Triphala

Metadata

Three-Fruit Composition

Triphala is not a single herb but a polyherbal formulation composed of equal parts of three dried fruits, each contributing distinct pharmacological properties:

1. Amalaki (Emblica officinalis / Phyllanthus emblica) — Indian gooseberry. The richest natural source of vitamin C (approximately 600-900 mg per 100 g of fresh fruit pulp; 20 times the vitamin C content of an orange). Also provides gallic acid, ellagic acid, and emblicannin A and B. Traditionally considered the primary antioxidant and rejuvenative component. Amalaki is classified as Pitta-pacifying in Ayurveda and is thought to support tissue repair, liver function, and immune health.

2. Haritaki (Terminalia chebula) — Known as the “King of Medicines” in Tibetan medicine. The primary source of chebulinic acid, chebulagic acid, and tannins in the formula. Haritaki contributes the bulk of the laxative and prokinetic activity through its anthraquinone content and tannin-mediated effects on intestinal motility. Classified as Vata-pacifying and considered the most directly purgative of the three fruits.

3. Bibhitaki (Terminalia bellirica) — Provides gallic acid, ellagic acid, lignans, and additional tannins. Traditionally valued for its effects on the respiratory system and its astringent properties. Classified as Kapha-pacifying. Contributes to the formula’s overall antioxidant capacity and mucosal toning activity.

The equal-parts combination is considered essential to the formula’s identity. The three fruits are understood to work synergistically: Amalaki provides antioxidant protection and tissue nourishment, Haritaki provides motility-enhancing and cleansing action, and Bibhitaki provides astringent toning and mucosal support. This tripartite synergy is a foundational concept in Ayurvedic formulation theory.

Approved Indications

Commission E / ESCOP / EMA

Triphala has not been assessed by any of the three major European phytotherapy regulatory bodies:

• Commission E (Germany): No monograph exists. Triphala was not part of the European phytotherapy tradition evaluated by Commission E during its active assessment period (1978-1994).
• ESCOP (European Scientific Cooperative on Phytotherapy): No monograph. Triphala falls outside the scope of European scientific cooperative assessment.
• EMA/HMPC (European Medicines Agency): No assessment report, herbal monograph, or Community list entry. Triphala is not listed in the EU herbal substances inventory.

This absence reflects scope rather than a negative assessment. These regulatory bodies focus on the European phytotherapy tradition and have not undertaken systematic evaluation of Ayurvedic polyherbal formulations. Individual constituent plants (particularly species in the Terminalia genus) have received limited academic attention in European pharmacognosy, but the specific three-fruit combination known as Triphala remains outside European regulatory frameworks entirely.

Ayurvedic Pharmacopoeia of India

• Listed: Yes. Triphala is an official drug in the Ayurvedic Pharmacopoeia of India (API), published by the Government of India, Ministry of AYUSH (formerly Ministry of Health and Family Welfare).
• Traditional classification: Tridoshic Rasayana — appropriate for balancing all three doshas (Vata, Pitta, Kapha), making it suitable for patients of all constitutional types and ages.
• Official indications: Constipation (Vibandha), digestive disorders (Agnimandya), eye diseases (Netra Roga), rejuvenation (Rasayana), and general detoxification (Shodhana).
• Pharmacopoeial standards: The API specifies quality parameters including total tannin content, gallic acid content, and identification tests for all three constituent fruits.
• Classical textual basis: Triphala is described in the foundational texts of Ayurveda, including the Charaka Samhita (circa 1500 BCE) and the Sushruta Samhita (circa 600 BCE), where it is recommended as a daily rejuvenative formula.

American Herbal Pharmacopoeia (AHP)

• The AHP has published a Triphala monograph providing botanical identity standards, chemical composition profiles, and quality control parameters. This monograph represents an important bridge between traditional Ayurvedic use and modern Western quality standards.

FSSAI (India)

• The Food Safety and Standards Authority of India (FSSAI) recognizes Triphala as a food ingredient and approves its use in nutraceutical formulations.

