Author’s Accepted Manuscript

Chyawanprash: A review of therapeutic benefits as

in authoritative texts and documented clinical
literature

D.B. Anantha Narayana, Sharanbasappa Durg, P.

Ram Manohar, Anita Mahapatra, A.R. Aramya
www.elsevier.com/locate/jep

PII: S0378-8741(16)30513-X
DOI: http://dx.doi.org/10.1016/j.jep.2016.07.078
Reference: JEP10343
To appear in: Journal of Ethnopharmacology
Received date: 4 February 2016
Revised date: 28 July 2016
Accepted date: 30 July 2016
Cite this article as: D.B. Anantha Narayana, Sharanbasappa Durg, P. Ram
Manohar, Anita Mahapatra and A.R. Aramya, Chyawanprash: A review of
therapeutic benefits as in authoritative texts and documented clinical literature,
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 Chyawanprash: A review of therapeutic benefits as in authoritative texts and
documented clinical literature

1, *
DB Anantha Narayana , Sharanbasappa Durg 1, Ram Manohar P 2, Anita Mahapatra 2,
Aramya AR 2

1
Ayurvidye Trust, Giri Nagar, Bengaluru-560085, Karnataka (India)
2
AVP Research Foundation, Coimbatore - 641045, Tamil Nadu (India)

*
Corresponding author
Dr. DB Anantha Narayana,
Ayurvidye Trust,
Giri Nagar, Bengaluru-560085 (Karnataka, India).
Tel: +91 9342582703
E-mail: [email protected]

1
Graphical abstract

Abstract

Ethnopharmacological relevance: Chyawanprash (CP), a traditional immune booster recipe, has a

long history of ethnic origin, development, household preparation and usage. There are even

mythological stories about the origin of this recipe including its nomenclature. In the last six

decades, CP, because of entrepreneurial actions of some research Vaidyas (traditional doctors) has

grown to industrial production and marketing in packed forms to a large number of

consumers/patients like any food or health care product. Currently, CP has acquired a large

accepted user base in India and in a few countries out-side India.

Aim of the study: Authoritative texts, recognized by the Drugs and Cosmetics Act of India,

describe CP as an immunity enhancer and strength giver meant for improving lung functions in

diseases with compromised immunity. This review focuses on published clinical efficacy and safety

2
studies of CP for correlation with health benefits as documented in the authoritative texts, and also

briefs on its recipes and processes.

Materials and methods: Authoritative texts were searched for recipes, processes, and other

technical details of CP. Labels of marketing CP products (Indian) were studied for the health

claims. Electronic search for studies of CP on efficacy and safety data were performed in

PubMed/MEDLINE and DHARA (Digital Helpline for Ayurveda Research Articles), and

Ayurvedic books were also searched for clinical studies.

Results: The documented clinical studies from electronic databases and Ayurvedic books

evidenced that individuals who consume CP regularly for a definite period of time showed

improvement in overall health status and immunity. However, most of the clinical studies in this

review are of smaller sample size and short duration. Further, limitation to access and review

significant data on traditional products like CP in electronic databases was noted.

Conclusions: Randomized controlled trials of high quality with larger sample size and longer

follow-up are needed to have significant evidence on the clinical use of CP as immunity booster.

Additional studies involving measurement of current biomarkers of immunity pre- and post-

consumption of the product as well as benefits accruing with the use of CP as an adjuvant are

suggested.

Keywords: Chyawanprash; Ayurvedic recipe; Immunity; Human studies.

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1. Introduction

Chyawanprash (CP; also spelled as cyavanaprasa, chyavanaprasha, chyavanaprash,

chyavanaprasam and chyawanaprash) is a renowned recipe from Ayurveda, and has a long history

of ethnic mention in Indian literature as well as Ayurvedic books. Treatises of Indian traditional

knowledge dating back to early Christian Era, cites mythological stories on the evolution of CP.

Sukanya, a princess (daughter of King Sharyati) is said to have pierced the eyes of the sage

Chyavan who was meditating and anthill like structure had got built and covered his body, except

leaving few holes through which the eyes and nose of the sage was open. The sage crying in pain

having lost his eye sight is said to have cursed the princess. The king of the land learnt the same and

begged pardon and married Sukanya with Chyavan. The caring attitude and work done by the

princess was appreciated by the twin sages Ashvini Kumaras who then handed over a recipe to be

prepared and fed to Chyavan sage to help him regain youthfulness and health, lost due to long years

of meditating. Since the recipe was to be eaten (prasha – meaning drug or a diet which is fit for

ingestion orally) – by the sage Chyavan, the recipe got the name “Chyawanprash” (Ojha, 2003). It

is said that due to consumption of this recipe the sage regained his health, energy and youthfulness.

Such an almost nondescript preparation tucked in the traditional books, and continued to be

prepared by few knowledgeable people at home for consumption by entire family. In the early 70’s

many traditional medicine manufacturers started to manufacture CP on large scale and offered them

in packed forms for consumers. Post introduction of regulations under the Drugs and Cosmetics

Act, 1940 and Rules there under 1945 with specifically provisions related to Ayurvedic drug and

medicines inserted by act 13 in 1964, firms manufactured and sold CP as an Ayurvedic medicine

(Deshpande and Gandhi, 2009). CP continued during these last six decades to be prepared at

home as a cultural and ethnic practice during winter season when fresh fruits of amla (Emblica

officinalis, also known as Indian gooseberry) arrives (just like preparing amla pickles or powder or

juice) for use by family. Some of the organizations also introduced CP in other nations namely, Sri

Lanka, Pakistan, Bangladesh, Malaysia, Singapore and other Asian nations.

4
CP is widely consumed by a large number of people in India and some part of the globe (Sharma,

1992). CP has gained much popularity that many versions of this formulation are available in Indian

market and also in many western countries. Available figures indicate that sales of CP increased

from nearly US$ 5 million in 1990 to US$ 80 million in 2010 which makes CP as India’s best-

selling Ayurvedic medicine (Bode, 2015). Figures for exports are not available.

CP, an avaleha preparation (semisolid jam like linctus), is originally cited in Charaka Samhita

(Sharma, 1992). However, more than six authoritative texts of Ayurveda as listed in the First

Schedule to Drugs and Cosmetics Act have recipes of CP which differ in their composition of herbs

and minerals as well their proportions cited in Charaka Samhita (Sharma, 1992; Deshpande and

Gandhi, 2009). Table 1 summarizes composition of the CP from Charaka Samhita with scientific

names, parts of herb used and their proportions (Sharma, 1992; The Ayurvedic Formulary of

India, 2003; The Ayurvedic Pharmacopoeia of India, 2007).

The classical textual process describes a multistep procedure for preparation of CP. Crude herbs

listed at serial number 1 to 36 (complying with required quality as specified in the Ayurvedic

Pharmacopoeia of India [API]) of the recipe given in the table 1 are taken, grounded and passed

through sieve number 44. Specified amount of purified water is added to this blend of herbs and

stirred (kwatha dravya – liquid for decoction). Fresh amla fruits are washed and tied into a bundle

using muslin cloth and this bundle is immersed in the kwatha dravya containing vessel, heat the

contents and boil gently. Heating is done till the amla fruits become soft, and at this time the bundle

is removed from the vessel. Boiling is continued till the quantum of water reduces to one fourth the

initial volume, allowed to cool and strained through muslin cloth. The strained decoction is

preserved for use in the next step. Marc is pressed and the liquid obtained is added to the strained

decoction and then the marc is discarded. The softened amla fruits are taken out from the bundle,

seeds and large fibers are removed, and the pulp so obtained is fried with ghruta (clarified butter –

ghee, food grade) and sesame oil (food grade) in equal proportions till it converts to a semisolid

blackish mass (pisthi) and the excess ghee and oil separates. Add this pisthi to the contents of the

5
vessel which has the decoction, add specified quantity of sharkara (sugar, either food grade or

pharma grade), and boil gently while stirring till it forms a soft semisolid gel like mass (leha paka).

