Remedy For Hypertension

Hypertension

History

Modern understanding of the cardiovascular system began with the work of physician William Harvey (1578–1657), who described the circulation of blood in his book "De motu cordis". The English clergyman Stephen Hales made the first published measurement of blood pressure in 1733. Descriptions of hypertension as a disease came among others from Thomas Young in 1808 and especially Richard Bright in 1836. The first report of elevated blood pressure in a person without evidence of kidney disease was made by Frederick Akbar Mahomed (1849–1884). However hypertension as a clinical entity came into being in 1896 with the invention of the cuff-based sphygmomanometer by Scipione Riva-Rocci in 1896. This allowed blood pressure to be measured in the clinic. In 1905, Nikolai Korotkoff improved the technique by describing the Korotkoff sounds that are heard when the artery is ausculated with a stethoscope while the sphygmomanometer cuff is deflated.

The concept of essential hypertension ('hypertonie essential') was introduced in 1925 by the physiologist Otto Frank to describe elevated blood pressure for which no cause could be found. In 1928, the term malignant hypertension was coined by physicians from the Mayo Clinic to describe a syndrome of very high blood pressure, severe retinopathy and adequate

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kidney function which usually resulted in death within a year from strokes, heart failure or kidney failure.

In 1931, John Hay, Professor of Medicine at Liverpool University, wrote that "there is some truth in the saying that the greatest danger to a man with a high blood pressure lies in its discovery, because then some fool is certain to try and reduce it". This view was echoed by the eminent US cardiologist Paul Dudley White in 1937, who suggested that "hypertension may be an important compensatory mechanism which should not be tampered with, even were it certain that we could control it".

Charles Friedberg's 1949 classic textbook "Diseases of the Heart", stated that "people with 'mild benign' hypertension ... [defined as blood pressures up to levels of 210/100 mm Hg] ... need not be treated". However the tide of medical opinion was turning: it was increasingly recognised in the 1950s that "benign" hypertension was not harmless.

Over the next decade increasing evidence accumulated from actuarial reports and longitudinal studies, such as the Framingham Heart Study, that "benign" hypertension increased de

ath and cardiovascular disease, and that these risks increased in a graded manner with increasing blood pressure across the whole spectrum of population blood pressures. Subsequently the National Institutes of Health also sponsored other population studies, which additionally showed that African Americans had a higher burden of hypertension and its complications.

Historically the treatment for what was called the "hard pulse disease" consisted in reducing the quantity of blood by bloodletting or the application of leeches. This was advocated by The Yellow Emperor of China, Cornelius Celsus, Galen, and Hipocrates.

In the 19th and 20th centuries, before effective pharmacological treatment for hypertension became possible, three treatment modalities were used, all with numerous side-effects:

strict sodium restriction (for example the rice diet), sympathectomy (surgical ablation of parts of the sympathetic nervous system), pyrogen therapy (injection of substances that caused a fever, indirectly reducing blood

pressure).

The first chemical for hypertension, sodium thiocyanate, was used in 1900 but had many side effects and was unpopular. Several other agents were developed after the Second World War, the most popular and reasonably effective of which were tetramethylammonium chloride and its derivative hexamethonium, hydralazine and reserpine (derived from the medicinal plant Rauwolfia serpentina).

A major breakthrough was achieved with the discovery of the first well-tolerated orally available agents. The first was chlorothiazide, the first thiazide diuretic and developed from the antibiotic sulfanilamide, which became available in 1958; it increased salt excretion while preventing fluid accumulation. A randomized controlled trial sponsored by the Veterans Administration comparing hydrochlorothiazide plus reserpine plus hydralazine versus placebo had to be stopped early in a high blood pressure group because those not receiving

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treatment developed many more complications and it was deemed unethical to withhold treatment from them.

The study continued in people with lower blood pressures and showed that treatment even in people with mild hypertension more than halved the risk of cardiovascular death. In 1975, the Lasker Special Public Health Award was awarded to the team that developed chlorothiazide. The results of these studies prompted public health campaigns to increase public awareness of hypertension and promoted the measurement and treatment of high blood pressure. These measures appear to have contributed at least in part to the observed 50% fall in stroke and ischemic heart disease between 1972 and 1994.

Soon more drugs became available to treat hypertension. The British physician James W. Black developed beta blockers in the early 1960s; these were initially used for angina, but turned out to lower blood pressure. Black received the 1976 Lasker Award and in 1988 the Nobel Prize in Physiology or Medicine for his discovery.

The next class of antihypertensives to be discovered were calcium channel blockers. The first member was verapamil, a derivative of papaverine that was initially thought to be a beta blocker and used for angina, but then turned out to have a different mode of action and was shown to lower blood pressure.

The renin-angiotensin system was known to play an important role in blood pressure regulation, and angiotensin converting enzyme (ACE) inhibitors were developed through rational drug design. In 1977 captopril, an orally active agent, was described; this led to the development of a number of other ACE inhibitors. More recently angiotensin receptor blockers and renin inhibitors have also been introduced as antihypertensive agents.

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WHAT IS HYPERTENSION?

Hypertension

Automated arm blood pressure meter showing arterial hypertension (shown a systolic blood pressure

158 mmHg, diastolic blood pressure 99 mmHg and heart rate of 80 beats per minute).

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated. This requires the heart to work harder than normal to circulate blood through the blood vessels. Blood pressure involves two measurements, systolic and diastolic, which depend on whether the heart muscle is contracting (systole) or relaxed between beats (diastole). Normal blood pressure at rest is within the range of 100-140mmHg systolic (top reading) and 60-90mmHg diastolic (bottom reading). High blood pressure is said to be present if it is persistently at or above 140/90 mmHg.

Hypertension is a major risk factor for stroke, myocardial infarction (heart attacks), heart failure, aneurysms of the arteries (e.g. aortic aneurysm), peripheral arterial disease and is a cause of chronic kidney disease. Even moderate elevation of arterial blood pressure is associated with a shortened life expectancy.

Dietary and lifestyle changes can improve blood pressure control and decrease the risk of associated health complications, although drug treatment is often necessary in people for whom lifestyle changes prove ineffective or insufficient

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ClassificationHypertension is classified as either primary (essential) hypertension or secondary hypertension; about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause.The remaining 5–10% of cases (secondary hypertension) are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Classification (JNC7) Systolic pressure Diastolic pressuremmHg kPa mmHg kPa

Normal 90–119 12–15.9 60–79 8.0–10.5Prehypertension 120–139 16.0–18.5 80–89 10.7–11.9

Stage 1 hypertension 140–159 18.7–21.2 90–99 12.0–13.2Stage 2 hypertension ≥160 ≥21.3 ≥100 ≥13.3

Isolated systolichypertension ≥140 ≥18.7 <90 <12.0

Adults

In people aged 18 years or older hypertension is defined as a systolic and/or a diastolic blood pressure measurement consistently higher than an accepted normal value (currently 139 mmHg systolic, 89 mmHg diastolic: see table — Classification (JNC7)). Lower thresholds are used (135 mmHg systolic or 85 mmHg diastolic) if measurements are derived from 24-hour ambulatory or home monitoring.

Recent international hypertension guidelines have also created categories below the hypertensive range to indicate a continuum of risk with higher blood pressures in the normal range. JNC7 (2003) uses the term prehypertension for blood pressure in the range 120-139 mmHg systolic and/or 80-89 mmHg diastolic, while ESH-ESC Guidelines (2007) and BHS IV (2004) use optimal, normal and high normal categories to subdivide pressures below 140 mmHg systolic and 90 mmHg diastolic.

Hypertension is also sub-classified: JNC7 distinguishes hypertension stage I, hypertension stage II, and isolated systolic hypertension. Isolated systolic hypertension refers to elevated systolic pressure with normal diastolic pressure and is common in the elderly. The ESH-ESC Guidelines (2007) and BHS IV (2004), additionally define a third stage (stage III hypertension) for people with systolic blood pressure exceeding 179 mmHg or a diastolic pressure over 109 mmHg. Hypertension is classified as "resistant" if medications do not reduce blood pressure to normal levels.

Neonates and infants

Hypertension in neonates is rare, occurring in around 0.2 to 3% of neonates, and blood pressure is not measured routinely in the healthy newborn. Hypertension is more common in

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high risk newborns. A variety of factors, such as gestational age, postconceptional age and birth weight needs to be taken into account when deciding if a blood pressure is normal in a neonate.

Children and adolescents

Hypertension occurs quite commonly in children and adolescents (2-9% depending on age, sex and ethnicity) and is associated with long term risks of ill-health. It is now recommended that children over the age of 3 have their blood pressure checked whenever they attend for routine medical care or checks, but high blood pressure must be confirmed on repeated visits before characterizing a child as having hypertension.

Blood pressure rises with age in childhood and, in children, hypertension is defined as an average systolic or diastolic blood pressure on three or more occasions equal or higher than the 95th percentile appropriate for the sex, age and height of the child. In adolescents, it has been proposed that hypertension and pre-hypertension are diagnosed and classified using the same criteria as in adults.

CausePrimary hypertension

Primary (essential) hypertension is the most common form of hypertension, accounting for 90–95% of all cases of hypertension. In almost all contemporary societies, blood pressure rises with aging and the risk of becoming hypertensive in later life is considerable. Hypertension results from a complex interaction of genes and environmental factors. Numerous common genes with small effects on blood pressure have been identifiedas well as some rare genes with large effects on blood pressurebut the genetic basis of hypertension is still poorly understood.

Several environmental factors influence blood pressure. Lifestyle factors that lower blood pressure, include reduced dietary salt intake, increased consumption of fruits and low fat products, exercise, weight loss and reduced alcohol intake. The possible role of other factors such as stress, caffeine consumption, and vitamin D deficiency are less clear cut.

Insulin resistance, which is common in obesity and is a component of syndrome X (or the metabolic syndrome), is also thought to contribute to hypertension. Recent studies have also implicated events in early life (for example low birth weight, maternal smoking and lack of breast feeding) as risk factors for adult essential hypertension, although the mechanisms linking these exposures to adult hypertension remain obscure.

Secondary hypertension

Secondary hypertension results from an identifiable cause:

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1. Renal disease is the most common secondary cause of hypertension. 2. Hypertension can also be caused by endocrine conditions, such as

Cushing's syndrome , hyperthyroidism , hypothyroidism , acromegaly , Conn's syndrome or hyperaldosteronism, hyperparathyroidism pheochromocytoma .

Other causes of secondary hypertension include

i. obesity, ii. sleep apnea ,

iii. pregnancy, iv. coarctation of the aorta , v. excessive liquorice consumption

vi. certain prescription medicines, vii. illegal drugs.

Signs and symptomsHypertension is rarely accompanied by any symptoms, and its identification is usually through screening, or when seeking healthcare for an unrelated problem.

A proportion of people with high blood pressure reports :

headaches (particularly at the back of the head and in the morning), lightheadedness, vertigo, tinnitus (buzzing or hissing in the ears),

altered vision

fainting episodes.

Secondary hypertension

Some additional signs and symptoms may suggest secondary hypertension, i.e. hypertension due to an identifiable cause such as kidney diseases or endocrine diseases.

For example:

Truncal obesity, glucose intolerance, moon facies, a "buffalo hump" and purple striae suggest Cushing's syndrome.

Thyroid disease and acromegaly can also cause hypertension and have characteristic symptoms and signs.

An abdominal bruit may be an indicator of renal artery stenosis (a narrowing of the arteries supplying the kidneys),

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Decreased blood pressure in the lower extremities and/or delayed or absent femoral arterial pulses may indicate aortic coarctation (a narrowing of the aorta shortly after it leaves the heart).

Labile or paroxysmal hypertension accompanied by headache, palpitations, pallor, and perspiration should prompt suspicions of pheochromocytoma.

Hypertensive crisesSeverely elevated blood pressure (equal to or greater than a systolic 180 or diastolic of 110 — sometime termed malignant or accelerated hypertension) is referred to as a "hypertensive crisis", as blood pressures above these levels are known to confer a high risk of complications.

symptoms

a) People with blood pressures in this range may have no symptoms, but are more likely to report headaches (22% of cases) and dizziness than the general population.

b) Other symptoms accompanying a hypertensive crisis may include visual deterioration or breathlessness due to heart failure or a general feeling of malaise due to renal failure.

c) Most people with a hypertensive crisis are known to have elevated blood pressure, but additional triggers may have led to a sudden rise.

A "hypertensive emergency", previously "malignant hypertension", is diagnosed when there is evidence of direct damage to one or more organs as a result of the severely elevated blood pressure.

This may include:

Hypertensive encephalopathy, caused by brain swelling and dysfunction, and characterized by headaches and an altered level of consciousness (confusion or drowsiness).

Retinal papilloedema and/or fundal hemorrhages and exudates are another sign of target organ damage.

Chest pain may indicate heart muscle damage (which may progress to myocardial infarction) or sometimes aortic dissection, the tearing of the inner wall of the aorta.

Breathlessness, cough, and the expectoration of blood-stained sputum are characteristic signs of pulmonary edema, the swelling of lung tissue due to left ventricular failure an inability of the left ventricle of the heart to adequately pump blood from the lungs into the arterial system.

Rapid deterioration of kidney function (acute kidney injury) and microangiopathic hemolytic anemia (destruction of blood cells) may also occur.

In these situations, rapid reduction of the blood pressure is mandated to stop ongoing organ damage. In contrast there is no evidence that blood pressure needs to be lowered rapidly in hypertensive urgencies where there is no evidence of target organ damage and over aggressive reduction of blood pressure is not without risks. Use of oral medications to lower the BP gradually over 24 to 48 hr is advocated in hypertensive urgencies.

In pregnancy

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Hypertension occurs in approximately 8-10% of pregnancies. Most women with hypertension in pregnancy have pre-existing primary hypertension, but high blood pressure in pregnancy may be the first sign of pre-eclampsia, a serious condition of the second half of pregnancy and puerperium.

Pre-eclampsia is characterised by increased blood pressure and the presence of protein in the urine. It occurs in about 5% of pregnancies and is responsible for approximately 16% of all maternal deaths globally. Pre-eclampsia also doubles the risk of perinatal mortality. Usually there are no symptoms in pre-eclampsia and it is detected by routine screening.

Symptoms of pre-eclampsia occur the most common are:

headache, visual disturbance (often "flashing lights"), vomiting, epigastric pain, oedema.

Pre-eclampsia can occasionally progress to a life-threatening condition called eclampsia, which is a hypertensive emergency and has several serious complications including:

vision loss, cerebral oedema,seizures or convulsions,renal failure,pulmonary oedema, disseminated intravascular coagulation (a blood clotting disorder).

In infants and children

Failure to thrive, seizures, irritability, lack of energy, and difficulty breathing can be associated with hypertension in neonates and young infants.

In older infants and children, hypertension can cause headache, unexplained irritability, fatigue, failure to thrive, blurred vision, nosebleeds, and facial paralysis.

Complications

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Remedy For Hypertension

Diagram illustrating the main complications of persistent high blood pressure.

Hypertension is the most important preventable risk factor for premature death worldwide.

It increases the risk of

ischemic heart disease strokes, peripheral vascular disease , other cardiovascular diseases, heart failure, aortic aneurysms diffuse atherosclerosis, pulmonary embolism

Hypertension is also a risk factor for :

congenitive impairment dementia ,

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Remedy For Hypertension

chronic kidney disease .

Other complications include:

Hypertensive retinopathy Hypertensive nephropathy

Pathophysiology

A diagram explaining factors affecting arterial pressure

In most people with established essential (primary) hypertension, increased resistance to blood flow (total peripheral resistance) accounting for the high pressure while cardiac output remains normal. There is evidence that some younger people with prehypertension or 'borderline hypertension' have high cardiac output, an elevated heart rate and normal peripheral resistance, termed hyperkinetic borderline hypertension.

These individuals develop the typical features of established essential hypertension in later life as their cardiac output falls and peripheral resistance rises with age. Whether this pattern is typical of all people who ultimately develop hypertension is disputed. The increased peripheral resistance in established hypertension is mainly attributable to structural narrowing of small arteries and arterioles, although a reduction in the number or density of capillaries may also contribute.

Hypertension is also associated with decreased peripheral venous compliance which may increase venous return, increase cardiac preload and, ultimately, cause diastolic dysfunction. Whether increased active vasoconstriction plays a role in established essential hypertension is unclear.

Pulse pressure (the difference between systolic and diastolic blood pressure) is frequently increased in older people with hypertension. This can mean that systolic pressure is abnormally high, but diastolic pressure may be normal or low — a condition termed isolated systolic hypertension. The high pulse pressure in elderly people with hypertension or isolated systolic hypertension is explained by increased arterial stiffness, which typically accompanies aging and may be exacerbated by high blood pressure.

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Many mechanisms have been proposed to account for the rise in peripheral resistance in hypertension. Most evidence implicates either:

Disturbances in renal salt and water handling, particularly abnormalities in the intrarenal renin-angiotensin system

and/or

Abnormalities of the sympathetic nervous system

These mechanisms are not mutually exclusive and it is likely that both contribute to some extent in most cases of essential hypertension. It has also been suggested that endothelial dysfunction and vascular inflammation may also contribute to increased peripheral resistance and vascular damage in hypertension.

DiagnosisTypical tests performed in hypertension

System Tests

Renal Microscopic urinalysis, proteinuria, serum BUN (blood urea nitrogen) and/or creatinine

Endocrine Serum sodium, potassium, calcium, TSH (thyroid-stimulating hormone).

Metabolic Fasting blood glucose, total cholesterol, HDL and LDL cholesterol, triglycerides

Other Hematocrit, electrocardiogram, and chest radiograph

Hypertension is diagnosed on the basis of a persistently high blood pressure. Traditionally, this requires three separate sphygmomanometer measurements at one monthly intervals. Initial assessment of the hypertensive people should include a complete history and physical examination.

With the availability of 24-hour ambulatory blood pressure monitors and home blood pressure machines, the importance of not wrongly diagnosing those who have white coat hypertension has led to a change in protocols. In the United Kingdom, current best practice is to follow up a single raised clinic reading with ambulatory measurement, or less ideally with home blood pressure monitoring over the course of 7 days.

Once the diagnosis of hypertension has been made, physicians will attempt to identify the underlying cause based on risk factors and other symptoms, if present. Secondary hypertension is more common in preadolescent children, with most cases caused by renal disease. Primary or essential hypertension is more common in adolescents and has multiple risk factors, including obesity and a family history of hypertension.

Laboratory tests can also be performed to identify possible causes of secondary hypertension, and to determine whether hypertension has caused damage to the heart, eyes, and kidneys. Additional tests for diabetes and high cholesterol levels are usually performed because these conditions are additional risk factors for the development of heart disease and require treatment.

