Nutritional deficiency anaemia, particularly Iron‑deficiency anaemia, remains a major public health concern in developing countries such as India. It commonly affects vulnerable groups including children, adolescents, and pregnant women, leading to symptoms such as fatigue, weakness, pallor, and reduced physical and cognitive performance. In Ayurveda, the clinical features of nutritional anaemia closely resemble Pandu Roga, a disorder described in classical texts characterized by pallor of the skin, diminished strength, and impairment of bodily tissues. According to Ayurvedic principles, Pandu Roga mainly results from impaired digestive fire (Agni), improper dietary habits, and vitiation of Doshas, particularly Pitta, which ultimately affects the formation and quality of blood (Rakta Dhatu). Management in Ayurveda emphasizes a holistic approach that includes Nidana Parivarjana (avoidance of causative factors), correction of Agni through digestive and metabolic stimulants, and the use of herbal formulations with haematinic and Rasayana (rejuvenating) properties. Dietary modifications and lifestyle regulation are also considered essential components of therapy to restore physiological balance and improve blood quality. This review aims to integrate classical Ayurvedic concepts with contemporary scientific understanding, highlighting the pathogenesis, clinical features, and evidence-based Ayurvedic interventions for the effective management of nutritional deficiency anaemia.

Introduction:

Anaemia happens when the amount of haemoglobin in the blood is lower than normal for a person’s age and sex, which means the blood cannot carry as much oxygen to the body. Nutritional anaemia in children arises primarily from deficiencies in iron, vitamin B12, folate, or other micronutrients, impairing haemoglobin synthesis and oxygen transport. Globally, it affects over 1.6 billion people, with children under five bearing a heavy burden—prevalence exceeds 70% in parts of India, leading to growth stunting, cognitive delays, and increased infection susceptibility.[1] Iron-deficiency anaemia (IDA) is the most common type and occurs when someone does not get enough iron from their diet, loses iron, or loses blood from periods, infections, or long-lasting bleeding. In India, IDA is especially common among school children, teenage girls, and pregnant women. This shows that we need real, lasting solutions in healthcare that do more than just hand out iron pills. To improve treatment, it is important to consider alternatives to iron supplements. In Ayurveda, this manifests as Pandu Roga, a Tridoshaja disorder predominantly involving Pitta, characterized by Panduta (pallor) and Rakta Dhatu Kshaya (blood tissue depletion). Classical texts like Charaka Samhita Chikitsa Sthana 16 describe it as stemming from Agnidushti (impaired digestion) and Dhatuposhana Nasha (nutrient malabsorption), mirroring modern nutritional deficits from poor diet, infections, or malabsorption. [2]

Children in Kaumarbhritya (pediatric branch) are prone due to immature Agni and the demands of rapid growth. This review synthesises Ayurvedic aetiology, pathology, management, and evidence, aiming to bridge traditional wisdom with contemporary needs for safer, sustainable interventions.

Aims:

To correlate current ideas about nutritional-deficiency anaemia with the Ayurvedic condition called Pandu Roga.

To describe how Ayurveda explains the causes of anaemia similar to Pandu.

To summarise traditional and modern Ayurvedic remedies used for iron-deficiency anaemia.

Materials and Methodology:

Source materials:

Classical Ayurvedic texts (Charaka Samhita, Sushruta Samhita, Ashtanga Hridaya, Bhavaprakasha, Sharangadhara Samhita).

Peer-reviewed journal articles on Ayurvedic management of iron‑deficiency anaemia and Pandu Roga indexed in PubMed and Ayurvedic journals.

Case reports and observational studies describing Ayurvedic interventions in anaemia.

Search strategy:

Keywords used: “Pandu Roga”, “Iron Deficiency Anaemia”, “Ayurveda”, “Ayurvedic formulations”, “nutritional anaemia”.​

Articles were chosen if they were related to Ayurvedic causes, treatments, and results in anaemia.

Result:

1. Conceptual correlation: Nutritional anaemia and Pandu Roga

Modern medicine classifies nutritional anaemia by the cause, such as iron, vitamin B12, or folate deficiency, or by blood cell breakdown. The most commonly found nutrient deficiency is iron, which causes anaemia. It is estimated that 30-50% of the global population has iron–deficiency anaemia, and most of these individuals live in developing countries. [3]

Ayurveda, on the other hand, sees Pandu as a problem caused by excessive accumulation of Pitta, which disrupts the blood and body fluids. Both systems agree: if there are not sufficient nutrients in the body, haemoglobin levels drop, and the body does not get enough oxygen. In Pandu, too much Pitta, along with Vata and Kapha, weakens digestion and the process that turns food into blood, making the body look pale and feel tired.[4]

2. Pathogenesis in Ayurveda

Pandu starts when digestion becomes weak and Vata and Pitta become unbalanced, often due to unhealthy eating, eating too many spicy or salty foods, mixing foods that do not go well together, eating at odd times, and stress. These habits create Ama (undigested toxin) which blocks the body's vital pathways and weakens tissues, leading to pale skin. Modern science sees something similar, linking long-lasting swelling, stomach problems, and trouble taking in nutrients to low iron levels and slow blood production.[5]

3. Clinical Features;

Common Lakshana: Panduta (pallor), Mandagni (impairment of digestive fire), Aruchi (anorexia), Gaurava (heaviness), Bhrama (dizziness), Hridaya Spandana (palpitations), Shwas (dyspnoea), and matching anaemia signs such as fatigue and irritability. [6]

4. Ayurvedic management principles

Ayurveda treats nutritional deficiency anaemia by combining changes in diet, herbal medicines, and lifestyle habits for a complete approach:

