Kushmanda Rasayana

The formulation takes its name from its principal ingredient. Kushmanda is the Sanskrit name for ash gourd, Benincasa hispida, the pale green winter melon sold across India as petha. In Ayurveda, Rasayana refers to preparations traditionally used to promote nourishment, strength and general well-being. Because the finished preparation is a semi-solid confection, it is also called Kushmanda Avaleha, and it is sold in South India as Kooshmanda Rasayanam.

The preparation is described in Bhaishajya Ratnavali, in the chapter on Raktapitta, and in Sharangadhara Samhita, Madhyama Khanda. The classical indications recorded for it are Kasa (cough), Shwasa (breathlessness), Kshaya and Kshata (wasting and chest injury), Raktapitta, and general debility. Ash gourd itself is described as Madhura (sweet) in rasa and Sheeta (cooling) in virya, and as Balya, meaning traditionally considered strength-giving. The pungent ingredients, Pippali, Maricha and Shunthi, are added to support digestion of the preparation, since a sweet and heavy base can otherwise be difficult to digest. Modern research on the formulation has focused on persistent cough (Kale et al., 2018).

The name of this preparation is a transliteration from Sanskrit rather than a direct translation. The variations below represent spelling and regional forms of the same preparation, although some terms may refer to related ash gourd-based preparations rather than identical formulations.

• Petha in Hindi
• Chalkumra in Bengali
• Boodida Gummadikaya in Telugu
• Poosanikai in Tamil
• Kumbalanga in Malayalam
• Kushmanda Lehyam in Kerala
• Kooshmanda Rasayanam in Tamil Nadu
• Kushmanda Avaleha: The name used when the preparation is described according to its dosage form.
• Kushmandaka Rasayana: A spelling used in the CCRAS clinical study and by several manufacturers.
• Kushmanda Rasayanam and Kooshmaanda Rasaayanam: Transliteration variations commonly seen on product labels.
• Kushmand Pak: A related name used for a similar ash gourd-based confection.

Kushmanda Rasayana is built on a sweet, nourishing base with a small group of warming spices added to support digestion. The ingredients below are the ones described in the classical preparation.

• Kushmanda (Benincasa hispida), ash gourd fruit pulp and juice, which forms the bulk of the preparation
• Go-Ghrita, cow's ghee, used to cook the pulp and to carry the fat-soluble constituents
• Sharkara, sugar, which contributes to the consistency and sweetness of the preparation
• Madhu, honey, added after the preparation has cooled
• Pippali (Piper longum), long pepper
• Maricha (Piper nigrum), black pepper
• Shunthi (Zingiber officinale), dry ginger
• Jeeraka (Cuminum cyminum), cumin
• Dhanyaka (Coriandrum sativum), coriander
• Twak (Cinnamomum verum), cinnamon bark
• Ela (Elettaria cardamomum), green cardamom
• Tejapatra (Cinnamomum tamala), Indian bay leaf

Chemical Constituents of Kushmanda Rasayana

Because Kushmanda Rasayana is a multi-ingredient formulation, its constituents come from several ingredients rather than a single plant. The key groups of compounds commonly identified include:

• Ash gourd: Phenolic compounds, flavonoids, triterpenes and polysaccharides.
• Long pepper and black pepper: Piperine, the alkaloid responsible for their pungent taste.
• Dry ginger: Gingerols and shogaols.
• Cinnamon bark: Cinnamaldehyde and related volatile compounds.
• Cardamom and Indian bay leaf: Cineole and other volatile oil components.
• Cumin and coriander: Cuminaldehyde and linalool, respectively.
• Sugar and ghee (base ingredients): Sucrose from sugar, along with fatty acids and fat-soluble compounds from ghee.

Kushmanda Rasayana has the following traditional Ayurvedic properties and researched effects, with the level of supporting evidence noted for each.

• Balya: Traditionally described as supporting strength.
• Rasayana: Traditionally described as supporting nourishment and restoration of body tissues.
• Brimhana: Traditionally described as supporting body nourishment and healthy weight.
• Antitussive: May help relieve a persistent cough.
• Deepana and Pachana: Traditionally described as supporting appetite and digestion.
• Antioxidant: Reported in laboratory studies on ash gourd.
• Anti-inflammatory: Reported in laboratory studies on ash gourd.

Among these properties, only the effect on a persistent cough has been evaluated in a clinical study of the finished formulation, and that study did not include a comparison group (Kale et al., 2018). The remaining properties are based on traditional Ayurvedic descriptions or laboratory studies of the individual ingredients.

This preparation is traditionally used to support respiratory health and general nourishment. The section below explains each traditional use and the current level of evidence supporting it.

This preparation is traditionally used to support respiratory health and general nourishment. The section below explains each traditional use and the current level of evidence supporting it.

Support in Long-Standing Cough and Chest Complaints

In a multicentre study run by three CCRAS institutes, 193 people with chronic bronchitis took 10 g twice daily for 12 weeks and showed improvement in symptoms and in lung function measured as FEV1 (Kale et al., 2018). Everyone in the study received the medicine, so there was no comparison group. This limits the extent to which the improvement can be attributed to Kushmanda Rasayana.

