Review · Volume 18, Issue 4 · pp. 1150–1158
Siddha Medicine in Cardiovascular Care: Clinical Evidence and Pharmacological Perspectives for Integrative Management-An Integrative Review
Nikil Niva John Raja1, Hema Nandhini Devi Veluchamy2
- 1Department of Outpatient, Siddha Clinical Research Unit, Central Council for Research in Siddha, Ministry of Ayush, Government of India, Safdarjung Hospital, New Delhi, INDIA.
- 2Department of Pharmacovigilance, Siddha Clinical Research Unit, Central Council for Research in Siddha, Ministry of Ayush, Government of India, Safdarjung Hospital, New Delhi, INDIA.
Abstract
Cardiovascular Diseases (CVDs) are leading causes of mortality globally and in India, contributing substantially to the burden of noncommunicable diseases. The Siddha system of medicine recommends several internal formulations for cardiovascular care; however, the consolidation of scientific evidence supporting these therapies is necessary to strengthen their role in integrative healthcare. The objective was to compile and analyze available preclinical, toxicity, and clinical evidence on Siddha internal medicines recommended for the management of cardiovascular diseases. This descriptive evidence-based review included preclinical studies, acute and chronic toxicity studies, clinical trials (case reports, case series, pilot studies, and randomized controlled trials), and postgraduate and doctoral theses related to Siddha formulations indicated for CVD treatment. Molecular docking studies and literature reviews of individual ingredients were excluded. A comprehensive search was conducted in PubMed, Embase, Web of Science, Science Direct, the Cochrane Library, and Google Scholar via relevant keywords with Boolean operators. The data were compiled and analyzed systematically. Thirty-four Siddha internal formulations recommended for cardiovascular diseases were identified. Among these compounds, 17 demonstrated antioxidant activity, 8 exhibited anti-inflammatory effects, 2 exhibited cardioprotective properties, 2 exhibited antihypertensive activity, 4 exhibited hypolipidemic effects, and 1 exhibited antiatherogenic action. Several formulations have also shown antidiabetic, Hepatoprotective, and immunomodulatory activities relevant to CVD comorbidities. Toxicity studies conducted on selected formulations indicated acceptable safety profiles under experimental conditions. Limited clinical evidence suggests improvements in lipid parameters and cardiovascular health indicators. Siddha internal medicines exhibit pharmacological activities relevant to cardiovascular disease management. While preclinical evidence is substantial, robust, large-scale clinical trials are warranted to validate efficacy and ensure safe integration into evidence-based cardiovascular care.
Keywords: Antioxidant; Cardiovascular diseases; Cardioprotective; Integrative medicine; Siddha medicine
FULL TEXT
INTRODUCTION
Noncommunicable Diseases (NCDs) pose considerable challenges to global health. These diseases significantly impact public health systems and require effective strategies for prevention and management (Sharma et al., 2024). NCDs, commonly referred to as chronic diseases, are characterized by a prolonged duration and result in a complex interplay of genetic, physiological, environmental, and behavioral factors. The primary categories of NCDs include cardiovascular diseases-such as heart attacks and strokes-various forms of cancer, chronic respiratory diseases (including chronic obstructive pulmonary disease and asthma), and diabetes. Notably, NCDs have a disproportionately severe impact on populations in low- and middle-income countries, where approximately three-quarters of global NCD-related fatalities, totaling 32 million, occur (Non communicable diseases, 2025). In 2023, NCDs continue to pose a significant global health challenge, accounting for 74% of total deaths and 86% of premature deaths from NCDs in Low- and Middle-Income Countries (LMICs) (Varghese et al., 2025).
In India, NCDs are responsible for approximately 6 million deaths each year, accounting for approximately 63% of all annual fatalities (Krishnan et al., 2025). Between 1990 and 2023, the proportion of deaths attributable to NCDs in India substantially increased, increasing from 37.9% to 66%. In many developed nations, NCDs typically manifest in individuals aged 55 years or older; however, in India, the onset of these diseases tends to occur approximately a decade earlier. The growing prevalence of NCDs in India is further aggravated by the increasing incidence of multimorbidity, particularly among adults residing in urban areas. Given the chronic nature of these illnesses, individuals frequently endure disabilities or diminished quality of life for prolonged periods, resulting in continuous emotional and financial strain (Hemram et al., 2025).
