Triphala

Common Names

Triphala churna
Triphala choornam
Phala trika

How It Works
Triphala has immunostimulatory effects and may help prevent gingivitis.
Triphala is an herbal formulation used in the Indian medicinal system of Ayurveda. It consists of three medicinal plants: Emblica officinalis, Terminalia chebula, and Terminalia belerica. It may also be combined with Guggulu, a tree gum resin, for additional therapeutic effects. Triphala is used for dental caries, anemia, jaundice, constipation, asthma, fever, chronic ulcers, inflammation, obesity, and to strengthen the immune system against infections such as pneumonia, tuberculosis, and AIDS.
Purported Uses
- To treat gastrointestinal problems
  A few animal models suggest gastroprotective effects.
- To control inflammation
  Animal studies suggest that Triphala may reduce inflammation.
- To decrease high levels of cholesterol
  Triphala was shown to reduce cholesterol levels and other markers associated with obesity. However, this has not been studied in humans.
- To strengthen the immune system
  A small study in healthy volunteers suggests immune system benefits. Larger confirmatory studies are needed.
- To prevent gingivitis
  Several clinical studies suggest that Triphala may help reduce dental plaque, but it is not clear if it as effective as chlorhexidine mouthwash.
- To treat cancer
  Although anticancer properties of Triphala have been observed in the lab, human data are lacking.
Do Not Take If
- You are taking Cytochrome P450 (CYP) substrate drugs: Triphala may increase the risk of side effects of drugs that are metabolized by the enzymes CYP3A4 and CYP2D6.
Side Effects
- Triphala may cause gastrointestinal side effects, but these are rarely reported.
Clinical Summary
Triphala is an herbal formulation used in Ayurveda for the treatment of various ailments ⁽¹⁾. It consists of equal portions of dried and powdered fruits of three medicinal plants: Emblica officinalis (Amalaki), Terminalia chebula (Haritaki) and Terminalia belerica (Bibhitaki) ⁽²⁾, and may also be combined with Guggulu, a tree gum resin, for additional therapeutic effects. Triphala is used to treat dental caries, anemia, jaundice, constipation, asthma, fever, chronic ulcers, inflammation, obesity, and to promote immunity against infections such as pneumonia, tuberculosis, and AIDS.
Preclinical studies using Triphala reported antibacterial ⁽³⁵⁾, anticancer ⁽³⁶⁾, antiobesity ⁽²⁴⁾, antiarthritic, anti-inflammatory ⁽²⁵⁾ ⁽²⁶⁾and hypolipidemic properties ⁽¹⁰⁾. It was also shown to have enteroprotective effects against methotrexate-induced damage ⁽¹⁴⁾, along with affecting reductions in colitis ⁽²²⁾ and bromobenzene-induced nephrotoxicity ⁽²³⁾.
Clinical findings indicate that Triphala mouthwash has antibacterial effects ⁽³⁷⁾; and its anti-plaque efficacy has been reported to be comparable to that of chlorhexidine. But the data are not definitive ⁽¹⁵⁾ ⁽¹⁷⁾ ⁽¹⁸⁾ ⁽²⁷⁾ ⁽²⁸⁾ ⁽²⁹⁾ ⁽³⁸⁾ ⁽³⁹⁾ ⁽⁴⁰⁾. Furthermore, Triphala may actually promote oral bacterial biofilm formation ⁽³⁰⁾. Additional trials in healthy volunteers reported immunostimulatory effects ⁽³¹⁾ and elevation in high density lipoprotein cholesterol (HDL-C) along with reductions in blood sugar level ⁽⁴¹⁾; as well as reversal of tobacco-induced oral precancerous lesions in young adults ⁽³²⁾.
Purported Uses
- Gastrointestinal problems
- Inflammation
- Gingivitis
- Hypercholesterolemia
- Cancer
Mechanism of Action
Polyphenolic compounds and flavonoids found in Triphala are thought to be responsible for many of its effects. Gallic acid, a major polyphenol, has antioxidant and immunomodulatory properties ⁽¹¹⁾ ⁽³³⁾.
In preclinical studies, Terminalia chebula, one of the components of Triphala, was shown to be a potent hyaluronidase and collagenase inhibitor that prevented degradation of cartilage ⁽⁷⁾. In addition, bromobenzen-induced nephrotoxic effects were attenuated via increased antioxidant enzyme activity ⁽²³⁾. Antiarthritic and anti-flammatory effects of Triphala are thought to be via NF-kBp65 and COX-2 inhibition ⁽²⁵⁾ ⁽²⁶⁾, whereas the anti-colitic effects are likely due to its antioxidant effects ⁽²²⁾.
Triphala also appears to stimulate neutrophil function and to decrease corticosterone levels in immunized rats exposed to noise stress ⁽³⁴⁾. In a small study of healthy human volunteers, Triphala increased cytotoxic T cells and natural killer cells ⁽³¹⁾. It also exerted radioprotective effects ⁽²¹⁾ by inhibiting oxidative damage. Triphala also increased reactive oxygen species (ROS) in MCF-7 and T-47D breast cancer cells resulting in apoptosis ⁽⁸⁾; afforded protection against X-radiation and bleomycin, both of which generate DNA strand breaks, in HeLa cells ⁽⁴²⁾; and protected mice from radiation-induced mortality ⁽²⁾ ⁽³⁾.
Despite its antibacterial properties, compounds in Triphala may promote the formation of oral bacterial biofilm via activation of glucosyl transferases ⁽³⁰⁾.
Adverse Reactions
Triphala may cause gastrointestinal side effects, but these are rarely reported ⁽¹⁵⁾ ⁽¹⁸⁾ ⁽³¹⁾.
Herb-Drug Interactions
- Cytochrome P450 substrates: Triphala inhibits CYP3A4 and CYP2D6, and can affect the intracellular concentration of drugs metabolized by these enzymes ⁽¹⁶⁾.
References
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37. Naiktari RS, Dharmadhikari C, Gurav AN, Kakade S. Determining the antibacterial substantivity of Triphala mouthwash and comparing it with 0.2% chlorhexidine gluconate after a single oral rinse: A crossover clinical trial. J Indian Soc Periodontol. 2018 Nov-Dec;22(6):498-502.
38. Padiyar B, Marwah N, Gupta S, Padiyar N. Comparative Evaluation of Effects of Triphala, Garlic Extracts, and Chlorhexidine Mouthwashes on Salivary Streptococcus mutans Counts and Oral Hygiene Status. Int J Clin Pediatr Dent. 2018 Jul-Aug;11(4):299-306.
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