Triphala

Triphala

1. Identity: Botanical Names, Natural Source, and Common Forms

Triphala (Sanskrit: tri = three, phala = fruits) is a well-recognized and revered polyherbal medicine consisting of dried fruits of three plant species — Emblica officinalis (Family Euphorbiaceae), Terminalia bellerica (Family Combretaceae), and Terminalia chebula (Family Combretaceae) — that are native to the Indian subcontinent. These three component plants are known by their Sanskrit names as follows:

• Amalaki (Emblica officinalis Gaertn., syn. Phyllanthus emblica L.) — also known as Indian gooseberry or Amla, Family Euphorbiaceae / Phyllanthaceae.
• Haritaki (Terminalia chebula Retz., Family Combretaceae)
• Bibhitaki (Terminalia bellirica Roxb., Family Combretaceae)

Triphala is a polyherbal Ayurvedic formulation, specifically a churna (powder), or a kwatha (decoction or infusion) produced from chebulic myrobalan (Haritaki), beleric myrobalan (Bibhitaki), and emblic myrobalan (Amalaki). It is considered an Ayurvedic rasayana formula when the dried and powdered fruit are prepared in a 1:1:1 or 1:2:3 ratio.

It is one of the most common Ayurvedic treatments in the world because of its ability to balance all three "doshas" simultaneously. Less prominently, as sanlejiang, the drink has a 1,200-year history as a kind of fruit wine in China, with the non-alcoholic form now being marketed there as a traditional herbal remedy.

Common Dosage Forms and Preparations

Triphala comes in capsules, tablets, and powders. The form that a person uses may depend on what they are treating. For instance, a person may mix a powdered form of triphala with water to make a mouthwash. To use it on the skin, they may mix a small amount of powder with a lotion or cream. Capsules and tablets may be helpful if a person is using triphala internally — to treat ulcers, arthritis, or constipation, for example.

The principal classical preparation is churna (powder). The drug is washed, cleaned, and dried. It is crushed to a fine powder using a pulverizer. The fineness of the powder improves therapeutic efficacy. In compound churna, each drug is powdered separately, and individual powders are mixed together. The churna should be fine — at least 80 mesh sieve.

The decoction form can be used as an eyewash or mouthwash. After cleaning the dried fruits and removing seeds, powders are made separately from the three dried fruits, mixed together in equal amounts to form a uniform mixture. This mixture is added to 16 times its volume of water for one hour and then boiled until half the water remains, then filtered through fine cotton cloth.

Beyond churna and decoction, Triphala is commercially available as standardized tablets, capsules, liquid extracts, and as a component of compound formulations such as Triphala Guggul (combined with guggul resin). Methanolic extract of Triphala is rich in catechins (catechin, epicatechin, and epigallocatechin gallate).

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2. Traditional and Historical Use

Textual and Cultural Origins

The formula has been used in traditional medicine in India for over 1,000 years according to the writings of the great physician Charak in a foundational text of Ayurveda called the Charaka Samhita, as well as in another key text called the Sushruta Samhita. Foundational Ayurvedic texts, including the Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya, contain extensive knowledge of medicinal herbs, therapeutic formulations, and lifestyle guidelines to promote health and manage diseases.

Triphala Rasayana, the polyherbal formulation, has been employed in Ayurveda, Siddha, and Unani medicine systems to address various health conditions. With its rich history in Ayurveda, Triphala's unique tridoshic properties are held to harmonize the body's three essential energies — Vata, Pitta, and Kapha — fostering overall well-being and diverse health applications.

Classical Texts and Specific Uses

Classical Ayurvedic texts describe Triphala's primary sphere of action as the digestive system and the channels of elimination (Srotas). The Charaka Samhita and Ashtanga Hridayam both reference Triphala in the context of supporting regular, healthy bowel function — described as a gentle Anulomana (supporting the downward movement of Vata and elimination) rather than a harsh purgative — and for supporting the health of the eyes (Chakshushya), one of the most consistently cited traditional uses across multiple classical texts.

