Ayurvedic preparation in the treatment of nutritional anemia

Abstract

Based on experience of author in his practice a pilot study was carried out on 600 non-pregnant anemic women of reproductive age group (11-45 years) from Dehradun district to generate baseline data on the efficacy of Ayurvedic iron preparation (Ayas)**, Ayurvedic non iron preparation (SS)*** and combination of these two. For comparison a group of subjects was also given IFA tablet. In a 90 days duration study, the maximum gain (1.8 g%) in hemoglobin level was recorded with SS + Ayas, followed by 1.6 g % with Ayas; 1.5 g % with SS and 1.1 g % with IFA. The good gain (1.5 g %) in haemoglobin level of anemic women given non-iron Ayurvedic preparation 'SS' was very encouraging as it is cost effective and showed almost no side-effects in the present study. Sootshekhar Rasa has been mentioned in various classical Ayurvedic text in the chapter of 'Amla pitta Rogadhikara', which means to reduce acid in the body. Similarly, Sitopaladi is a well-known classical Ayurvedic formulation, which has been described in the text as cough reducing agent. In the present study, author used these medicines for the formulation first time in improving nutritional anemia in non-pregnant women. The hypothesis for using non-iron Ayurvedic preparation SS was that it improves the absorption of iron in gastrointestinal tract. The results of this pilot study to indicate the possibility of using SS for improving nutritional anemia. Further studies are required covering larger population from different parts of the country to ascertain efficacy, sustainability of hemoglobin level after discontinuation of treatment and also to understand the intrigue phenomenon about the character and pharmacology of these Ayurvedic formulations.

Full text

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
AYURVEDIC PREPARATION IN THE TREATMENT OF
NUTRITIONAL ANEMIA
Prakash B, Pandey S, Singh S
Based on experience of author in his practice a pilot study was carried out on 600 non-pregnant
anemic women of reproductive age group (11-45 years) from Dehradun district to generate
baseline data on the efficacy of Ayurvedic iron preparation (Ayas)**, Ayurvedic non iron
preparation (SS)*** and combination of these two. For comparison a group of subjects was also
given IFA tablet. In a 90 days duration study, the maximum gain (1.8 g%) in hemoglobin level was
recorded with SS + Ayas, followed by 1.6 g % with Ayas; 1.5 g % with SS and 1.1 g % with IF A.
The good gain (1.5 g%) in hemoglobin level of anemic women given non-iron Ayurvedic
preparation 'SS' was very encouraging as it is cost effective and showed almost no side-effects in
the present study. Sootshekhar Rasa has been mentioned in various classical Ayurvedic text in
the chapter of 'Amla pitta Rogadhikara', which means to reduce acid in the body. Similarly,
Sitopaladi is a well-known classical Ayurvedic formulation, which has been described in the text
as cough reducing agent. In the present study, author used these medicines for the formulation
first time in improving nutritional anemia in non-pregnant women. The hypothesis for using non-
iron Ayurvedic preparation SS was that it improves the absorption of iron in gastrointestinal tract.
The results of this pilot study do indicate the possibility of using SS for improving nutritional
anemia. Further studies are required covering larger population from different parts of the country
to ascertain efficacy, sustainability of hemoglobin level after discontinuation of treatment and also
to understand the intrigue phenomenon about the character and pharmacology of these
Ayurvedic formulations.
Key word: Anemia, Hemoglobin, Ayas, Soothsekha and Sitopaladi.
INTRODUCTION
Anemia is a problem of public health significance. The consequences of iron deficiency anemia in
infants and children are, impaired motor development and coordination, decreased physical
activity, inattention, fatigue etc. (Pollitt and Leibel,1982; Pollitt et al 1983; Soemantri et ai, 1985
and Pollitt et at, 1985). In adult male and female anemia causes decreased resistance to fatigue
and decreased physical work and earning capacity (Viteri and Torun, 1974 and Hallberg and
Scrimshaw, 1981). In pregnant women, the iron deficiency anemia causes increased maternal
and fetal morbidity and mortality and increased risk of low birth weight (Mac Gregor, 1981;
Llewellyn Jones, 1965; Ratten.and Beishcher, 1972 and Yusufji et al, 1973). Anemia is the most
prevalent nutrition problem in the world today, affecting more than 700 million persons (DeMaeyer
and Adiels- Tegman, 1985). In India the prevalence of anemia in pregnant women (hemoglobin <
11 g%) of different parts of the country is in range of33 to 89% (Seshadri et al, 1994; ICMR, 1992;
Christian et al, 1989; ICMR, 1989; Agarwal et al, 1987; Prema et al, 1981 b;Soodetal,
1975;YusufjietaI1973). Data on prevalence of anemia in adolescent girls are limited. A study
concluded on 1513 rural adolescent girls in Gujarat indicated that 61 % of the girls were anemic
i.e. Hb < 12g% (Seshadri,1998). The healing powers of Ayurveda, the age-old practice of going to
the root of any disease without causing any side effects seems to find favour with public.
Preliminary studies carried out by Principal Investigator revealed that in general Ayurvedic
treatment on women, especially on anemic women was encouraging.
The objective of the pilot study conducted was to evaluate the efficacy of the various Ayurvedic
formulations in curing nutritional anemia. The study was conducted during 1999-2000.
Correspondence to VCP Cancer Research Foundation, Mandir Marg, Turner, Clement Town, Dehradun-248002
e-mail: vcucrf@deI2.vsnl.net.in, Fax: 0135-640909
**Ayas: A proprietary Ayurvedic preparation containing Iron Bhasma and Triphla Powder
***SS: Classical Ayurvedic preparation –combination of Soothsekhar Rasa and SitopaJadi Powder

