Comparison of Antimicrobial Efficacy of Morinda citrifolia, Triphala, and Camellia sinensis Extracts as Root Canal Irrigants in Primary Molars: A Randomized Clinical Trial.

Objective: To evaluate the reduction of microbial loading using Morinda citrifolia (M. citrifolia), Triphala, and Camellia sinensis (C. sinensis) as irrigating agents in deciduous molars after pulpectomy. Materials and methods: A controlled, randomized clinical trial involving 150 multirooted deciduous molars from both genders between 6 and 9 years old children were included, 30 molars irrigated with M. citrifolia (group I), Triphala (group II), C. sinensis (group III), chlorhexidine (CHX) (group IV), and saline (group V) each. In all cases, two microbiological samples from within the canal were taken with sterile paper points, one before the first irrigation and the other immediately after pulp extirpation. Cleaning and shaping were completed with intermittent irrigation with 10 mL of experimental irrigants in the initial visit. After 3 days, reentry to the root canal was obtained, rinsed with 5 mL of the test irrigants, and the second microbial sample was collected. All the microbial samples obtained were cultured under anaerobic conditions on blood agar. The colony-forming units (CFUs) were counted using a colony counter. Data was analyzed using paired student t-test and Tukey's post hoc test. Results: After analysis of the pre- and postsamples in all groups, a strong significant decrease in bacterial load (p ≤ 0.001) was found with CHX, M. citrifolia, and Triphala. Conclusion: Morinda citrifolia (M. citrifolia) and Triphala, with effective antimicrobial efficacy, can be suggested as an alternative root canal irrigant as CHX, while C. sinensis was found ineffective in reducing microbial count as normal saline. How to cite this article: Pathivada L, Kapur D, Pandranki J, et al. Comparison of Antimicrobial Efficacy of Morinda citrifolia, Triphala, and Camellia sinensis Extracts as Root Canal Irrigants in Primary Molars: A Randomized Clinical Trial. Int J Clin Pediatr Dent 2024;17(5):511-517.

Burning Mouth Syndrome in Association With Angular Cheilitis: A Case Report.

A burning sensation in the mouth without any obvious mucosal alterations is the hallmark of burning mouth syndrome, a chronic pain syndrome. BMS can worsen pain if it coexists with angular cheilitis, a condition characterized by inflammation around the corners of the mouth. Conventional therapies for angular cheilitis and burning mouth syndrome sometimes have unfavorable side effects and offer only little relief. When ozone is combined with oil, it accelerates tissue repair and oxygenation while destroying germs, fungi, and viruses. Triphala is a traditional treatment for oral health problems because of its anti-inflammatory, antioxidant, and antibacterial qualities. The effectiveness of alternative medicines, particularly ozonated oil, and triphala, a traditional herbal combination, in treating these diseases is examined in this case study. A 72-year-old woman reported a burning sensation in her mouth. The patient described the prolonged heat or burning sensation in the anterior two-thirds of her tongue. She was diagnosed with angular cheilitis and burning mouth syndrome. Conventional treatments, such as topical steroids and antifungal drugs, have not been effective. The patient was instructed to apply ozonated oil topically to the affected regions twice daily and to rinse their mouth with triphala. The patient reported full healing of the angular cheilitis lesions and considerable alleviation from burning feelings following two weeks of therapy. The patient noticed a significant decrease in the burning sensation in her mouth, characterized by a lack of discomfort, irritation, or pain. Throughout the treatment, no side effects were seen. According to this case study, ozonated oil and triphala may be useful in treating the symptoms of angular cheilitis and burning mouth syndrome, providing an alternative to traditional treatments.

Triphala ameliorates cognitive deficits and anxiety via activation of the Nrf2/HO-1 axis in chronic sleep-deprived mice.

