He Zi
StarTerminalia chebula Retz.
Traditionally used for
- Nose & throat
- Cough & breathing
- Bowel health
- Energy & fatigue
Cautions & contraindications
- Liver conditions
☯ TCM Properties
Astringes the Intestines and Stops Diarrhea; Astringes the Lungs and Stops Cough; Descends Qi; Clears the Lungs and Benefits the Throat
Traditional Chinese Uses
He Zi (chebulic myrobalan fruit) is a neutral, astringent herb used in Chinese medicine to bind the intestines and stop chronic diarrhea, astringe the Lung to relieve persistent cough and hoarseness, and clear Lung Heat for specific types of throat conditions. It is specifically indicated for chronic, deficiency-type diarrhea that has not responded to treatment, and for long-standing cough with loss of voice. It is not appropriate for acute infections or the early stages of illness where the pathogen has not yet been resolved.
Western Herbalism Properties
Relationships
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Botanical Description
Terminalia chebula (Combretaceae), known as Haritaki in Sanskrit and He Zi in Chinese, is a medium to large deciduous tree 15-30 m tall with a rounded crown, ash-grey to dark brown longitudinally fissured bark, and pubescent young twigs. Leaves are opposite or subopposite, broadly elliptic, 7-20 cm long, with rusty pubescence beneath and two glands on the petiole. Small dull white to yellowish flowers with an offensive odor are borne in terminal spikes, followed by ovoid, longitudinally ridged drupes 2.5-4.5 cm long that ripen from green to yellowish-brown. The hard, astringent fruits, harvested when partially ripe and sun-dried, are one of the three myrobalans of Triphala and a cornerstone of Ayurvedic and Tibetan medicine. (Sources: POWO; Wikipedia; PFAF)
Active Constituents
Chebulagic acid
Ellagitannin (hydrolysable tannin)Concentration: One of the two most abundant tannins of the fruit
A chebuloyl ellagitannin largely specific to this genus, and one of the marker constituents used to authenticate the drug by HPLC alongside gallic acid, corilagin, ellagic acid and chebulinic acid. As a large polyphenol it precipitates mucosal protein, which is the physical basis of the astringent action on the intestines and the throat.
Chebulinic acid
Hydrolysable tannin (chebuloyl gallotannin)Concentration: The other of the two most abundant tannins of the fruit
Isolated preparatively from the fruit by counter-current chromatography alongside chebulagic acid. It is one of the five validated marker constituents for quality control of Terminalia species and is cited as an active constituent in pharmacological work on the fruit.
Corilagin
EllagitanninA widely distributed ellagitannin and one of the five HPLC marker constituents validated across four Indian Terminalia species. It is among the compounds most often credited with the antioxidant and anti-inflammatory activity attributed to the fruit.
Gallic acid
Phenolic acidThe simplest phenolic of the drug and the hydrolysis product of its gallotannins, so its measured level rises with extraction conditions and storage. It is a marker constituent for identity, and it has been reported to inhibit CYP3A4 and CYP2D6 in vitro, which is relevant to how the whole extract behaves.
Chebulic acid
Hydrolysable tannin acid unitThe acyl unit that defines the chebuloyl tannins and one of the fourteen components quantified in a validated RP-HPLC assay of the fruit. Its presence separates T. chebula from other high-tannin astringent drugs.
Ellagic acid
Dilactone of hexahydroxydiphenic acid (ellagitannin-derived polyphenol)A hydrolysis product of the ellagitannins and one of the routine marker constituents. Much of the free ellagic acid in a finished decoction is generated during preparation rather than present in the raw fruit.
Punicalagin, terchebulin, casuarinin, chebulanin and 1,2,3,4,6-penta-O-galloyl-D-glucose
Hydrolysable tannins (gallotannins and ellagitannins)Further members of the tannin complex quantified together with the markers above in a fourteen-component RP-HPLC assay of Chebulae Fructus. They matter because the drug's actions are those of a whole tannin fraction, and a single-marker specification does not capture it.
⚠ Drug Interactions
CYP2C19 substrates (omeprazole and other proton pump inhibitors, clopidogrel, voriconazole, diazepam)
In rats given T. chebula for 15 days and then a cocktail of probe drugs, plasma clearance of omeprazole fell while Cmax and AUC rose, indicating CYP2C19 inhibition; theophylline, midazolam, metoprolol and tolbutamide were unaffected, so CYP1A2, 3A4, 2D6 and 2C9 appear not to be involved. The authors attribute the effect to the tannins in the water extract. An earlier in vitro assay of standardised T. chebula extract also showed concentration-dependent CYP inhibition. Clopidogrel is the important asymmetric case: it is a prodrug that CYP2C19 activates, so inhibition would reduce rather than increase its effect.
