Triphala Described as an Antidiabetic Agent in Ayurveda Treatises: A Review

Asian Journal of Pharmaceutic s • Oct-Dec 2017 (Suppl) • 11 (4) | S 685 Triphala Described as an Antidiabetic Agent in Ayurveda Treatises: A Review Chandra Shekhar, K. R. C. Reddy, Komal Bansal Department of Rasashastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India Abstract Triphala is a well-known traditional ayurvedic formulation which is most commonly used to tone up and support the normal functioning of the bowel Many traditional compounds containing Triphala as an ingredient, is found to be useful in the treatment of several kinds of ailments and diabetes is among one of them. Triphala has been described elaborately in Ayurveda for the treatment of Prameha (diabetes). In this present paper, an attempt has been made to summarize the antidiabetic potential of Triphala as a whole as well as the impact of individual drugs of Triphala. In present paper antidiabetic potential of this formulation is complied. In, Charaka Samhita 7 (30.4%), Sushruta Samhita 4 (17.4%) Astanga Samgraha 2 (8.7%), Vrinda Madhav 4 (17.4%), Gada Nigraha 4 (17.4%), and Chakradatta 2 (8.7%) formulations are described which possess Triphala as ingredient for antidiabetic action. Triphala has been used widely in different dosage forms. 1 formulation in the form of Swaras/rasa (4.3%), 4 as Churna (17.4%), 13 as Kwath/Kashaya (57.0%), 2 as Gutika/Guggulu (8.7%), 1 as Kshaar (4.3%), and 2 in the form of Avasa and Arishta (8.4%) Keywords: Antidiabetic agent, Ayurveda, Prameha, Pramehahar, Triphala Address for correspondence: Prof. K. R. C. Reddy, Department of Rasashastra and Bhaishajya Kalpana, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh, India. E-mail: drkrcreddybhu@yahoo.co.in Received: 03-11-2017 Revised: 21-11-2017 Accepted: 28-11-2017 INTRODUCTION N owadays, Prameha is recognized as annoyance lifestyle disorder in the society. Although Prameha is considered as a single disease entity, in real sense it provides space for flourishment of many notorious and incurable diseases with due course of time. Various complications related to the kidney damage (nephropathy), cardiovascular diseases, nerve damage (neuropathy), eye damage (retinopathy), foot damage, hearing impairments, skin worse conditions, etc., [1] in a person suffering from diabetes for a longer duration. Long-term usage of many contemporary therapies for diabetes including insulin injections, various oral antidiabetic agents such as sulfonylureas, biguanides, and glinides are also some other factors which are responsible for generating a number of serious ill effects on the vital organs of a diabetic person. Hence, it is the need of hour to develop some safer, effective and therapeutically more potent alternative hypoglycemic agents which are competent enough to treat the symptoms and complications associated with diabetes mellitus Usage of traditional medicines (TM) is now being accepted worldwide for its therapeutic benefits for many diseases and also for diabetes mellitus [2] In TM even a single herb or formulation contains many phytochemical constituents such as alkaloids, terpenoids, and flavonoids which alone or in conjunction with one another synergistically exhibits desired pharmacological action [3] There are no known drug interactions with the three herbal ingredients of Triphala . Hence, administration of any other antidiabetic drugs with Triphala is safer as compared to other formulations, which do not possess it [4] Intake of Triphala is considered to be gentle to human body, so it can be administered to the people of all age groups [5] In this present paper, an attempt has been made to summarize the extraneous outstanding potential of three fruits (dry fruits of Haritaki, Vibhitaki, and Amalaki which is collectively called Triphala) in cursing disease of today’s time, i.e., Prameha which is explained elaborately in numerous ayurvedic treatises [Table 1] REVIEW AR TICLE

