Triphala

Purported Benefits, Side Effects & More
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Triphala

Purported Benefits, Side Effects & More
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Triphala

Common Names

  • Triphala churna
  • Triphala choornam
  • Phala trika

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For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.

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.

Studies of this formulation for various conditions in humans are limited, and additional studies are needed.

Purported Uses and Benefits
  • To treat GI problems
    Animal models suggest gastroprotective effects, but human studies are lacking.
  • To control inflammation
    Animal studies suggest that Triphala may reduce inflammation, but human studies are lacking.
  • To decrease high levels of cholesterol
    Clinical studies are limited and mixed. Additional studies are needed.
  • To strengthen the immune system
    Data are limited and larger 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 CYP substrate drugs: Triphala may increase risk of side effects from drugs that are metabolized by CYP3A4 and CYP2D6 enzymes.
Side Effects

Rare: Gastrointestinal side effects

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For Healthcare Professionals

Clinical Summary

Triphala is an herbal formulation used in the Indian medicinal system of Ayurveda (1). It consists of equal portions of dried and powdered fruits of three medicinal plants: Emblica officinalis (Amalaki), Terminalia chebula (Haritaki) and T. 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 strengthen the immune system.

Preclinical studies using Triphala report antibacterial (35), anticancer (36), antiobesity (24), antiarthritic, anti-inflammatory (25) (26) and hypolipidemic properties (10). It may also protect against intestinal damage (14), colitis (22), and nephrotoxicity (23).

Studies in humans are limited. Data suggest Triphala mouthwash has antibacterial effects (37) and that antiplaque efficacy is comparable to chlorhexidine, but data are not definitive (15) (17) (18) (27) (28) (29) (38) (39) (40). Furthermore, Triphala may actually promote oral bacterial biofilm formation (30).

Other preliminary data suggest immunostimulatory effects (31), reversal of oral precancerous lesions (32), and improved HDL cholesterol and blood sugar levels (41). However, a double-blind study of Triphala in combination with guggulu showed no benefit on serum cholesterol levels, BMI, or waist circumference (43).

Purported Uses and Benefits
  • GI problems
  • Inflammation
  • Immune function
  • Gingivitis
  • High cholesterol
  • 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 inhibited hyaluronidase and collagenase to prevent cartilage degradation (7). Antiarthritic and anti-inflammatory effects of Triphala are attributed to NF-kBp65 and COX-2 inhibition (25) (26), whereas the anticolitic effects are attributed to antioxidant properties (22). Nephrotoxic effects were also thought to be attenuated via increased antioxidant activity (23).

Triphala appears to stimulate neutrophil function and decrease corticosterone levels in immunized rats exposed to noise stress (34). It also exerted radioprotective effects (21) by inhibiting oxidative damage. Triphala increased ROS in breast cancer cells resulting in apoptosis (8), protected against X-radiation and bleomycin, both of which generate DNA strand breaks in HeLa cells (42), and appeared to protect 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).

In a small study of healthy human volunteers, Triphala increased cytotoxic T cells and NK cells (31).

Adverse Reactions

Rare: Gastrointestinal side effects (15) (18) (31)