Triphala is renowned for its curative attributes and has been utilized for centuries to address diverse health ailments. Moreover, the active component of Triphala, polyphenols, is widely recognized for its excellent pharmacological activities, such as anti-inflammatory properties, and has been utilized as a potential natural remedy. However, the precise mechanism through which Triphala alleviates cognitive dysfunction and anxiety induced by chronic sleep deprivation (SD) remains restricted. The objective of this investigation is to examine and clarify the potential mechanism of action that underlies the therapeutic benefits of Triphala in addressing cognitive dysfunction and anxiety induced by chronic SD. Our results demonstrated that Triphala significantly alleviates chronic SD-induced behavioral abnormalities. Additionally, Triphala was highly effective at preventing histopathological or morphological damage to neurons located in the hippocampus. The therapeutic effects of Triphala in treating cognitive dysfunction and anxiety induced by chronic SD involve the modulation of several biological pathways, including inflammation and immune responses, oxidative stress, cell growth and differentiation, metabolism, and neurotransmitter communication. Moreover, our study illustrated that Triphala increased the nuclear translocation of nuclear factor erythroid 2-related factor 2 (Nrf2) and significantly activated the Nrf2/hemeoxygenase-1 (HO-1) axis. Additionally, the neuroprotective properties of Triphala were found to be counteracted by the Nrf2 inhibitor ML385. Our study represented the first to unveil that Triphala exerts therapeutic benefits in alleviating chronic SD-induced cognitive deficits and anxiety by activation of the Nrf2/HO-1 axis. Triphala emerges as a promising nutraceutical ingredient for mitigating cognitive deficits and anxiety linked to chronic SD.

Comparative anti-plaque and anti-gingivitis efficiency of Triphala versus chlorhexidine mouthwashes in children: a systematic review and meta-analysis.

The aim of this systematic review is to comparatively evaluate the Triphala and chlorhexidine mouthwashes efficacies in decreasing plaque formation and gingivitis in children. With a priori-set inclusion and exclusion criteria's and relevant MeSH terms, the PubMed, Cochrane and Ovid SP were scrutinized from the year 1980 to April 2023 for prospective articles. Outcomes evaluated were plaque formation and gingivitis through Plaque index and Gingival index. Five studies were finally included and were analyzed qualitatively and quantitatively. Meta-analysis, was performed using a random effects model. Plaque index (PI) and Gingival Index (GI). There was no significant difference between reduction in the gingivitis and plaque accumulation between Triphala and chlorhexidine mouthwash groups in children (p value 0.83, 0.96).

Indian Ayurvedic medicine: Overview and application to brain cancer.

Ayurveda is the traditional medicine system of India, and has been in practice for millennia. It is a traditional approach that uses 1000's of different plant preparations in various combinations for treatment of human ailments, including cancer. Ethnopharmacological and phytochemical analyses are now elucidating the bioactive constituents of the different plant species and herbal formulations, including ashwagandha, curcumin, guduchi, triphala, and others. To provide an overview of: 1) the ethnopharmacology of Ayurveda and several of its most important plant species and formulations, including pharmacological and molecular mechanisms of its anti-cancer effects; 2) review the literature applying Ayurvedic herbs and formulations to brain tumors. A detailed PubMed search was performed that included publications involving Ayurveda, cancer, ethnopharmacology, phytochemical analysis, molecular analysis, and brain tumors. In recent decades, significant research has begun to elucidate the bioactive compounds of ashwagandha, tumeric, guduchi, and triphala, such as withaferin A, withanolides, curcumin, palmatine, and many others. These compounds and extracts are now being applied to brain tumor cells in vitro and in animal models, with positive signs of anti-cancer activity including reduced cell growth, increased apoptosis, cell cycle arrest, increased differentiation, and inhibition of important internal signal transduction pathways. Several Ayurvedic herbs (ashwagandha, curcumin) have bioactive compounds with significant anti-cancer activity, and are effective in early pre-clinical testing against brain tumor cells in vitro and in animal models. Further pre-clinical testing is warranted, along with advancement into phase I and phase II clinical trials of patients with glioblastoma and other brain tumors.

A Novel Gum Paint Formulation Derived From Licorice and Triphala: Characteristics and Clinical Significance for Improved Oral Health.