In response to the increasing incidence of NCDs, India established the National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Disease, and Stroke (NPCDCS) in 2010. This program positioned India as the inaugural country to implement the global NCD monitoring framework and to set national objectives aimed at reducing premature mortality associated with these diseases (MoHFW, 2017). Despite significant advancements in public health, including lower mortality rates and longer life expectancies, India still faces considerable challenges in addressing NCDs (Chaurasia, 2017; Singh et al., 2017).
Ayush systems possess considerable potential to significantly contribute to the prevention and management of NCDs such as diabetes, cardiovascular disease, cancer, and stroke. The 12th Five-Year Plan for health in India advocates the integration of Ayush systems, particularly in their areas of expertise, which encompass preventive and promotive health care, as well as the treatment of health conditions affecting women, children, elderly individuals, NCDs, mental health disorders, palliative care, and rehabilitation. The National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), established by the Indian Government, has incorporated Ayush interventions to address the escalating burden of NCDs and associated risk factors at designated pilot sites. This initiative serves as a commendable model for further integration efforts. The implementation of early screening, accurate identification, and timely referrals within these integrated programs, coupled with the promotion and adoption of Ayush-based lifestyle practices, can significantly increase efforts to prevent and manage NCDs (Kumar et al., 2023).
As the incidence of morbidity and mortality related to NCDs continues to escalate annually, it is imperative to adopt a preventive strategy grounded in the Siddha system of medicine. This ancient and holistic approach underscores the importance of maintaining a balanced lifestyle and adhering to established health guidelines. By strictly following the lifestyle prescriptions advocated within the Siddha framework-such as nutritional recommendations, physical activity regimens, and mental well-being practices-individuals can substantially decrease their risk of developing NCDs. These preventive measures can not only effectively manage the onset of these debilitating diseases but also contribute to their prevention, thereby increasing overall health and longevity (Lekha et al., 2015).
In Siddha medicine, various botanical species and their formulations have been demonstrated to offer significant benefits in the management of cardiovascular conditions. The marudham pattai (Terminalia arjuna) tree and its constituents, particularly arjunolic acid, exhibit a cardioprotective effect in rats, which is attributable to their antioxidant properties (Singh et al., 2024). In the Siddha system of medicine, herbs, minerals, and therapeutic techniques are utilized to treat respiratory diseases, such as wheezing, coughing, and shortness of breath (Panneerselvam et al., 2025). Many medicines are recommended for respiratory diseases, such as Thalisathi chooranam, Adathodai manapagu, Thirikadugu chooranam, and Thoothuvalai Nei (Shalini et al., 2025). Many Siddha medicines are recommended for the integrative management of Noncommunicable Diseases (NCDs).
The "Standard Treatment Guidelines on Management of Metabolic Disorders in the Siddha System of Medicine," published by the Ayush Vertical of the Directorate General of Health Services in New Delhi in April 2025 (STG, 2025), along with the Siddha Standard Treatment Guidelines released by the National Institute of Siddha (STG 2019), detail a range of internal and external medications for the four primary NCDs: cardiovascular diseases, cancer, chronic respiratory diseases (including chronic obstructive pulmonary disease and asthma), and diabetes.
A significant number of these medications contain phytoconstituents, and numerous clinical studies have demonstrated their pharmacological efficacy in the management and treatment of Noncommunicable Diseases (NCDs). The scientific validity and safety considerations of Siddha medicines are crucial in the integrated approach to addressing NCDs.
The primary aim of this comprehensive review is to collect and analyze data that support the scientific validity of internal medicines for Cardiovascular Diseases (CVDs), as outlined in the aforementioned guidelines for the integrative treatment of Noncommunicable Diseases (NCDs). Furthermore, the secondary objective of this review is to investigate strategies to enhance the scientific framework associated with the improvement of the aforementioned pharmaceutical interventions.
