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Triphala

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Background & General Info

Triphala in Hindi or Sanskrit translates to “three fruits” in relation to the dried and powdered fruits of its three constituents, namely, amalaki (Emblica officinalis), bibhitaki (Terminalia bellirica), and haritaki (Terminalia chebula), that comprise this Ayurvedic herbal formulation. [1] Triphala is celebrated as a central herbal preparation in the traditional medicinal system of Ayurveda in India, which associates it with the “rasayana” group that is assumed to uphold health, immunity, and longevity, especially when accompanied by a balanced diet. [2]

Terminalia chebula, commonly referred to as the black or chebulic myrobalan, is a deciduous tree species inhabiting in abundance from the sub-Himalayan tracks, to West Bengal and Assam, to areas in the Himalayas with an altitude up to 1,500 meters, to the wild forests of Indian states such as Madhya Pradesh, Gujarat, and Maharashtra. [3][4] This tree has been considered in Tibet as the “king of medicine,” being ranked atop the list of Ayurvedic Materia Medica not only due to its remarkable healing power and high medicinal value but also because of its remedial use in treating a variety of human conditions and disorders. [4]

Terminalia bellirica, also called Beleric or bastard myrobalan, is another large deciduous tree of the dry and desert regions of India and plains, mixed forests, and lower hills of Southeast Asia. [4] Emblica officinalis is also a deciduous tree that is best known for its light greenish-yellow edible fruits used either alone or in combination with other herbs to take care of different diseases such as common cold and fever. The tree is commonly identified as emblic myrobalan, Indian gooseberry, or amla. [5]



Botany

Terminalia chebula is a deciduous tree with a round crown and spreading branches that grows to a height of 50–80 feet. This tree has a dark brown bark marked with some longitudinal cracks and possesses ovate and elliptical leaves in alternate to subopposite arrangement, with two large glands at the top of the petiole. Blooming from May until June, its dull white to yellow monoecious flowers arise in terminal spikes or short panicles and exude a powerful unpleasant odor. The roughly 1-2-inch drupe-like fruits come out from July to December and have five lines or ribs on the outer skin and a fibrous pericarp. Unripe fruits are green but turn into yellowish grey when ripe. [4]

Terminalia bellirica is a 50-meter-tall tree with a rounded crown and a branchless, often buttressed bole at the base. The bluish or ashy-gray bark of this tree is cracked with several fine longitudinal lines, with the inner bark being yellowish. Its large, glabrous leaves are arranged alternately and are broadly elliptic to obovate-elliptical; the base of the leaves is rounded to cuneate but turns into glabrescent eventually, with 6–9 pairs of secondary veins. The young leaves transition from copper red, to parrot green, and finally to dark green. The small solitary flowers are 3–15 cm long in axillary spikes, are greenish white, and possess a strong honey-like aroma, appearing along with new leaves. The subglobular to mainly ellipsoid light yellow fruit is densely velutinous or sericeous. [6]

Emblica officinalis is an 18-meter ornamental tree with fairly smooth, light grayish-brown bark that peels off in thin flakes similar to that of the guava. It possesses minute oblong leaves that are distichously disposed on very slender branchlets, putting on view an impression of finely pinnate foliage. Its small greenish-yellow flowers clump in compact clusters in the axils of the lower leaves, with the male flowers located at the lower end of a growing branchlet and the female flowers being above them. The round smooth fruits are indented at the base, although at times faintly evident ridges extend from the base to the apex, somewhat segmenting the fruit. The fruits shift in color toward maturity, from light green to whitish or dull, greenish yellow or, more rarely, brick red. The ripe fruits are distinctly astringent and extremely acidic. [7]

History & Traditional Use

Based on ancient Indian texts, Chinnodbhavadi kwath (decoction), one of the triphala formulations, is used as remedy of chronic hyperacidity and gastric problems. [8] In Indian medicinal literature. Triphala has been documented to relieve an array of diseases and conditions and the synergistic effect of this polyherbal formulation leads to a restoration and rejuvenation of the immune system. [3]

