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Journal of Health & Medical Informatics

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The Heart and Herbs: Back to the Nature

Aamer Saeed*, Fayaz Ali Larik, Pervaiz Ali Channar and Urooj Muqadar

Department of Organic Chemistry,Quaid-i-Azam University, Islamabad-45320, Pakistan

*Corresponding Author:
Aamer Saeed
Department of Organic Chemistry
Quaidi-Azam University
Islamabad 45320, Pakistan
Tel:` +92-51-9064-2128
E-mail: [email protected]

Received Date: November 02, 2015; Accepted Date: December 26, 2015; Published Date: December 31, 2015

Citation: Saeed A, Larik FA, Channar PA, Muqadar U (2015) The Heart and Herbs: Back To The Nature. J Health Med Informat 6:212. doi: 10.4172/2157-7420.1000212

Copyright: © 2015 Saeed A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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It is believed that herbal medicines act in a holistic way, but been derived from nature they can be specific in response. Herein, we review herbal medicines which are used for the treatment of cardiovascular diseases (CVDs) and their interactions with other drugs. CVDs have a high mortality rate and morbidity in the world, therefore, prevention and reduction of risk factors, which are associated with CVD, are the major tasks of healthcare professionals and scientists. Modern medicines despite having promising effects are unable to bring to a standstill the CVDs, consequently people are are paying attention to CAM (complementary and alternative medicines) -the herbal medicines.


CVDs; Herbal medicine; Molecular; Drug interaction


Herbal medicines can be defined as, plant structures capable of showing phytomedicinal or phytopharmaceutical effects. The peoples are looking outside the decorated glass of conventional medicines to improve their health care needs. In the light of critics and proponents the treatment of cardiovascular diseases with herbal medicines is a charged subject. However, medical practitioners can no longer turn a deaf ear to herbal medicines. The World Health Organization (WHO) estimated that approximately 17.1 million people died from CVDs and its complications in 2004, and the number of deaths will dramatically increase to almost 23.6 million by 2030 (WHO, 2010). Herbal medicine is a heritage that is thousands of years old and is still used by millions of people all over the world—even after the development of modern scientific medicine, however several fundamental questions are still unanswered. What are the mechanisms of action of the herbs? What are the precise targets of these herbs? What are the relationships between these herbals and diseases? How to explain one of the basic theories of TCM, i.e., “multiple herbal drugs can treat one disease”? Herbal medicine has been widely used in China as well as other Asian countries for the treatment of cardiovascular diseases for hundreds of years. Cardiovascular disease (CVD) is the major cause of mortality and morbidity in the Western world. Therefore, prevention and reduction of risk factors, which are associated with CVD, are the major tasks of health care professionals and scientists. According to the Centers for Disease Control and Prevention (CDC) and the American Heart Association, heart disease is the leading cause of death in the United States with a mortality rate of more than a quarter of total deaths in 2004. Angina (pain from decreased blood flow to the heart), coronary syndrome, heart failure, pulmonary embolism, arrhythmias, aortic valve disorders, or bacterial endocarditis are some of the cardiovascular diseases that account for the most deaths worldwide, with heart disease responsible for 7.2 million deaths in 2004.

Through the ages, humans have relied on nature for their basic needs for the production of foodstuffs, shelter, clothing, means of transportation, fertilizers, flavors and fragrances, and, not least, medicines. Apart from their cultural significance, herbal medicines are generally more accessible and affordable. There is evidence concerning the participation of reactive oxygen species (ROS) in the etiology and physiopathology of human diseases. Cardiovascular disease (CVD) is one of the top menaces of human lives and a global burning issue and CVD, encompasses a spectrum of diseases, including, Coronary artery disease,peripheral vascular disease,congestive heart failure, dyslipidemias, ,hypertension [1]. Despite being promising effects, peoples are turning faces away from modern medicines mainly due to unsatisfying treatment results, redundant side effects, Economic issues.During the last two to three decades, developed countries, such as the United States, Canada, Australia, and members of the European Union, judiciously promoted the use of herbal medicine in the form of complementary and alternative medicine. However, efficacy or safety of the majority of herbal medicines in CVDs has not been fully established through an evidence-based approach. Further, other issues, such as scientific, cultural, educational, economical, and legal, need to be addressed. Safety is a major concern for the use of herbs in humans. It is generally believed that herbal medicines approach a patient in a holistic way. Nevertheless, to make it easier to understand and to study these herbs, in this review, we chose to introduce these herbs one by one individually and even introduce the main components in molecular level. Following Table 1 depicts the role of herbal medicines in the treatment of CVDs [2].

