1,2,3,4,Rungta Institute of Pharmaceutical Sciences, Bhilai
5,6 Rungta Institute of Pharmaceutical Science & Research, Bhilai
Cough and respiratory symptoms arise from infection and chronic conditions that cause repeated clinical complications. Conventional allopathic medicines such as expectorants, antitussives, etc, provide symptomatic relief, but longer-term use causes side effects. Herbal medicines increase attention to the preference for safer, more effective therapies for diseases. Terminalia chebula (chebulic myrobalan or haritaki ) is used in Ayurveda as a medicinal plant containing antioxidant, antimicrobial, inflammation suppressing, and bronchodilator properties that enhance respiratory health basically used for cough, sore throat and respiratory discomfort. It has been observed that extensive role in traditional use, scientific studies specifically validating in cough and related respiratory symptoms remain limited. Based on the reviewed studies and their evaluations, the review integrates therapeutic relevance with pharmacological evidence and identifies research gaps.
Every year, millions of people around the world struggle with respiratory illnesses, making these conditions a serious public-health issue. They cover a wide range of problems that interfere with how efficiently our lungs exchange oxygen and carbon dioxide. The respiratory system itself includes the nose, airways, bronchi, bronchioles, alveoli, and the muscles that help with breathing. When any of these parts fail to work properly, the result can be infections, inflammation, or long-term diseases such as asthma and chronic bronchitis (Smruti, 2021).
Respiratory-related issues like airway irritation,cough, asthma , bronchitis, etc., are caused when a physiological or anatomical barrier occurs in the respiratory tract (Molynex & Morice, 2011). It appears that conversational allopathic drugs, like bronchodilators, antitussives, anti-inflammatory antimicrobials, and antibiotics, give sympathetic relief and may cause side effects or adverse effects from prolonged use. For this reason, herbal alternatives enhance the attention as they are safer and more efficacious based on scientific and clinical evidence (Smuti, 2021).
Terminalia chebula (chebulic myrobalan or haritaki) is a natural herb that holds a notable role in ayurveda and respiratory health medicine that includes phytoconstituents such as tannins, gallic acid and chebulagic acid which possess potent antioxidant, inflammation reducing and antimicrobial activities (Alli & Khan, 2009; Ikram et al.,2022). In practical terms, these pharmacological effects help in the management of respiratory issues where oxidative stress and inflammation play a central role. It becomes evident that T. chebula extract has significant antitussive activity in citric acid-induced cough models, suggesting both central and peripheral mechanisms of action (Nosalova et al., 2013).
Even with these encouraging results, a significant research deficit persists in comprehending the direct clinical efficacy, standardisation, and dosage optimisation of T. chebula in respiratory diseases. Most available studies are preclinical or observational, and systematic human trials are scarce. Moreover, variations in extraction methods and regional chemotypes may lead to inconsistent pharmacological outcomes (Abiri et al., 2023). Subsequent research studies should focus on controlled clinical evaluations, molecular mechanism elucidation, and synergistic studies with other herbal or conventional drugs to establish T. chebula as a validated and standardized herbal therapy for cough and respiratory disease.
Cough: Clinical and Pathophysiological Background
Introduction :- Cough is a protective reflex that clears the airways of secretions and irritants; clinically it ranges from a self-limited acute symptom to a persistent chronic condition that significantly impairs quality of life. (Irwin & Madison, 2000). Chronic cough commonly reflects either upper airway cough syndrome (post-nasal drip), asthma (including cough-variant asthma), or gastroesophageal reflux disease, although a broad differential must be considered for refractory cases. (Morice, 2002). Pathophysiologically, cough involves an afferent vagal sensory limb, central processing in the brainstem (modifiable by cortical input), and an efferent motor limb producing the expulsive maneuver; many chronic coughs show a state of cough reflex hypersensitivity, explaining persistent symptoms despite treatment of obvious airway disease. (Irwin & Madison, 2000; Morice et al., 2006).
Pathophysiology of cough :-
Airway irritation / inflammation
?
Activation of cough receptors
(Vagal sensory pathways)
?
