Benefits of Triphala – The Three Fruit Ayurvedic Synergy (A Review)

Disha Dhiman
January 23, 2023

Ayurveda “Science of life” aims at treating various health conditions by balancing the three pillars of life known in Sanskrit as the three doshas, namely, Vata (elements of space and air), Kappha (elements of earth and water), and Pitta (elements of fire and water) [1]

“Triphala” in Sanskrit means Tri (Three) and Phala (Fruit). It is a well-recognized equiproportional mixture of dried fruits of the three plant species Emblica officinalis (Family Euphorbiaceae), Terminalia bellerica (Family Combretaceae), and Terminalia chebula (Family Combretaceae) that are native to the Indian subcontinent. It is classified as a tridoshic rasayana in Ayurvedic medicine as it promotes longevity and rejuvenation in patients of all constitutions and ages.

Image source: Oxidative Stress and Cancer: Chemopreventive and Therapeutic Role of Triphala. Sahdeo Prasad and Sanjay K. Srivastava, Antioxidants 2020, 9, 72

More on the Constituents of Triphala

1. AMLA (Emblica officinalis): It is a fruit from a small to medium sized deciduous tree, found throughout India, Pakistan, Uzbekistan, Sri Lanka, South East Asia, China, and Malaysia. Amla is highly nutritious and is one of the richest sources of vitamin C, amino acids and minerals. It contains several chemical constituents like tannins, alkaloids, and phenols. Among all hydrolysable tannins, Emblicanin A and B; gallic acid, ellagic acid are reported to possess biological activity.

In ayurveda Amla is used as a powerful rasayana. Amla fruit is widely used in the Indian system of medicine as alone or in combination with other plants to treat common cold and fever, as diuretic, laxative, liver tonic, refrigerant, stomachic, restorative, antipyretic, hair tonic and to prevent ulcer and dyspepsia. Modern science has shown amla to have hypoglycemic, anti-inflammatory, anti-hyperglycemic, anti-hyperlipidemic, and antioxidant properties in animal and human studies [2-4]

Also, it has been scientifically proven that Amla possesses anti-thrombosis properties to promote vascular health by improving blood fluidity, anti-coagulant, and antiplatelet activity. Amla also supports natural immunity and digestive functions. [5,6-8] The combined anti-inflammatory, anti-thrombosis, anti-coagulant, and anti-platelet activities of amla make it an attractive target for the prevention of a variety of vascular disorders [9].

2. HARADA (Terminalia chebula): It is commonly called as Chebulic Myrobalan in English, Harad or Harra in Hindi and Abhaya in Sanskrit. It is conceived as one of the most significant ayurvedic herbaceous plants whilst it has an astringent and unpleasant taste. Harada has been used widely for many centuries in both Ayurvedic and Tibetian medicine. It is named as “king of medicine” in Tibetan medicine.

It is an evergreen flowering tree, and leaves, fruits, seeds, and barks are widely used in conventional folk medicine. The fruits are reported to contain tannins (30-40%) e.g. chebulinic acid, neochebulinic acid, corilagin, chebulagic acid, gallic acid, ellagic acid, punicalagin, terchebin, and terflavin A.[10,11].

The fruits also have flavonoids e.g. luteolin, rutin and quercetin in them[12]. Apart from these, they also contain various other phytochemicals, carbohydrates, amino acids, and fatty acids[13]. Due to presence of range of biologically active compounds, the fruits of T. chebula have been used in traditional medicine to combat a number of ailments of upper respiratory tract, gastrointestinal tract, urinary tract, and skin[13-20]. These active compounds are effective in treating cancer[13] and other diseases of the heart, nervous system, bones, and joints.

3. BIBHITAKI/BAHEDA: (Terminalia Bellerica): Also known as belleric myrobalan, is a large deciduous tree, common to the plains and lower hills of Southeast Asia. It is a strong laxative herbaceous plant. By nature, it is astringent, sweet, and also heating. It is a restorative to “Kapha” and is believed to amend conditions of vitiated voice [21]. In traditional Indian Ayurvedic medicine, the fruit of Terminalia bellerica is extensively used as a folk medicine for the treatment of diabetes, hypertension, and rheumatism [26]. The major polyphenolic components of the fruit are reported to be gallic acid, ellagic acid, and chebulagic acid [27]. Baheda is a potent ancient rejuvenator with detoxifying calibers on the body muscles, blood, and tissues with fat in the body. This plant exhibits several pharmacological effects including anti-bacterial, anti-malarial, anti-fungal, anti-HIV, anti-oxidant, and anti-mutagenic effects[22-25].