The consistency of leha paka is tested by dropping 2 to 3 g of it to a glass of water at room

temperature (RT); the added leha paka should settle down and not disperse in water for 5 to 10 min.

Stop heating and allowed to cool up to 50 °C. Separately grind raw materials complying with

quality requirements as per API listed at serial number 43 to 48 (table 1) to get fine powder (99%

passing through sieve number 60). Add this powder (prakshepa dravya) to the leha paka obtained

above and mix to get a homogeneous blend. After cooling this to RT, add madhu (honey of API

quality) and mix. Pack this leha paka, also called as avaleha, in a suitable tightly closable container

to protect from light and moisture to obtain CP (Ojha, 2003).

However, it is learnt that industrially this is a time consuming, energy intensive step, difficult to

adopt on a large scale and hence most of the CP produced industrially uses a pishti directly without

the steps mentioned above. For such purpose fresh amla fruits are decorticated to remove the seeds,

and then the fruit pieces are crushed to a pulp and the pulp is fried with ghee and sesame oil as

described above. The pishti so obtained is stored in double woven sacs in cold storage and taken out

when required during the year, when fresh fruits of amla may not be available.

2. Modifications in Chyawanprash recipes

Modifications in CP recipes in different classical texts and in current practice in the industry are

briefly listed as below:

1. Addition of different proportions of the Indian gooseberry pulp and also use of freshly prepared

pulp compared to a stored pulp, which was prepared many months ago when fresh amla fruits

were available.

2. The variation in the ingredients/herbs, their numbers, proportion and parts of the herbs.

3. The alteration in the ingredients/herbs, their numbers, proportion and parts of the prakshepa

dravya (additional drugs added at the last stage of the preparation). Some of the CP preparations

6
 claim the addition of a higher proportion of Kumkuma (saffron, made from the flower of

Crocus sativus) leads to variations in proprietary versions of CP.

4. Variations in the content of sugar (not told in classical text).

5. Variations in the content of ghee and oil.

6. A few firms claim innovations in the formula by way of addition of Swarna (gold), and Rajata

(silver).

7. A set of herbs falling under the class of Ashtavargha (group of eight drugs) is being replaced

with their accepted substitutes (Srikanthamurthy, 2008). In some of the marketed formulations

one or two of such herbs would not have been added due to sustainability issues, though these

herbs may be in the official book recipes or listed on the label.

Indian regulations permit manufacture and sale of CP either as an Ayurvedic medicine by following

exactly the recipe and the process as per authoritative text listed in the regulations (referred

commonly as classical Ayurvedic medicine) or as a proprietary Ayurvedic medicine when

modification to an authoritative text based recipe is allowed as long as all the ingredients are listed

in any one of the texts officially recognized by the law (Deshpande and Gandhi, 2009). Except for

a few traditional Ayurvedic firms like AryaVaidyaSala, AryaVaidya Pharmacy, Shree

Dhootpapeswar and the like, most of the firms manufacture proprietary CP preparations. Author

Maarten Bode from Institute for Ayurveda, University of Amsterdam (the Netherlands) provides an

excellent description of this best-selling Ayurvedic medicine in his latest review article and traces

the development of this recipe to its present industrial production levels (Bode, 2015). The use of

names or part of the name of the recipes given in the authoritative texts was banned by the

Government of India, where prefixing or suffixing the names of products with official names in the

authoritative texts were prohibited by a Notification in the Gazette, amending the Drugs and

Cosmetics Rules in October, 2013 and one year time was given to the manufacturers to make

necessary changes (Department of AYUSH, 2013).

7
Table S1 (supplementary file) lists CP recipes in the different authoritative texts, their indications,

dosage levels and any caution or contraindication mentioned. It is interesting to note that different

firms make CP with differences in formula and make certain specific claims on usage of the product

(table S2, supplementary file). The authoritative texts recommend CP to be consumed primarily for

rejuvenation purpose. It is further indicated for kasa (broadly cough) - and svasa (broadly breathing

and lung functions) - meaning for health (to build immunity) and improvement of functioning of the

lungs and for providing resistance to the body (Sharma, 1992).

However, few firms have added specific ingredients and make ingredient based variations to the

benefit claims of CP. For example, addition of gold and silver to make benefit claims of strength

and enhancement of brain functions including memory. Several years ago M/S Hamdard, another

leading traditional product manufacturing company, had introduced “Dimagwala CP” (meaning for

intelligence enhancer), CP with brahmi (Baccopa monneri), mandookaparni (Centella asiatica),

shankhapushpi (Convolvulus alsinoides) and almonds to make a health benefit positioning for

learning and memory in addition to immunity, a product which is not seen in the market today.

Growing science and greater understanding of immunology is possible today through identification

and validation of a number of pathways and understanding of biomarkers for immunity.

3. Quality specifications of Chyawanprash

The authors also tried to brief on the quality specifications of CP. However, very few research

studies exist on quality testing for a complex preparation like CP and one such study was conducted

at Notational Botanical Research Institute, Lucknow (India) (Govindarajan et al., 2007). This

research study indicated that CP contains a number of phenolics which may account for its

therapeutic activity. The high-performance liquid chromatography (HPLC) method developed by

Govindarajan and colleagues assists in standardization of CP using biologically active phenolics

markers viz., gallic acid, protocatechuic acid, catechin, caffeic acid, vanillic acid, chlorogenic acid,

syringic acid, rutin, ferulic acid, and quercitrin. On the contrary, individual firms manufacturing

8
such a preparation have their in-house specifications for quality of CP, which are not in the public

domain. The department of AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and

Homoeopathy), Ministry of Health and Family Welfare, the nodal governmental agency in its

official publication (The Ayurvedic Pharmacopoeia of India, 2007) has provided a monograph on

CP along with a brief method of preparation and test for quality involving various physico-chemical

and assay tests as official quality standards. These include description, identification (microscope

and thin layer chromatography [TLC]), and physico-chemical parameters (loss drying, total ash,

acid-insoluble ash, alcohol-soluble extractive, water-soluble extractive, pH [1% aqueous solution]),

and assay, microbial limit and test for aflatoxin. The Ayurvedic Pharmacopoeia of India (2007)

prescribes CP formulation to contain not less than 0.5% of gallic acid when assayed by the

officially stated method.

4. Role of Chyawanprash in immunity

CP belongs to the category of Rasayanas (rejuvenating tonic) as per Ayurveda and the classical

texts provide a number of verses that describe the benefit of Rasayanas. One of the most commonly

cited verse is quoted below;

DeergahmaayuhSmurutimMedhamaraogyamTarunaVayaha I

PrabahavranaswaradarthaDehendriyabalamParam II

VaaksiddhimPranatiKaantiLabahate Ta Rasayanat I

Labhopaayo Hi ShastanamRasaadeenamRasaynam II

-CharakSamhita, ChikitsaStahana 1.1.7-8. (Sharma, 1992)

The meaning of this verse in oriental language of Sanskrit is “A person undergoing rejuvenation

therapy attains longevity, enhancement of memory, intellect, freedom from disease, youthful age,

and excellence of luster, complexion and voice, optimum strength of physique and sense organs,

skills in speech, respectability and brilliance.”

