A review of Ayurvedic alcoholic fermentation products used in Prameha Chikitsa

 Corresponding author: Akash Toshniwal Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution License 4.0. A review of Ayurvedic alcoholic fermentation products used in Prameha Chikitsa Akash Shamsundar Toshniwal 1, * and Trupti Pankaj Bhole 2 1 Department of Rasashastra Evam Bhaishajya Kalpana, Bharati Vidyapeeth (Deemed to be University) Pune, College of Ayurved, Pune-411043. 2 Associate Professor, Department of Rasashastra Evam Bhaishajya Kalpana, Bharati Vidyapeeth (Deemed to be university) Pune. World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 Publication history: Received on 23 April 2025; revised on 01 June 2025; accepted on 04 June 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.26.3.2258 Abstract Ayurveda, one of the oldest medical systems, has long recognized diabetes (Prameha) as a significant health concern. This is evident from ancient texts, particularly the Charaka Samhita, where Nidana Sthana (Chapter 4) and Chikitsa Sthana (Chapter 6) provide detailed discussions on its etiology, classification, and treatment. These classical references highlight the historical understanding of diabetes and its management within the Ayurvedic framework. The primary cause of diabetes (Prameha) is an excess of Kaphadosha in the body, which leads to an imbalance in the dhatus (tissues) and upadhatus (sub-tissues). Diabetes (Prameha) presents a significant treatment challenge, as drug therapy must be individualized based on a patient’s body constitution and the stage of disease progression. While numerous antidiabetic medications are currently in use, the steady increase in diabetes prevalence over the years suggests the need for a more refined and innovative treatment approach through the development of novel therapeutic agents. Alcoholic fermented decoctions (Madyajanak Sandhana Kalpana) a process involving controlled alcohol formation within medicinally permissible limits, have been widely recommended in Ayurveda for managing complex diseases. These formulations continue to play a crucial role in Ayurvedic medical practice today. A critical analysis of the broad therapeutic potential of fermented decoctions has led to the hypothesis that they may hold promise in the management of Prameha. Given that diabetes (Prameha) has been recognized as a leading cause of mortality among non-communicable diseases, there is an urgent need to explore novel remedies that not only alleviate symptoms but also modify the disease progression and its harmful effects, offering a more comprehensive and effective approach to diabetes management. Keywords: Diabetes; Prameha; Alcoholic Fermentation; Aristha Kalpana; Ayurveda; Non-Communicable Disease 1. Introduction Globally, diabetes (Prameha) is categorized as a non-communicable disease. It is typified by endocrine dysfunction, which disrupts the ability of pancreas to regulate insulin, resulting in high blood and urine glucose levels(1). Recent statistics show that the number of diabetes cases increased steadily between 2016 and 2020, according to an ICMR analysis. The prevalence of diabetes keeps rising in spite of a great deal of study and a variety of pharmaceutical treatments available in different medical systems. A paper from lancet journal titled ‘Metabolic non-communicable diseases in India: time to act’ discusses that there will be steady rise in the number of people with diabetes with estimate of 101 million, 36% higher than the 74·2 million and awareness, treatment, and control rates of diabetes in India are 46%, 36%, and 16% respectively in current situation(2). To reduce this increasing public health burden, these figures highlight the urgent need for innovative ways to diabetes management as well as proactive changes in treatment approaches. World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 1640 In this current review paper, alcoholic fermented products (Madyajanak Sandhana Kalpana) for treating diabetes (Prameha) have been reviewed with reference to Ayurveda guidelines. Diabetes (Prameha) is discussed as a predominant disease in Ayurveda context by the father of ayurvedic medicine