Agreement/Disagreement

There is no direct agreement or disagreement between European and Indian regulatory bodies because European bodies have not assessed Triphala. The regulatory landscape is characterized by parallel systems rather than conflict:

• Indian regulatory authorities (API, FSSAI, AYUSH Ministry) fully recognize Triphala as a legitimate therapeutic agent with well-documented traditional use spanning more than 2,000 years.
• European and US regulatory bodies have not formally evaluated Triphala but do not prohibit its sale. It is available as a dietary supplement in the United States under DSHEA and as a food supplement in the EU.
• The AHP monograph represents the most significant attempt to bridge these regulatory traditions by applying modern pharmacognostic standards to the traditional formula.

Conditions Treated

Primary — Chronic Constipation and Bowel Regulation

Triphala’s most well-documented clinical application is as a gentle bowel regulator for chronic or habitual constipation. Unlike stimulant laxatives such as senna, Triphala is positioned as a non-habit-forming bowel tonic that normalizes intestinal transit rather than forcing evacuation. Clinical trial evidence supports improvements in:

• Bowel frequency: Multiple studies demonstrate significant increases in weekly bowel movements. An open-label clinical trial by Munshi et al. (2011) showed a 64.4% increase in average weekly bowel frequency after 1 week and 79.5% after 2 weeks of treatment with a Triphala-containing formulation, with effects partially maintained 7 days after cessation of treatment.
• Stool consistency: Improvement in stool form (assessed via Bristol Stool Scale in some studies) toward normal type 3-4 stools.
• Straining and incomplete evacuation: Reduction in the subjective sensation of straining and incomplete evacuation in constipated patients.
• Dose-dependent action: At low doses (1-2 g/day), Triphala acts as a mild bowel tonic; at moderate doses (3-6 g/day), it functions as a gentle laxative; at higher doses (6-10 g/day), it produces more pronounced purgative effects. This dose-response relationship is well-characterized in the Ayurvedic literature and partially validated by clinical observation.

Secondary — Oral and Dental Health; Antioxidant Support

Oral Health: Triphala mouthwash has been evaluated in several randomized controlled trials as an antiplaque and anti-gingivitis agent. Results demonstrate efficacy comparable to 0.2% chlorhexidine (the clinical gold standard for antimicrobial mouthwash) for reducing plaque index and gingival index scores. The antibacterial activity against oral pathogens, combined with the astringent and anti-inflammatory properties of its tannin constituents, underlies this application.

Antioxidant Support: Triphala powder has an exceptionally high ORAC (Oxygen Radical Absorbance Capacity) value of approximately 706,250 micromol TE/100 g, making it one of the most potent antioxidant preparations available. The combination of gallic acid, ellagic acid, vitamin C, and hydrolysable tannins provides broad-spectrum free radical scavenging activity targeting superoxide, hydroxyl, peroxyl, and DPPH radicals. This antioxidant profile supports a potential role in reducing oxidative stress markers, though clinical evidence for systemic antioxidant outcomes remains preliminary.

Traditional — Ayurvedic Rasayana, Eye Health, and Detoxification

Rasayana (Rejuvenation): In classical Ayurveda, Triphala holds a special status as a Rasayana — a rejuvenative formula intended to promote longevity, prevent disease, and maintain tissue vitality. The Charaka Samhita states that taking Triphala Rasayana (Triphala combined with honey and ghee) daily “has the potential to make a person live for one hundred years devoid of old age and diseases.” While this is a traditional claim without modern clinical validation, the Rasayana concept aligns broadly with modern concepts of antioxidant protection, gut health optimization, and immunomodulation.

Eye Health (Netra Roga): Traditional Ayurvedic practice uses Triphala decoction as an eye wash (Triphala Ghrita — Triphala infused in clarified butter) for eye strain, conjunctivitis, and progressive myopia. Preclinical studies have demonstrated that chebulagic acid, chebulinic acid, and gallic acid from Triphala inhibit TNF-alpha-induced pro-angiogenic and pro-inflammatory activities in retinal capillary endothelial cells by inhibiting p38, ERK, and NF-kB phosphorylation (Lu et al., 2018). This provides a plausible mechanistic basis for the traditional eye health claims, though no clinical trials have validated ophthalmic applications.

Detoxification (Shodhana): Triphala is used traditionally as a gentle internal cleanser, supporting what Ayurveda terms the removal of “Ama” (metabolic waste products). From a modern perspective, this likely corresponds to the formula’s combined laxative, prebiotic, and antioxidant actions — facilitating intestinal transit, supporting beneficial gut flora, and reducing oxidative stress. [NEEDS-RESEARCH: No clinical trials have specifically evaluated Triphala’s “detoxification” effects using modern biomarkers.]