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Specifically, there are many verses in classical texts that describe the benefits of CP. The verse

from Charaka Samhita and other books indicate CP as the best Rasayana, also for cough, asthma,

depletion, injury, old, children, physical growth, hoarseness of voice, diseases of chest and heart,

rheumatism, thirst, diseases of urine and semen, to attain youthfulness, intellect, enhancement of

memory, excellence of luster, freedom from disease, longevity, optimum strength of physique and

sense organs, sexual excitement, improvement of digestion and skin complexion, normal

movements in the body channels, for rejuvenation and diseases of old age. In Astangahrdaya,

uttarasthana in verse 39–41, Rasayana vidhiadhyaya, indicates the varied use of CP; it is similar to

the previous quote of Charak along with the newly mentioned indication for fever, depletion and

emaciation (Vagbhata, 2002).

CP scientifically proved for its immunity booster activity (Bode, 2015). The experimental studies

evidenced different pathways through which the immunomodulatory activity of CP is evaluated and

quantified. CP pretreatment significantly reduced plasma histamine level and serum

immunoglobulin E (IgE) release when rats and mice were challenged with allergen- and ovalbumin-

induced allergy, respectively. This outcome suggests anti-allergic activity of CP. Natural killer

(NK) cell activity was significantly (versus dimethyl sulfoxide) augmented in different

concentration ratios of NK cells and target cells by CP treatment. Dendritic cells when treated with

CP, significant increase in the secretions of tumor necrosis factor-alpha (TNF-α) and macrophage

inflammatory protein-1 alpha (MIP-1α), stimulation in interleukin-1 beta (IL-1β) levels and rise in

phagocytic activity were observed. The augmented immunity marker levels (TNF-α, IL-1β and

MIP-1α), as well as enhancement of NK cells and phagocytic activity support the

immunomodulatory properties of CP (Sastry et al., 2014a). The clinical studies also encourage the

immunity booster activity of CP as demonstrated by reduced disease symptoms of seasonal

influences, modulated IgE and immunity markers C 3 and C 4 levels, improved pulmonary functions,

decreased cortisol levels, and increased quality of life (QoL) (Sastry et al., 2014b).

10
Recent studies have indicated implication of inflammatory reactions to be a part of immune

responses and hence biomarkers like ILs, nuclear factor kappa-B (NF-kB) also provide a means to

study immunity (Plaza-Diaz et al., 2014). The role of stress and chronic stress on the immune

status of human beings are also well understood. Table 2 provides a list of biomarkers that can be

evaluated to study the changes in immune levels of individuals when supplemented with CP

(Dhabhar, 2009; Szefler et al., 2012).

5. Clinical studies of Chyawanprash

We attempted to collate the available published primary scientific data and literature where human

intervention or clinical studies have been reported assessing the efficacy of CP. On the basis of the

classical texts, a correlation was attempted for each of the reported studies with the indications or

the benefits of a Rasayana cited in the classical text. Documented clinical trials on CP support the

health benefit claims given in the major authoritative Ayurvedic texts (tables 3a and 3b).

A published book - Chyawanprash from Vedic to Genomic era by Prof. JK Ojha has presented the

compilation of such studies on humans till 2001 (Verma et al., 1973; Ojha et al., 1975; Narayana

and Dobriyal, 2001; Manjunatha et al., 2001; Mishra, 2003; Ojha, 2003). The recent studies on

human subjects (Debnath et al., 2012; Gupta and Mahapatra, 2013; Sailesh et al., 2014; Sastry

et al., 2014b) were searched in the databases such as PubMed/MEDLINE and DHARA (Digital

Helpline for Ayurveda Research Articles) using the keywords ‘chyawanprash,’ OR

‘chyavanaprasha,’ OR ‘chyavanaprash,’ OR ‘chyavanaprasam,’ OR ‘chyawanaprash,’ AND

‘immunity,’ OR ‘infections,’ OR ‘pulmonary function.’ The reference lists of included clinical

articles were screened manually for additional significant studies.

Many Ayurvedic journals that are not part of above databases, journals that could not be confirmed

to be following standard processes expected of research publications, research thesis leading to

MD/PhD work on CP where complete details of the study were not available, and any in-house

11
study data that firms possess and not in public domain do not form part of the database for this

review.

Further, two cytogenetic studies assessed the genoprotective activity of CP awaleha against tobacco

smoke on the somatic chromosomes of male bidi (a thin, Indian cigarette filled with tobacco flake

and wrapped in a tendu) smokers (n = 25) and betel quid chewers (n = 15) suffering fromoral

precancerous lesions (Yadav et al., 2003; Uma and Kotasthane, 2014). CP-fed (20 g twice a day,

for 2 months) bidi smokers when compared with bidi smokers not fed on CP reported significant

decrease (P < 0.01) in the frequency of mitotic index, chromosomal aberrations, sister chromatid

exchanges and satellite associations (SA). These findings support CP use in reducing the genotoxic

effect due to mutagenic agents present in tobacco smoke (Yadav et al., 2003). In another study,

betel quid cessation reduced the effect of DNA damage in oral precancerous lesions. But there was

a significant mean difference in SA in CP group (20 g twice a day, for 3 months) compared to

patients who quit betel quid chewing, which evidently demonstrated that CP can further minimize

the genotoxic risk caused by mutagenic agents present in betel quid (Uma and Kotasthane, 2014).

6. Pharmacological activities of Chyawanprash and future research

The data in this review show the availability of few clinical studies that provide supportive

indication of properties and therapeutic or pharmacological activities of CP. It is evident from the

above tables (3a and 3b) that most of the properties directly or indirectly indicate improvement in

overall health status and immunity in individuals who consume CP regularly for a definite period of

time. To that extent studies that provide limited support for maintenance of immune status is

available. However, an immunologist may not accept the available evidence as adequate. Over the

last two decades understanding of immunity has improved drastically. Currently, several

biomarkers like cluster of differentiation (CD) -4 and CD-6 counts, IL-6, levels of IgG and IgE,

inflammatory biomarkers like NF-kB are taken as direct indicators of immune status. More recently

change in NK cell activity is considered as an accepted biomarker for immunity. Gamma - delta -

12
(gd) T cells are also emerging as immunity biomarkers. Studies so far published used different

variables for measurement of cell- or humoral-mediated immunity status, which provide only

indirect support. No studies have so far been reported on CP usage and its impact on NK cell

activity or gd T cell.

Reliance on history of efficacy and safety documented in the classical texts seem to be the primary

source of evidence for all claims made for CP. While this may appear to be factual it has to be

borne in mind that most of the marketed CP preparations in India do not exactly follow the

prescribed recipes. Extrapolation of the history of use, data alone may not be adequate in such

circumstances and additional human studies are required to generate sufficient evidence for all the

claims made on CP. There are challenges in developing an appropriate protocol that helps in

establishing efficacy data in human beings, difficulties in deciding the number of volunteers

required for such studies to obtain a statistically significant data, logistics and economies of scale,

and cost of such studies contributing to the low level of data available on CP. Given the structure of

the Ayurvedic industry, most of which are in medium sector and small sector investment in research

is dismally low and until recently the law did not demand claims support data as mandatory. These

are two primary reasons for this state of limited availability of data on efficacy of CP. Even in such

an unfavorable atmosphere, the availability of literature of some studies done in India and abroad is

very much appreciable. It is also possible that studies with negative outcomes may not have been

published. In traditional products like CP, efficacy may be seen through different pathways in the

human system and may work on multiple targets and designing a study that can capture all these

diverse elements is challenging. Such studies are extremely difficult to conduct and demand large

finances, which act as a deterrent for investing in such studies. Current clinical trial protocols

normally demand defining a hypothesis with a primary and a secondary outcome and choose

variables to measure these outcomes only. Protocols that can simultaneously and concurrently

measure multiple variables on multiple targets/organs are very few. Furst et al. demonstrated that

randomized controlled trials (RCTs) can be conducted to evaluate classical Ayurvedic treatment

13
customized to individuals with blinding and placebo control (Frust et al., 2011). Witt et al. have

also developed protocols that aim to study complex interventions in Ayurveda using the RCT

design. Whole system approach to research will have to be adopted in the case of Ayurveda to

preserve its complexity and multimodal approach to treatment. Alternative models have been

proposed for research to evaluate the traditional methods of treatments that are found to be effective

in actual clinical practice (Witt et al., 2013; Manohar, 2011).

