Bibhitaki

Terminalia bellirica (Gaertn.) Roxb. belongs to Combretaceae and shares its genus with haritaki, Terminalia chebula. Gaertner first described it in 1790 as Myrobalanus bellirica, and Roxburgh moved it to Terminalia in Plants of the Coast of Coromandel in May 1805, spelling it ‘bellerica’ (International Plant Names Index). Kew’s Plants of the World Online (POWO) accepts the spelling bellirica, but bellerica and belerica remain common: the Ayurvedic Pharmacopoeia of India uses Terminalia belerica, and most clinical trials use bellerica. POWO lists 16 synonyms, including T. punctata, T. gella, and T. laurinoides. It gives the native range as the Indian Subcontinent to southern Yunnan in China and Malesia, from Pakistan, Nepal, India, Sri Lanka, and Bangladesh through Myanmar, Thailand, Laos, Cambodia, and Vietnam to Malaya, Sumatra, Java, Borneo, Sulawesi, and the Maluku Islands, with introduced populations in Mauritius, Rodrigues, and Trinidad and Tobago. The pharmacopoeia records Sanskrit names vibhīta, akṣa, and akṣaka, alongside regional names such as bahera in Hindi, baheda in Bengali, and thanrikkai in Tamil; the World Agroforestry database adds bedda nut tree in English, samo-phiphek in Thai, and thitsein in Burmese.

It is a big tree. The World Agroforestry database, compiled by Orwa and colleagues in 2009, describes a deciduous tree up to 50 m tall and 3 m across, with a rounded crown and a frequently buttressed trunk that can rise 20 m before branching. The bark is bluish or ashy grey with fine lengthwise cracks. Broad, elliptic to obovate leaves, up to 24 cm long on stalks of 2.5–9 cm, cluster toward the ends of the branches; the genus name comes from the Latin terminus, for this habit of bearing leaves at the shoot tips. New leaves open copper-red, turn parrot green, then dark green, and appear together with small greenish-white flowers on spikes 3–15 cm long that have a strong, honey-like smell. The fruit is roughly round to broadly ellipsoid, 2–4 cm long, densely velvety, and faintly five-angled. The pharmacopoeia describes fresh ripe fruits as silvery with a shiny, whitish down, drying grey or greyish-brown and slightly wrinkled, with a rind 3–5 mm thick and an astringent taste. The tree grows in monsoon and mixed deciduous forests, often with teak, up to about 1,000 m, demands light, tolerates drought fairly well, and has seeds that cannot be dried and stored like grain; animals eat the fruit and spread the seeds.

The pharmacopoeia defines the drug as the rind (pericarp) of the dried ripe fruit, with no more than 2% foreign matter, no more than 7% total ash, and at least 35% water-soluble extract, and it names gallic acid, tannic acid, and glycosides as constituents. Gupta and colleagues (Phytomedicine 2020) list tannins, gallic acid, corilagin, ellagic acid, ethyl gallate, galloyl glucose, chebulagic acid, and arjunolic acid among the main compounds, and a 2018 review by Tarasiuk and colleagues in Chinese Medicine adds β-sitosterol and chebulic acid, noting that gallic acid is the major phytoconstituent of all three triphala fruits. Valsaraj and colleagues (Journal of Natural Products 1997) isolated two new lignans from the fruit rind, which they named termilignan and thannilignan, together with anolignan B and a flavan. The commercial extract used in the uric acid trials, sold as Ayuric, is a water extract standardized by its maker to at least 1% each of chebulinic and chebulagic acids and at least 15% other small hydrolysable tannins. The tree has many other uses: World Agroforestry records that its leaves are valued fodder and feed tussar silkworms, the fruit yields tannins and dyes for leather, cloth, mats, and ink, the kernel gives an oil used in soap, and the soft, whitish wood is used for boxes and furniture.