BACKGROUND: The clinical use of antimicrobial agents for managing aphthous ulcers and periodontal diseases has long been a subject of intensive research by numerous investigators. As concerns over the side effects and antibiotic resistance associated with conventional therapies persist, there has been a concerted effort to explore alternative medicinal approaches. In line with this objective, our study introduces a novel herbal gum paint designed specifically to address the therapeutic needs of individuals suffering from oral ulcers and periodontal diseases. MATERIALS AND METHODS: The herbal formulation utilized in our study was prepared using extracts derived from Licorice (Glycyrrhiza glabra) and Triphala, a combination of three fruits: Emblica officinalis, Terminalia chebula, and Terminalia belerica. These ingredients were selected based on their documented medicinal properties. The preparation process involved extraction and formulation techniques optimized for maximum efficacy. Antimicrobial activity was assessed using the bacterial culture method, where the formulation's ability to inhibit the growth of specific bacterial strains relevant to oral health was tested. Meanwhile, cytotoxicity was evaluated using the Brine Shrimp Assay method. Statistical analysis was conducted using a one-way analysis of variance (ANOVA) and Tukey post hoc test to validate the significance of our findings with statistical significance set at p<0.05. RESULTS: The formulation exhibited significant activity against microbes when compared to the control. The cytotoxic activity was present at a concentration of 60 and 80µL, which indicated safe usage within specified concentration ranges, highlighting its potential for clinical application without adverse effects on biological systems. Statistically significant differences were obtained between the antimicrobial activity of the formulated gum paint and the commercial gum paint against Candida albicans species at 25 µL and 80 µL (p=0.00). CONCLUSION: The study underscores the promising therapeutic potential of the herbal gum paint developed in this research. By harnessing the natural antimicrobial and anti-inflammatory properties of Licorice and Triphala, the formulated gum paint showed efficacy against C. albicans. These findings contribute to the growing body of evidence supporting the integration of herbal remedies into mainstream oral healthcare practices. Future investigations could further elucidate the mechanisms underlying its therapeutic actions and explore its broader clinical applications in diverse patient populations.

The Efficacy of Triphala in the Management of Minor Aphthous Ulcers: A Case Report.

Aphthous ulcers, also known as canker sores, are the most frequently encountered lesions in the oral cavity by clinicians and particularly by dentists. It might affect populations of all age groups, although common in the younger age group. Though multifactorial causes are known to be associated with the occurrence of aphthae, the most common etiologies are stress, inadequate sleep, and improper digestion. They can appear on the oral mucosa, palate, gingiva, labial mucosa, and tongue. They can be very uncomfortable during mastication, speech, and deglutition. Generally, the management relies on identifying the cause and prescribing medications such as the local application of anesthetic, steroid ointments specifically for refractory cases, and multivitamin tablets to relieve the symptoms. Ayurvedic preparations such as Triphala oral rinse can prove to be really effective in relieving pain and burning sensation and also cause the lesions to subside, although, like other allopathy medications, it is not known to reduce the frequency of episodes. In this article, we present a case of a male patient aged 21 years who came with a complaint of ulcers on the right lateral border of the tongue. He was prescribed Triphala oral rinse and Triphala ingestion for 15 days, and on the follow-up visit, the patient reported the complete resolution of ulcers.

Computational identification of potential bioactive compounds from Triphala against alcoholic liver injury by targeting alcohol dehydrogenase.

Alcoholic liver injury resulting from excessive alcohol consumption is a significant social concern. Alcohol dehydrogenase (ADH) plays a critical role in the conversion of alcohol to acetaldehyde, leading to tissue damage. The management of alcoholic liver injury encompasses nutritional support and, in severe cases liver transplantation, but potential adverse effects exist, and effective medications are currently unavailable. Natural products with their potential benefits and historical use in traditional medicine emerge as promising alternatives. Triphala, a traditional polyherbal formula demonstrates beneficial effects in addressing diverse health concerns, with a notable impact on treating alcoholic liver damage through enhanced liver metabolism. The present study aims to identify potential active phytocompounds in Triphala targeting ADH to prevent alcoholic liver injury. Screening 119 phytocompounds from the Triphala formulation revealed 62 of them showing binding affinity to the active site of the ADH1B protein. Promising lipid-like molecule from Terminalia bellirica, (4aS, 6aR, 6aR, 6bR, 7R, 8aR, 9R, 10R, 11R, 12aR, 14bS)-7, 10, 11-trihydroxy-9-(hydroxymethyl)-2, 2, 6a, 6b, 9, 12a-hexamethyl-1, 3, 4, 5, 6, 6a, 7, 8, 8a, 10, 11, 12, 13, 14b-tetradecahydropicene-4a-carboxylic acid showed high binding efficiency to a competitive ADH inhibitor, 4-Methylpyrazole. Pharmacokinetic analysis further confirmed the drug-likeness and non-hepatotoxicity of the top-ranked compound. Molecular dynamics simulation and MM-PBSA studies revealed the stability of the docked complexes with minimal fluctuation and consistency of the hydrogen bonds throughout the simulation. Together, computational investigations suggest that (4aS, 6aR, 6aR, 6bR, 7R, 8aR, 9R, 10R, 11R, 12aR, 14bS)-7, 10, 11-trihydroxy-9-(hydroxymethyl)-2, 2, 6a, 6b, 9, 12a-hexamethyl-1, 3, 4, 5, 6, 6a, 7, 8, 8a, 10, 11, 12, 13, 14b-tetradecahydropicene-4a-carboxylic acid from the Triphala formulation holds promise as an ADH inhibitor, suggesting an alternative therapy for alcoholic liver injury.