Acharya Charaka by mentioning it in the diagnosis chapter and treatment chapter both. As per Ayurveda’s concepts, in diabetes; the body functioning weakens and disrupts due to unhealthy lifestyle pattern paving a way to the disease progression. Out of the three doshas diabetes shows dominance of kaphadosha in disease pathology(3). The qualities of Kapha dosha (phlegmatic imbalance) include Snigdha (oily/unctuous), Sheeta (cold), Guru (heavy), Manda (mild), Sandra (dense/viscous), Slakshna (smooth), Prasanna (clear), Pichchila (slimy), Shlakshnatva (jelly-like) and Sthira (immobile/stable). This Kapha (Kaphadosha) begins to increase quantitatively, leading to an overgrowth of dhatus (tissues) that depend on Kapha for their function and share its qualities. Fat tissues (Meda Dhatu), blood (Rakta Dhatu), and the endocrine system-associated dhatus undergo malfunctioning due to the instability of Kapha dhatu, ultimately leading to diabetes (Prameha). One of the primary goals of diabetes (Prameha) treatment is to reduce excess Kapha (Kaphadosha). Ayurveda, with its focus on disease-specific (Vyadhi Pratyanika) and cause-specific (Nidana Pratyanika) treatments for various ailments, provides physicians with the flexibility to choose the most appropriate therapies based on the progression of the disease in each patient.(4). Alcoholic fermentation products of medicinal plants (Asava-Arishta Kalpana)is one such formulation of Ayurveda which is a smart fit for treatment of Ayurveda through yuktipramana (logical thinking)(5).Fermented decoctions (Arishta Kalpana) is a process of alcoholic preparation in which the concentration gradient of alcohol is regulated within medicinally permissible limits(6). A review article on fermented decoctions (Arishta Kalpana) provides insights into the modern approach to these formulations and their therapeutic utility. It highlights that older Arishta and Asava preparations are preferred, as newly prepared formulations tend to be Tridoshakara (aggravating all three Doshas) whereas aged ones become Tridoshashamaka (balancing all three Doshas). Additionally Asava and Arishta have a longer shelf life, enhancing their medicinal efficacy over time(7). This helps us understand the shifting perspective on the use of fermented decoctions (Arishta Kalpana), emphasizing their evolving significance in Ayurvedic therapeutics. Alcohol is self-generated in the Asava-Arishta formulations by addition of yeast containing natural medicinal flowers of Dhataki (Woodfordia fruticos) or Madhuka(Madhuka indica). The qualities of alcohol (Madya) in the Ayurvedic context include Laghu (light), Ushna (hot), Teekshna (penetrative), Sukshma (subtle), Amla (sour), Vyavayi (permeable/distributing throughout the body), Vikasi (ability to spread quickly), Ruksha (rough/drying), and Prasanna (clear in nature)(8).If we compare the qualities of asawa/arishta and Kaphadosha, they are opposite to each other. This implies that alcoholic fermentations (Sandhana Kalpana) may serve as a useful therapeutic approach for controlling diabetes (Prameha) and regulating excess Kapha, due to their opposing qualities that help balance Kaphadosha. 2. Materials and Methods All Ayurvedic reference classics related to Prameha (diabetes), literature related to Kapha Dosha, and Madya (alcohol) were reviewed. Key references were selectively taken from Charaka Samhita for disease understanding, while Bhaishajya Ratnavali was referred to for fermentation based formulations (Sandhana Kalpana). Additionally, various research papers and articles were analyzed and interpreted based on their relevance to the subject. The collected literary data was systematically sorted, examined, and evaluated in alignment with the objectives of this review paper. Table 1 Denotes Granthokta Arishtas and Asavas for the treatment of Prameha. Ingredients Sandhan Dravya Madhur Dravya Prakshepa Dravya Indications Devdarvarishta (9) Devdaru,Adulsa, Indrayava,Danti, Manjistha, Tagara, Haridra,Daruharidra, Rasna, Mustak,Shirish, Vaividang, Khadira, Arjuna bark, Yamani,Kushta bark, Dhataki Madhu+ Sarkara Dalchini, Tejpata, Elachi,Suntha, Kalimarich, Pippali Priyangu, Nagkesar