Mediator release
(Cytokines, histamine, bradykinin)
?
Mucosal edema & mucus hypersecretion
?
Airway narrowing + receptor hypersensitivity
?
Cough reflex stimulation ? Persistent cough
Figure 1. Pathogenesis and clinical mechanisms of cough.
Conventional Allopathic Management of Cough :-
Cough management in allopathic medicine aims to suppress the cough reflex, reduce airway inflammation, and aid mucus clearance through agents like codeine, bronchodilators, and corticosteroids. (Irwin & Madison, 2000; Morice et al., 2006). However, frequent side effects and limited long-term safety have encouraged exploration of herbal options such as Terminalia chebula. (Gairola , 2010; ul Haq , 2013).
Table (1.1):- Conventional Allopathic Management of Cough.
|
N. |
Drug class |
Example |
Mechanism (MOA) |
Limitation/ Side effect |
References |
|
1 |
Antitussives |
Codeine, Dextromethorphan |
Suppress medullary cough center |
Sedation, constipation, |
Irwin & Madison, 2000 |
|
2 |
Expectorants / Mucolytics |
Guaifenesin, N-acetyl-cysteine |
Loosen mucus → ease clearance |
Mild GI upset; low efficacy in dry cough. |
Gairola et al., 2010; Morice et al., 2006 |
|
3 |
Bronchodilators |
Salbutamol, Salmeterol |
Relax bronchial muscles → relieve bronchospasm |
Tremor, palpitations. |
Irwin & Madison, 2000; Painuli et al., 2025 |
|
4 |
Inhaled Corticosteroids |
Budesonide, Fluticasone |
↓ Airway inflammation & hyperreactivity |
Local infection (thrush), dysphonia. |
Morice et al., 2006; Painuli et al., 2025 |
|
5 |
Antihistamine ± Decongestant |
Chlorpheniramine + Pseudoephedrine |
Reduce post-nasal drip (UACS-related cough) |
Sedation, dryness, |
Morice, 2002; Lewith, 1998
|
|
6 |
Proton Pump Inhibitors (PPIs) |
Omeprazole, Esomeprazole |
↓ Acid reflux → less laryngeal irritation |
Long-term use ↓ malabsorption |
Morice et al., 2006; Painuli et al., 2025 |
Traditional and Ethanomedical Use of Terminalia chebula
Terminalia chebula (Haritaki) holds a key component of traditional systems such as Ayurveda, Siddha, and Unani, where it is revered as the “King of Medicines” for its wide therapeutic range (Sharma , 2019). According to classical Ayurvedic literature, including Charaka Samhita and Sushruta Samhita, Haritaki is cited as a major ingredient of Triphala, a formulation used for rejuvenation, digestion, and respiratory disorders (Suryawanshi , 2024).
Traditionally, T. chebula has been used in formulations like Vyaghri Haritaki Avaleha and in powder or decoction form to treat respiratory ailments like bronchitis, cough, asthma, and throat irritation (Gairola, 2010; Sharma , 2019).
Triphala works in concert to reduce upper respiratory tract irritation and mucosal inflammation and is beneficial for the management of allergic diseases, including chronic cough (Jantrapirom et al., 2021).
Ethnomedical evidence All over Southeast Asia, it also highlights T. chebula as a traditional antitussive, expectorant and bronchodilator, especially when combined with honey or black pepper for better efficacy. (ul Haq et al., 2013; Lewith, 1998). Moreover, deep investigation provides information that its long-standing folk use for colds, sore throats and chest congestion demonstrates integration into both household and codified traditional medicine systems. (Irwin & Madison, 2000; Morice et al., 2006).
Phytochemical Constituents of Terminalia chebula
Terminalia chebula has phytoconstituents, mainly tannins, flavonoids, phenolic acids, glycosides and alkaloids, which are responsible for their pharmacological effects (Rathinamoorthy & Thilagavathi, 2014). On the other hand, it seems that hydrolysable tannins, chebulinic acid and gallic acid are considered the most bioactive and antioxidant and anti-inflammatory activities.(Ali & Khan, 2009; Sultan et al., 2023).