Mechanism of Action

Triphala’s therapeutic activity is best understood as a multi-mechanism, multi-target system arising from the synergistic combination of its three constituent fruits. The following mechanisms have been characterized through in vitro, animal, and limited human studies:

1. Prokinetic and Mild Laxative Action

Triphala enhances colonic motility through multiple pathways:

• Anthraquinone content: Terminalia chebula contains low concentrations of anthraquinone glycosides that stimulate myenteric plexus activity in the colon, promoting peristaltic contractions. The anthraquinone content is substantially lower than in dedicated stimulant laxatives such as senna, which accounts for Triphala’s gentler action profile and reduced risk of dependency.
• Tannin-mediated mucosal stimulation: Hydrolysable tannins (chebulinic acid, chebulagic acid) interact with intestinal mucosa, promoting mucus secretion and softening of stool. This contributes to the stool-normalizing effect rather than a purely stimulant action.
• Fiber and bulk: The dried fruit powder provides dietary fiber that adds bulk to intestinal contents, mechanically stimulating peristalsis through distension of the intestinal wall. This mechanism parallels the action of bulk-forming laxatives such as psyllium.
• Dose-dependent biphasic response: At low doses, tannins predominate and exert an astringent, toning effect on the intestinal mucosa; at higher doses, the laxative and prokinetic effects of anthraquinones and mucus-stimulating compounds dominate. This explains the traditional observation that low-dose Triphala tones the bowel while high-dose Triphala purges it.

2. Prebiotic Effects on Gut Microbiota

A growing body of evidence supports Triphala’s role as a prebiotic that selectively promotes beneficial gut bacteria:

• Polyphenol-mediated microbiome modulation: The high polyphenol content of Triphala (gallic acid, ellagic acid, chebulagic acid) serves as substrate for beneficial gut bacteria. Peterson et al. (2017) reported that Triphala polyphenols promote the growth of beneficial Bifidobacteria and Lactobacillus species while inhibiting the growth of undesirable gut microbes.
• Short-chain fatty acid (SCFA) production: Bacterial fermentation of Triphala polyphenols in the colon generates SCFAs (butyrate, propionate, acetate) that nourish colonocytes, maintain intestinal barrier integrity, and exert anti-inflammatory effects on the colonic mucosa.
• Bidirectional microbiome-polyphenol interaction: Gut bacteria metabolize Triphala’s complex polyphenols into smaller, more bioavailable anti-inflammatory metabolites (urolithins from ellagic acid, for example), which in turn modify the gut microbial community composition. This reciprocal interaction means that the bioactivity of Triphala is partially dependent on the host’s existing gut microbiome composition.
• Clinical evidence: A double-blind, randomized, placebo-controlled pilot study (Peterson et al., 2020) demonstrated that Triphala dietary supplementation significantly altered fecal microbial communities in human subjects, supporting the prebiotic hypothesis.

3. Tannin-Mediated Antioxidant Activity

• Direct free radical scavenging: Gallic acid, ellagic acid, and chebulinic acid directly scavenge reactive oxygen species (ROS) and reactive nitrogen species (RNS) through donation of hydrogen atoms from their phenolic hydroxyl groups.
• Metal ion chelation: Tannins in Triphala chelate pro-oxidant transition metal ions (Fe2+, Cu2+), preventing Fenton reaction-mediated hydroxyl radical generation.
• Upregulation of endogenous antioxidant defenses: Preclinical studies suggest that Triphala constituents activate the Nrf2/ARE (nuclear factor erythroid 2-related factor 2 / antioxidant response element) pathway, enhancing expression of endogenous antioxidant enzymes including superoxide dismutase (SOD), catalase, and glutathione peroxidase.
• Protection against lipid peroxidation: Gallic acid and ellagic acid inhibit lipid peroxidation in cell membranes, protecting cellular integrity under oxidative stress conditions.

