Triphala is an old Ayurvedic herbal formula made from three plants: Haritake, Bibhitaki, and Amalaki, also known as amla. Triphala has antioxidnat properties and is promoted as an herbal combination for good digestion. See Ayurvedic Herbs for a list of herbs used in Ayurvedic Medicine.

Triphala has historically been used as a digestive aid for constipation.

Benefit of Triphala
Limited research suggests Triphala may play a role in cancer therapy, diabetes, heart disease, and weight loss. Some claim it helps with constipation relief.

Infection
Indian J Exp Biol. Sept 2013. Antibacterial potential of hydroalcoholic extracts of triphala components against multidrug-resistant uropathogenic bacteria--a preliminary report. Triphala, the Ayurvedic wonder is used traditionally for the treatment of different types of diseases since antiquity. The hydroalcoholic extracts of the three components of Triphala powder demonstrated varying degrees of strain specific antibacterial activity against multidrug-resistant uropathogenic bacteria. Terminalia chebula fruit extract was active against all the test isolates followed by Terminalia belerica and Emblica officinalis. There was a close association between antibacterial activity and total phenolic content of Triphala components. The test plant extracts were also found to be non-toxic on human erythrocyte membrane at recommended and even higher doses. The preliminary results of the present study may help in developing effective and safe antimicrobial agents from components for the treatment of urinary tract infections caused by multidrug-resistant bacteria.

Liver protection
J Ayurveda Integr Med. 2015. Protective effect of Triphala Rasayana against paracetamol-induced hepato-renal toxicity in mice. Paracetamol, a widely used analgesic and antipyretic, is known to cause liver and renal injury in humans when administered in higher and repeated doses that cause acute liver injury. Triphala is a well-known Ayurvedic Rasayana formulation that is prescribed for balancing of Vata, Pitta and Kapha. Traditionally, it is used for the treatment of liver and kidney diseases. The present study gives an evidence of the protective role of Triphala extract against paracetamol-induced hepato-renal toxicity and validates its traditional claim in the Ayurveda system.

Pancreatic cancer
Extracts of triphala slow the growth of human pancreatic tumors grafted onto mice. Professor Sanjay K Srivastava says, "Triphala triggered the cancerous cells to die off and significantly reduced the size of the tumors."  Previous studies have shown triphala to have an anti-cancer activity in cell cultures, and the new research found this effect also worked in mice fed the herb preparation, without damaging normal pancreatic cells. Professor Sanjay K Srivastava and his colleagues fed mice grafted with human pancreatic tumors a triphala solution five days per week. After four weeks they compared the tumor size and proteins contents of the tumors with those of a control group of mice that had not received the triphala. They found that the tumors in triphala-treated mice were half the size of those in the untreated mice. The also found the treated mice tumour cells had higher levels of proteins associated with apoptosis - the process by the which the body normally disposes of damaged, old of unneeded cells. In cancer cells this process is often faulty, allowing the tumors to divide rapidly without any cells dying.

Triphala protects against stress in rodents
Protective effect of Triphala on cold stress-induced behavioral and biochemical abnormalities in rats.
Yakugaku Zasshi. 2007. Department of Physiology, Dr. ALM. PG. Institute of Basic Medical Sciences, University of Madras, Taramani Campus, Chennai, Tamilnadu, India.
The present study was aimed to investigate the effect of Triphala (Terminalia chebula, Terminalia belerica and Emblica officinalis) against the cold stress-induced alterations in the behavioral and biochemical abnormalities in four different groups (saline control, Triphala, cold-stress and Triphala with cold-stress) of Wistar strain albino rats. Oral administration of Triphala (1 g/kg/animal body weight) for 48 days significantly prevented these cold stress-induced behavioral and biochemical abnormalities in albino rats. The results of this study suggest that Triphala supplementation can be regarded as a protective drug against stress.