Further research reports that flavonoid compounds like quercetin and luteolin, along with other phenolic constituents, help to neutralise the oxygen species which play a role in respiratory protection (Venkatesan et al., 2017). .It appears that terpenoid-, saponin- and anthraquinone-containing fruits synergistically modulate oxidative and inflammatory action (Rathinamoorthy & Thilagavathi, 2014; Sultan et al., 2023). Highly concentrated phytoconstituents of their bark and pericarp give mucoprotective and antibacterial potential relevant to respiratory health. (Venkatesan et al., 2017). This can be understood as the phytochemical profile of T. chebula establishes strong evidence for its use in coughs and respiratory disorders.(Ali & Khan, 2009; Sultan et al., 2023).
Pharmacological Activities Related to Cough
Experimental and clinical evidence indicates that Terminalia chebula possesses notable antitussive, expectorant, and bronchodilatory properties that help its traditional use in the management of respiratory conditions.(ul Haq et al., 2013; Gairola et al., 2010).One way to interpret this is that the ethyl acetate fraction, notably of Terminalia chebula, was demonstrated to suppress cough frequency and prolong latency, suggesting a secure and efficient mechanism (ul Haq et al., 2013).
Some others point out that tannins and polyphenols present in Terminalia chebula possess inflammation suppressing and antioxidant properties which offer reduction of airway irritation and mucus hypersecretion. (Rathinamoorthy & Thilagavathi, 2014; Venkatesan et al., 2017).It appears that, moreover, flavonoids lessen bronchial hyperresponsiveness by stabilising mast cells, thereby preventing the release of histamine. (Sultan , 2023).
The ability of this fraction to fight common respiratory bacteria such as Streptococcus pneumoniae and Haemophilus influenzae further supports its usefulness in treating cough-related respiratory tract infections. (Venkatesan , 2017; Sultan , 2023). The combined activity of its multiple phytoconstituents supports a multifaceted mechanism-combining antioxidant defense, anti-inflammatory action, and mucosal protection-that collectively explains its efficacy in managing cough and related respiratory conditions (Gairola , 2010; ul Haq , 2013; Rathinamoorthy & Thilagavathi, 2014).
Pharmacological Activities of Terminalia chebula in Respiratory Health
Terminalia Chebula shows a broad spectrum of pharmacological actions that support its traditional use in managing cough and respiratory issues. It appears that their anti-inflammatory activities offer the ability to suppress NLRP3 inflammasome activation, cytokine release and oxidative stress, thereby reducing airway oedema and mucosal irritation.(Chittasupho et al., 2024; Venkatesan et al., 2017).A key point here is that polyphenols and tannins, like chebulagic acid and chebulinic acid, are strong free radical scavengers that protect lung tissue from oxidative damage and allergic inflammation. (Rathinamoorthy & Thilagavathi, 2014; Sultan et al., 2023).
Several researchers have shown that Terminalia chebula has strong expectorant and antitussive effects that lower the frequency and intensity of coughs without making people sleepy or dependent on them. This is different from traditional central antitussives.(ul Haq et al., 2013; Gairola et al., 2010). Such effects are evident because of its soothing impact on the irritated mucosa and its regulatory effect on the cough impulse.(Morice et al., 2006). Moreover, its bronchodilator effect may also be useful in inhibiting histamine release and fixing the mast cells in the airways, thus alleviating bronchial spasms in asthmatics and patients with bronchitis. (Sultan et al., 2023; Sreedharan, Suryawanshi & Bhapkar, 2022).
On the other hand, it seems that clinical evidence confirms the effectiveness of T. Chebula-comprising formulations such as the Vyaghri, haritaki, avaleha utilize for the treatment of bronchitis and allergic airway disease by reducing the severity of cough, sputum expectoration, and breathlessness (Ram & Baghel, 2015; Bhangare & Lahange, 2016). Up-to-date research studies indicate the presence of a protective effect in lung injury. These include low levels of inflammatory infiltration and improved lung tissue recovery(Solaiyappan et al., 2025).