Shekhar, et al .: Triphala: An antidiabetic agent Asian Journal of Pharmaceutic s • Oct-Dec 2017 (Suppl) • 11 (4) | S 686 PRAMEHA Prameha is well described in the ancient literature, i.e. in Vedas and in the Ayurveda. Premeha is a syndrome which includes a group of clinical conditions and mainly characterized by increased quantity of turbid urine, described in classics as “Prabhuta Avila Mutrata.” [6] Polyuria and Turbidity of the urine are the two essential features of this particular disease [7] Some of the ayurvedic scholars have quoted that the word Prameha comprises a list of urinary disorders which may be characterized by abundant urination due to severe imbalances of Dosha and Dushyas [8] Two main types of Prameha are described in Ayurveda – Sahaja (refers to natural, inherited or congenital factors) and Doshaja (refers to Dosha vitiation). Based on the clinical importance it is further divided into two types - Sthoola Prameha (urinary disorders of stouts) and Krisha Prameha (urinary disorders of lean [9] Diabetes Mellitus is similar to Madhumeha which is one among the Vataja Prameha. In which the patient voids excessive quantity of urine having Madhura Rasa, Ruksha Sparsha, and Kashaya Varna [10] TRIPHALA Triphala is an important ayurvedic herbal formulation consisting of the dried fruits of three medicinal plants Terminalia chebula , Terminalia bellerica , and Emblica officinalis Triphala means “three” (tri) “fruits” (phala) and are popularly known in India as Harar, Bahera, and Amla, respectively [11] The formulation is prescribed as the first line of treatment of many aliments as a detoxifying agent and rejuvenator. Apart from the formulation, the individual herbs also reported to have dozens of other health benefits such as laxative in chronic constipation, colon cleansing, digestive disturbances, ophthalmic disorders, hypertensive diseases, serum cholesterol reduction, hepatic abnormalities, enteritis, and ulcerative colitis [12] But along with these therapeutic activities, it has a wide range of description for the management of different kinds of Prameha in the ayurvedic literature [Table 2] either individually or in combination with some other formulations The most valuable treasures of Ayurveda including Brihatrayee (Charaka Samhita, Sushruta Samhita, and Astanga Samgraha), Rasa Granthas (Vrinda Madhav), Nighantu (Gada Nigraha), and Chakradatta were filtered out for the formulations having Triphala as a whole or in parts and especially indicated for Prameha Pramehahar properties of Triphala in Ayurveda Pramehahar (antidiabetic) formulations having Triphala as the main ingredient are very well defined in Brihatrayee especially in the chapters dealing with the treatment of Prameha. In Charaka Samhita total 7 (30.4%), Sushruta Samhita 4 (17.4%), Astanga Samgraha 2 (8.7%), Vrinda Madhav 4 (17.4%), Gada Nigraha 4 (17.4%), and Chakradatta 2 (8.7%) formulations are there containing Triphala as ingredient for antidiabetic action. Total 13 (57.0%) formulations contains more than 50% of Triphala, while 10 (43.0%) possesses <50% of Triphala as the main ingredients. On screening out the above texts it was found that at four places usage of only Triphala (100%) in the form of kwath (decoction) and churna (powder) has been prescribed for the patient suffering from Prameha [Table 2] Researches validation about antidiabetic potentials of Triphala Haritaki is known to possess antidiabetic effect as its aqueous extract on oral administration can improve glucose utilization Table 1: General description and pharmacodynamic properties of Haritaki, Bibhitaki, and Amalaki [13] Description Haritaki Bibhitaki Amalaki Latin name Terminalia chebula Linn Terminalia bellerica Roxb Emblica officinalis Gartn Family Combretaceae Combretaceae Euphorbiaceae Common synonyms Haritaki, Pathya, Abhaya, Avyatha, Vayastha, Shiva Aksha, Kaliphala, Bhutavasa, Kalidruma, Karnaphala Amalaki, Dhatri, Vyastha English name Chebulic Myrobalan Belleric Myrobalan Emblic myrobalan Parts used Fruits Fruits Fruits Rasa Pancharasa (Lavana Rahita), Kashaya Pradhan Pancharasa (Lavana Rahita), Kashaya Pradhan Pancharasa (Lavana Rahita), Amla Pradhan Guna Laghu, Ruksha Laghu, Ruksha Laghu, Ruksha, Sita Virya Ushna Ushna Sita Vipaka Madhura Madhura Madhura Prabhava Tridosha hara Tridosha hara Tridosha hara Dosha karma Visheshatah Kapha pitta Samaka Visheshatah Kapha hara Visheshatah Pitta hara Chemical composition Tannin, chebulic acid, gallic acid, Coliragin Tannin, B‑sitosterol, gallic acid, tannic acid, ellagic acid Gallic acid, tannic acid, albumin, Vitamin C

