Supplement
Terminalia chebula is the dried fruit of a tree used in Ayurvedic medicine, rich in polyphenols that act as antioxidants. People look at it mostly for oral health, and three trials found a mouthwash made from it worked comparably to chlorhexidine for dental plaque, gum inflammation and cavity-linked bacteria. Evidence for joints, blood sugar and skin is limited, and much of it comes from animal or lab work.
Sources: PMID 24123617; PMID 25386630
- Updated
- How we grade
- 21 studies cited
- Best evidence
- Grade B
- Conditions studied
- 4
- Outcomes
- 12
- Graded outcomes
- 0165
Evidence by condition
- Strong
- Moderate
- Limited
- Very limited
General
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Oral Health Three RCTs (total ~208 participants) found T. chebula mouthwash comparable to chlorhexidine for reducing dental plaque, gingival inflammation, and Streptococcus mutans counts, with favorable effects on salivary pH. No adverse effects associated with chlorhexidine (staining) were observed. | Improves (the measure goes up) | Moderate effect | 3 studies | 208 people | ||
Studies that measured oral health
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| Blood Glucose and Diabetes Markers One double-blind RCT (n=60 type 2 diabetics) found 500 mg BID T. chebula extract significantly improved endothelial function, reduced CRP and IL-6, and improved lipid profile over 12 weeks. Multiple animal studies confirm anti-diabetic effects including improved insulin sensitivity, decreased HOMA-IR, and increased SIRT1 expression. | Improves (the measure goes down) | Moderate effect | 3 studies | 60 people | ||
Studies that measured blood glucose and diabetes markers
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| Inflammation One RCT in type 2 diabetics (n=60) showed significant reductions in CRP and IL-6 with 500 mg BID for 12 weeks. Extensive preclinical studies demonstrate inhibition of COX-2, 5-LOX, TNF-alpha, IL-1beta, and NF-kappaB pathway, with chebulagic acid identified as a key anti-inflammatory compound. | Improves (the measure goes down) | Moderate effect | 2 studies | 60 people | ||
Studies that measured inflammation
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| Pain Threshold Two small human volunteer studies using mechanical (Randall-Selitto) and hot air pain models found a single 1000 mg oral dose of T. chebula significantly increased pain threshold and pain tolerance compared to placebo (P<0.001 in crossover design, n=12). | Changes; see studies | Small effect | 2 studies | 24 people | ||
| Antimicrobial Activity In vitro studies demonstrate broad-spectrum antibacterial activity against S. aureus, S. typhi, P. aeruginosa, Klebsiella, and B. subtilis (MIC 94-556 ug/mL). Shows synergistic effects with tetracycline against GI pathogens. Also exhibits antiviral activity against HSV-1 and HSV-2, with chebulagic acid and chebulinic acid inhibiting viral attachment more effectively than acyclovir in vitro. | Improves (the measure goes up) | Moderate effect | 3 studies | |||
Studies that measured antimicrobial activity | ||||||
| Liver Protection In rodent models, T. chebula water extract (50-200 mg/kg) significantly attenuated elevations in AST, ALT, and LDH after toxic liver injury, reduced pro-inflammatory cytokines, and improved antioxidant capacity. Chebulinic acid blocked ROS production in hepatocytes. Also protective against anti-tuberculosis drug-induced hepatotoxicity in animals. | Improves (the measure goes up) | Moderate effect | 2 studies | |||
| Wound Healing In rat models, T. chebula-treated wounds showed faster healing, improved contraction rates, increased collagen and protein content, and ~40% greater tensile strength. In burn wound models, T. chebula extract outperformed silver sulfadiazine 1% cream with complete granulation tissue formation by day 14. | Improves (the measure goes up) | Moderate effect | 2 studies | |||
| Neuroprotection In vitro studies show T. chebula extracts and chebulagic acid protect PC12 and SH-SY5Y neuronal cells against H2O2-induced and amyloid-beta-induced toxicity via ROS inhibition and autophagy induction. Also inhibited LPS-induced microglia activation. A combination product (T. chebula + Boswellia) improved memory in one RCT, but effects cannot be attributed to T. chebula alone. | Improves (the measure goes up) | Small effect | 1 study | |||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Antioxidant Status Extensive in vitro and animal studies demonstrate strong DPPH radical scavenging, ferric-reducing antioxidant activity, superoxide dismutase stimulation, and improved glutathione levels. Key polyphenols include gallic acid, ellagic acid, chebulagic acid, and chebulinic acid. Human RCTs report improvements in oxidative stress biomarkers. | Improves (the measure goes up) | Moderate effect | 2 studies | |||
