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Introduction: Sandhana Kalpana refers to a unique category of fermented preparations in Ayurveda, including Arishta, Asava, and fermented medicated wines. Traditionally used for enhancing bioavailability, digestion, and therapeutic efficacy, these formulations harness microbial metabolism to enrich herbal bioactives. Modern research increasingly recognizes their relevance in gut health, immunomodulation, and as functional nutraceuticals. Methods: A systematic literature review was conducted using classical Ayurvedic texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya) and modern databases (PubMed, Scopus, Web of Science, AYUSH Research Portal). Inclusion criteria comprised pharmacological studies, clinical trials, and experimental research on Sandhana Kalpana; studies lacking scientific methodology or unrelated fermented products were excluded. Data were analyzed thematically to integrate traditional knowledge with contemporary evidence. Results: Sandhana Kalpana demonstrates enhanced extraction of phytochemicals, improved gastrointestinal absorption, and generation of bioactive metabolites. Clinical evidence supports benefits in gastrointestinal disorders, metabolic syndrome, immunomodulation, and chronic fatigue. Microbial diversity in these formulations, predominantly lactic acid bacteria and yeast strains, contributes to probiotic effects, antioxidant activity, and anti-inflammatory properties. Discussion: Sandhana Kalpana bridges traditional fermentation principles with modern nutraceutical and probiotic science. While Ayurvedic texts highlight therapeutic indications and preparation methods, contemporary research provides mechanistic insights into microbial metabolism, bioactive enhancement, and safety profiles. Regulatory standardization, strain characterization, and controlled clinical trials are necessary to integrate these formulations into modern healthcare. Conclusion: Sandhana Kalpana represents a promising interface of traditional fermented medicine and modern healthcare, with applications in functional nutrition, immunomodulation, and chronic disease management. Future research should focus on standardization, mechanistic studies, and clinical validation to optimize their therapeutic potential.

KEYWORDS: Ayurveda, fermented preparations, microbiota, nutraceuticals, Sandhana Kalpana