Health Care Professional Information

Clinical Summary

Triphala is an herbal formulation that is widely 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, Terminalia chebula, and Terminalia belerica (2). 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.
It demonstrated antioxidant (3) (2), anti-inflammatory (4), antibacterial (5), immunomodulatory (6), chondroprotective (7), antidiarrhoeal (12), and anticancer (8) (1) (9) (13) properties in vitro. These effects are due to the polyphenols and flavonoids present in its constituents. Triphala also showed hypolipidemic (10) and enteroprotective effects against methotrexate-induced damage in rats (14). However, these effects have not been tested in clinical trials.
Several studies compared the anti-plaque efficacy of triphala mouthwash to that of chlorhexdine. However, results are mixed (15) (17) (18).

Triphala may cause gastrointestinal side effects.

Purported Uses
  • Anemia
  • Jaundice
  • Constipation
  • Asthma
  • Infections
  • Chronic ulcers
  • Inflammation
  • Obesity
  • Hypercholesterolemia
  • Cancer
Constituents
  • Amla (Emblica officinalis)
  • Myrobalan (Terminalia chebula)
  • Belleric Myrobalan (Terminalia belerica)
Mechanism of Action

The exact mechanism of action is not known although the polyphenols and flavonoids are thought to be responsible for many of Triphala's effects. Gallic acid, a major polyphenol in Triphala, has antioxidant property (11). Triphala also increased the reactive oxygen species (ROS) in breast cancer cells (MCF-7 and T-47D), resulting in apoptosis (8). Terminalia chebula, one of the components of Triphala, was shown to be a potent hyaluronidase and collagenase inhibitor that prevented degradation of cartilage (7). Triphala also protected mice from radiation-induced mortality (2) (3). Oral administration of Triphala enhanced immune functions in rats (6).

Adverse Reactions

Intestinal gas, stomach upset, diarrhea

Herb-Drug Interactions
  • Cytochrome P450 substrates: Triphala inhibits CYP3A4 and CYP2D6, and can affect the intracellular concentration of drugs metabolized by these enzymes (16).
Dosage (Inside MSKCC Only)
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References
  1. Sandhya T, Lathika KM, Pandey BN, Mishra KP. Potential of traditional ayurvedic formulation, Triphala, as a novel anticancer drug. Cancer Lett 2006;231(2):206-14.
  2. Naik GH, Priyadarsini KI, Bhagirathi RG, et al. In vitro antioxidant studies and free radical reactions of triphala, an ayurvedic formulation and its constituents. Phytother Res 2005;19(7):582-6.
  3. Jagetia GC, Malagi KJ, Baliga MS, et al. Triphala, an ayurvedic rasayana drug, protects mice against radiation-induced lethality by free-radical scavenging. J Altern Complement Med 2004;10(6):971-8.
  4. Rasool M, Sabina EP. Antiinflammatory effect of the Indian Ayurvedic herbal formulation Triphala on adjuvant-induced arthritis in mice. Phytother Res 2007;21(9):889-94.
  5. Kumar MS, Kirubanandan S, Sripriya R. Triphala Promotes Healing of Infected Full-Thickness Dermal Wound. J Surg Res 2007.
  6. Srikumar R, Parthasarathy NJ, Devi SR. Immunomodulatory activity of triphala on neutrophil functions. Biol Pharm Bull 2005;28(8):1398-403.
  7. Sumantran VN, Kulkarni AA, Harsulkar A, et al. Hyaluronidase and collagenase inhibitory activities of the herbal formulation Triphala guggulu. J Biosci 2007;32(4):755-61.
  8. Sandhya T, Mishra KP. Cytotoxic response of breast cancer cell lines, MCF 7 and T 47 D to triphala and its modification by antioxidants. Cancer Lett 2006;238(2):304-13.
  9. Deep G, Dhiman M, Rao AR, Kale RK. Chemopreventive potential of Triphala (a composite Indian drug) on benzo(a)pyrene induced forestomach tumorigenesis in murine tumor model system. J Exp Clin Cancer Res 2005;24(4):555-63.
  10. Saravanan S, Srikumar R, Manikandan S. Hypolipidemic effect of triphala in experimentally induced hypercholesteremic rats. Yakugaku Zasshi 2007;127(2):385-8.
  11. Kaur S, Michael H, Arora S, et al. The in vitro cytotoxic and apoptotic activity of Triphala—an Indian herbal drug. J Ethnopharmacol 2005;97(1):15-20.
  12. Biradar YS, Singh R, Sharma K, et al. Evaluation of anti-diarrhoeal property and acute toxicity of Triphala Mashi, an Ayurvedic formulation. J Herb Pharmacother. 2007;7(3-4):203-12.
  13. Shi Y, Sahu RP, Srivastava SK. Triphala inhibits both in vitro and in vivo xenograft growth of pancreatic tumor cells by inducing apoptosis. BMC Cancer. 2008 Oct 10;8:294.
  14. Nariya M, Shukla V, Jain S, Ravishankar B. Comparison of enteroprotective efficacy of triphala formulations (Indian Herbal Drug) on methotrexate-induced small intestinal damage in rats. Phytother Res. 2009 Aug;23(8):1092-8.
  15. Tandon S, Gupta K, Rao S, Malagi KJ. Effect of Triphala mouthwash on the caries status. Int J Ayurveda Res. 2010 Apr;1(2):93-9.
  16. Ponnusankar S, Pandit S, Babu R, Bandyopadhyay A, Mukherjee PK. Cytochrome P450 inhibitory potential of Triphala—a Rasayana from Ayurveda. J Ethnopharmacol. 2011 Jan 7;133(1):120-5.
  17. Narayan A, Mendon C. Comparing the effect of different mouthrinses on de novo plaque formation. J Contemp Dent Pract. 2012 Jul 1;13(4):460-3. 
  18. Srinagesh J, Pushpanjali K. Assessment of antibacterial efficacy of triphala against mutans streptococci: a randomised control trial. Oral Health Prev Dent. 2011;9(4):387-93.

Consumer Information

How It Works

BOTTOM LINE: The anticancer effects of Triphala have not been confirmed in humans.

Triphala is an herbal formulation used in the Indian medicinal system of Ayurveda for the treatment of various ailments. It consists of three medicinal plants: Emblica officinalis, Terminalia chebula, and Terminalia belerica. It 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. Triphala was shown to have beneficial effects in studies done in laboratory and in animals. However human data are limited.

Purported Uses
  • To treat Infections
    Studies done in mice showed that triphala can reduce infections. Human data are lacking.
  • To decrease high levels of cholesterol
    Triphala was shown to reduce cholesterol levels in rats with high cholesterol. However, this has not been studied in humans.
  • To strengthen the immune system
    Studies in rats have shown that Triphala can improve immune function but human data are lacking.
Research Evidence

Several laboratory studies have shown that Triphala has beneficial effects. However, these effects have yet to be proven in humans.
Two clinical studies found triphala mouthwash is as effective as chlorhexidine in preventing plaque formation. However, this benefit has not been observed in children.

Do Not Take If
  • If you are taking drugs that are substrates of Cytochrome P450 3A4 and CYP2D6 (Triphala may increase the risk of side effects of these drugs).
Side Effects
  • Intestinal gas
  • Stomach upset
  • Diarrhea
E-mail your questions and comments to aboutherbs@mskcc.org.