The antitumor effects of herbal medicine Triphala on oral cancer by inactivating PI3K/Akt signaling pathway: based on the network pharmacology, molecular docking, in vitro and in vivo experimental validation.

BACKGROUND: This research aimed to investigate the anti-tumor effects and underlying genetic mechanisms of herbal medicine Triphala (TRP) in oral squamous cell carcinoma (OSCC). METHODS: The target genes of Triphala (TRP) in oral squamous cell carcinoma (OSCC) were identified, and subsequent functional enrichment analysis was conducted to determine the enriched signaling pathways. Based on these genes, a protein-protein interaction network was constructed to identify the top 10 genes with the highest degree. Genes deregulated in OSCC tumor samples were identified to be hub genes among the top 10 genes. In vitro experiments were performed to investigate the influence of TRP extracts on the cell metabolic activity, migration, invasion, apoptosis, and proliferation of two OSCC cell lines (CAL-27 and SCC-9). The functional rescue assay was conducted to investigate the effect of applying the inhibitor and activator of an enriched pathway on the phenotypes of cancer cells. In addition, the zebrafish xenograft tumor model was established to investigate the influence of TRP extracts on tumor growth and metastasis in vivo. RESULTS: The target genes of TRP in OSCC were prominently enriched in the PI3K-Akt signaling pathway, with the identification of five hub genes (JUN, EGFR, ESR1, RELA, and AKT1). TRP extracts significantly inhibited cell metabolic activity, migration, invasion, and proliferation and promoted cell apoptosis in OSCC cells. Notably, the application of TRP extracts exhibited the capacity to downregulate mRNA and phosphorylated protein levels of AKT1 and ESR1, while concomitantly inducing upregulation of mRNA and phosphorylated protein levels in the remaining three hub genes (EGFR, JUN, and RELA). The functional rescue assay demonstrated that the co-administration of TRP and the PI3K activator 740Y-P effectively reversed the impact of TRP on the phenotypes of OSCC cells. Conversely, the combination of TRP and the PI3K inhibitor LY294002 further enhanced the effect of TRP on the phenotypes of OSCC cells. Remarkably, treatment with TRP in zebrafish xenograft models demonstrated a significant reduction in both tumor growth and metastatic spread. CONCLUSIONS: Triphala exerted significant inhibitory effects on cell metabolic activity, migration, invasion, and proliferation in OSCC cell lines, accompanied by the induction of apoptosis, which was mediated through the inactivation of the PI3K/Akt pathway.

Comparing the Biofilm Removal Capacity of NaOCl, Povidone-Iodine, Chlorhexidine, Curcumin, and Triphala as Endodontic Irrigants.