Shekhar, et al .: Triphala: An antidiabetic agent Asian Journal of Pharmaceutic s • Oct-Dec 2017 (Suppl) • 11 (4) | S 687 during glucose tolerant test (46.8% reduction in blood glucose at 2 h) within 90 min after administration of the extract and also brings down the fasting blood sugar to near the normal value in 2 weeks from an initial high value of 253 + 9.4 mg/dl [24] Diabetic nephropathy is one of the complications associated with diabetes mellitus in chronic stage and Haritaki in its chloroform extract form produces renoprotective effects in STZ induced diabetic rats [2] Apart from antidiabetic activities, it is also helpful in curing the diseases associated with imbalance of all the three Doshas, i.e., Vata, Pitta, and Kapha, stimulating digestion and promoting longevity [25] Similarly, Amalaki ( E. officinalis ) is known to be effective in the long-term treatment of Prameha and it also could protect the alpha cells of pancreas from oxidative stress and make them to function properly, with the extraneous advantage of modulating the lipid profile [26] It is also used for urinary tract dysfunctioning such as painful urination and conditions which tends to be difficulty in micturition [27] It has Ushan Virya (i.e., cooling effect) that manages Pitta, further supporting the liver to perform its natural functions natural functions and also boost up the immune system. E. officinalis extract has been shown to reduce liver injury and prevents from hepatotoxicity [28,29] In the line of various medicinal impacts of Haritaki and Amalaki, Bibhitaki also exhibits antidiabetic effect and most commonly it is used for the removal of excessive phlegm deposited in respiratory tract via acting as bronchodilator, and also removes Kapha deposited in urinary tract such as stones [30] DISCUSSION Triphala is an esteemed drug in ayurvedic system of medicines which has been prescribed for centuries to cure a wide range of ailments. As it is a polyherbal formulation, thus it exhibits a different mechanism of action from that of synthetic drugs or single substances. And looking out on all the above formulations, it was observed that Triphala has been used widely in different dosage forms such as 1 formulation in the form of Swaras/rasa (4.3%), 4 as Churna (17.4%), 13 as Kwath/Kashaya (57.0%), 2 as Gutika/Guggulu (8.7%), 1 as Kshaar (4.3%), and 2 in the form of Avasa and Arishta (8.4%) [ Table 2] Acharya Charaka has described 20 types of Prameha and treatment planned by categorizing the patients into two Table 2: Triphala containing formulations in ayurvedic texts [14‑23] Name of formulations References Ingredients Percentage of Triphala Indications as a antidiabetic agent Triphaladi Kwath C.S.Su. 23/10,11 Triphala + 7 30 Santarpanottha Prameha Triphala Kashaya C.S.Chi. 6/22 Triphala + 3 50 Santarpanajanya Prameha Triphala Kwath C.S.Chi. 6/26 Triphala + 3 50 Prameha Nashak Phalatrikadi Kwath C.S.Chi. 6/40 Triphala + 4 42.85 Sarvapramehahar Madhvasava C.S.Chi. 6/41‑44 Triphala + 27 10 In Kapha‑pittaj Prameha Triphala Rasa C.S.Chi. 6/46 Triphala 100 Udakapan in Sarva prameha Triphaladi Kshaar C.S.Chi. 15/188‑193 Triphala + 27 10 Pramehahar Triphala Churna S.S.Su. 38/57 Triphala 100 Pramehahar Triphala Kwath S.S.Chi. 11/8 Triphala + 3 50 Sarvapramehahar Triphala Kwath S.S.Chi. 11/8 Triphala + 2 60 Phenamehahar Triphala Kwath S.S.Chi. 11/8 Triphala 100 Kshaarmeha nashaka Triphala Kashaya A. S. Su. 12/47 Triphala 100 Pramehahar Muskadi Kashaya A. S. Su. 16/26 Triphala + 7 30 Pramehahar Phenmehahar Kwath Vi. Ma. 35/8 Triphala + 2 60 Phen Mehahar Triphaladi Kwath Vi. Ma. 35/11‑13,19 Triphala + 3 50 