Prameha, vatroga, grahani, Arsha, Mutrakrishra Darukushta. World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 1641 Chandana,kutki, Chitrakmool. Ushirasava(10) Ushira,Lotus,Hribera, Gambhari,Neelotpala, Priyangu, Dhanvayasa, Patha,Kiratatikta, Padmaka, Lodhra,Manjishta, Shati, Parpataka,Pundarika, Patola, Kanchanara, Nyagrodha, Udumbara,Jambu, Shalmali,Draksha. Dhataki Madhu+ Sarkara Pippali Raktapitta , Pandu , Kustha, Prameha, Arsa, Krmi &shotha. Chavikasavam(11) Chavya,Chitrakmool, Dikemali, Pushkarmool,Vacha, Hauber Kurchi,Indravaruni, Dhania, Rasna,Dantimool, Kachora, Patolamoola,Haritiki, Bibhitiki,Amalki, Ajwain, Vidang,Mustak, Manjishta, Devdaru,Sunth. Dhataki Guda Lavang,Pippali, Sunth,Kankol, Dalchini,Ela, Tejpatra, Nagkeshar,Kali Marich. Sarv gulma, Prameha, Pratishaya, Kasa,Ashtila, Vatashonita, Udara, Antravruddhi. Dashmularishta (12) Dashmoola,Chitraka, Pushkaramoola, Lodhra,Guduchi,Amla, Durlabha,Khadira, Bijsara, Pata,Kushta, Manjishta, Devdaru,Vidanga, Madhuka,Bharangi, Kapittha,Bibhitaki, Punarnava,Chavya, Jatamansi,Priyangu, Sariva,Trivruta, Nirgundi,Rasana, Puga,Shati,Haridra, Dhataki Madhu+ Jaggery Kankola, Chandana, Jatiphala, Lavanga,Twak, Ela, Tamrapatra Katkaphala Arsha, Bhangandra, Pandu, Kamla, Udara, Mutravibandha, Agnimandya, Aruchi, Chardi, Grahani, Gulma,Kasa, Shawasa, Vatvadhi, Kushta,Meha, Ashmari, World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 1642 Shatpushpa,Padmaka, Nagkeshra,Musta, Indravya, Karkatshrungi, Jivka,Rishabhaka, Meda,Mameda,Kakoli, Ksheerakakoli,Riddhi, Draksha, Vriddhi, Vandhytva, Karshya, Dorbalya & shukrashaya Babularishta(13) Babul twak Dhatki Jaggery Pippali, Jatiphala, Kankola,Ela, Twak,Patra, Nagkeshkar, Lavanga, Maricha Kashaya, Kushta, Atisara, Prameha, Shwasa,Kasa Punarnavadyarishta (14) Shwetapunarnava, Rakta Punarnava,Bala, Atibala, Danti,Guduchi, Chitraka, Nidigadhika. Nil Madhu+ Jaggery Twak,Patra, Ela, Maricha, Hrivera, Agaru. Hrudaroga, Pandu, Jwara,Pliha, Aruchi,Meha, Gulma, Bhagandara, Jathararoga, Kasa,Shwasa, Kushta, Kandu, Hikka, Kilasa Halimaka. Ashokarishta(15) Ashoka,Ajaji,Mustaka, Shunthi,Daruharidra, Vtphala,Amrasthi, Jeeraka, Vasa,Chandana Dhataki Jaggery Nil Jwara,Arsha, Aruchi, Prameha, Shotha, Rakta pitta. Madhvasava(16) Lodhra,Shati, Puskaramoola, Murva,Vidanga, Triphala, Yavani,Chavya, Priyangu, Kramuka,Vishala, Kiratikta, Katurohini, Nata, Chitraka,Kushta, Ativisha,Patha, Nil Madhu Ela,Pippali, Patra, Maricha. Kaphaja and Pittika types of meha, Pandu, Arsha, Aruchi, Grahanidosha, Kilasa, Different types of Kushta. World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 1643 Kalingaka, Kesara,Indrasahva, Nakha,Plava Dantyasava(16) Danti,Lodhra,Shati, Puskaramoola, Murva, Vidanga,Triphala, Yavani,Chavya, Priyangu, Kramuka,Vishala, Kiratikta,Katurohini, Nata, Chitraka,Kushta, Ativisha,Patha, Kalingaka, Kesara,Indrasahva, Nakha,Plava. Nil Madhu+Sarkara Ela,Pippali, Patra, Maricha Kaphaja and Pittika types of meha, Pandu,Arsha, Aruchi, Grahani-dosha, Kilasa, Different types of Kushta. A review of nine Ayurvedic formulations reveals that honey (madhu) is used as the Madhura dravya in six formulations, while jaggery is employed as the madhura dravya in five formulations. In two formulations, Dantyasava and Devadarvarishta, both honey and jaggery have been utilized as the madhura (sweetening) agents. Notably, four formulations do not mention any fermentation agents, neither dhataki nor madhuka, as part of their composition. 2.1.1. Innovative products For the treatment of Diabetes Mellitus, the Jamun fruit and its seed (Eugenia jambolana) are well-known for their ability to reduce blood sugar levels. Two formulations containing Jamun seeds and/or fruit are already available in the market; these represent novel formulations, not derived from traditional Granthas. • Jambavasav (Abhay pharmaceutical) • Jambhulasav (Vaidya Khadiwale) Jambvasav(17):- Jambavasava of Abhay Pharmaceuticals is a well-known and widely marketed polyherbal Ayurvedic formulation, recognized for its significant role in managing diabetes. This formulation demonstrates satisfactory therapeutic outcomes, thanks to its synergistic blend of herbal extracts, each contributing to blood