Haritaki

The drug is haritaki, the dried fruit. Ayurveda ranks it as the leading rasayana, or rejuvenative, and as a principal digestive. It is considered tridoshic, acting on all three doshas, and it pacifies vata in particular.

It is given for constipation and slow digestion, bloating, and ama, the residue of incomplete digestion. Beyond the gut it is used for the eyes and the skin, and as a general rejuvenative taken over long periods.

It is taken as churna, the plain powder, with warm water, honey or ghee, and the vehicle is part of the prescription. Most often it is taken as one third of Triphala, with bibhitaki and amalaki.

The same fruit is used in Chinese medicine as he zi. It is classed as sour and astringent, a binding herb.

It astringes the Lungs, and is given for chronic cough and hoarseness. It binds the Intestines, and is given for chronic diarrhoea.

In Sowa Rigpa the fruit is the most venerated of all medicinal plants. It is shown in the hand of the Medicine Buddha, and it forms the base of a great many compound formulas rather than being used on its own.

A 4-week double-blind trial found a T. chebula mouthrinse cut plaque and gingival inflammation as effectively as 0.2% chlorhexidine and better than placebo ^{4Reference 4Gupta et al. · 2015RCTComparative evaluation of Terminalia chebula extract mouthwash and chlorhexidine mouthwash on plaque and gingival inflammation — 4-week randomised controlled trialView study →}.

A 2-week trial found the same on periodontal indices while neutralising salivary pH ^{9Reference 9Gupta et al. · 2014RCTEffect of Terminalia chebula extract and chlorhexidine on salivary pH and periodontal health: 2-week randomised controlled trial — RCTView study →}.

Most of the meta-analytic weight sits with Triphala: seven pooled RCTs found the rinse improved gingival and plaque indices comparably to chlorhexidine at lower cost ^{3Reference 3AlJameel et al. · 2020Meta-analysisEffect of triphala mouthrinse on plaque and gingival inflammation: a systematic review and meta-analysis of randomised controlled trials — meta-analysisView study →}, echoed in a paediatric meta-analysis ^{10Reference 10Minervini et al. · 2024Meta-analysisComparative anti-plaque and anti-gingivitis efficiency of Triphala versus chlorhexidine mouthwashes in children: a systematic review and meta-analysis — meta-analysisView study →}.

The activity tracks the astringent gallic acid and ellagitannin fraction. The rinse matches chlorhexidine without its staining and taste.

Gap: The strongest pooled data are for the three-fruit Triphala formula used as a rinse, not haritaki alone; there are no trials of oral (swallowed) haritaki for gum disease.

In a head-to-head comparison of the three Triphala fruits, T. chebula ranked highest, with very low antioxidant IC50 values and dose-dependent rises in hepatic antioxidant enzymes in rats, reflecting its dense hydrolysable-tannin content ^{5Reference 5Hazra et al. · 2010In vitroComparative study of the antioxidant and reactive oxygen species scavenging properties in the extracts of the fruits of Terminalia chebula, Terminalia belerica and Emblica officinalis — in vitro and animalView study →}.

In the type 2 diabetes RCT the extract lowered malondialdehyde and raised glutathione against placebo ^{2Reference 2Pingali et al. · 2020RCTEffect of an aqueous extract of Terminalia chebula on endothelial dysfunction, systemic inflammation, and lipid profile in type 2 diabetes mellitus: a randomised, double-blind, placebo-controlled clinical study — RCTView study →}.

The active molecules are the ellagitannins and phenolic acids — chebulagic acid, chebulinic acid, corilagin and ellagic acid. What has been measured in people is a surrogate biomarker, not a disease endpoint.

The 60-patient diabetic RCT above is the main human trial for this indication ^{2Reference 2Pingali et al. · 2020RCTEffect of an aqueous extract of Terminalia chebula on endothelial dysfunction, systemic inflammation, and lipid profile in type 2 diabetes mellitus: a randomised, double-blind, placebo-controlled clinical study — RCTView study →}.

An RCT of a haritaki-containing combination in women with hyperlipidaemic type 2 diabetes improved fasting glucose and LDL ^{11Reference 11Shokoohi et al. · 2017RCTEffects of an herbal combination on glycemic control and lipid profile in diabetic women: a randomised, double-blind, placebo-controlled clinical trial — RCTView study →}, and a systematic review of twelve Triphala RCTs (749 patients) found reductions in LDL, total cholesterol, triglycerides, body weight and waist circumference ^{6Reference 6Phimarn et al. · 2021Systematic reviewEffects of Triphala on lipid and glucose profiles and anthropometric parameters: a systematic reviewView study →}.