METHODOLOGY
Study Selection
This descriptive review encompasses preclinical studies, acute and chronic toxicity studies, and clinical trials, including case studies, case reports, case series, pilot studies, Randomized Controlled Trials (RCTs) and doctoral and postgraduate theses. This review specifically excludes molecular docking studies and literature reviews concerning the individual ingredients of the medicines.
Search strategy
The present study involved an extensive search of various search engines and biomedical databases, such as PubMed, Embase, Web of Science, Science Direct, Cochrane Reviews, and Google Scholar, using keywords such as Siddha, traditional medicine, ancient wisdom, NCDs, CVD, pharmacological actions, toxicity, etc., and Boolean operators, such as AND, OR, NOT, AND NOT.
Data collection
To establish a correlation between Siddha disease terminologies and their English counterparts, the World Health Organization's publication on International Standard Terminologies in Siddha Medicine was utilized.
Data compilation, processing, and statistical analyses were conducted systematically, employing basic statistical methods in Microsoft Excel 2010. The information obtained from the comprehensive literature review has been tabulated, analyzed, and reported in this manuscript.
RESULTS
According to the Standard Treatment Guidelines for the Management of Metabolic Disorders within the Siddha System of Medicine, 34 medicinal formulations are listed under the section dedicated to cardiovascular diseases. This compilation includes 6 Kudineer (decoction), 10 Chooranam (medicinal powders), 2 Rasayanam (semi-solid confection), 1 Ilagam (electuary), 4 Mathirai (pills/tablets), 9 Parpam (white calx), and 2 Chendooram (red calx). Among these 34 formulations, 17 demonstrate antioxidant activity, 8 possess anti-inflammatory properties, 1 has antiatherogenic effects, 2 are identified as cardioprotective, 2 possess antihypertensive properties, and 4 exhibit hypolipidemic activities. The pharmacological actions of each medicine are outlined in Table 1, and the significant activities related to CVDs in Siddha medicines are shown in Table 2.
| Sl. No. | Name of the internal medicine | Preclinical Studies | Pharmacological actions | Toxicity study | Clinical studies related to CVDs |
|---|---|---|---|---|---|
| Cardiovascular Diseases (CVDs) | |||||
| 1 | Venthamarai kudineer | - | - | - | - |
| 2 | Thamaraga kudineer | - | - | - | - |
| 3 | Maruthampattai kudineer | (Vinubharathi et al., 2019 and Vinubharathi et al., 2018). | Antioxidant (Vinubharathi et al., 2019), antidiabetic (Vinubharathi et al., 2018). | (Vinubharathi et al., 2019) | - |
| 4 | Nerunjil kudineer | (Praba et al., 2018 and Akila et al., 2013 and Alam et al., 2019). | Antiurolithiasis (Praba et al., 2018), anti-inflammatory, antinociceptive (Akila et al., 2013), Nephroprotective (Alam et al., 2019). | (Noorul Alam, 2019 and Akila et al., 2012) | - |
| 5 | Adathodai kudineer | (Perumal et al., 2020). | Antioxidant, anti-atherogenic (Perumal et al., 2020). | - | - |
| 6 | Thiratchai kudineer | (Mantela et al., 2024). | Hepatoprotective, antioxidant (Mantela et al., 2024). | (Mantela et al., 2024) | - |
