Moringa oleifera: A Comprehensive Review of Its Ethnopharmacology, Pharmacology, Phytochemistry, and Therapeutic Potential

The paper introduces Moringa oleifera (the "miracle tree"), a drought-tolerant species native to South Asia but now cultivated across tropical and subtropical regions worldwide. It highlights the plant’s extensive ethnomedicinal use and rising global research interest, evidenced by a surge of publications in the past decade and international collaborations. The review sets out to synthesize current knowledge on M. oleifera’s taxonomy, distribution, traditional uses, pharmacological activities, phytochemistry, formulations, toxicology, clinical evidence, and broader applications.

The review compiles extensive ethnomedicinal reports indicating nearly all plant parts (leaves, pods, bark, gum, flowers, seeds, seed oil, and roots) are traditionally used to manage conditions such as hypertension, anxiety, diarrhea, dysentery, colitis, inflammatory ailments, hepatitis, joint pain, kidney stones, liver disease, ulcers, ear/tooth pain, fever, and for laxative, abortifacient, and wound-healing purposes. Classical Ayurvedic texts (Charaka Samhita, Ashtanga Hridaya, Kashyapa Samhita, Sharangadhara Samhita, Yogaratnakara) document uses for worms, headache, ascites/edema, asthma/hiccough, ear ailments, puerperal disorders/sleeplessness, conjunctivitis, splenomegaly, fever, abscess, and edema. Modern studies report broad pharmacological activities: antimicrobial/antifungal; anti-inflammatory; antioxidant and anti-glycation; anticancer; fertility/anti-fertility effects; hepatoprotective; cardioprotective; gastroprotective/anti-ulcer; analgesic/antipyretic; neuropharmacological and neuroprotective (including in models of epilepsy, Alzheimer’s, Parkinson’s, neuropathic pain); wound healing; immunomodulatory; hematinic and platelet effects; anti-obesity; anti-allergic; anti-diabetic; diuretic/antiurolithic; ACE-inhibitory/antihypertensive; antivenom; and cytotoxicity against certain cancer cell lines. The phytochemical literature identifies more than 90 compounds across classes including proteins/amino acids, phenolic acids, carotenoids, alkaloids, glucosinolates (notably glucomoringin), flavonoids (quercetin, kaempferol, myricetin, rutin, isorhamnetin), sterols (β-sitosterol), terpenes/diterpenes (phytol), tannins, saponins, fatty acids, glycosides (niazirin/niazirinin), and polysaccharides. Nutrient and phytochemical content varies with geography and cultivation conditions.

This is a narrative review compiling literature primarily from 2010–2022 on Moringa oleifera’s phytochemistry and pharmacology, alongside earlier foundational studies. The authors conducted mapping and collaboration analyses: a spatial distribution of global publications was generated using ArcGIS 10.1 with GIS layers from the open-source DIVA-GIS platform; international research networks were visualized using VOSviewer (1.6.18). Phytochemical data were collated from studies employing techniques such as HPLC, UPLC-ESI-MS/MS, LC/MS, GC-MS, HPTLC, NMR, and others. The review aggregates preclinical in vitro and in vivo studies, limited clinical trials, and reports on phytoformulations and non-medicinal applications (agriculture, water treatment).