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
METHODOLOGY
Sampling
A total of 1830 women of reproductive age groups (11-45 years) were initially recruited for the
study from 15 clusters covering rural and urban areas falling under Raipur and Doiwala blocks of
Dehradun district of Uttar Pradesh. Blood samples from these women were collected and
hemoglobin estimation was
carried out. A total of838 (45.79%) out of 1830 women found anaemic (hemoglobin < 12 g%). Out
of these 838 anemic women 600 were selected for study and they were further divided intofive
groups, each consisting of 120 women (Table 1).
Table 1: Various study groups and type of treatment given
Group
Status
Treatment
I
Control group
Diet + starch
II
Experiment group
Diet + IF A
III
Experiment group
Diet + Ayas
IV
Experiment group
Diet + SS
V
Experiment group
Diet + Ayas + SS
Study Design
During screening, those women showed symptoms of pregnancy, lactation of < 6 months,
diabetes, malaria, tuberculosis, or any malignancies/tumour were excluded from the study.
Group-I was control and women recruited in this group were taking normal diet. Women of groups
II, III, IV and V were given IFA tablets,
Ayas (an Ayurvedic preparation), Sootshekhar Rasa and Sitopaladi
Churana (SS: an Ayurvedic preparation) and Ayas + SS together respectively as per scheduled
given in Table 2.
Table 2 : Doses of medicines given to women of various study groups
S.No.
Medicine
Dosage
1
IFA
(1X1) 1OD
2
AYAS
(1X2) 1BD
3
SS
(1X2) 1BD
4
SS+AYAS
(1X2) 1BD
One dose of Ayas is made up of 125 Iron Bhasma and 500 mg Triphla Churana. The
Soothshekher Rasa and Sitopaladi Churana (SS) is a non-iron containing ayurvedic preparation.
One dose ofSS contains 125 mg and 500 mg ofSootshekher and Sitopaladi respectively. On 0
day, blood samples were drawn form all the subjects for hemoglobin estimation and thereafter
medicines were given as per schedule mentioned in Table 2. Blood samples were drawn at
fortnightly intervals thereafter upto the duration of study i.e. 90 days for assessment of
hemoglobin level. A questionnaire was also used for collection of demographic information and
assessment of knowledge, attitude and practices about anemia among women recruited for the
study.
Operationalisation of study
.Several meetings of villagers and the elected representatives ! of the Panchayat and other
functionaries were held before the onset of study. The Block Pramukhs were roped in to motivate
the subjects. Further the investigators for the study were also introduced to the subjects who
acquainted them with the aim, design and methodology of the study.
Biochemical investigation
Hemoglobin was estimated using filter paper method prescribed by Dacie and Lewis, 1984 and
INACG, 1985.