The Charaka Samhita describes specific extended Rasayana protocols using Triphala, typically taken over weeks or months in progressively increasing doses with specific carriers (Anupana) such as honey, ghee, or warm water.

Traditional Applications

It has been used to manage gastrointestinal disorders such as nausea, vomiting, indigestion, constipation, non-bleeding piles, and toxins in the colon, and is also advised in cardiovascular disorders, diabetes mellitus, hepatic dysfunction, chronic inflammatory conditions, ophthalmic conditions, cough, leucorrhea, ulcers, pyorrhea/scurvy, fever, hypertension, inflammatory bowel disease, and hypercholesterolemia.

In Ayurvedic practice, Triphala is frequently used to treat digestion problems, poor food assimilation, constipation, and gastric acidity. Besides these, it is used in the treatment of many other diseases such as asthma, anemia, jaundice, fever, cough, chronic ulcers, leucorrhea, and pyorrhea.

Triphala has traditionally been used to treat microbial infections such as wounds, ulcers, and dental caries, and has been subjected to many studies to evaluate its potency as a wound healer and antimicrobial agent.

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3. Key Constituents and Active Compounds

Major Phytochemical Classes

Pharmaceutical analyses have revealed that Triphala is rich in saponins, terpenoids, tannins, flavonoids, and phenolic acids. Among these compounds, ellagitannins and tannin-related compounds — especially gallic acid, ellagic acid, chebulinic acid, and chebulagic acid — are considered the major constituents responsible for the bioactivities of Triphala.

Phytochemicals detected in the fruits of the three plants include phenolic compounds (gallic acid, ellagic acid, chebulinic acid, chebulagic acid, and emblicanin A and B), flavonoids (quercetin and kaempferol), alkaloids (phyllantidine and phyllantin), ascorbic acid, carbohydrates, and proteins.

Methanolic extract of Triphala is rich in catechins (catechin, epicatechin, and epigallocatechin gallate).

Compound-Specific Contributions by Component Fruit

• Emblica officinalis (Amalaki): The phytochemical profile of dried Amla fruit is characterized by an abundance of bioactive compounds, including phenolic compounds, amino acids, alkaloids, isostrictiniin, ellagic acid, apigenin, chebulinic acid, quercetin, gallic acid, chebulagic acid, tannins, and carbohydrates. Emblicanin A and B — unique to Emblica — are also significant constituents. The components in E. officinalis including Emblicanin A and B and ellagitannin have been reported to have anti-carcinogenic activity by interfering with cell cycle regulation at the G2 phase via modulation of cyclin B in a dose-dependent manner.
• Terminalia bellerica (Bibhitaki): The main chemical constituents of T. bellerica are tannins that mainly include β-sitosterol, gallic acid, ellagic acid, ethyl gallate, and galloyl glucose. In T. bellerica, the chemical composition features a notable presence of benzene derivatives and organooxygen compounds.
• Terminalia chebula (Haritaki): High performance liquid chromatography (HPLC) has revealed gallic acid, ellagic acid, and chebulinic acid to be the major constituents of Triphala formulations. Chebulinic acid and chebulagic acid are especially concentrated in this fruit.

Quantitative Phytochemical Data

Content analysis of Triphala extracts obtained from equal portions of the three fruits has observed total phenolic compounds (62.87 ± 0.21 mg gallic acid equivalent/mL), total flavonoids (0.24 ± 0.01 mg catechin equivalent/mL), hydrolyzable tannins (177.27 ± 10.09 mg gallotannin equivalent/mL), and condensed tannins (0.62 ± 0.11 mg catechin equivalent/mL).

Both chebulinic acid and chebulagic acid have been demonstrated to contribute to the antitumour activities of Triphala, but chebulinic acid shows higher antitumour activities than gallic acid, ethyl gallate, luteolin, and tannic acid against a human osteosarcoma cell line in vitro. It has also been reported that chebulinic acid has the highest antioxidative activity among all the constituents of Triphala.

The amount of each phytochemical varies depending on the methods used to extract it, the solvents used, and the region in which the parent plant was grown.

