Pharmacognostical and Pharmacotherapeutic Effect of Kakodumbarphala Churna (Ficus hispida L.f.) in the Management of Raktapradara (Menorrhagia)

Abstract

Background: Raktapradara, described in Ayurvedic classics as Asrigdara, is a Yonivyapad characterised by excessive and irregular uterine bleeding and correlates closely with Menorrhagia, a common gynaecological disorder that affects women\'s health, quality of life and productivity worldwide. Modern management relies largely on hormonal agents, antifibrinolytics and, in refractory cases, hysterectomy, all of which carry limitations and adverse effects. Kakodumbara (Ficus hispida L.f., family Moraceae), possessing Tikta-Kashaya Rasa, Laghu-Ruksha Guna and Sheeta Veerya with documented Stambhana (haemostatic) and Raktaprasadana (blood-purifying) properties, is a classical Ayurvedic drug indicated for Raktapradara and offers a rational, low-cost therapeutic alternative. Objective: To evaluate the pharmacognostical and phytochemical profile of Kakodumbarphala (fruit of Ficus hispida) and to assess the clinical efficacy of Kakodumbarphala Churna in the management of Raktapradara (Menorrhagia). Materials and Methods: Authenticated Kakodumbarphala was evaluated by macroscopic, microscopic and powder-microscopic pharmacognostical methods, physicochemical analysis (loss on drying, ash values, extractive values, pH), qualitative phytochemical screening and thin-layer chromatography. In a single-arm, open-label, prospective clinical trial conducted at the OPD of PGIA, Jodhpur, 42 diagnosed patients of Raktapradara (age group spanning menarche to menopause) were treated with Kakodumbarphala Churna 3 g twice daily with Madhu (honey) as Sahapana and Milk with Sharkara as Anupana, after meals, for 90 days, with a 60-day follow-up. Subjective parameters (Angamarda, Vedana, duration/intensity/amount of menstrual flow, intermenstrual period, Daurbalyata, Daha and Panduta) and objective parameters (Hb%, CT, BT and USG endometrial thickness) were graded before and after treatment and analysed using the Wilcoxon signed-rank test and paired t-test. Results: Pharmacognostical evaluation revealed characteristic diagnostic markers — thick-walled sclereids, laticiferous vessels, unicellular trichomes, spiral xylem vessels and calcium-oxalate crystals in the fruit and its powder. Physicochemical and qualitative phytochemical analysis confirmed the presence of carbohydrates, alkaloids, saponins, glycosides, tannins, amino acids and proteins, and thin-layer chromatography of the methanolic extract resolved six spots (Rf 0.16-0.75). Of 42 patients registered, 40 (95.2%) completed treatment. All nine subjective parameters and the total symptom score improved significantly (p < 0.001), with relief ranging from 44.9% (Vedana) to 77.1% (Daurbalyata), and a 61.5% reduction in total symptom score. Objective parameters also improved — haemoglobin increased by 8.8%, endometrial thickness reduced by 28.3%, bleeding time by 8.9% and clotting time by 12.9%. Overall, 82.5% of patients showed good-to-excellent improvement, and no adverse events were reported. Conclusion: Kakodumbarphala Churna showed reproducible pharmacognostical and phytochemical standardisation markers together with clinically meaningful, statistically significant improvement in both subjective and objective parameters of Raktapradara (Menorrhagia), supporting its traditional classification as a Rakta-Stambhaka and Raktaprasadana dravya. Larger, controlled trials are warranted to confirm these preliminary findings.

Introduction

This study evaluates the pharmacognostical, phytochemical, and clinical effects of Kakodumbarphala Churna (Ficus hispida L.f.) in the management of Raktapradara (Menorrhagia/abnormal excessive menstrual bleeding). Ayurveda considers menstrual health an important component of women's reproductive health, and Raktapradara is described as excessive or abnormal Artava flow. The study highlights the need for safer and less invasive alternatives to conventional treatments for excessive uterine bleeding.

Aim and Objectives

The main aim is to assess the efficacy and pharmacotherapeutic effects of Kakodumbarphala Churna in Raktapradara.

The secondary objectives are to:

• Study the pharmacognosy and phytochemistry of Kakodumbarphala.
• Review classical literature concerning Kakodumbarphala and Madhu (honey).
• Review Ayurvedic literature related to Raktapradara.
• Evaluate the clinical effectiveness of the formulation in reducing excessive menstrual bleeding.

Materials and Methods

The research uses an open-label, prospective, single-arm clinical trial involving 42 patients. The treatment period is 90 days, followed by a 60-day follow-up.