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Serum creatinine is measured to assess for the presence of kidney disease, which can be either the cause or the result of hypertension. Serum creatinine alone may overestimate glomerular filtration rate and recent guidelines advocate the use of predictive equations such as the Modification of Diet in Renal Disease (MDRD) formula to estimate glomerular filtration rate (eGFR). eGFR can also provides a baseline measurement of kidney function that can be used to monitor for side effects of certain antihypertensive drugs on kidney function. Additionally, testing of urine samples for protein is used as a secondary indicator of kidney disease. Electrocardiogram (EKG/ECG) testing is done to check for evidence that the heart is under strain from high blood pressure. It may also show whether there is thickening of the heart muscle (left ventricular hypertrophy) or whether the heart has experienced a prior minor disturbance such as a silent heart attack. A chest X-ray or an echocardiogram may also be performed to look for signs of heart enlargement or damage to the heart.

PreventionMuch of the disease burden of high blood pressure is experienced by people who are not labelled as hypertensive. Consequently, population strategies are required to reduce the consequences of high blood pressure and reduce the need for antihypertensive drug therapy. Lifestyle changes are recommended to lower blood pressure, before starting drug therapy. The 2004 British Hypertension Society guidelinesproposed the following lifestyle changes consistent with those outlined by the US National High BP Education Program in 2002for the primary prevention of hypertension:

maintain normal body weight for adults (e.g. body mass index 20–25 kg/m2) reduce dietary sodium intake to <100 mmol/ day (<6 g of sodium chloride or <2.4 g of

sodium per day) engage in regular aerobic physical activity such as brisk walking (≥30 min per day, most days

of the week) limit alcohol consumption to no more than 3 units/day in men and no more than 2 units/day

in women consume a diet rich in fruit and vegetables (e.g. at least five portions per day); consume a diet with reduced content of saturated and total fat.

Effective lifestyle modification may lower blood pressure as much an individual antihypertensive drug. Combinations of two or more lifestyle modifications can achieve even better results.

ManagementLifestyle modifications

The first line of treatment for hypertension is identical to the recommended preventative lifestyle changes and includes: dietary changes physical exercise, and weight loss. These have

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all been shown to significantly reduce blood pressure in people with hypertension. If hypertension is high enough to justify immediate use of medications, lifestyle changes are still recommended in conjunction with medication. Different programs aimed to reduce psychological stress such as biofeedback, relaxation or meditation are advertised to reduce hypertension. However, in general claims of efficacy are not supported by scientific studies, which have been in general of low quality.

Dietary change such as a low sodium diet is beneficial. A long term (more than 4 weeks) low sodium diet in Caucasians is effective in reducing blood pressure, both in people with hypertension and in people with normal blood pressure. Also a diet rich in nuts, whole grains, fish, poultry, fruits and vegetables promoted by the National Heart, Lung, and Blood Institute lowers blood pressure. A major feature of the plan is limiting intake of sodium, although the diet is also rich in potassium, magnesium, calcium, as well as protein.

MedicationsSeveral classes of medications, collectively referred to as antihypertensive drugs, are currently available for treating hypertension. Prescription should take into account the person's cardiovascular risk (including risk of myocardial infarction and stroke) as well as blood pressure readings, in order to gain a more accurate picture of the person's cardiovascular profile.

If drug treatment is initiated the National Heart, Lung, and Blood Institute's Seventh Joint National Committee on High Blood Pressure (JNC-7) recommends that the physician not only monitor for response to treatment but should also assess for any adverse reactions resulting from the medication.

Reduction of the blood pressure by 5 mmHg can decrease the risk of stroke by 34%, of ischaemic heart disease by 21%, and reduce the likelihood of dementia, heart failure, and mortality from cardiovascular disease.

The aim of treatment should be to reduce blood pressure to <140/90 mmHg for most individuals, and lower for those with diabetes or kidney disease (some medical professionals recommend keeping levels below 120/80 mmHg). If the blood pressure goal is not met, a change in treatment should be made as therapeutic inertia is a clear impediment to blood pressure control.

Awareness

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Graph showing, prevalence of awareness, treatment and control of hypertension

The World Health Organization has identified hypertension, or high blood pressure, as the leading cause of cardiovascular mortality. The World Hypertension League (WHL), an umbrella organization of 85 national hypertension societies and leagues, recognized that more than 50% of the hypertensive population worldwide are unaware of their condition.

To address this problem, the WHL initiated a global awareness campaign on hypertension in 2005 and dedicated May 17 of each year as World Hypertension Day (WHD). Over the past three years, more national societies have been engaging in WHD and have been innovative in their activities to get the message to the public.

In 2007, there was record participation from 47 member countries of the WHL. During the week of WHD, all these countries – in partnership with their local governments, professional societies, nongovernmental organizations and private industries – promoted hypertension awareness among the public through several media and public rallies. Using mass media such as Internet and television, the message reached more than 250 million people.

As the momentum picks up year after year, the WHL is confident that almost all the estimated 1.5 billion people affected by elevated blood pressure can be reached.

Pulmonary Hypertension: Causes, Symptoms, Diagnosis, Treatment

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What is pulmonary hypertension?

Pulmonary hypertension is a rare lung disorder in which the arteries that carry blood from the heart to the lungs become narrowed, making it difficult for blood to flow through the vessels. As a result, the blood pressure in these arteries -- called pulmonary arteries -- rises far above normal levels. This abnormally high pressure strains the right ventricle of the heart, causing it to expand in size. Overworked and enlarged, the right ventricle gradually becomes weaker and loses its ability to pump enough blood to the lungs. This could lead to the development of right heart failure.

Pulmonary hypertension occurs in individuals of all ages, races, and ethnic backgrounds although it is much more common in young adults and is approximately twice as common in women as in men.

Why do the pulmonary arteries narrow?

Scientists believe that the process starts with injury to the layer of cells that line the small blood vessels of the lungs. This injury, which occurs for unknown reasons, may cause changes in the way these cells interact with the smooth muscle cells in the vessel wall. As a result, the smooth muscle contracts more than normal and narrows the vessel.

What are the symptoms of pulmonary hypertension?

Symptoms of pulmonary hypertension do not usually occur until the condition has progressed. The first symptom of pulmonary hypertension is usually

shortness of breath with everyday activities, such as climbing stairs. Fatigue, dizziness, fainting. Swelling in the ankles, abdomen or legs; bluish lips and skin, chest pain may occur as strain on the heart increases.

Symptoms range in severity and a given patient may not have all of the symptoms.In more advanced stages of the disease, even minimal activity will produce some of the symptoms.

Additional symptoms include:

irregular heart beat (palpitations or strong, throbbing sensation), racing pulse, passing out or dizziness, progressive shortness of breath during exercise or activity, difficulty breathing at rest.

Eventually, it may become difficult to carry out any activities as the disease worsens.

What causes pulmonary hypertension?

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The following are some known causes of pulmonary hypertension:

The diet drug "fen-phen." Although the appetite suppressant "fen-phen" (dexfenfluramine and phentermine) has been taken off the market, former fen-phen users have a 23-fold increase risk of developing pulmonary hypertension, possibly years later.

Liver diseases, rheumatic disorders, lung conditions. Pulmonary hypertension also can occur as a result of other medical conditions, such as chronic liver disease and liver cirrhosis; rheumatic disorders such as scleroderma or systemic lupus erythematosus (lupus); and lung conditions including tumors, emphysema, chronic obstructive pulmonary disease (COPD), and pulmonary fibrosis.

Certain heart diseases. Heart diseases including aortic valve disease, left heart failure, mitral valve disease, and congenital heart disease can also cause pulmonary hypertension.

Thromboembolic disease. A blood clot in a large pulmonary artery can result in the development of pulmonary hypertension.

Low-oxygen conditions. High altitude living, obesity, and sleep apnea can also lead to the development of pulmonary hypertension.

Genetic predisposition. Pulmonary hypertension is inherited in a small number of cases. Knowing that someone in the family had or has pulmonary hypertension should prompt you to seek early evaluation should symptoms occur.

Pulmonary hypertension may also be caused by other conditions, and in some cases, the cause is unknown.

How is pulmonary hypertension diagnosed?

Because pulmonary hypertension may be caused by many medical conditions, a complete medical history, physical exam, and description of your symptoms are necessary to rule out other diseases and make the correct diagnosis. During the physical exam, your health care provider will:

listen for abnormal heart sounds such as a loud pulmonic valve sound, a systolic murmur of tricuspid regurgitation, or a gallop due to ventricular failure.

examine the jugular vein in the neck for engorgement. examine the abdomen, legs, and ankles for fluid retention. examine nail beds for bluish tint. look for signs of other underlying diseases that might be causing pulmonary hypertension.

Other tests that might be ordered include:

Blood tests: o Complete metabolic panel (CMP): Examines liver and kidney function o Autoantibody blood tests, such as ANA, ESR, and others: Screens for collagen vascular

diseases o Thyroid stimulating hormone (TSH): A screen for thyroid problems o HIV: A screen for human immunodeficiency virus o Arterial blood gases (ABG): Determines the level of oxygen in arterial blood. o Complete blood count (CBC): Tests for infection, elevated hemoglobin, and anemia o B-type natriuretic peptide (BNP): A marker for heart failure

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Doppler echocardiogram: Uses sound waves to show the function of the right ventricle, to measure blood flow through the heart valves, and then calculate the systolic pulmonary artery pressure.

Chest X-ray: Shows an enlarged right ventricle and enlarged pulmonary arteries. 6 minute walk test: Determines exercise tolerance level and blood oxygen saturation level

during exercise. Pulmonary function tests: Evaluates for other lung conditions such as chronic obstructive

pulmonary disease and idiopathic pulmonary fibrosis among others. Polysomnogram or overnight oximetry: Screens for sleep apnea (results in low oxygen

levels at night). Right heart catheterization: Measures various heart pressures (ie, inside the pulmonary

arteries, coming from the left side of the heart), the rate at which the heart is able to pump blood, and finds any leaks between the right and left sides of the heart.

Ventilation perfusion scan (V/Q scan): Looks for evidence of blood clots along the pathway to the lungs.

Pulmonary angiogram: Looks for blood clot blockages in the pulmonary arteries. Chest CT scan: Looks for blood clots and other lung conditions that may be contributing to

or worsening pulmonary hypertension.

Tests To Look for the Underlying Cause of Pulmonary Hypertension

PH has many causes, so many tests may need to be done to find its underlying cause.

Chest CT scan. A chest computed tomography (to-MOG-ra-fee) scan, or chest CT scan, creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. These pictures can show signs of PH or a condition that may be causing PH.

Chest MRI. Chest magnetic resonance imaging, or chest MRI, shows how your right ventricle is working. The test also shows blood flow in your lungs. Chest MRI also can help detect signs of PH or an underlying condition causing PH.

Lung function tests. Lung function tests measure how much air you can breathe in and out, how fast you can breathe air out, and how well your lungs deliver oxygen to your blood. These tests can help detect a lung disease that may be causing PH.

Polysomnogram (PSG). This test records brain activity, eye movements, heart rate, and blood pressure while you sleep. A PSG also measures the level of oxygen in your blood. A low oxygen level during sleep is common in PH, and it can make the condition worse.

A PSG usually is done while you stay overnight at a sleep center. For more information about this test, go to the Health Topics Sleep Studies article.

Lung ventilation/perfusion (VQ) scan. A lung VQ scan measures air and blood flow in your lungs. This test can help detect blood clots in your lung's blood vessels.

Blood tests. Blood tests are used to rule out other diseases, such as HIV, liver disease, and autoimmune diseases (such as rheumatoid arthritis).

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Finding Out the Severity of Pulmonary Hypertension

Exercise testing is used to find out the severity of PH. This testing consists of either a 6-minute walk test or a cardiopulmonary exercise test.

A 6-minute walk test measures the distance you can quickly walk in 6 minutes. A cardiopulmonary exercise test measures how well your lungs and heart work while you exercise on a treadmill or bicycle.

During exercise testing, your doctor will rate your activity level. Your level is linked to the severity of your PH. The rating system ranges from class 1 to class 4.

Class 1 has no limits. You can do regular physical activities, such as walking or climbing stairs. These activities don't cause PH symptoms, such as tiredness, shortness of breath, or chest pain.

Class 2 has slight or mild limits. You're comfortable while resting, but regular physical activity causes PH symptoms.

Class 3 has marked or noticeable limits. You're comfortable while resting. However, walking even one or two blocks or climbing one flight of stairs can cause PH symptoms.

Class 4 has severe limits. You're not able to do any physical activity without discomfort. You also may have PH symptoms while at rest.

Over time, you may need more exercise tests to find out how well your treatments are working. Each time testing is done, your doctor will compare your activity level with the previous one.

Other Names for Pulmonary Hypertension

Group 1 pulmonary arterial hypertension (PAH) that occurs without a known cause often is called primary PAH or idiopathic PAH.

Group 1 PAH that occurs with a known cause often is called associated PAH. For example, PAH that occurs in a person who has scleroderma might be called "PAH occurring in association with scleroderma," or simply "scleroderma-associated PAH."

Groups 2–5 pulmonary hypertension (PH) sometimes are called secondary PH.

Who Is at Risk for Pulmonary Hypertension?

The exact number of people who have pulmonary hypertension (PH) isn't known.

Group 1 pulmonary arterial hypertension (PAH) without a known cause is rare. It affects women more often than men. People who have group 1 PAH tend to be overweight.

PH that occurs with another disease or condition is more common.

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PH usually develops between the ages of 20 and 60, but it can occur at any age. People who are at increased risk for PH include:

Those who have a family history of the condition. Those who have certain diseases or conditions, such as heart and lung diseases, liver disease,

HIV infection, or blood clots in the pulmonary arteries. (For more information about the diseases, conditions, and factors that cause PH, go to "Types of Pulmonary Hypertension.")

Those who use street drugs (such as cocaine) or certain diet medicines. Those who live at high altitudes.

Living With Pulmonary HypertensionPulmonary hypertension (PH) has no cure. However, you can work with your doctor to manage your symptoms and slow the progress of the disease.

Ongoing Care

Follow your treatment plan as your doctor advises. Call your doctor if your PH symptoms worsen or change. The earlier symptoms are addressed, the easier it is to treat them.

Some symptoms, such as chest pain, may require emergency treatment. Ask your doctor when you should call him or her or seek emergency care.

Also, talk with your doctor before taking any over-the-counter medicines. Some medicines can make your PH worse or interfere with the medicines you're taking for PH. Ask your doctor whether you should get a pneumonia vaccine and a yearly flu shot.

You may have a complex schedule for taking medicines. Call your doctor or nurse if you're having problems with this schedule. Knowing the names of your medicines and how they work is helpful. Keep a list of your medicines with you. Don't stop or change medicines unless you talk with your doctor first.

Pay careful attention to your weight. You may want to keep a daily record of your weight. You should weigh yourself at the same time each day. If you notice a rapid weight gain (2 or more pounds in 1 day or 5 or more pounds in 1 week), call your doctor. This may be a sign that your PH is worsening.

Pregnancy is risky for women who have PH. Consider using birth control if there is a chance you may become pregnant. Ask your doctor which birth control methods are safe for you.

Lifestyle ChangesMaking lifestyle changes can help you manage your symptoms. These changes will depend on the type of PH you have. Talk with your doctor about which lifestyle changes can help you.

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Quit Smoking

If you smoke, quit. Smoking makes PH symptoms worse. Ask your doctor about programs and products that can help you quit. Also, avoid exposure to secondhand smoke.

Follow a Healthy Diet

Following a healthy diet and maintaining a healthy weight are part of a healthy lifestyle. A healthy diet includes a variety of fruits, vegetables, and whole grains. It also includes lean meats, poultry, fish, and fat-free or low-fat milk or milk products. A healthy diet also is low in saturated fat, trans fat, cholesterol, sodium (salt), and added sugar.

Talk with your doctor about whether you need to limit the amount of salt and fluids in your diet. Ask him or her whether you also need to regulate foods that contain vitamin K. These foods can affect how well blood-thinning medicines work. Vitamin K is found in green leafy vegetables and some oils, such as canola and soyabean oil.

For more information about following a healthy diet, go to the NHLBI's Aim for a Healthy Weight Web site, "Your Guide to a Healthy Heart," and "Your Guide to Lowering Your Blood Pressure With DASH."

All of these resources include general advice about healthy eating.

Be Physically Active

Physical activity is an important part of a healthy lifestyle. Try to do physical activity, such as walking, regularly. This will keep your muscles strong and help you stay active. Ask your doctor how much activity is safe for you. Your doctor may tell you to limit or avoid certain activities, such as:

Those that cause straining, such as lifting heavy objects or weights. Sitting in a hot tub or sauna or taking long baths. These activities can lower your blood

pressure too much. Flying in an airplane or traveling to high-altitude areas. Your doctor may ask you to use extra

oxygen during air travel.

Avoid activities that cause breathing problems, dizziness, or chest pain. If you have any of these symptoms, seek care right away.

Emotional Issues and Support

Living with PH may cause fear, anxiety, depression, and stress. You may worry about your medical condition, treatment, finances, and other issues.

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Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Joining a patient support group may help you adjust to living with PH. You can see how other people who have the same symptoms have coped with them. Talk with your doctor about local support groups or check with an area medical center.

Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.

High Blood Pressure In Children Few children have signs, symptoms or adverse events though these are possible when hypertension is severe.

The main significance is the implication for the future in that these children are very likely to have hypertension in adulthood and indeed may start having tissue changes in adolescence.

Another important significance is that almost all hypertensive children younger than 15 years had secondary highbloodpressure. That is hypertension caused by a disease or condition. Only 25 % of 15 to 18 year olds with high readings had secondary hypertension. That’s still a lot more than the 5 % of adult hypertensives who have secondary type.

Thus it behooves us to look very persistently in children for secondary causes which are quite potentially curable. The best treatment for anything is to remove the cause.

Definition of High Blood Pressure in Children:

It is defined by Age, Sex, and Height.

Here it is: Three separate readings that are at or above the 95th percentile for that age, sex, and height.

Pre-Hypertension would be the 90th to the 95th percentile.

A few representative readings of high blood pressure in children would be:

A 5 year old boy at the 50th percentile of height would have hypertension at 112/72 mm Hg. Add 4 mm systolic for the 95th percentile and subtract 4 mm for the 5th.

A similar girl would be hypertensive at 110/72. Add and subtract 3 mm systolic for the 95th and 5th percentiles.