Therapeutic uses of Triphala

There are various compelling preclinical in vitro and in vivo studies which support antioxidant, antimicrobial, immunomodulatory properties of Triphala and its components, and prove its usefulness in an array of diseases, including hemorrhoid, skin disease, asthma, dysentery, uterine debility, anemia, diabetes, heart disease, and others.

Antimicrobial activity

Triphala is known to exert antibacterial action against a variety of Gram-positive and Gram-negative bacteria—e.g. Streptococcus mutans, a gram-positive, anaerobic bacterium mostly found between adjacent teeth or in the deep crevices on occlusal of teeth, or Helicobacter pylori, the principal cause of inflammation in the gastric mucosa [28–30]. Triphala is also an antiviral operator that acts against swine flu and other viruses. [31,32]

Antioxidant activity and Eye Health

Antioxidants play an important role in protecting the human body against damages caused by reactive oxygen species (ROS). Many studies have been devoted to uncovering the antioxidant potential of Triphala. It possesses superoxide radical scavenging and hydroxyl radical-scavenging activity as shown in in-vitro and in vivo studies [33-35].

The Antioxidant effects of Triphala have the potential to help maintain eye health. Triphala is a rich source of vitamin C and flavonoids. Triphala delays or forbids selenite-induced experimental cataractogenesis in vitro and in vivo perhaps due to antioxidant activity [45].

Hypolipidemic effect

A study showed that volunteers given a constituent of Triphala-amla (500 mg/day) for 16 weeks had significantly improved HDL/LDL ratio and glucose tolerance, and reduced cholesterol levels, in comparison to the control group receiving 500 mg/day of vitamin C [36]. In one study, Triphala reduced the total cholesterol, low-density lipoprotein, very low-density lipoprotein, and free fatty acid levels in rats fed an atherogenic diet for 48 days.[37]
Triphala is known to be one of the best ayurvedic medicines, with antioxidant and anti-aging properties.

Anti‐cancer activity

The major phytoconstituent of Triphala—gallic acid, is believed to have a great impact on the anticancer properties of the polyherbal formulation of Ayurveda, as it inhibits cancer cell proliferation [38, 39]. Data in cell lines show that Triphala has a differential modulatory effect on normal and cancer cell lines. Triphala induces cytotoxicity in cancer cells, which showed increases in intracellular reactive oxygen species, but not normal cells. Preclinical studies using in vitro and in vivo models report that Triphala inhibits cancer growth in both cell and in vivo models and the effects are mediated through the ERK and p53 pathways [40]. In addition, the methanol extract of Triphala suppressed proliferation and induced p53-independent apoptosis in human colon cancer stem cells. [41]

Immunomodulatory activity

Immunomodulation is the process that alters the immune system of the host resulting in either immunostimulation or immunosuppression thus regulating or normalizing it. Hence, immunomodulators referred to as biological response modifiers, improve the host defense mechanism against diseases by striking a balance between regulatory and effector cells [44]. Using this quality of biological mediators, various alternative Ayurvedic formulations have been developed for various diseases where they either activate the host defense mechanism e.g. in case of an impaired immune response, or can selectively suppress it in conditions like autoimmune disorders and hypersensitivity. Such immunomodulatory properties of various medicinal plants provide an alternative to conventional synthetic drug therapy, which causes side effects, allergic reactions, tolerance to drugs, and increased resistance of microorganisms to antibiotics.

Triphala shows immunomodulatory properties and helps in improving the body’s defense system. It has been observed that through the range of biologically active compounds, e.g. gallic acid, ellagic acid, chebulinic acid, etc. Triphala can help reduce inflammation by lowering the expression of pro-inflammatory mediators [42,43].