| 7 | Amukkara chooranam | (Jain et al., 2018 and Rajamohamed et al., 2019 and Punitha, 2013 and Patra et al., 2014). | Immunomodulatory, antioxidant (Jain et al., 2018), antibiofilm (Rajamohamed et al., 2019), hypolipidemic (Punitha, 2013), antiulcer (Patra et al., 2014). | (Jain et al., 2018 and Patra et al., 2014) | (Punitha et al., 2018) |
| 8 | Dhratchathy chooranam | (Ganapathy et al., 2020). | Cardio protective, antioxidant, anti-inflammatory (Ganapathy et al., 2020). | (Ganapathy et al., 2020) | - |
| 9 | Elathy chooranam | (Tamilselvan et al., 2022 and Rajalakshmi et al., 2017). | Antihypertensive (Tamilselvan et al., 2022), antioxidant, anti-inflammatory (Rajalakshmi et al., 2017). | - | - |
| 10 | Venthamarai chooranam | (Babu et al., 2014; Ravichandran, 2014 and Indrakumar, 2016). | Antihypertensive (Babu et al., 2014), cardio protective (Ravichandran, 2014), Thrombolytic, Vasodilator, Hypolipidemic, Cardio protective (Indrakumar, 2016) | (Babu et al., 2014) | - |
| 11 | Seenthil chooranam | (Sheeba et al., 2025; Sivamanisha et al., 2022). | Antidiabetic, Hepatoprotective, antimicrobial, antihistamine, antioxidant, anti-obesity, anti-asthmatic (Sheeba et al., 2025), immunomodulatory (Sivamanisha et al., 2022). | (Sheeba et al., 2025) | - |
| 12 | Keezhanelli chooranam | (Kumar et al., 2023 and Chinraji et al., 2025 and Nikil Niva et al., 2025). | Hematinic (Kumar et al., 2023), Hepatoprotective, hypolipidemic (Chinraji et al., 2025), antioxidant, anti-inflammatory, antiviral (Nikil Niva et al., 2025). | (Kumar et al., 2023) | - |
| 13 | Panchadeepakini chooranam | (Rakshitaa et al., 2015). | Antioxidant, antimicrobial (Rakshitaa et al., 2015). | - | - |
| 14 | Maruthampattai chooranam | (Manoharan et al., 2023). | Hypolipidemic (Manoharan et al., 2023). | - | - |
| 15 | Karpoorathi chooranam | - | - | - | - |
| 16 | Asai chooranam | (Keerthana et al., 2018). | Antioxidant (Keerthana et al., 2018). | - | - |
| 17 | Inji Rasayanam | (Ashok Kumar et al., 2014). | Antiurolithiatic (Ashok Kumar et al., 2014). | - | - |
| 18 | Parangi Rasayanam | (Mahalakshmi et al., 2021 and Kaaruniya et al., 2020 and Kavita Chandra, 2023 and Mahalakshmi et al., 2024). | Antioxidant (Mahalakshmi et al., 20210, anticancer (Kaaruniya et al., 2020), antifungal (Kavita Chandra, 2023), anti- psoriatic (Mahalakshmi et al., 2024). | (Non Communicable Diseases, 2025; Alam, 2019) | - |
| 19 | Kesari ilagam | - | - | - | - |
| 20 | Kasthuri maathirai | (Vanitha et al., 2020). | Antioxidant (Vanitha et al., 2020). | - | - |
| 21 | Korosanai maathirai | (Tamil Muhil et al., 2018). | Antimicrobial (Tamil Muhil et al., 2018). | - | - |
| 22 | Vasantha kusumakara maathirai | (Indhumathi et al., 2023 and Indhumathi et al., 2018). | Anti- histamine (Indhumathi et al., 2023), Bronchodilator (Indhumathi et al., 2018). | (Indhumathi et al., 2022) | - |
| 23 | Poorana chandhirodaya maathirai | (Hazeena Begum et al., 2014 and Muthukumaran Pakkirisamy et al., 2022 and Vaishnavi et al., 2024 and Balasubramanian et al., 2024). | Antioxidant (Hazeena Begum et al., 2014 and Muthukumaran Pakkirisamy et al., 2022), anticancer (Vaishnavi et al., 2024), anti-amnesic (Balasubramanian et al., 2024). | (Muthukumaran et al., 2020) | - |