 

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A 15 year old boy at the 50th percentile of height should be less than 131/83. Add and subtract 4 mm for the 95th and the 5th.

A similar girl should be less than 127/83. Add 4 mm and subtract 3 mm at the 95th and 5th.

Doctor’s Practical Guide:

The American Academy of Pediatrics, the American Heart Association and the American Medical Association all recommend screening for high blood pressure in normal children starting at the age of

As noted above, the high chance of it being due to a secondary cause demands a diligent search for said cause. A considerable majority will turn out to be of renal origin.

Level of Severity Systolic Blood Pressure

Diastolic Blood pressure

Mild Hypertension 140-160 90-100Moderate Hypertension 160-200 100-120

Severe Hypertension Above 200 Above 120

Blood Pressure Range Chart Notes

NORMAL BLOOD PRESSUREBP READINGS RANGE

HIGH Blood Pressure Symptoms -Stressed, Sedentary, Bloated, Weak, Failing

Systolic - Diastolic

210 - 120 - Stage 4 High Blood Pressure180 - 110 - Stage 3 High Blood Pressure160 - 100 - Stage 2 High Blood Pressure140 -   90 - Stage 1 High Blood Pressure

140 - 90 - BORDERLINE HIGH130 - 85 - High Normal120 - 80 - NORMAL Blood Pressure110 - 75 - Low Normal

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 90 - 60 - BORDERLINE LOW

 60 - 40 - TOO LOW Blood Pressure 50 - 33 - DANGER Blood Pressure

LOW Blood Pressure Symptoms -Weak, Tired, Dizzy, Fainting, Coma

Blood Pressure Levels TableHere is essentially the same information

presented above, in tabular format,with notes at the bottom.

Comment Systolic Diastolic

PulsePressure(S - D) MAP

Far, Far, FarTOO HIGH

Medication IsABSOLUTELYNECESSARY

To PreventHeart Attackand Stroke

230 135 95 167225 130 95 162220 130 90 160215 125 90 155210 125 85 153205 120 85 148

200 120 80 147195 115 80 142190 115 75 140185 110 75 135

Way Too High -Medication Is

STRONGLY ADVISED

180 110 70 133175 105 70 128170 105 65 127165 100 65 122

Too High -Most Doctors

Will Prescribe Meds

160 100 60 120155 95 60 115150 95 55 113

Borderline -Some Doctors

Will Prescribe Meds

145 90 55 108140 90 50 107

135 85 50 102Good 130 85 45 100

125 80 45 95120 80 40 93

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Very Good

115 75 40 88110 70 40 83

105 70 35 82

Children and Athletes100 65 35 7795 65 30 75

90 60 30 70Too Low -

Meds May BeRequired To

Prevent Fainting(Syncope)

85 55 30 6580 55 25 6375 50 25 5870 50 20 57

Far, Far, FarToo Low -

MEDICATIONREQUIRED

65 45 20 5260 45 15 5055 40 15 4550 35 15 43

270-510 60 60 60 60

1. Why did I do this? I searched high and low on the Internet, and I could find nothing like this in one place - a Summary of human BP range, the Averages, and the Comments relating to each BP level.

2. How did I get the numbers? I started with the commonly seen "Systolic/ Diastolic pairs" seen in the literature - 200/120, 160/100, 140/90, 120/80 and 90/60. From there, I interpolated and extrapolated all the other numbers. Note that these are AVERAGE relationships. For instance, instead of 140/90, your BP may be 140/100, or 140/80. Each individual will have a unique systolic-diastolic relationship. If your S/D difference varies significantly from the averages shown above, this can be helpful in assessing your particular cardiovascular condition.

3. Fairly recently, the difference between Systolic and Diastolic pressure, named "Pulse Pressure", has been gaining interest in the research community. This Pulse Pressure has been found to correlate linearly with heart attack risk - the higher the number, the higher the risk. According to this theory, a BP of 140/ 90 (PP=50) is more desirable than a BP of 140/ 80 (PP=60).This PP relationship at each pressure appears to be almost linear.

4. As for the comments, I have "averaged" the references made in the literature, since not all doctors agree upon the pressures at which to treat, and how aggressively to treat (multiple medications, type of meds, etc.). You can rest assured that the pharmaceutical companies prefer that you take medication at 135/80, since they sell the meds. Most doctors are not

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so aggressive. Remember that ALL medications have side effects. Heart medications have more serious side effects than any other class of prescription drugs.

5. Be aware of the "Circadian Rhythm" cycle. Your Blood Pressure is highly influenced by the time of day. For normal people, the highest BP occurs about midday, and the lowest at about 3-4 AM in the morning. For some people, described as "non-dippers", this early morning BP dip does not occur. For these people, highest blood pressure usually occurs around 6 AM to 9 AM in the morning. Some doctors are not aware of this, and make erroneous assumptions. A non-dipper may see 150/95 in the morning, and 130/85 in the evening. Non-dipping is usually associated with abnormal sleep conditions, such as sleep apnea, heavy snoring, drug and alcohol abuse, etc.

6. One blood pressure reading means very little. The advice to "Have your blood pressure checked once a year" is useless. What time of day? Had you eaten less salty foods recently? Were you relaxed that day, when you are usually much more stressed? Had you recently exercised vigorously? You must check your BP far more often than once a year, especially if you show "borderline" readings. I can produce a very low, or very high blood pressure AT WILL, based upon what I do during the 24 hours prior to the measurement.

7. Beware of "white coat syndrome", which results in a much higher BP reading than normal, due to the authoritative doctor, the foreboding, sterile exam room, and the smells such as alcohol and disinfectant. All this is not relaxing. Some unaware doctors may prescribe medication, when in fact, you don't need it at all. As soon as you leave the office, your BP returns to normal. This is another great reason to use your own automatic BP wrist monitor, so that you come to know your own body, and the effects of stress, food, mood, sleep, and time of day.

8. MAP = Mean Arterial Pressure. Three formulas are used to compute MAP. All three produce very similar results.Above, I used Method #1 -MAP = DP + (1/3 (SP - DP))Ideal Mean Arterial Pressure is defined as 93 mm of mercury, which corresponds to 120/80.

Alternative Method #2 -Also, MAP = (2/3 DP) + (1/3 SP)

Alternative Method #3MAP = ((2*DP) + SP) / 3

where SP= Systolic Pressure,and DP= Diastolic Pressure

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Fluctuating Blood Pressure

...is not a big deal but what if fluctuating blood pressure predicts something that is a big deal?

Definitions of Fluctuating and Labile Blood Pressure:

Fluctuating blood pressure: This is not an official term in medicine. It merely means that the pressure varies from the desirable level to an undesirable level.

Labile blood pressure: Also called borderline hypertension. A condition in which the pressure is sometimes in the normo tensive range and sometimes in the hypertensive range.

This sounds a lot alike and as far as I know they are basically the same thing.

The Significance of Fluctuating Blood Pressure:

This depends on what percentage of the time your pressure is up and what percentage it is down:

Up a small % of the time: Then you will get only a small % of the adverse effects and risks of the higher pressure.

Up about one half of the time: You will get about one half of the adverse effects and risks.

Up most of the time: You will probably suffer most of the adverse

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effects of elevated pressure.

Doctor’s Practical Guide:

So the significance of the fluctuations in blood pressure is dependent on how high it goes and how long it stays up.

There is a further significance. There is something different about someone whose blood pressure is sometimes elevated. Today’s’ intermittent elevation is tomorrow’s sustained elevation. In other words it is a predictor of hypertension in the future.

This is a great opportunity and a very fertile area for natural measures to lower blood pressure and indeed prevent moving into the actual hypertensive state. Measures like:

Exercise Diet Smoking cessation Alcohol restriction (1 or 2 drinks a day) Weight loss (easier said than done) Sodium (salt) reduction Deep breathing exercises Herbs and other supplements.

These carry no real risk and can make a marvelously better you. The benefits of the measures go far beyond just eliminating fluctuations in blood pressure.

High Blood Pressure Diet: Foods to Avoid

1. Alcohol

People with high blood pressure should not drink alcohol. While studies have demonstrated that low levels of alcohol intake can have protective effects for the heart, and can possibly reduce the risk of developing high blood pressure, research has also clearly demonstrated that consuming alcohol in the setting of exisiting high blood pressure is unhealthy.

Alcohol directly raises blood pressure, and further acts to damage the walls of blood vessels, which can elevate the blood pressure further and make it more difficult to treat, while simultaneously increasing the risk of complications.

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2. Salt

In some people, eating too much salt can make high blood pressure much worse. In others, the same salt consumption may have no effect. The problem is that no doctor or scientist can tell which is the case for an individual patient until it is too late.

This, combined with the fact that too much salt is bad for the heart regardless of blood pressure status, means that reduced sodium is a strongly recommended part of a healthy diet. These recommendations are especially important in the setting of secondary high blood pressure due to kidney problems.

3. Fats

Saturated fats, especially trans-fats, are bad for both the heart and blood vessels. Because the circulatory system is already under a lot of stress in the setting of high blood pressure, extra strain can be devastating.

The balanced high blood pressure diet should include sparse amounts of saturated and trans-fats (red meat, fast food), and moderate amounts of other fats (olives, canola oil).

Sphygmomanometer

Electronic sphygmomanometer

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Aneroid sphygmomanometer with an adult cuff

Aneroid sphygmomanometer dial, bulb, and air valve

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Clinical mercury Manometer

A sphygmomanometer blood pressure meter (also referred to as a sphygmometer) is a device used to measure blood pressure, composed of an inflatable cuff to restrict blood flow, and a mercury or mechanical manometer to measure the pressure. It is always used in conjunction with a means to determine at what pressure blood flow is just starting, and at what pressure it is unimpeded. Manual sphygmomanometers are used in conjunction with a stethoscope.

The word comes from the Greek sphygmós (pulse), plus the scientific term manometer (pressure meter). The device was invented by Samuel Siegfried Karl Ritter von Basch in 1881. Scipione Riva-Rocci introduced a more easily used version in 1896. In 1901, Harvey Cushing modernized the device and popularized it within the medical community.

A sphygmomanometer consists of an inflatable cuff, a measuring unit (the mercury manometer, or aneroid gauge), and inflation bulb and valve, for manual instruments.

Operation

In humans, the cuff is normally placed smoothly and snugly around an upper arm, at roughly the same vertical height as the heart while the subject is seated with the arm supported. Other sites of placement depend on species, it may include the flipper or tail. It is essential that the correct size of cuff is selected for the patient. Too small a cuff results in too high a pressure, while too large a cuff results in too low a pressure.

For clinical measurements, it is imperative to measure both arms in the initial consultation, to determine if the pressure is significantly higher in one arm than the other. A difference of 10 mm Hg may be a sign of coarctation of the aorta.

Records notes should be made as to which arm measures the highest. Afterwards, measure the higher reading arm.

The cuff is inflated until the artery is completely occluded. Listening with a stethoscope to the brachial artery at the elbow, the examiner slowly releases the pressure in the cuff. As the pressure in the cuffs falls, a "whooshing" or pounding sound is heard when blood flow first starts again in the artery. The pressure at which this sound began is noted and recorded as the systolic blood pressure. The cuff pressure is further released until the sound can no longer be heard. This is recorded as the diastolic blood pressure.

In noisy environments where auscultation is impossible (such as the scenes often encountered in emergency medicine), systolic blood pressure alone may be read by releasing the pressure until a radial pulse is palpated (felt).

In veterinary medicine, auscultation is rarely of use, and palpation or visualization of pulse distal to the sphygmomanometer is used to detect systolic pressure.

Significance

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By observing the mercury in the column while releasing the air pressure with a control valve, one can read the values of the blood pressure in mm Hg. The peak pressure in the arteries during the cardiac cycle is the systolic pressure, and the lowest pressure (at the resting phase of the cardiac cycle) is the diastolic pressure. A stethoscope is used in the auscultatory method. Systolic pressure (first phase) is identified with the first of the continuous Korotkoff sounds. Diastolic is identified at the moment the Korotkoff sounds disappear (fifth phase).

Measurement of the blood pressure is carried out in the diagnosis and treatment of hypertension (high blood pressure), and in many other healthcare scenarios.

Types

There are three types of sphygmomanometers:

Digital with manual or automatic inflation. These are electronic, easy to operate, and practical in noisy environments. They measure mean arterial pressure (MAP) and use oscillometric detection to calculate systolic and diastolic values. In this sense, they do not actually measure the blood pressure, but rather derive the readings. Digital oscillometric monitors are also confronted with "special conditions" for which they are not designed to be used: arteriosclerosis; arrhythmia; preeclampsia; pulsus alternans; and pulsus paradoxus.

Digital portable finger blood pressure monitors with automatic inflation. These are more portable and easy to operate, although less accurate. They are the smallest blood pressure monitors.

Manual. Ideally operated by a trained person, mercury manometers are considered to be the gold standard and cannot be decalibrated , they are consistently accurate. Due to their accuracy, they are often required in clinical trials of pharmaceuticals and for clinical evaluations of determining blood pressure for high risk patients including pregnant women.

Aneroid (mechanical types with a dial) are in common use but they require regular calibration checks, unlike a mercury manometer. Aneroid sphygmomanometers are considered safer than mercury based, although less accurate.The prime reason for such maintenance is their susceptibility to bumps which can alter their accuracy. Wall mounted and mobile aneroids avoid this shortcoming. The aneroid sphygmomanometer should be checked for accuracy (usually every 6 months) by using a mercury manometer, as the gold standard.

The unit of measurement of blood pressure is millimeters of mercury (mmHg) and are usually given as an even number. Manual sphygmomanometers require a stethoscope for auscultation. Although it is possible to obtain a basic reading through palpation, this only yields the systolic number.

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Siddha aspect of hypertensionSiddhars call hypertension as “Kuruthiazhal” or “Irratha pitham”.

Definition of kuruthiazhal:

Due to external reasons pitham increases from its normal level and merge with the second udal thathu blood and increases the blood’s pressure and disturbs the normal parameters of blood.

Causes of kuruthiazhal:

It is caused due to the following reasons: Excessive exposure to hot sun, Taking more spicy,salty,sour and pungent taste foods frequently, Over indulgence in sex, Improper sleep habits.

Types of kuruthiazhal:

Ther are two thoughts in classifying this disease.1st type of classification: 8 types. They are:

1. Vali kuruthiazhal:2. Azhal kuruthiazhal:3. Iyam kuruthiazhal:4. Valiazhal kuruthiazhal:5. Valiiyam kuruthiazhal:6. Iyavali kuruthiazhal:

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7. Iyaazhal kuruthiazhal:8. Mukkutra kuruthiazhal:

2nd type of classification: 4 types. They are:1. Melnooku2. Keelnooku3. Iru nokku4. Azhalavilla nokku.

Symptoms of kuruthiazhal:

1. Headache2. Anorexia3. Nausea4. Vomiting5. Apthousulcer6. Guidiness7. Sleeplessness8. Breathlessness9. Palpitation10. Excessive sweeting11. Dysurea

Treatment:

The word siddha means “An object to be attained”, “Perfection” or “heavenly bliss”.”

The knowledge of siddha was hand over to siddhar’s by God Shiva.

Even though the siddhars are numerous, the Eighteen siddhars  are well known by the Tamil community.

Siddha is fully based on Panchabutha Theory ( Five element) and it emphasis a strong relationship between the universe and body.

Vatham, Pitham and Kapam that is three humours play important role in different functions of the body called Uyirthathu (Physiology). Disturbance in equilibrium of uyirthathu is called Mukkuttrum (Pathology). The Diagnosis, treatment and preventive care are based on three humours.

According to siddhars in case of hypertension reducing pitha is the main objective in treating hypertension.

Treatment in herbal medicine:

A Few Herbs For High Blood Pressure :

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According to the Natural Medicines there are fifteen supplements including herbs that are rated "Possibly Effective" in lowering blood pressure: Only stevia, garlic, green tea and oolong tea tea are herbs. The others are naturally occurring substances. All fifteen are listed here with comments:Alpha-linolenic acid: Reduces risk of hypertension by about one third. Good

preventive effect. Some safety concerns.

Blond psyllium: Reduces by 8 mm systolic and 2 mm diastolic. Good effect

Calcium: Very modest reductions. May not be worth the effort. Important in osteoporosis and should be taken in regard to this consideration. Bulky.

Cod liver oil: Modest effect. Bulky.

Coenzyme Q-10: May get up to 17 mm reduction in systolic and 10 mm in diastolic. 26% reduction in isolated systolic hypertension. Takes about 12 weeks to obtain full benefit. Excellent effect.

Fish oil: A modest effect, similar to cod liver oil. Bulky.Garlic: A 2 to 7% reduction. Modest effect. A food and bulky.Green tea and Oolong tea: One half to two cups a day for a year cuts the risk of developing high blood pressure by 46%. 600 ml a day (2 ½ cups) cuts risk by 65%. An excellent preventive effect Very bulky but available as an extract.

Olive or olive leaf extract: Some lowering effect. Has other benefits such as cholesterol lowering, reducing heart attacks and heart disease, and reducing risk of breast cancer and colorectal cancer and, oddly, rheumatoid arthritis.

Potassium: Reduces systolic 2-4 mm and diastolic 0.5 to 3.5 mm. Modest effect. Controls cardiac rhythm Both high and low levels are serious! We won’t meddle with this.

Pycnogenol (pine bark extract): Affects only systolic, reducing Stage One hypertensives (140-159) to about 133 mm Hg. Very good effect.

Stevia (stevioside): Reduces systolic by 10-14 mm and diastolic by 6-14 mm. Very good effect. Bulky.

Sweet orange (juice): Rich in potassium so the effect is that of potassium. Drink some orange juice. A food and bulky.

Vitamin C: Works only in conjunction with antihypertensive medication, otherwise has no effect. Does it work in conjunction with herbs that lower blood pressure? A study to this effect was not found. Why not try it and see?Wheat bran: Modest effects, but how much bran can you eat? A food and bulky.

A number of these are “foods”, are bulky and therefore can only be taken separately.

They are listed here:

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Blond psyllium Calcium Cod liver oil Fish oil Garlic. Can be extract. Green and Oolong teas. Can be extract. Olive oil. Can be extract. Stevia. Can be extract but still too bulky. Sweet orange Wheat bran

These must be considered singly because of their bulk except for the ones that can be made into extracts or concentrates of their active ingredients.