Acceptable uses or purposes by Natural and Non-prescription Health Products Directorate (NNHPD)

Triphala is classified as a NHP (Natural health Product) in Canada.

The following uses/purposes have been taken from the Monograph Triphala published by NNHPD Health Canada. [46]

Traditionally used in Ayurveda:

  • As a source of antioxidant
  • As a laxative for the relief of occasional constipation
  • As an eye tonic
  • As a Rasayana- a digestive tonic to promote digestive fire, increase appetite and aid in digestion (stomachic) Products containing Amalaki
  • To help relieve symptoms such as heartburn and indigestion associated with Amlapitta (hyperacidity/dyspepsia)

Conclusion

The use of traditional medicines for improving immunity and treating various diseases has been approved by WHO. India has a rich documented history of traditional medicines such as Sushrut Samhita and Charak Samhita. Triphala is a powerful polyherbal formula with many therapeutic uses for maintaining homeostasis and for the prevention and treatment of disease. Many scientific studies have reported evidence-based validation of various uses of Triphala as discussed above.

In Canada, Triphala falls under the category of an NHP ( Natural Health Product) and cannot be sold in the Canadian Market without a valid NPN. An NPN is an eight-digit Natural product Number on the label which ensures that the NHP is safe, effective and of high quality.

For more information on how to attain an NPN contact us.