A closer look suggested that Terminalia Chebula shows notable antimicrobial activity against respiratory pathogens, including S. pneumoniae and H. influenzae, making it useful for coughs usually caused by infection.(Venkatesan et al., 2017; Ovia, Yasasve & Vishal, 2021). Terminalia chebula is a multi-mechanism therapeutic agent for respiratory health and cough relief because of its antioxidant, anti-inflammatory, mucosal protective, bronchodilatory, antimicrobial, and antitussive qualities (Sreedharan et al., 2022; Sultan et al., 2023).
Mechanistic Insight of Terminalia chebula in Respiratory Health
The herbal use of Terminalia Chebula for cough and respiratory ailments can be characterised by potentiating more than one biomechanism. The major polyphenols and tannins present in the herb (chebulagic acids, chebulinic acids, gallic acid, and ellagic acids) have high antioxidant properties through which the epithelial lining of the respiratory tracts can be saved from oxidative damage (Rathinamoorthy & Thilagavathi, 2014; Sultan et al., 2023).
Seems to These agents suppress cytokines, including TNF-α, IL-6, and IL-1β, hence minimizing airway inflammation and oedema caused by cough (Venkatesan et al., 2017; Chittasupho et al., 2024).
One way to interpret that is that T. chebula has been shown to stabilise mast cells and decrease histamine secretion, thereby lowering airway narrowing characteristic of asthma and cough due to allergens.(Jantrapirom et al., 2021; Sreedharan et al., 2022).
It has has antimicrobial properties that are useful in fighting secondary infections. An induced cough is likely to protect and thin mucus for ease of expulsion and soothe irritated mucosa.(Gairola et al., 2010; Venkatesan et al., 2017).
These mechanisms, when considered together, show the multi-target protective action on the respiratory system that follows both traditional and scientific methods for therapeutic use.(Sultan et al., 2023; Ram & Baghel, 2015).
Flowchart of Mechanism
Irritation / Infection in Respiration
?
Oxidative Stress & Cytokine Release
?
Airway Inflammation & Mucosal Damage
?
Chemical constituents of T. Chebula (Chebulagic acid, Chebulinic acid )
?
?
? Airway Hyperreactivity & ? Mucus Viscosity
?
Relief of Cough & Improved Breathing
Terminalia chebula's clinical and formulation sign in respiratory disease
The various classic ayurvedic formulations containing Terminalia chebula have clinical studies interpreting respiratory benefits in cough, asthma, bronchitis and respiratory conditions. The clinical study has shown positive effects on cough, sputum expectoration, wheezing, and shortness of breath, confirming relief and lung functional improvement.(Ram & Baghel, 2015; Bhangare & Lahange, 2016).
Evidence based reviews is closely linked to Ayurvedic practices regarding lungs and respiratory passages highlight the importance of T. chebula in Triphala formulation to cure chronic cough, allergic rhinitis, and airway hyper reactivity (Sreedharan, Suryawanshi & Bhapkar, 2022).Based on some new pharmacological research, it seems that T. chebula has shown potential to be useful by inhibiting inflammatory infiltration and protecting the lungs in experimentally established models of pulmonary injury. (Solaiyappan et al., 2025).
A key point here is that T. chebula extract-based triphala preparations have also displayed potential in reducing cytokine-mediated airway inflammation and NLRP3-inflammasome activation, thus suggesting their relevance in resisting viral-induced airway inflammation.(Chittasupho et al., 2024).
Taken all together, the interpreted results indicate that Terminalia chebula is important and relevant as a potential medication capable of influencing cough and respiratory health through a variety of mechanisms
Safety and Toxicity Profile of Terminalia chebula
It has been consumed as churna, kvatha, and avaleha in oral traditional forms for thousands of years, indicating its efficacy in respiratory and digestive health. It has been reported to be safe when taken in appropriate therapeutic dose ranges (Sharma, Singh & Kumar, 2019). According to clinical experience, asthma and chronic bronchitis tolerate Ayurvedic formulations such as Vyaghri Haritaki Avaleha well. During the treatment course, we were unremarkable (Ram & Baghel, 2015; Bhangare & Lahange, 2016). In a similar manner, relative research on Ayurvedic inhalers for pulmonary ailments has found T. chebula to retain tolerability in a broad spectrum of patients (Sreedharan, Suryawanshi & Bhapkar, 2022).