Ayurvedic management actions can be grouped into three key approaches:

Digestive Rekindling: This includes Nidana-parivarjana (elimination of cause), in which you remove triggers such as junk food, too much tea or coffee, and poor food combinations. It also means dealing with causes like, parasite infections, or stomach problems. Deepana-Pachana therapies, using herbal starters and digestives such as Chitrakadi vati and Hingvadi churna, are used to restart digestion and help the body better absorb nutrients. Use of various ghrutas should be promoted for anaemia, e.g., Dadim ghruta, Katukadya ghruta, Pathya ghruta, Draksha ghruta, Haridradi ghruta. [7]

Blood Enrichment: This group focuses on nourishing the blood and other vital body fluids with iron-rich Ayurvedic products such as Loha-bhasma and Mandur Bhasma along with strengthening herbs like Ashwagandha, Shatavari, Amalaki, and Yashtimadhu.

Elimination and Recovery: Gentle cleansing therapies, such as Virechana or Vamana, are used when needed to clear Ama and restart digestion. After cleansing, foods are gradually reintroduced through the Samsarjana-krama diet.[8]

Classical Formulations

Prominent herbo-mineral compounds include Dhatri Lauha (Emblica officinalis, Lauha Bhasma, Yashtimadhu, Guduchi), dosed at 500 mg twice daily, showing significant haemoglobin rise (0.72 g/dl in 45 days) and improved MCV and ferritin levels in trials. Punarnavadi Mandura with buttermilk enhances absorption via lactic acid, effective in pediatrics and geriatrics. Others: Navayasa Lauha, Sarva-Jvara-Hara Lauha (highest Hb gain: 0.16 g/dl/day), Pradarantaka Lauha, and Dadimadi Ghrita for special groups. Over 100 formulations use 138 plants, including Pippali and Shunthi, most frequently. [9]

Iron-containing Bhasmas and Lauha preparations

These are the backbone of Pandu treatment and act as organic iron supplements with better bioavailability and fewer side‑effects than conventional ferrous salts.

Table 1

Discussion:

Pandu Roga's framework explains nutritional anaemia's multifactorial nature better than singular nutrient focus, addressing root Agnidushti via Rasayana (e.g., Drakshasava) for sustained Dhatu Poshana. Children's vulnerability stems from Sukradhatu dependency on parental health and immature Rasavaha Srotas, advocating early Pathya like Ghrita-Mamsa soups.

Ayurvedic iron formulations typically contain lauha or mandura bhasma in organic or nano‑crystalline form, which is believed to be better tolerated than inorganic ferrous salts. The accompanying herbs often provide:

• Vitamin‑C‑rich components (amalaki, draksha, yastimadhu) that enhance non‑haem iron absorption.
• Deepana‑pachana herbs (trikatu, chitrak, ajamoda) that improve agni and nutrient assimilation.
• Anti-inflammatory and hepatoprotective agents (kutki, yastimadhu, punarnava) that correct underlying metabolic dysfunction.

This explains why many trials report not only haemoglobin rise but also improvement in fatigue, appetite, and quality of life, with fewer GI side‑effects than conventional iron.

Ghruta, or medicated ghee, plays a pivotal role in managing Pandu Roga. Due to its unique properties, such as snigdha (unctuous), sara (mobile), jivaniya (life-promoting), and snehana (oleation), It lubricates srotas (channels), ignites jatharagni and dhatvagnis (digestive fires), and nourishes depleted rasa-rakta dhatus without aggravating pitta, the primary dosha in Pandu.

Evidence from clinical and experimental studies

• A controlled trial on six commonly used Ayurvedic iron preparations (Navayasa Churna, Punarnavadi Mandura, Dhatri Lauha, Pradarantaka Lauha, Sarva‑Juara‑Hara Lauha, Vrihat Yakrdari Lauha) showed significant improvement in haemoglobin and iron indices over 30 days, with good tolerability.​ [11]

• Studies on Kasisa Bhasma and Dhatri Lauha in children and adults with nutritional deficiency anaemia reported sustained rise in haemoglobin and iron stores, suggesting long‑term correction of absorption defects. [12]

• Case reports in young women with iron‑deficiency anaemia treated with Pandu‑line formulations plus iron‑rich diet documented rapid improvement in pallor, palpitation, and haemoglobin (e.g., from 8.6 g/dL to 12.7 g/dL in one month. [13]

The duration is usually 3–6 months, with periodic monitoring of haemoglobin, serum iron, ferritin, and the symptom profile. Most classical Ayurvedic iron formulations are reported to be safe when used at recommended doses and under supervision, with fewer GI side effects than conventional ferrous salts. However, quality control of bhasmas (heavy‑metal content and particle size) remains critical, and standardisation of doses, anupana, and treatment duration requires further large‑scale trials.

Integrating Ayurveda with modern haematology offers a promising model:

• Using Ayurvedic therapy for long‑term correction of agni, dhatu‑poshana, and iron absorption,
• Reserving parenteral iron or high‑dose oral iron for severe, acute, or non‑responsive cases,
• Combining nutritional counselling and deworming in endemic areas.

Conclusion:

Ayurveda provides a wide, evidence-informed armamentarium—from single-drug food-based remedies to complex lauha preparations—for the management of nutritional deficiency anaemia. A systematic, phase-wise approach combining nidana parivarjana, agni‑deepana, shodhana where indicated, and targeted haematinic therapy can offer not only symptomatic relief but also sustained correction of underlying metabolic and nutritional defects.

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