Herbal drug Clinical use Pharmacological effects
Garlic Hypertension ↓ SBP, ↓DBP
Danshen Moderate gestational ↓ HCT, ↓ BV, ↓ PV
Red yeast rice Hyperlipidemia ↓ Total cholesterol, ↓LDL
Coronary heart disease ↓ coronary events
↓ Death from coronary heart disease.
Hawthorn Primary mild hypertension ↓SBP, ↓DBP
Coronary heart disease ↓ cardiac mortality
Ginkgo biloba Cerebral insufficiency Improvement off memory
Panaxnotoginsengg Spontaneous Intracerebral hemorrhage ↓NIHSS score
↓ Hematoma volume
↓Inflammatory responses
↑Hematoma absorption
Ischemic stroke ↑ score of ESS
↑Score of BI
Berberine Acute coronary syndrome Ameliorates inflammation following percutaneous coronary intervention
Chronic congestive heart failure ↑ LVEF, exercise capacity and Dyspnea-Fatigue Index, ↓ Frequency of VPCs
Tetamethylpyrazine Acute coronary syndrome Preventing coronary thrombosis after PCI
Myocardial infarction ↓ Attack of angina pectoris, ↓ LPO, ↑ SOD

Table 1: Herbal medicine their clinical use and pharmacological effects.

The theme of this MS is uncler.The materials including the effect of 34 kinds Japanese herbal medicines, anoxidant effect of resvertrol, effect of strawberry, etc, are loosely put together

Effectively put together. Effect of strawberry has been replaced by another exciting topic, that is troika of herbal medicines. Antioxidant effects of resveratrol are reorganized. Also effect of 34 kinds Japanese herbal medicines has been improved.

Effect of 34 kinds of japanese herbal medicines on sustainability of cardiac allograft survival

Herbal medicines have been used for over 3,000 years in Asia as alternative therapy for their varying effects and recently have become popular in Europe and the United States. In this study, X Jin et al investigated the effect of 34 kinds of traditional Japanese herbal medicines (prior to this gynecological effect also treated with herbal medicines [3], on alloimmune responses in a murine model of cardiac allograft transplantation [4-6]. In this study, the effect of 34 kinds of traditional Japanese herbal medicines of alloimmune responses in a murine model of cardiac allograft transplantation was examined at molecular level. Table 1 shows the major components found in all 34 Japanese herbal medicine.

Antioxidant effects of resveratrol in cardiovascular diseases.

Resveratrol—a natural polyphenolic compound—was first discovered in the 1940s. It has shown beneficial effects against most cardiovascular diseases. A large part of these effects are related to its antioxidant properties [7].

Structure of resveratrol:


Effects of resveratrol on antioxidant mechanisms protecting against oxidative cardiovascular pathophysiology: It has been recently demonstrated that resveratrol reduces endothelial dysfunction in vessel from dyslipidemic patients with hypertension; this antioxidant action of resveratrol was mediated by up regulation of manganese superoxide dismutase (Mn-SOD) via a mechanism dependent upon nuclear factor (erythroid-derived 2)-like 2 (NRF2). This finding in humans was in agreement with experimental models showing that resveratrol was able to increase Mn-SOD expression in the mouse myoblast line C2C12 via nuclear translocation and activation of sirtuin 1 (SIRT1), a NAD+-dependent class III histone deacetylase. It also hampers platelet aggregation and activation of phytoalexin seems to inhibit the interaction of platelets with collagen and thrombin in vitro in isolated platelets and in animal models. Reduction in the rate of cytochrome C oxidation by hydroxyl radicals Jiian et al. reported that resveratrol significantly reduced cytochrome C protein levels in the heart tissue of rats subjected to trauma-hemorrhage.Mechanism of action is shown in Figure 1.


Figure 1: Resveratrol reduces cardiovascular diseases.

Use of herbal medicines, evidence dominates over belief in case of treatment of cardiovascualar diseases.