BACKGROUND AND AIM: A sessile multicellular organism that is immersed in a self-produced matrix of extracellular polymeric substances and has its cells firmly attached to a surface is referred to as a microbial biofilm. When it comes to pulp and periradicular pathosis, biofilms are crucial. To reduce the number of microorganisms in the root canal and assist in treating periapical pathosis, endodontic therapy must include decontamination of the system of tooth root canals through biomechanical preparation and irrigation of the root canal. This study compares sodium hypochlorite (NaOCl), povidone-iodine, chlorhexidine, curcumin, and triphala as endodontic irrigating solutions regarding their capacity to eliminate biofilm from root canals. MATERIALS AND METHODS: A total of 60 patients were included if they had pulpitis. Two specific samples (samples A and B) were chosen for analysis from a collection of samples so that their bacterial composition is most similar to that of acute pulpitis. The suspensions of bacterial cells from this polymicrobial culture have been collected from frozen stock and then regrown by inoculation on Columbia agar base (Basingstoke, UK) with the addition of vitamin K1, hemin, and 5% (v/v) calf blood. The pureness of the suspensions was assessed using colony morphology and Gram staining. Analytical profile index (API) 20A tests or automated test for bacteria (ATB) ID 32A tests were initially used to identify the isolates. These polymicrobial cultures' in vitro biofilms were developed using membrane filters made of cellulose nitrate. The tested irrigating solutions were as follows: 5.25% sodium hypochlorite, 10% triphala, 0.2% chlorhexidine gluconate, 10% povidone-iodine, and 5% curcumin (CUR). On the other hand, phosphate-buffered saline was taken as a control agent. RESULTS: As the standard of excellence in endodontic irrigation, NaOCl has eliminated all germs in sample A following 15 minutes of culture and in both of the specimens after 40 minutes. Iodine also eliminated all germs after 40 minutes of administration, indicating that it would be worth exploring using iodine as a potential endodontic irrigant. Iodine achieved total bacterial elimination after 40 minutes in both samples; however, it was less effective after 15 minutes. Our findings indicate that iodine solution is the most suitable alternative after the supremely effective NaOCl, although it requires longer contact times to generate the necessary and recognized broad-spectrum antibacterial properties, including in the case of biofilms. Furthermore, curcumin also showed significant results after NaOCl and iodine. CONCLUSION: The antibacterial potency of each studied irrigant was significant, supporting their usage in endodontics. It was observed that NaOCl has the maximum antibacterial activity.

Study on the mechanism of natural polysaccharides on the deastringent effect of Triphala extract.

This present study investigated the masking effect of high methoxyl pectin, xanthan gum, and gum Arabic on the astringency of the traditional herbal formula Triphala and further examined the mechanism of polysaccharide reducing astringency. Results of sensory evaluation and electronic tongue illustrated that 0.6 % pectin, 0.3 % xanthan gum, and 2 % gum Arabic had a substantial deastringent effect. The polyphenols in Triphala are basically hydrolysable tannins, which with high degree of gallic acylation may be the main astringent component of Triphala. Moreover, the three polysaccharides can combine with ß-casein through CO and NH groups to form soluble binary complexes and decrease the secondary structure of ß-casein. When polysaccharides were added to the Triphala-protein system, polyphenol-protein precipitation was also diminished, and they were capable of forming soluble ternary complexes. Consequently, the competition between polysaccharides and polyphenols for binding salivary proteins and the formation of ternary complexes help decrease the astringency of Triphala.

Preventive mechanisms of Chinese Tibetan medicine Triphala against nonalcoholic fatty liver disease.

BACKGROUND: Triphala (TLP), as a Chinese Tibetan medicine composing of Emblica officinalis, Terminalia chebula and Terminalia bellirica (1.2:1.5:1), exhibited hepatoprotective, hypolipidemic and gut microbiota modulatory effects. Nonetheless, its roles in prevention of high-fat diet (HFD)-induced nonalcoholic fatty liver disease (NAFLD) and the related mechanistic insights involving the interplay of gut microbiota and hepatic inflammation are not known. PURPOSE: The present study seeks to determine if TLP would prevent HFD-induced NAFLD in vivo and its underlying mechanisms from the perspectives of gut microbiota, metabolites, and hepatic inflammation. METHODS: TLP was subjected to extraction and chemo-profiling, and in vivo evaluation in HFD-fed rats on hepatic lipid and inflammation, intestinal microbiota, short-chain fatty acids (SCFAs) and permeability, and body weight and fat content profiles. RESULTS: The TLP was primarily constituted of gallic acid, corilagin and chebulagic acid. Orally administered HFD-fed rats with TLP were characterized by the growth of Ligilactobacillus and Akkermansia, and SCFAs (acetic/propionic/butyric acid) secretion which led to increased claudin-1 and zonula occludens-1 expression that reduced the mucosal permeability to migration of lipopolysaccharides (LPS) into blood and liver. Coupling with hepatic cholesterol and triglyceride lowering actions, the TLP mitigated both inflammatory (ALT, AST, IL-1ß, IL-6 and TNF-α) and pro-inflammatory (TLR4, MYD88 and NF-κB P65) activities of liver, and sequel to histopathological development of NAFLD in a dose-dependent fashion. CONCLUSION: TLP is promisingly an effective therapy to prevent NAFLD through modulating gut microbiota, mucosal permeability and SCFAs secretion with liver fat and inflammatory responses.