Herb-Drug Interactions
  • CYP450 substrates: Triphala inhibits CYP3A4 and CYP2D6, and may affect the intracellular concentration of drugs metabolized by these enzymes (16).
Dosage (OneMSK Only)
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.
  19. Prabhakar J, Balagopal S, Priya MS, et al. Evaluation of antimicrobial efficacy of Triphala (an Indian Ayurvedic herbal formulation) and 0.2% chlorhexidine against Streptococcus mutans biofilm formed on tooth substrate: an in vitro study. Indian J Dent Res. Jul-Aug 2014;25(4):475-479.
  20. Shakouie S, Eskandarinezhad M, Gasemi N, et al. An in vitro comparison of the antibacterial efficacy of triphala with different concentrations of sodium hypochlorite. Iran Endod J. Fall 2014;9(4):287-289.
  21. Sandhya T, Lathika KM, Pandey BN, et al. Protection against radiation oxidative damage in mice by Triphala. Mutat Res. Oct 10 2006;609(1):17-25.
  22. Rayudu V, Raju AB. Effect of Triphala on dextran sulphate sodium-induced colitis in rats. Ayu. Jul-Sep 2014;35(3):333-338.
  23. Baskaran UL, Martin SJ, Mahaboobkhan R, et al. Protective role of Triphala, an Indian traditional herbal formulation, against the nephrotoxic effects of bromobenzene in Wistar albino rats. J Integr Med. Mar 2015;13(2):115-121.
  24. Gurjar S, Pal A, Kapur S. Triphala and its constituents ameliorate visceral adiposity from a high-fat diet in mice with diet-induced obesity. Altern Ther Health Med. Nov-Dec 2012;18(6):38-45.
  25. Kalaiselvan S, Rasool M. Triphala exhibits anti-arthritic effect by ameliorating bone and cartilage degradation in adjuvant-induced arthritic rats. Immunol Invest. 2015;44(4):411-426.
  26. Kalaiselvan S, Rasool MK. The anti-inflammatory effect of triphala in arthritic-induced rats. Pharm Biol. Jan 2015;53(1):51-60.
  27. Bhattacharjee R, Nekkanti S, Kumar NG, et al. Efficacy of triphala mouth rinse (aqueous extracts) on dental plaque and gingivitis in children. J Investig Clin Dent. May 22 2014.
  28. Chainani SH, Siddana S, Reddy C, et al. Antiplaque and antigingivitis efficacy of triphala and chlorhexidine mouthrinse among schoolchildren - a cross-over, double-blind, randomised controlled trial. Oral Health Prev Dent. 2014;12(3):209-217.
  29. Naiktari RS, Gaonkar P. A randomized clinical trial to evaluate and compare the efficacy of triphala mouthwash with 0.2% chlorhexidine in hospitalized patients with periodontal diseases. Jun 2014;44(3):134-140.
  30. Mishra S, Routray S, Kumar Sahu S, et al. The role and efficacy of herbal antimicrobial agents in orthodontic treatment. J Clin Diagn Res. Jun 2014;8(6):Zc12-14.
  31. Phetkate P, Kummalue T, Y UP, et al. Significant increase in cytotoxic T lymphocytes and natural killer cells by triphala: a clinical phase I study. Evid Based Complement Alternat Med. 2012;2012:239856.
  32. Deshpande A, Tandon S, Deshpande N. Low resource screening method of pre-cancerous lesions and its reversal by Triphala in teen-age Indian population. Ayu. Apr 2014;35(2):160-167.
  33. Belapurkar P, Goyal P, Tiwari-Barua P. Immunomodulatory effects of triphala and its individual constituents: a review. Indian J Pharm Sci. Nov-Dec 2014;76(6):467-475.
  34. Srikumar R, Jeya Parthasarathy N, Sheela Devi R. Immunomodulatory activity of triphala on neutrophil functions. Biol Pharm Bull. Aug 2005;28(8):1398-1403.
  35. Manoraj A, Thevanesam V, Bandara BMR, Ekanayake A, Liyanapathirana V. Synergistic activity between Triphala and selected antibiotics against drug resistant clinical isolates. BMC Complement Altern Med. 2019 Aug 2;19(1):199.
  36. Tsering J, Hu X. Triphala Suppresses Growth and Migration of Human Gastric Carcinoma Cells In Vitro and in a Zebrafish Xenograft Model. Biomed Res Int. 2018 Dec 10;2018:7046927.
  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.
  39. Pradeep AR, Suke DK, Martande SS, Singh SP, Nagpal K, Naik SB. Triphala, a New Herbal Mouthwash for the Treatment of Gingivitis: A Randomized Controlled Clinical Trial. J Periodontol. 2016 Nov;87(11):1352-1359.
  40. Baratakke SU, Raju R, Kadanakuppe S, Savanur NR, Gubbihal R, Kousalaya PS. Efficacy of triphala extract and chlorhexidine mouth rinse against plaque accumulation and gingival inflammation among female undergraduates: A randomized controlled trial. Indian J Dent Res. 2017 Jan-Feb;28(1):49-54.
  41. Phetkate P, Kummalue T, Rinthong PO, Kietinun S, Sriyakul K. Study of the safety of oral Triphala aqueous extract on healthy volunteers. J Integr Med. 2019 Oct 16. pii: S2095-4964(19)30100-1.
  42. Takauji Y, Miki K, Mita J, et al. Triphala, a formulation of traditional Ayurvedic medicine, shows protective effect against X-radiation in HeLa cells. J Biosci. 2016 Dec;41(4):569-575.
  43. Donato F, Raffetti E, Toninelli G, et al. Guggulu and Triphala for the Treatment of Hypercholesterolaemia: A Placebo-Controlled, Double-Blind, Randomised Trial. Complement Med Res. 2021;28(3):216-225.
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