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and has been thoroughly studied by Indian and Western scientists
alike. The epistemological differences of indigenous medical science
Ayurveda and biomedicine, at times, make it difficult to translate the exact
mode of all attributes and activities of Triphala; however the effort is
worthwhile. In this chapter, the Ayurvedic perspectives of the three plants,
known bioactive components of the formulation, in vitro and in vivo
experiments, and clinical trials oriented to specific d iseases are discussed
in brief.
9.2 Ayurvedic Perspective on Triphala
Ayurveda pharmacology Dravyagunavigyan explains the tastes (rasa), potency
(virya), post-digestive effect (vipaka), attributes (guna) and actions (karma)of
each plant, and of some prominent herbal formulations like Triphala. The
functions are inferred based on the rasa and attributes. Triphala is a pan-
charasa formulation, having five tastes, viz. sour, astringent, pungent, bitter
and sweet. The only missing taste is sa lt. Its post-digestive effect is sweet and
potency neutral.
1
It is a perfect balance of heavy and light along with dry
attributes. The formulation balances, restores and rejuvenates all three
doshas, namely vata, pitta and kapha, wherein Amalaki works on Pittadosha,
Bibhitaka on Kaphadosha, and Haritaki on Vatadosha.
3,4
The synergistic ac-
tion of these three ingredients is unique to Triphala.
Both conventional medicine and Ayurveda have endorsed that health and
disease initiate in the gut.
5,6
Triphala promotes absorption, digestion,
elimination and rejuvenation. Numerous references in well-respected Ayur-
vedic medical texts make clear that Triphala is well-regarded as a multiuse
therapeutic and perhaps the best remedy traditionally.
5,7
Triphala is a well-
known Ayurvedic herb constituent of about 1500 Ayurveda formulations and
is widely used in several diseases, especially for anaemia, abdominal pain,
blood purification, cough, upper respiratory diseases, dental, skin, consti-
pation, malignancies, orbital oedema, liver disorders, peptic and mouth
ulcers, obesity, wound healing and toxic conditions
2
(Figure 9.1 and
Table 9.1).
It has been used as a stand-alone formulation in powder, decoction, oil,
ghee and mashi forms.
10
Triphala decoction and ghee are used as accom-
paniments (anupan) to the main drug and have interesting, targeted effects.
Triphala powder with sugar works on acid peptic disease, while with hot
water it is used as a mild laxative and with oil in non-healing ulcers.
11
The
most widely used formulations containing Triphala are Triphala Ghrita for
vision loss or retinopathy, and Triphala Guggul for joint diseases, haemor-
rhoids/fistula, sciatica and other musculoskeletal/neurovegetative diseases
(Figure 9.2). Triphala Guggul inhibits the hyaluronidase and collagenase
enzymes that degrade cartilage matrix, and also inhibits protein fibrillation
responsible for neurodegeneration.
12,13
Another important formulation is
Triphala mashi wherein Triphala powder is carbonised at 450 1C and is
202 Chapter 9
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traditionally used to treat hiccups and dyspnoea. It has been reported to be
non-toxic and has antimicrobial and antidiarrhoeal activities.
It is used to process inorganic metals and minerals such as iron, zin cite,
biotite mica, etc., which belong to the Rasaushadhi class of Ayurvedic drugs
(Table 9.2). The conversion of inorganic metals/minerals into biologically
active nanomolecules with a therapeutic effect is brought about by various
processes including quenching, amalgamation, trituration and heating. It
has been reported that during the specific processes various phytochemicals
find their way to bind at different sites of the metal molecule which can be
traced using FTIR-like techniques.
14–16
Triphala has been stu died for its biological activity through cellular, mo-
lecular and animal experiments (Figure 9.3). It is reported to possess anti-
arthritic, antibacterial, analgesic, antiaging, antiallergic, anti-inflammatory,
antimicrobial, anticancer, antifungal, antiviral, apoptogenic, cardiotonic,
hypoglycaemic, immunomodulatory, antimutagenic, antimalarial, hepato-
protective and capillary-strengthening activities.
18–30
9.3 Bioactive Components of Triphala
The bioactive herbs are commonly found under the Universal Natural
Products Database (UNPD). According to the UNPD, Triphala herbs contain
114 bioactives from Phyllanthus emblica L., 25 from Terminalia bellirica and
Figure 9.1 Therapeutic uses of Triphala.
Therapeutic Potential of Triphala in Ayurveda and its Phytochemical Studies 203
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Table 9.1 Therapeutic uses of Triphala from Ayurvedic treatises.
a
No. Phyllanthus emblica L.