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4. Established Mechanisms of Action

Antioxidant and Free Radical Scavenging

Triphala is rich in polyphenols, vitamin C, and flavonoids, which provide antioxidant and anti-inflammatory effects. It also contains various types of acids — gallic, chebulagic, and chebulinic — which additionally possess cytoprotective and antifungal properties.

The dual nature of Triphala, acting as an antioxidant in normal cells and prooxidant in cancer cells, facilitates its function as both a chemopreventive and chemotherapeutic agent.

Anti-inflammatory Pathways

Through the range of biologically active compounds — gallic acid, ellagic acid, chebulinic acid — Triphala can help reduce inflammation by lowering the expression of pro-inflammatory mediators.

Triphala contains ellagic acid, which has been shown to reduce histamine release and inflammation in the lung via suppressing the activity of NF-κB; these effects help speed up the resolution of allergic airway inflammation. Gallic acid has been reported to suppress nasal histamine release and inflammation and is one of the active components that may help reduce nasal symptoms caused by autacoids and inflammatory cytokines. Chebulagic acid has been shown to possess anti-inflammatory properties by reducing cytokine production and inflammatory enzymes including COX-2 and LOX.

Treatment with chebulagic acid, chebulinic acid, gallic acid, and the whole Triphala extract showed characteristic inhibition of MMP-9, cell proliferation/migration, and tube formation, as well as the expression of IL-6, IL-8, and MCP-1, without affecting cell viability in retinal endothelial cell models.

Gut Microbiome Modulation and Urolithin Production

Polyphenols in Triphala modulate the human gut microbiome and thereby promote the growth of beneficial Bifidobacteria and Lactobacillus while inhibiting the growth of undesirable gut microbes. The bioactivity of Triphala is elicited by gut microbiota to generate a variety of anti-inflammatory compounds.

Triphala-derived polyphenols such as chebulinic or ellagic acids can be transformed by the human intestinal microbiota into various active metabolites, including urolithins, which modulate the inflammatory process by generating anti-inflammatory compounds and preventing oxidative injuries of enterocytes.

Gallic acid and quercetin in Triphala promote the growth of beneficial bacteria like Lactobacillus and Bifidobacteria while preventing the growth of harmful bacteria like Escherichia coli. Lactic acid bacteria possess tannase enzymes, breaking down plant tannins like gallic acid in Triphala Rasayana. Triphala Rasayana polyphenols, such as ellagic acids and chebulinic acid, and the human gut microbiome convert Triphala into active compounds called urolithins, unlocking its health benefits.

Anti-Angiogenic Activity

Tumor inhibitory effects of Triphala or its active constituents operate through suppression of VEGF actions. Triphala and one of its active compounds, chebulinic acid, specifically inhibit VEGF-induced angiogenesis by suppressing VEGF receptor-2 (VEGFR-2) phosphorylation and thus reduce tumor growth and metastasis.

Gastrointestinal Mechanisms

The components of Triphala are believed to cause restoration of the epithelium lining of the digestive tract and, by exhibiting mild laxative properties, facilitate passage of stool in the colon.

The stimulatory action on the gut is supposedly mediated through the activation of muscarinic receptors.

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5. Scientific Evidence by Health Area

5.1 Gastrointestinal Health and Constipation

Animal studies have shown that both aqueous and alcohol-based extracts of Triphala prevent diarrhea. Triphala also induces enteroprotective effects, which are likely due, at least in part, to the high antioxidant content. In a rodent model, Triphala replenished depleted protein in the intestinal villi of the brush border as well as glutathione and phospholipid levels; the formula simultaneously decreased myeloperoxidase and xanthine oxidase levels in intestinal epithelium. In rats, Triphala exerted a gastroprotective effect on stress-induced ulcer. One human clinical trial that investigated the use of Triphala in patients with gastrointestinal disorders reported that treatment reduced constipation, mucous, abdominal pain, hyperacidity, and flatulence while improving the frequency, yield, and consistency of stool.