- Ethnomedicine: Nearly all plant parts are used traditionally for diverse ailments; Ayurvedic texts corroborate extensive historical usage. - Antimicrobial/antifungal: Ethanolic root extract (N-benzylethyl thioformate) and seed isothiocyanates (e.g., 4-(α-L-rhamnosyloxy)benzyl isothiocyanate) inhibit a wide range of bacteria (e.g., S. aureus, K. pneumoniae, E. coli) and fungi (e.g., Aspergillus spp., Botrytis cinerea), with some extracts showing ~99% inhibition against B. cinerea. - Anti-inflammatory: Compounds such as moringin, β-sitosterol, and others suppress NO and TNF-α, inhibit NF-κB activation (blocking IκBα phosphorylation and NF-κB nuclear translocation) reducing inflammatory mediators (TNF-α, COX-2, IL-6, iNOS) in cell and animal models; topical leaf extract ameliorated atopic dermatitis in mice. - Antioxidant/oxidative stress: Pretreatment with extracts protected mice from methotrexate-induced oxidative stress; stem extract protected keratinocytes from H2O2 injury; leaf extract mitigated diclofenac-induced hepatotoxicity. Leaf extracts reduce ROS in HEK-293 cells and increase GSH while lowering MDA in volunteers; seed-derived myricetin outperformed BHT and α-tocopherol in antioxidant assays. - Anticancer: Isothiocyanates/thiocarbamates exhibit chemopreventive/cytotoxic effects; dichloromethane leaf fraction selectively cytotoxic to MCF7 via Bax, p53, caspase-8 upregulation; niazimincin shows chemopreventive potential; computational work suggests rutin binds BRCA1 strongly. Aqueous cold extracts reduced cancer cell ROS and growth in vitro. - Fertility/anti-fertility: Aqueous extracts (200–400 mg/kg) show abortifacient/anti-fertility effects; ingestion of leaf extracts around pregnancy adversely affected fetal development in animal studies. - Hepatoprotective: Flower quercetin and other constituents reversed acetaminophen- and CCl4-induced liver injuries, normalizing AST/ALT/ALP and other markers. - Cardiovascular: Aqueous/alcoholic extracts protected against isoproterenol-induced myocardial injury, improving SOD, catalase, LDH, GPx, CK; butanolic extract reduced inflammation/necrosis (N-α-rhamnopyranosyl vincosamide); leaves lowered cholesterol and showed antihypertensive effects. - Gastroprotective/anti-ulcer: Leaf bisphenols/flavonoids reduced ulcer indices in ibuprofen and stress models; extracts neutralized gastric acidity and improved microcirculation. - Analgesic/antipyretic: Multiple solvent fractions showed analgesia vs. aspirin; seed ether/ethyl acetate fractions had notable antipyretic activity vs. paracetamol (200 mg/kg standard). - Neuropharmacology/neuropathic pain: Leaf/root extracts modulated monoamines, exhibited anticonvulsant and anxiolytic effects; leaf extracts attenuated chronic constriction injury-induced neuropathic pain in diabetic rats via oxidative stress reduction; seed fractions showed glycemic control and antinociception. - Wound healing: Leaf/seed/pulp extracts enhanced wound closure and tensile strength; aqueous leaf extract optimized for film dressings promoted cell proliferation/migration and improved healing, including in diabetic models. - Immunomodulatory/hematological: Isothiocyanates and cyanogenic glycosides enhanced immunity; small clinical trial showed aqueous leaf extract improved hemoglobin in women (8–12 g/dL) and increased platelet counts in healthy volunteers over 14 days. - Anti-obesity: Leaf powder (∼49 days) reduced BMI in hypercholesterolemic rats; mechanisms included downregulation of resistin/leptin and upregulation of adiponectin; improved lipid profile, glucose tolerance, and decreased vaspin, leptin, resistin. - Anti-allergic: Ethanolic seed extract reduced histamine release and IgG-induced anaphylaxis, likely via mast cell membrane stabilization. - Anti-diabetic: Leaves improved glucose tolerance and reduced FPG; seeds contain insulin-like proteins with antihyperglycemic activity; leaf extracts modulated CAT, MDA, LDL-C, VLDL-C and increased insulin in subjects. - Diuretic/antiurolithic: Root extracts reduced calcium oxalate urolithiasis and lowered serum urea nitrogen, creatinine, uric acid in rats. - ACE inhibitory/antihypertensive: Niazimin-A/B and niazicin-A showed high docking affinity for ACE vs. captopril/enalapril; extracts (with Azadirachta indica, Hibiscus sabdariffa) inhibited renin-angiotensin enzymes by ∼71.8–74%; β-sitosterol implicated. - Antivenom: Leaf extracts mitigated Naja nigricollis venom-induced toxicity, improved anemia, and reduced micronucleated polychromatic erythrocytes in rats. - Cytotoxicity: Methanolic leaf extract was cytotoxic to multiple myeloma cell lines; ethanolic leaf extract alleviated cyclophosphamide-induced testicular toxicity via endocrine and gene-expression modulation. - Toxicology: Aqueous leaf extract LD50 >2000 mg/kg in female rats; dried leaves up to 2000 mg/kg showed no acute harm; seed methanolic extract acute toxicity at 4000 mg/kg (mortality at 5000 mg/kg); stem bark safe up to 2000 mg/kg; subacute doses up to 1500 mg/kg over 60 days had LD50 ≈1585 mg/kg with no major hematologic or sperm quality changes; consumption considered safe but suggested not to exceed ~70 g/day to avoid cumulative toxicity. - Clinical studies: 25 clinical studies identified (15 completed), mostly dietary interventions; reported benefits in malnutrition, chronic kidney disease, HIV infection, reproductive health; seed kernel powder (3 g twice daily, 3 weeks) improved symptoms and respiratory function in bronchial asthma. - Phytopharmaceutical formulations: Numerous delivery systems developed (ointments, creams, micro-dispersions, lozenges, nano-micelles, nasal in-situ gels, hydrocolloid films/nanofibers, microparticles, phytosomes, effervescent tablets, suppositories, emulgels), generally enhancing stability, permeation, bioactivity, and patient acceptability. - Miscellaneous uses: Agricultural biostimulant and biopesticide increasing crop yields by 20–35%; improves drought tolerance via zeatin; water treatment—seed extracts reduced color/microorganisms by up to ∼90–95% and water hardness by 50–70%; supports livestock/poultry health.