Bibhitaki’s oldest appearance is at the gambling table. Arthur Macdonell’s A Vedic Reader for Students (1917) introduces Rigveda hymn 10.34, the Gambler’s Lament, as the monologue of a man who cannot resist the dice and has ruined himself and his family, and explains that the dice (akṣás) were the nuts of a large tree called vibhīdaka, Terminalia bellerica, which he says was still used for this purpose in India. The hymn’s first verse names the vibhīdaka directly. The word turns up again in a hymn to the god Varuna (7.86), where Macdonell translates it simply as dice: the speaker tells Varuna that it was not his own intent but seduction, ‘liquor, anger, dice, thoughtlessness.’ The link survives in the plant’s names: the Ayurvedic Pharmacopoeia of India records akṣa and akṣaka as Sanskrit synonyms for bibhitaki, the same word Macdonell gives for the Vedic dice. The medicinal history of the fruit is harder to date, but Gupta and colleagues describe it as one of the oldest medicinal herbs of India, Pakistan, Nepal, Bangladesh, and Sri Lanka, used in Ayurveda, Unani, Siddha, and traditional Chinese medicine.

The connection with dice, numbers, and bad luck reappears in the Mahabharata. In the story of King Nala in the Vana Parva, translated by Kisari Mohan Ganguli (section 72), Nala is working in disguise as charioteer to King Rituparna when the king stops beside a vibhitaka tree and states exactly how many leaves and fruits it carries. Nala fells the tree to count them, finds the king was right, and asks how he did it; Rituparna answers that he is proficient at dice besides being versed in numbers, and the two trade knowledge, the king’s skill with dice for Nala’s horse lore. At that moment Kali, the spirit who had long afflicted Nala, leaves his body and, frightened, takes refuge in the vibhitaka tree. The epic adds that from the touch of Kali the vibhitaka tree fell into disrepute from that hour, a story that ties the tree once more to dice, numbers, and misfortune.

In medicine, bibhitaki matters mostly as part of triphala. Peterson and colleagues (Journal of Alternative and Complementary Medicine 2017) explain that triphala means ‘three fruits’ in Sanskrit, that it is classed as a tridoshic rasayana, a rejuvenating remedy suitable for all constitutions, and that it is described in the Charaka Samhita and Sushruta Samhita, the foundational Ayurvedic texts; Charaka wrote that taking triphala daily with honey and ghee could let a person live a hundred years free of old age and disease. Classical texts call triphala a mild laxative at normal doses, a bowel tonic at low doses, and a purgative at high doses, as well as carminative and expectorant. For bibhitaki itself, the Ayurvedic Pharmacopoeia of India records an astringent taste and heating potency, classes it as good for the eyes and hair, purgative, worm-expelling, and cough-relieving, and lists it for vomiting, cough, worm infestation, constipation, hoarseness, and eye diseases. Its listed formulations are Triphala Churna, Triphaladi Taila, and Lavangadi Vati. World Agroforestry adds Ayurvedic uses for tuberculosis, dyspepsia, diarrhea, dysentery, liver disease, leprosy, and hair growth.

Bibhitaki is above all a tannin-rich fruit, which explains its astringent taste. Its main polyphenols, gallic acid, ellagic acid, and hydrolysable tannins such as chebulagic acid and corilagin, are strong antioxidants in the test tube, and Gupta and colleagues (Phytomedicine 2020) summarize laboratory and animal studies reporting antioxidant, anti-inflammatory, immune-modulating, antimicrobial, liver-protecting, kidney-protecting, blood-sugar-lowering, cholesterol-lowering, and anticancer effects. Their review is a useful map of this literature but also a reminder of its limits: they conclude that more animal studies and clinical trials are needed before these activities can be called medicinal benefits. Gut bacteria also shape what these compounds do. Peterson and colleagues describe how gut microbes break down triphala polyphenols such as chebulinic acid into smaller compounds called urolithins, and report that triphala compounds such as quercetin and gallic acid encourage Bifidobacteria and Lactobacillus while inhibiting less welcome gut bacteria. How much of this applies to bibhitaki alone, at the doses people take, has not been measured.

The uric acid trials point to a more specific mechanism. Uric acid is made by xanthine oxidase, the enzyme blocked by the gout drugs allopurinol and febuxostat. Usharani and colleagues (Clinical Pharmacology 2016) report that in test-tube assays carried out by the extract’s manufacturer, Natreon, the bibhitaki and haritaki extracts inhibited xanthine oxidase as effectively as allopurinol, but these data are cited as on file rather than published, and no independent group has confirmed them. In the later kidney disease trial (Pingali and colleagues, BMC Complementary Medicine and Therapies 2020), the extract groups, like the febuxostat group, also showed improvements in a measure of blood-vessel function and in high-sensitivity C-reactive protein, a marker of inflammation, while none of the three treatments affected platelet aggregation. Because that trial had no placebo group, it cannot show whether these changes were caused by the extract.