A placebo-controlled trial of guggulu plus Triphala in hypercholesterolaemia found no benefit ^{12Reference 12Donato et al. · 2021RCTGuggulu and Triphala for the treatment of hypercholesterolaemia: a placebo-controlled, double-blind, randomised trial — RCTView study →}.

HbA1c effects are inconsistent throughout.

Gap: The positive lipid and glucose signals mostly come from combination formulas or small trials; there is no large, well-powered RCT of haritaki alone, and at least one good trial was null.

Chebulagic acid is a dual COX-2 and 5-LOX inhibitor (COX-2 IC50 ~0.9 µM) ^{13Reference 13Reddy et al. · 2009In vitroChebulagic acid, a COX-LOX dual inhibitor isolated from the fruits of Terminalia chebula Retz., induces apoptosis in COLO-205 cell line — in vitroView study →}, and the whole tannin fraction suppresses NO, ROS and cytokine release in macrophages via NF-κB and MAPK ^{14Reference 14Ekambaram et al. · 2022In vitroModulation of NF-κB and MAPK signalling pathways by hydrolysable tannin fraction from Terminalia chebula fruits contributes to its anti-inflammatory action in RAW 264.7 cells — in vitroView study →}.

In animals, chebulinic acid reduced paw swelling and joint pathology in collagen-induced arthritis by blocking VEGF-driven angiogenesis ^{15Reference 15Lu et al. · 2020AnimalChebulinic acid is a safe and effective antiangiogenic agent in collagen-induced arthritis in mice — mouseView study →}, and chebulagic acid eased DSS colitis ^{16Reference 16Zhang et al. · 2025AnimalChebulagic acid ameliorates DSS-induced colitis in mice by improving oxidative stress, inflammation and the gut microbiota — mouseView study →}.

The one human read-out is a 105-subject placebo-controlled trial of a standardised extract (AyuFlex, 250–500 mg twice daily) in overweight adults, which improved knee-joint comfort, function and 6-minute walk over 12 weeks ^{7Reference 7Lopez et al. · 2017RCTEffects of dietary supplementation with a standardised aqueous extract of Terminalia chebula fruit (AyuFlex) on joint mobility, comfort, and functional capacity in healthy overweight subjects: a randomised placebo-controlled clinical trial — RCTView study →}.

Gap: The joint-comfort RCT was in healthy overweight people with activity-related discomfort, not diagnosed osteoarthritis or rheumatoid arthritis; the anti-inflammatory disease evidence remains preclinical.

Animal protection has been replicated across several different liver insults. A water extract protected mice against tert-butylhydroperoxide liver injury, lowering AST/ALT and restoring antioxidant enzymes ^{17Reference 17Choi et al. · 2015AnimalHepatoprotective effect of Terminalia chebula against t-BHP-induced acute liver injury in C57/BL6 mice — mouseView study →}.

An ethanolic fruit extract prevented liver toxicity from 12 weeks of the anti-tuberculosis drugs rifampicin, isoniazid and pyrazinamide in rats ^{18Reference 18Tasduq et al. · 2006AnimalTerminalia chebula (fruit) prevents liver toxicity caused by sub-chronic administration of rifampicin, isoniazid and pyrazinamide in combination — animal modelView study →}.

Chebulinic acid protected against acetaminophen and carbon-tetrachloride damage in cells, zebrafish and mice via Nrf2/HO-1 ^{19Reference 19Feng et al. · 2021AnimalIn vivo hepatoprotective activity and the underlying mechanism of chebulinic acid from Terminalia chebula fruit — mouseView study →}.

Every one of these studies is preclinical, and the traditional liver-tonic use has not been tested in people.

Astringent tannins bind and tone the gut at low doses, while anthraquinone glycosides produce a laxative-to-purgative action at higher ones ^{1Reference 1Bag et al. · 2013ReviewThe development of Terminalia chebula Retz. (Combretaceae) in clinical research — reviewView study →}.

Oral T. chebula (100 mg/kg for 15 days) increased gastric emptying in rats, more than a single injected dose of metoclopramide ^{20Reference 20Tamhane et al. · 1997AnimalEffect of oral administration of Terminalia chebula on gastric emptying: an experimental study — ratView study →}, and the colitis and microbiota work on chebulagic acid shows an effect on the intestinal wall ^{16Reference 16Zhang et al. · 2025AnimalChebulagic acid ameliorates DSS-induced colitis in mice by improving oxidative stress, inflammation and the gut microbiota — mouseView study →}.