(8)
Terminalia bellirica
(9)
Terminalia chebula
(9)
1 Impaired digestion
(ACB-23) (Agnimandya)
Cough (EA-3) and
dyspnoea (EA-4) (Kasa,
shwasa)
Intermittent pyrexia
(EC-3.0) (Visham
jwara)
2 Anorexia (EC-7) (Aruchi) Diarrhoea (EB-2) (Atisara) Filariasis (ED-13)
(Shipada)
3 Constipation (AAC-12.4)
(Vibandha)
Oedema (EK-3) (Shotha) Diarrhoea (EB-2)
(Atisara)
4 Liver disorders (Yakrut
Vikar)
Vitiligo (ED-5) (Shwitra) Dysentery (EB-9)
(Pravahika)
5 Hyperacidity (EB-4)
(Amlapitta)
Lithiasis (EJ-2) (Ashmari) Constipation (AAC-
12.4) (Vibandha)
6 Ascites (EK-4) (Udara) Acute spreading eruptions
(ED-10) (Visarpa)
Impaired digestion
(ACB-23)
(Agnimandya)
7 Obstipation (EB-11)
(Udavarta)
Corneal ulcer (HE-1)
(Savrana shukla)
Indigestion (EB-3)
(Ajirna)
8 Haemorrhoid (EE-3)
(Arsha)
— Vomiting (EB-6)
(Chardi)
9 Heart diseases (EC-2)
(Hridrog)
— Hyperacidity (EB-4)
(Amlapitta)
10 Epistaxis/bleeding
disorder (ED-7)
(Raktapitta)
— Obstipation (EB-11)
(Udavarta)
11 Anaemia (EC-5) (Pandu) — Ascites (EK-4) (Udara
)
12 Cough (EA-3) and
dyspnoea (EA-4) (Kasa,
Shwasa)
— Disorders of lower
G.I.T. (EB-7) (Grahani)
13 Consumption (BI)
(Rajayakshma)
— Duodenal ulcer (EB-
10.10) (Parinamshool)
14 Improves memory (Smriti
and medha vardhak)
— Lump (EB-8) (Gulma)
15 Menorrhagia (EL-4)
(Raktapradara)
— Hepatomegaly (EK-4.6)
(Yakruddaludar)
16 Infertility (EI-1)
(Garbhashaya daurbalya)
— Anaemia (EC-5) (Pandu)
17 Spermaturia (EF-2.2.6)
(Shukrameha)
— Jaundice (ED-3)
(Kamala)
18 Dysuria (EJ-4)
(Mutrakruchchra)
— Obesity (EF-3)
(Medoroga)
19 Diabetes (EF-2.3) (Pittaj
Prameha)
— Diabetes (EF-2)
(Prameha)
20 Acute spreading eruptions
(ED-10) (Visarpa)
— Rheumatism (EC-6)
(Amavata)
21 Integumentary diseases
(ED-4) (Kushtha)
— Sciatica (AAC-20)
(Grudhrasi)
22 Chronic fever (Jeerna
jwara)
— Rheumatism (ED-8)
(Vatarakta)
23 Polidypsia (EK-2) (Trishna) — Oedema (EK-3) (Shotha)
24 Burning sensation (ED-20)
(Daha)
— Integumentary diseases
(ED-4) (Kushtha
)
25 Rejuvenation (Rasayana) — Syphilis (EI-5)
(Upadansh)
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63 from Terminalia chebula. A few bioactives are common to all three herbs.
Altogether, the Triphala formulation comprises of 177 bioactive compounds.
These bioactive data further help to build human and microbial proteome
targeting networks. The bioactives are scored from 0.9–1, based on the max-
imum binding closeness between the ligand and target protein, where score 1
denotes a higher binding database (DB). According to June 2015 binding DB
search, Triphala has 36 bioactives scoring 1, as depicted in Figures 9.4–9.6
31
and Table 9.3.
9.4 Effects of Triphala on Various Diseases
9.4.1 Anticancer Activity and Triphala
Triphala has been used for centuries to treat different ailments. Numerous
reports of recent in vitro, in vivo and clinical studies on Triphala have
Table 9.1 (Continued)
No. Phyllanthus emblica L.
(8)
Terminalia bellirica
(9)
Terminalia chebula
(9)
26 — — Pytiriasis capitis (FA-4)
(Darunak)
27 — — Rejuvenation
(Rasayana)
a
The letters and numbers in brackets show the NAMC (National Ayurveda Morbidity Code).
Figure 9.2 Different dosage forms of Triphala. All images are taken from
pixabay.com.
Therapeutic Potential of Triphala in Ayurveda and its Phytochemical Studies 205
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demonstrated its protective and therapeutic efficacy against malignancies
such as melanoma, breast, colon, cervical, endometrial, pancreatic, pro-
static, ovarian and lymphatic cancers (Table 9.4).
13,32–41
On the other hand,
experimental studies have also revealed that through modulation of vario us
signalling molecules, Triphala displays antineoplastic, chemoprotective and
radioprotective effects.