Participants were women from menarche to menopause who had excessive uterine bleeding for more than two consecutive menstrual cycles. Patients with conditions such as malignancy, large fibroids, abortion-related bleeding, coagulation disorders, IUCD use, uncontrolled diabetes or thyroid disease, and PCOS were excluded.

Participants received:

Kakodumbarphala Churna – 3 g twice daily after meals for 90 days, with Madhu (honey) as Sahapana and milk with sugar (Sharkara) as Anupana.

Clinical Assessment

Treatment effectiveness was assessed using subjective and objective parameters.

Subjective parameters included:

• Bodyache
• Menstrual pain
• Duration of menstruation
• Menstrual bleeding intensity and amount
• Intermenstrual interval
• Weakness
• Burning sensation
• Pallor/anemia

Objective parameters included:

• Hemoglobin level
• Bleeding time
• Clotting time
• Hormonal profile when required
• Ultrasonographic endometrial thickness

Physicochemical and Phytochemical Findings

The drug was evaluated for foreign matter, moisture, ash values, pH, extractive values, and chemical constituents. The major findings included:

• pH of 10% aqueous solution: 5.8
• Foreign matter: 0.62%
• Loss on drying: 15%
• Total ash: 12.4%
• Acid-insoluble ash: 1.3%
• Water-soluble ash: 4.3%
• Methanol extractive value: 15%
• Aqueous extractive value: 13%

Qualitative phytochemical screening indicated the presence of carbohydrates, reducing sugars, alkaloids, saponins, glycosides, tannins, amino acids, and proteins. The ash also contained calcium, iron, phosphorus, and potassium. The reported physicochemical parameters were within acceptable Ayurvedic Pharmacopoeial quality limits.

Pharmacognostical Findings

Macroscopically, Kakodumbarphala is characterized by a light green to yellowish-brown colour, turbinate to obovoid shape, rough/hairy surface, bitter taste, and distinctive odour.

Microscopic examination identified characteristic diagnostic features such as:

• Thick-walled sclereids
• Branched laticiferous canals
• Collateral vascular bundles
• Calcium-oxalate crystals
• Starch grains
• Lignified fibres and xylem vessels
• Tannin-containing parenchyma

Powder microscopy further confirmed the presence of parenchyma, starch grains, sclereids, lignified fibres, spiral and pitted vessels, calcium-oxalate crystals, and tannin-containing epidermal fragments. These features can be used for authentication and quality control of Kakodumbarphala Churna.

Conclusion

This section outlines the conclusions drawn from the observations, results and discussion of the present study, entitled “Pharmacognostical and Pharmacotherapeutic Effect of Kakodumbarphala Churna (Ficus hispida L.f.) in the Management of Raktapradara (Menorrhagia).” The study may be summarised and concluded as follows: 1) Pharmacognostical and phytochemical evaluation established reproducible macroscopic, microscopic, physicochemical and chromatographic standardisation markers for Kakodumbarphala, confirming its correct botanical identity and quality. 2) Qualitative screening confirmed the presence of carbohydrates, alkaloids, saponins, glycosides, tannins, amino acids and proteins, and TLC of the methanolic extract resolved six reproducible spots (Rf 0.16-0.75). 3) In the clinical trial, Kakodumbarphala Churna (3 g twice daily with honey and milk-sugar as Anupana for 90 days) produced statistically highly significant (p < 0.001) improvement in all nine subjective parameters of Raktapradara, with a 61.5% reduction in total symptom score. 4) Objective parameters also improved meaningfully — haemoglobin increased by 8.8%, endometrial thickness reduced by 28.3%, bleeding time by 8.9% and clotting time by 12.9%. 5) Of 40 patients who completed treatment, 82.5% achieved good-to-excellent improvement, and no adverse events were reported, indicating that the drug is both effective and well tolerated. 6) These findings validate the classical description of Kakodumbara as a Rakta-Stambhaka and Raktaprasadana dravya and support its potential as a safe, effective and affordable Ayurvedic option for Raktapradara (Menorrhagia). The study was limited by its single-arm design, modest sample size (n = 40) and the absence of a control group. Larger, multi-centric, randomised controlled trials with extended follow-up, exploration of alternative Kalpanas, and mechanistic studies on endometrial angiogenesis, prostaglandin synthesis and hormonal regulation are recommended to further establish and generalise these findings.

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Copyright

Copyright © 2026 Dr. Monam Yadav, Dr. Rajendra Prasad Purvia, Dr. Nikita Panwar. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.