One of triphala’s components, chebulic myrobalan, has been expansively exploited in Ayurvedic, Unani, and Homoeopathic systems of medicine and has long been used in folklore medicine as treatment of asthma, sore throat, vomiting, hiccough, diarrhea, dysentery, bleeding piles, ulcers, gout, and heart and bladder diseases. [4]

General Herbal Uses

An antioxidant-rich herbal formulation, triphala displays a range of diverse beneficial and health-promoting properties and is a commonly prescribed Ayurvedic colon cleanser, digestive, diuretic, and laxative. [9] In India, vaidyas or Ayurvedic physicians conventionally recommend triphala and its constituents as therapeutics that encourage digestion and satiety and as a health tonic to conditions such as anemia, jaundice, constipation, asthma, fever, and chronic ulcers. [10][2] When employed either singly or together with other ingredients in Ayurvedic therapeutics, the triphala formulation is valued in Ayurveda as a treatment of gastrointestinal problems and is additionally classified as a tridoshik rejuvenator with established antioxidant property. [8] Triphala is also suggested for Kalpha-type boils where the affected area can be washed with triphala tea produced by mixing one teaspoon of triphala in a cup of water. The tea is allowed to cool in the area with boils. A half-teaspoon of triphala can be given in lukewarm at night as remedy for constipation and its external application on the skin can be helpful to cool sun-exposed skin. [11]

The fruits of chebulic myrobalan have mild laxative, stomachic, tonic, and antispasmodic properties and have been traditionally employed as remedies of ophthalmia, hemorrhoids, dental caries, bleeding gums, and ulcerated oral cavity. A paste can be made from the chebulic myrobalan’s fruits when mixed with water, which can be applied on wounds because of the fruits’ anti-inflammatory, analgesic, and purifying and healing properties. Terminalia chebula decoction is recommended as gargle in cases of oral ulcers and sore throat, and the powder obtained from this plant can be a good astringent dentifrice in loose gums with bleeding and ulceration and is believed to increase appetite and stimulate the liver. [4] On the other hand, the fruit of Emblica officinalis serves as a diuretic, laxative, liver tonic, refrigerant, stomachic, restorative, alterative, antipyretic, anti-inflammatory, and hair tonic agent and has been employed traditionally to prevent peptic ulcer and dyspepsia. [9]



Constituents/Active Components

A 2015 phytochemical analysis via liquid chromatography (LC)–mass spectrometry (MS)/MS on the composition of methanol extract of triphala revealed high concentrations of various phenolics such as naringin, quercetin, homoorientin, and isorhamnetin. [12] Tannins (30–40%) such as chebulinic acid, neochebulinic acid, corilagin, chebulagic acid, gallic acid, ellagic acid, punicalagin, terchebin, and terflavin A have been reported in Terminalia chebula, as well as flavonoids, including luteolin, rutins, and quercetin; phytochemicals, such as anthraquinones, saponins, β-D-glucogallin, 1, 3, 6-trigalloyl glucose, and 1, 2, 3, 4, 6-penta-O-galloyl; and carbohydrates, amino acids, and fatty acids. [4] Experimental studies and chemical analysis on amla detected phytochemicals such as gallic acid, ellagic acid, pyrogallol, some norsesquiterpenoids, corilagin, geraniin, elaeocarpusin, and prodelphinidins B1 and B2. [9]

Medicinal/Scientific Research

A number of scientific works have been devoted to evaluating and establishing the therapeutic effectiveness of triphala and its individual components, especially their phytochemistry and pharmacological and medicinal properties. Terminalia chebula alone has been shown to display antioxidant, antimicrobial, antidiabetic, hepatoprotective, anti-inflammatory, antimutagenic, antiproliferative, radioprotective, cardioprotective, antiarthritic, anticaries, gastrointestinal motility, and wound healing activities, which all have been attributed to phytochemicals existing in the plant, such as polyphenols, terpenes, anthocyanins, flavonoids, alkaloids, and glycosides. [4] Preclinical studies on the health-promoting properties of Emblica officinalis have found the plant to possess antipyretic, analgesic, antitussive, antiatherogenic, adaptogenic, cardioprotective, gastroprotective, antianemia, antihypercholesterolemia, wound-healing, antidiarrheal, antiatherosclerotic, hepatoprotective, nephroprotective, and neuroprotective activities. This triphala component has also been determined to exert radiomodulatory, chemomodulatory, chemopreventive, free radical scavenging, antioxidant, anti-inflammatory, antimutagenic, and immunomodulatory activities. [9]