Possible clinical application of Triphala has been assessed in patients with functional constipation. An open-label, prospective, interventional, and exploratory clinical trial demonstrated that one week of treatment with a Triphala-containing formulation increased average weekly bowel frequency by 64.4%, and by 79.5% after two weeks. The increase in mean bowel movement was maintained seven days after the observational period and was approximately 18% higher than the baseline value.

Triphala is taken in powder form in dosages of 3 to 6 g daily for the treatment of flatulence and constipation.

Triphala holds potential in improving lower GI symptoms and may be a valuable and effective addition to standard treatment of IBS. Supplementation of Triphala herbal formulations alone or along with other probiotics can be recommended in ongoing clinical studies.

Limitation: Relevant cell culture and animal studies, and rationally designed clinical trials are required to uncover the full potential of Triphala, understand its mechanism of action, determine permissible doses, and assess side effects that may appear over longer administration.

5.2 Weight Management and Metabolic Health

In a 12-week, double-blind, randomized placebo-controlled trial, human subjects treated with Triphala lost approximately 5 kg compared with the placebo control group. Mean fasting blood sugar and fasting serum insulin levels were also reduced in the treated compared with control subjects.

Another study assessed the efficacy of Itrifal Saghir (triphala) on reduction of weight and body mass index (BMI) of simple obese subjects in comparison with placebo. Obese subjects aged between 16 and 60 years were selected for a 12-week, double-blind, randomized, placebo-controlled trial using a parallel design. Subjects were randomly assigned to take 5 grams of either the Itrifal Saghir (n = 31) or placebo (n = 31), twice daily for 12 weeks. Body weight, BMI, waist circumference, and hip circumference were assessed at baseline and once every four weeks.

A randomized clinical trial demonstrated that taking Triphala tablets at a dose of 1,000 mg twice daily resulted in significant weight loss and a decrease in body fat percentage compared with a placebo.

A systematic review of five RCTs demonstrated that triphala-treated groups showed a statistically significant decrease in body weight, body mass index, and waist circumference in obese patients. Moreover, triphala significantly decreased fasting blood glucose level in diabetic subjects. Twelve studies on a total of 749 patients were included in this systematic review.

Overall assessment: Oral short-term consumption of Triphala led to a reduction in body weight across individuals with obesity, although its efficacy for body mass index remains indecisive.

5.3 Oral Health

In controlled studies, oral Streptococcus levels were measured after using a 6% Triphala mouthwash or 0.2% chlorhexidine mouthwash twice per day for 48 hours and for 7 days; Streptococcus levels were reduced by 17% and 44%, respectively, in the Triphala-treated group. The researchers concluded that Triphala was as effective as 0.2% chlorhexidine mouthwash given that the results of the Triphala treatment were similar to the chlorhexidine-treated group.

Another double-blind human clinical trial also reported significant reductions in oral Streptococcus levels at 5 and 60 minutes after rinsing with 15 mL of aqueous Triphala extract (10%) mouthwash. In addition, a double-blind, randomized human clinical trial reported that Triphala (10%) mouthwash is effective against dental plaque and gingivitis in teenagers, with Triphala reported as equally effective in antiplaque and antigingivitis activity compared with chlorhexidine.

A randomized, controlled, double-blind, parallel-group clinical trial was conducted among 72 schoolchildren aged 14–15 years, divided into two study groups: Group A with 0.4% Triphala mouthwash (n = 36) and Group B with 0.12% chlorhexidine mouthwash (n = 36).

In a double-blind, randomized, multicenter clinical trial, 120 patients were equally divided into three groups. Patients in group A were advised to rinse their mouths with 10 mL of distilled water, group B with 0.2% chlorhexidine, and group C with Triphala mouthwash for one minute twice daily for two weeks. The plaque index (PI) and gingival index (GI) were recorded on the first and fifteenth day. There was no significant difference when the efficacy of Triphala was compared with 0.2% chlorhexidine in hospitalized patients with periodontal disease.