High Blood Pressure Natural Remedies:

Taking naturally occurring substances: Potassium: This works. Expect an average reduction in systolic pressure of 4.4

mm Hg. Calcium: This works but to a lesser extent, perhaps a third as much as

potassium. Look for an average of 1.4 mm Hg. Fish oil supplementation: As good as potassium. Expect about 4.5 mm Hg

reduction in systolic pressure. Unpleasant side-effects for 1/3 of people. Magnesium: Frequently touted as one of the high blood pressure natural

remedies. Inadequate data provides no reason to believe it works. Small studies demonstrated mixed results.

Avoiding naturally occurring substances: Salt (Sodium chloride) : Provides some of the best results in pressure reduction.

Cut your salt by a little more than half and see a 6.8 mm Hg reduction in systolic.

Saturated fat: Eating vegetables and fruits and other preferred food in place of saturated fats reduces systolic by 5.5 mm Hg.Excellent.

Excess alcohol: Hold it down to 2 or 3 drinks a day and see a 2.6 mm Hg reduction. African-American men get twice as much benefit.

Caffeine and Nicotine: These substances have a transient effect on blood pressure and don’t contribute to a sustained elevation. Elimination of these does not affect average blood pressure. We all can think of reasons to quit smoking.

Lifestyle modifications: Proper diet: Eating fruits, vegetables, nuts and low-fat dairy products lowers

blood pressure by 5.5 mm Hg systolic and you don’t have to lose weight. Exercise: My favorite. Expect at least 4 mm Hg reduction. Many other benefits

as well. Weight loss: 4.5 mm Hg systolic drop. Could be a lot more. Other benefits

accrue not the least of which are looking good and feeling good”.

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Aravindh Herbal Remedy For High Blood Pressure:Few people know which herbs that lower blood pressure can be effective and how much to take. Don’t waste your efforts.

How nice it would be to have a combination of supplements or herbs that lower blood pressure all in one capsule. This is available right now in aravindh herbals. Read this physician’s guide...

It’s the capsule “HERBO SERPIN” which contains the following ingredients:

1. Rauvolfia serpentine2. Andrographis paniculata3. Vetriveria zizanioides4. Citrus reticulate5. Santalum album6. Tricosanthes cucumerina7. Cyperus rotundus8. Zingiber officinale9. Piper nigrum10.Withania somnifera

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Action of the ingredients in Herboserpin:

The action of the ingredients are mentioned with a detailed study of each and every ingredients of the capsule on scientific basis.

Read the following to understand the capsule’s action to control hypertension.

Rauvolfia serpentina

Kingdom: Plantae

Division: Magnoliophyta

Class: Magnoliopsida

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Order: Gentianales

Family: Apocynaceae

Genus: Rauvolfia

Species: Serpentine

Botanical name:

Rauvolfia Serpentine

Distribution

Rauvolfia serpentina, or 'snakeroot' or 'sarpagandha' is a species of flowering plant in the family Apocynaceae. It is native to South and East Asia (from India to China and Indonesia) The plant is found in almost all parts of India up to an altitude of about 1000 meters. It grows in Bengal, Bihar, Uttar Pradesh, Sri Lanka, Burma and Jawa, in abundance.

Morphology

An erect glabrous shrub grows 0.33-1 meter in height. The leaves whorled, 7-15 cm long and 5-6 cm broad, bright green above and pale beneath. The flowers about 1.5 cm long, petals white or pinkish. or red, occurring in whorls. Peduncle deep red, in small clusters. The fruits, drupes, small, round, dark purple when ripe. The roots 40 cm long and 2 cm in diameter, hard when dry, grayish in color. It is the roots of the plant that are mainly used for medicinal purposes.

Chemical Contents

The root contains an alkaloid ophioxylin, an orange colored crystalline principle, resin, st

and wax. The total alkaloid yield is 0.5%.

Five crystalline alkaloids isolated are ajmaline. Ajmalicine, serpentine, serpent-tinine and yohimbine.

Other constituents identified are phytosterol, oleic acid and unsaturated alcohols or formula C25 H44O2.

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The root also contains a lot of resin and starch and when incinerated leaves about 8% of ash consisting mainly of potassium carbonate, phosphate, silicate and traces of iron and manganese.

About 7 species of Rauwolifa are uninvestigated. Structure elucidation of reserpine and deserpidine; essential oil (0.22%) from roots yielded chief terpene constituent – serpoterpine.

Detection of reserpine, reserpinine, yohimbine, ajmaline, serpentine and serpentinine by PC. Stereo-chemical studies in structure elucidation of yohimbine and reserpine.Bio chemicals isolated from it’s root are ajmaline, ajmalicine, reserpine, sarpagine, yohimbine, deserpidine, rescinnamine aricine and serpiline.

Medicinal uses

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Sarpagandha is bitter and pungent in taste, pungent in the post digestive effective and has hot potency. It alleviates kapha and vata doshas but aggravates the pitta dosha.

It has a special potency as a sedative, anti-epileptic and anti-hysteric. It possesses light and dry attributes. It is beneficial in the treatment of hypertension (ati asrabhinodana), fever, psychogenic disorders (manasa roga) and worm infestations.

The extract of the plant has also been used for millennia in India — Alexander the Great administered this plant to cure his general Ptolemy of a poisoned arrow.

It was reported that Mahatma Gandhi took it as a tranquilizer during his lifetimeA compound which it contains called reserpine, is used to treat high blood pressure and mental disorders including schizophrenia, and was particularly popular for that purpose in the West from 1954 to 1957.

It has been used for millennia as an antidote against bites of venomous reptiles.

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The wood, commonly known as serpentwood, is mildly popular amongst woodcarving and woodturning hobbyists.Sarpagandha is a famous tranquilizer and antipsychotic herb of India for the treatment of paranoia and schizophrenia, as well as a substance that controls hypertension..

Although this plant was well known in India, westerners paid no attention to it until an Indian physician wrote an article on rauvolfia in 1943. Because of the drug's noted sedative effects, it was used to treat over a million Indians in the 1940s for high blood pressure.

After a U.S. physician named Wilkins demonstrated the positive effects of reserpine (1952), the plant made front page news. This drug rapidly replaced electric shock and lobotomy as treatments for certain types of mental illness.

Moreover, knowledge about the chemistry of this natural plant stimulated the synthesis of other similar alkaloids that are now used as major tranquilizers.

The Sanskrit word sarpagandha literally means one which smells like a serpent. It is mentioned in all ancient Ayurvedic scriptures for its special property, as a sedative. It is also cited to have a special potency as an anti-epileptic and as a remedy for gysteria.

Maharishi Charka has categorized it as svapna janana – sedative Sarpagandha, during last few decades, has attracted the attention of the scientists for its anti hypertensive property.

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The roots of sarpagandha orally, it is used in gastrointestinal maladies like anoresia, dyspe-psia, worms and abdominal pain. For this purpose, sarpagandha, kutaja bark skin and vyaghri eranda roots are mixed (in 1:2:3 proportion) and given with the milk. It destroys ama and eliminates vata from the gut.

In fever associated with delirium or agitation, sarpagandha works well as it relieves the fever, along with digests the ama.

In hypertension the paste of its roots, mixed with rose water and rock candy ameliorates mental stress. Headache, giddiness and induces sound sleep.

In hyper excited patients of hysteria and epilepsy, sarpagandha renders a calming effect on mind. It also acts as a catalyst to sadhaka pitta and imparts a nervine activity.

In insomnia, it works well when given along with ghee.

Sarpagandha works well with Kutaj skin, given with the buttermilk in treating bacillary dysentery. In chronic fever, the root powder is given by itself.

In serpant bite, the powder of its roots is given orally, as well as, applied topically on the site of bite.

Sarpagandha , being an uterine stimulant, is beneficial in dysmenorrheal and is salutary in the delivery of the placenta and to augment the uterine contractions (labor pains).

In males, it is used to suppress the excessive sexual vigor, as it depresses the libido. The juice of the leaves is used as a remedy for the removal of opacities of the cornea.

Recently, Sarpagandha has regained the attraction of scientists as a safe antihypertensive medicine.

Adulteration

While selecting the raw material (root), care should be taken to see that the bark is intact. If the bark is peeled off, the quality of the root is severely affected as the bark contains more alkaloid than the woody portion. Among commercial supplies, this raw material is often adulterated with stems of Rauwolfia serpentine, roots of other Rauwolfia species and roots of the Clerodendrum species.

Pharmacological action Constituent that helps lower high blood pressure: Reserpine, an alkaloid substance with powerfulsedativeeffectfoundintheroot.

Although this herb is best known for treating high blood pressure, it is used in Indian folk medicine as remedy for mental disorders too. The role of reserpine in reducing blood pressure can be described as follows.

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Dopamine, epinephrine (adrenaline), and noradrenaline are a group of hormones (neurotransmitters) known collectively as catecholamines. These are produced in the adrenal glands and are released into the bloodstream in response to physical or emotional stress.Noradrenaline constricts the blood vessels increasing the blood pressure and adrenaline increases the heart rate and metabolism.

Reserpine works by significantly lowering catecholamines stores in adrenergic nerves and in the heart. This slows down the heart rate and helps open up capillaries and arterioles which in turn cause areductioninbloodpressure. The powdered root of Rauwolfia serpentina contains not less than 0.15 percent of alkaloids calculated as reserpine. Studies conducted to determine the effect of R.serpentinarootonbloodpressurefoundthat reserpine is effective in reducing systolic blood pressure approximately to the same degree as otherfirstlineanti-hypertensivedrugs.

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Andrographis paniculata

Kingdom: Plantae

Division: Angiosperms

Class: Eudicots

Order: Lamiales

Family: Acanthaceae

Genus: Andrographis

Species: paniculata

Botanical name:

Andrographis paniculata

Distribution

Andrographis paniculata is a herbaceous plant in the family Acanthaceae, native to India and Sri Lanka.

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It is widely cultivated in Southern and Southeastern Asia. Mostly the leaves and roots were used for medicinal purposes.

The genus Andrographis consists of 28 species of small annual shrubs essentially distributed in tropical Asia. Only a few species are medicinal, of which A. paniculata is the most popular.

A. paniculata is distributed in tropical Asian countries, often in isolated patches. It can be found in a variety of habitats, such as plains, hillsides, coastlines, and disturbed and cultivated areas such as roadsides, farms, and wastelands.

Native populations of A. paniculata are spread throughout south India and Sri Lanka which perhaps represent the center of origin and diversity of the species.

The herb is an introduced species in northern parts of India, Java, Malaysia, Indonesia, the West Indies, and elsewhere in the Americas.

The species also occurs in Hong Kong, Thailand, Brunei, Singapore, and other parts of Asia where it may or may not be native. The plant is cultivated in many areas, as well.

Unlike other species of the genus, A. paniculata is of common occurrence in most places in India, including the plains and hilly areas up to 500 m, which accounts for its wide use.

Morphology

Andrographis paniculata is an erect annual herb extremely bitter in taste in all parts of the plant body. The plant is known in north-eastern India as Maha-tita, literally "king of bitters".

As an Ayurveda herb it is known as Kalmegh or Kalamegha, meaning "dark cloud".

It is also known as Bhui-neem, meaning "neem of the ground", since the plant, though being a small annual herb, has a similar strong bitter taste as that of the large Neem tree (Azadirachta indica).

In Malaysia, it is known as Hempedu Bumi, which literally means 'bile of earth' since it is one of the most bitter plants that are used in traditional medicine.

Description

Andrographis paniculata grows erect to a height of 30–110 cm in moist, shady places.

The slender stem is dark green, squared in cross-section with longitudinal furrows and wings along the angles.

The lance-shaped leaves have hairless blades measuring up to 8 centimeters long by 2.5 wide.

The small flowers are borne in spreading racemes.

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The fruit is a capsule around 2 centimeters long and a few millimeters wide. It contains many yellow-brown seeds.

Cultivation

It does best in a sunny location. The seeds are sown during May and June. The seedlings are transplanted at a distance of 60 cm x 30 cm.

Chemical contents

Andrographolide is the major constituent extracted from the leaves of the plant which is a bicyclic diterpenoid lactone. This bitter principle was isolated in pure form by Gorter (1911).

Such other activities as liver protection under various experimental conditions of treatment with galactosamine, paracetamol etc. are also attributed to Andrographolide.

The hepatoprotective action of andrographolide is related to the activity of certain metabolic enzymes.

Systematic studies on chemistry of A. paniculata have been carried out.Some known constituents are:

"14-Deoxy-11-dehydroandrographolide, Plant 14-Deoxy-11-oxoandrographolide, Plant 5-Hydroxy-7,8,2',3'-Tetramethoxyflavone, Plant 5-Hydroxy-7,8,2'-Trimethoxyflavone, Tissue Culture Andrographine, Root Andrographolide, Plant Neoandrographolide, Plant Panicoline, Root Paniculide-A, Plant Paniculide-B, Plant Paniculide-C, Plant"

Andrographis contains andrographolide, deoxyandrographolide and neoandrographolide, 5,7, tetramethoxyflavanone and 5-hydroxy-7, trimethoxyflavone, as well as several other flavonoids and polyphenols.

Medicinal use

Since ancient times, A. peniculata is used in traditional Siddha and Ayurvedic systems of medicine as well as in tribal medicine in India and some other countries for multiple clinical applications.

From a biomedicinal perspective, the therapeutic value of Kalmegh is due to its mechanism of action which is perhaps by enzyme induction.

The plant extract exhibits antityphoid and antifungal activities.

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Kalmegh is also reportedto possess

antihepatotoxic, antibiotic, antimalarial, antihepatitic, antithrombogenic, antiinflammatory, anti-snake venom, antipyretic immunostimulant agent.

A study conducted at BastyrUniversity, showed a significant rise in the mean CD4 lymphocyte level of HIV subjects after administration of 10 mg/kg andrographolide, the chief constituent extracted from the leaves of the plant.

The herb has shown an ability to reduce inflammation (heat) and fight viral infection, and is used as a principal ingredient in traditional Chinese medicinal formulas for lung support from colds.

The herb is the well-known drug Kalmegh 'green chiretta', and forms the principal ingredient of a household medicine used as a bitter tonic and febrifuge.

The Tamils have been using Nilavempu - as it is called in Tamil - for centuries. In Siddha medicine, Andrographis Paniculata is used widely to treat fevers like chikenguinea, swine-flu, typhoid etc.

DiabetesThe ethanolic extract of andrographis  possesses antidiabetic property. Its antidiabetic effect may be attributed at least in part to increased glucose metabolism.

Familial Mediterranean Fever Standardized fixed combination of Andrographis paniculata Nees, with Eleutherococcus senticosus Maxim, Schizandra chinensis Bail. and Glycyrrhiza glabra L. extracts a good result in patients with Familial Mediterranean Fever.

Herpes Simplex

Andrographis paniculata inhibits herpes simplex I activity in vitro.

Immune systemMost flavonoids have anti-microbial activity and have a positive effect on the immune system. Andrographis has demonstrated significant activity in fighting common cold, flu, and upper respiratory infections.

MalariaAnti-malarial activity of some xanthones isolated from the roots of Andrographis paniculata..

Mind and mental effect & Hypertension

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Andrographis extract exhibited a significant alteration in behavior pattern and a reduction in spontaneous motility in animals.

The extract also produced a prolongation of the pentobarbitone-induced sleeping time and lowered the body temperature in different experimental animal models.

This proved its action in lowering stress and hypertension simultaneously.

Rheumatoid arthritisEfficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms:

Andrographis paniculata possesses anti-inflammatory effects, attributed to the main constituent andrographolide proposed as alternative in the treatment of autoimmune disease.

A prospective, randomized, double blind, and placebo-controlled study in patients with rheumatoid arthritis was performed. Tablets made of an extract of A. paniculata (30% total andrographolides) were administered three times a day for 14 weeks, after a 2-week washout period to 60 patients with active RA.

The intensity of joint pain decreased .A significant diminishing in tender joint, number of swollen joints, total grade of swollen joint, number of tender joints, total grade of swollen joints was observed within the group with the active drug.

Moreover, it was associated to a reduction of rheumatoid factor, IgA, and C4.

These findings suggest that A. paniculata herb could be a useful natural complement in the treatment of rheumatoid arthritis.

Pharmacological action

Andrographis paniculata plant extract is known to possess a variety of pharmacological activities.

Andrographolide is a bitter water-soluble lactone exhibiting protective effects in carbon tetrachloride induced hepatotoxicity in rats.

Its LD in male mice was 11.46 gm/kg, ip. This bitter principle was isolated in pure form by Gorter (1911). Such other activities as liver protection under various experimental conditions of treatment with galactosamine, paracetamol etc. are also attributed to andrographolide.

The hepatoprotective action of andrographolide is related to activity of certain metabolic enzymes.

Andrographolide, the major constituent of the extract, is implicated in its pharmacological activity. A study has been conducted on the cellular processes and targets modulated by andrographolide treatment in human cancer and immune cells.

Andrographolide treatment inhibited the in vitro proliferation of different tumor cell lines, representing various types of cancers. The compound exerts direct anticancer activity on

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cancer cells by cell cycle arrest at G0/G1 phase through induction of cell cycle inhibitory protein p27 and decreased expression of cyclin dependent kinase 4 (CDK4).

Immunostimulatory activity of andrographolide is evidenced by increased proliferation of lymphocytes and production of interleukin 2.

Andrographolide also enhanced the tumor necrosis factor α production and CD marker expression, resulting in increased cytotoxic activity of lymphocytes against cancer cells, which may contribute for its indirect anticancer activity.

The in vivo anticancer activity of the compound is further substantiated against B16F0 melanoma syngenic and HT 29 xenograft models. These results suggest that andrographolide is an interesting pharmacophore with anticancer and immunomodulatory activities and hence has the potential for being developed as a cancer therapeutic agent

In one Chilean study, the herb had a significant drying effect on the nasal secretions of cold sufferers who took 1,200 milligrams of andrographis extract daily for five days.

A systematic review of the literature and meta-analysis of randomized controlled trials also suggested the herb alone or in combination with eleuthero may be an appropriate alternative treatment of uncomplicated acute upper respiratory tract infection.

A recent(2011)randomised, double-blind, multicentre,study found Andrographis paniculata as effective as mesalazine (mesalamine) in ulcerative colitis.

Further, andrographolide inhibits interleukin-6 expression and suppresses prostate cancer cell growth in vitro.

Andrographis has been shown to be a safe traditional botanical for supporting upper respiratory tract health, per analysis of seven double-blind controlled trials.

The herb has been shown to inhibit RANTES secretion in inflamed bronchial cells.

RANTES is a chemoattractant for eosinophils, monocytes and lymphocytes that is stored in, and released by, platelets and activated T-cells.

In related research: Andrographolide, an active ingredient in Andrographis, has been shown to be responsible for the herb's inflammatory modulating actions, including the reduction of cytokine and peritoneal deposition of neutrophils, and modulation of lung inflammation in vivo.