Antiobesity

Fresh juice from Emblica officinalis, one of triphala’s core components, had been proven in an earlier study to exhibit lipid-lowering, hypolipidemic, and antiatherosclerotic effects in rabbits wherein hyperlipidemia was experimentally induced via an atherogenic diet and cholesterol feeding. Administration of fresh juice of Emblica officinalis for 60 days at a dose of 5 mL/kg body weight per rabbit reduced the levels of serum cholesterol, triglycerides, phospholipids, and low-density lipoproteins by 82%, 66%, 77%, and 90%, respectively, and also decreased the levels of lipids in tissues. Moreover, aortic plaques had been found to have regressed, and there was an increased quantity of excreted cholesterol and phospholipids in treated rabbits, signifying that the mode of absorption was affected. [13]

Findings from a 2012 study indicated the protective effect of triphala and its constituents against obesity due to high dietary intake of fats and demonstrated their attractive antiobesity and lipid profile-modulating properties. The study induced obesity via a high-fat diet in 42 male Swiss albino mice, with feeding lasting for 10 weeks, and supplemented the high-fat diet with herbal treatments. Grouped into six weight-matched clusters consisting of seven individuals, the mice were fed with either a normal diet, a high-fat diet alone, a high-fat diet with triphala, a high-fat diet with amalaki, a high-fat diet with haritaki, or a high-fat diet with bibhitaki. A marked decrease in body weight (p < 0.0001), energy intake, and percentage of body fat (p < 0.001) was observed in mice fed with a high-fat diet for 10 weeks and supplemented with herbal preparations of triphala or its constituents, as compared with mice fed with high-fat diet alone. These herbal preparations had also significantly enhanced the lipid profiles of mice; specifically, they had lowered the levels of serum total cholesterol, triglycerides, and low-density lipoprotein cholesterol and increased the levels of high-density lipoprotein cholesterol, as compared with mice fed with a high-fat diet. Furthermore, triphala and its components had attenuated glucose levels, oral glucose tolerance, and plasma alanine transaminase levels. The Ayurvedic formulation of triphala had also reversed the pathological alterations in the liver tissues and reduced the relative weight of visceral adipose fat pads, as examined by a pathologist. [10]

Antioxidant

A 2005 study published in Phytotherapy Research confirmed the in vitro antioxidant activity of aqueous extracts acquired from the fruits of three equiproportional components of triphala, namely, Emblica officinalis, Terminalia chebula, and Terminalia bellirica. In this study, strand break formation in plasmid DNA (pBR322) triggered by gamma radiation was efficiently suppressed by triphala and its constituents at concentrations of 25–200 μg/mL. The ranges of inhibition percentages of strand break formation were 30–83%, 21–71%, 8–58%, and 17–63% for Emblica officinalis, Terminalia chebula, Terminalia bellirica, and triphala itself, respectively. Furthermore, all four successfully inhibited lipid peroxidation induced by radiation in rat liver microsomes, with IC50 values being <15 μg/mL, and the aqueous plant extracts scavenged free radicals such as DPPH and superoxide. Such radical scavenging activity was attributed to the phenolic compounds characteristic of these extracts, which was expressed in 33% to 44% gallic acid equivalents. Overall, the study found each triphala constituent to display slightly dissimilar activities under different conditions, with Emblica officinalis demonstrating higher effectiveness in lipid peroxidation and plasmid DNA assay and Terminalia chebula displaying better radical scavenging activity than other triphala components. [14]