Tooth cavities
Infect Disord Drug Targets. 2015. Triphala in prevention of dental caries and as an antimicrobial in oral cavity - a review. Dental caries is a widely prevalent infectious disease afflicting the humans worldwide. Each year oral infections such as dental caries, periodontal diseases and oral candidiasis significantly adds to the economic burden of the world. Though there are standard management techniques for these diseases; they do have side effects and are not cost effective. Ayurveda is a traditional Indian system of medicine that is being practiced in the Indian peninsula since ages. Among the various herbal medicines in ayurveda, triphala occupies a royal position due to its wide beneficial systemic actions. Triphala is a mixture of fruits of Terminalia bellirica, Terminalia chebula and Emblica officinalis. The antimicrobial actions of triphala are well documented in the literature. However availability of review articles regarding triphala as an antimicrobial against oral infections is limited. Need was felt to review this aspect of triphala. The present article reviews the use of triphala and its constituents in the prevention and control of dental caries and other common oral infections. Thorough review of the literature indicated that triphala can be effectively used to manage dental caries, gingival and periodontal diseases. Further it can also be utilized as a root canal irrigant and against oral candida species. Tooth decay information is reviewed.

Weight Loss
Daru. 2012. Efficacy of 'Itrifal Saghir', a combination of three medicinal plants in the treatment of obesity; A randomized controlled trial.
Department of surgery, Mostafa Khomeyni Hospital, Shahed University, Clinic Salamat, Iranian Traditional Medicine Group, Dashtestan, Pasdaran Ave, Tehran, Iran.
Herbal combination of Itrifal Saghir (triphala) has been widely used in traditional medicine. And brings health benefits such as antioxidant effect and scavenger of hydroxyl radicals and nitric oxide radicals activity and substantiated in traditional medicine a anti-obesity. In this study we aimed to assess the efficacy of this herbal medicinal 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 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 or placebo, 2 times daily for 12 weeks. Measures of body weight, BMI, waist circumference (WC), hip circumference (HC), were assessed at baseline and once every four weeks during the 12 week treatment period. The safety was evaluated by means of measuring the liver and kidney function. Compared to placebo group, in treatment group the mean difference of effective weight loss was 4.82Kg, the mean of decrease in waist circumference was 4 cm, and the mean decrease in hip circumference was 3. 2 cm in treated subjects. No adverse effects or significant changes in liver and kidney function tests were observed in both placebo and treated groups. Itrifal Saghir appears to produce a positive effect on weight loss in obese subjects.

Triphala antioxidant effect and protection from radiation
Protection against radiation oxidative damage in mice by Triphala.
Mutat Res. 2006. Radiation Biology and Health Sciences Division, Bhabha Atomic Research Centre, Trombay, Mumbai 400085, India.
Protection against whole body gamma-irradiation (WBI) of Swiss mice orally fed with Triphala, an Ayurvedic formulation, in terms of mortality of irradiated animals as well as DNA damage at cellular level has been investigated. It was found that radiation induced mortality was reduced by 60% in mice fed with triphala (1g/kg body weight/day) orally for 7 days prior to whole body radiation at 7.5 Gy followed by post-irradiation feeding for 7 days. An increase in xanthine oxidoreductase activity and decrease in superoxide dismutase activity was observed in the intestine of mice exposed to WBI, which, however, reverted back to those levels of sham-irradiated controls, when animals were fed with triphala for 7 days prior to irradiation. Triphala seems to have potential to develop into a novel herbal radio-protector for practical applications.

Interactions with medications
Q. I am a 60 yr old cardiac stent patient, presently on Plavix, Rosuvas and Ecosprin. Can I have Triphala based laxatives with these heart medications, as I have heard that they tamper seriously with functioning of blood thinners and platelets?
   A. It is very difficult to determine the interaction of an herb with a medication, and particularly multiple herbs with multiple medications.