It is to be recognized that CP is a traditional recipe manufactured and popularized by firms. Each

firm has held information generated by them as propriety and has not published them in research

journals, perhaps to own such information and link to their product. This review actually points out

to this limitation of today’s scientist to access and review data on traditional products through

online searches that they are used too. Offline search of published books from reputed houses

provides data which need to be considered. It is in fact to the credit of the leading firm viz., Dabur

India Ltd., whose CP leads 60% of the market to have complied and permitted publication of CP’s

data in the book “Chyawanprash from Vedic to Genomic era” (Ojha, 2003; Bode, 2015).

7. Conclusion

In this study, the authors reviewed the therapeutic benefits of CP as in authoritative texts and

documented clinical literature, and also discussed about its recipe and process in brief. This review

reveals that CP may be effective in improving the overall health status and immunity in individuals

who consume it regularly for a definite period of time. As most of the included clinical studies in

this review are of smaller sample size and short duration, well-designed RCTs of high quality with

a larger sample size and longer follow-up are needed to support significantly the clinical use of CP

as immunity booster.

Keeping in mind the importance of a product of CP that reflects the Rasayana concept of Ayurveda,

it is hoped that this study will trigger many studies on CP. However, the authors wish to

recommend a few RCTs for consideration and initiation in: volunteers who have low level of NK

14
cell activity and involving tracking of various immunity and inflammatory biomarkers upon

administration of CP for at least 60 days; patients who have a chest infection, suffer from

tuberculosis, bronchitis, mild to moderate asthma and study the role of the CP, the stages at which

CP provides supportive or improvement benefits; volunteers on usefulness of CP in stress and

anxiety disorders; volunteers, especially in children and youth as a nourishment and nutrient

product. In addition, studies on CP as adjuvant during treatment of diseases and disorders like

severe infections (antibiotic treatment), cancer (while on chemotherapy), tuberculosis (anti-

tuberculosis drugs) and viral diseases would be interesting and beneficial.

15
References:

Bode, M., 2015. Assembling cyavanaprāsh, Ayurveda's best-selling medicine. Anthropol. Med.

22, 23–33.

Debnath, P.K., Chattopadhyay, J., Mitra, A., Adhikari, A., Alam, M.S., Bandopadhyay, S.K.,

Hazra, J.,2012. Adjunct therapy of Ayurvedic medicine with anti tubercular drugs on the

therapeutic management of pulmonary tuberculosis. J. Ayurveda Integr. Med. 3, 141–149.

Department of AYUSH, 2013. Amendment in Rule 157 of the Drugs

and Cosmetics Rules, 1945 vide G.S.R.

704(E). http://www.inclinition.com/manage/pages/files/2002240472_29%20Oct%202013.pdf

(accessed 22. 05. 2016).

Deshpade, S.W., Gandhi, N., 2009. Drugs and Cosmetic Act 1940 and rules 1945, fifth ed.

Susmit Publisher, Mumbai.

Dhabhar, F.S., 2009. Enhancing versus suppressive effects of stress on immune function:

implications for immunoprotection and immunopathology. Neuroimmunomodulation 16, 300–

317.

Furst, D.E., Venkatraman, M.M., Krishna Swamy, B.G., McGann, M., Booth-Laforce, C., Ram

Manohar, P., Sarin, R., Mahapatra, A., Krishna Kumar, P.R., 2011. Well controlled, double-

blind, placebo-controlled trials of classical Ayurvedic treatment are possible in rheumatoid

arthritis. Ann. Rheum. Dis. 70, 392–393.

Govindarajan, R., Singh, D.P., Rawat, A.K., 2007. High-performance liquid chromatographic

method for the quantification of phenolics in 'Chyavanprash' a potent Ayurvedic drug. J. Pharm.

Biomed. Anal. 43, 527–532.

16
Gupta, N., Mahapatra, S.C., 2013. Effects of an ancient nutritional supplement chyawanprash

and vitamin C on antioxidant enzymes and serum immunoglobulin G levels in humans. Acta

Hortic. 972, 61–66.

Manjunatha, S., Jaryal, A.K., Bijlani, R.L., Sachdeva, U., Gupta, S.K., 2001. Effect of

Chyawanprash and vitamin C on glucose tolerance and lipoprotein profile. Indian J. Physiol.

Pharmacol. 45, 71–79.

Manohar, P.R., 2011. Whole system research and ayurveda. Anc. Sci. Life 31, 37.

Mishra, L.C.,2003. Scientific Basis for Ayurvedic Therapies. CRC Press, New York, pp.70

Narayana, D.B.A., Dobriyal, R.M., 2001. Complimentary medicines and 21st century

therapeutics: challenges for pharmacologists, in: Gupta, S.K., Pharmacology and Therapeutics

in the New Millennium.Narosa Publishing House, New Delhi, pp. 332.

Ojha, J.K. (Eds.), 2003. Chyawanprash from vedic and genomic era. Chaukhamba Sanskrit

Pratishtha, Delhi.

Ojha, J.K., Khanna, M.N., Bajpai, H.S., Sharma, P.V., Sharma, T.N., 1975. A clinical study of

chyawanprash as an adjunct in the treatment of pulmonary tuberculosis. J. Res. Indian Med. 10,

1.

Plaza-Diaz, J., Gomez-Llorente, C., Fontana, L., Gil, A., 2014. Modulation of immunity and

inflammatory gene expression in the gut, in inflammatory diseases of the gut and in the liver by

probiotics. World J. Gastroenterol. 20, 15632–15649.

Sailesh, K.S., Archana, R., Mishra, S., Symphoria, Mukkadan, J.K., 2014. Effect of

chyawanprash on cognitive, autonomic and respiratory parameters in college students. Int. J.

Res. Ayurveda Pharm. 5, 435–438.

17
Sastry, J.L.N., Gupta, A., Brindavanam, N.B., Kanjilal, S., Kumar, S., Setia, M., Vedula, S.,

Srivastava, R., 2014a. Quantification of immunity status of Dabur chyawanprash - a review

part-1 (experimental studies). Indian J. Applied Res. 4, 20–24.

Sastry, J.L.N., Gupta, A., Brindavanam, N.B., Kanjilal, S., Kumar, S., Setia, M., Vedula, S.,

Srivastava, R., 2014b. Quantification of immunity status of Dabur chyawanprash - a review

part-2 (clinical studies). Indian J. Applied Res. 4, 205–211.

Sharma, P.V., 1992. Caraka Samhita, second ed., Vol II, Chaukhamba Orientalia, Varanasi, pp.

3–10.