| 24 | Silasathu parpam | (Thirupathi et al., 2002). | Antiulcer (Thirupathi et al., 2002), spermatogenic (Balasubramaniyan et al., 2014), Antihyperglycemic (Revathy, 2019), Diuretic, Lithotriptic (Nikil Niva et al., 2024), anti-inflammatory, antinociceptive (Christian CBS et al., 2024). | (Vikesh et al., 2018) | - |
| 25 | Sangu parpam | (Thirupathi et al., 2002). | Antiulcer (Thirupathi et al., 2002), anti-inflammatory, antioxidant (Nikil Niva et al., 2026). | (Madhavan et al., 2021) | - |
| 26 | Muthuchippi parpam | (Ganesan et al., 2016). | Antioxidant, antimicrobial (Ganesan et al., 2016), antiulcer, anti-inflammatory, Anti osteoporotic (Senthil Velu Kanthal et al., 2017). | - | - |
| 27 | Aya naaga parpam | - | - | - | - |
| 28 | Muthu parpam | (Chitra et al., 2023). | Antioxidant (Chitra et al., 2023), anticataract (Chitra et al., 2024), neuroprotective (Sabari girija et al., 2020), anti-inflammatory (Shanmugapriya et al., 2025). | (Jenifer Vimala et al., 2022) | |
| 29 | Sirungi parpam | (Omprakash et al., 2011). | Antiulcer (Omprakash et al., 2011). | (Omprakash et al., 2011) | |
| 30 | Pavala parpam | (Thanuja et al., 2021). | Hemostatic, Hepatoprotective (Thanuja et al., 2021), antibacterial (Thanigavelan et al., 2011). | (Thanuja et al., 2021) | |
| 31 | Kaariya parpam | - | - | - | - |
| 32 | Uppu parpam | (Kavitha et al., 2013). | Folliculogenitic (Kavitha et al., 2013). | - | - |
| 33 | Kalameganarayana chendooram | (Satheesh et al., 2024). | Anticancer (Satheesh et al., 2024). | (Ramkumar et al., 20140 | |
| 34 | Ekku chendooram | - | - | - | - |
| Formulation Type (Total) | Antioxidant | Cardioprotective | Antihypertensive | Hypolipidemic | Anti-atherogenic | Anti-inflammatory |
|---|---|---|---|---|---|---|
| Kudineer (6) | 3 | 1 | 1 | 0 | 0 | 1 |
| Chooranam (10) | 8 | 1 | 1 | 4 | 1 | 3 |
| Rasayanam (2) | 1 | 0 | 0 | 0 | 0 | 1 |
| Ilagam (1) | 0 | 0 | 0 | 0 | 0 | 0 |
| Mathirai (4) | 2 | 0 | 0 | 0 | 0 | 0 |
| Parpam (9) | 3 | 0 | 0 | 0 | 0 | 4 |
| Chendooram (2) | 0 | 0 | 0 | 0 | 0 | 0 |
DISCUSSION
Cardiovascular Diseases (CVDs) remain a leading cause of morbidity and mortality globally and in India, where they account for a significant proportion of Noncommunicable Disease (NCD)-related deaths (Krishnan et al., 2025). The present review consolidates scientific evidence on the pharmacological efficacy of Siddha internal medicines recommended for CVD management, highlighting their potential role in integrated healthcare approaches.
The 34 Siddha formulations identified for cardiovascular diseases have diverse pharmacological effects, including antioxidant, anti-inflammatory, cardioprotective, antihypertensive, antiatherogenic, and hypolipidemic effects. The antioxidant activity of 17 formulations plays a central role in CVD prevention and management by mitigating oxidative stress, which is a well-established contributor to endothelial dysfunction, atherosclerosis, and myocardial injury (Vinubharathi et al., 2019; Keerthana et al., 2018; Hazeena Begum et al., 2014). The anti-inflammatory properties of 8 formulations further reduce vascular inflammation, which underlies plaque formation and the progression of coronary artery disease (Ganapathy et al., 2020; Rajalakshmi, et al., 2017; Nikil Niva et al., 2026).