4. Gallic Acid Pharmacology

Gallic acid (3,4,5-trihydroxybenzoic acid) is one of the most abundant and pharmacologically significant constituents of Triphala. Its specific actions include:

• Anti-inflammatory effects: Inhibition of NF-kB nuclear translocation, suppression of COX-2 expression, and reduction of pro-inflammatory cytokine production (TNF-alpha, IL-6, IL-1beta).
• Anticancer activity: Induction of apoptosis in cancer cell lines through activation of caspase-3 and caspase-9, and inhibition of cell proliferation through G1/S cell cycle arrest. Chebulinic acid, a gallotannin derived from gallic acid units, has demonstrated potent anti-proliferative effects in human colorectal carcinoma cell lines via inhibition of PI3K/AKT and MAPK/ERK signaling pathways (Aisha et al., 2018).
• Anti-angiogenic effects: Triphala and its active constituent chebulinic acid inhibit VEGF-mediated angiogenesis by suppressing VEGFR-2 (vascular endothelial growth factor receptor 2) phosphorylation (Srikumar et al., 2012).
• Bioavailability considerations: Gallic acid has moderate oral bioavailability and undergoes extensive first-pass metabolism through methylation and glucuronidation. Intestinal microbiota also metabolize gallotannins to release free gallic acid in the colon, providing a sustained-release effect.

5. Anti-Inflammatory Mechanisms

• TNF-alpha antagonism: In silico studies have demonstrated that chebulagic acid, chebulinic acid, and gallic acid are capable of binding the TNF-alpha receptor-1 (TNFR-1), mediating anti-TNF-alpha activity (Lu et al., 2018).
• Inhibition of p38 MAPK, ERK, and NF-kB: These three signaling pathways, central to inflammatory cascades, are suppressed by Triphala’s major polyphenolic constituents, leading to reduced expression of MMP-9, IL-6, IL-8, and MCP-1.
• COX-2 modulation: Gallic acid and ellagic acid inhibit cyclooxygenase-2 enzyme activity, reducing prostaglandin E2 synthesis.

Clinical Evidence Summary

Clinical evidence for Triphala consists of several small-to-moderate RCTs, open-label trials, and one major comprehensive review. While no single large definitive trial has been conducted, the overall body of evidence is moderately supportive of the constipation, oral health, and antioxidant claims.

Key Clinical Trials

Systematic Reviews and Major Reviews

• Peterson et al. (2017): Comprehensive narrative review published in the Journal of Alternative and Complementary Medicine. Reviewed therapeutic uses of Triphala across multiple domains including gastrointestinal, antioxidant, anti-inflammatory, immunomodulatory, anticancer, and antimicrobial applications. Concluded that Triphala is a multi-functional polyherbal medicine with promising clinical potential, though larger confirmatory RCTs are needed.

• Phimarn et al. (2021): Systematic review of effects of Triphala on lipid and glucose profiles and anthropometric parameters. Found that across five RCTs, Triphala-treated groups showed statistically significant decreases in body weight (mean difference = -2.4 kg), BMI, and waist circumference in overweight/obese subjects.

• Peterson et al. (2018) — “Triphala: Current Applications and New Perspectives”: Published in Chinese Medicine journal. Reviewed functional gastrointestinal disorder applications and prebiotic mechanisms. Emphasized the gut microbiome modulation pathway as a unifying mechanism for many of Triphala’s diverse effects.

Evidence Limitations

• Sample sizes are generally small (n=34-160 in constipation trials; n=90-120 in oral health trials).
• Many studies originate from India, potentially limiting geographic and dietary generalizability.
• Heterogeneity in Triphala preparation (powder vs. extract vs. combination products), dosing, and standardization across studies.
• Several of the constipation studies are open-label rather than double-blind, introducing potential expectation bias.
• No head-to-head RCTs directly comparing Triphala to modern first-line constipation treatments (polyethylene glycol, lactulose) in well-powered, double-blind designs. [NEEDS-RESEARCH: A large, well-designed comparative effectiveness trial against PEG or lactulose would substantially clarify Triphala’s clinical position.]
• Publication bias cannot be excluded given the cultural significance of Triphala in India.
• Long-term efficacy and safety data beyond 60 days are limited from controlled studies, though traditional use supports chronic administration.