Srikanthamurthy, K.R.., 2008. Bhavaprakasa of Bhavamisra, Vol I, Chowkhamba Krishnadas

Academy, Varanasi, pp. 178.

Szefler, S.J., Wenzel, S., Brown, R., Erzurum, S.C., Fahy, J.V., Hamilton, R.G., Hunt, J.F.,

Kita, H., Liu, A.H., Panettieri, R.A. Jr., Schleimer, R.P., Minnicozzi, M., 2012. Asthma

outcomes: biomarkers. J. Allergy Clin. Immunol. 129, S9–S23.

The Ayurvedic Formulary of India, 2003. Department of Indian Systems of Medicine and

Homeopathy, Ministry of Health and Family Welfare, Government of India, part I, second

revised English ed. Controller of Publications, Delhi, India.

The Ayurvedic Pharmacopoeia of India, 2007. Department of Ayurveda, Yoga & Naturopathy,

Unani, Siddha and Homeopathy, Ministry of Health and Family Welfare, Government of India,

part II (Formulations), volume – I, first ed. Controller of Publications, New Delhi, India.

Uma, A.N, Kotasthane, D.S., 2014. A cytogenetic study on the efficacy of chyawanprash

awaleha as an antioxidant in oral premalignant cancer. J. Oral Oncol. 2014, 1–5.

Vagbhata, 2002. AshtangaHridaya, in: Paradakar, H.S. (Eds), Rasayanavidhiadhyaya, ninth ed.

Chaukhambha Surbharti Prakashan, Varanasi, pp. 927.

18
Verma, M.D., Singh, R.H., Udupa, K.N., 1973. Physiology, endocrine and metabolic studies on

the effect of Rasayan therapy in aged persons. J. Res. Indian Med. 8, 1.

Witt, C.M., Michalsen, A., Roll, S., Morandi, A., Gupta, S., Rosenberg, M., Kronpass, L.,

Stapelfeldt, E., Hissar, S., Müller, M., Kessler, C., 2013. Comparative effectiveness of a

complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee –

Study protocol for a randomized controlled trial. Trials 14, 149.

Yadav, J.S, Thakur, S., Chadha, P., 2003. Chyawanprash awaleha: a genoprotective agent for

Bidi smokers. Int. J. Hum. Genet. 3, 33–38.

19
Table 1: Composition of the Chyawanprash from Charaka Samhita with scientific names, parts of herb used and proportions (Sharma, 1992; The
Ayurvedic Formulary of India, 2003; The Ayurvedic Pharmacopoeia of India, 2007)

S. No. Sanskrit name Botanical name (Family) Part of plant Proportions

1. Bilva Aegle marmelos Corr. (Rutaceae) Rt./St.Bk. 48 g
2. Agnimantha Premna integrifolia Linn. (Verbenaceae) Rt./St.Bk. 48 g
3. Śyonāka Oroxylum indicum (Linn.) Vent. (Bignoniaceae) Rt./St.Bk. 48 g
4. Kāśmarī (Gambhārī) Gmelina arborea Roxb. (Verbenaceae) Rt./St.Bk. 48 g
5. Pātalā Stereospermum suaveolens DC. (Bignoniaceae) Rt./St.Bk. 48 g
6. Balā Sida cordifolia Linn. (Malvaceae) Rt. 48 g
7. Śālaparnī Desmodium gangeticum DC. (Fabaceae) Pl. 48 g
8. Prśniparnī Uraria picta (Jacq.) Desv. ex DC. (Fabaceae) Pl. 48 g
9. Mudgaparnī Phaseolus trilobus Ait. (Fabaceae) Rt./Pl 48 g
10. Māsaparnī Teramnus labialis Spreng. (Fabaceae) Rt./Pl 48 g
11. Pippalī Piper longum Linn. (Piperaceae) Fr. 48 g
12. Śvadaṁṣṭrā(Gokṣura) Tribulus terrestris Linn. (Zygophyllaceae) Pl. 48 g
13. Bṛhatī Solanum indicum Linn. (Solanaceae) Pl. 48 g
14. Kaṇṭakārī Solanum surattense Burm.f. (Solanaceae) Pl. 48 g
15. Śṛṅgī Pistacia integerrima J.L.Stewart ex Brandis (Anacardiaceae) Gl. 48 g
16. Tāmalakī Phyllanthus amarus (Euphorbiaceae) Pl. 48 g
17. Drākṣā Vitis vinifera Linn. (Vitaceae) Dr. Fr. 48 g
18. Jīvantī Leptadenia reticulata Wt. and Arn. (Asclepiadaceae) Rt. 48 g
19. Puṣkara Inula racemosa Hook.f. (Asteraceae) Rt. 48 g
20. Agaru Aquilaria agallocha Roxbe.(Thymelaeaceae) Ht. Wd. 48 g
21. Abhayā (Harītakī) Terminalia chebula (Gaertn.) Retz. (Combretaceae) P. 48 g
22. Amṛtā (guduci) Tinospora cordifolia (Willd.) Hook.f. (Menispermaceae) St. 48 g

20
23. Ṛddhi Habenaria intermedia D.Don. (Orchidiaceae) Sub. Rt. Tr. 48 g
24. Jīvaka Malaxis acuminata D.Don. (Orchidiaceae) Pseudo-bulb 48 g
25. Rṣabhaka Malaxis muscifera (Lindl.) Kunte.(Orchidiaceae) Rt. Tr. 48 g
26. Śaṭī Hedychium spicatum Buch.-Ham. (Zingiberaceae) Rz. 48 g
27. Mustā Cyperus rotundus Linn. (Cyperaceae) Rt. Tr. 48 g
28. Punarnavā Boerhavia diffusa Linn. (Nyctaginaceae) Pl. 48 g
(Raktapunarnavā)
29. Medā Polygonatum cirrhifolium Royle (Liliaceae) Rt.Tr. 48 g
30. Elā Elettaria cardamomum (Linn.) Maton (Zingiberaceae) Sd. 48 g
31. Candana (Śvetacandana) Santalum album Linn. (Santalaceae) Ht.Wd. 48 g
32. Utpala Nymphoea stellata Willd. (Nymphaeaceae) Fl. 48 g
33. Vidārī (Kanda) Pueraria tuberosa DC. (Fabaceae) Rt. Tt. 48 g
34. Vṛṣamūla (Vāsā) Adhatoda Vasica (L.) Nees. (Acanthaceae) Rt. 48 g
35. Kākolī API Lilium polyphyllum D. Don. (Liliaceae) Sub. Rt. 48 g
36. Kākanāsīkā Martynia annua Linn. (Martyniaceae) Fr. 48 g
37. Āmalaka (Āmalakī) Phyllanthus emblica Linn. (Euphorbiaceae) P. 5 kg
(Emblica officinalis)
38. Jala API for decoction Water 12.291
Reduced to 3.071
39. Ghṛta Clarified butter from cow’s milk 288 g
40. Taila (Tila) Sesamum indicum L. (Pedaliaceae) oil. 288 g
41. Matsyaṇḍikā (Śarkarā) Sugar 2.4 kg
42. Madhu Honey 288 g
43. Tugākṣīrī (Vaṁśa) Bambusa bambos (L.) Voss (Poaceae) Siliceous 192 g
deposit
44. Pippalī Piper longum Linn. (Piperaceae) Fr. 96 g
45. Tvak Cinnamomum zeylanicum Blume (Lauraceae) St. Bk. 48 g

21
 46. Elā Elettaria cardamomum (Linn.) Maton (Zingiberaceae) Sd. 48 g
47. Patra ( Tejapatra) Cinnamomum tamala (Ham.) Nees and Eberm. (Lauraceae) Lf. 48 g
48. Keśara (Nāgakeśara) Mesua ferrea Linn. (Clusiaceae) Stmn. 48 g

Note: Stem bark of the ingredients number 1 to 5 of the formulation composition has been used in place of root.

