Ashvamaraka (Ashvamaraka (Karavira, Shatakumbha))

Properties

Cardiac glycoside activity, Immunomodulation, Antimicrobial activity, Antioxidant activity

Dosage

*Nerium indicum* is a toxic herb and should only be used under the strict guidance of a qualified healthcare professional. Powder: 30-125 mg per day is the maximum dose. Decoction: 5–10 g of dried leaves boiled in 200 ml water until reduced to 50 ml; strain and take 10–15 ml once daily for skin conditions. Tincture: 1:5 ratio in 45% ethanol; 5–10 drops in honey, once daily, strictly under professional guidance. Ointment: 5–10% leaf extract in a neutral base applied topically two to three times daily for wounds and joint pain.

Classical attributes

• Rasa: Katu (Pungent), Tikta (Bitter)
• Virya: ["Ushna (Heating)"]
• Vipaka: ["Katu (Pungent)"]

Benefits

• Vishaghna (Anti-toxic)
• Raktashodhaka (Blood purifier)
• Kushtaghna (Relieves skin diseases)

Traditional uses

• Skin diseases
• Poisoning
• Wounds

Dosha effects

• vata: balancing
• kapha: increasing
• pitta: balancing

Preparation methods

• Shodhana (Detoxification): Ayurvedic texts emphasize the importance of *shodhana* (detoxification) before using *Nerium indicum* due to its inherent toxicity.
• Forms: The herb can be found in powder, tincture, decoction, and ointment forms. It can also be processed into essential oils.
• Extraction: Dried plant powder can be extracted using solvents like petroleum ether, benzene, and ethanol.
• Traditional Preparation: Leaves and flowers undergo detoxification before being made into decoctions, powders, or ointments.
• Linseed Oil Extract: In traditional medicine, a linseed oil extract of *Nerium indicum* leaves is prepared by boiling fresh leaves and oil (1:10 ratio) over a water bath.
• Aqueous Extract: The aqueous extract of flowers can be prepared using a soxhlet apparatus.

Contraindications

• Pregnancy and lactation: It is unsafe for pregnant and breastfeeding women.
• Children: It is not safe for use in children.
• Heart conditions: Individuals with heart conditions should avoid it, especially if they are taking medications like digoxin, as it can affect heart rhythm and may increase the risk of arrhythmias. Use with caution in individuals on digitalis or diuretics.
• Hypokalemia: It should be avoided in cases of low potassium levels, as it can exacerbate this condition and increase the risk of toxicity.
• General toxicity: Nerium indicum contains cardiac glycosides, such as oleandrin, which can cause severe poisoning if not used correctly. Symptoms of poisoning include nausea, vomiting, abdominal pain, diarrhea, and irregular heartbeat, potentially leading to cardiotoxicity and even death.
• External use: Even topical application should be done with caution, as skin absorption of cardiac glycosides can cause systemic effects if overused or applied to broken skin. It may cause skin irritation, burning, or redness in some individuals.

Side effects

• GI upset
• Dizziness
• Cardiac arrhythmias
• Visual disturbances (blurred vision, altered color perception)
• Rare reports of fatal poisoning in livestock ingesting plant cuttings
• Accidental oral intake may lead to severe poisonous symptoms
• Overdosing can lead to nausea, arrhythmias, and visual disturbances

Interactions

• Neritaloside, a compound in *Nerium indicum*, may enhance the effects of other cardiotonic drugs.
• Flavonoid fractions could alter cytochrome P450 enzymes, impacting drug metabolism.
• Avoid internal use if you're on prescription medications, especially antiarrhythmics or antihypertensives.

Clinical evidence

One clinical trial assessed the impact of a proprietary extract of *Nerium oleander* on immune function, as evidenced by COVID-19 symptoms and mortality. More research is needed.

Ayurvedic karmas

• Vishaghna (Anti-toxic)
• Raktashodhaka (Blood purifier)
• Kushtaghna (Relieves skin diseases)

Classical clinical indications

• Skin diseases
• Poisoning
• Wounds