sugar management. The key ingredients of Jambavasava include Jamun, Neem, Methi Beej, Karela, Shuddha Shilajeet, Gudmar, Triphala, Kutki, Belpatra, Kavach Beej, Haridra, Triwang Bhasma, Dhataki, Gokharu, Chirayta, Kalijiri, Lodhra, Rasana, Shatavari, Sunthi, Askand, Dalchini, Erandmul, and Punarnava. NoteMany anti-diabetic drugs are included. Dhatki has been incorporated as a Sandhan Dravya. Jambhulasav (Vaidya Khadiwale)(18):- The key herbal components of Jambhulasav include:- Jambhul Kalk, Bedki Pala, Asana, Saptkapi, Avalakathi, Haridra, Jitsaya, Jambhul Saal, Khadir, Sunthi, Marich, Pippali, Tamalpatra, and Dhataki used as a natural fermenting agent, and madhu as Madhura dravya. In this formulation, both the Jambu fruit and bark (phala and twak) have been utilized, with Dhatki serving as the fermenting agent. This is an experience-based, innovative formulation by Vaidya Khadiwale. 2.2. Therapeutic Uses Jambhulasav is primarily indicated in the treatment of Prameha, being especially beneficial for diabetes mellitus. The formulation works by regulating blood sugar levels, improving digestion, and supporting overall metabolism. The herbs World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 1644 in Jambhulasav collectively enhances the body's ability to metabolize glucose, cleanse the urinary system, and reduce symptoms associated with Prameha, such as excessive urination and thirst. The fermentation process in Jambhulasav, facilitated by Dhataki, enhances the bioavailability and potency of its ingredients, making it more effective in managing Madhumeha. This formulation balances Kapha and Pitta Doshas, which are often aggravated in diabetic conditions. Jambhulasav represents a time-honored Ayurvedic approach to managing Prameha, particularly diabetes. By harnessing the properties of its carefully selected herbs and the fermentation process, this formulation offers a potent and natural therapeutic option for maintaining healthy glucose levels and overall well-being. Further standardization and research into its pharmacological properties would enhance its clinical application and recognition in both Ayurvedic and modern medical practices. 3. Discussion 3.1. Properties of Kapha Dosha The qualities of Kapha Dosha play a crucial role in the progression of diabetes (Prameha). Kapha is heavy in nature, referring to high molecular weight substances like saliva and phlegm. It is cold, acting as the body’s cooling agent and balancing Pitta Dosha. It is unctuous, causing it to adhere to surfaces, and greasy, allowing selective permeability. Its mild and soft nature is gentle on mucosal linings, while its sweet quality increases the body’s calorific value. Additionally, it is solid, stable, and sedentary, meaning it is less active and tends to remain in one place. Its sticky, slimy nature causes it to cling to surfaces(19). These properties are detailed in the Charaka Samhita, Sutra Sthana, Chapter 1, Verse 61. According to Acharya Charaka, excessive Kapha should be treated with drugs or food preparations that possess opposing qualities. 3.2. Properties of Alcohol Ayurveda describes alcohol as light, hot, penetrative, subtle, sour, permeable, rough, and rapidly dispersing. Its lightness allows it to permeate membranes easily, while its heat promotes metabolic activity and molecular breakdown. Alcohol’s penetrative nature enables it to pass through oily and sticky surfaces or thick membranes. Being subtle, alcohol has a fine molecular structure, and its sour quality does not add calorific value to the body. Due to these attributes, alcohol is capable of rapidly disseminating throughout the body, crossing membranes and overcoming barriers. Alcoholic fermentation products ie asava and arishta share the same properties as alcohol, making them effective in treatment(20). 3.3. Causative Factors of Diabetes (Prameha) in Ayurveda Ayurveda identifies unhealthy eating habits, a sedentary lifestyle with minimal physical activity, excessive daytime sleeping, and overconsumption of jaggery-based products and dairy products as contributing factors to diabetes (Prameha)(21). These habits aggravate Kapha Dosha, leading to its accumulation and stagnation in the srotasas (channels). 