Bibhitaki compounds also act on microbes in the laboratory. Valsaraj and colleagues (Journal of Natural Products 1997) traced the activity of a fruit rind extract to four compounds, the lignans termilignan, thannilignan, and anolignan B and a flavan, each of which showed activity against HIV-1, a malaria parasite, and fungi in vitro, and World Agroforestry notes fruit extracts active against Micrococcus pyogenes and Escherichia coli. Test-tube activity of this kind says nothing on its own about treating infections in people. A more relevant laboratory finding concerns drug metabolism: MSKCC reports that triphala inhibits CYP3A4 and CYP2D6, two liver enzymes that clear many prescription drugs, and notes that compounds in triphala may encourage bacterial biofilm on teeth despite their antibacterial effects. The laxative action that Ayurveda attributes to bibhitaki has not been studied in human physiology experiments.

High uric acid is the only use of bibhitaki alone backed by randomized trials. Usharani and colleagues (Clinical Pharmacology: Advances and Applications 2016) randomized 110 people with raised uric acid at a hospital in Hyderabad to five groups for 24 weeks: bibhitaki extract 250 mg or 500 mg twice a day, haritaki extract 500 mg twice a day, febuxostat 40 mg once a day, or placebo. Of the 88 who completed the study, those on bibhitaki 500 mg saw average uric acid fall from 8.07 to 5.78 mg/dL, a drop nearly twice that seen with haritaki or the lower bibhitaki dose, while febuxostat brought levels from 8.53 to 4.28 mg/dL and levels on placebo rose. All treatments were well tolerated. The study is small, roughly 17 or 18 completers per group, a fifth of participants were lost to follow-up, and it measured blood levels rather than gout attacks, joint damage, or kidney outcomes. The extract, Ayuric, and the matching placebo were supplied by its manufacturer, Natreon, although the authors declared no conflicts of interest.

The same group then tested the extract in people with chronic kidney disease and high uric acid (Pingali and colleagues, BMC Complementary Medicine and Therapies 2020). Fifty-nine adults were randomized to febuxostat 40 mg once a day or bibhitaki extract 500 mg or 1,000 mg twice a day for 24 weeks, and 55 finished. Uric acid fell by an average of 63.7% with febuxostat, 19.8% with the lower bibhitaki dose, and 33.9% with the higher one. Creatinine fell and estimated kidney function rose in all groups, and the increase with the higher dose was similar to febuxostat’s. The authors suggested the extract could be a natural alternative for lowering uric acid, but the trial had no placebo arm, so natural variation and better medical follow-up during the study could explain part of the kidney improvement. It was also registered only after it had been completed, and Natreon again provided the medicines and laboratory kits. Two trials from one center, both using one company’s product, are a promising start rather than proof, and people with gout or kidney disease should not swap prescribed treatment for an extract.

Mouth and teeth: Saxena and colleagues (Journal of Clinical and Diagnostic Research 2017) ran a double-blind crossover study in dental clinic visitors aged 15 to 40, who each rinsed in turn with 15 ml of freshly made 10% water extracts of bibhitaki, haritaki, amla, and triphala. All four rinses reduced Streptococcus mutans, a bacterium linked to tooth decay, in saliva samples taken 5 and 60 minutes later, but triphala reduced it significantly more than any single fruit, and amla least. The study measured only short-term bacterial counts after single rinses, not plaque, gum health, or cavities. Triphala mouthwash has been tested more often. MSKCC reports that several clinical studies suggest it may reduce dental plaque, but that it is not clear whether it works as well as chlorhexidine, the standard antiseptic mouthwash, and adds that compounds in triphala may actually promote bacterial biofilm formation in the mouth. Those findings concern triphala, not bibhitaki alone.