Experimental studies also support its low toxicity, showing protection of lung tissue and reductions in inflammatory infiltration without causing organ-level damage in animal models (Solaiyappan et al., 2025). However, mild gastrointestinal effects such as loose stools or abdominal tightness may occur when taken in excess dosage, likely due to its natural laxative tannins (Sultan et al., 2023). Long-term or high-dose intake should therefore be avoided, particularly in pregnancy, dehydration, or individuals with electrolyte imbalance, where caution is advised (Rathinamoorthy & Thilagavathi, 2014).
Overall, available clinical, ethnomedical, and pharmacological evidence suggests that T. chebula is safe when used at prescribed therapeutic doses, with minimal toxicity and a favorable safety margin, making it a suitable plant-based option for long-term respiratory health support (Sultan et al., 2023; Sharma, Singh & Kumar, 2019).
Research Gap and Future Prospects
Although Terminalia chebula has been utilised for many decades in the treatment of cough and respiratory infections, relatively little research has been carried out (Sharma, Singh & Kumar, 2019). Few studies interpreting that the clinical use of the substance is related to the effectiveness of the respiratory system have been undertaken, except that which focuses on the anti-oxidantive activity of Terminalia chebula.(Lee ., 2005; Cheng ., 2003). Even in classical preparations such as Vyaghriharitaki Avaleha, the number of patients with chronic bronchitis and asthma was limited, as there were no strict controls (Ram & Baghel, 2015; Bhangare & Lahange, 2016). Along with this, the standardised dosage form and ratio of extract in standardised extracts that have not been clearly defined bring about discrepancies in individual responses to treatment (Sultan et al., 2023). Recent mechanistic data suggest modulation of NLRP3 inflammasome signaling, but pathway-specific validation in human airway disease remains underdeveloped (Chittasupho et al., 2024).Even though relatively little scientific research has been conducted, Terminalia chebula has been used for several decades as an effective treatment for a cough and respiratory illnesses.(Solaiyappan et al., 2025).
CONCLUSION
Specifically, it has been mentioned in the review that Terminalia chebula ( Haritaki), has shown great potential in the management of cough and respiratory ailments. It has been observed that in the case of cough and respiratory ailments, Haritaki has shown varied mechanisms such as antioxidant, anti-inflammatory, muco-servative, mast cell stabilizing, and immune mechanisms. Clinical efficacy and formulation evidence, including the use of compounds like Vyaghri haritaki Avaleha or Triphala, has shown signs of the effectiveness of this herb in reducing the occurrences of cough, aiding in expectoration, and relieving discomfort in respiration with a safe action of the herb in the doses.Even so, despite such encouraging results, the existing studies are impaired by a small sample size for human clinical studies and unstandardized formulations of the plant extracts used, as well as a lack of large-scale controlled trials. When considering utilizing Terminalia chebula as a widely accepted and scientifically proven respiratory medication, various clinical trials could be aimed at establishing the dosage levels and pharmacokinetics of the medication. Overall, possible reason for this is that Terminalia chebula is a useful herb-based phytomedicine, which has strong traditional bases as well as modern pharmacological backing; thus, its use is entitled to a high potential for integration into the evidence-based treatment of respiratory health.
REFERENCES
Chitren Verma, Mohnish Kumar, Kamlesh Patel, Abhay Kaushal, Praveen Kumar Sahu, Dr. Gyanesh Kumar Sahu, A Review on Terminalia chebula (Chebulic Myrobalan) in Cough and Respiratory Health, Int. J. of Pharm. Sci., 2026, Vol 4, Issue 2, 4183-4192. https://doi.org/10.5281/zenodo.18776802
10.5281/zenodo.18776802
