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Background: Asava and Arishta are fermented liquid dosage forms of Ayurveda, prepared from herbal juices or decoctions with jaggery or sugar and a fermentation initiator, usually Dhataki (Woodfordia fruticosa) flowers. Their self-generated alcohol acts as a solvent and preservative, and they are among the most widely sold Ayurvedic products. Objective: To review the microbiology and biochemistry of Sandhana kalpana, the factors that govern alcohol content and product quality, and the quality and regulatory issues that arise. Methods: A critical narrative review of microbiological, biochemical, phytochemical and quality-assessment studies of Asava and Arishta. Results: Dhataki flowers carry wild yeasts, mainly Saccharomyces cerevisiae, together with other yeasts and Bacillus species, which drive a spontaneous mixed fermentation. During about 30–35 days, pH falls from about 5.5 to 3.5, sugars are consumed and ethanol rises; final ethanol of 6.5% and 9.3% v/v was reported in Balarishta and Chandanasava, and 4–9.2% in Mustakarishta made with different Dhataki treatments. GC-MS shows that many compounds disappear and new ones form during fermentation. Studies of marketed brands show wide variation in physicochemical parameters. Methanol, aflatoxins and heavy metals were absent in the products tested in one study, but routine testing is not universal. Conclusion: Sandhana kalpana is a controllable biotechnological process. Defined starter cultures, monitoring of ethanol, sugar and pH, and chemical fingerprinting would improve consistency, while clear labelling of alcohol content is needed for patient safety.