THERAPEUTIC POTENTIAL OF TRYUSHNADI MANDURA IN IRON-DEFICIENCY ANEMIA: A REVIEW

THERAPEUTIC POTENTIAL OF TRYUSHNADI MANDURA IN IRON-DEFICIENCY ANEMIA: A REVIEW

Apoorva Sharma *, Brahm Dutt Sharma and Nisha K. Ojha

Department of Kaumarbhritya, National Institute of Ayurveda (Deemed to be University), Jaipur, Rajasthan, India.

ABSTRACT: Background: Iron deficiency anemia (IDA) is a major global health problem, especially affecting children, women, and pregnant females. In Ayurveda, IDA can be correlated with Pandu Roga, which is associated with impaired digestion (Mandagni) and defective formation of Rakta Dhatu. Iron deficiency anemia (IDA) is the most frequent hematological disorder in children, with an incidence in industrialized countries of 20.1% between 0 and 4 years of age and 5.9% between 5 and 14 years (39 and 48.1% in developing countries). Objective: To critically review the available classical and contemporary evidence on the safety and therapeutic potential of Tryushanadi Mandura in the management of iron deficiency anemia. Material and Mathods: A narrative literature review was conducted using Ayurvedic classical texts such as Chakradutta and electronic databases including PubMed, Google Scholar, and Medline. Relevant articles on formulation components, pharmacological actions, and anemia management were screened. The index, non-index medical journals has also referred to collect information of relevant topic. Results: The formulation contains multiple herbal and mineral ingredients with reported Deepana, Pachana, Rasayana, and Raktavardhaka properties. Individual components demonstrate pharmacological activities such as antioxidant, anti-inflammatory, hepatoprotective, and bioavailability-enhancing effects. However, there is limited direct clinical evidence specifically evaluating Tryushanadi Mandura in IDA. Conclusion: Tryushanadi Mandura shows potential as a supportive formulation in IDA management based on classical rationale and pharmacological properties. However, current evidence is insufficient to conclusively establish its clinical safety and efficacy. Well-designed clinical trials are required.

Keywords: Hematinic, Iron deficiency anemia, Mandagni, Pandu Roga, Tryushanadi Mandura

INTRODUCTION: Iron deficiency Anemia (IDA) is a global public health crisis, so also in India.

As per the World Health Organization's (WHO's) report, there are about two billion Anemia cases globally, of which half of them are IDA ¹.

Anemia is the late indicator of iron deficiency in the human body, hence the prevalence of iron deficiency is estimated 2.5 times higher than that of Anemia. Similarly, IDA during pregnancy is associated with maternal mortality, preterm labor, low birth weight, and infant mortality ².

IDA among children affects their cognitive and motor development and increases the susceptibility of infections ³. According to the World Health Organization, the global prevalence of anemia was estimated at 29.9% in women of reproductive age, 29.6% in non-pregnant women of reproductive age, 36.5% in pregnant women, 39.8% in children aged 6–59 months, and 60.2% in children under 5 years old in 2019. It leads to symptoms such as lassitude, general debility, lethargy, and poor work performance, and in some cases, it can result in mental retardation, low intelligence, and an aberrant immune response ⁴.

The Ayurvedic anemia correcting agents are found to be practiced since centuries ⁵. With this background, an effort is made to review various types of Ayurvedic formulations that have prove efficient in the management of IDA. In Ayurveda, the disease Pandu Roga can be compared with that of IDA, especially owing to the clinical manifestation of Panduta or pallor in the whole body ⁶. Unlike modern medicine, which primarily addresses hematological parameters, Ayurveda emphasizes a systemic imbalance rooted in digestion, metabolism, and tissue nourishment ⁷.