Prameha har Nyogrodhadi Churna Vi. Ma. 35/24‑28 Triphala + 24 11.1 Vinshatimehahar Trikatvadi Gugglu Vi. Ma. 35/32‑33 Triphala + 8 27.3 Pramehahar Triphaladi Kashaya G. Ni. 30/46 Triphala + 2 60 Phen Mehahar Gokshur Gugglu Vatika G. Ni. 30/61‑62 Triphala + 5 37.5 Pramehahar Kushtadhya Churnam G. Ni. 30/77 Triphala + 7 30 Pramehjanya Vedanahar Shavadanstradhyam Churnam G. Ni. 30/78‑84 Triphala + 29 9.4 Pramehahar Triphaladi Kwath Chakradutta 35/6‑11 Triphala + 2 60 Phen Mehahar Triphaladi Kutajadishcha Chakradutta 35/19 Triphala + 3 50 Pramehahar C.S.Su.: Charaka Samhita Sutrasthana, C.S.Chi.: Charaka Samhita Chikitsasthana, S.S.Su.: Sushruta Samhita Sutrasthana, S.S.Chi.: Sushruta Samhita Chikitsasthana, A.S. Su.: Astanga Samgraha Sutrasthana, Vi. Ma.: Vrinda Madhava, G. Ni.: Gada Nigraha

Shekhar, et al .: Triphala: An antidiabetic agent Asian Journal of Pharmaceutic s • Oct-Dec 2017 (Suppl) • 11 (4) | S 688 groups, i.e., Sthula Pramehee (stout built person) and Krisha Pramehee (lean built person). In the formulations mentioned above 14 (61.0%) are Sarvapramehahar (effective in all the Twenty types of Prameha), 4 (17.4%) are Phenmehahar, 2 (8.7%) in Santarpanjanya Prameha, and 1 (4.3%) in each Vata Kaphaja Prameha, Kshaar Meha and Pramehajanya Vedana [ Table 2]. Hence, it can be said that Triphala consists the potential to treat each and every type of Prameha or acting as an effective antidiabetic agent. Antidiabetic activity of the herbal drugs is mainly due to their ability to restore the functions of pancreatic tissues by causing an increase in insulin output or inhibit the intestinal absorption of glucose or to the facilitation of metabolites in insulin-dependent processes [31] As herbal drugs are a complex mixture of different phytoconstituents and these are one of the responsible factors along with pharmacological properties of that drug for a drug to perform its action. Individual drugs of Triphala contain glycosides, alkaloids, terpenoids, flavonoids, carotenoids, etc., and these all are frequently implicated to possess potential as antidiabetic [Table 1] [32] In different classical treatises, huge therapeutic properties of Triphala have been given and various research works have also been done in this regard to further validate the above consideration. Individual drugs of Triphala, i.e., Haritaki, Bibhitaki, and Amalaki exhibits wide range of medicinal properties especially antidiabetic properties. From the above aspects, it can be said that Triphala is one of the magic remedy in various ailments and specifically in Prameha . Different references are available for Triphala in different treatises. Barley soaked in Triphala Kashaya, kept overnight and then mixed with honey acts as a nourishing diet. Furthermore, Triphala along with Musta ( Cyperus rotundus ), Patha ( Cissampelos pareira ) mixed with honey has also been given. Moreover, it should be taken by the patient suffering from Prameha regularly to overcome the disease [33] Triphala as a whole is expected to be more effective due to the combined activity of the individual components. Antioxidant property of Triphala arises from the Polyphenols, which reduces the oxidative stress by converting the reactive oxygen free radicals to non-reactive products [34] Triphala are also the drugs said to act as Naimittika Rasayanas which is beneficial in Prameha . [35] Its potency as an anticancer drug, antibacterial, anti-inflammatory and in treatment of arthritis, stress, and cataract is all well studied and proven. As there is lot of adulteration and substitution in the herbal market more studies and parameters for Quality Control of the individual ingredients and the compound formulation Triphala needs to be established and carried out so as to ensure reliability and reproducibility of the formulation CONCLUSION As usage of herbal medicines is increasing worldwide, hence it can act as a medicinal boon at different stages of diabetes mellitus and also in complicated phases of diabetes mellitus. 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