Modern medicines used for the treatment of various cardiovascular diseases provide symptomatic relief or slow down the progress of disease. In the treatment of heart failure, adverse effects of medicines may be observed in the form of rise in frustration in patient, scientists have gone to apply extreme alternatives like gene therapy and stem cell therapy. Under such sensitive circumstances, understanding the high risk of morbidities and mortality of CVD hybrid with the limitations of modern medicines, there is an dire need to explore (Table 2) herbs for the prevention and possible, “cure” of CVDs.

Name of Japanese Herbal Medicine Main Component Major Element Molecular Formula Chemical Structure
Platycodon root Platycodin D C57H92O28 image
Bupleuri radix Saikosaponin A C42H68O13 image
Ogon Baicalin C21H18O11 image
Alismatisrhizoma Alisol B 23-acetate C28H44O4 image
Paeoniae radix Paeoniflorin C23H28O11 image
Poriasclerotium Eburicoic acid C31H50O3 image
Citrus unshiu peel (R)-(+)-Limonene C10H16 image
Zizyphifructus Oleanolic acid C30H48O3 image
Astragalus root Formononetin C16H12O4 image
Ginseng radix Ginsenoside Rx C42H72O14 image
Hinesol C15H26O image
Poriasclerotium Eburicoic acid C3H50O3 image
Astragalus root Formononetin C16H12O4 image
Pinellia tuber Homogentisic acid C8H8O4 image
Rehmannia root Rehmaglutin A C9H14O5 image
Hinesol C15H26O image
Pinellia tuber Homogentisic acid C8H8O4 image
Pinellia tuber Homogentisic acid C8H8O4 image
Ophiopogonis tuber Ophiopogonin B C39H62O12 image
Pinellia tuber Homogentisic acid C8H8O4 image
Cyperirhizoma Cyperol C15H24O image
Processed ginger [6]-Shogaol C17H24O3 image
Jujube seed Jujuboside A C58H94O26 image
Rehmannia root Rehmaglutin A C9H14O5 image
Atractylodisrhizoma Atractylon C15H20O image
Ophiopogonis tuber Ophiopogonin B C39H62O12 image
Bupleuri radix Saikosaponin A C24H68O13 image
Alismatisrhizoma Alisol B 23-acetate C28H44O4 image
Poriasclerotium Eburicoic acid C31H5O3 image
Apricot kernel Amygdalin C20H27NO11 image
Ephedra herb (-)-Ephedrine C10H15NO image
Keihi-to (TJ-128) Atractylodislanceae
Hinesol C15H26O image
6,7-Dimethylesculetin C11H10O4 image
Formononetin Formononetin C16H12O4 image

Table 2: Herbal medicines with molecular information.

Table 3 List of medicinal plants and their application against cardiovascular diseases in humans [8].

A troika of herbal medicines (Crataegus monogyna, Ginkgo biloba, and Aesculus hippocastanum) on the treatment of cardiovascular diseases