Comparative Evaluation of the Effectiveness of Triphala and Chlorhexidine in Full-mouth Disinfection Treatment of Periodontitis in Type 2 Diabetes Patients.

AIM: To evaluate and compare the efficacy of triphala and chlorhexidine (CHX) in the treatment of stages II and III periodontitis with one-stage complete mouth disinfection in type 2 diabetes mellitus (DM) patients. MATERIALS AND METHODS: A total of 24 type 2 diabetic subjects with either stage II or stage III periodontitis were randomly divided into test and control groups with 12 patients in each group. For control group, full-mouth disinfection (FMD) was done using CHX and for test group, FMD was done using triphala. Clinical parameters were evaluated at baseline and at 6 months which comprised of probing pocket depth (PPD), plaque index (PI), clinical attachment level (CAL), papillary bleeding index (PBI). The primary outcomes considered were a reduction in PPD and a gain in CAL. The data were recorded, tabulated, and statistically analyzed. RESULTS: The PPD reduction for the test group was 3.38 ± 0.75 mm and for the control group was 3.39 ± 0.76 mm. The CAL gain for the test group was 3.39 ± 0.76 mm and for the control group was 3.18 ± 0.74 mm. Although there was a statistically significant PPD reduction, statistically not significant CAL gain was observed. CONCLUSION: Both the groups with the FMD protocol showed beneficial results in terms of PPD reduction and CAL gain but the test group showed slightly better results. CLINICAL RELEVANCE: Clinically, there is more PPD reduction and CAL gain from baseline to 6 months in the test group compared to the control group. Clinically, the test group has more favorable results compared to the control group.

Bidirectional Effect of Triphala on Modulating Gut-Brain Axis to Improve Cognition in the Murine Model of Alzheimer's Disease.

SCOPE: The emerging role of gut microbiota and their metabolites in the modulation of the gut-brain axis has received much attention as a new hope for the treatment of hard-to-treat chronic neurodegenerative diseases like Alzheimer's disease. The naturally occurring polyphenols can restore the gut-brain axis by modulating gut microbiota and brain neurotransmitters. The Indian traditional medicine Triphala, a rich source of polyphenols, has been used on humans based on Prakriti or disease conditions for many years. METHODS AND RESULTS: In this study, the dual mode (morning and evening) action of Triphala is used to provide scientific evidence of its superior preventive and therapeutic efficacy in C57BL/6 and 5xFAD, APP/PS1 transgenic mouse model of Alzheimer's disease. The study observes that Triphala treatment has significantly improved cognitive function, by modulating the APP pathway, reducing inflammation, and restoring the gut-brain axis by increasing the gut microbiota phyla of Bacteroides, Proteobacteria, Actinobacteria, etc., involved in maintaining the gut homeostasis. CONCLUSIONS: The study paves a new path for using dual modes of Triphala alone or in combination to treat incurable AD.

Assessment of the Antimicrobial Effectiveness of Herbal Root Canal Irrigants (Propolis, Triphala, and Aloe Vera) and Chlorhexidine Against Enterococcus Faecalis.

BACKGROUND: Complete microbial eradication from the root canal and 3-dimensional obturation of the canal space are necessary for an efficient root canal procedure. AIM: The current research was conducted to assess the antimicrobial effectiveness of herbal root canal irrigants and Chlorhexidine against Enterococcus faecalis. MATERIALS AND METHODS: The brain heart infusion (BHI) broth was used to grow the E. faecalis (ATCC) bacterial culture overnight before it was inoculated onto Mueller-Hinton agar plates. Agar-well diffusion was used to measure antibacterial inhibition. Respective propolis, Triphala, aloe vera, and chlorhexidine irrigants were added to the appropriate wells in agar plates and incubated for 24 hours at 37°C. Each well's bacterial inhibition zone was measured and recorded. Statistics were used to tabulate and analyze the results. RESULTS: Chlorhexidine indicated the maximum inhibitory zone against E. faecalis, subsequently propolis and Triphala, and the lowest by A. vera extract. CONCLUSION: Propolis, Triphala, and aloe vera were tested herbal remedies that demonstrated an inhibitory zone against E. faecalis. These irrigants are therefore, suitable for use as root canal irrigating solutions.