Cough, digestion, and constipation are bibhitaki’s main traditional uses. The Ayurvedic Pharmacopoeia of India lists it for cough, hoarseness, vomiting, worm infestation, constipation, and eye diseases, and classes it as purgative, and World Agroforestry adds uses for dyspepsia, diarrhea, dysentery, and liver disease. None of these uses has been tested in modern controlled trials of bibhitaki on its own. Laboratory and animal studies summarized by Gupta and colleagues report liver-protecting, kidney-protecting, blood-sugar-lowering, and cholesterol-lowering activity, but these have not been confirmed in people. A similar trial in type 2 diabetes from the same Hyderabad group, which measured blood sugar, lipids, and blood-vessel function, tested an extract of haritaki, not bibhitaki, so it does not apply here. For a cough, a sore throat, or ongoing digestive trouble, bibhitaki remains a traditional remedy rather than an evidence-based one.

Triphala, the three-fruit combination, accounts for most of the human research involving bibhitaki. Peterson and colleagues (2017) describe it as a cornerstone of Ayurvedic gastrointestinal and rejuvenating treatment and review laboratory and early clinical findings for constipation, dental plaque, inflammation, and immune function, though their review is enthusiastic in tone and many of the studies are small. Tarasiuk and colleagues (2018) concluded that the limited clinical data do not allow firm conclusions about triphala for irritable bowel syndrome (IBS), suggested it might suit constipation-predominant IBS, and noted that its laxative action makes it unhelpful when diarrhea predominates. MSKCC calls human studies of triphala limited and notes that a double-blind trial of triphala combined with guggulu, a resin, did not lower cholesterol, body mass index, or waist size more than placebo. Any benefit seen with triphala belongs to that combination and cannot be credited to bibhitaki, which makes up only a third of it.

Traditionally, bibhitaki is used as a powder of the dried fruit rind. The Ayurvedic Pharmacopoeia of India gives a dose of 3–6 g of powder, which it describes as an approximate conversion of classical measures intended for adults, and lists three classical formulations that contain it: Triphala Churna, a powder; Triphaladi Taila, an oil; and Lavangadi Vati, a tablet. Triphala churna is the form most people encounter. MSKCC and Peterson and colleagues describe it as equal portions of the three dried, powdered fruits, and Saxena and colleagues note that the Ayurvedic Formulary of India specifies a 1:1:1 mixture. Charaka recommended taking triphala with honey and ghee, and Ayurvedic texts describe it as mildly laxative at ordinary doses and purgative at high ones (Peterson). Triphala is now sold as loose powder, capsules, tablets, and liquid extracts, and the amount of bibhitaki in a daily dose varies widely between them, so it is worth reading the label for the weight of each fruit or extract.

The clinical trials used a different kind of product: Ayuric, a standardized water extract of the fruit made by Natreon, in capsules. In the hyperuricemia trial, people took 250 mg or 500 mg twice a day after meals, and in the kidney disease trial 500 mg or 1,000 mg twice a day, for 24 weeks in both cases. Because extracts are concentrated, these doses do not translate directly into grams of powdered fruit, and results from this extract cannot be assumed for other bibhitaki or triphala products. The mouth rinse study used 15 ml of a freshly made 10% water extract, rinsed once. Labels may use any of the three spellings of the Latin name, Terminalia bellirica, bellerica, or belerica, or one of the common names bibhitaki, vibhitaki, bahera, baheda, or beleric myrobalan; all refer to the same plant.

Choosing a product carefully matters more for Ayurvedic remedies than for most herbs. Saper and colleagues (JAMA 2008) analyzed 193 Ayurvedic medicines ordered online and found lead, mercury, or arsenic in 20.7%, with similar rates for US-made and Indian-made products; 75% of the contaminated products claimed to follow Good Manufacturing Practices, and every one exceeded at least one standard for acceptable daily intake of a toxic metal. Products made by rasa shastra, the deliberate combining of herbs with metals, minerals, or gems, were contaminated more often, 40.6% versus 17.1%. The National Center for Complementary and Integrative Health (NCCIH) notes that there is no significant regulation of Ayurvedic practice or education in the United States. Simple plant-only products from manufacturers that publish heavy metal testing for each batch are the safer choice. Do not eat the seed kernels of the fruit in quantity, given World Agroforestry’s warning about their narcotic effect.