References

  1. Peterson, C. T., Denniston, K., and Chopra, D. (2017). Therapeutic uses of triphala in ayurvedic medicine. J. Altern. Complement. Med. 23, 607–614. doi:10.1089/ acm.2017.0083 
  1. M.S. Akhtar, A. Ramzan, A. Ali, M. Ahmad, Effect of Amla fruit (Emblica officinalis Gaertn.) on blood glucose and lipid profile of normal subjects and type 2 diabetic patients, Int. J. Food Sci. Nutr. 62 (6) (2011) 609–616. 
  1. T. Yokozawa, H.Y. Kim, H.J. Kim, T. Okubo, D.C. Chu, L.R. Juneja, Amla (Emblica officinalis Gaertn.) prevents dyslipidemia and oxidative stress in the aging process, Br. J. Nutr. 97 (6) (2007) 1187–1195. 
  1. B. Antony, M. Benny, T.N.B. Kaimal, A pilot clinical study to evaluate the effect of Emblica officinalis extract (Amlamax™) on markers of systemic inflammation and dyslipidemia, Indian J. Clin. Biochem. 23 (4) (2008) 378–381. 
  1. P.M. Vanhoutte, Endothelial dysfunction, Circ. J. 73 (4) (2009) 595–601. 
  1. S. Khanna, A. Das, J. Spieldenner, C. Rink, S. Roy, Supplementation of a standardized extract from Phyllanthus emblica improves cardiovascular risk factors and platelet aggregation in overweight/class-1 obese adults, J. Med. Food 18 (4) (2015) 415–420. 
  1. N. Fatima, R.M. Hafizur, A. Hameed, S. Ahmed, M. Nisar, N. Kabir, Ellagic acid in Emblica officinalis exerts anti-diabetic activity through the action on β-cells of pancreas, Eur. J. Nutr. 56 (2) (2017) 591–601.
  1. P. Usharani, N. Fatima, N. Muralidhar, Effects of Phyllanthus emblica extract on endothelial dysfunction  and biomarkers of oxidative stress in patients with type diabetes mellitus: a randomized, double-blind, controlled study, Diabetes, Metab. Syndrome Obes. Targets Ther. 6 (2013) 275–284. 
  1. N. Fatima, U. Pingali, R. Pilli, Evaluation of Phyllanthus emblica extract on cold pressor induced cardiovascular changes in healthy human subjects, Pharmacogn. Res. 6 (1) (2014) 29–35. 
  1. Lee HS, Koo YC, Suh HJ, Kim KY, Lee KW. Preventive effects of chebulic acid isolated from Terminalia chebula on advanced glycation end product-induced endothelial cell dysfunction. J Ethnopharmacol. 2010;131:567–74. 
  1. Reddy TC, Aparoy P, Babu NK, Kumar KA, Kalangi SK, Reddanna P. Kinetics and docking studies of a COX-2 inhibitor isolated from Terminalia bellerica fruits. Protein Pept Lett. 2010;17:1251–7. 
  1. SuryaPrakash DV, Satya NS, Avanigadda S, Vanglapati M. Pharmacological review on Terminalia chebula. Int J Res Pharma Biomed Sci. 2012;3:679–83. 
  1. Saleem A, Husheem M, Harkonen P, Pihlaja K. Inhibition of cancer cell growth by crude extract and the phenolics of Terminalia chebula Retz fruit. J Ethnopharmacol. 2002;81:327–36. 
  1. Phadke SA, Kulkarni SD. Screening of in-vitro antibacterial activity of Terminalia chebula, Eclapta alba and Ocimum sanctum. Indian J Med Sci. 1989;43:113–7. 
  1. Hamada S, Kataoka T, Wo JT, Yamada A, Yoshida T, Nishimura T, et al. Immunosuppressive effects of gallic acid and chebulagic acid on CTL-mediated cytotoxicity. Biol Pharma Bull. 1997;20:1017–9. 
  1. Tamhane MD, Thorat SP, Rege NN, Dahanukar SA. Effect of oral administration of Terminalia chebula on gastric emptying: An experimental study. J Postgrad Med. 1997;43:12–3.
  1. Shin TY, Jeong HJ, Kim DK, Kim SH, Lee JK, Kim DK, et al. Inhibitory action of water soluble fraction of Terminalia chebula on systemic and local anaphylaxis. J Ethnopharmacol. 2001;74:133–40. 
  1. Ahn MJ, Kim CY, Lee JS, Kim TG, Kim SH, Lee CK, et al. Inhibition of HIV-I integrase by galloyl glucoses from Terminalia chebula and flavonol glycoside gallates from Euphorbia pekinensis. Planta Med. 2002;68:457–9. 
  1.  Na M, Bac K, Kang SS, Mim BS, Yoo JK, Kamiryo Y, et al. Cytoprotective effect on oxidative stress and inhibitory effect on cellular aging of Terminalia chebula fruit. Phytother Res. 2004;18:737–41.
  1.  Na M, Bac K, Kang SS, Mim BS, Yoo JK, Kamiryo Y, et al. Cytoprotective effect on oxidative stress and inhibitory effect on cellular aging of Terminalia chebula fruit. Phytother Res. 2004;18:737–41. 
  1. Revathi S, Gopal V, Jeyabalan G, Dhanaraju M. Triphala – The Sanctifying Medicine To Human Domain: A Review. Scholars Research Library Der Pharmacia Lettre, 2018, 10 [9]: 71-89 
  1. Aqil F, Ahmad I. Antibacterial properties of traditionally used Indian medicinal plants. Methods Find Exp Clin Pharmacol. 2007;29:79–92. 