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
Quality Assurance Programme
Internal and External Quality Assurance Programmes were run alongwith other ICMR study on
micronutrients (vitamin A, iron and iodine) deficiency disorders and protein energy malnutrition.
For External Quality Assurance Programme, the Assam Medical College, Oibrugah was the
'reference laboratory'.
Results
The initial mean hemoglobin (Hb) levels (at 0 day) in all study groups were in range of 10.1 to
10.3 g% (Table-3). The initial mean level of Hb in control group was 10.3 g% and at the
completion of study at 90 days the level of Hb was 10.6 g%; gain of 0.3 g%. Similarly, the gain in
Hb level. in other four groups II,m, IV and V was respectively 1.1, 1.6, 1.5 & 1.8 g% (Table-3 and
Figure 1). The maximum gain in Hb level (1.8 g%) was observed in-group V (Ayas + SS),
whereas minimum (1.1 g%) gain was found in group II (IFA). The gain in Hb level was also
considerable in group III (1.6 g%) and IV (1.5 g %) where Ayurvedic preparations Ayas and SS
were given respectively.
Indian J. Hemat & Blood Transf. 2000; Vol. 18: No.4; 79-83
Table 3: Effect of Ayurvedic preparations on hemoglobin levels of non-pregnant women
(11-45 years)
Mean of Hemoglobin (g%) Level
Days
Group
I
II
III
IV
V
N
110
118
119
117
118
0 days
10.3
10.2
10.1
10.3
10.1
15 days
10.4
10.6
10.5
10.6
10.2
30 days
10.6
10.9
10.8
10.9
10.6
45 days
10.5
11.1
11.0
11.3
10.9
60 days
10.4
11.3
11.2
11.4
11.2
75 days
10.5
11.3
11.2
11.6
11.5
90 days
10.6
11.3
11.7
11.8
11.9
Gain
0.3
1.1
1.6
1.5
1.8
N=582
Table 4: Effect of Ayurvedic preparation on moderate anemic women (Hb 7 to 10 g%)
Mean of Hemoglobin (g%) Level
Days
Group
I
II
III
IV
V
N
52
45
56
50
57
0 days
8.8
8.7
8.3
8.1
8.3
15 days
9.0
9.2
9.0
8.5
9.0
30 days
9.1
9.7
9.5
8.9
9.6
45 days
9.2
9.9
9.9
9.2
10.3
60 days
9.2
10.3
10.2
9.7
10.3
75 days
9.3
10.7
10.4
10.2
10.6
90 days
9.3
10.7
10.5
10.4
11.3
Gain
0.5
2.0
2.2
2.3
3.0
N=260
Out of 582 anemic women, 260 were moderate anemic (Hb 7 to 10 g%). Attempt was made to
see the impact of ayurvedic preparations on moderate anemic women. The mean Hb levelin all
the five groups on 0 day was in range of 8.1 to 8.8 g% (Table 4 and Figure 2). There was a gain
of 0.5% at the end of study in control group. The gain in Hb level in experimental groups was in
range of 2.0 to 3.0 g%, the maximum being in group V (Ayas + 88), and minimum being in group

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
11 (IFA). The gain in Hb in two other groups i.e. III (Ayas) and IV (88) was 2.2 and 2.3 g%
respectively.
Table 5 : Effect of Ayurvedic preparations on mild anemic women (Hb 10.1 % -11.9 gm%)
Mean of Hemoglobin (g%) Level
Days
Group
I
II
III
IV
V
N
58
73
63
67
61
0 days
10.8
11.0
10.8
11.1
11.2
15 days
10.9
11.3
11.2
11.2
11.0
30 days
10.8
11.4
11.4
11.4
11.3
45 days
10.9
11.3
11.6
11.8
11.5
60 days
10.8
11.4
11.7
11.9
11.7
75 days
10.9
11.5
11.8
12.0
11.8
90 days
10.8
11.5
11.9
12.3
12.1
Gain
0
0.5
1.1
1.2
0.9
3.0
N=322
A total of 322 women, out of 582 were mild anemic (Hb 10.1 -11.9 g%). The initial Hb level at 0
day in five groups was in range of 10.8 to 11.2 g% (Table 5 and Figure 2). There was no gain in
Hb level in control group at the end of90 days, where as the maximum (1.2g%) and minimum
(0.5g%), gain was observed in group IV (SS) and group II (IFA) respectively. In group III (Ayas)
the gain was 1.1 g%, whereas in group V (Ayas + SS) , the 0.9 g% gain was recorded.
Table 6: Effect of Ayurvedic preparations on adolescent girls (11-18 years)
Mean Haemoglobin (g%) Level
Days
Group
I
II
III
IV
V
N
72
99
98
92
74
0 days
10.2
10.3
10.2
10.3
10.7
15 days
10.4
10.6
10.4
10.6
10.6
30 days
10.5
10.9
10.7
10.8
11.1
45 days
10.6
10.8
10.9
11.3
11.2
60 days
10.5
11.2
11.2
11.4
11.5
75 days
10.5
11.3
11.3
11.6
11.6
90 days
10.5
11.6
11.6
11.8
11.7
Gain
0.3
1.1
1.4
1.5
1.0
N=435
There were 435 adolescent girls among 582 subjects. The initial i hemoglobin level at 0 day in all
five groups was in range of 10.2 to 10.7 g% (Table 6 and Figure 3). There was gain of 0.3 g% at
90 days in control group. In all four experimental groups the maximum (1.5 g%) and minimum
(1.0 g%) Hb gain was in group IV (SS) and group V (Ayas + SS) respectively. In group II (IFA)
and III (Ayas) the gain was 1.1 and 1.4 g% respectively.