Antidiabetic

Triphala and equal proportions of methanol extracts of Terminalia chebula, Terminalia bellirica, and Emblica officinalis have been shown to hinder the formation of lipid peroxide and to scavenge hydroxyl and superoxide radicals in vitro. These plant extracts suppressed 50% of lipid peroxidation stimulated by Fe2+/ascorbate at concentrations of 27, 74, 69, and 85.5 μg/mL, respectively. Hydroxyl radical scavenging was inhibited at concentrations of 71, 155.5, 151, and 165 μg/mL, respectively, whereas superoxide scavenging activity was suppressed at 40.5, 6.5, 12.5, and 20.5 μg/mL, respectively. Oral administration of the aforementioned extracts at a dose of 100 mg/kg body weight resulted in a decrease in blood sugar level in normal and alloxan-induced diabetic rats within 4 hours, and their continuous administration on a daily basis produced a sustained effect. [15]

Anticancer

Up to the present, research has been geared toward the development of efficient nontoxic therapeutic alternatives that can prevent cancer. One such alternative is triphala, which has been shown by several experimental studies in the past decade to contribute to cancer prevention and to exert antineoplastic, radioprotective, and chemoprotective properties. [9] Results from the investigation of Kaur et al. (2005) have validated the considerable cytotoxic effect of triphala acetone extract against Shionogi 115 (S115) and MCF-7 breast cancer cells and PC-3 and DU-145 prostate cancer cells, which were the cancer lines utilized as models in the study. Furthermore, this study attributed the inhibition of growth of cancer cells to gallic acid, the chief polyphenol component of the triphala extract, as identified through structural analysis via spectroscopic techniques. [16] Angiogenesis, which is crucial in the pathogenesis of cancer and the initiation, growth, and progression of malignant tumors, has been known to be induced by vascular endothelial growth factor-A (VEGF); in the study of Lu et al. (2012) VEGF-induced angiogenesis was determined to be significantly and specifically inhibited by triphala and chebulinic acid, its active constituent, via suppression of VEGF receptor-2 (VEGFR-2) phosphorylation. [17]

A 2015 investigation revealed the antiproliferative and proapoptotic attributes of triphala on HCT116 colon cancer cells and human colon cancer stem cells. The methanol extract of triphala had been observed in the said study to have successfully inhibited proliferation even in the absence of p53 in HCT116 colon cancer cells and human colon cancer stem cells and to have evoked p53-independent apoptosis in human colon cancer stem cells, which was confirmed by the increased levels of PARP cleavage. In a BrdU assay, the colon cancer cells were treated with triphala methanol extract at escalating concentrations of 25, 50, 100, and 200 μg/mL for 20 hours, with the standard cytotoxic drug 5-fluorouracil included in the study to act as a positive control. The results from this assay indicated a dose-dependent suppression of cancer cell proliferation, increasing with elevated concentrations of triphala methanol extract on both cell lines. IC50 values of the extract against the tested HCT116 colon cancer cells and human colon cancer stem cells were 104 ± 5 μg/mL and 153 ± 8 μg/mL, respectively. Data from Western blotting had also pointed out suppressed protein levels of c-Myc and cyclin D1, which are principal proliferation proteins, and an induced apoptosis via an increase in Bax/Bcl-2 ratio due to triphala treatment. Moreover, the methanol extract of triphala appeared to have hindered the colony formation of human colon cancer stem cells, which is a gauge of the self-renewal capacity of colon cancer cells. [12]

Sandhya et al. (2006) demonstrated on the other hand the cytotoxic effects of aqueous extract of triphala against a human breast cancer cell line (MCF-7) and a transplantable mouse thymic lymphoma (barcl-95) and its ability to not harm normal cells during the process of inducing cytotoxicity in tumor cells. The viability of these two tested cancer lines declined with elevated concentrations of triphala. As revealed by annexin-V fluorescence, the triphala aqueous extract stimulated apoptosis in MCF-7 and barcl-95 cells in vitro, with the number of apoptotic cells being reliant on the concentration of triphala. Furthermore, single cell gel electrophoresis also showed a pattern of DNA damage that is distinct to apoptosis in MCF-7 cells treated with triphala. A concentration-dependent increase in intracellular reactive oxygen species had also been noted in treated MCF-7 and barcl-95 cells, but this increase in reactive oxygen species was observed to be insignificant in normal breast epithelial cells (MCF-10 F) and murine spleen and liver normal cells. When directly fed to mice transplanted with barcl-95 at a dose of 40 mg/kg body weight, triphala reduced the growth of tumor in vivo attributable to the involvement of apoptosis, as assessed through tumor volume measurement. Interestingly, excised tumor tissues of experimental mice fed with triphala manifested considerably higher apoptosis in comparison with controls. [18]