  1. Bajpai M, Pande A, Tewari SK, Prakash D. Phenolic contents and antioxidant activity of some food and medicinal plants. Int J Food Sci Nutr. 2005;56:287–291. 
  1. Padam SK, Grover IS, Singh M. Antimutagenic effects of polyphenols isolated from Terminalia bellerica myroblan in Salmonella typhimurium. Indian J Exp Biol. 1996;34:98–102. 
  1. Valsaraj R, Pushpangadan P, Smitt UW, Adsersen A, Christensen SB, Sittie A, Nyman U, Nielsen C, Olsen CE. New anti-HIV-1, antimalarial, and antifungal compounds from Terminalia bellerica. J Nat Prod. 1997;60:739–742. 
  1. Modak, M.; Dixit, P.; Londhe, J.; Ghaskadbi, S.; Devasagayam, T.P. Indian herbs and herbal drugs used for the treatment of diabetes. J. Clin. Biochem. Nutr. 2007, 40, 163–173. 
  1. Pfundstein, B.; El Desouky, S.K.; Hull, W.E.; Haubner, R.; Erben, G.; Owen, R.W. Polyphenolic compounds in the fruits of Egyptian medicinal plants (Terminalia bellerica, Terminalia chebula and Terminalia horrida): Characterization, quantitation and determination of antioxidant capacities. Phytochemistry 2010, 71, 1132–1148. 
  1. Malekzadeh F, Ehsanifar H, Shahamat M, Levin M, Colwell R. Antibacterial activity of black myrobalan (Terminalia chebula Retz) against Helicobacter pylori. Int J Antimicrob Agents. 2001;1:85–8. 
  1. Malfertheiner P, Me F, Graud Â, O’morainà C, Hungin APS, Jones R, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III consensus report. Gut. 2007;56:772–81. 
  1.  Jagtap AG, Karkera SG. Potential of the aqueous extract of Terminalia chebula as an anticaries agent. J Ethnopharmacol. 1999;68:299–306.
  1. Ahn M-J, Kim CY, Lee JS, Kim TG, Kim SH, Lee C-K, et al. Inhibition of HIV-1 integrase by galloyl glucoses from Terminalia chebula and flavonol glycoside gallates from Euphorbia Pekinensis. Planta Med. 2002;68:457–9. 
  1. Kim TG, Kang SY, Jung KK, Kang JH, Lee E, Han HM, et al. Antiviral activities of extracts isolated from Terminalis chebula Retz., Sanguisorba officinalis L., Rubus coreanus Miq. and Rheum palmatum L. against hepatitis B virus. Phytother Res. 2001;15:718–20. 
  1. Chandran U, Mehendale N, Tillu G, Patwardhan B. Network pharmacology of ayurveda formulation Triphala with special reference to anti-cancer property. Comb Chem High Throughput Screen. 2015;18:846–54. 
  1. Sabu MC, Kuttan R. Anti-diabetic activity of medicinal plants andits relationship with their antioxidant property. J Ethnopharmacol. 2002;81:155–60. 
  1. Sandhya T, Mishra KP. Cytotoxic response of breast cancer cell lines, MCF7 and T 47 D to triphala and its modification by antioxidants. Cancer Lett.2006;238:304–13. 
  1. Manjunatha S, Jaryal AK, Bijlani RL, Sachdeva U, Gupta SK. Effect of Chyawanprash and vitamin C on glucose tolerance and lipoprotein profile. Indian J Physiol Pharmacol. 2001;45:71–9. 
  1. Saravanan S, Srikumar R, Manikandan S, et al. Hypolipidemiceffect of triphala in experimentally induced hypercholesteremic rats. Yakugaku Zasshi 2007;127:385–388. 
  1. Kaur S, Michael H, Arora S, Härkönen PL, Kumar S. The in vitro cytotoxic and apoptotic activity of Triphala—an Indian herbal drug. J Ethnopharmacol.2005;97:15–20. 
  1. Sandhya T, Mishra KP. Cytotoxic response of breast cancer cell lines, MCF7 and T 47 D to triphala and its modification by antioxidants. Cancer Lett.2006;238:304–13. 
  1. 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;8:294. 
  1. Vadde R, Radhakrishnan S, Reddivari L, Vanamala JK. Triphala extract suppresses proliferation and induces apoptosis in human colon cancer stem cells via suppressing c- Myc/cyclin D1 and elevation of Bax/Bcl-2 ratio. BioMed Res Int 2015;2015:649263. 
  1. Belapurkar P, Goyal P, Tiwari-Barua P. Immunomodulatory effects of triphala and its individual constituents: a review. Indian J Pharm Sci. 2014;76:467–75. 
  1. Srikumar R, Parthasarathy NJ, Manikandan S, Muthuvel A, Rajamani R, Sheeladevi R. Immunomodulatory effect of Triphala during experimentally induced noise stress in albino rats. J Heal Sci. 2007;53:142–5.
  1. Sehar I, Kaul A, Bani S, Pal HC, Saxena AK. Immune up-regulatory respose of a non-caloric natural sweetener, stevioside. Chem Biol Interact. 2008;173:115–21. 
  1. Bhatane SG., Effect of Triphala Ghrita Netratarpana in Diabetic Retinopathy. International Ayurvedic Medical Journal, 2016. 4 (8): 2519-2521. 
  1. Triphala monograph, NHPD, February 25, 2019