Overall assessment: Studies have shown that Triphala was effective in preventing dental caries, and this effect was equal to that of chlorhexidine. The oral health evidence base — comprising multiple randomized controlled trials — is among the more robust areas of Triphala clinical research.

5.4 Antioxidant and Immunomodulatory Effects

To evaluate the immunostimulatory and side effects of Triphala in a clinical phase I study, all volunteers took Triphala (3 capsules per day) for 2 weeks. Complete physical examination, routine laboratory analysis, and immunological studies were performed before ingestion and for 4 consecutive weeks afterwards. Triphala demonstrated significant immunostimulatory effects on cytotoxic T cells (CD3−CD8+) and natural killer cells (CD16+CD56+). Both increased significantly compared with control samples. However, no significant change in cytokine secretion was detected. All volunteers were healthy and showed no adverse effects throughout the duration of the study.

A clinical safety trial concluded that aqueous extract of Triphala is safe for healthy volunteers and that it elevates HDL-C levels and lowers blood sugar. Further clinical study should investigate its effects on HDL-C and blood sugar levels among the dyslipidemic and prediabetic groups. This safety study evaluated administration of aqueous extract of Triphala to healthy volunteers at 2,500 mg per day.

5.5 Anticancer and Chemopreventive Effects

Studies in the recent past have indicated that Triphala has immense potential in the reduction of oxidative damage as well as in the prevention and treatment of cancer. Some studies indicated that antioxidants from dietary supplements may promote tumor growth and metastasis. However, it is noteworthy that Triphala acts as an anticancer agent by exhibiting prooxidant effects in cancer cells.

The anticancer activity of Triphala has been investigated; Triphala has been found to inhibit growth of several malignancies including both in vitro and in vivo, such as breast cancer, prostate cancer, and pancreatic tumor. A recent report demonstrates that Triphala can mediate its antitumor effects via inhibition of vascular endothelial growth factor and can prevent angiogenesis.

Oral administration of Triphala (50–100 mg/kg) suppresses the growth of Capan-2 pancreatic tumor-xenograft in animal models. Reduction in tumor growth by Triphala in mice was found to be due to increased apoptosis in the tumor cells, associated with increased activation of p53 and ERK.

Limitation: Triphala has shown high efficacy and safety in humans as well as in experimental studies; however, most of the studies are done in animals and in vitro models. Direct human clinical trials evaluating Triphala specifically as a cancer treatment are lacking, and its chemopreventive role in humans remains unconfirmed.

5.6 Blood Glucose and Lipid Profiles

Triphala has been reported to have potential for reduction of low-density lipoprotein-cholesterol, total cholesterol and triglyceride, body weight, body mass index, and waist circumference in humans.

In vivo studies have elucidated anti-obesity properties, finding that administration of the aqueous extract led to reductions in noradrenaline, leptin, interleukin-6, C-reactive protein, MDA, and total cholesterol levels, and increased levels of HDL, adiponectin, superoxide dismutase, serotonin, and dopamine. Several genes associated with lipid metabolism were downregulated in albino Wistar rats. Additionally, the aqueous extract decreased total cholesterol and triglyceride levels and increased HDL cholesterol levels in Sprague-Dawley albino rats receiving a high-fat diet.

Limitation: While the systematic review of RCTs confirms statistically significant metabolic improvements in some trials, the evidence remains heterogeneous in study design, population, dosage, and duration, requiring larger and more rigorous clinical trials.

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6. Body Systems and Health Areas Associated with Triphala

In addition to laxative action, Triphala research has found the formula to be potentially effective for several clinical uses such as appetite stimulation, reduction of hyperacidity, antioxidant, anti-inflammatory, immunomodulating, antibacterial, antimutagenic, adaptogenic, hypoglycemic, antineoplastic, chemoprotective, and radioprotective effects, and prevention of dental caries.

Triphala may also promote proper digestion and absorption of food, reduce serum cholesterol levels, improve circulation, relax bile ducts, prevent immunosenescence, maintain homeostasis of the endocrine system, and increase production of red blood cells and hemoglobin.