Antiarthritic

Rasool and Sabina (2007) presented the favorable anti-inflammatory activity of triphala against adjuvant-induced arthritis in mice. Right hind paw of Swiss albino mice was intradermally injected with 0.1 mL of complete Freund’s adjuvant, which resulted in an elevation of lysosomal enzyme, tissue marker enzyme, and glycoprotein levels and an increase in paw thickness in adjuvant-induced arthritic mouse models. At a dose of 1 g/kg body weight, triphala, which was orally provided for 8 days after adjuvant injection, starting from day 11 to day 18, had reversed the physical and biochemical alterations evident in arthritic mice to near normal conditions. [19]

Anticataract

A 2010 research published in Journal of Ayurveda and Integrative Medicine offered evidence on the antioxidant-associated ability of triphala to prevent or delay experimental selenite-induced cataract in vitro and in vivo. In this investigation, the normal and control groups consisted of enucleated rat lenses kept in vitro in organ culture containing Dulbecco’s Modified Eagles medium alone or the aforementioned medium plus 100 μM selenite, respectively, whereas the test group involved a medium supplemented with selenite and an aqueous extract of triphala at various concentrations. The rat lenses were incubated for a day at a temperature of 37°C, followed by an approximation of reduced glutathione, lipid peroxidation product, and antioxidant enzymes. Sodium selenite at a concentration of 25 μmole/kg body weight was subcutaneously injected in 9-day-old rat pups to elicit in vivo cataract, and triphala, at doses of 25, 50, and 75 mg/kg, was intraperitoneally administered to the experimental groups 4 hours prior to selenite challenge. Results had demonstrated that triphala significantly (p < 0.01) reinstated glutathione levels but reduced malondialdehyde levels and also restored the activities of antioxidant enzymes, including superoxide dismutase (p < 0.05), catalase (p < 0.05), glutathione peroxidase (p < 0.05), and glutathione-s-transferase (p < 0.005), in tested groups compared with controls. At a dose of 25 mg/kg of triphala, only 20% nuclear cataract developed in comparison with 100% in control, as determined through slit lamp examination at the end of the study period. [20]

Gastroprotective

Recognized as a rejuvenator, triphala has been customarily used as remedy for gastric disorders such as intestinal inflammation. It is valued as one of the most essential formulations in Ayurvedic therapeutics due to its established protective effects of multiple organs such as gastroprotection. Nariya et al. (2011) evaluated the gastroprotective property of triphala formulations against experimental gastric ulcer, which was elicited in rats through water immersion stress, and determined the effects of the drug through studies of macroscopic gross injury and stomach tissue biochemical parameters. An unequal formulation of triphala and Chinnodbhavadi kwath, one of the triphala formulations in ancient Indian text, exhibited noteworthy antiulcer activity, as evidenced by a decrease in ulcer index, lipid peroxidation, and hydroxyl radical levels alongside an increase in catalase and superoxide dismutase levels. Moreover, an elevation of glutathione and ATPase levels was observed for Chinnodbhavadi kwath; however, the equal formulation of triphala raised significantly the level of glutathione only. [8]

Radioprotective

As indicated by a 2002 investigation, triphala is an excellent radioprotective agent with an optimum protective dose of 1/28 its LD50 dose. Intraperitoneal treatment of aqueous extract of triphala at doses of 5, 6.25, 10, 12.5, 20, 25, 40, 50, and 80 mg/kg body weight 5 days prior to irradiation resulted in a delayed onset of radiation-induced mortality in mice exposed to 10 Gy of gamma radiation and a decreased number of radiation sickness symptoms in comparison with non-drug-treated irradiated controls. At a concentration 12.5 mg/kg, the highest radioprotection attributed to triphala against gastrointestinal death was noted, with several reported survivors up to 10 days following irradiation. 10 mg/kg of intraperitoneally administered triphala conferred the greatest protection, as manifested by the highest number of survivors after 30 days following irradiation in comparison with other doses of triphala. [2]