Name of herbal product Country of study Disease indication Efficacy  
Terminaliaarjuna India Post myocardial infarction Ischemic cardiomyopathy ↓ Symptoms of angina, left ventricular ejection fraction, and left ventricular mass Terminalia group, severity of cardiomyopathy also improved from NYHA class III to class I in two patients during the study  
Terminaliaarjuna India Congestive heart failure with severe refractory heart failure (NYHA class IV) Improvement of edema, fatigue and dyspnea along with walking toleranc, stroke volume, left ventricular ejection fractio, with decrease in end-diastolic and end-systolic left ventricular volume  
Terminaliaarjuna India Patients with coronary artery disease (CAD) ↓ Total cholesterol, ↓ LDL cholesterol, ↓ lipid peroxide levels after 30-day follow up.  
Allium sativam Australia Progression of carotidatherosclerosis Anti-atherosclerotic effect on carotid atherosclerosis  
Allium sativum India Hyperttension, Oxidative stress ↓ 8-hydroxy-2-deoxyguanosine, ↓ nitric oxide level, ↓ lipid peroxidation, ↑ Vitamins C, ↑ vitamin E  
Allium sativum  India Effect of garlic powder (Kwai) on plasma lipids and lipoproteins in mild hypercholesterolemia No change in blood lipids and lipoproteins levels  
Apiumgraveolens China Hypertension ↓ Blood pressure
↓ Blood pressure
AchlleaWilhelmsi Iran Antihyperlipidemic and antihypertensive effects ↓ Triglyceride after 2 months, ↓ total cholesterol and LDL-C after 4 months ↑ HDL-C levels after 6 months of treatment, ↓ diastolic and systolic blood pressure after 2 and 6 months, respectively  
Fenugreek Trigonellafoenum India Coronary artery disease (CAD) patients and patients with type 2 diabetes without CAD ↓ Total cholesterol
↓ triglycerides
Curcumin India Lipid level in patients with acute coronary syndrome Moderate-dose curcumin showed the minimal effect of increase, followed by the low-dose curcumin and finally,high-dose ccurcumin that showed the highest effect of increase.  
Curcumin India Overweight hyperlipidemia Reduction in lipids profiles such as serum total cholesterol, triglyceride and LDL-cholesterol and VLDL-cholesterol  
(Ginger) Zingiberofficinale Saudi Saudi Lipid levels in patients with hyperlipidemia after 45 days. ↓ Triglyceride, ↓ LDL-C,↑ HDL-C  
Artichoke (Cynaracardinculusvar.scolymus) India Hyperlipoproteinemia ↓ Total cholesterol, ↓ LDL-C  
Artichoke (Cynaracardunculusvar.scolymus) UK Hypercholesterolemia ↓ Total cholesterol  
Rhubarb (Rheum rhapontiam) USA Cholesterol-lowering effect in hypercholesterolemic men ↓ Total cholesterol (8% and ) LDL-C (9%), while HDL-C concentrations remained unchanged. The depressed total and LDL-C levels returned to baseline after the fiber supplementation was withdrawn for 1 month.  
Hibiscus sabdariffaL.tea Boston Pre-and mildly hypertensive adults ↓ Blood pressure in pre-and mildly hypertensive adults  
Combination ofCommiphoramukuland Irularacemosa(1:1ratio) India Ischemic heart disease ↓ Total cholesterol
↓ Triglycerides,↓ Total blood lipids
Inularacemosa India Ischemic heart disease All nine subjects showed improvement in ST-segment depression on ECG.  
Crataegus China Cardiac insufficiency stage NYHA II heart failure Reduced performance in the exercise tolerance test, fatigue, palpitation, and exccercise dyspnea
C.mukulGuggul USA Hypercholesteromia No improvement of cholesterol level
C.mukul (Guggul) in combination with Irularacemosa  India Ischemic heart disease Improved electrocardiogram readings and decreased episodes of dyspnea and chest pain
Crataegusmonogyna(Hawthorn) USA Heart failure Provides no symtomatic or functional benefit when given with standard medical therapy to patients with heart failure
Conventional drug Herbal medicine Result of interaction Possible mechanism Ref
Interaction with cardiac drugs
Digoxin Gum guar ↓ plasma digoxin concentration Reduced absorption [20]
Digoxin St.John’s ↓ plasma digoxin concentration Induction of P-glycoprotein [24]
Digoxin Siberian ginseng ↑ plasma digoxin concentration Some component of Siberian ginseng might impair digoxin elimination or interfere with the digoxin assay. [25]
Digoxin Wheat bran ↓ plasma digoxin concentration Reduced absorption [26]
Interactions with antihypertensive drugs
Diuretic thiazide Ginkgo ↑ in blood pressure Not known [27]
Antihypertensive Liquorice Hypokalemia Additive effect on potassium excretion [28]
Interactions with antiplatet drugs
Aspirin Ginkgo Spontaneous hyphema Additive inhibition of platelet aggregation [29]
Aspirin Tamarind ↑ bioavailability of aspirin Not known [30]
Interactions with anticoagulants
Warfarin Boldo/Fenugreek ↑ anticoagulant effect Additive effect on coagulation mechanisms [31]
Warfarin Danshen ↑ Additive effect on coagulation mechanisms and/or increased In addition to its antiplatet activity, Danshen decreases warfarin elimination in rats. [32-34]
Warfarin Devil’s claw ↑ anticoagulant effect, purpura Unknown [27]
Warfarin Garlic ↑ anticoagulant effect; increase in clotting time Additive effect on coagulation mechanisms [35]
Interactions with anticoagulants
Warfarin Ginkgo Intracerebral hemorrhage Additive effect on coagulation mechanism [36]
Warfarin Ginseng Decreased anticoagulant effect Unknown [37]
Warfarin Green tea ↓ anticoagulant effect Pharmacological antagonism [38]
Warfarin Lycium ↑ anticoagulant effect Uknown [23]
Warfarin Mango ↑ anticoagulant effect Hepatic enzyme inhibition [22]
Warfarin Papaya ↑anticoagulant effect Unknown [27]
Warfarin PC-SPES ↑ anticoagulant effect Additive effect on coagulation mechanisms [14]
Warfarin Soy ↓ anticoagulant effect Not known [15]
Warfarin St.John’s wort ↓ anticoagulant effect Hepatic enzyme induction [15]
Phenprocoumon St.John’s wort ↑”Quick-Wert test (indicating decreased anticoagulant effect) Hepatic enzyme induction [40,41]
Phenprocoumon Wheat bran ↓ plasma level of Phenprocoumon; increase in the free plasma Phenprocoumon fraction ↓ Absorption can explain the decreased plasma level; however, the mechanism of the increase of free plasma Phenprocoumon fraction is Unknown. [42,43]
 Interactions with antilipidaemic drugs
Simvastatin St.john’swort ↓ plasma simvastatin concentration Hepatic enzyme induction [37]
Lovastatin Oat bran ↓ lovastatin absorption Bran contains fibers which can trap digoxin [38]
Lovastatin Pectin ↓ lovastatin absorption Pectin can trap digoxin [39]