Ayurvedic Drug Triphala in Combination with Providone Iodine Mitigates Radiation-Induced Mucositis in Head and Neck Cancer Patients without Affecting the Tumor Response.

Radiation-induced mucositis is a dose-limiting concern in the treatment of head and neck cancers (HNC). This study was conducted to determine the effectiveness of the Ayurvedic drug Triphala in reducing radiation-induced mucositis and influencing tumour control when combined with providone iodine. Data from patient files of HNC patients who received Triphala in conjunction with iodine or iodine alone over the course of curative radiotherapy (> 60 Gy) from May 2013 to February 2015 were extracted for this retrospective chart based study. Data was subjected to statistical analysis, X2 and unpaired t test using the Statistical Package for Social Sciences (SPSS), version 17 (IBM, Chicago, USA). When compared to iodine alone, the group that utilised Triphala gargling was very efficient in delaying mucositis, the extent of weight loss (p = 0.038), the incidence (p = 0.03), and the number (p = 0.02) of treatment breaks. However, it had no influence on the radiation-induced tumour response. According to the observations, Triphala coupled with iodine was more successful in preventing radiation mucositis, and without affecting the killing of tumour cells than iodine gargle alone. According to the authors, this is the first observation to demonstrate the value of combining providone iodine with Triphala in preventing radiation-induced oral mucositis.

Insights into the potential benefits of triphala polyphenols toward the promotion of resilience against stress-induced depression and cognitive impairment.

In response to environmental challenges, stress is a common reaction, but dysregulation of the stress response can lead to neuropsychiatric disorders, including depression and cognitive impairment. Particularly, there is ample evidence that overexposure to mental stress can have lasting detrimental consequences for psychological health, cognitive function, and ultimately well-being. In fact, some individuals are resilient to the same stressor. A major benefit of enhancing stress resilience in at-risk groups is that it may help prevent the onset of stress-induced mental health problems. A potential therapeutic strategy for maintaining a healthy life is to address stress-induced health problems with botanicals or dietary supplements such as polyphenols. Triphala, also known as Zhe Busong decoction in Tibetan, is a well-recognized Ayurvedic polyherbal medicine comprising dried fruits from three different plant species. As a promising food-sourced phytotherapy, triphala polyphenols have been used throughout history to treat a variety of medical conditions, including brain health maintenance. Nevertheless, a comprehensive review is still lacking. Here, the primary objective of this review article is to provide an overview of the classification, safety, and pharmacokinetics of triphala polyphenols, as well as recommendations for the development of triphala polyphenols as a novel therapeutic strategy for promoting resilience in susceptible individuals. Additionally, we summarize recent advances demonstrating that triphala polyphenols are beneficial to cognitive and psychological resilience by regulating 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) receptors, gut microbiota, and antioxidant-related signaling pathways. Overall, scientific exploration of triphala polyphenols is warranted to understand their therapeutic efficacy. In addition to providing novel insights into the mechanisms of triphala polyphenols for promoting stress resilience, blood brain barrier (BBB) permeability and systemic bioavailability of triphala polyphenols also need to be improved by the research community. Moreover, well-designed clinical trials are needed to increase the scientific validity of triphala polyphenols' beneficial effects for preventing and treating cognitive impairment and psychological dysfunction.

Diabetic foot ulcer with osteomyelitis, successfully treated with the holistic approach of multiple ayurvedic treatment modalities - A case report.