Extracts of Andrographis exhibit potent inflammatory modulating and antioxidant actions in mouse models.

Andrographis paniculata extracts are mosquito repellent and can also be adulticidal to mosquitoes, viz., Culex quinquefasciatus and Aedes aegypti.

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Vetiveria zizanioides.

Kingdom: Plantae

Division: Angiosperms

Class: Commelinids

Order: Poales

Family: Poaceae

Genus: Vetiveria

Species: Zizanioides

Botanical name:

Vetiveria zizanioides

Distribution

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Chrysopogon zizanioides, commonly known as vetiver (from Tamil), is a perennial grass of the Poaceae family, native to India. In western and northern India, it is popularly known as khus. Though it originates in India, vetiver is widely cultivated in the tropical regions of the world. The world's major producers include Haiti, India, Java, and Réunion.

Morphology

Vetiver can grow up to 1.5 metres high and form clumps as wide. The stems are tall and the leaves are long, thin, and rather rigid; the flowers are brownish purple. Unlike most grasses, which form horizontally spreading mat-like root systems, vetiver's roots grow downward, 2–4 metres in depth.

Vetiver is most closely related to Sorghum but shares many morphological characteristics with other fragrant grasses such as lemongrass (Cymbopogon citratus), citronella (Cymbopogon nardus, C. winterianus), and Palmarosa (Cymbopogon martinii

The most commonly used commercial genotypes of vetiver are sterile (do not produce fertile seeds), and because vetiver propagates itself by small offsets instead of underground stolons, these genotypes are noninvasive and can easily be controlled by cultivation of the soil at the boundary of the hedge.

The vetiver grass has a gregarious habit and lives in bunches.

Shoots growing from the underground crown make the plant frost and fire resistant and allow it to survive heavy grazing pressure.

The leaves can become up to 120-150 centimeters long and 0.8 centimeters wide.

The inflorescence is a panicle of numerous slender racemes in whorls on a central axis. The panicles are 15-30 centimeters long and have whorled, 2.5-5.0 centimeters long branches.

The spikelets are grey-green or purplish in colour and in pairs. One is sessile and the other is pedicelled. Those of each pair are more or less alike in shape and size, different in sex and 2-flowered. The lower floret is reduced to a lemma. Upper is bisexual in the sessile. Male is in the pedicelled spikelet, glumes armed with short, tubercle-based spines, lemmas awn-less, palea minute.

The flowers grey, purplish, in slender racemes 10-30 cm in length. The fruits are oblong grains; the roots are hairy and aromatic and flowers in June.

The plant stems are erect and stiff. They can persist deep water flow. Under clear water, the plant can survive up to 2 months.

The root system of vetiver is finely structured and very strong. It can grow 3–4 meters deep within the first year. Vetiver has no stolons nor rhizomes.

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Because of all these characteristics, the vetiver plant is highly drought tolerant and can help to protect soil against sheet erosion. In case of sediment deposition, new roots can grow out of buried nodes. The Vetiver System, a technology of soil conservation and water quality management, is based on the use of the vetiver plant.

Chemical contents

A volatile oil resins, coloring agents, iron oxide and lime salts have isolated from the plant.

Khusimal, zizanol and isovalesenol are isolated from essential oil together with a new sequiterpene alcohol which was characterized.

A new epoxy alchoholkhusinol oxide-isolated from oil and its structure established Cyclopacamphenol, epicyclocopacamphenol, vetiselinenol and zizanol isolated and their structures elucidated Tetrahedron.

Vetiver oil or khus oil is a complex oil containing over 100 identified components, typicall.They are:

benzoic acid furfurolvetivene vetivenyl vetivenateterpinen-4-ol 5-epiprezizaneKhusimene -muuroleneαKhusimone Calacorene

-humuleneβ -longipineneα-selineneγ -selineneδ-cadineneδ valencene

Calarene,-gurjunene -amorpheneαEpizizanal 3-epizizanolKhusimol Iso-khusimolValerenol -vetivoneβ

-vetivoneα vetivazulene

Structure of α-vetivone, the main fragrant component of the oil of vetiver.

Structure of khusimol, another fragrant component of the oil of vetiver.

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Structure of β-vetivone, another fragrant component of the oil of vetiver.

Vetiveer’s oil:

The oil is amber brown and rather thick.

The odor of vetiver oil is described as deep, sweet, woody, smoky, earthy, amber, balsam.

The best quality oil is obtained from roots that are 18 to 24 months old.

The roots are dug up and cleaned then dried. Before the distillation, the roots are chopped and soaked in water. The distillation process can take up to 18 to 24 hours.

After the distillate separates into the essential oil and hydrosol, the oil is skimmed off and allowed to age for a few months to allow some undesirable notes which form during the distillation to dissipate.

Like patchouli and sandalwood essential oils, the odor of vetiver develops and improves with aging.

The characteristics of the oil can vary significantly depending on where the grass is grown and the climate and soil conditions.

The oil distilled in Haiti and Réunion has a more floral quality and is considered of higher quality than the oil from Java which has a smokier scent.

In the north of India, oil is distilled from wild-growing vetiver. This oil is known as Khus or Khas and is considered superior to the oil obtained from the cultivated variety. It is rarely found outside of India as most of it is consumed within the country.

Medicinal use

The commercial importance of roots is confirmed from the incidence of leving duty on vetiver roots by the king of Kannauj in 12 th century.

Vetiver grass is grown for many different purposes.

The plant helps to stabilise soil and protects it against erosion, but it can also protect fields against pests and weeds.

Vetiver has favourable qualities for animal feed.

From the roots, oil is extracted and used for cosmetics and aromatherapy.

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Due to its fibrous properties, the plant can also be used for handicraft, ropes and else.

Vetiver roots

The leaves of vetiver are a useful byproduct to feed cattle, goats, sheep and horses. The nutritional content depends on season, growth stage and soil fertility. Under most climates, nutritional values and yields are best if vetiver is cut every 1-3 months.

Young Vetiver Mature Vetiver Old Vetiver

Energy [kcal/kg] 522 706 969

Digestibility [%] 51 50 -Protein [%] 13.1 7.93 6.66Fat [%] 3.05 1.30 1.40

Vetiver is mainly cultivated for the fragrant essential oil distilled from its roots.

It is contained in 90% of all western perfumes Réunion is considered to produce the highest quality vetiver oil called "bourbon vetiver" with the next favorable being Haiti and then Java.

In the hot summer months in India, sometimes a muslin sachet of vetiver roots is tossed into the earthen pot that keeps a household's drinking water cool. Like a bouquet garni, the bundle lends distinctive flavor and aroma to the water.

Usira is one of the best refrigerant herbs that cools and calms the entire body and mind, with its influence spreading throughout the circulatory, digestive, reparatory, and urinary and nervous systems.

It enjoys an important place among medicinal herbs in India since ancient times. The great sage Charka has categorized it as varnya {complexion improving herb}, dahaprasamana – {refrigerant}, angamarda prasamana {relieves body pains}, chardi nigrahana {anti emetic}, stanya janana{ galactogogue} and svedapanayana{ alleviates the excessive sweating}.

It has been cited also to be jvaraghna {anti- pyretic}, pacana{ digestant}, trsnaghna{relieves the thirst} and raktapittahara{ mitigates blood diathesis}.

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The commercial importance of roots is confirmed from the incidence of leving duty on vetiver roots by the king of Kannauj in 12 th century.

Usira is bitter and sweet in taste, pungent in the post digestive effect and has cold potency.

It alleviates pitta and kapha doshas, but aggravates the vata dosha.

As it is fragrant, is deodorant.

It is also diuretic and a rejuvenative. It alleviates the blood diseases, excessive thirst, dysuria, fever, skin disorders and the burning sensation of the body .

The paste of usira and sandal wood is applied on skin, in burning sensation.

In prickly heat, the paste of usira, coriander fruit and musta is applied with benefit.

The paste of usira roots is applied by itself to alleviate the burning sensation, excessive sweating and foul body smell.

It is also beneficial in various skin ailments to improve the complexion of the skin. Usually, the thin paste of its roots is applied in summer season, to pacify the vitiated pitta.

To control the excessive sweating (hyperhidrosis), it is used externally and internally also. Orally, the fine powder of its roots, approximately 2-3 grams, is given with rock candy and milk. It ameliorates the burning sensation of the body.

Because of its bitter taste, it is an appetizer and digestant, and cold potency aids in alleviating vomiting, excessive thirst and also arrests bleeding. Hence, it is benevolent in treating anorexia, dyspepsia, thirst, vomiting and diarrhea.

It also destroys ama, so effectively used in diarrhea of pitta type. The decoction of usira, musta, dhanyaka, bilva, lajjalu, dhataki, lodhra and sunthi is given with honey to mitigate diarrhea associated with the fever and bleeding.

It is also effective to treat colitis due to vitiated pitta.

The cold infusion works well to control vomiting.

The root powder of usira, combined with honey, relieves the phlegm and so used in asthma, coughs and hiccup. In such conditions, the smoking of usira root powder in a form of cigarette is often recommended.

Usira is a valuable blood purifier, destroys ama and toxins. To alleviate the burning sensation, it works well with sugar.

In the bleeding disorders, Rakta pitta, the decoction of usira, chandana for better results.

It also serves to strengthen the nerves and imparts a pacifying effect on brain in nervine debility due to pitta.

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In hysteria, unconsciousness and chronic alcoholism, the decoction of usira, jatamansi and parpata is used with benefit.

Usira alleviates the vitiation of pitta and works well a lactodepurant and galactogogue.

The cold infusion with sugar imparts a diuretic action and alleviates dysuria of pitta type.

Many a times, the decoction of the roots of usira, iksu and darbha along with raktacandana is of special benefit in dysuria.

The general burning sensation of the body is tackled, by giving the misture of usira, rose petals, karcura and rock candy alongwith the milk.

The cardiac pan is said to get relieved with the mixture of usira and pimpala mula, when given along with ghee.

The cold infusion or decoction of usira and patha is commonly recommended in treating fever.

In treating erysipelas, the decoction of usira, amalaki, sariva and musta is very effective.

The bleeding per rectum and anal canal in Rakta pitta is controlled by the milk, medicated with usira, kamala and sunthi.

When locally applied in rheumatism, lumbago and sprain, it is a good ambrocation and affords relief.

The plant is used as an anthelmintic for children.

The oil is reported to be used as a carminative in flatulence, colic and obstinate vomiting.

It is regarded as a stimulant, refrigerant and antibacterial and when applied externally, it removes excess heat from the body and gives a cooling effect.

A decoction of the leaves is recommended as a diaphoretic.

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Citrus reticulata

Kingdom: Plantae

Division: Angiosperms

Class: Rosids

Order: Sapindales

Family: Rutaceae

Genus: Citrus

Species: reticulata

Botanical name:

Citrus reticulata

Distribution

The Citrus reticulata resembles other oranges. The tree is more drought-tolerant than the fruit. It can be grown in tropical and subtropical areas. Citrus is believed to have originated in the part of Southeast Asia bordered by Northeastern India, Myanmar (Burma) and the Yunnan province of China.

Citrus fruit has been cultivated in an ever-widening area since ancient times

Morphology

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These plants are large shrubs or small trees, reaching 5–15 m tall, with spiny shoots and alternately arranged evergreen leaves with an entire margin.

The flowers are solitary or in small corymbs, each flower 2–4 cm diameter, with five (rarely four) white petals and numerous stamens; they are often very strongly scented.

The fruit is a hesperidium, a specialised berry, globose to elongated, 4–30 cm long and 4–20 cm diameter, with a leathery rind or "peel" called a pericarp.

The outermost layer of the pericarp is an "exocarp" called the flavedo, commonly referred to as the zest.

The middle layer of the pericarp is the mesocarp, which in citrus fruits consists of the white, spongy "albedo", or "pith".

The innermost layer of the pericarp is the endocarp.

The segments are also called "liths", and the space inside each lith is a locule filled with juice vesicles, or "pulp".

From the endocarp, string-like "hairs" extend into the locules, which provide nourishment to the fruit as it develops.

Citrus fruits are notable for their fragrance, partly due to flavonoids and limonoids (which in turn are terpenes) contained in the rind, and most are juice-laden.

The juice contains a high quantity of citric acid giving them their characteristic sharp flavour.

Citrus fruits are usually self-fertile (needing only a bee to move pollen within the same flower) or parthenocarpic (not needing pollination and therefore seedless, such as the satsuma).

Varieties

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Canned and peeled mandarin orange segments

Kinnow, a variety of Mandarin orange from Pakisthan

The mandarin orange is a variety of the orange family. The mandarin has many names, some of which actually refer to crosses between the mandarin and another citrus fruit.

Satsuma, a seedless variety, of which there are over 200 cultivars, such as Owari and mikan; the source of most canned mandarins, and popular as a fresh fruit due to its ease of consumption

Owari, a well-known Satsuma cultivar which ripens during the late fall season Clementine, sometimes known as a "Christmas orange", as its peak season is

December; becoming the most important commercial Mandarin orange form, have displaced mikans in many markets

Tangerine sometimes known as "Dancy Mandarin" Tangor, also called the temple orange, a cross between the Mandarin orange and the

common sweet orange; its thick rind is easy to peel and its bright orange pulp is sour-sweet and full-flavored

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Chemical contentsCitrus fruits are notable for their fragrance, partly due to flavonoids and limonoids (which in turn are terpenes) contained in the rind, and most are juice-laden.

The juice contains a high quantity of citric acid giving them their characteristic sharp flavour.

They are also good sources of vitamin C and flavonoids.

The flavonoids include various flavanones and flavones.

Mandarin oil is extracted from the Mandarin tree, or Citrus Reticulata. .

Mandarin oil contains metyl methylanthraniate and limonene as well as geraniol, citral, and citronellal.

The essential oil is extracted by cold compression of the fresh peels of these fruits and contains are alpha thujone, alpha pinene, beta pinene, camphene, citral, citronellal, gamma terpinolene, geranial, geraniol, limonene, linalool, methyl methylanthranilate, myrcene, nerol, sabinene and terpineol.

Phytochemical investigation of the fruit peels of Citrus reticulata Blanco (Rutaceae) resulted in the isolation of three new phytoconstituents along with n-hexacosonoic acid.

Their structures have been established as 18betaH-urs-5,11-dien-3beta-ol-11-one-3beta-D-glucopyranosyl-(4'-->1'')-D-glucopyranosyl-6''-(3''',4'''-dihydroxyl)-benzoate (reticulataursenoside), stigmast-5-en-3beta-ol-3beta-D-glucopyranosyl-4'-eicosanoate (citrusteryl arachidate), and lanost-5-en-3beta-ol-3beta-D-glucopyranosyl-4'-eicosanoate (citruslanosteroside) on the basis of spectral data analysis and chemical reactions.

Medicinal usesThe dried peel of the fruit is used to treat abdominal distension, to enhance digestion, and to reduce phlegm.

Citrus fruits have long been valued as part of a nutritious and tasty diet. The flavours provided by citrus are among the most preferred in the world, and it is increasingly evident that citrus not only tastes good, but is also good for people. It is well established that citrus and citrus products are a rich source of vitamins, minerals and dietary fibre (non-starch polysaccharides) that are essential for normal growth and development and overall nutritional well-being.

The major nutritional content in oranges is Vitamin C. This powerful antioxidant neutralizes harmful elements within the body. Vitamin C also stimulates the absorption of non-heme iron and thus reduces the iron deficiency. As a whole the Vitamin C content in orange fruits keep your immune system strong and healthy.

A glass of orange juice (240 milliliter or 8 oz.) supplies 100% or more of the daily value for vitamin C, a valuable "antioxidant". Scientists believe that antioxidants may counteract the

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harmful molecules called "free radicals," which they believe may contribute to the onset of several major diseases.

Vitamin C also helps maintain collagen, the substance that helps the human body repair body tissue.

The nutritional value of orange makes it good for indigestion, constipation, bowel disorders, dyspepsia, dental care, pyorrhea, bone health, heart diseases, respiratory problems, cold, cough, influenza, skin care, pimples, acne, fever, measles, typhoid and tuberculosis (T.B.).

Orange essential oil efficiently tackles the problem of colds and flu. It detoxifies the body and boosts the lymphatic system. At the same time, it also takes care of the collagen formation in the skin. . It is known to possess antispasmodic, anti-inflammatory, sedative and antiseptic therapeutic properties. The shelf life of oil extracted from sweet orange is usually 6 months. Talking about the consistency, it is pretty thin in consistency.

A daily glass of orange juice can help prevent the recurrence of kidney stones better than other citrus fruit juices such as lemonade.

The fibre in orange reduces high cholesterol level in the body.

The natural fruit sugar, fructose in orange controls the rising blood sugar levels after a meal. So, make sure that you have that delicious fruit as a part of your everyday diet.

Orange essential oil is very valuable in the treatment of diseases such as flatulence, constipation, stress, slow digestion and dull skin. Thus, it provides a multitude of health benefits for which it is preferred amongst others.

Health Benefits of Mandarin oil:

Mandarin oil can be used to treat digestive problems.

It has a calming as well as stimulating effect on the liver, stomach, and intestines, and has been used for centuries as an effective cure for all digestion related ailments.

It is especially useful for treating children and pregnant women.

When mixed with a carrier oil such as sweet almond, safflower, or grape seed extract, Mandarin oil can also be used as a treatment for stretch marks, acne, oily skin, and age spots.

Mandarin oil also plays a significant role in the treatment of anxiety and depression. Known as the “happy oil,” it is popular as a mood-lifter. It also helps to de-stress the nerves and soothe the mind.Thus it also helps to reduce hyper tension.

Finally, Mandarin oil can also be used to relieve muscle aches and cramps. Simply add 10 drops of Mandarin oil and 5 drops of Geranium oil to your bath water. Keep in mind that water does not mix with oil and so it best to add the oils to a cup of milk first, and then add the milk to the water.

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Other uses of Mandarin oil: Apart from its cosmetic and health-related uses, Mandarin oil is also useful around the house, owing to the antiseptic properties. It works as an excellent natural cleaner, which not only disinfects the room and but also has an uplifting fragrance.

Mandarin oil has several properties that make it an effective healer in most aromatherapy treatments. It is has antiseptic, antispasmodic, and diuretic properties, and is a laxative and digestive. Mandarin oil can also be used as a sedative as well as a stimulant.

Mandarin oil is extremely popular because it is safe and can be used by children as well as pregnant women.

