpenes (about 60%) such as
arturmeron, zingeberen, -atlanton, felandren,
eugenol, borneol.
Other content is polysaccharides such as
glycans, ukonan A-D
Dose
Dosage for adults in the form of simplicia 3-9 g a day; 15-3 g extract daily or
equivalent preparation
Infusion form 0.5-1 g three times a day, tincture (1:10) 0.5-1 ml a day 3 times

Pharmacology
Turmeric extract and the compound it contains ar-turmerone have an anti-
platelet effect. From studies conducted with collagen and arachidonic acid
inducers, the anti-platelet activity of turmerone is better than aspirin.
 Simplicia ginseng radix (ginseng root)
In the form of whole roots or pieces of roots that have been dried
Derived from the Panax ginseng plant C.A Meyer.
(synonym P. schinseng Ness.), Araliaceae tribe.
Chemical content
The main compound in the root of the ginseng
plant is ginsenoside. Ginsenosides are saponins
and can be divided into two classes. The
protopanasatriol class consists of Rg1, Rg2, Rf,
and Re. The protopanaxadiol class consists of Rc,
Rd, Rb1, Rb2, and Rb3. Ginseng also contains
other saponins, polysaccharides, amino acids
(especially glutamine and arginine), essential oils.
Three new sesquiterpene hydrocarbons were also
isolated from essential oils, namely panaksene,
panaginsene, and ginsene.
Adult Dose: 20 drops diluted in 1/2 cup water (100 mL), taken 2-3
times a day. For Treatment: 20 drops diluted in 1/2 cup water (100
mL), taken 1-2 times a day.
This dosage is very suitable for chronic conditions and long-term use

Toxicity
Ginseng has very low toxicity. Sub-acute doses of 1.5-15 mg/kg of 5:1
ginseng extract produced no negative effects on body weight, food
consumption, hematological or biochemical parameters or histologic
findings in dogs, and no effect has been observed with similar doses in
two generations of mouse progeny.
ANGINA
Manifestations of cardiac muscle ischemia are usually caused by
obstruction of the coronary arteries or reduced coronary blood flow.
Heart attack risk factors

Conventional treatment is required, combination with herbs is

recommended
• Non-drug therapy:
• Quit smoking
• Weight reduction
• Control of blood pressure, lipid and cholesterol levels in the
blood
Crataegus oxycantha

• Flavonoids contain anti-oxidants that

strengthen blood vessels
• Blood vessels are dilated thereby increasing
coronary blood flow
Lowers blood lipid levels and
Indication increases the dynamic energy of the
heart muscle
Dose 12-15 mg a day

Content Flavonoids and antioxidants

Dizziness, sweating, palpitations,
Side effect
trouble sleeping
Clinical trial CHF Test
Salvia miltiorrhiza

Chemical constituents: diterpenes, quinones,

phenolic acid derivatives, thanshinone (I,
IIA, IIB), cryptotanshinone,
isocryptotanshinone, militirone, tanshinol
(I and II), salviol.
Pharmacological effects
1. Angina pectoris
2. Cerebrovascular
3. Antiplatelet
4. Anticoagulants and thrombolytics
5. Antibiotics
6. Hepatoprotective
7. CNS suppressant/sedative effect
8. Anti cancer
Toxicity
at high doses can cause dry mouth, dizziness, fatigue, numbness, shortness of
breath. According to materia medika china rare, salvia miltiorrhiza is not
recommended for patients who have blood deficiency and cold, or with a
tendency to bleed

Quality of preparation: According to the rare Chinese materia medica, doses up

to 30-60gram can be used for angina and arthritis.
 Piperis Longi Fructus
(Java Chili Fruit)

Simplisia piperis longi fructus in the form of unripe and dried fruit from the Piper
longum (L.) B1 plant, the Piperaceae family.
Chemical Content

