LAUHA BHASMA AND AYURVEDIC IRON FORMULATIONS IN IRON DEFICIENCY ANAEMIA: A CRITICAL REVIEW OF CLINICAL EVIDENCE AGAINST CONVENTIONAL ORAL IRON
Background: Iron deficiency anaemia remains highly prevalent in India, and oral ferrous salts, the standard treatment, are limited by gastrointestinal side effects and poor adherence. Ayurveda manages Pandu with iron-based preparations such as Lauha bhasma, Mandura bhasma and Kasisa bhasma, alone or in compound formulations, and claims good tolerability. Objective: To review the clinical evidence for Ayurvedic iron formulations in iron deficiency anaemia, with particular attention to comparison with conventional oral iron, trial quality and the iron content of the products tested. Methods: A critical narrative review of clinical studies, systematic reviews and supporting physicochemical and bioavailability studies of Ayurvedic iron formulations. Results: Clinical studies consistently report rises in haemoglobin, for example from 8.52 to 11.85 g/dL over 10 weeks with Trikatrayadi Lauha in 123 children, and significant improvement with Kasisa bhasma in a 40-patient randomised trial. A 2016 systematic review included 10 studies, mostly small, without meta-analysis. Few trials used an active iron comparator, most did not report ferritin or other iron studies, and almost none stated the elemental iron dose. Characterisation studies show that Lauha and Mandura bhasmas are iron oxides whose uptake depends on dissolution and can be increased by ascorbic acid. Conclusion: Ayurvedic iron formulations probably correct iron deficiency, but claims of equivalence or superiority to oral iron are not yet supported by adequately designed trials. Standardised iron content and head-to-head randomised trials with iron indices are needed.