Body systems with the most documented research activity include:

• Gastrointestinal system — laxative, antispasmodic, gastroprotective, and microbiome-modulating effects
• Oral cavity — anticariogenic, antiplaque, antigingivitis
• Metabolic/endocrine — blood glucose regulation, lipid-lowering, anti-obesity
• Immune system — cytotoxic T-cell and NK-cell stimulation, immunomodulation
• Oncology — chemopreventive, anti-angiogenic, pro-apoptotic (primarily preclinical)
• Ophthalmic — traditional use as eyewash; in vitro evidence for retinal vascular protection via anti-TNFα mechanisms

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7. Dosage Forms and Doses Reported in Studies

Triphala is taken in powder form in dosages of 3 to 6 g daily for the treatment of flatulence and constipation.

In the obesity RCT, subjects were randomly assigned to take 5 grams of Itrifal Saghir (triphala) or placebo, two times daily for 12 weeks.

A randomized clinical trial demonstrating weight loss used Triphala tablets at a dose of 1,000 mg twice daily.

A Phase I safety trial evaluated the aqueous extract of Triphala administered to healthy volunteers at 2,500 mg per day.

In the Phase I immunostimulatory clinical study, all volunteers took Triphala at 3 capsules per day for 2 weeks.

For oral health, clinical trials have used 6% Triphala mouthwash twice per day, or 15 mL of aqueous Triphala extract (10%) mouthwash, or 0.4% Triphala mouthwash.

There is no established dosage of Triphala for internal use, but many supplements include about 300 mg of each ingredient per dose, making one dose approximately 900–1,000 mg of Triphala.

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8. Safety Considerations and Drug Interactions

General Tolerability

In the Phase I immunostimulatory clinical study, all volunteers were healthy and showed no adverse effects throughout the duration of the study.

A clinical trial concluded that aqueous extract of Triphala is safe for healthy volunteers.

Stomach upset is a possible side effect of Triphala. Triphala can have laxative effects, causing diarrhea or stomach upset, especially at higher dosages.

CYP450 Enzyme Interactions

A study was the first to investigate direct in vitro and in vivo evidence of pharmacokinetic interactions between Triphala and the CYP-probes of phenacetin and midazolam in rats via CYP1A and 3A inhibition. Clinical caution needs to be taken when drugs metabolized by CYP1A2 and/or CYP3A4 enzymes are used in combination with Triphala extract, since adverse events of those drugs may be pronounced by Triphala intake.

Gallic acid potently inhibited CYP1A2, CYP2C9, and CYP2C19 with a non-competitive nature, while the inhibitory potencies on CYP2D6 and CYP3A4 were weak. Chronic dosing of Triphala formulation at 1,000 and 3,000 mg/kg body weight significantly induced mRNA expression of CYP1A2 but not CYP3A1. Results suggest the propensity of metabolic drug interactions when Triphala formulation is concurrently administered with other conventional drugs or herbal medicines.

Interaction with Cisplatin

Studies suggest that Triphala may interact with cisplatin by inhibiting the CYP2E1 enzyme, potentially affecting the metabolism and toxicity of cisplatin. These findings highlight the need for further research to evaluate the clinical implications of using Triphala alongside cisplatin-based cancer therapies.

Pregnancy and Special Populations

Toxicological studies are required to ensure safety, minimize side effects, and assess herb-drug interactions comprehensively.

Long-Term Safety and Research Gaps

To establish Triphala as a globally accepted therapeutic agent, future research must focus on pharmacokinetics, bioavailability, and molecular mechanisms, particularly its effects on gene expression, microbiota modulation, and cell signaling pathways. Well-designed clinical trials are essential to validate its long-term efficacy and safety.

The plasma levels of gallic acid and ellagic acid after oral intake of fruits containing these two compounds — and thereby their bioavailability — have been reported to be poor. This has implications for interpreting in vitro studies using isolated compounds, as the active metabolic species reached in vivo (e.g., urolithins formed by gut bacteria) may differ from parent compounds tested in cell culture.

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