Safety Profile

General Assessment

Triphala has a favorable safety profile supported by more than 2,000 years of widespread dietary and medicinal use across the Indian subcontinent. It is consumed daily by millions of people in India as a health tonic. No serious adverse events have been reported in any published clinical trial, and a toxicity study in Sprague-Dawley rats (Sireeratawong et al., 2022) found no evidence of acute or chronic toxicity at doses up to the equivalent of standard therapeutic ranges.

Contraindications

• Diarrhea or dysentery: Triphala’s laxative action may worsen diarrheal conditions. The formula should be discontinued during acute diarrhea and reintroduced only after stool normalization.
• Severe dehydration or electrolyte imbalance: As with any agent that increases intestinal transit and fluid secretion, Triphala should be avoided in severely dehydrated patients or those with pre-existing electrolyte disturbances.
• Bowel obstruction or undiagnosed abdominal pain: Standard precaution for all laxative agents.
• Pre-surgical: Consider discontinuing 1-2 weeks before elective surgery due to potential effects on bleeding time (gallic acid has mild antiplatelet activity in vitro).

Drug Interactions

Triphala has documented potential for pharmacokinetic drug interactions via cytochrome P450 enzyme inhibition:

• CYP450 inhibition: An in vitro study using human liver microsomes demonstrated that Triphala extract inhibited CYP isoforms in the order CYP1A2 > CYP3A4 > CYP2C9 > CYP2D6, with IC50 values of 23.6, 28.1, 30.4, and 93.9 microg/mL, respectively (Nantasupha et al., 2022). CYP1A2 and CYP2C9 inhibition was non-competitive; CYP3A4 inhibition was competitive (Ki = 64.9 microg/mL). Importantly, CYP1A2 and CYP3A4 inhibition was not time-dependent, reducing the risk of irreversible enzyme inactivation.
• In vivo pharmacokinetic evidence: In rats, co-administration of Triphala at 500 mg/kg increased the oral bioavailability of phenacetin (CYP1A2 substrate) by 61.2% and midazolam (CYP3A4 substrate) by 40.7%, providing direct evidence for clinically relevant drug interactions via CYP1A and CYP3A inhibition (Nantasupha et al., 2022).
• Medications of concern: Patients taking drugs with narrow therapeutic indices metabolized by CYP1A2 (theophylline, clozapine, tizanidine), CYP3A4 (cyclosporine, tacrolimus, many statins, calcium channel blockers, certain antiretrovirals), or CYP2C9 (warfarin, phenytoin) should exercise caution and consult their prescriber before using Triphala.
• Anticoagulants and antiplatelets: Theoretical increased bleeding risk due to gallic acid-mediated antiplatelet activity. No clinical case reports exist, but caution is warranted with concurrent warfarin, aspirin, or clopidogrel use.
• Antidiabetic medications: Triphala has demonstrated mild blood glucose-lowering effects in some studies. Concurrent use with insulin or oral hypoglycemics may require blood glucose monitoring.
• Antihypertensives: Some evidence suggests mild blood-pressure-lowering effects; additive hypotension is a theoretical concern.

Side Effects (at recommended doses)

• Common: Mild gastrointestinal effects including loose stools, increased bowel frequency, flatulence, and mild abdominal cramping. These are generally dose-dependent and self-limiting.
• Uncommon: Bloating, abdominal distension, mild nausea. Typically resolves with dose reduction.
• Rare: Allergic reactions to any of the three constituent fruits are possible but very rarely reported. Headache at higher doses has been reported anecdotally.
• High-dose effects: Excessive doses may cause diarrhea, abdominal cramps, and dehydration. The dose should be titrated downward if stools become watery.

Pregnancy and Lactation

• Pregnancy (Category C): Insufficient safety data from human studies during pregnancy. Haritaki (Terminalia chebula) has traditionally been avoided during pregnancy in some Ayurvedic texts due to its purgative properties. The laxative action at higher doses could theoretically stimulate uterine contractions. Pregnant women should avoid Triphala or use it only under direct supervision of a qualified practitioner.
• Lactation: Insufficient data. The constituent fruits are consumed as food items in India by lactating women without reported adverse effects, but systematic safety assessment is lacking. Caution is advised.