The health benefits of Mandarin Essential Oil can be attributed to its properties like

antiseptic, anti spasmodic, circulatory, cytophylactic, depurative, digestive, hepatic, nervous

relaxant, sedative, stomachic and tonic.

Anti Septic: It protects wounds from being septic and other bacterial, fungal or viral infections. It forms a protective covering on the wound and promotes collection of blood platelets and leucocytes at the effected place, thereby checking the intrusion of microbes. Further, the oil itself has bactericidal and fungicidal properties and kills them, thereby adding to the effect.Anti Spasmodic: A spasm in the respiratory system can make you suffer from breathing troubles, congestion and exhausting coughs while muscular spasm gives cramps and muscle pulls, which are very painful. Spasm in the digestive system (intestines etc.) can cause vomiting and pulling aches in the stomach and intestines while a spasm in the nervous system gives nervous afflictions and convulsions. Treatment? You have one that is herbal and has no adverse side effects. It is the Mandarin Essential Oil. Just a few drops and the spasm cured. You get a pleasing relief.Circulatory: This oil of Mandarin improves circulation of blood and lymph, particularly below the skin which keeps the skin rejuvenated and looking young and vibrant. The improved circulation also gives warmth and gives relief from rheumatism and arthritis. This also aids growth and boosts immunity.Cytophylactic: The Essential Oil of Mandarin promotes growth of new cells and tissues, thereby helping faster healing of wounds and other wear & tears. This also promotes growth of the body.Depurative: It purifies blood by helping removal of toxic and unwanted substances from the body through means of excretion, such as urine, excreta and sweat. This prevents diseases resulting from deposition of toxins, such as abscesses, boils, acne, gout & arthritis etc.Digestive: A few drops of this oil after the lunch or dinner, facilitates digestion by provoking discharges of digestive juices and bile into the stomach. It also increases appetite.Hepatic: This oil is good for the liver as it helps maintain proper discharge of bile from it and protects it from infections. It also strengthens liver.Nervous Relaxant: Although the oil is a common sedative, but it sedating action is more prominent in relaxing and calming nervous afflictions and disturbances. It can calm attacks of epilepsy, hysteria and convulsions. Further, it takes away stress and anxiety.Sedative: The Essential Oil of Mandarin is a reputed sedative for inflammations and nervous disturbances.Stomachic: This oil helps maintain the acid and base balance in the stomach and protects it from ulcers and other disorders. It also fights any infections in the stomach.

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Tonic: Mandarin Essential Oil tones up overall health and boosts up the immune system. Being a tonic, it helps in the growth and proper functioning of the body by toning up all the organic systems functioning in the body, such as the respiratory system, the digestive system, the cardio-vascular system, the circulatory system, the neurotic system, the excretory system, the nervous system and the endocrinal system. It also boosts up the immune system of the body.Other Benefits: Relieves stress; cures skin disorders and maintains moisture balance in the skin; treats diarrhoea, constipation, flatulence and other such disorders related to digestive and excretory systems and diminishes scars and stretch marks, fat cracks on skin.

Blending: Mandarin Essential Oil, being citrus oil itself, blends with most of the citrus oils such as

those of neroli, grapefruit, orange and lime & lemon. Except these, it also blends well with

essential oils of bergamot, cinnamon, clary sage, clove, frankincense, lavender and nutmeg.

Pharmacological actions

Though displaced by tastier varieties, researchers have shown great interest in the lowly bitter orange after recently discovering that Citrus aurantium contains a number of natural alkaloids that safely increase weight loss.

Best of all, Citrus aurantium does so without many of the negative side effects to the cardiovascular and central nervous systems commonly experienced with weight-control agents such ephedra.

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Over the centuries bitter oranges were highly valued for their food and medicinal properties.

In ancient China unripened bitter oranges were used to make zhi shi, an herbal extract used to treat constipation, improve energy (chi) and to calm nerves in cases of insomnia and shock.

In the Amazon rainforest indigenous tribes used bitter orange tea as a laxative and to relieve nausea, stomach pains, indigestion, gas and constipation.

In Western medicine the health benefits of oranges were first noted in 1746 when the noted Scottish naval surgeon James Lind demonstrated that consuming citrus fruits, such as orange and limes, completely prevented scurvy, a deadly disease that killed tens of thousands of New World sailors. What Lind didn't know at the time was that oranges and related citrus fruits are a rich source of, vitamin C (ascorbic acid), one of the premier antioxidants.

Until recently, ma huang (ephedra sinica) was considered to be one of the most effective natural weight loss agents available.

At the cellular level, ephedrine, the main active ingredient in ma huang, is a powerful adrenergic agent that activates two types of cell receptors – called a alpha and beta cells – to stimulate lipolysis (the breaking down of fat into free fatty acids and glycerol) and thermogenesis (the production of body heat in the muscles and fat).

Alpha- and beta-receptors are found on the surface of every cell in the body and normally respond to the stimulatory effects of the two primary adrenergic amines (nitrogen-containing compounds) produced by the body – adrenaline and noradrenaline.

The specific cellular response to adrenergic amines is determined by the location, number and type of different alpha and beta-receptors – alpha-1 and-2, and beta-1, -2, and -3. In general, receptor types and their responses are described as follows:

• Alpha-1: causes constriction of arteries and potential increase in blood pressure.• Alpha-2: affects blood pressure by constricting peripheral blood vessels, inhibits lipolysis.• Beta-1: affects cardiac function, causes bronchodilation and dilation of blood vessels in heart and skeletal muscle.• Beta-2: affects cardiac function, causes bronchodilation and dilation of blood vessels in heart and skeletal muscle.• Beta-3: increases rate of fat release from body stores (lipolysis) and increases resting metabolic rate (thermogenesis).

The Alpha (and Beta) of Ephedra

While ephedra has been shown to be an effective agent for triggering thermogenesis, one of the continuing problems has been the potential for cardiovascular and central nervous system over-stimulation in certain individuals

The primary benefits seen with ephedra are due to stimulation of beta-3 receptors, which causes an increase in lipolysis and thermogenesis.

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Ephedra also stimulates the beta-1 and beta-2 receptors, potentially causing over-stimulation of the cardiovascular and central nervous systems – the classical 'fight or flight' response. Ephedra also stimulates both of the alpha-1 and alpha-2 receptors, which, as seen above, causes arterial constriction and increased blood pressure.

Additionally, by stimulating alpha-2 receptors ephedra has the undesirable effect of blocking lipolysis – exactly the opposite effect one desires when trying to control weight.

Bitter Orange Extracts More Effective than Ephedra

Recently researchers from McGill University in Montreal isolated five adrenergic amines from bitter orange (Citrus aurantium): synephrine, N-methyl-tyramine, hordenine, octopamine, and tyramine. While these alkaloids are similar to those found in ephedra, they work on a different set of receptors to stimulate lipolysis and thermogenesis.

Laboratory tests have found that Citrus aurantium alkaloids show properties similar to ephedrine, by triggering beta-receptors. More recently, studies have shown that both octopamine and synephrine appear particularly effective in stimulating lipolysis, a postulated beta-receptor effect.

Other researchers had previously revealed that synephrine was about 3.5 times as effective in stimulating lipolysis as octopamine, leading researchers to state that "the alkaloid mixture in bitter orange extract is superior to the mixture of ephedrine alkaloids in ma huang (Ephedra sinica) in terms of effects on beta-receptors in general."

Citrus Amines Selective for beta-3 Receptors

The amines contained in ephedra – adrenaline and noradrenaline – are highly lipophilic, meaning that they are readily attracted to fats and easily cross the fatty membranes that comprise the blood-brain barrier.

Once past this protective barrier, adrenaline and noradrenaline target the alpha-1 and-2 and beta-1, -2, and -3 receptors to cause amphetamine-like effects on the cardiovascular and central nervous systems believed to occur with ma huang.

By contrast, research shows that the amines found in Citrus aurantium extract make minimal contact with the alpha and beta-1 and -2 receptors, but exert their adrenergic effects by acting exclusively on beta-3 receptors to stimulate lipolysis and increase resting metabolic rate.

Sparing Lean Muscle Mass

New research suggests that by increasing lipolysis and burning stored fats as fuel, citrus extracts increase energy stores necessary for the sustained physical exertion required to tone muscle tissues.

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In addition, researchers believe that these dual actions of stimulating thermogenesis and lipolysis help to increase the amount of fatty acids released from fat stores, thereby sparing lean muscle tissues usually broken down during weight loss.

Summary

Citrus aurantium extract is both safe and natural, it functions in four specific ways:

1. Increasing lipolysis (breaking down fat stores to be used as fuel);2. Stimulating weight loss by enhancing thermogenesis (burning of fat);3. Increasing fuels available for physical performance; and4. Helping to spare and maintain lean muscle mass.

Additionally, Citrus aurantium extract has been shown to significantly increase metabolic rate in volunteers, with no evidence of cardiovascular effects after single or repeated doses. When given to obese subjects, researchers measured significant increases in rates of weight loss, due almost entirely to fat loss (a consequence of lipolysis), again with no evidence of any side effects or changes in cardiovascular parameters, making Citrus aurantium extract an exciting new addition to programs that combine diet, moderate exercise and thermogenic agents to control obesity.

Santalum album

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Kingdom: Plantae

Division: Angiosperms

Class: Core eudicots

Order: Santalales

Family: Santalaceae

Genus: Santalum

Species: album

Botanical name: Santalum album

Distribution

Santalum album or Indian sandalwood is a small tropical tree, the most commonly known source of sandalwood.

It is a hemiparasitic tree, native to semi-arid areas of the Indian subcontinent.

It is now planted in India, China, Sri Lanka, Indonesia, Malaysia, the Philippines and Northwestern Australia.

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S. album occurs from coastal dry forests up to 700 m elevation.

It normally grows in sandy or stony red soils, but a wide range of soil types are inhabited.

This habitat has a temperature range from 0 to 38°C and annual rainfall between 500 and 3000 mm.

It is commonly found in the comparatively dry regions of peninsular India from Vindhya mountains southwards, especially in Mysore and Tamil Nadu, ascending to an altitude of c. 1,200 m.

It has also been introduced into Rajasthan, parts of Uttar Pradesh, Madhya Pradesh and Orissa, where it has become naturalized at some places, but the sandalwood produced in these areas is usually of an inferior quality

Morphology

The height of the evergreen tree is between 4 and 9 metres.

They may live to one hundred years of age.

The tree is variable in habit, usually upright to sprawling, and may intertwine with other species.

The plant parasitises the roots of other tree species, with a haustorium adaptation on its own roots, but without major detriment to its hosts.

An individual will form a non-obligate relationship with a number of other plants.

Up to 300 species (including its own) can host the tree's development - supplying macronutrients phosphorus, nitrogen and potassium, and shade - especially during early phases of development.

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It may propagate itself through wood suckering during its early development, establishing small stands.

A small to medium-sized, evergreen semi-parasitic tree, with slender branches, sometimes reaching up to 18 m. in height and 2.4 m. in girth.

The reddish or brown bark can be almost black and is smooth in young trees, becoming cracked with a red reveal.

The heartwood is pale green to white as the common name indicates.

The leaves are thin, opposite and ovate to lanceolate in shape. , 1.5-8 cm. x 1.6-3.2 cm., sometimes larger.Glabrous surface is shiny and bright green, with a glaucous pale reverse.

Flowers straw-coloured, brownish purple, reddish purple, or violet, unscented, in terminal and axillary paniculate cymes; the drupe globose, 1.3 cm. diam., purple-black, with hard, ribbed endocarp; the seeds globose or obovoid.

Fruit is produced after three years, viable seeds after five. These seeds are distributed by birds.

ConservationThe species is threatened by over-exploitation and degradation to habitat through altered land use; fire, agriculture and land-clearing are the factors of most concern.

To preserve this vulnerable resource from over-exploitation, legislation protects the species, and cultivation is researched and developed.

The Indian government has placed a ban on the export of the timber.

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Young saplingChemical contents

The main constituent of sandalwood oil is santalol.

This primary sesquiterpene alcohol forms more than 90 per cent of the oil and is present as a mixture of two isomers, a -santalol and &szlig;-santalol, the former predominating.

The characteristic odor and medicinal properties of sandalwood oil are mainly due to the santalols.

The other constituents reported in sandalwood oil include: the hydrocarbons santene, nor-tricycloekasantalene and a- and ,&szlig;-santalenes; the alcohols santenol and teresantalol.

The aldehydes nor-tricycloekasantalal, and isovaleraldehyde; the ketones l-santenone and santalone; and the acids teresantalic acid occurring partly free and partly in esterfied form, and a-and &szlig;-santalic acids.

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Medicinal Use

Both the wood and the oil have long been employed in medicine.

They are credited with cooling, diaphoretic, diuretic and expectorant properties, and sandalwood finds several applications in household remedies.

A paste of the wood is applied to burns; in fevers and headache, it is applied to the forehead and upper eyelids.

The oil was at one time official in many pharmacopeias and was prescribed for the treatment of gonorrhea.

The oil from the seeds is used in skin troubles.

The essential oil is used in treatment of chronic inflammation of mucous membrane, gonorrhea, excessive sweating and fevers.

 Sandal wood powder is taken internally in a form of infusion or decoction as alterative, antibacterial, antiseptic, astringent, carminative, disinfectant, diuretic, expectorant, hemostatic, refrigerant, and as well as sedative and stimulant.

It is also applied externally for eczema, acne and other skin conditions.

 For allergic rashes; an equal quantity of Sandal wood powder and Tinospora cordifolia in a form of paste is applied externally.

 For menstrual disorders; a decoction of Sandal wood powder along with milk is taken internally to counteract menstrual problems.

 For spermatorrhoea; infuse one teaspoon of sandal wood powder, a teaspoon of Terminalia arjuna bark powder along with hot milk or water, add a sip of honey and drink, 1-2 times daily.

 For Hiccups; make a paste of sandal wood powder with human or cow milk and the squeeze the liquid in the nose drop-wise.

 For poisoning; apply a paste of sandal wood powder on the chest region.

For nausea and vomiting; take a teaspoon of Embalica officinalis and Sandal wood along with warm water.

For nose bleeding; snuff a little amount of Sandal wood powder. It quickly checks the condition.

For burning sensation in the body; prepare by adding Sandal wood powder into rice water, mix it with a little amount of sugar or honey and take internally.

 Pharmacological action The essential oil of Santalum album contains a large amount of alpha- and beta-santalol that exerts antibacterial, sedative stimulant and antiseptic properties.

Because of it’s sedative action it is used in vaso dilatation and hence it lowers the hypertension.

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Trichosanthes cucumerina

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Kingdom: Plantae

Division: Angiosperms

Class: Rosids

Order: Cucurbitales

Family: Cucurbitaceae

Genus: Trichosanthes

Species: cucumerina

Botanical name: Trichosanthes cucumerina

Distribution

Trichosanthes cucumerina is a tropical or subtropical vine, raised for its strikingly long fruit, used as a vegetable & medicine.

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Grows in forests or thick along valleys, thickest on mountain slopes; 400-1600 m. [Bangladesh, India, Indonesia, Malaysia, Myanmar, Nepal, Pakistan, Sri Lanka; N Australia].

Morphology

The narrow, soft-skinned fruit can reach 150 cm long.

Its soft, bland, somewhat mucilaginous flesh is similar to that of the luffa and the calabash.

The shoots, tendrils, and leaves are also eaten as greens.

The lace-like flower of T. cucumerina opens only after dark. Here, it is shown in the process of unfurling.

Fully open

A full grown snake gourd.

Plants annual.

Stems slender, profusely branched, ± pubescent.

Leaf blade reniform or broadly ovate, (5-)7-10 × 8-11 cm, membranous, ± deeply 5-7-lobed; lobes triangular or rhombic.

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Plants monoecious.

Male peduncles in pairs, earlier 1-flowered, later bearing a raceme; raceme few flowered; peduncle slender, 15-20 cm, puberulent; pedicel erect, 0.5-1.5 cm, puberulent; bracts absent or very small; calyx tube somewhat dilated at apex, 15-16 mm.

Female flowers solitary or sometimes replacing earlier male flower; ovary oblong.

Fruit ovoid-oblong, 5-7 × 2.5-3.5 cm, with 7-10 seeds.

Seeds ovate-oblong, 9-12 × 5-6 mm, compressed, rugulose, margin thick with toothed projections from both surfaces. Fl and fr. autumn.

The roots, fruit, and seeds are used medicinally.

Parts utilized for preparationLeaves, stems, shoots, fruit.

Chemical contents

Root extract study isolated are:

bryonolic acid,

chondrillasteryl glucoside,

bryononic acid,

cucurbitacin B,

dihydrocucurbitacin B,

Medicinal uses

It is abortifacient, anthelmintic, emetic and purgative.Fruit is purgative and emetic.Root is cathartic, aperient.

Two ounces of root juice is a drastic purgative.Roots used for expelling worms.

Leaf juice rubbed externally for fevers.

Roots used for diabetes, skin swellings likes boils and furuncles.

Stalks and leaves for fevers.

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In siddha medicine, its constituent in many formulations used for treatment of liver disorders and thereby used for lowering high blood pressure.

In India, seeds have been used for dysentery, coughs and as an emetic.

Used as a purgative; for fever and bronchitis.

Plant pacifies:

vitiated pitta, constipation, skin diseases, burning sensation, diabetes, anorexia, flatulence, constipation, worm infestation, fever general weakness. hypertension

Pharmacological action

• Anti-diabetic: Trichosanthes cucurmerina impoves glucose tolerance and tissue glycogen in non insulin dependent diabetes mellitus induced rats:

Study showed T cucurmerina possess antidiabetic activity with improvement in oral glucose tolerance and glucose uptake in peripheral tissues.•

Anti-inflammatory: Anti-inflammatory activity of root tubers of trichosanthes cucumerina is proved in mouse's hind paw oedema induced by carrageenin.•

Hepatoprotective: A study of the methanolic extract of the whole plant of Tricosanthes cucumerina, evaluated for hepatoprotective activity against carbon tetrchloride induced heapatotoxicity, showed histopath changes that support the protective effect of the extract and scientifically supports its use in various siddha preparations and traditional medicine for treatment of hepatic disorders.•

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Anti-fertility: The ethanol extract of TC was evaluated for antiovulatory activity in adult rats. The extract affected normal estrous cycle, reduced the number of healthy follicles and increased the number of regressing follicles. The study observed antiovulatory activity of the EE of the whole plant of TC.•

Gastroprotective: Results show the hot water extract of Tricosanthes cucumerina possesses significant and dose-dependent gastroprotective effects in the alcohol model. The same dose also mediated a significant gastroprotective activity in the indomethacin model. In both, the effect was comparable with that produced by cimetidine. •

Bioactive Constituents of Root and Fruit Juice: Study of root and fruit juice isolated bryonolic acid, chondrillasteryl glucoside, bryononic acid, cucurbitacin B and dihydrocucurbitacin B. The isolated compounds showed antimalarial and antiviral activity.•

Antibacterial: Sudies on extracts of the leaves of Trichosanthes cucumerina screened for antibacterial activity against various pathogenic bacteria (B cerus, E faecalis, S paratyphi, S aureus, E coli, Strep faecalis, P vulgaris, K pneumonia, P aeruginosa and S marcescens) showed the ethyl acetate, chloroform and methanol extracts of T cucumerina leaves showed pronounced activity on all organisms tested with activity comparable to standard antibiotics.