The synthesis of ethnomedicinal records, phytochemical profiling, and extensive preclinical data supports the central proposition that Moringa oleifera is a multifunctional medicinal and nutritional plant with broad therapeutic potential. Identified bioactives (e.g., glucosinolates/isothiocyanates, flavonoids, sterols, phenolic acids) provide mechanistic bases for observed antimicrobial, anti-inflammatory, antioxidant, antihypertensive, antidiabetic, neuroprotective, and anticancer activities via pathways including NF-κB inhibition, antioxidant enzyme induction, and modulation of glucose and lipid metabolism. Translation into various formulations strengthens the feasibility of clinical use through improved delivery and efficacy. At the same time, safety data indicate a wide margin at typical doses but caution at high intake due to potential toxicity and abortifacient effects. The heterogeneity in phytochemical content by geography and extraction underscores the need for standardization and quality control. The limited but positive clinical evidence (e.g., anemia, asthma) indicates promise, yet broader, rigorously designed clinical trials are necessary to confirm efficacy and safety across indications.

Moringa oleifera contains diverse bioactive constituents—alkaloids, phenolic acids, glycosides, sterols, glucosinolates, flavonoids, terpenes, fatty acids, vitamins and micronutrients—that underpin its wide-ranging pharmacological activities. Preclinical studies demonstrate benefits in conditions such as neuropathic pain, cancer, hypertension, diabetes, obesity, and inflammatory disorders, and multiple formulation strategies enhance therapeutic potential. Beyond human health, M. oleifera serves as an agricultural biostimulant, biopesticide, and water-treatment aid. However, many phytochemicals remain underexplored, and more high-quality clinical trials are needed, including in serious diseases (e.g., viral outbreaks, AIDS, cancers). Future research should pursue mechanism-based investigations, standardization, identification of active/synergistic compounds, and dose–response safety profiles. Overall, M. oleifera justifies its moniker as a “miracle tree,” with strong promise as a phytopharmaceutical and functional food for chronic disease prevention and management.

- Predominance of preclinical evidence; relatively few well-powered, randomized clinical trials across indications. - Variability in phytochemical composition and nutrient content by geography, cultivation conditions, and extraction methods complicates standardization and reproducibility. - Potential toxic and abortifacient effects at high doses and during pregnancy; safety windows and long-term effects require further elucidation. - Heterogeneous methodologies across studies (models, doses, extracts) limit direct comparability and meta-analytic integration.