Table 3: Clinical interaction between herbal medicines and conventional cardiovascular drugs [23].

The cardiovascular diseases that account for the most deaths worldwide, with heart disease responsible for 7.2 million deaths in 2004 [9] many of the components and complications of cardiovascular diseases including the damage caused by oxidants in the aftermath of ischemic heart failure. McCune investigated the role of these herbal medicines in cardiovascular. Flavonoids and other antioxidants have the ability to regulate the metabolism of cholesterol, triglyceride and induction of inflammatory cytokinese, which inhibit the build up of foam cells, platelets and fatty acids deposits in arteries.

The German Commission E Monographs, the standard reference for prescription herbal products in some of the countries of Europe, lists the following plants for treatment of cardiovascular indications: Ginkgo biloba leaf extract (Ginkgo biloba L.), onion (Allium cepa L.), motherwork herb (Leonuri cardiacae L.), hawthorn leaf with flower (Crataegus monogyna Jaquin emend. Lindmand or C. laevigata (Poiret) de Candolle), lily of the valley herb (Convallariae majalis L.), pheasants eye herb (Adonidis vernalis L.), squill (Urginea maritime (L.) Baker), butcher’s bloom (Ruscus aculeatus L.), camphor (Cinnamomum camphora (L.) Siebold), lavender flower (Lavandulae angustifolia Miller), rosemary leaf (Rosmarinus officinalis L.), scotch broom herb (Cytisus scoparius (L.) Link), garlic (Allium sativum L.), soy lecithin and phospholipid (Glycine max (L.) Merrill), Indian snakeroot (Rauwolfia serpentine (L.) Bentham ex Kurz), arnica flower (Arnica Montana L. or A. chamissonis Less. subsp. foliosa (Nutt.) Maguiere), sweet clover (Melilotus officinalis (L.) Pallas and/or M. altissimus Thuillier), and horse chestnut seed (Aesculus hippocastanum L).


Hawthorn (Crataegus monogyna or laevigata frequently referred to as C. oxyacantha) has other common names such as may bush and white thorn and is found in Europe, North America, and Asia as a deciduous tree in the Rosaceae family [10]. Hawthorn contains polycyclic flavonoids including epicatechin, chlorogenic acid, rutin, isoquercitin, and hyperoside [11] .Vitexin-4-O-glucoside and vitexin- 2-O-rhamnoside have been described as the major flavonoids present in hawthorn leaves that are readily absorbed when the products are fed to rats [12]. Hawthorn shows antiarrhythmic properties. Many flavonoids found in it have shown increased coronary blood flow. Problems of heart contraction and blood flow can be successfully solved by using hawthorn.