42
Different cancer cell lines have been tested using Triphala where it has
shownananticancereffect.Thechemicalanalysis of Triphala (aqueous extract)
showed that it was rich in gallic acid (a polyphenol), which is considered as a
major factor in inducing cytotoxicity of breast and prostate cancer cells.
40
Sandhya et al.
30
presented that the increasing concentrations of Triphala con-
sistently decreased the viability and induced apoptosis in treated breast cancer
cells. Interestingly, normal breast epithelial cells, human peripheral blood
Table 9.2 Triphala as a processing formulation for inorganic drug sources.
17
No Name of drug Name of the process
Form of Triphala as a
processing
ingredient
For processing
1 Abhrak (biotite
mica)
Shodhana (detoxification) by Nirvap
(quenching)
Triphala quath
2 Abhrak (biotite
mica)
Maran (incineration) Triphala quath
3 Vaikrant
(tourmaline)
Satwapatan (extraction) Triphala churna
4 Shilajeet (black
bitumen)
Detoxification Triphala quath
5 Rasak (zinc
carbonate)
Extraction Triphala churna
8 Loha (iron) Detoxification by Quenching followed
by bhavana (trituration)/boiling/sun
drying followed by incineration
Triphala quath
9 Mandoor (iron
oxide)
Detoxification by quenching Triphala quath
For internal use
1 Shilajeet (black
bitumen)
Mixture Triphala churna
2 Rasak (zinc
carbonate)
Mixture Triphala quath
3 Gandhak
(sulfur)
Mixture Triphala churna
4 Gandhak
(sulfur)
(Kushthahar
yog)
Mixture Triphala churna
5 Kasis (ferrous
sulfate)
Mixture Triphala churna
6 Rajat (silver) Mixture Triphala churna
7 Nag Mixture Triphala quath
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mononuclear cells, and mouse liver and spleen cells did not show a cytotoxic
effect or DNA damage with the same concentrations of Triphala. Hence, this
study revealed that Triphala was selectively cytotoxic to cancer cells.
30
Triphala has cancer chemo-preventive potential as shown in animal
studies. This effect was elucidated by the molecular mechanism against
human pancreatic cancer in the cellular and in vivo model. Oral adminis-
tration of Triphala (50–100 mg kg
1
) significantly reduces the growth of
Capan-2 pancreatic tumour-xenograft. It was found that a decrease in tu-
mour growth by Triphala in mice was due to increased apoptosis in tumour
cells, which was associated with elevated stimulation of p53 gene and
extracellular-signal-regulated kinase (ERK).
43
Another in vivo study demon-
strated that the tumour inhibitory effects of Triphala or its active ingredients
were enabled through the suppression of vascular endothelial growth factor
(VEGF). Triphala and one of its active ingredients, chebulinic acid, specif-
ically prevent VEGF-induced angiogenesis by suppressing VEGF receptor-2
(VEGFR-2) phosphorylation and thus reduce tumour growth and metas-
tasis.
44
Triphala treatment in a zebrafish xenograft model inhibited the
growth and metastasis of transplanted gastric carcinoma cells. The anti-
neoplastic effect of Triphala was assessed by western blotting and the results
demonstrated that it inhibited phosphorylation of epidermal growth factor
receptor (EGFR), protein kinase B (PKB, also known as AKT) and ERK.
38
9.4.2 Immunomodulatory Effect and Triphala
Triphala has been shown to strengthen the immune system and act as an
immunomodulatory agent. A review of the literature suggests that the
Figure 9.3 Biological activities of Triphala.
Therapeutic Potential of Triphala in Ayurveda and its Phytochemical Studies 207
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Table 9.3 The chemical constituents, score-1 bioactives and their corresponding protein targets of Triphala.