Toxicology

• Acute toxicity: No acute toxicity observed in rat studies at standard doses (Sireeratawong et al., 2022).
• Chronic toxicity: No evidence of organ toxicity in 90-day chronic toxicity studies in rats.
• Genotoxicity: No mutagenic activity has been reported. Some preclinical studies suggest antimutagenic and chemoprotective effects.
• Heavy metal contamination concern: Some commercially available Triphala products, particularly those sourced from unregulated manufacturers, have been found to contain elevated levels of lead, mercury, or arsenic. Consumers should choose products from manufacturers who provide third-party heavy metal testing and Certificate of Analysis. [IMPORTANT: This is a product quality issue, not an intrinsic toxicity of the herbs themselves.]

Clinical Dosage

Triphala Churna (Traditional Powder)

• Mild bowel tonic dose: 1-2 g per day, taken at bedtime with warm water
• Standard laxative dose: 3-6 g per day, taken at bedtime with warm water or mixed with honey
• Stronger purgative dose: 6-10 g per day (use with caution; may cause loose stools)
• Traditional Rasayana dose: 2-4 g per day mixed with honey and ghee (clarified butter) in specific seasonal ratios as described in classical Ayurvedic texts
• Triphala decoction: 3-5 g of powder boiled in 200 mL water, reduced to 50 mL, strained and consumed at bedtime

Standardized Extract (Capsules/Tablets)

• Standard dose: 500-1000 mg, 1-2 times daily, typically taken at bedtime or before meals
• Clinical trial doses: Most clinical studies have used 3-6 g per day of Triphala Churna or equivalent extract doses
• Mouthwash preparation: 10 mL of Triphala decoction (typically 0.4-6% concentration) used as a rinse for 1 minute, twice daily (based on oral health clinical trials)

Dose Titration and Timing

• Start low: Begin with the lowest dose (1-2 g powder or 500 mg extract) and increase gradually based on response and tolerance.
• Timing: Traditionally taken at bedtime (Kala Bhojan — post-dinner timing) for overnight action and morning bowel movement. Some traditions recommend early morning on an empty stomach with warm water.
• With food vs. empty stomach: For laxative effect, take on an empty stomach or at bedtime. For general tonic/Rasayana effect, take with food (honey and ghee traditionally).
• Duration of use: Unlike stimulant laxatives, Triphala is traditionally used for extended periods (weeks to months to years) as a daily tonic. Clinical trials have assessed durations of 2-8 weeks without safety concerns. Long-term traditional use supports chronic administration, though periodic breaks are recommended in some Ayurvedic texts.