Cyperus rotundus

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Kingdom: Plantae

Division: Angiosperms

Class: Commelinids

Order: Poales

Family: Cyperaceae

Genus: Cyperus

Species: rotundus

Botanical name: Cyprus rotundus

Distribution

Cyperus rotundus (coco-grass, purple nut sedge, red nut sedge) is a species of sedge (Cyperaceae) native to Africa, southern and central Europe, and southern Asia.

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A cross section through the flower stem

Morphology

Cyperus rotundus is a perennial plant, that may reach a height of up to 55 inches.

The names "nut grass" and "nut sedge" are derived from its tubers, that somewhat resemble nuts, although botanically they have nothing to do with nuts.

As in other Cyperaceae, the leaves sprout in ranks of three from the base of the plant. It has a dark green thin stem and the leaves are long and sharp, with a width of 1/6 to 1/3 inch.

The spiklets in compound umbels are 5-20 cm long.

The flower stems have a triangular cross-section.

The flower is bisexual and has three stamina and a three-stigma carpel.

Flower from March to July.

The fruit is a three-angled achene.

The fruits are small, ovoid and the seeds tiny, numerous.

The root system of a young plant initially forms white, fleshy rhizomes.

Some rhizomes grow upward in the soil, then form a bulb-like structure from which new shoots and roots grow, and from the new roots, new rhizomes grow.

Other rhizomes grow horizontally or downward, and form dark reddish-brown tubers or chains of tubers.

The rhizomes are blackish, hard, fragrant tubers and aerial stems triquetrous.

The Cyperus Rotundus or Nut Grass flowers are hermaphrodite (have both male and female organs)

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Nut Grass prefers light (sandy) and medium (loamy) soils prefers acid, neutral and basic (alkaline) soils cannot grow in the shade and requires moist or wet soil.

A Cyperus rotundus tuber, approximately 20 mm long

Flower stem showing triangular cross-section

Chemical contents

Several pharmacologically active substances have been identified in Cyperus rotundus.They are:

α-cyperone, β-selinene, cyperene, cyperotundone, patchoulenone, sugeonol, kobusone,

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isokobusone, that may scientifically explain the alternative-medicine uses.

The essential oil from the plant contains at least 27 components comprising sesquiterpene hydrocarbons, epoxides, ketones, monoterpene and aliphatic alcohols and some unidentified constituents, (+) copadiene and (+) epoxyquaine.

The rhizomes contain sitosterol, cyperene, seniline, cyperenone and sesquiterpenes cyperone is obtained from the tubers.

The leaves contain luteolin and auresidin. Cyperene 1 and cyperene- 2 isolated from tubers.

Muskatone and patchoulenone isolated from essential oil.

Structure of rotunol and rotunol, two norsesquiter penoides – kobusone and isokobusone identified.

From the rhizomes cyperene, selinene, cyperenone and cyperone isolated. A new saponon-olenolic acid -3-0 neohesperidoside (I) isolated from tubers.

It contains aromatic oil (0.5-0.6%), stable oil, alkaloids, minerals, vitamins, calcium, phosphorus, sodium, carbonates, sesquiterpene hydrocarbons, epoxides, ketones, monoterpene, aliphatic alcohols, cyperene, seniline, cyperenone, sesquiterpenes cyperone, luteolin, auresidin, cyperene-1, cyperene-2, muskatone, patchoulenone, rotuno, kobusone, isokobusone, selinene, saponon-olenolic acid-3-0 neohesperidoside (I).

Medicinal uses

Mustaka was held in high esteem by the ancient sages of India.

Siddhars has admired it as the drug of choice for any type of fever.

They has also mentioned it as an appetizer, digestant ,anti diarrhoeal, anti-saturative, – thirst relieving, reducing herb, anti-pruritic and lactodepurant herb.

It is also well known for its diaphoretic properties.

Modern alternative medicine recommends using the plant to treat nausea, fever and inflammation; for pain reduction; for muscle relaxation and many other disorders.

Mustaka is pungent, bitter and astringent in taste, pungent in the post digestive effect and has cold potency.

It alleviates kapha and pitta doshas, but aggravates the vata dosha.

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It possesses light and dry attributes. It is fragrant, astringent, diuretic and galactogogue in properties and is used in diarrhea, fever, thirst, distaste, blood diseases etc.

It is used both, internally as well as externally.

Externally it is used for:

The root extract oil instilled into eyes in conjunctivitis reduces the pain, redness and ocular discharges.

The external application of its paste relieves itching and reduces the foul odor due to excessive sweating, and is salutary in skin diseases like scabies, eczema etc.

Application of its paste on the breasts purifies the breast milk.

In obesity, the massage with its dry powder (udvartana) is extremely beneficial for reducing the subcutaneous fat deposition.

Internally, mustaka is used for:

It is a keen stimulant for appetite, digestion, digestion of ama, and is also vermicide, astringent. Therefore, it is an effective remedy for distaste, vomiting, diarrhea, colitis, dyspepsia, worms etc,

Mustaka is highly praised as the best panacea for dental diarrhea in children. It works well in combination with Rhus succedanea and Aconitum heterophyllum in such condition. In dental diarrhoea, traditionally, the decoction of mustaka combined with mustaka powder (1gm) is given with great benefit. Hence, mustaka should be used in diarrhea, associated with fever and excessive thirst.

In mental debility and epilepsy, it is given along with cow’s milk. It also promotes the intelligent.

It is beneficial in cough and asthma as it alleviates the kapha .

Mustaka is the best herb for treating any type of fever.

The decoction of its roots is the best remedy for purifying the breast milk in lactation mothers.

It is also one of the most effective menstrual regulators. It helps to promote and regulate the menstruation (emmenagogue). As an emmenagogue, it can be used with Asparagus racemosus in proportions of 1:4 and also for burning micturition, urinary calculi, heamaturia etc. mustaka renders excellent results, as it is diuretic in property and so helps to reduce hyper tension.

The roots  are considered astringent, diaphoretic, diuretic, analgesic, antispasmodic, aromatic, carminative, antitussive, emmenagogue, litholytic, sedative, anti hyper tensive,stimulant, stomachic, vermifuge, tonic and antibacterial.

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They are used in treatment of paralysis, loss of memory, insect bites, food poisoning, indigestion, nausea, dysuria, bronchitis, infertility, cervical cancer and menstrual disorders, and the aromatic oils are made of perfumes and splash.

An essential oil in the tubers has antibiotic activity and has been shown to arrest the growth of Micrococcus pyrogenes.

The decoction of the roots and tubers are excellent antidote to all poisons.

A paste of the fresh tubers applied to the breast acts as an effective galactagogue.

The root is often used for developing high memory.

This herb also harmonizes the liver, spleen, and pancreas.

The grass is anthelmintic, anti-fungal, anti-parasitic, anti-rheumatic, antispasmodic,anti hypertensive, aphrodisiac and astringent.

It cures kapha and pitta disorders, dyspepsia, vomiting, indigestion, thirst, worm troubles, cough, bronchitis, dysuria, and poisonus affections.

It is used as an insect repellent, for perfuming clothing.

Pharmacological action

Modern research on purple nutsedge has investigated its possible

antioxidant, antimicrobial, antidiabetic, weight control effects, blood disorders controller, blood flow stimulater, blood thinner, liver protector.

At this time, there is a lack of high-quality human trials supporting the efficacy of purple nutsedge for any indication.

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Zingiber officinale

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Kingdom: Plantae

Division: Angiosperms

Class: Commelinids

Order: Zingiberales

Family: Zingiberaceae

Genus: Zingiber

Species: officinale

Botanical name:

Zingiber officinale

Distribution

Ginger cultivation began in South Asia and has since spread to East Africa and the Caribbean.

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Morphology

Ginger is a knotted, thick, beige underground stem, called a rhizome.

The stem sticks up about 12 inches above ground with long, narrow, ribbed, green leaves.

Ginger produces clusters of white and pink flower buds that bloom into yellowish green flowers.

Because of its aesthetic appeal and the adaptation of the plant to warm climates, ginger is often used as landscaping around subtropical homes.

It is a perennial reed-like plant with annual leafy stems, about a meter (3 to 4 feet) tall.

Traditionally, the root is gathered when the stalk withers; it is immediately scalded, or washed and scraped, to kill it and prevent sprouting.

Chemical content

The important active components of the ginger root are thought to be volatile oils and pungent phenol compounds (such as gingerols and shogaols).

The characteristic odour and flavour of ginger is caused by a mixture of zingerone, shogaols and gingerols, volatile oils that compose one to three percent of the weight of fresh ginger.

gingerol (1-[4'-hydroxy-3'-methoxyphenyl]-5-hydroxy-3-decanone) is the major pungent principle of ginger.

Ginger contains up to three percent of a fragrant essential oil whose main constituents are sesquiterpenoids, with (-)-zingiberene as the main component.

Smaller amounts of other sesquiterpenoids (β-sesquiphellandrene, bisabolene and and a small monoterpenoid fraction (β-phelladrene, cineol, and citral) have also farnesene) been identified.

The pungent taste of ginger is due to nonvolatile phenylpropanoid-derived compounds, particularly gingerols and shogaols, which form from gingerols when ginger is dried or cooked.

Zingerone is also produced from gingerols during this process

Medicinal uses

Fresh ginger is one of the main spices used for making pulse and lentil curries and other vegetable preparations.

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Fresh, as well as dried, ginger is used to spice tea and coffee, especially in winter.

Ginger powder is also used in certain food preparations, particularly for pregnant or nursing women, the most popular one being katlu which is a mixture of gum resin, ghee, nuts, and sugar.

Ginger is also consumed in candied and pickled form.

The traditional medical form of ginger historically was called Jamaica ginger; it was classified as a stimulant and carminative and used frequently for dyspepsia, gastroparesis, slow motility symptoms, constipation, and colic.

It was also frequently employed to disguise the taste of medicines.

Some studies indicate ginger may provide short-term relief of pregnancy-related nausea and vomiting.

Studies are inconclusive about effects for other forms of nausea or in treating pain from rheumatoid arthritis, osteoarthritis, or joint and muscle injury.

Tea brewed from ginger is a common folk remedy for colds.

Ginger has a sialagogue action, stimulating the production of saliva, which makes swallowing easier.

Ginger field

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Fresh ginger rhizome.

Two varieties of ginger as sold in Haikou, Hainan, China

Today, health care professionals may recommend ginger to help prevent or treat nausea and vomiting from motion sickness, pregnancy, and cancer chemotherapy.

It is also used as a digestive aid for mild stomach upset, to reduce pain of osteoarthritis, and may even be used in heart disease or cancer.

Several studies -- but not all -- suggest that ginger may work better than placebo in reducing some symptoms of motion sickness.

A few studies suggest that ginger reduces the severity and duration of nausea -- but not vomiting -- during chemotherapy.

Ginger extract has long been used in traditional medical practices to reduce inflammation. And there is some evidence that ginger may help reduce pain from osteoarthritis (OA). In a study of 261 people with OA of the knee, those who took a ginger extract twice daily had less pain and needed fewer pain-killing medications than those who received placebo.

A few preliminary studies suggest that ginger may lower cholesterol and help prevent blood from clotting. That can be helpful in treating heart disease, where blood vessels can become blocked and lead to heart attack or stroke.

Laboratory studies have also found that some substances in ginger may kill cancer cells in test tubes.

The chemical composition and antioxidant activity (in aqueous and solvent extracts) of Ginger root (Zingiber officinale) were determined.

The antioxidant components analysed were polyphenols, vitamin C, β carotene, flavonoids and tannins.

Antioxidant assays such as free radical scavenging activity, reducing power and total antioxidant activity were carried out for ethanol, methanol, acetone, 80% methanol and 80% ethanolic extracts.

Antioxidant components (polyphenols, flavonoids and total tannin) were higher in hot water (100C) extract than other solvent extracts and 30C water extract.

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. Ash, minerals namely (iron, calcium, phosphorous, zinc, copper, chromium and manganese) and vitamin C were 3.85 (g), 8.0 (mg), 88.4 (mg), 174 (mg), 0.92 (mg), 0.545 (mg), 70 (µg), 9.13 (mg) and 9.33 (mg) per 100 g of sample, respectively.

Pharmocological action

Preliminary research indicates that nine compounds found in ginger may bind to human serotonin receptors which may influence gastrointestinal function.

In limited studies, ginger was found to be more effective than placebo for treating nausea caused by seasickness, morning sickness and chemotherapy, although ginger was not found superior to placebo for pre-emptively treating post-operative nausea.

Other preliminary studies showed that ginger may affect arthritis pain or have blood thinning and cholesterol lowering properties.

Advanced glycation end-products are possibly associated in the development of diabetic cataract for which ginger was effective in preliminary studies, apparently by acting through antiglycating mechanisms.

Zingerone may have activity against enterotoxigenic Escherichia coli in enterotoxin-induced diarrhea.

Ginger section

In laboratory animals, the gingerols increase the motility of the gastrointestinal tract and have analgesic, sedative, antipyretic and antibacterial properties.

Ginger oil has been shown to prevent skin cancer in mice and a study at the University of Michigan demonstrated that gingerols can kill ovarian cancer cells.

The chemopreventive potentials of gingerol present a promising future alternative to expensive and toxic therapeutic agents.

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Nutritional information

100g of Ginger contains the following nutritional information according to the USDA.

Calories : 80 Fat: 0.75 Carbohydrates: 17.77 Fibers: 2 Protein: 1.82

Black pepper

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Kingdom: Plantae

Division: Angiosperms

Class: Magnoliids

Order: Piperales

Family: Piperaceae

Genus: Piper

Species: nigrum

Botanical name

Piper nigrum

Distribution

Black pepper is extensively cultivated in hotter and moist part of india.

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Black pepper is native to South East Asia and China, and is extensively cultivated there and elsewhere in tropical regions. Currently Vietnam is the world's largest producer and exporter of pepper, producing 34% of the world's Piper nigrum crop as of 2008.

Pepper is native to South East Asia and can be grown in soil that is neither too dry nor susceptible to flooding, moist, well-drained and rich in organic matter (the vines do not do too well over an altitude of 3000 ft above sea level).

The plants are propagated by cuttings about 40 to 50 centimetres long, tied up to neighbouring trees or climbing frames at distances of about two metres apart; trees with rough bark are favoured over those with smooth bark, as the pepper plants climb rough bark more readily.

Morphology

The pepper plant is a perennial woody vine growing up to 4 metres (13 ft) in height on supporting trees, poles, or trellises.

It is a spreading vine, rooting readily where trailing stems touch the ground.

The leaves are alternate, entire, 5 to 10 cm long and 3 to 6 cm across.

The flowers are small, produced on pendulous spikes 4 to 8 cm long at the leaf nodes, the spikes lengthening up to 7 to 15 cm as the fruit matures.

The fruit of the black pepper is called a drupe and when dried it is a peppercorn.

The fruit, known as a peppercorn when dried, is approximately 5 millimetres (0.20 in) in diameter, dark red when fully mature, and, like all drupes, contains a single seed.

The spiciness of black pepper is due to the chemical piperine. It is ubiquitous in the industrialized world, often paired with table salt.

Varieties

Black and white peppercorns

Black pepper

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Roughly mashed black peppercorns

Black pepper is produced from the still-green unripe drupes of the pepper plant.

The drupes are cooked briefly in hot water, both to clean them and to prepare them for drying.

The heat ruptures cell walls in the pepper, speeding the work of browning enzymes during drying.

The drupes are dried in the sun or by machine for several days, during which the pepper around the seed shrinks and darkens into a thin, wrinkled black layer.

Once dried, the spice is called black peppercorn.

On some estates, the berries are separated from the stem by hand and then sun dried without the boiling process.

Once the peppercorns are dried, pepper spirit & oil can be extracted from the berries by crushing them.

epper spirit is used in famous beverages like Coca-Cola and many medicinal and beauty products.

Pepper oil is also used as an ayurvedic massage oil and used in certain beauty and herbal treatments.

A single stem will bear 20 to 30 fruiting spikes.

The harvest begins as soon as one or two fruits at the base of the spikes begin to turn red, and before the fruit is fully mature, and still hard; if allowed to ripen completely, the fruit lose pungency, and ultimately fall off and are lost.

The spikes are collected and spread out to dry in the sun, then the peppercorns are stripped off the spikes.

The other types of pepper are:

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White pepper Green pepper Orange pepper and red pepper Pink pepper Malabar pepper and Tellicherry pepper. Sarawak pepper Lampung pepper White Muntok pepper Vietnam pepper

White pepper

Black, green, pink (Schinus terebinthifolius), and white peppercorns

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Piper nigrum on tree support.

Pepper

Pepper before ripening

Peppercorn close-up

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Pepper harvested for the European trader, from a manuscript Livre des merveilles de Marco Polo (The book of the marvels of Marco Polo)

Chemical contents

Pepper gets its spicy heat mostly from the piperine compound, which is found both in the outer fruit and in the seed. Black pepper contains between 4.6% and 9.7% .

The outer fruit layer, left on black pepper, also contains important odour-contributing terpenes including pinene, sabinene, limonene, caryophyllene, and linalool, which give citrusy, woody, and floral notes.

Notes:Pepper loses flavour and aroma through evaporation, so airtight storage helps preserve pepper's original spiciness longer.

Pepper can also lose flavour when exposed to light, which can transform piperine into nearly tasteless isochavicine

Once ground, pepper's aromatics can evaporate quickly; most culinary sources recommend grinding whole peppercorns immediately before use for this reason.

Peppercorns are composed of many health benefiting essential oils such as piperine, an amine alkaloid, which gives strong spicy pungent character to the pepper. It also contains numerous monoterpenes hydrocarbons such as sabinene, pinene, terpenene, limonene, mercene etc that gives aromatic property to the pepper.

Medicinal uses

Like many eastern spices, pepper was historically both a seasoning and a medicine. Long pepper, being stronger, was often the preferred medication, but both were used.