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
Table 7: Effect of Ayurvedic preparations on women aged 19-45 years
Mean of Hemoglobin (g%) Level
Days
Group
I
II
III
IV
V
N
38
19
21
25
44
0 days
10.5
10.2
10.3
10.3
9.0
15 days
10.4
10.5
10.6
10.6
9.5
30 days
10.3
10.7
10.7
10.7
9.9
45 days
10.3
11.0
11.0
11.0
10.5
60 days
10.4
11.0
11.1
11.1
10.9
75 days
10.4
11.3
11.4
11.4
11.0
90 days
10.5
11.5
12.0
12.0
10.6
Gain
0
1.3
1.7
1.7
1.6
N=147
Out of 582 anemic women, 147 were in age group of 19-45 years. In control group, there was no
gain in mean hemoglobin level at the end of experiment i.e. after 90 days (Table 7). The gain in
mean hemoglobin was maximum (1.7 g %) in both groups III (Ayas) and IV (SS). The gain in
hemoglobin level in two other groups II (IF A) and (Ayas + SS) was 1.3 and 1.6 g 0/0 (Figure 3).
Table 8: Side effects reported among study groups
Group
Control (I)
DIET+IFA (II)
DIET+API
(III)
DIET+AP2
(IV)
DIET + PI +
AP2 (V)
No. of total participants
110
118
119
117
118
No. of Complaints
4(3.6%)
22 (18.6%)
6(5%)
4(3.4%)
12*(10.2%)
Nature of Complaints
Headache
Nausea
Loose motion
Nausea
Headache
Constipation
Loss of Apetite
11.3
Pimples
Headache
Nausea
Loose Motion
Out of Total 118 women studied in group-II (IFA), 22 (18.6%) reported complaints of loose
motion, nausea, headache, constipation and loss of appetite. In group-III (Ayas) 6 (5.1%) women
developed pimples. In group IV, 4(3.4%) women out of 117 complained of mild headache. In
group –V 12 (10.2%) women complained of headache, nausea and loose motion. In this group 8
women who reported such complaints were from a particular pocket.
Table 9: Cost of various medicines used in study.
S.NO.
Medicine
Dose
Unit Price (Rs.)
Total (Rs.)
1
IFA
(1X1) 1OD
0.65
0.65
2
SS
(1X2) 1 BD
0.44
0.88
3
AYAS
(1X2) 1 BD
0.85
1.70
4
SS + AYAS
(1X2) 1 BD
0.44 + 0.85 =1.29
2.58
The unit cost was minimum (Rs.O.44) for SS and maximum (Rs.l.29) for SS + Ayas. However,
the total dose cost was the cheapest (Rs. 0.65) for IF A tablets and costliest for SS + Ayas (Rs.
2.58). The per day cost for SS was Rs.0.88 and for Ayas Rs. 1.70 More than half (57%) of the
total women (582) studied were from rural clusters whereas the remaining (43%) were from urban
areas. Majority of women (92.1 %) had more than primary education. Only 45.2% subjects were
aware of IFA program.