Immunomodulatory

Triphala and its individual components are promising immunostimulants and/or immunosuppressants that stimulate neutrophil function and, during stressful conditions, put off any increase in IL-4 levels and reverse decreased IL-2 and IFN-γ levels, making them superior alternatives for allopathic immunomodulators. Immunomodulators, or biological response modifiers, are highly important because they enhance the body’s line of defenses against diseases by maintaining a balance between regulatory and effector cells. The immunosuppression associated with triphala treatment during inflammatory stress relates to its inhibition of the complement system, humoral immunity, cell-mediated immunity, and mitogen-induced T-lymphocyte proliferation. Aqueous and alcoholic extracts from Terminalia bellerica, Terminalia chebula, and Emblica officinalis have been described to improve macrophage activation because of their abilities to scavenge free radicals and neutralize reactive oxygen species. [3]

Contraindications, Interactions, And Safety

In a 2002 evaluative study of the radioprotective effect of triphala, triphala was found as safe and nontoxic up to a dose of 240 mg/kg, which did not lead to drug-induced mortality, as indicated by toxicity screening. The LD50 dose of intraperitoneally injected triphala is 280 mg/kg body weight. [2] Triphala appears to inhibit cytochrome P450 enzymes, which are responsible for metabolizing likely toxic substances such as drugs and endogenous metabolism products. This signifies the potential or likelihood of triphala to interact with drugs administered concomitantly with it. In a study, triphala displayed 23% inhibition of rat liver microsomes, as determined through CYP450-CO complex assay, and gallic acid in triphala also inhibited isoforms CYP3A4 and 2D6 at IC50 values of 87.24 ± 1.11 μg/mL and 92.03 ± 0.38 μg/mL, respectively. [21]

References:

[1] A. P. Committee, The Ayurvedic Formulary of India, Part I, 2nd ed., New Delhi: Controller of Publications, 2003. http://www.ayurveda.hu/api/API-Vol-2.pdf

[2] G. Jagetia, M. Baliga, K. Malagi and K. M. Sethukumar, "The evaluation of the radioprotective effect of Triphala (an ayurvedic rejuvenating drug) in the mice exposed to gamma-radiation," Phytomedicine, vol. 9, no. 2, p. 99–108, 2002. https://www.ncbi.nlm.nih.gov/pubmed/11995956

[3] P. Belapurkar, P. Goyal and P. Tiwari-Barua, "Immunomodulatory effects of triphala and its individual constituents: A review," Indian Journal of Pharmaceutical Sciences, vol. 76, no. 6, p. 467–475, 2014. https://www.ncbi.nlm.nih.gov/pubmed/25593379

[4] A. Bag, S. K. Bhattacharyya and R. R. Chattopadhyay, "The development of Terminalia chebula Retz. (Combretaceae) in clinical research," Asian Pacific Journal of Tropical Biomedicine, vol. 3, no. 3, p. 244–252, 2013. https://www.ncbi.nlm.nih.gov/pubmed/23620847

[5] M. Baliga and J. Dsouza, "Amla (Emblica officinalis Gaertn), a wonder berry in the treatment and prevention of cancer," European Journal of Cancer Prevention, vol. 20, no. 3, p. 225–239, 2011. https://www.ncbi.nlm.nih.gov/pubmed/21317655

[6] O. e. al., "Terminalia bellirica," World Agroforestry Centre Database 4.0, 2009. http://www.worldagroforestry.org/treedb/AFTPDFS/Terminalia_bellirica.PDF

[7] O. e. al., "Emblica officinalis Database 4.0," World Agroforestry Centre, 2009. http://www.worldagroforestry.org/treedb/AFTPDFS/Emblica_officinalis.PDF

[8] M. Nariya, V. Shukla, B. Ravishankar and S. Jain, "Comparison of gastroprotective effects of triphala formulations on stress-induced ulcer in rats," Indian Journal of Pharmaceutical Sciences, vol. 73, no. 6, p. 682–687, 2011. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3480757/