Sources

• Peterson CT, Denniston K, Chopra D. Therapeutic uses of Triphala in Ayurvedic medicine. J Altern Complement Med. 2017;23(8):607-614. doi:10.1089/acm.2017.0083 (PMC5567597)
• Peterson CT, Sharma V, Iablokov SN, et al. 16S rRNA gene profiling and genome reconstruction reveal community metabolic interactions and prebiotic potential of medicinal herbs used in neurodegenerative disease and as nootropics. PLoS One. 2019;14(3):e0213869
• Peterson CT, Rodionov DA, Iablokov SN, et al. Modulatory effects of Triphala and Manjistha dietary supplementation on human gut microbiota: a double-blind, randomized, placebo-controlled pilot study. J Altern Complement Med. 2020;26(11):1015-1024
• Munshi R, Bhalerao S, Rathi P, Kuber VV, Nipanikar SU, Kadbhane KP. An open-label, prospective clinical study to evaluate the efficacy and safety of TLPL/AY/01/2008 in the management of functional constipation. J Ayurveda Integr Med. 2011;2(3):144-152. (PMC3193686)
• Saini P, et al. A randomized controlled trial to evaluate the laxative effect of prescribed diet compared with Triphala Churna in Vibandha with special reference to constipation. J Ayurveda. 2022;16(2):106-111
• Patel MV, Patel KB, Gupta SN, et al. Clinical study of Triphala — a well known phytomedicine from India. Iranian J Pharmacol Ther. 2012;11:16-19
• Naiktari RS, Gaonkar P, Gurav AN, Khiste SV. A randomized clinical trial to evaluate and compare the efficacy of triphala mouthwash with 0.2% chlorhexidine in hospitalized patients with periodontal diseases. J Periodontal Implant Sci. 2014;44(3):134-140. (PMC4050230)
• Bajaj N, Tandon S. The effect of Triphala and chlorhexidine mouthwash on dental plaque, gingival inflammation, and microbial growth. Int J Ayurveda Res. 2011;2(1):29-36
• Mamgain P, Kandwal A, Mamgain RK. Comparative evaluation of Triphala, aloe vera, and chlorhexidine mouthwash on gingivitis: a randomized controlled clinical trial. J Indian Assoc Public Health Dent. 2020;18(2):152-156. (PMC7145231)
• Singh DP, Srivastava S, Patel AB, et al. Effect of 0.4% Triphala and 0.12% chlorhexidine mouthwash on dental plaque, gingival inflammation, and microbial growth in 14-15-year-old schoolchildren: a randomized controlled clinical trial. Int J Clin Pediatr Dent. 2021;14(Suppl 2):S194-S199. (PMC8603804)
• Lu K, Chakroborty D, Bhende PM, et al. Chebulagic acid, chebulinic acid, and gallic acid, the active principles of Triphala, inhibit TNF-alpha induced pro-angiogenic and pro-inflammatory activities in retinal capillary endothelial cells. Vascul Pharmacol. 2018;108:23-35
• Srikumar R, Parthasarathy NJ, Shankar EM, et al. Triphala and its active constituent chebulinic acid are natural inhibitors of vascular endothelial growth factor-A mediated angiogenesis. PLoS One. 2012;7(8):e43934. (PMC3427174)
• Aisha AF, et al. Chebulinic acid derived from Triphala is a promising antitumour agent in human colorectal carcinoma cell lines. BMC Complement Altern Med. 2018;18:322. (PMC6307174)
• Nantasupha C, et al. Inhibitory effects of Triphala on CYP isoforms in vitro and its pharmacokinetic interactions with phenacetin and midazolam in rats. Heliyon. 2022;8(6):e09564. (PMC9243172)
• Sireeratawong S, et al. Safety of the oral Triphala recipe from acute and chronic toxicity tests in Sprague-Dawley rats. Toxicol Rep. 2022;9:1605-1612. (PMC9503284)
• Phimarn W, Sungthong B, Itabe H. Effects of Triphala on lipid and glucose profiles and anthropometric parameters: a systematic review. J Evid Based Integr Med. 2021;26:2515690X211011038. (PMC8072855)
• Belapurkar P, Goyal P, Tisber P. Immunomodulatory effects of triphala and its individual constituents: a review. Indian J Pharm Sci. 2014;76(6):467-475
• Baliga MS, Meera S, Mathai B, et al. Scientific validation of the ethnomedicinal properties of the Ayurvedic drug Triphala: a review. Chin J Integr Med. 2012;18(12):946-954
• The Ayurvedic Pharmacopoeia of India. Part I, Volumes I-VI. Government of India, Ministry of AYUSH
• American Herbal Pharmacopoeia. Triphala Monograph. Scotts Valley, CA: AHP

Connections

• Compare with Psyllium as fellow constipation remedy — psyllium is a pure bulk-forming fiber with FDA/EMA well-established use status, while Triphala combines multiple mechanisms (bulk, prokinetic, prebiotic, antioxidant) without European regulatory recognition
• Compare with Senna for constipation — senna is a potent stimulant laxative for short-term use with well-established European status, while Triphala is positioned as a gentler, non-habit-forming alternative suitable for long-term use in the Ayurvedic tradition
• Compare with Linseed/Flaxseed as another bulk-forming constipation remedy with additional systemic benefits (omega-3 fatty acids in linseed; polyphenol antioxidants in Triphala)
• Compare with Aloe Vera — aloe latex contains anthraquinones (barbaloin) with stimulant laxative action; Triphala contains lower anthraquinone concentrations combined with tannins, producing a milder and more balanced laxative effect
• Triphala represents one of the most thoroughly studied Ayurvedic formulations, paralleling the trajectory of Ashwagandha and Holy Basil in bridging traditional Indian medicine and Western evidence-based evaluation
• The CYP450 inhibition profile of Triphala (CYP1A2, CYP3A4, CYP2C9) is relevant to understanding potential herb-drug interactions, an area of concern shared with St. John’s Wort (which induces rather than inhibits CYP3A4) and Turmeric/Curcumin
• The oral health applications of Triphala mouthwash provide an interesting comparison with other antimicrobial herbal preparations such as Tea Tree oil and Sage mouthwash