Clinical note: The direct evidence is animal and in vitro, not human. Use caution and monitor effect rather than assuming no interaction where the co-prescribed drug has a narrow margin, and be particularly careful with clopidogrel after stenting.
CYP2E1 substrates (paracetamol/acetaminophen, chlorzoxazone, and ethanol)
In the same rat cocktail study, clearance of chlorzoxazone, the standard CYP2E1 probe, fell with Cmax and AUC rising, indicating CYP2E1 inhibition. CYP2E1 is the route by which paracetamol generates its hepatotoxic quinone imine, so the direction of any effect on paracetamol would be complex and has not been tested in people.
Clinical note: Do not extrapolate a protective effect on paracetamol from this. Simply avoid pairing high-dose long-course He Zi with regular high-dose paracetamol, and note the rat data if unexplained liver enzyme changes appear.
Oral iron salts and other divalent mineral supplements
He Zi is a high-tannin drug, with hydrolysable tannins as the dominant constituent class. Hydrolysable and condensed tannins are well established to bind non-haem iron in the gut lumen into non-absorbable complexes; this is the mechanism behind the reduced iron status associated with tea. The specific quantification for this drug has not been done, but the chemistry is the same.
Clinical note: Separate the herb from iron by at least two hours, and be alert to it in patients taking He Zi for chronic diarrhoea, who are already at risk of poor iron status.
Antidiabetic drugs (metformin, sulfonylureas, insulin)
In a randomised double-blind placebo-controlled trial in 60 people with type 2 diabetes, an aqueous T. chebula extract at 250 mg and 500 mg twice daily for 12 weeks significantly improved endothelial function and other cardiovascular risk indicators against placebo, with glycosylated haemoglobin among the measured outcomes. Patients in that trial were on their usual diabetic care, so this is an add-on effect rather than a stand-alone one.
Clinical note: Not a reason to avoid the combination, but a reason to monitor. Ask patients to check capillary glucose more often for the first fortnight after starting He Zi.
Immature Terminalia chebula fruit (Xi Qing Guo / Zang Qing Guo) or Terminalia bellirica (Mao He Zi) supplied as He Zi
Xi Qing Guo is the immature fruit of the same species and is a separate Pharmacopoeia entry directed at throat heat, not at the intestinal astringency of the mature He Zi. Terminalia bellirica is a different species used in the same Ayurvedic and Tibetan formulas (both are components of Triphala), and the validated HPLC marker assay was developed precisely because gallic acid, corilagin, chebulagic acid, ellagic acid and chebulinic acid distinguish four Terminalia species that are otherwise easily confused in commerce.
Clinical note: Specify mature fruit when ordering, and note that a patient already taking Triphala is receiving T. chebula plus T. bellirica plus Phyllanthus emblica, so a separate He Zi prescription is stacking the tannin dose.
Dosage
| Form | Amount | Frequency | Duration | Population | Notes |
|---|---|---|---|---|---|
| decoction | 3–10 g | Daily | — | — | 中国药典 2020 【用法与用量】3～10g。 【性味与归经】苦、酸、涩，平。归肺、大肠经。 — Chinese Pharmacopoeia 2020, quoted verbatim; route and cautions preserved. Replaces a cleared category-filler value. |
Dui Yao — Herb Pairs
The classical two-herb combinations this herb appears in, each with an action neither herb has alone.
Astringing the Lung while opening Lung qi and benefiting the throat, the pair restores the voice in chronic cough with hoarseness or loss of voice.
Traditionally with Gan Cao.
Core pair of a classical formula — He Zi Tang, Huang Di Su Wen Xuan Ming Lun Fang (Liu Wansu)
Two strongly astringent herbs reinforce each other to bind the intestines and stop intractable chronic diarrhea and dysentery.
Only for chronic cases without residual pathogen; contraindicated in early-stage diarrhea or dysentery. Ying Su Ke is addictive and legally controlled in many jurisdictions.
Core pair of a classical formula — Zhen Ren Yang Zang Tang, Tai Ping Hui Min He Ji Ju Fang
Evidence Tier
Strong evidence · 6 studiesRecorded studies by study design, strongest design at the top. This is a study-design tier only, not a GRADE rating: it does not weigh risk of bias, consistency or precision.