Arthritis (Multiple Kinds)
- Joint Pain and Mobility: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Joint Pain and Mobility A double-blind, placebo-controlled RCT (n=105 overweight adults) found standardized T. chebula extract (AyuFlex, 250-500 mg BID for 84 days) significantly improved knee joint comfort, 6-minute walk distance, and overall joint function scores compared to placebo. | Improves (the measure goes down) | Moderate effect | 1 study | 105 people | ||
Aging
- Skin Aging: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Skin Aging A double-blind, placebo-controlled RCT in healthy females found 250 mg T. chebula extract (Synastol TC) twice daily for 8 weeks significantly reduced facial wrinkles by 4.3%, decreased forehead sebum excretion by 33% in high-sebum subjects, and reduced cheek erythema compared to placebo. | Improves (the measure goes down) | Small effect | 1 study | 50 people | ||
Studies that measured skin aging | ||||||
Cardiovascular Health
- Cardiovascular Health: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Cardiovascular Health In animal models, ethanolic extract (500 mg/kg) ameliorated isoproterenol-induced myocardial damage. Studies in cholesterol-fed rabbits showed anti-atherogenic activity with liver cholesterol decreased by 50% and heart cholesterol by 60%. One RCT protocol for coronary artery disease adjunct therapy is registered but results not yet available. | Improves (the measure goes up) | Small effect | 1 study | |||
Studies that measured cardiovascular health | ||||||
Key findings
- Oral HealthImproves (the measure goes up)
- Blood Glucose and Diabetes MarkersImproves (the measure goes down)
- InflammationImproves (the measure goes down)
Safety notes in the studies
- No adverse effects associated with chlorhexidine (staining) were observed.
- chebula extracts and chebulagic acid protect PC12 and SH-SY5Y neuronal cells against H2O2-induced and amyloid-beta-induced toxicity via ROS inhibition and autophagy induction.
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Third-party tested Terminalia Chebula products, in the forms the graded studies used where we can match them.
- Grade B
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Studies cited
21 studies from PubMed
- Comprehensive review on fruit of Terminalia chebula: traditional uses, phytochemistry, pharmacology, toxicity, and pharmacokinetics
- Randomized, double-blind, placebo-controlled trial of oral Terminalia chebula extract on skin health parameters
- A comprehensive review on the diverse pharmacological perspectives of Terminalia chebula Retz
- Effect of aqueous extract of Terminalia chebula on endothelial dysfunction, systemic inflammation, and lipid profile in type 2 diabetes mellitus: a randomized, double-blind, placebo-controlled clinical study
- Anticancer activity of Terminalia chebula against lung and breast carcinoma cell lines
- Effects of a standardized aqueous extract of Terminalia chebula (AyuFlex) on joint comfort, functional mobility, and related biomarkers: a randomized, double-blind, placebo-controlled study
- Anti-HSV-2 activity of Terminalia chebula fruit extract and its constituents chebulagic acid and chebulinic acid
- Analgesic activity of standardized aqueous extract of Terminalia chebula in healthy human participants using mechanical pain model
- Evaluation of the anti-plaque efficacy of a herbal-based toothpaste: a double-blind, randomized controlled clinical trial with Terminalia chebula mouthwash
- Analgesic activity of standardized aqueous extract of Terminalia chebula in healthy human participants using hot air pain model
- Hepatoprotective effect of Terminalia chebula extract against t-BHP-induced acute liver injury in mice
- Wound healing efficacy of Terminalia chebula extract in burn wound model
- Efficacy of Terminalia chebula rinse on salivary pH and periodontal health: a randomized controlled trial
- Neuroprotective effects of Terminalia chebula on OGD-induced PC12 cell death and LPS-induced microglia activation
- Anticariogenic effect of Terminalia chebula mouthwash on Streptococcus mutans
- Hepatoprotective activity of Terminalia chebula against anti-tuberculosis drug-induced hepatotoxicity
- Antidiabetic and renoprotective effects of Terminalia chebula seeds in streptozotocin-induced diabetic rats
- Long-term glycemic control effects of Terminalia chebula in diabetic rats
- Antioxidant activity of Terminalia chebula in vivo and in vitro
- Cardioprotective effect of Terminalia chebula against isoproterenol-induced myocardial damage in rats
- Wound healing activity of Terminalia chebula in dermal wounds of rats