Review article
Chin J Integr Med. 2012. Scientific validation of the ethnomedicinal properties of the Ayurvedic drug Triphala: a review. Department of Research and Development, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India.
Triphala, a herbal formula composed of the three fruits of Terminalia chebula, Terminalia bellirica and Phyllanthus emblica (Amalaki or the Indian gooseberry) is considered to be a universal panacea in the traditional Indian system of medicine the Ayurveda. Ayurvedic physicians use Triphala to treat various gastrointestinal disorders. Scientific studies show it to possess free radical scavenging, antioxidant, antiinflammatory, antipyretic, analgesic, antibacterial, antimutagenic, wound healing, anticariogenic, antistress, hypoglycaemic, anticancer, chemoprotective, radioprotective and chemopreventive effects. Clinical studies have also shown that Triphala was found to have good laxative property, to improve appetite and reduce gastric hyperacidity. Studies have also shown that Triphala was effective in preventing dental caries and that this effect was equal to that of chlorhexidine.

Research study
Potential of traditional ayurvedic formulation, Triphala, as a novel anticancer drug.
Cancer Lett. 2005;
The cytotoxic effects of aqueous extract of Triphala, an ayurvedic formulation, were investigated on human breast cancer cell line (MCF-7) and a transplantable mouse thymic lymphoma (barcl-95). The viability of treated cells was found to decrease with the increasing concentrations of Triphala. On the other hand, treatment of normal breast epithelial cells, MCF-10 F, human peripheral blood mononuclear cells, mouse liver and spleen cells, with similar concentrations of Triphala did not affect their cytotoxicity significantly. The drug treatment was found to induce apoptosis in MCF-7 and barcl-95 cells in vitro as determined by annexin-V fluorescence and proportion of apoptotic cells was found dependent on Triphala concentration. MCF-7 cells treated with Triphala when subjected to single cell gel electrophoresis, revealed a pattern of DNA damage, characteristic of apoptosis. Studies on Triphala treated MCF-7 and barcl-95 cells showed significant increase in intracellular reactive oxygen species (ROS) in a concentration dependent manner. ROS increase was, however, found to be insignificant in MCF-10 F as well as in murine spleen and liver normal cells. In vivo, direct oral feeding of Triphala to mice (40mg/kg body weight) transplanted with barcl-95 produced significant reduction in tumor growth as evaluated by tumor volume measurement. It was also found that apoptosis was significantly higher in the excised tumor tissue of Triphala fed mice as compared to the control, suggesting the involvement of apoptosis in tumor growth reduction. These results suggest that Triphala possessed ability to induce cytotoxicity in tumor cells but spared the normal cells. The differential effect of Triphala on normal and tumor cells seems to be related to its ability to evoke differential response in intracellular ROS generation. The differential response of normal and tumor cells to Triphala in vitro and the substantial regression of transplanted tumor in mice fed with Triphala points to its potential use as an anticancer drug for clinical treatment.

Evaluation of the Inhibitory Effect of Triphala on PMN-Type Matrix Metalloproteinase (MMP-9).
J Periodontol. 2005.
This study evaluated the inhibitory activity of triphala on PMN-type matrix metalloproteinase (MMP-9) expressed in adult periodontitis patients and compared its activity with another ayurvedic drug, kamillosan, and doxycycline, which has known inhibitory activity. Methods: Matrix metalloproteinases (MMPs) were extracted from gingival tissue samples from 10 patients (six males, four females) with chronic periodontitis. Tissue extracts were treated with the drug solutions, the inhibition was analyzed by gelatin zymography, and the percentage of inhibition was determined by a gel documentation system. The activity of MMPs was significantly decreased with the use of the drugs. Triphala showed a 76% reduction of MMP-9 activity, whereas kamillosan showed a 46.36% reduction at a concentration of 1,500 micrograms /ml (crude extract) and doxycycline showed a 58% reduction at a concentration of 300 microg/ml (pure drug). Conclusion: The present study showed the strong inhibitory activity of triphala on PMN-type MMPs involved in the extracellular matrix (ECM) degradation during periodontitis.