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
DISCUSSION
The mean hemoglobin level in control group did not increase more than 0.5 g% in all types of
subjects viz. moderate and mild anemic women and, adolescent girls (11-18 years) as well as
adult women (19-45 years) at the completion of the study i.e. after 90 days (Table 10). Even in
mild anemic and adult women, there was no change in mean hemoglobin values of control group
recorded at the initiation and completion of the project. In terms of gain in hemoglobin level at the
end of the study, all preparations viz. IFA, Ayas, SS and SS + Ayas were most effective in
moderate anemic women and least in mild anemic women (Table 10). In 582 anemic women the
maximum gain (1.8 g%) in hemoglobin level was recorded with SS + Ayas, followed by 1.6 g %
with Ayas; 1.5 g % with SS and 1.1 g % with IF A. One tablet of IF A was given per day which
contains 100 mg of elemental iron whereas two doses of Ayas were given per day which contain
together 250 mg of iron. The double dose of iron in Ayas as compared to IF A made better
hemoglobin gain ( 1.6 g %) in anemic women. However, the anemic women given non-iron
Ayurvedic preparationration 'SS' also showed good gain (1.5 g %) in hemoglobin level; a little less
thaniron containing Ayurvedic preparation and much more than iron containing IF A tablets. In
moderate anemic women the maximum gain (3.0 g %) in hemoglobin level was observed with SS
+ Ayas and minimum (2.0 g %) with IFA. The gain in hemoglobin level was 2.2 and 2.3 g %
respectively with Ayas and SS. In mild anemic women, adolescent girls (11-18 years) and adult
women (19-45 years), the maximum gain was recorded with SS a non-iron Ayurvedic preparation
(Table 10). However, in adult anemic women the maximu gain in hemoglobin level with Ayas was
the same (1.7 g %) as recorded for SS. The gain in hemoglobin level was minimum with IF A in
all the groups ranging from 0.5 g % to 2.0 g % (Table 10). The gain in hemoglobin level in two
Ayurvedic preparations i.e. Ayas and SS was comparable in all the groups, slightly higher gain
with SS in most of the groups (Table 10).
Table 10: Gain in mean hemoglobin level (%) at the completion of study
11 – 18 years women
19 – 45 years women
N
582
260
322
435
147
Control
0.3
0.5
0
0.3
0
IFA
1.1
2.0
0.5
1.1
1.3
Ayas
1.6
2.2
1.1
1.4
1.7
SS
1.5
2.3
1.2
1.5
1.7
SS + Ayas
1.8
3.0
0.9
1.0
1.6
Gain in Haemoglobin(%) moderate and mild Anaemia subjects
Gain in Haemoglobin(%) among different age groups
0.5
22.2 2.3 3
0
0.5
1
1.5
2
2.5
3
3.5
Gr-I Gr-II Gr-III Gr-IV Gr-V
Moderate Anaemia (7-10 g%)
00.5
1.1 1.2 0.9
0
0.4
0.8
1.2
1.6
Gr-I Gr-II Gr-III Gr-IV Gr-V
Mild Anaemia (10.1-12 g%)
0.3
1.1 1.4 1.5 1
0
0.5
1
1.5
2
Gr-I Gr-II Gr-III Gr-IV Gr-V
( 11 - 18 years)
0
1.3 1.3 1.7 1.6
0
0.5
1
1.5
2
Gr-I Gr-II Gr-III Gr-IV Gr-V
( 19 - 45 years)

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
Sootshekhar Rasa has been mentioned in various classical Ayurvedic text in the chapter of' Amla
pitta Rogadhikara', which means to reduce acid in the body. Similarly, Sitopaladi is a well known
classical Ayurvedic formulation which has been described in the text as cough reducing agent. In
the present study the Principal Investigator has used this formulation first time in improving
nutritional anemia in non-pregnant women The hypothesis for using non-iron Ayurvedic
preparation SS was that it improves the absorption of iron in Gastrointestinal tract. The results of
this pilot study does indicate the possibility of using SS for improving nutritional anemia which
need to be ascertain by doing a larger study before it could be taken as a multicentre study.
ACKNOWLEDGEMENTS
The author is grateful to the Dept of Women & Child Welfare, Ministry of Human Resources, Govt
of India for sponsoring this study & to Assam Medical College, Guwahati for participating in the
quality assurance programme for Haemoglobin Estimation. The author also acknowledges the
efforts of Mr Prabhu Lal Bahuguna -Block Pramukh, Raipur, District Dehradun, Mr Chaddha -
Manager, Oriental Bank of Commerce, Balawale, Dehradun, for motivating the community to
participate in the study.
Gain in Haemoglobin among various groups of Non- pregnant women (11-
45 years)
10.3 10.2 10.1 10.3 10.1
10.6
11.3 11.7 11.8 11.9
9
9.5
10
10.5
11
11.5
12
12.5
Gr-I Gr-II Gr-III Gr-IV Gr-V
0 Day 90 Day
0.3 1.1
1.6
1.5
1.8
Gr-I Gr-II Gr-III Gr-IV Gr-V

Indian J. Hemat & Blood Transf. 2000; Vol. 18: No. 4; 79-83
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