The Concept of Iron Deficiency Anemia in Ayurveda: In Ayurveda, a condition with striking resemblance to anemia is described as Pandu Roga. Irregular and faulty PittaPrakopaka dietary habits and lifestyle like Amla, Lavana, Katu Rasa Atisevana, Kshara, Ushna, Tikshna, Ruksha Ahara Atisevana impairs the digestion, leading to Mandagni. Due to Nidana, Pittadosha gets vitiated and expelled by Vayu. It then reaches the Hridya and from there it mobilizes into entire body via Dashadhamani and get localized between Twaka and Mamsa causing Dhatushaithayata and Guruta. Vitiated kapha, Vata, Asruk, Twaka and Mamsa cause Twakavaivarnata such as Pandu, Haridra, Harita etc. There are systemic symptoms like Exertion dyspnoea, tiredness, breathlessness, leg cramps, etc. In ayurvedic classics, this diseased condition is known as Pandu Roga.

Exploring the Potential Superiority of Traditional Medicine in Managing IDA: The burden of iron-deficiency anemia (IDA) remains persistently high in India due to the poor tolerability of oral iron supplementation. Therefore, more focus is required to explore traditional medicine for safe and effective options for managing IDA. The primary treatment for IDA is oral iron replacement therapy, which is convenient, affordable, and effective in the management of stable IDA patients ⁸. It rapidly improves hemoglobin levels, but it is often poorly tolerated over time due to associated nausea, vomiting, constipation, and abdominal discomfort ⁹. The poor tolerability of oral iron supplementation may compromise its good compliance and, in turn, leads to the persistence of IDA ¹⁰. Hence, it is imperative to explore traditional medical systems for interventions with comparable efficacy to oral iron supplementation, minimal adverse event/adverse drug reaction, and better tolerability.

Drug Review: Tryushanadi Mandura (Chakradutta Pandu Roga Chikits Adhyaya8/35-40).