Piperine, piperitin, piperanine, piperylin, cavicin (piperine isomer),

asarinin, pellitorin, piperlongunium, essential oils with components
including piperonal, eugenol, karyofelen, bisabolen, pentadecane,
safrole
Pharmacology

Piperlongumin (derived from Javanese chili) has the effect of inhibiting

platelet aggregation in rabbits induced by collagen, arachidonic acid and
platelet activating factor (Platelet activating factor). The activity of
piperlongumin is stronger than other acidamides (piperine, pipernonalin,
piperoctadecalidine). The mechanism of action of aspirin is to inhibit the
action of the cyclooxygenase enzyme, while piperlongumin is thought to
be due to the presence of pyridine and pyridine compounds as breakdown
products of piperlongumin.
Hyperlipidemia
In the form of hypercholesterolemia (> 240 mg / dl) or
hypertriglyceridemia (> 250 mg / dl). Risk factors for premature
ischemic heart disease: control of hyperlipidemia is important for its
secondary prevention
Non-drug therapy:
• Increased intake of soluble fiber from vegetables and fruit, nuts,
oats and weight
• Increased intake of fish and fish oil
• Olive oil may be beneficial
• Cholesterol intake restriction
• Restriction of alcohol intake
Green tea

Green tea leaves contain 2-3% caffeine, Theobromine,

Theophylline, Tannins, Xanthine, adenine, essential oils,
quercetin, naringenin, and natural fluoride. Every 100 grams of tea
leaves has 17kJ calories and contains 75%-80% water, 25%
polyphenols, 20% protein, 4% carbohydrates, 2.5%-4.5% caffeine,
27% fiber, and 6% pectin (Dalimartha , 2006).

The main elements in tea are caffeine, tannins, and essential oils
(Spillane, 1992). Tannins in tea are mostly composed of
catechins, epicatechins, error epicatechins, epigallo catechins,
and gallocatechin epigallocatechins (Hartoyo, 2003).
Clinical Trials

The potential of green tea has been shown to primarily function as an

antioxidant. Alam Syah (2006), tested the scavenger ability of green tea
polyphenols in the Fenton reaction. In this test catechins are exposed to
hydrogen peroxide, superoxide radicals and hydroxyl precursors. The order
according to the strength of the scavenger is EGCG>ECG>EGC>EC
 Cynara (Globe artichoke)

Content:
Cynara Scolymus (Globe Artichoke) 905 mg.
Indications:
▰ Helps increase the amount of bile in liver cells which is
useful for stimulating the digestion of fats from food.
▰ Helps with nausea and bloating.
▰ Helps increase the breakdown and reduce the absorption
of fat in the intestine.
▰ Has a good effect in lowering cholesterol levels.
Varicose Veins

• Venous insufficiency due to weak vein walls and lack of

venous flexibility

Non-drug therapy:
• Increased intake of flavonols from vegetables and fruit
• Walk
• Sleep with feet higher than head
• Keep the feet warm in the morning and compress the feet
with cold water to improve blood flow
Ruscus aculeatus L (Butcher’s broom)

▰ Chemical content
Butcher's broom plant contains saponin glycosides
(ruscine and ruscosida) which are biogenetic
turned into derivatives of cholesterol compounds
such as ruscogenin and neuruscogenin. It also
contains flavonoids, anthraquinones, benxofuran,
and essential oils in small amounts.
Side effects Pharmacological effects

Can cause irritation, nausea and Butcher's broom has an anti-

gastric disorders inflammatory effect and is used to treat
venous disorders such as varicose
veins and hemorrhoids (hemorrhoids).
The compound ruscogenin has been
shown to reduce vascular permeability
and improve retinopathy symptoms as
well as lipids in diabetics.
• The part used for treatment is the rhizome. Dosage forms in general
are in the form of herb extracts, ointments and suppositories (for
people with hemorrhoids), and some are in the form of capsules and
tablets but are very rare in some countries.
Look for 2 plants other than those previously described that
have cardiovascular effects

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