Ayurveda iron preparations used in Sri Lanka R. L. Jayakody 1, Damayanthi Withanage 2 The Ceylon Journal of Medical Science 1999; 42:95-99 Abstract Iron deficiency anaemia has a high prevalence in Sri Lanka. As ayurveda treatment is popular a proportion of patients with anaemia, especially the rural folk are treated with ayurveda' haematinics. This descriptive study attempts to briefly review the ayurveda iron preparations and the bioavailability of iron from them. There are between 15 to 20 ayurveda iron preparations that are listed in the formularies. Of these Punarnava Mandura Vati, Lauha Asava and Chandr- aprabha Vati are three preparations that are com­ monly used. It is difficult to get at bioavailability and efficacy data of these preparations. A pilot study conducted in Sri Lanka has shown that Punarnava Mandura Vati has efficacy as a haem- atinic during pregnancy. Introduction Iron deficiency anaemia is a serious health prob­ lem in Sri Lanka. The Third National Nutrition and Health Survey conducted between October 1994 and January 1995 involving seven provinces (North and Eastern provinces excluded) has shown the prevalence of anaemia to be 45% amongst pre-school children, 58% amongst chil­ dren between 5 and 10.9 years and 36% among adolescents. Among women, 45% non- pregnant and 39% of pregnant were anaemic. Prevalence of anaemia was most amongst non-pregnant mothers in the plantations (59%) than those in the urban (40%) and rural (46%) areas. This means that a very high proportion of the rural population living in the villages are anaemic to varying degrees. Sri Lanka has practitioners of Ayurveda spread throughout the country. Most villages have their own ayurveda practitioners who look after the health problems of the villagers. Due to the de­ mand these practitioners have now expanded their services to semi urban and urban areas. State owned ayurveda hospitals and clinics are found spread throughout the country. Although exact figures are not available a fair proportion of the population (especially the rural popula­ tion), seek ayurveda medicine for their health problems. This means that patients with iron deficiency anaemia are being treated by ayur­ veda practitioners. While ayurveda practitioners use herbs and other remedies to treat symptoms of anaemia, the ex­ tent to which these practices complement pre­ ventive and therapeutic care provided by the Western system of medicine is not fully under­ stood. Programmes designed to combat iron de­ ficiency should also take into account the part played by the ayurveda sector. As part of in the Anaemia Control Project under the Ministry of Plan Implementation and Parliamentary Affairs we undertook to review the contribution of the ayurveda sector in the control of anaemia. There are several questions that could be asked on the subject of ayurveda haematinics. For ex­ ample we would want to know about the ayur­ veda iron preparations, extent of their use, manu­ facturers, consumption of haematinics, iron con­ tent and bioavailability, acceptability, compli­ ance, adverse effects, cost etc. Because of the pau­ city of data in this field we restricted our inquiry to two areas given under the objectives. Objectives We attempted to answer the following two ques­ tions: 1. Department of Pliarmacology, Faculty of Medicine, P. 0. Box 271, Colombo 8. 2. Department ofDravya Guna Vingnana, Institute of Indigenous Medicine, Rajagiriya. 96 R. L. Jayakody, Damayanthi Withanage 1. What are the ayurveda iron preparations used in Sri Lanka? 2. What is the bioavailability of iron in them? Methods In order to answer these questions we had dis­ cussions with ayurveda practitioners and opin­ ion leaders in the premier ayurvedic hospitals in Sri Lanka, including the Institute of Indigenous Medicine (IIM) and the Bandaranaike Memorial Ayurvedic Research Institute (BMARI). Scientists attached to the Universities and other institutes (e.g. Ceylon Institute of Scientific and Industrial Research (CISIR)) who had conducted research in this field were also consulted. Ayurveda for­ mularies, journals and textbooks were perused. Inquiries were also made from the teaching cen­ tres of ayurveda in India and from reputed local and Indian manufacturing houses. MEDLINE and internet searches were done using appropri­ ate key words. Lists of formularies, journals and textbooks con­ sulted and the persons contacted, their addresses and contact numbers could be obtained from the authors. Results The information about the iron preparations was available in the formularies and the textbooks. We were also able to obtain some impressions from the discussions and the correspondence. However we were not successful in getting much information on this subject from India The searches of the databases also did not reveal any information. 