INTRODUCTION: Diabetic foot ulcer (DFU) with osteomyelitis is the devastating condition, which is a challenge to surgeons in saving the limb of the patient and in many circumstances ends up with amputation, which leaves physical and psychosocial trauma for both the patient and patient's family. PRESENTATION OF CASE: A 48-year-old female patient with uncontrolled type 2 diabetes presented with swelling and gangrenous deep circular ulcer of size approx. 3 × 4 cm on plantar aspect of great toe of her left foot with involvement of first webspace from last three months. Plain X ray showed disrupted and necrotic proximal phalanx suggestive of diabetic foot ulcer with osteomyelitis. Despite using antibiotics and antidiabetic drugs for past three months she didn't get significant response and was suggested for toe amputaion. Hence, she approached our hospital for further treatment. We successfully treated the patient with the holistic approach of surgical debridement, medicinal leech therapy (MLT), irrigation of the wound with triphala decoction, jatyadi tail dressings, oral ayurvedic antidiabetic drugs to control blood sugar levels and a mixture of herbo mineral drug which is having antimicrobial property. DISCUSSION: DFU may lead to infection, gangrene, amputation, death of the patient. Hence it is the need of the hour to look for limb salvage treatment modalities. CONCLUSION: The holistic approach of these ayurvedic treatment modalities are effective and safe in treating DFUs with osteomyelitis and in preventing amputation.

Chemical fingerprint analysis and quality assessment of Tibetan medicine Triphala from different origins by high-performance liquid chromatography.

INTRODUCTION: Although the Tibetan medicine Triphala (THL) is widely used in many countries, insufficient progress has been made in quality control. OBJECTIVES: The present study aimed to propose a methodology for quality control of THL based on HPLC fingerprinting combined with an orthogonal array design. METHODS: Seven identified peaks were used as indicators to examine the effects of temperature, extraction time, and solid-liquid ratio on the dissolution of active ingredients in THL. Fingerprint analysis was performed on 20 batches of THL from four geographical areas (China, Laos, Thailand, and Vietnam). For further chemometric assessment, analysis techniques including similarity analysis, hierarchical clustering analysis, principal component analysis, and orthogonal partial least squares discrimination analysis (OPLS-DA) were used to classify the 20 batches of samples. RESULTS: Fingerprints were established and 19 common peaks were identified. The similarity of 20 batches of THL was more than 0.9 and the batches were divided into two clusters. Four differential components of THL were identified based on OPLS-DA, including chebulinic acid, chebulagic acid, and corilagin. The optimal extraction conditions were an extraction time of 30 min, a temperature of 90°C, and a solid-liquid ratio of 30 mL/g. CONCLUSION: HPLC fingerprinting combined with an orthogonal array design could be used for comprehensive evaluation and quality assessment of THL, providing a theoretical basis for further development and utilization of THL.

Efficacy of Triphala extracts on the changes of obese fecal microbiome and metabolome in the human gut model.

Triphala is a mixture of tree fruits obtained from Terminalia chebula, Terminalia bellerica, and Phyllanthus emblica. It is one of the Ayurveda medicinal recipes used to treat health diseases such as obesity. The chemical composition analysis of Triphala extracts obtained from an equal portion of three fruits was performed. The contents of total phenolic compounds (62.87 ± 0.21 mg gallic acid equivalent/mL), total flavonoids (0.24 ± 0.01 mg catechin equivalent/mL), hydrolyzable tannins (177.27 ± 10.09 mg gallotannin equivalent/mL), and condensed tannins (0.62 ± 0.11 mg catechin equivalent/mL) were observed in Triphala extracts. The 1 mg/mL of Triphala extracts was applied to batch culture fermentation which contained the feces from voluntarily obese female adults (body mass index of 35.0-40.0 kg/m2) for 24 h. The extraction of DNA and metabolites was each conducted on the samples obtained from batch culture fermentation within and without Triphala extracts treatment. The 16S rRNA gene sequencing and untargeted metabolomic analysis were carried out. There was no statistically significant difference between Triphala extracts and control treatments on the changes in microbial profiles (p-value <0.05). While the metabolomic analysis showed statistically significant differences of 305 up-regulated and 23 down-regulated metabolites in the treatment of Triphala extracts when compared with the control (p-value <0.05 and fold-change ≥2) belonging to 60 pathways. The pathway analysis revealed that Triphala extracts play an important role in the activation of phenylalanine, tyrosine and tryptophan biosynthesis. In this study, phenylalanine and tyrosine were identified metabolites which involve in the regulation of energy metabolism. The treatment of Triphala extracts possesses the induction of phenylalanine, tyrosine and tryptophan biosynthesis in fecal batch culture fermentation of obese adults and therefore it can be suggested as a probable herbal medicinal recipe for obesity treatment.