Dr.Fr., Dried fruit; Fl., Flower; Fr., Fruit; Gl., Gall leaves; Ht.Wd., Heart wood; Lf., Leaf; P., Pericarp; Pl., Plant (whole); Rt. Bk., Root bark; Rt.
Tr., Root tuber; Rt., Root; Rz., Rhizome; Sd., Seed; St., Stem; St.Bk., Stem bark; Stmn., Stamens; Sub. Rt. Tr., Subterranean root tuber; Sub. Rt.,
Subterranean root.

22
Table 2: Information of biomarkers and variables that can be studied to identify changes in immune status of human subjects/volunteers (Dhabhar,
2009; Szefler et al., 2012)

Pathways Some of the biomarkers that can be studied Remarks

Activation of phagocytes Macrophage activation, Nk cell activity, gamma-delta T cells

Cytotoxic T lymphocytes T cells and their activities

Generally recognized as direct markers
Release of cytokines CD-4, CD-6, CD-8 cell counts

Inflammatory response IL-6, IL-8, TNF-beta, TNF-alpha

Antibody response Specific antibody titers to infection/antigens for example virus infection Surrogate markers

Globulins Levels of IgG and IgE Generally recognized as direct markers

Stress levels Stress questionnaires, levels of cortisol and oxytocin in blood

Surrogate markers
Endurance ability Performance studies like running, physical exercises, swimming

QoL studies QOL evaluation- objective evaluation by expert/volunteer’s perception Acceptable if objectively evaluated/study

post product consumption- well being/energy levels/no of time falling design is appropriate/n=large and adequate

sick (fever/headache/rhinitis/cough and cold), sleep pattern to name a

few variables

Hemograms (blood profiles) TLC, DLC, (especially eosinophil count) and ESR Potential cause for recurrent rhinitis,

23
 allergies and throat infection/URTI

CD, Cluster of differentiation; DLC, Differential Leukocyte count; ESR, erythrocyte sedimentation rate; Ig, Immunoglobulin; IL, Interleukin; QoL,
Quality of Life; TLC, Total leukocyte count; TNF, Tumor necrosis factors; URTI, Upper respiratory tract infection.

24
 Table 3a: A compilation of published Chyawanprash clinical studies and their findings reported (Investigations from India)

Study Design Sample Size with Indication Grouping and Dosage Results

Randomized controlled 90 (male, 59 and female, 31) Group-I: 10 gm of CP twice a day - Cough, expectoration, weakness, loss of appetite, loss of

trial (Ojha et al., 1975; patients of pulmonary tuberculosis as an adjuvant therapy, in addition weight, fever, oedema aches and haemoptysis

Mishra, 2003) aged 21–40 years assigned to to ATD disappeared almost completely in group-I. Group-II

primary ATD treatment comprising Group-II: assigned to a showed significant recovery while group-III exhibited

of streptomycin (1 g IM/day), combination of anabolic steroid slow and incomplete recovery at the end of therapy

isoniazid (300 mg/day) and PAS (25 mg once a week IM), protein - Mean of weight gain was better in group-I compared to

(12 g/day in three divided doses) supplement (2 tea spoonful or 4 g group–II. Similar response was also seen in serum protein

thrice a day) and vitamins (one - Improvement in the Hb levels was seen in group-I and

cap/day) along with ATD group-II; patients in group-III showed slower or no

Group-III: only ATDs without an recovery

adjuvant therapy - Comparison of X-ray chest before and after treatment

showed effective healing in group-I and II as compared to

the observations in group-III

Observational study Nine volunteers aged 60–70 years CP Rasayan was supplemented at - A marked reduction in urinary nitrogen excretion,

25
(Verma et al., 1973) with no signs of ill health a dose of 25 g twice a day for a creatinine, polysaccharide, hydroxyl proline,

period of 3 months acetylcholine and histamine levels

- Alteration of the endocrinal responses as well,

evidenced by changes in urinary 17-ketosteroids, 17-

hydroxycorticosteroids and urinary testosterone levels

Double-blind, placebo- 60 participants (normal volunteers Group-I: normal volunteers (n = - CP achieved a significantly effective reduction in the

controlled study (Ojha, and patients suffering from 30) divided into placebo and CP Hamilton-D (HAM-D) scores compared to placebo. The

2003) depression) aged 26–older than 56 sub-groups (CP-I) effect was also consistent in both normal subjects and

years Group-II: patients diagnosed with patients of depression

depression (n = 30) divided into - An increase in alpha waves was observed in 37%

placebo and CP sub-groups (CP- normal subjects and 29.62% depressive patients in CP-II

II) group, while it was less in CP-I group in both the subjects

Patients were given CP or placebo

at a dose of 10 g twice daily

preferably with milk for 12 weeks

Randomized controlled 75 patients of head and neck Group-I:10 g of CP twice a day Skin and mucosal reactions:

26
trial (Ojha, 2003) cancer, assigned to teletherapy during the radiation therapy - Most patients in group-II had a mild reaction; none of

alone in the dosage of 45 to 70 gray Group-II: Haemtinics and them had severe reaction. One patient in group-I and two

in 41/ 2 to 7 weeks, were randomly vitamins (A,B-complex, C,D, and patients in group-III had severe reactions

allocated to three treatment groups E)and iron along with CP in the - Group-III patients had the highest incidence of severe

same dosage as in group-I during mucosal reactions (42.1%), followed by group-I (4.2%)

radiotherapy and group-II (8.2%) patients

Group-III: only Haematinics and Blood counts:

vitamins during the radiotherapy - Group-I and –II patients had a rise in Hb percentage

compared to group-III during radio-therapy, however the

difference was not statistically significant

Observational study 40 patients of either sex aged 5–75 Group-I (Normal): Apparently - Hb increased in all groups, except in normal subjects;

(Narayana and years attending the medical OPD of with no signs and symptoms of the decrease in normal group was largely due to one

Dobriyal, 2001) chest and allergy centre, New Delhi disease (control group) person wherein Hb fell considerably

were included in the study Group-II (Allergy): Increase of - ESR fell significantly in normal, allergic and viral

eosinophills cell in nasal secretion groups. ESR increased slightly in bacterial group

and blood. Increase in IgE in the - A marked increase in serum albumin in normal subjects.