3.4. Principles of Diabetes Treatment in Ayurveda Ayurvedic treatment for diabetes involves both Panchakarma (purification) and medicinal management, depending on the patient’s constitution and the disease's progression. The decision to employ Shodhana (cleansing) or Shamana (pacification) is based on individual patient assessment. A study on the efficacy of integrated Ayurvedic treatment in Type 2 diabetes concluded that Ayurvedic therapy had a beneficial effect on most parameters of Prameha over a 90-day period(22). This highlights the effectiveness of Ayurvedic medicines in managing diabetes. 3.5. Current Diabetes Prevalence in India According to a recent study, 11% of the Indian population is diabetic. The Indian Council of Medical Research (ICMR) estimates that India, the world's most populous country, now has 101 million people with diabetes—an increase of 36% from the 74.2 million estimated in 2021 by the International Diabetes Federation(23). Statista reports that diabetes is a global health crisis, and India has the second-highest number of diabetics worldwide. In 2021, over 74 million Indians were diagnosed with diabetes, with the number projected to exceed 124 million by 2045(24). By yukti praman and by guidelines of Charaksamhita, it is possible to formulate innovative asava arishta formulations for prameha chikitsa by using anti-hyperglycemic medicinal plants. World Journal of Advanced Research and Reviews, 2025, 26(03), 1639-1646 1645 4. Conclusion A comprehensive review of the literature reveals a significant relationship between diabetes (Prameha) and Alcoholic fermentation formulations as a potential treatment, these formulations are fast acting and have better bioavailability due to presence of alcohol. This suggests that Alcoholic fermentations may play a promising role in halting the progression of diabetes (Prameha). To this end, Alcoholic fermentation products containing anti-diabetic herbs, widely documented in Brihatrayi and Lagutrayi, may be effective in managing the disease. The activity of Asava-Arishta in Prameha Chikitsa can be understood through several therapeutic pathways. In Ayurveda, Sthula Pramehi and Krisha Pramehi represent two distinct categories of Prameha patients. For Sthula Pramehi, Aptarpana serves as the primary line of treatment, aimed at reducing excess Kapha and fat. The alcohol generated through the fermentation process in Asava-Arishta formulations can support this action by enhancing metabolism and aiding in the breakdown of excess tissues. The active principles of medicinal plants get extracted in asava – arishta. In the case of Jambhulasav, its antihyperglycemic effect plays a crucial role in managing elevated blood glucose levels, offering an effective natural intervention for Prameha, particularly in conditions like Madhumeha. During the process of Sandhan (fermentation) for preparing new formulations, sugar or jaggery is converted into alcohol. For such preparations, it may be preferable to use jaggery instead of sugar. This review comprehensively examines Madhyanjanak Sandhan formulations for Prameha Chikitsa. Treatment decisions should be based on Rugna Nidan (differentiating Sthula Pramehi and Krisha Pramehi). Compliance with ethical standardsNot applicable Acknowledgments The author is thankful to department of Rasashastra Evam BhaishajyaKalpna B.V.D.U College of Ayurved of Pune411043 Disclosure of conflict of interest The Authors declare that there are no conflicts of interest. References [1] Olokoba AB, Obateru OA, Olokoba LB. Type 2 diabetes mellitus: a review of current trends. Oman Med J. 2012 Jul;27(4):269–73. [2] Habeeb S, Thankappan KR. Metabolic non-communicable diseases in India: time to act. Vol. 11, The lancet. Diabetes & endocrinology. England; 2023. p. 897–8. [3] Roy CK, Ojha JK, Bajpai HS. A review of the history of prameha and diabetes mellitus. Anc Sci Life. 1993 Jan;12(3– 4):394–8. [4] Kumari K, Singh S, Patel B. A critical review on prameha management from various compendia. Glob j res med plants indig med. 2017 may 1;6:75–88. [5] Gupta Sonal, Yadav Sudama Singh. 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