The cardio protective activity of formulations such as Dhratchathy Chooranam and Venthamarai Chooranam likely arises from the synergistic effects of phytochemicals, including flavonoids, saponins, and polyphenols. These compounds modulate lipid metabolism, reduce oxidative damage, and stabilize myocardial cellular function, as evidenced in preclinical studies (Kumar et al., 2023; Mahalakshmi et al., 2021; Mahalakshmi et al., 2016. The antihypertensive and hypolipidemic properties of certain formulations complement conventional pharmacotherapy by regulating blood pressure and lipid profiles, which are critical risk factors for CVD morbidity and mortality (Tamilselvan et al., 2022; Babu et al., 2014; Indrakumar, 2016; Kumar et al., 2023; Manoharan et al., 2023).
Preclinical studies indicate robust pharmacological actions across multiple Siddha formulations, including antidiabetic, hepatoprotective, immunomodulatory, and antiulcer activities, which are relevant in the context of CVD comorbidities (Vinubharathi et al., 2018; Jain et al., 2018; Rajamohamed et al., 2019; Punitha, 2013; Patra et al., 2014; Sheeba et al., 2025). Toxicity studies performed on several formulations, such as Amukkara Chooranam, Keezhanelli Chooranam, and Silasathu Parpam, have demonstrated safety profiles that support their clinical use (Jain et al., 2018; Patra et al., 2014; Kumar et al., 2023; Vikesh et al., 2018).
Clinical evidence, although limited in scope, supports the efficacy of these formulations in human subjects. Studies on Amukkara Chooranam, Parangi Rasayanam, and Maruthampattai Kudineer have revealed improvements in lipid profiles, glycemic control, and overall cardiovascular health (Vinubharathi et al., 2019; Punitha et al., 2018; Muthukumaran et al., 2020). These findings align with the pharmacological rationale observed in preclinical models, suggesting translational potential for the integrative management of CVDs.
The multifactorial actions of Siddha medicines can be attributed to their polyherbal and mineral compositions, which act through complementary pathways: antioxidant activity neutralizes reactive oxygen species, protecting endothelial and myocardial cells (Baharuddin, 2024). Anti-inflammatory mechanisms inhibit proinflammatory cytokines (e.g., TNF-α and IL-6) and reduce vascular inflammation (Popko et al., 2010). Lipid-lowering and hypolipidemic effects prevent atherogenesis and improve blood lipid profiles (Majdalawieh et al., 2023). Cardioprotective and antihypertensive actions enhance myocardial resilience and reduce cardiac workload (Nagata et al., 2011). Such multifaceted pharmacodynamics offer advantages over single-target conventional drugs, particularly in managing complex conditions such as CVDs, which involve intertwined metabolic, inflammatory, and oxidative pathways (Kabir et al., 2022).
The integration of Siddha formulations into mainstream cardiovascular care aligns with national health initiatives, including the NPCDCS, and supports preventive strategies. The incorporation of lifestyle modifications, early screening, and Siddha-based therapeutics can help delay disease onset, reduce complications, and enhance quality of life, particularly in populations prone to premature CVD onset, such as urban adults in India (Kumar et al., 2023; Lekha et al., 2015).
LIMITATIONS AND FUTURE DIRECTIONS
While preclinical evidence is extensive, clinical studies on Siddha cardiovascular medicines remain limited in scale, sample size, and methodological rigor. Standardized clinical trials with larger cohorts and long-term follow-up are necessary to validate the efficacy and safety of these methods. Additionally, mechanistic studies at the molecular and genomic levels could further elucidate the pathways modulated by these formulations, enhancing their scientific credibility.
Future research should also explore drug–herb interactions, dose optimization, and pharmacokinetics, ensuring safe integration with conventional therapies. Strengthening pharmacovigilance and quality control measures for Siddha formulations will be crucial for broader clinical adoption.
CONCLUSION
This review demonstrates that Siddha internal medicines exhibit significant pharmacological activities relevant to the management of cardiovascular diseases, including antioxidant, anti-inflammatory, cardioprotective, antihypertensive, and hypolipidemic effects. Preclinical and limited clinical evidence supports their efficacy and safety, highlighting their potential role in integrative strategies for CVD prevention and management. Comprehensive clinical studies and mechanistic research are warranted to consolidate these findings and facilitate evidence-based incorporation of Siddha therapies into mainstream cardiovascular care.