[9] M. Baliga, "Triphala, Ayurvedic formulation for treating and preventing cancer: a review," Journal of Alternative and Complementary Medicine, vol. 16, no. 12, p. 1301–1308, 2010. https://www.ncbi.nlm.nih.gov/pubmed/21138390

[10] S. Gurjar, A. Pal and S. Kapur, "Triphala and its constituents ameliorate visceral adiposity from a high-fat diet in mice with diet-induced obesity," Alternative Therapies, Health and Medicine, vol. 18, no. 6, p. 38–45, 2012. https://www.ncbi.nlm.nih.gov/pubmed/23251942

[11] A. McIntyre, Herbal Treatment of Children: Western and Ayurvedic Perspectives, Elsevier, 2005. https://www.researchgate.net/publication/237128750

[12] V. Ramakrishna, S. Radhakrishnan, L. Reddivari and J. K. P. Vanamala, "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 Research International, vol. 2015, p. 12, 2015. https://www.hindawi.com/journals/bmri/2015/649263/

[13] R. Mathur, A. Sharma, V. Dixit and M. Varma, "Hypolipidaemic effect of fruit juice of Emblica officinalis in cholesterol-fed rabbits," Journal of Ethnopharmacology, vol. 50, no. 2, p. 61–68, 1996. https://www.ncbi.nlm.nih.gov/pubmed/8866725

[14] G. Naik, K. Priyadarsini, R. Bhagirathi, B. Mishra, K. Mishra, M. Banavalikar and H. Mohan, "In vitro antioxidant studies and free radical reactions of triphala, an ayurvedic formulation and its constituents," Phytotherapy Research, vol. 19, no. 7, p. 582–586, 2005. https://www.ncbi.nlm.nih.gov/pubmed/16161061

[15] M. Sabu and R. Kuttan, "Anti-diabetic activity of medicinal plants and its relationship with their antioxidant property," Journal of Ethnopharmacology, vol. 81, no. 2, p. 155–160, 2002. https://www.ncbi.nlm.nih.gov/pubmed/12065146

[16] S. Kaur, H. Michael, S. Arora, P. Härkönen and S. Kumar, "The in vitro cytotoxic and apoptotic activity of Triphala--an Indian herbal drug," Journal of Ethnopharmacology, vol. 97, no. 1, p. 15–20, 2005. https://www.ncbi.nlm.nih.gov/pubmed/15652269

[17] K. Lu, D. Chakroborty, C. Sarkar and e. al., "Triphala and its active constituent chebulinic acid are natural inhibitors of vascular endothelial growth factor-A mediated angiogenesis," PLoS One, vol. 7, no. 8, p. e43934, 2012. https://www.ncbi.nlm.nih.gov/pubmed/22937129

[18] T. Sandhya, K. Lathika, B. Pandey and K. Mishra, "Potential of traditional ayurvedic formulation, Triphala, as a novel anticancer drug," Cancer Letters, vol. 231, p. 206–214, 2006. https://www.ncbi.nlm.nih.gov/pubmed/15899544

[19] M. Rasool and E. Sabina, "Antiinflammatory effect of the Indian Ayurvedic herbal formulation Triphala on adjuvant-induced arthritis in mice," Phytotherapy Research, vol. 21, no. 9, p. 889–894, 2007. https://www.ncbi.nlm.nih.gov/pubmed/17533629

[20] S. K. Gupta, V. Kalaiselvan, S. Srivastava, S. S. Agrawal and R. Saxena, "Evaluation of anticataract potential of Triphala in selenite-induced cataract: In vitro and in vivo studies," Journal of Ayurveda and Integrative Medicine, vol. 1, no. 4, p. 280–286, 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117320/

[21] S. Ponnusankar, S. Pandit, R. Babu, A. Bandyopadhyay and P. Mukherjee, "Cytochrome P450 inhibitory potential of Triphala—a Rasayana from Ayurveda," Journal of Ethnopharmacology, vol. 133, no. 1, p. 120–125, 2011. https://www.ncbi.nlm.nih.gov/pubmed/20883765

Article researched and created by Dan Albir for herbs-info.com. © herbs-info.com 2018

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