Triphala, an ayurvedic rasayana drug, protects mice against radiation-induced lethality by free-radical scavenging.
J Altern Complement Med. 2004.
The effects of 10 mg/kg of triphala extract was studied on radiation-induced sickness and mortality in mice exposed to 7-12 Gray (Gy) of gamma-irradiation. Treatment of mice with triphala once daily for 5 consecutive days before irradiation delayed the onset of mortality and reduced the symptoms of radiation sickness when compared with the non-drug double distilled water treated irradiated controls (DDW). Triphala provided protection against both gastrointestinal and hemopoetic death. However, animals of both the triphala extract + irradiation and DDW + irradiation groups did not survive up to 30 days post-irradiation beyond 11 Gy irradiation. The LD50/30 was found to be 8.6 Gy for the DDW + irradiation group and 9.9 Gy for triphala extract + irradiation group. The administration of triphala resulted in an increase in the radiation tolerance by 1.4 Gy, and the dose reduction factor was found to be 1.15. To understand the mechanism of action of triphala, the free radical scavenging activity of the drug was evaluated. Triphala was found to scavenge (.)OH, O(2) (.) 2,2'-azinobis(3-ethylbenzthiazoline-6-sulfonate) diammonium salt (ABTS)(.+) and NO radicals in a dose dependent manner.

The in vitro cytotoxic and apoptotic activity of Triphala--an Indian herbal drug.
J Ethnopharmacol. 2005.
A study on cytotoxic effect of acetone extract of Triphal" whose antimutagenicity has already been tested. The in vitro antimutagenic activity of Triphala --an Indian herbal drug. Food Chemistry and Toxicology 40, 47-54) was extended to test its cytotoxic effects on cancer cell-lines using Shionogi 115 (S115) and MCF-7 breast cancer cells and PC-3 and DU-145 prostate cancer cells as models. The results revealed that acetone extract of "Triphala" showed a significant cytotoxic effect on these cancer cell-lines and the effect was similar on all cancer cell lines used in this study. The major phenolic compounds in the most potent acetone extracts were isolated and purified. Structural analysis was conducted using spectroscopic techniques including mass spectroscopy, nuclear magnetic resonance (NMR) and infrared (IR) which showed gallic acid as the major component. The suppression of the growth of cancer cells in cytotoxic assays may be due to the gallic acid-a major polyphenol observed in Triphala.

The evaluation of the radioprotective effect of Triphala (an ayurvedic rejuvenating drug) in the mice exposed to gamma-radiation.
Phytomedicine. 2002.
The effect of aqueous extract of Triphala administrered intraperitoneally was studied on the radiation-induced mortality in mice exposed to 10 Gy of gamma-radiation. Treatment of mice with different doses of triphala consecutively for five days before irradiation delayed the onset of mortality and reduced the symptoms of radiation sickness when compared with the non-drug treated irradiated controls. The highest protection against GI (gastrointestinal) death was observed for 12.5 mg/kg triphala, where a highest number of survivors were reported up to 10 days post-irradiation. While 10 mg/kg triphala i.p. provided the best protection as evidenced by the highest number of survivors after 30 days post-irradiation in this group when compared with the other doses of triphala. Toxicity study showed that triphala was non-toxic up to a dose of 240 mg/kg, where no drug-induced mortality was observed. The LD50 dose i.p. of triphala was found to be 280 mg/kg b. wt. Our study demonstrates the ability of triphala as a good radioprotective agent.

The Ayurvedic medicines Haritaki, Amala and Bahira reduce cholesterol-induced atherosclerosis in rabbits.
Int J Cardiol. 1988.
Four groups of 25 rabbits each, were studied to determine the effect of Haritaki (Terminalia chebula), Amla (Emblica officinalis) and Bahira (Terminalia belerica) on cholesterol-induced hypercholesteolaemia and atherosclerosis. The control group was fed with cholesterol alone; the Haritaki group received Haritaki and cholesterol; the Bahira group received Bahira and cholesterol; and the Amla group received Amla and cholesterol for 16 weeks. Cholesterolaemia was significantly less (P less than 0.001) in the Haritaki group (166 mg/dl), the Bahira group (240 mg/dl) and the Amla group (205 mg/dl) than in the control group (630 mg/dl). The Haritaki group had significantly less cholesterolaemia (P less than 0.001) as compared to the Bahira and Amla groups. Aortic sudanophilia was significantly less in the Haritaki group (6%), the Bahira group (16%), and the Amla group (12%) than in the control group (38%). The cholesterol contents of the liver and aorta, respectively, were significantly less in the Haritaki group (46 mg/100 g, 28 mg/100 g), the Bahira group (78 mg/100 g, 72 mg/100 g) and the Amla group (46 mg/100 g, 42 mg/100 g), than in the control group (604 mg/100 g, 116 mg per 100 grams). Among the drug-fed groups, the Haritaki group had significantly lower degrees of sudanophilia and cholesterol content of aorta and liver as compared to the Bahira and Amla groups. Although all three drugs reduced serum cholesterol, aortic sudanophilia and cholesterol contents of liver and aorta, their effects were in ascending order of magnitude. The drugs did not influence serum triglyceride levels, euglobulin clot lysis time or platelet adhesiveness.