Chemical constituents of Triphala Ingredients Score-1 bioactives of Triphala Protein targets of Triphala
P. emblica
(32,33)
Ascorbic acid
Catechol
Ellagic acid
Flavonoids
Gallic acid
Pectin
Phyllaemblic compounds
Quercetin
Rutin
Tannins
Vitamin C
Catechin
Chebulanin
Ellagic acid
Epicatechin
Gallocatechin
Gallic acid
Kaempferol
Methyl gallate
Quercetin
Tannic acid
1,2,3,6-Tetrakis-(O-galloyl)-beta-
D-glucose
1,2,3,4,6-Pentagalloylglucose
1,6-Digalloyl-beta-
D-glucopirano-side
Trans- 3,3
0
,4
0
,5,7-pentahydroxylflavane
Alkaline phosphatase (ALPL)
Beta-secretase 1 (BACE1)
Carbonic anhydrase 7 (CA7)
Coagulation factor X (F10)
DNA repair protein RAD51 homolog 1
(RAD51)
GSTM1 protein (GSTM1)
Plasminogen activator inhibitor 1
(SERPINE1)
Prothrombin (F2)
Regulator of G-protein signalling (RGS)
4, 7, and 8, tissue-type plasminogen activator
(PLAT)
Tyrosine–protein phosphatase nonreceptor
type 2 (PTPN2)
T. bellirica
(34)
Ellagic acid
Ethyl acid
Ethyl gallate
Gallic acid
Galloyl glucose
Chebulaginic acid
b-Sitosterol
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T. chebula
(35–37)
1,2,3,4,6-Penta-O-galloyl-b-
D-glucose
1,6-Di-o-galloyl-
D-glucose
3,4,6-Tri-o-galloyl-
D-glucose
Anthraquinones
Casuarinin
Chebulagic acid Punicalagin
Chebulanin
Chebulinic acid
Corilagin
Ellagic acid
Gallic acid
Galloyl glucose
Maslinic acid
Neochebulinic acid
Punicalagin
Terchebulin
Terflavin A
Therapeutic Potential of Triphala in Ayurveda and its Phytochemical Studies 209
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2.
3.
4.
5.
1.
6.
7.
8.
[(2R,3S,4S,5R,6S)-3,4,5-trihydroxy-6-(3,4,5-
trihydroxybenzoyl)oxyoxan-2-yl]methyl 3,4,5-
trihydroxybenzoate (1,6-digalloyl-beta-
Dglucopirano-side)
2,3,7,8-
Tetrahydroxy[1]benzopyr
ano[5,4,3-
cde][1]benzopyran-5,10-
dione (ellagic acid)
3,4,5-trihydroxybenzoic
acid (gallic acid)
(2R,3R)-5,7-Dihydroxy-2-(3,4,5-
trihydroxyphenyl)-3,4-dihydro-2H-1-
benzopyran-3-yl 3,4,5-trihydroxybenzoate
(epigallocatechin-3-gallate)
methyl 3,4,5-trihydroxybenzoate
(methyl gallate)
2-(3,4-
dihydroxyphenyl)-3,5,7-
trihydroxychromen-4-
one (quercetin)
[2,3-dihydroxy-5-[[(2R,3R,4S,5R,6S)-3,4,5,6-
tetrakis[[3,4-dihydroxy-5-(3,4,5-
trihydroxybenzoyl)oxybenzoyl]oxy]oxan-2-
yl]methoxycarbonyl]phenyl] 3,4,5-
trihydroxybenzoate (tannic acid)
benzene-1,2,3-triol;methanesulfonic
acid (1,2,3-benzenetriol)
Figure 9.4 Chemical structures of active compounds of Triphala, part I.
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1. 2. 3. 4.
5. 6. 7. 8.
[(2R,3R,4S,5R,6S)-3,4,5,6-
tetrakis[(3,4,5-
trihydroxybenzoyl)oxy]oxan-2-
yl]methyl 3,4,5-
trihydroxybenzoate (1,2,3,4,6-
pentagalloylglucose)
2-[(4R,5S,7R,8R,11S,12S,13S,21S)-13,17,18-
trihydroxy-2,10,14-trioxo-5,21-bis[(3,4,5-
trihydroxybenzoyl)oxy]-7-[(3,4,5-
trihydroxybenzoyl)oxymethyl]-3,6,9,15-
tetraoxatetracyclo[10.7.1.14,8.016,20]henicosa-
1(19),16(20),17-trien-11-yl]acetic acid
(chebulinic acid)
5,13-bis(3,4,5-trihydroxyphenyl)-4,12,14-
trioxapentacyclo[11.7.1.02,11.03,8.015,20]
henicosa-2(11),3(8),9,15,17,19-hexaene-
6,9,17,19,21-pentol (prodelphinidin A1)
2-[13,17,18,21-tetrahydroxy-7-
(hydroxymethyl)-2,10,14-trioxo-
5-(3,4,5-trihydroxybenzoyl)oxy-
3,6,9,15-tetraoxatetracyclo
[10.7.1.14,8.016,20]henicosa-1
(19),16(20),17-trien-11-yl]acetic
acid (chebulanin)
2,3,7,8-Tetrahydroxy[1]benzopyrano
[5,4,3-cde][1]benzopyran-5,10-dione
(ellagic acid)
3,4,5-trihydroxybenzoic
acid (gallic acid)
2-(3,4-dihydroxyphenyl)-3,5,7-
trihydroxychromen-4-one (quercetin)
methyl 3,4,5-trihydroxybenzoate
(methyl gallate)
Figure 9.5 Chemical structures of active compounds of Triphala, part II.
Therapeutic Potential of Triphala in Ayurveda and its Phytochemical Studies 211
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