Horse chestnut seed

Horse chestnut seed (Aesculus hippocastanum L.), of the family Hippocastanceae, is a medicinal tree species cultivated widely for ornamental and shade purposes.Horse chestnut is one of the top 20 herbal supplements sold in the United States with sales of $558946 in 2009 in the mass market alone [13]. Extracts of horse chestnut are commonly standardized to about 20% of triterpene saponin glycosides (the natural mix of these is commonly referred to as aescin). Aescin is found in A. hippocastanum seeds at the rate of 9.5% dry matter as well as the flavonoids quercetin, kaempherol, epicatechin, and anthocyanins; and the fatty acids lauric acid, palmitic acid, myristic acid, stearic acid, arachidic acid, and oleic acid. Dosages in these trials ranged from 100 to 150 mg aescin daily.Experiments in animal and cell culture systems have demonstrated the effectiveness of horse chestnut in decreasing inflammation and platelet aggregation, increasing venous contractions and protecting venous endothelium relaxation.In ADP-induced human platelet aggregation studies, it was determined that horse chestnut extract reduced platelet aggregation. Endothelial dysfunction is a precursor to hypertension, atherosclerotic disease, hypercholesterolemia,and chronic venous insufficiency (CVI). There are many studies on the effects of horse chestnut extracts on the traits and symptoms of CVI (these can includevaricose veins, venous ulcers, leg-tiredness, swelling, and the hardening of the skin caused by lipidermatosclerosis) [14,15]


Ginkgo (Ginkgo biloba L.) is an ancient tree species that has been used as a heart medicine in Chinese phytomedicine since at least 1509 .The German Commission E Monographs listed the leaf extract as an approved herb due to established results in experimental research. In the United States, it is one of the top-selling herbal supplements with over 16 million US$ in sales in the mass market in 2009 and $4 276 489 in the US natural and heath food retailers alone. Ginkgo leaves have diterpene terpenoids (chiefly the ginkgolides and bilobalide) and flavonoids (including quercetin, kaempferol, and isorhamnetin). Suggested dosages are between 120 and 240 mg daily in multiple increments.

Its free radical scavenging action has been responsible for protecting nitric oxide and prostaglandin I2 activity, thereby ensuring continued blood flow via smooth muscle relaxation .clinical trials have reported antioxidant activity, improved blood flow, and anti-inflammatory properties against cardiovascular disease development.

Cardiovascular herbal medicines: The risk of drug interaction

Herbal medicines are widely used for the treatment of cardiovascular diseases, so it is important to support credible research on the use of herbal medicines by focusing and explaining herb-drug interactions to provide a reliable alternative path to cardiovascular patients [16]. Recent data have revealed that all herbal medicines contain many active ingredients including those used in the therapy of cardiovascular diseases [17-21], Like all the other things of the world (excess of everything is very bad) herbal medicines (HB) are not always right, so medical professionals must care and know that HBs are not completely risk free [22].

Table 3 clinical interaction between herbal medicines and conventional cardiovascular drugs [23].

PC-PCS is a mixture of eight herbal drugs, namely, Dendrathema morofolium (Chrysanthemum), Isatis indigotica (Dyer’s woad), and Glycyrrhiza glabra (liquorice), Ganoderma lucidum (reishi), Panax pseudoginseng (san-qui ginseng), Rabdosia rubescens (rubescens), Serenoa repens (saw palmetto) and Scutellaria bacicalensis (Baikal skullcap).


Herbal medicine, almost by definition, is the application of a group of compounds rather than single pure entities. These compounds can have synergistic or antagonistic properties that affect how the compounds interact and the potential to affect multiple aspects of a disease. Plant products, whether food, herb, or spice, can contribute antioxidants to ameliorate symptoms of cardiovascular diseases. Hawthorn can improve exercise tolerance, pressure-heart rate product, fatigue, maximal workload, and has antiarrhythmic properties. Gingko’s antioxidant and anti-inflammatory properties improve brachial artery endothelial vasomotor function (flow-mediated dilation) and coronary artery blood flow.Horse chestnut seed decreases inflammation and platelet aggregation, increases venous contractions, and protects venous endothelium relaxation in animal and cell studies, while in humans it has been shown to improve conditions of CVI. The search for plant medicines should encompass the food, herb, and spice use of cultures around the world. Human pharmacokinetic studies are needed on plants used for food, herbs, and spice


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