Systematic review / meta-analysis
0
Randomized controlled trial
4
3 verified · 1 unverified
Show 4 studies
- Effect of an 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
- Effects of dietary supplementation with a standardized aqueous extract of Terminalia chebula fruit (AyuFlex®) on joint mobility, comfort, and functional capacity in healthy overweight subjects: a randomized placebo-controlled clinical trial
- Effect of Terminalia chebula Extract and Chlorhexidine on Salivary pH and Periodontal Health: 2 Weeks Randomized Control Trial
- Evaluation of the efficacy of topical Terminalia chebula Retz. with vinegar in the treatment of tinea corporis: a non-inferiority randomized controlled trial
Other clinical trial
0
Observational / case report
0
In vitro / animal
2
0 verified · 2 unverified
Other / unclassified
0
Verified: design read from PubMed for a DOI that resolves to the cited paper Unverified: taken from the study's recorded description
Clinical Studies
Effect of an 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
60 patients with type 2 diabetes were randomised to aqueous T. chebula extract 250 mg, 500 mg or placebo twice daily for 12 weeks. Both doses significantly improved endothelial function measured as reflection index against placebo (-2.55 ± 1.82% and -5.21 ± 2.41% versus +1.40 ± 2.11%), with the 500 mg dose stronger, and other cardiovascular risk indicators including nitric oxide, malondialdehyde, glutathione, hsCRP, HbA1c and lipids also improved. It is a single-centre trial of modest size.
Effects of dietary supplementation with a standardized aqueous extract of Terminalia chebula fruit (AyuFlex®) on joint mobility, comfort, and functional capacity in healthy overweight subjects: a randomized placebo-controlled clinical trial
105 overweight but otherwise healthy adults aged 35-70 with activity-related knee discomfort took placebo, 250 mg or 500 mg of a standardised aqueous fruit extract twice daily for 84 days. The pooled active groups improved modified KOOS global scores (p = 0.023) and knee discomfort with activity (p = 0.001), improved 6-minute walk distance (p = 0.047) and post-walk discomfort (p = 0.026), with no adverse events and safety bloods within normal limits. The two doses were not significantly different. The trial was sponsored by the extract's manufacturer and the subjects were not an osteoarthritis population.
Effect of Terminalia chebula Extract and Chlorhexidine on Salivary pH and Periodontal Health: 2 Weeks Randomized Control Trial
A double-blind randomised trial of a 10% T. chebula mouth rinse against 0.12% chlorhexidine, used twice daily for two weeks in 78 patients (26 per group). The T. chebula rinse reduced microbial plaque and gingival inflammation and neutralised salivary pH. This supports the classical use for throat and mouth rather than the intestinal indications, and it is a topical rather than a systemic exposure.
Evaluation of the efficacy of topical Terminalia chebula Retz. with vinegar in the treatment of tinea corporis: a non-inferiority randomized controlled trial
A non-inferiority trial of T. chebula fruit powder mixed with vinegar against terbinafine hydrochloride 1% cream in tinea corporis, analysed per protocol on 40 participants (21 test, 19 control). Differences in KOH mount hyphae, pruritus VAS, physician's global assessment and dermatology life quality index exceeded the non-inferiority margin, so the test preparation was judged not inferior. It is a small single-centre trial with a per-protocol rather than intention-to-treat analysis.
Cytochrome P450 Inhibition Assay for Standardized Extract of Terminalia chebula Retz.
A standardised T. chebula extract showed concentration-dependent inhibition of cytochrome P450 in vitro, establishing that the drug has herb-drug interaction potential through this route. In vitro CYP inhibition does not by itself predict a clinically meaningful interaction, and the more specific isoform picture comes from the later rat work.
Effects of mongolian medicine Terminalia chebula Retz. on 6 CYP450 enzymes in rats
Wistar rats received T. chebula for 15 days and were then given a cocktail of probe drugs. Clearance of chlorzoxazone (CYP2E1) and omeprazole (CYP2C19) fell while Cmax and AUC rose, whereas theophylline, midazolam, metoprolol and tolbutamide were unchanged, indicating selective inhibition of CYP2E1 and CYP2C19 with no effect on CYP1A2, 2C9, 3A4 or 2D6. The authors attribute the effect to tannins in the water extract and advise care with substrates of the two affected isoforms.
Historical Texts
Xin Xiu Ben Cao (Tang Ben Cao)
Tang dynasty (659)References
- Juang LJ, Sheu SJ, Lin TC. Determination of hydrolyzable tannins in the fruit of Terminalia chebula Retz. by high-performance liquid chromatography and capillary electrophoresis . Journal of Separation Science (2004) [DOI]
- Dhanani T, Shah S, Kumar S. A Validated High-Performance Liquid Chromatography Method for Determination of Tannin-Related Marker Constituents Gallic Acid, Corilagin, Chebulagic Acid, Ellagic Acid and Chebulinic Acid in Four Terminalia Species from India . Journal of Chromatographic Science (2014) [DOI]
This information is for educational purposes only and is not intended to replace professional medical advice. Always consult a qualified healthcare provider before using any herbal remedy, especially if you are pregnant, nursing, or taking medications.
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