In November 2020, the American Herbal Pharmacopoeia (AHP) released a monograph containing quality control standards and a therapeutic compendium (as one document) for triphala, a traditional Ayurvedic herbal formula made from the fruits of amla (Phyllanthus emblica, Phyllanthaceae), belleric myrobalan (vibhitaka; Terminalia bellirica, Combretaceae), and chebulic myrobalan (haritaki; T. chebula).1
Triphala is one of the most important and commonly used formulas in India’s traditional medicine system of Ayurveda, which reportedly is the oldest continually used health care system in the world. Triphala, which often is used for gastrointestinal health, is also one of the oldest herbal formulas in continued use and has been used in the same way for more than 2,000 years.
This is the first time AHP has undertaken a monograph and therapeutic compendium for a multi-herb formula. AHP claims that it is the first monograph of its kind in a Western pharmacopeia and the most complete review of triphala’s therapeutic and safety profile in English. In January 2019, AHP released an individual monograph and therapeutic compendium for belleric myrobalan fruit, and it is creating individual monographs and therapeutic compendia for amla and chebulic myrobalan fruits, the formula’s two other ingredients.
“Interest in Ayurveda continues to grow, and it seemed appropriate to showcase one of its most important formulas,” wrote Roy Upton, RH (AHG), DipAyu, president of AHP and editor of the monograph (email, November 4, 2020). “This monograph is also a natural extension of our work on the individual fruits that make up the triphala formula and are highly regarded in their own right.”
AHP monographs establish identification, purity, and quality standards for botanical raw materials and preparations. The therapeutic compendia provide a comprehensive review of pharmacological and safety data, including medical indications and evidence from clinical, animal, and in vitro studies; modern and traditional uses; pharmacokinetics; pharmacodynamics; and guidance for structure and function claims. The compendia also cover dosages, interactions, side effects, contraindications, toxicology, and more. This information can be used by individuals in the herbal community, from consumers and health care practitioners to industry members like quality control personnel, purchasing agents, and dietary supplement manufacturers.
Triphala, which means “three fruits” in Sanskrit, is made of the dried pericarps (coats or hulls) of the fruits in equal parts, unless otherwise specified. Often, whole fruits are traded, but deseeded fruits are preferable. Archaeological evidence suggests that the three fruits were cultivated in northern India as early as 1,000 BCE. The Caraka Samhita, which is one of the foundational texts of Ayurvedic medicine and is roughly dated to about the first to second century BCE, mentions triphala, primarily for the intestines and as a rejuvenating tonic (rasayana).
The three fruits are said to have five of the six primary flavors recognized in Ayurveda, with the flavor corresponding to pharmacological activity in Ayurvedic tradition. Triphala’s primary action is on the gastrointestinal tract, and it has been used as a blood purifier (a common indication in traditional medicine systems), bowel regulator, intestinal cleanser (detoxifier), and eyewash to treat conjunctivitis, redness, and soreness of eyes. It also has been used for constipation, dyspepsia (indigestion), headache, leukorrhea (vaginal discharge), and liver conditions. Paradoxically, it has been used for both diarrhea and constipation.
Modern clinical and pre-clinical evidence indicates that triphala has multiple benefits for gastrointestinal health. For example, it may be able to promote bowel regularity without causing dependence like other laxatives, elicit antioxidant activity in intestinal cells thereby reducing inflammation, heal the brush border of intestinal villi thereby helping leaky gut syndrome, and positively affect the intestinal microbiome, which is important for human health. It may also have antidiabetic and anti-obesity effects and can reduce abdominal pain, flatulence, and hyperacidity.
Belleric myrobalan and chebulic myrobalan also were the subjects of a feature article in HerbalGram issue 123.2 That article describes how a FairWild Standard implementation project in the Western Ghats mountains of India is preserving wild belleric myrobalan and chebulic myrobalan trees and, as a result, the nesting/roosting sites of two rare hornbill species, which may disperse the trees’ seeds. The project was largely made possible by the support of Pukka Herbs in Bristol, United Kingdom, which was also one of the financial and technical supporters of the AHP triphala monograph.
The new triphala monograph was also a collaboration among AHP and researchers at Jadavpur University in Kolkata, India, including Pulok Kumar Mukherjee, PhD, a prominent researcher of Ayurvedic botanicals. In all, 29 co-authors from around the world contributed to the monograph, and 19 experts reviewed it before publication. Work on the monograph began around 2017.
Upton hopes the monograph will make more people aware of the many health benefits associated with triphala, “as no other herbal or medical tradition has anything that matches its uniqueness,” he wrote. “Monographing three botanicals in one was a unique challenge, but that was largely overcome by the cadre of experts we brought together to make this a reality. Also, formulas are among the most common preparations used in traditional healing systems. Western pharmacopeias have to begin opening up to the inclusion of classic formulas to adequately recognize the benefits that these systems have to offer.
“There are a variety of grades of individual fruits that make up triphala as well as formulas prepared from fruits in which the pits have been removed (which cost more and are more consistent with traditional practices) and those with pits still intact,” Upton added. “Marketers, manufacturers, and practitioners should be aware of the different types that are available so they can make an educated decision regarding sourcing. The pits do not render the formula inactive, but they may render it less active for some people because the pits add a lot of weight to the fruit (approximately 50%), and the constituent profile in the pits is much less than in the fruits themselves.”
Sebastian Pole, cofounder of Pukka Herbs, wrote: “Ayurveda’s contribution to how we understand and manage health is exemplary, but Ayurveda faces challenges, as all herbal traditions do, in relation to sustainability and consistent quality standards across the value chain. AHP’s best-in-class monograph shines a light on the fundamental value that traditional medical knowledge can bring to so many of today’s urgent health care needs. It is vital for everyone involved in the herbal tradition that the quality, safety, and therapeutics of nature’s pharmacopeia are thoroughly assessed. This is also true with triphala, one of the most popular herbal formulas, whose history, character, and uniqueness are described so expertly in AHP’s monograph” (email, November 10, 2020).
“The reputation and effectiveness of herbal medicine depend on the plants’ being as exemplary as the traditions of which they are part,” Pole added. “Just because triphala is popular does not mean that every batch is high quality or sustainably harvested. This monograph will help ensure that high standards are met. Three cheers for the three fruits and AHP.”
The triphala monograph is the 42nd monograph published by AHP since 1998. It is available for purchase through AHP’s website1 and was made possible by the financial support of Aveda Corporation, Banyan Botanicals, East West School of Planetary Herbology, EuroPharma USA, Gaia Herbs, Herb Pharm, Nature’s Way, NOW Foods, NuAxon Bioscience, Organic India Charitable Trust, Phalada Agro, Planetary Herbals, Pukka Herbs, The Ayurvedic Institute, Traditional Medicinals, Verdure Sciences, and Vikram Naharwar.
References
- AHP Monographs – Triphala. American Herbal Pharmacopoeia website. Available at: herbal-ahp.org/ahp-monographs-triphala/. Accessed December 13, 2020.
- Yearsley C. FairWild Project in India Is a Win-Win-Win for Terminalia Trees, People, and Hornbills. HerbalGram. 2019;123:44-51. Available at: http://herbalgram.org/resources/herbalgram/issues/123/table-of-contents/hg123-feat-fairwild/. Accessed December 16, 2020.