Black Pepper was believed to cure illness such as

constipation, diarrhea, earache, gangrene, hypertension heart disease,

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hernia, hoarseness, indigestion, insect bites, insomnia, joint pain, liver problems, lung disease, oral abscesses, sunburn, tooth decay, toothaches.

Black pepper, either powdered or its decoction, is widely used in traditional Indian medicine and as a home remedy for relief from sore throat, throat congestion, cough etc.

Piper Nigrum or Black pepper oil can be used to help in the treatment of pain relief, rheumatism, chills, flu, colds, increase circulation, exhaustion, muscular aches, physical and emotional coldness, nerve tonic and fevers.

It furthermore increases the flow of saliva, stimulates appetite, encourages peristalsis, tones the colon muscles and is a general digestive tonic.

Sometimes it is used in place of cubebs for gonorrhoea.

As a gargle it is valued for relaxed uvula, paralysis of the tongue.

On account of its stimulant action it aids digestion and is especially useful in atonic dyspepsia and turbid condition of the stomach.

It will correct flatulence and nausea.

It has also been used in vertigo, paralytic and arthritic disorders.

It has also been advised in diarrhoea, cholera, scarlatina and in solution for a wash for tinea capititis.

Externally it is used for its rubefacient properties and as a local application for relaxed sore throat and some skin diseases.

Its oleoresin has bacteriostatic and fungistatic properties

Peppers have been used therapeutically in dentistry as an antiseptic for tooth-decay and gum swellings.

Peppercorns are also being used in traditional medicines in treating flatulence and indigestion in traditional medicine, but there is little or no data to support these claims in modern medicine.

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Pharmacological action

It has been shown that piperine can dramatically increase absorption of

selenium, vitamin B, beta-carotene curcumin other nutrients.

Extracts from black pepper have been found to have antioxidant properties and anti-carcinogenic effects, especially when compared to chili.

Piperine present in black pepper acts as a thermogenic compound. Piperine enhances the thermogenesis of lipid and accelerates energy metabolism in the body .

Also increases the serotonin and beta-endorphin production in the brain.

Piperine and other components from black pepper may also be helpful in treating vitiligo although when combined with UV radiation should be staggered due to the effect of light on the compound.

Black peppercorns contain good amount of minerals like potassium, calcium, zinc, manganese, iron, and magnesium.

Potassium is an important component of cell and body fluids that helps controlling heart rate and blood pressure.

Manganese is used by the body as a co-factor for the antioxidant enzyme, superoxide dismutase.

Iron is essential for cellular respiration and blood cell production.

They are also excellent source of many vital B-complex groups of vitamins such as Pyridoxine, riboflavin, thiamin and niacin.

Peppercorns are rich source of many anti-oxidant vitamins such as vitamin-C and vitamin-A.

They also rich in flavonoid polyphenolic anti-oxidants like carotenes, cryptoxanthin, zea-xanthin and lycopene. These compounds help body remove harmful free radicals and help protect from cancers and diseases.

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Black pepper grains

Pepper in Kolli Hills in India

Black pepper corns(Piper nigrum)

Pepper plant with green fruits

Nutritional facts

Black peppers (Piper nigrum), Nutritional value per 100 g.

Principle Nutrient ValuePercentage of RDA

Energy 255 Kcal 13%Carbohydr 64.81 g 49%

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atesProtein 10.95 g 19.5%Total Fat 3.26 g 11%Cholesterol 0 mg 0%

Dietary Fiber 26.5 g 69%

VitaminsCholine 11.3 mg 2%Folic acid 10 mcg 2.5%Niacin 1.142 mg 7%Pyridoxine 0.340 mg 26%Riboflavin 0.240 mg 18%Thiamin 0.109 mg 9%Vitamin A 299 IU 10%Vitamin C 21 mg 35%Vitamin E-γ 4.56 mg 30%

Vitamin K 163.7 mcg 136%Electrolyt

esSodium 44 mg 3%Potassium 1259 mg 27%Minerals

Calcium 437 mg 44%Copper 1.127 mg 122%Iron 28.86 mg 360%Magnesium 194 mg 48.5%

Manganese 5.625 mg 244.5%

Phosphorus 173 mg 25%

Zinc 1.42 mg 13%Phyto-

nutrientsCarotene-β 156 mcg --

Carotene-α 0 mcg --

Crypto-xanthin-β 48 mcg --

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Lutein-zeaxanthin 205 mcg --

Lycopene 6 mcg --

Withania somnifera

Kingdom: Plantae

Division: Angiosperms

Class: Asterids

Order: Solanales

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Family: Solanaceae

Genus: Withania

Species: somnifera

Botanical name: Withania somnifera

Distribution

Withania somnifera, known as ashwagandha, is a shrub cultivated in India and North America whose roots have been used for thousands of years by siddha practitioners.

Withania somnifera is cultivated in many of the drier regions of India, such as Mandsaur District of Madhya Pradesh, Punjab, Sindh, and Rajasthan.

It is also found in Nepal. Ashwagandha in Sanskrit means "horse's smell" (ashwa- horse, gandha- smell), probably originating from the odour of its root which resembles that of a sweaty horse.

The species name somnifera means "sleep-inducing" in Latin. Withania somnifera is grown as late rainy-season (kharif) crop.

Semitropical areas receiving 500 to 750 mm rainfall are suitable for its cultivation as a rainfed crop.

If one or two winter rains are received, then root development improves.

The crop requires a relatively dry season during its growing period.

It can tolerate a temperature range of 20 to 38°C and as low a temperature as 10°C. The plant grows from sea level to an altitude of 1500 meters.

Morphology

It grows as a short shrub (35–75 cm) with a central stem from which branches extend radially in a star pattern (stellate) and covered with a dense matte of wooly hairs (tomentose).

The stems are around 3 to 4 feet in height. Its stem contain fibre like texture. One plant survives for up to 4 to 5 years.

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The leaves are bowl shaped, small and without thorns. It remains green for 12 months near big trees and ponds. The leaves are oval shaped , 2 to 4 inches long and contain fibre.

The flowers are blooming at the base of the stems are small, somewhat long with chimney shape and yellowish green in colour. The flowers bloom from the base of the leaves and become red when wipe.

The seeds are small, heart shaped, smooth and flat. The seeds are sown in rainy season and harvested in the spring season.

The ripe fruit is orange-red and has milk-coagulating properties.

The roots are rough, white from within, strong, transparent, thick and one to one and half feet long.

Crushing the fresh leaves and raw roots gives urine like smell and hence named Ashwagandha, Ashwa means ' horse' and gandha means 'smell'.

The plant's long, brown, tuberous roots are used for medicinal purposes.

Chemical contents

The roots excrete Cuseihygrine, Anahygrine, Tropine and 13 different kinds of acid. The acids include Vithenyle oil, which evaporates, Hentiroctane, Phitosteryl are obtained.

It also contains a chemical called Bidaphyrine A.

Other than these Glycocide, Vithenyle, acidic starch, contain Vethinine and someniphyrine alkaline and nicotine somanani vetheninine alkaline.

Withaferin A

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The main active constituents are alkaloids and steroidal lactones. These include tropine and cuscohygrine. The leaves contain the steroidal lactones, withanolides, notably withaferin A, which was the first withanolide to be isolated from W. somnifera.

Withaferin A inhibits notch-1 signaling and downregulates prosurvival pathways, such as Akt/NF-κB/Bcl-2, in three colon cancer cell lines (HCT-116, SW-480, and SW-620). Recent research in mice suggests that withaferin A may have anti-metastatic activity. Withaferin A inhibits Transcription Factors Sp1 and NF-κB activity.Withaferin A down regulates Vascular Endothelial Growth Factor (VEGF) gene expression and inhibits angiogenesis.

Withanolide sulfoxide has been shown to suppress NF-κB and to selectively inhibit COX-2 in cultured cell lines in vitro.

The effect of a semipurified root extract of W. somnifera containing mostly withanolides was investigated using a transgenic mouse model of Alzheimer's disease. The transgenic mice showed reversal of behavioral deficits and plaque load after treatment with the extract for 30 days.

Medicinal usesIn Siddha the berries and leaves of W. somnifera are locally applied to tumors, tubercular glands, carbuncles, and ulcers.

Several studies over the past few years have looked into the role of withania somnifera in having anti-inflammatory, anti-tumor, anti-stress, antioxidant, mind-boosting, immune-enhancing, and rejuvenating properties.

Historically Withania somnifera root has also been noted to have sex-enhancing properties.

It is used as a general tonic and "adaptogen", helping the body adapt to stress. 

In addition, this herb has been shown to possess antioxidant activity as well as an ability to support a healthy immune system.

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It is beneficial in case of watery diseases, vata, kapha, respiratory problems, tuberculosis, swelling, leprosy, poison, wounds, blood purifier, pain, swelling in the uterus and vagina, bleeding, pain reliever.

Regular consumption of Ashwagandha for one year removes the deformities of the body. Consumption of Ashwagandha in the months of December and january removes weakness and makes the body strong. All these qualities are of the roots.

Consuming this medicine for 15 days regularly with milk, ghee or plain water brings back the youth fullness.

It is very effective in case of Leucoderma, bronchitis and asthma.

Nadkarni says that Ashwagandha is a tonic, which increases sperm count and sexual potency.

In the rural areas vegetable made out of this plant is given to TB patients.

It increases the iron content in the blood. Sohat has termed it anti-tumor.

It is considered to be one of the seven siddha herbs capable of curing AIDS.

The Bidaphyrine chemical present in the plant is capable of killing the cancer cells.

Taking Ashwagandha powder with milk, ghee or water cures weakness in children, weakness in old people and reduces the aging process.

Taking ashwagandha powder with ghee made out of cow milk or sugar cures sleeplessness and pain in the hips.

The decoction is beneficial to cure tuberculosis. Adding honey in the juice of winter cherry leaves cures the problem of sleeplessness due to joint pain.

Adding sugar candy and ghee in Ashwagandha powder cures pain in the hips and backache.

Add liquorice in Ashwagandha powder and take it with amla juice to cure weak eyesight.

Taking Ashwagandha powder with honey and ghee regularly for one month in winter season cures old age problems. Take Ashwagandha powder and Baheda with jaggery for quick relief in heart ache.

Regular consumption of Ashwagandha with Giloy extract and honey cures all types of problems.

Consumption of Ashwagandha, Shatavari, ghee and honey cures the vata dosha.

Take round 3gm of Ashwagandha powder with 12gm of sugar candy and sugar twice daily with milk to cure white discharge and infertility Ashwagandha for Constipation:

Take Ashwagandha powder with hot milk to cure constipation

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Take Ashwagandha powder and sugar in equal proportions measuring 3 to 6 gm with milk everyday cures impotency

Add one gm each of Ashwagandha, sugar candy, honey and take 10gm ghee every morning to improve humors, strengthening the body and brings back youthfulness.

Take equal quantities of Ashwagandha and Vidhara powder and store it in greasy container. Take around 6 to 12 gm twice daily with hot milk regularly for 4 months. his cures vata dosha, old age related problems and rejuvenates the body. The same taken with 6gm ghee and 3 gm honey cures the disease in which vital humors of the body are excreted through urine.

Take 10gm Ashwagandha with Amla juice everyday and gradually increase the quantity. This stops aging.

Add Ashwagandha in one fourth quantity of ghee, grind it nicely and store it in a container. Take 5gm of this powder with milk or lukewarm water regularly for one month to increase strength and sperm. This cures all types of pains ad wind related problems.

Extract of the pure oil from Ashwagandha roots cures weakness and wind related problems.

Take 12gm each of Ashwagandha , Vidhara, Jaiphal, small cardamom, Nagarmotha, Gokharu, cronch seeds, Shatavari, Triphala, Lajvanti, poppy seeds and vansh lochan. Grind and sieve them nicely. Add equal quantity of sugar candy and take 6gm of this powder twice daily with milk to cure dream problems.

Add ghee in the decoction of Ashwagandha powder and cook. Consume this to cure wind related problem. It helps the women to conceive.

Grind Ashwagandha roots in cow urine and apply on the affected ares to cure the swelling due to stomach disorder.

Grind Ashwagandha powder with hot water and take it regularly to cure wind related problem due to heart disease

Take decoction made out of Ashwagandha roots and sugar to cure bleeding due to vata dosha.

Make decoction with Ashwagandha roots, Vidharikand and Mulethi and take it with milk to increase the breast milk. Coarsely grind the roots, skin , leaves, flowers and fruits of Ashwagandha and take out the rasa, take at least 30 to 60 gm of this juice to cure arthritis.

Add the skin of Ashwagandha and Nirgundi with Kateri fruits and paipal with ghee and burn it. Give fumigation in the rectum area to cure piles.

In case of snake bite give 6gm of Ashwagandha roots juice at an interval of 1 hour to remove the effect of poison

Take 12gm of Ashwagandha, grind them and add 12 gm of sugar candy, now pour one liter water and make the decoction till it reduces to one-eight quantity. Give this decoction in little quantity to cure whooping cough.

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Take 3 gm of winter cherry powder and add equal quantity of ghee and one gm unrefined sugar and take it twice daily to cure joint pain.

Take equal quantities of Ashwagandha powder and sugar, make a fine powder and take 4gm with honey to cure blood impurities.

The word Ashwagandha literally means "the sweat of a horse" indicating that one who takes it would have the strength and sexual vitality of a horse.

Pharmacological action

T ardive dyskinesia is one of the major side effects of long-term neuroleptic treatment. The term neuroleptic refers to the effects on cognition and behavior of antipsychotic drugs that reduce confusion, delusions, hallucinations, and psychomotor agitation in patients with psychoses.

Withania somnifera root extract could be a useful drug for the treatment of drug-induced dyskinesia.

some of the chemicals within withania somnifera are powerful antioxidants. They tested these

compounds for their effects on rat brain and found an increase in the levels of three natural antioxidants , superoxide dismutase, catalase and glutathione peroxidase.

They say, "These findings are consistent with the therapeutic use of Withania somnifera as an Ayurvedic rasayana (health promoter). The antioxidant effect of active principles of Withania somnifera root may explain, at least in part, the reported anti-stress, cognition-facilitating, anti-inflammatory and anti-aging effects produced by them in experimental animals, and in clinical situations."

A new dimeric withanolide, ashwagandhanolide, was isolated from the roots of an Ayurvedic medicinal herb, withania somnifera. Ashwagandhanolide displayed growth inhibition against human gastric, breast (MCF-7), central nervous system (SF-268), colon (HCT-116), and lung (NCI H460) cancer cell lines. In addition, ashwagandhanolide inhibited lipid peroxidation and the activity of the enzyme cyclooxygenase-2 in vitro.

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Withania somnifera is historically used as an aphrodisiac. Withania somnifera is mentioned in the ancient Kama Sutra as an herb to be used for heightening sexual experience, Laboratory studies show withania somnifera can produce nitric oxide which is known to dilate blood vessels. Withania somnifera has the ability to restore sexual health and improve overall vitality while promoting a calm state of mind.

The roots of Withania somnifera are used extensively in Ayurveda, the classical Indian system of medicine, and Withania somnifera is categorized as a rasayana, which are used to promote physical and mental health, to provide defense against disease and adverse environmental factors and to slow the aging process. In rodent studies Withania somnifera has been shown to reduce anxiety and have positive effect on mood.

Withania somnifera is used in India to treat mental deficits in geriatric patients, including amnesia After injecting some of the chemicals in withania somnifera into rats, they later examined slices of their brain and found an increase in acetylcholine receptor activity. The researchers say, "The drug-induced increase in acetylcholine receptor capacity might partly explain the cognition-enhancing and memory-improving effects of extracts from Withania somnifera observed in animals and humans."

A study done in 1991 at the Department of Pharmacology, University of Texas Health Science Center indicated that extracts of Withania somnifera had GABA-like activity. This may account for this herb’s anti-anxiety effects.

A 2002 laboratory study indicates Withania somnifera stimulates the growth of axons and dendrites. A 2001 study in rodents showed it had memory boosting ability. A 2000 study with rodents showed Withania somnifera to have anti-anxiety and anti-depression effects.

One small study found withania somnifera was able to reduce blood sugar and cholesterol levels and had a diuretic effect.Hence it is used to controll hypertension.

Clinical trials and animal research support the use of Withania somnifera for anxiety, cognitive and neurological disorders, inflammation, and Parkinson's disease.

Withania somnifera's chemopreventive properties make it a potentially useful adjunct for patients undergoing radiation and chemotherapy.

Ashwaganda is also used therapeutically as an adaptogen for patients with nervous exhaustion, and debility due to stress, and as an immune stimulant in patients with low white blood cell counts.

Studies indicate ashwagandha possesses anti-inflammatory, antitumor, antistress, antioxidant, immunomodulatory, hemopoietic, and rejuvenating properties.

It also appears to exert a positive influence on the endocrine, cardiopulmonary, and central nervous systems. The mechanisms of action for these properties are not fully understood. Toxicity studies reveal that ashwagandha appears to be a safe compound.

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Remedy For Hypertension

ConclusionIn short Herbo serpin acts as follows: Andrographis paniculata reduces the mainly increased pitha dosha.

Vetriveria zizanioides,Santalum album cooles the body by their demulcent action ,thereby dilates the bloodvessels which are constricted due to excessive pressure exerted by the blood on the capillary walls because of the increased azhal and vatha dosha. Citrus reticulata by its rich vitamins and mineral contents increases the body’s immunity and also controlls triglycerides level it results in the controll over hypertension.

Withania somnifera,Cyperus rotundus by their sedative action reduces the mental stress and strain which is the main reason for hypertension and cures the symptom sleeplessness araising due to hypertension.

Trichosanthes cucumerina by its prooved hepato protective action strengthens liver and corrects the portal circulation and there by systemic circulation too hence effectively reduce the blood pressure.

Zingiber officinale and Piper nigrum by their carminative action reduces the vatha dosha and by their thridosha neutraliser reduces the pitha dosha and helps in reducing the blood pressure.

Rauvolfia serpentina the queen controller of hyper tension by its active principal reserpine acts on the brain cortex and reduces the stress.

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Remedy For Hypertension

Rauvolfia serpentina along with Santalum album,Vetriveria zizanioides, Trichosanthes cucumerina by their diuretic action eliminates the excessive salt & water retained in the body and corrects the renal mechanism thereby reduces and keeps the blood pressure in normal level.

Get Herboserpin and take it under the physicians advice with regular check up of your bloodpressure .

Many patients under the clinical trail nearly 90 out of 100 got a good controll over their blood pressure and 20 persons got a moderate controll over their blood pressure..

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