27
 serum The increase in globulin was uniform and consistent in

Group-III (Viral): History of all the groups. Albumin globulin ratio decreased in all the

viral infection in the throat groups, which might be due to a rise in globulins

occurring in many people at a - Baseline IgE was maximum in the allergic group and

time. Absence of pyogenic minimum in a viral group. A definite decrease was

bacteria in a throat swab culture noticed after CP supplementation in all the groups

Group-IV (Bacterial): Spectrum - A decrease in C 3 level in the serum was noted in all the

culture positive to pathogenic groups, where as decrease in C 4 was noted in all groups

bacteria of recurrent cough and cold excepting in normal group. In

One heaped teaspoon of CP was the bacterial group 9 out of 10 showed decrease in C 3 and

given twice a day to all 8 out of 10 in C 4

participants; observations were

made at each case at baseline, after

6 and after 12 weeks of therapy

Observational study 50 smokers were categorized in Group-I: Participants with Effect of CP on respiratory system symptoms as

28
(Ojha, 2003) three groups complaints of cough in the follows:

morning (n = 19) - In group-I, PEFR significantly improved. 60% of the

Group-II: Volunteers reporting smokers reported that their cough was less than that prior

phlegm equal to or more than one to taking the trial drug

ounce/day for more than 3 months - In Group-II, spirometry results showed a significant

in a year or for more than 2 years improvement in PEFR

(n = 18) - In group-III, use of CP contributed to a significant

Group-III: Any of the symptoms improvement in the QoL index

covered for groups A and B, plus

breathlessness on exertion (n = 13)

To all groups, CP at a dose of 12 g

twice a day for 12 weeks

Single-blind, Non-diabetic volunteers and Group-I: normal adult volunteers - Significant reduction in fasting plasma glucose level at

randomized, NIDDM patients of either sex (n = 10) 0.5 and 1 h, area under 2 h plasma glucose curve,

comparative study attending the All India Institutes of Group-II: patients of NIDDM LDL/HDL ratio (4th and 8th week) and increase in HDL-

(Manjunatha et al., Medical Sciences (New Delhi) (n = 6) cholesterol in normal subjects taking CP

29
2001) campus and outpatient department, Both the groups were given either - Results of NIDDM subjects were also similar, but could

respectively, were selected for the CP or vitamin C treatments for 8 not be analysed statistically as the number of subjects was

study weeks and follow-up for 8 more very small

weeks - Supplementation of vitamin C on normal subjects had

no significant effects, but on NIDDM subjects there was a

reduction in glucose and LDL/HDL ratio at 8th week

Double-blind, placebo- A total of 177 subjects with non- Summer season, 52 cases (of 61) - CP improved Hb level which was consistent irrespective

controlled study (Ojha, specific physical ailments due to were evaluated. During two rainy of the season of its consumption

2003) the seasonal variations/influences seasons, 45 patients (of 53) were - A significant decrease (~ 25%) in eosinophil count after

(no underlying organic disease) evaluated, and during winter 3 months of treatment with CP-A during summer season;

attending the OPD of Department season 40 subjects were evaluated. a reduction of 10.26% in winter season (CP group) and in

of Dravyaguna, Institute of Medical In round-the-year group, 40 cases rainy season, no change was seen

Sciences (Banaras Hindu were evaluated. - In round-the-year group, polymorph count in the CP-A

University, Varanasi ), were The eligible patients were assigned group after 8 months of therapy significantly reduced

enrolled for the study to treatment with the trial drugs, which was back to baseline at the end of the therapy.

CPA or CPB, by means of an Similar observations were seen in the placebo group

30
alternative drug allocation at a - CP intake decreased ESR which was consistent in all the

dose 12 g twice a day seasons; 38.7% reduction in summer season, 12.7% in

rainy season, 26.14% in winter season, and 39% in the

round-the-year group. Placebo group showed an increase

in the ESR value

- Pulmonary function tests: FEV 1 and FEV 1 /FVC

percentage increase in CP group was clinically significant

in the summer season; an increase in FEV 1 was seen in

winter season

- Plasma cortisol levels: CP group had a decline in mean

plasma cortisol level in summer, rainy, winter, and round-

the-year

- Immunological parameters: CP treatment decreased

IgE levels by ~30% in summer, 15% in rainy, 11.6% in

winter. Placebo group showed 18.3% increase in summer

and insignificant decrease in rainy and winter seasons

31
Observational study 99 newly diagnosed pulmonary Group-I: only ATD - Symptoms abated, body weight showed improvement,

(Debnath PK et al., tuberculosis patients from both the (Pyrazinamide, Isoniazid) ESR values were normal

2012) sexes (aged 11–65 years) randomly Group-II: ATD + Aswagandha - Considerable change in IgA and IgM patterns and

divided into two groups irrespective (Withania somnifera; StresscomÒ significantly increased bioavailability of isoniazid and

of age, sex and religion capsule) 500 mg - 2 caps twice pyrazinamide

daily for 28 days)

Group-III: ATD + CP (IP; 10 g

thrice daily for 28 days)

Observational study 12 healthy male adults were divided Group-I: vitamin C (500 mg/day) - Significant increase in the erythrocyte SOD activity in

(Gupta and randomly into two groups of six Group-II: CP (15 g/day) CP group, but not in vitamin C group

Mahapatra, 2013) subjects each Both treatments for 8 weeks - CP and vitamin C significantly decreased serum IgG

levels to near normal

Randomized controlled 128 college students (male, 53 and Group-I: Sona Chandi CP plus (n - CP significantly improved cognitive functions, i.e.,

trial (Sailesh et al., female, 75; 19 years and older) = 75; male, 35 and female, 40) was alertness, attention and concentration

2014) without any major disease were given at a dose of 15 g twice daily - Blood pressure, pulse, and oxygenation were within

32
 divided randomly into two groups for 150 days normal range

Group-II: control (n = 53; male,

18 and female, 35)

ATD, anti-tubercular drugs; ALP, Alkaline phosphatase; CP, Chyawanprash; ESR, Erythrocyte sedimentation rate; FEV1, Forced expiratory volume
in 1 second; FVC, Forced vital capacity; Hb, Haemoglobin; HDL, High-density lipoprotein; Ig, Immunoglobulin; IM, Intramuscular; IP, Indian
Pharmacopeia; LDL, Low-density lipoprotein; NIDDM, Non-insulin-dependent diabetes mellitus; PAS, Para-aminosalicylic acid; PEFR, Peak
expiratory flow rate; QoL, Quality of Life; SOD, Superoxide dismutase.

33
 Table 3b: A compilation of published studies and their findings reported on Chyawanprash (Investigations from abroad: Ojha, 2003)

Study Name and Location Study Description Findings

Application of biologically active food CP was given as a complimentary remedy in the CP intake for one week increased albumin, albumin-globulin

supplement CP in the clinic of surgical treatment of 110 patients suffering from acute ratio and also average cytochemical coefficient of functional

infections surgical infections activity

Spesivitev YA

St. Peterburg, Russia

CP in the treatment of children with In acute and chronic phases of bacterial tonsillitis Children on CP had less episodes of fever compared to

bacterial infections CP was administered to two sets of children, 3–7 control group. Hb and other haemetological parameters

Rodionova OV years and 7–14 years for a period of one month improved within one month therapy of CP. ESR also

St.Peterburg, Russia decreased significantly in CP group

CP in the treatment of infectious Children suffering from an acute phase of Temperature episodes and cases of hepatomegaly were

Rodionova OV infectious mononucleosis were treated with CP reduced in the CP group compared to control group. CP

St.Peterburg, Russia for 7 to 10 days shows hepatoprotective activity, but has limited usage in the

acute phase of infectious mononucleosis

Application of biologically active Out of 40 children suffering from acute intestinal In the CP group, Asthenic syndrome lasted lesser days

34
additional CP in the treatment of acute infection, 15 were given CP and 25 were given compared to other groups. Period of anorexia and stool

intestinal infections only vitamin B-complex therapy dysfunction were also shortened by regular use of CP. Study

Tikhomirova OV suggests CP useful in the conditions of acute enteric

St.Peterburg, Russia infection and also in the recovery period

Ref: The experiment of applications of CP was given to the swimmers The functional condition level assessed by comparing the

CP in swimmers volume and intensity of training and adaptation to the

Verkhovtseva NA exercise. CP was found to increase the adoptability to the

St.Peterburg, Russia physical exercises besides being non-doping

CP in the treatment of the hyperplastic CP was given in the conditions of hyperplastic CP showed improvement in the general body resistance and

processes in the endometrium process in the endometrium increasedvital capacity of the body. Study validates the