1. Ayurveda iron preparations used in Sri Lanka There are between 15 to 20 ayurveda iron prepa­ rations that are listed in the formularies and the books. Of these the following three preparations are widely used in Sri Lanka. i. Punanrava Mandura Vati -(powder made into tablets or pills) ii. Laulia Asava - (iron containing herbal wine) Hi. Chandraprabha Vati - (powder made into tab­ lets or pills) The following information about these three products are given in the Table 1. Sources of iron in the preparation Composition (as per standard composition tables) Method of preparation Whether made daily or stored; shelf life etc. Cost Age group to which it is targeted Method of administration (with food or fast ing etc.) Recommended dose Bioavailability of iron (if information is avail­ able) The ayurveda haematinics containing metallic iron are generally not recommended in the pharmacopoeias for use on children. However it was revealed that both Punamava Mandura Vati and Lauha Asava are given to children from year 4 upwards. Punanrava Mandura Vati and Lauha Asava are used exclusively for the management of anaemia (pandu). However Chandraprabha Vati is used for anaemia and for several other condi­ tions as well (e.g. urinary tract infection). These three haematinics are used in the ayurveda hospitals and clinics. There are a few individual practitioners who prepare the drugs themselves, but this component must be small. Several manu­ facturing houses manufacture them and sell in the open retail market. These drugs are also manufactured by the Sri Lanka Ayurvedic Drugs Corporation. This Corporation informed us that they sell about 500 kg of Punarnava Mandura Vati and 17000 bottles (750 to 1000 mL per bottle) of Lauha Asava per year. There are about 7 or 8 such manufacturers. The sales figures from these manufacturing houses were not available. Con­ sidering the sales figures given by the Ayurvedic Drugs Corporation we may assume that the The Ceylon Journal of Medical Science Table 1 Pharmacological information about three commonly used ayurvedic iron preparations Source of Method How it is Cost Age Method Recom­ Bioavail­ s Iron of Prepration stored CA B- group of mended ability of o s i n O Si targeted administra­ dose iron 1 | 5 a. a. nposition de daily • stored life of the oduct t ion Iron rust or Mandura is purified CA In glass vessels 1 Rupee Adults Orally; with 250 mg to No 5 impure oxide to and incinerated by a o re as powder or per 250 mg including lukewarm 500 mg informa­ •5 from % special method and o. tablets; keep tablet pregnancy, water or with twice daily tion blacksmith's » re boiled in cow's urine away from approx. do not use decoction of before available. anvil purified fl> until it becomes a moisture approx. below 12 Tripala meals. Probably allowed to rust re 3 paste. The products 5' years having E ^ giving re* mentioned in the recipe o. n efficacy. « E iron oxide 4& 5 are added and stirred g; Assay for 4& 5 well. Tablets are prepared from the paste. rS iron 18 - 22%w/w Iron filings or 3F Jaggery and honey. In dark Rs. 80 to 85 Adults Orally; mixed Taken on No sheets allowed ft Lauha bhasma, other coloured glass 5° a. per 750 ml bottle. including with equal or an empty informa­ = 2 to rust sr* herbal products are CA bottles 5° a. per 750 ml bottle. pregnancy, double the stomach 20 tion •5 (Lauha to i-i to mixed in water and the a 3 (air tight) re £•% per 750 ml bottle. do not use quantity of ml - 30 ml available. «3 § bhasma) £ vessel is sealed. After re a s\ below 12 water. twice (A one month the (5 years daily. fermented liquid is strained. "•C Iron filings re The ingredients (except In glass vessels not Adults Orally; with water, milk and gingilly powder; not No allowed to rust re guggulu) are powdered as powder or available including Orally; with water, milk and gingilly powder; available informa­ (Lauha 79 re and mixed. Then tablets; keep 5" a. pregnancy Orally; with water, milk and gingilly powder; tion i s bhasma) re" 3 guggulu is added little