Triphala

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Triphala

Common Names

  • Triphala churna
  • Triphala choornam
  • Phala trika

For Patients & Caregivers

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.
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For Healthcare Professionals

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).
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.
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