Human bowel-regularity evidence sits mainly with Triphala.

Gap: Despite being the herb’s central traditional use, there are no direct randomised trials of pure haritaki for constipation or diarrhoea — the human data are all on Triphala or absent.

In a double-blind placebo-controlled trial in chronic schizophrenia, six 500 mg capsules a day, taken in two doses for 4 weeks, improved cognitive impairment, negative symptoms and excitement/activity scores against placebo ^{8Reference 8Banazadeh et al. · 2022RCTEvaluating the effect of black myrobalan on cognitive, positive, and negative symptoms in patients with chronic schizophrenia: a randomised, double-blind, placebo-controlled trial — RCTView study →}.

A proof-of-concept RCT of a Boswellia-plus-T. chebula blend in adults with memory complaints improved verbal learning, processing speed, sleep and serum BDNF ^{21Reference 21Salter et al. · 2025RCTA standardised combination of Boswellia serrata and Terminalia chebula extracts to improve cognition in adults with subjective memory complaints: a randomised controlled proof-of-concept study — RCTView study →}.

In animals, the extract protected memory and hippocampal synapses against restraint stress ^{22Reference 22Khazani et al. · 2024AnimalTerminalia chebula attenuates restraint stress-induced memory impairment and synaptic loss in the hippocampus and amygdala by inhibiting oxidative damage — ratView study →}. The fruit contains acetylcholinesterase inhibitors ^{23Reference 23Zhao et al. · 2022In vitroScreening of acetylcholinesterase inhibitory and antioxidant active compounds from Terminalia chebula fruits by spectrum-effect relationship and LC-MS analysis — in vitroView study →}, and its polyphenols reduced injury in a mouse stroke model ^{24Reference 24Lin et al. · 2022AnimalNeuroprotective effect of polyphenol extracts from Terminalia chebula Retz. against cerebral ischemia-reperfusion injury — mouseView study →}.

Gap: The evidence is early and heterogeneous — one monotherapy RCT in a specific psychiatric population, one combination trial, and otherwise animal models; no trials in dementia or age-related cognitive decline.

Haritaki is broadly antibacterial, tracking its tannin and gallic acid fraction ^{1Reference 1Bag et al. · 2013ReviewThe development of Terminalia chebula Retz. (Combretaceae) in clinical research — reviewView study →}.

A 2024 study of Terminalia fruit extracts against gastrointestinal pathogens found MICs of ~94–755 µg/mL against Shigella and Salmonella Typhimurium, and the extracts potentiated conventional antibiotics ^{25Reference 25Tiwana et al. · 2024In vitroPhytochemical analysis and antimicrobial activity of Terminalia bellirica and Terminalia chebula fruit extracts against gastrointestinal pathogens — in vitro. https://pubmed.ncbi.nlm.nih.gov/39770866/View study →}.

These results bear on its traditional use in dysentery and diarrhoeal disease. An MIC in a dish is not clinical efficacy, and no trial has tested haritaki as an antimicrobial in people.

In rats an extract accelerated dermal wound healing, raising collagen, protein and DNA content and tensile strength ^{26Reference 26Suguna et al. · 2002AnimalInfluence of Terminalia chebula on dermal wound healing in rats — ratView study →}.

In culture it promoted keratinocyte and fibroblast proliferation ^{27Reference 27Singh et al. · 2014In vitroEffect of extracts of Terminalia chebula on proliferation of keratinocytes and fibroblasts cells: an alternative approach for wound healing — in vitroView study →}.

In reconstituted human skin a tannin-rich extract shifted gene expression opposite to UV and wounding, raising collagen and barrier genes and inhibiting matrix metalloproteinases ^{28Reference 28Swindell et al. · 2020In vitroA standardised Terminalia chebula fruit extract alters the expression of genes associated with skin architecture and barrier formation — in vitroView study →}.

Two small human trials exist: a non-inferiority RCT found topical fruit powder in vinegar not inferior to 1% terbinafine cream for tinea corporis ^{29Reference 29Tasneem Parapur et al. · 2023RCTEvaluation of the efficacy of topical Terminalia chebula Retz. with vinegar in the treatment of tinea corporis: a non-inferiority randomised controlled trial — RCTView study →}, and a randomised trial of a bakuchiol-plus-T. chebula serum improved wrinkle, elasticity and barrier measures in sensitive skin over 28 days ^{30Reference 30Shi et al. · 2025RCTProspective, randomised, double-blind assessment of supramolecular bakuchiol and Terminalia chebula extract for facial photoaging in Chinese sensitive skin — RCTView study →}.