Questions
Q. I find a dosage of 4 grams of Triphala every night extremely beneficial in regularizing my bowels and am extremely happy with the results. I only wanted to ask you whether it is safe to take this dosage indefinitely or whether it would cause dependency in future as far as bowel movements are concerned. I am 31 years old and have been taking this dose for past 1.5 months as I often suffer from chronic constipation. Somehow the smaller doses dont help as much. Can I take a 4 gram dose indefinitely for the rest of my life? There are conflicting replies to this question from other sources and the net.
   A. Not enough long term human research in the West is available to know how safe Triphala supplements are for long term use. As a general rule, we prefer people take occasional breaks from the use of herbs.

Q. I thought you might find my experience with triphala interesting. My health was generally very good up to age 50, when I was infected with Lyme disease. I was not diagnosed for 5 years. Treatments with extended courses of antibiotic gave temporary relief, but symptoms always returned. In the past 13 years, I've had one 3 week period where I was symptom-free. That was the result of taking triphala. The improvement was sudden and dramatic. But about 3 weeks into the triphala routine, everything fell apart: I had hives over most of my body, and constant diarrhea. I stopped the triphala, and the problems slowly receded, as I sunk back into the abyss of the past several years. I've since tried to take smaller doses, but always have a negative reaction - digestive upset, night sweats, joint pain. I have had vitiligo for many years and thought maybe autoimmune might be involved. Of the many physicians I've seen, none has been able to either solve my health problems, or explain what might have accounted for that short 3 weeks of nirvana.
   A. This is interesting. I really have no idea.

Q. I have lyme and coinfections, and after tons and tons of research, here is a possible explanation for this person’s reaction (the email above). Triphala apparently can bust biofilms. Lyme spirochetes and the other infections that come with the same tick bite eventually form biofilms and evade antibiotics and the immune system. That would be why this person keeps having recurrences. The person takes triphala, busts up the biofilm, gives themselves a herx effect (worsening of symptoms as the critters die off), which is actually a good sign. Herxes eventually subside.

Q. I am a biotech engineering student. I am working on a project regarding vitro drug based plasmid protection against radiation.  When triphala is injested, what is the bio transformation pathway occurring? Is there an active drug form? What are the chemical natures of triphala responsible for the DNA protection against radiation?
    A. This product is made of several herbs and each of the herbs has dozens or hundreds of chemicals within it. Therefore there is no easy answer since this product is not made of one chemical as a drug would be.

I am a general dentist and have quite a bit of training in medicine from my studies at Columbia University. I have an 8% mutation from radiation treatment received 25 years ago for a uterine tumor. The mutation created is called Jak 2 and I have developed essential thrombocytosis, which as you know, signifies an over-production of platelets. ( my level is 750K) I am managed on a baby aspirin alone and I do take a lot of herbs such as ginger and red beet crystals to promote circulation. I am trying to avoid cytotoxic drugs at all costs. I also take holy basil as I have recently discovered the benefits of Indian herbs. My question for you is regarding any possible significant link between taking triphala and increased platelet production. I realize you can not advise me or make any diagnosis and I certainly wouldn't expect that.
   This is difficult to answer since I have not seen such evaluations regarding its effect on platelets.

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