TABLE 1: INGREDIENTS OF TRYUSHANADI MANDURA

TABLE 2: THE RASA-PANCHAKA OF CONTENTS OF TRYUSHANADI MANDURA

TABLE 3: AYURVEDA PROPERTIES AND PHARMACOLOGY ACTION FOUND IN THE INGREDIENTS OF TRYUSHANADI MANDURA

TABLE 4:  CHEMICAL CONSTITUENTS FOUND IN THE INGREDIENTS OF TRYUSHANADI MANDURA

DISCUSSION: Due to the predominance of Katu-Tikta Rasa Tryushanadi Mandura will improve the Agni, exhibit germicidal action, and will aid in clearing the Srotas ⁷⁹. Due to predominance of Laghu Rooksha Guna, it will act as Pathya, Ropana, and Sthambana. Since most of the drugs possess mainly Katu Vipaka, it will help in subsiding the symptoms due to vitiated Kapha. The formulation will enhance Pachana due to its Ushna Veerya which is very essential in conditions associated with Mandagni and Ama ⁸⁰. The ingredients such as Chitraka, Chavya, and Pippali will act as appetizer, digestive, hepatoprotective, cholagogue, and gastro protective which will alleviate Aruchi. Further, Tryushanadi Mandura contains Amalaki, one of the richest sources of ascorbic acid which helps in the absorption of iron Further, Lauha Bhasma possesses hematinic and hemoglobin regeneration properties ⁸¹. Pippali, Amalaki, Musta is Balya and will act as immunomodulator which is helpful for controlling Shrama. Mandura Bhasma, Daruharidra, and Gomutra are digestive and hematinic which will help in balancing erythropoiesis and thus alleviates Panduta, the cardinal symptom of the disease. The drugs such as Maricha, Pippalimula, Chavya, Shunti, and Pippali will act as analgesic and thus help in managing Pindikodweshtana. Pippali, Musta, Chitraka, Triphala, Maricha, Shunti, Vidanga, and Daruharidra possess Dipana, Pachana, and Amahara properties along with antipyretic activity and are effective against symptoms such as Jwara, Alasya, and Gaurava. The Rasayana and Raktavardhaka action of Triphala, Vidanga, Daruharidra, and Mandura bhasma will act against Dhatu kshaya. Few drugs such as Pippali, Shunti, Bibhitaki, and Daruharidra act on Pranavaha Srotas and help in alleviating Shwasa, that is, shortness of breath. Drug such as Triphala, and Gomutra exhibits properties such as Dipana, Pachana, Rechana, and Bhedana. Gomutra, and Shunti ingredients will act as Mutrala and Shothaghna and thus alleviate Shotha. In cases of anemia of inflammation due to associated inflammatory diseases in which features such as low serum iron despite adequate systemic iron stores is present, drugs possessing anti-inflammatory action such as Pippali, and Amalaki will come in aid ⁸². Rakta Dhatu gets vitiated due to the intake of Nishpava, Masha, Pinyaka, Tila, Kshara, Mrit, and food substances which are Ushna, Vidahi, Teekshna, Asatmya, and Viruddha Ahara. The vitiated Rakta Dhatu will further affect the Moolasthana of Raktavaha Srotas, that is, Yakrut and Pleeha ⁸³. The drugs possessing hepatoprotective action will help in preventing the condition from further progression. Anti-ulcerative drugs such as Amalaki, Devadaru and Musta will help in sustaining the gastric function which is very essential for absorption of Iron ⁸⁴. Helminths that are transmitted through soil may get ingested and further infect the gastrointestinal tract leading to hampered food intake, malabsorption, and nutrient loss due to the intake of Mrit (pica) which is enlisted as one of the causative factors for Pandu Roga ⁸⁵. Drugs such as Vidanga, Musta, Chitraka, Pippali, and Pippalimoola possesses anti-helminthic property and can act against the progression of the disease in such conditions. Mandura bhasma is considered as incinerated red oxide of iron, which is the main component of Tryushanadi Mandura. It pacifies aggravated Pitta and improves digestion and metabolism. The required amount of iron for normal erythropoiesis can be supplied by the ferric and ferrous forms of Mandura. Gomutra, the Dravya which is used for the Shodana of Mandura, is an antioxidant and it contains erythropoietin hormone which helps in the production of red blood cells and hemoglobin. The functional grouping of the formulation ingredients according to their principal Ayurvedic actions (Deepana-Pachana, Rasayana, Balya, and Anulomana) is summarized in Fig. 1.

CONCLUSION: Pandu is a Tridoshaja Vyadhi with Pitta as a predominant Dosha. It is more prevalent among poor and middle class and especially women are more prone to this disease. It is found more in Mandagni people. It can be concluded that Tryushanadi Mandura, a poly herbomineral formulation. Iron is an essential element as it is essential for various metabolic processes such as oxygen transport, DNA synthesis, and electron transport ⁸⁶. The body requires iron for the synthesis of its oxygen transport proteins, that is, hemoglobin and myoglobin and for the formation of heme enzymes and other iron-containing enzymes involved in electron transfer and oxidation reductions ⁸⁷. Anemia, if left untreated, can affect cognitive development, immunity mechanisms, work capacity, and learning ability. In case of unresolved IDA during pregnancy, it can lead to increased risk of sepsis, maternal mortality, perinatal mortality, and low birth weight ⁸⁸. So, we can use Tryushanadi Mandura as easily obtainable, palatable, cost-effective alternative drug of choice in iron deficiency anemia (IDA) in children.

FIG. 1: FUNCTIONAL GROUPING OF THE INGREDIENTS OF TRYUSHANADI MANDURA ACCORDING TO THEIR PRINCIPAL AYURVEDIC ACTIONS

ACKNOWLEDGEMENT: Nil

CONFLICTS OF INTEREST: Nil

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    Sharma A, Sharma BD and Ojha NK: Therapeutic potential of Tryushnadi Mandura in iron-deficiency Anemia: a review. Int J Pharm Sci & Res 2026; 17(9): 2622-29. doi: 10.13040/IJPSR.0975-8232.17(9).2622-29.

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