Both are small, both are topical and cosmetic, and the second tests a combination.

Anticancer interest centres on the isolated tannins. Chebulinic acid is anti-proliferative and pro-apoptotic in colorectal lines via PI3K/AKT and MAPK/ERK ^{31Reference 31Wang et al. · 2018In vitroChebulinic acid derived from triphala is a promising antitumour agent in human colorectal carcinoma cell lines — in vitroView study →}, and kills triple-negative breast cancer cells by downregulating SOD1 ^{33Reference 33Sharma et al. · 2020In vitroChebulinic acid inhibits MDA-MB-231 breast cancer metastasis and promotes cell death through down-regulation of SOD1 and induction of autophagy — in vitroView study →}.

Chebulagic acid induces apoptosis in colon cancer cells ^{13Reference 13Reddy et al. · 2009In vitroChebulagic acid, a COX-LOX dual inhibitor isolated from the fruits of Terminalia chebula Retz., induces apoptosis in COLO-205 cell line — in vitroView study →} and suppressed gastric tumour growth in mice via AURKA/β-catenin/Wnt inhibition ^{32Reference 32Zhao et al. · 2023AnimalChebulagic acid suppresses gastric cancer by inhibiting the AURKA/β-catenin/Wnt pathway — mouseView study →}.

Whole-fruit extract reduced chemically-induced skin tumorigenesis in mice ^{34Reference 34Majed et al. · 2015AnimalTerminalia chebula attenuates DMBA/croton oil-induced oxidative stress and inflammation in Swiss albino mouse skin — mouseView study →}.

Gap: This is almost entirely cell-line and constituent-level work with a handful of mouse models; there is no human oncology evidence, and cytotoxicity in a dish is not clinical anticancer activity.

Two of haritaki’s isolated tannins are broad-spectrum antivirals in the lab. Chebulagic acid and punicalagin block entry and cell-to-cell spread of herpes simplex virus type 1 by targeting viral glycoprotein–glycosaminoglycan interactions ^{35Reference 35Lin et al. · 2011In vitroHydrolysable tannins (chebulagic acid and punicalagin) target viral glycoprotein–glycosaminoglycan interactions to inhibit herpes simplex virus type 1 entry and cell-to-cell spread — in vitroView study →}, an effect extending to HCMV, HCV, dengue, measles and RSV ^{36Reference 36Lin et al. · 2013In vitroBroad-spectrum antiviral activity of chebulagic acid and punicalagin against viruses that use glycosaminoglycans for entry — in vitroView study →}.

Chebulinic acid inhibits influenza neuraminidase, including an oseltamivir-resistant strain ^{37Reference 37Li et al. · 2020In vitroIdentification of chebulinic acid and chebulagic acid as novel influenza viral neuraminidase inhibitors — in vitroView study →}.

Gap: All of this is isolated-constituent, in vitro work with no animal or human antiviral trials — the effect belongs to purified molecules, not necessarily to the fruit as consumed.

Skin rash. Two of 46 people taking a combination of guggulu and Triphala developed a hypersensitivity rash, against none on placebo ^{12Reference 12Donato et al. · 2021RCTGuggulu and Triphala for the treatment of hypercholesterolaemia: a placebo-controlled, double-blind, randomised trial — RCTView study →}. Haritaki is one of several herbs in that product, so the rash cannot be attributed to it.

Blood sugar. The fruit lowered blood glucose in trials in people with diabetes ^{2,11Reference 2Pingali et al. · 2020RCTEffect of an aqueous extract of Terminalia chebula on endothelial dysfunction, systemic inflammation, and lipid profile in type 2 diabetes mellitus: a randomised, double-blind, placebo-controlled clinical study — RCTView study →Reference 11Shokoohi et al. · 2017RCTEffects of an herbal combination on glycemic control and lipid profile in diabetic women: a randomised, double-blind, placebo-controlled clinical trial — RCTView study →}. It may add to the effect of antidiabetic drugs.

Other medicines. The tannins can bind drugs and minerals in the gut, so other oral medicines are best taken about two hours apart. No pharmacokinetic or CYP450 interaction study of haritaki has been published.