Kochanevich Ye et al. recommended use of CP in a combination therapy of

Kiev,Ukraine hyperplastic processes in the endometrium and also as an

adjunct in hormonal therapy

The application of elixir CP in the CP was given to 46 patients of chronic tonsillitis Reduction in the neutrophils count and increase in the active

treatment of chronic tonsillitis lymphocytes shows the positive influence of CP on lymphoid

Tkachuk IV tissues of tonsils. 82% of patients did not suffer from any

35
St.Peterburg, Russia pharyngeal disease for another 10 months with CP treatment

Application of biologically active food CP was given to neurological patients who had CP showed anabolic, antioxidant as well as antistress actions

supplement CP in the clinic of surgical participated in military operations. 52 patients out

infections of 91 received CP in the dosage of one teaspoon

Spesivitev YA twice a day

St. Peterburg, Russia

CP in the treatment of children with CP was given to two groups, 12 children in the Significant decrease in the respiratory viral infections was

bacterial infections junior group aged 3–4 years received the dosage observed with low cases of tracheitis and rhinopharyngitis.

Rodionova OV of 1/3 teaspoon once a day before meal with milk The use of antibiotics was drastically reduced by regular

St.Peterburg, Russia or tea. In the middle/elder group 25 children aged intake of CP. Allergic rash was noticed on 2nd day of the CP

4–7 years were given CP in dose of ½ teaspoon treatment in two cases. CP can be successfully used to

once daily to check the respiratory infections in prevent the onset of respiratory infections

winters

CP, Chyawanprash; ESR, Erythrocyte sedimentation rate; Hb, Haemoglobin.

36
 Supplementary Tables

Table S1: List of Chyawanprash recipes in the different authoritative texts, their indications, dosage levels and any caution or contraindication
mentioned (Sharma, 1992)

Classical texts Indication* Dosage Caution/

Contraindication

Charaka Samhita rasayana (rejuvenation), kasa (cough), cvasa (dyspnea), ksina (debilitation), ksata

Does not interfere with diet; no contra indication mentioned in the

(trauma), vrddha (old age), bala (children), aggavardhana (growth of organs), svaraksaya

(loss of voice), uroroga (diseases of the chest), hrdroga (heart disease), vataconita

(inflammatory arthritis), pipasa (thirst), mutra (urinary diseases), cukra (diseases of

12-24 g in divided doses daily with water or milk

sperm), suvrddhaanubhutapunaryuva (restores youthfulness even in an old person), medha

(grasping power), smrti (memory), kanthi (lustre), anamayatvam (freedom from diseases),

ayuprakarsam (longevity), balamindriyanam (strength of sense organs),

strisupraharsamparam (sexual vigour), agnivrddhi (improvement in digestion),

varnaprasada (enhancement of complexion), pavananuloma (normal movement in the

body channels), jara (antiaging effects)

Saraggadharasamhita Nariksina (debilitatedby excessive sexual indulgence), cosinam (those who are

texts
debilitated), urograha (diseases of chest), vata pitta (diseases caused by aggravation of

37
 vata and pitta)

Ayurvedic Formulary Same as Charaka Samhita

of India

Bhaisajyaratnavali Same as Charaka Samhita

Ashtangahrdaya Jvara (fever), cosa (debilitation), krca (emaciation) Avelehamatra Pathyabhojana

(quantity of jam like (No dietary

preparation)=48 g restrictions)

*
Sanskrit terms used in these texts with English meaning given in parenthesis.

38
 Table S2: List of marketed Chyawanprash in India, manufacturer, their category, label claims/statements made about health benefits

Name of the product Manufacturer Textual Reference Category/License Label Claims

Chyawanprash Avaleha Dabur India Ltd. Charaka Samhita Classical (note2) - 3 times more immunity, helps fight illness, heritage of

Ayurveda, derived from over 2500 years old Ayurvedic

formula

- Made from 48 trusted Ayurvedic ingredients like Amla,

Ashwagandha, Guduchi etc.

- Proven by science: modulates natural killer cells which

help in protecting from harmful foreign bodies; modulates

cytokines which boost the immune system

Chyawanprash Himalaya Herbal Modified recipe PAM (note3) - Gluten free, USDA organic, for energy

Healthcare - General health and well being, with organic forest honey

SonaChandi Himani Ltd., Kolkata Modified recipe PAM# - Mind and body revitalization

Chyawanprash - 51 Ayurvedic nutra - herbs and minerals

- Surakshit Tan and Tez Dimaag

Chyawanprash Special Shree Baidyanath Modified recipe PAM# - Improves immunity, packed with power, rich in protein,

39
 Ayurved Bhawan (p) carbohydrate, vitamin C and E, and iron

Ltd., Kolkata - For healthy body and mind

- 100% Indian

Chyavanaprasam Arya Vaidya Sala, Astangahridayam Classical* - Ayurvedic herbal supplement

Kottakkal - Rejuvenator, energizer, and immunity booster

Chyawanprash Organic India Pvt. Ltd. Modified recipe PAM# - Rejuvenates and boosts immunity

- 100% certified (USDA) organic

SonaChandi Zandu Pharmaceutical Modified recipe PAM# - Immunity and mind power

Chyawanprash Plus Works Ltd.

Sri Sri Chyawanprash Sri Sri Ayurveda Charaka Samhita Classical* - A unique combination of more than 40 different effective

herbs

- Ensuring highest levels of purity, the herbal formulation is

prepared with the age-old, traditional technique of ancient

'rishis' (sages)

- Boosts immunity, rejuvenates health and restores vitality

and energy levels in the body

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 - Enriched with the goodness of fresh amla (a rich source of

vitamin C) and pure honey

- Improves digestion, absorption, assimilation delays ageing

and promotes youthfulness and longevity

- Strengthens the sense organs, enhances memory and

nourishes the nervous system

- All these and more benefits make Sri Sri Chyawanprash an

indispensible part of every healthy family

Jeevanprash Gold Alkem Laboratories Ltd. Modified recipe PAM# - Fortified with gold and silver

Chyawanprash (Alkem Health Foods

Division)

Dhootapapeshwar Shree Dhootapapeshwar Sharangadhar Samhita Classical* - Traditional Ayurvedic herbal supplement

ASHTAVARG Ltd. Madhyam Khanda 8/10- - Rejuvenator, energizer, and immunity booster

Chyawanprash 21

Bhumiprash Bhumija Life Sciences Modified recipe PAM# - Herbal supplement, ashtwarg, aloe vera and amla, for

Chyawanprash Capsules health and happy living

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 - Traditional Ayurvedic herb

Chyavanaprasam Arya Vaidya Pharmacy Astangahridayam Classical* - Ayurvedic herbal supplement

Ltd., Coimbatore - Rejuvenator, energizer, and immunity booster

Chyavanaprasam Arya Vaidya Pharmacy Modified recipe PAM# - Ayurvedic herbal supplement

Biscuits Ltd., Coimbatore - Rejuvenator, energizer, and immunity booster

PAM, Proprietary Ayurvedic Medicine; USDA, United States Department of Agriculture.

Note 1: Nonexhaustive list.

Note 2: Classical means as per recipe in authoritative texts recognized by law in India - Definition 3(a) of Drugs and Cosmetics Act.

Note 3: Proprietary Ayurvedic Medicine means - prepared to meet Definition of 3(h)(i) as per Drugs and Cosmetics Act - all ingredients should be

listed in one of the authoritative texts.

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