Nourishment During Recovery From Illness

Traditionally, Ayurvedic texts describe this preparation for Kshaya and Kshata, terms that refer to wasting and depletion following illness or injury. The formulation contains ghee and sugar, making it energy dense, while ash gourd is traditionally described as Balya, meaning supportive of strength. This is a traditional Ayurvedic use and has not been established through modern clinical trials.

Appetite and Digestion

Long pepper, black pepper, dry ginger and cumin are classed in Ayurveda as Deepana and Pachana, meaning they are traditionally described as supporting appetite and digestion. They are included partly for this reason and partly so that a sweet, heavy preparation may be easier to digest. This is traditional reasoning, not a tested effect.

Weight Gain During Convalescence

The preparation is energy dense because of its ghee and sugar content, which is why it is used traditionally in Brimhana therapy for someone who is underweight after illness. The weight gain comes from the calories it supplies, not from any established effect on metabolism.

Disclaimer: Kushmanda Rasayana is a nourishing preparation and not a treatment for any diagnosed lung disease. If you have a persistent cough, breathlessness, coughing up blood, fever or unexplained weight loss, consult a registered medical practitioner rather than treating it yourself. Do not stop any prescribed inhaler or medicine in order to take it.

This preparation turns up in a few specific situations rather than as an everyday supplement. Here is when it is typically used.

During Recovery After a Chest Illness

It is given once an acute infection has settled, when a cough lingers and the person feels weak, rather than during the acute illness itself. It is not a substitute for treatment of the infection.

As a Prescribed Rasayana Course

Ayurvedic physicians prescribe Rasayana preparations as a defined course rather than on an open-ended basis, usually alongside dietary advice. The length of the course is set by the practitioner and reviewed at the end of it.

Where Appetite Is Poor and Body Weight Is Low

Used traditionally in Brimhana therapy for someone who is underweight after illness. Because it is energy dense, it is intended for that situation specifically and not as a general daily tonic.

Alongside Other Respiratory Preparations

It is sometimes given with a churna such as Sitopaladi or Talisadi, where one preparation is traditionally used for nourishment and the other for respiratory symptoms. Combinations of this kind should be arranged by a practitioner rather than assembled at home.

This preparation contains sugar, ghee and honey, making it a sweet, energy-dense formulation. Most of the precautions are related to these ingredients. Read the points below before using it.

• Do not give Kushmanda Rasayana to a baby under 12 months. It contains honey, which is not safe for infants because of the risk of infant botulism.
• Consult your doctor first if you have diabetes or prediabetes. The preparation is largely sugar and will affect blood glucose, and the amount of sugar per dose is not usually stated on the pack.
• Take medical advice if you have raised cholesterol or triglycerides, or have been told to reduce saturated fat, because the base is cow's ghee.
• Avoid using this preparation specifically for weight gain if you are trying to lose weight. It is an energy-dense formulation intended to provide additional calories, which may not be suitable during weight-loss efforts.
• Use it only on medical advice in pregnancy and while breastfeeding.
• Do not use it to treat unexplained bleeding of any kind, including bleeding from the back passage, the nose or heavy periods. Bleeding needs to be medically assessed to identify the cause, and self-treating it can delay a diagnosis that matters.
• Do not use it in place of an inhaler, antibiotic or any other prescribed treatment for a chest problem.
• Stop it and seek advice if a cough lasts more than three weeks, or if you cough up blood, lose weight without trying, have night sweats or run a fever.
• Check the pack for the full ingredient list if you have any food allergy, since commercial versions vary.
• Stop it and consult your doctor if you develop persistent nausea, loose stools, a rash or a marked loss of appetite

Disclaimer: This is general safety information and not a substitute for advice from a registered medical practitioner or a qualified Ayurvedic physician.

Kushmanda Rasayana is available as a ready-made semi-solid preparation. The points below explain how to use it and store the container properly.

Measuring the Dose

• Use the measuring spoon provided with the jar, or weigh the dose, as the amount in a teaspoon can vary depending on how full it is.
• Take the dose recommended by your practitioner rather than the maximum amount stated on the product label.
• If taking a daily dose, divide it into two smaller doses instead of taking it all at once, as this may be easier on the stomach.

Taking It With Water or Milk

• Swallow the measured paste and follow it with lukewarm water, or stir it into warm milk if you prefer.
• Do not stir it into very hot milk or boiling water. Honey is an ingredient in the preparation, and traditional Ayurvedic practice advises against heating honey directly or exposing it to high temperatures.
• Take it after food, particularly if your digestion is sensitive.

Herbs Traditionally Used With Kushmanda Rasayana

Kushmanda Rasayana is a nourishing base rather than a complete treatment, so practitioners usually pair it with something that acts more directly on the symptom. The preparations below are traditionally combined with it:

Measure the dose by weight rather than by spoonfuls, as the amount in a spoonful of thick paste can vary considerably. The guidance below is general and does not replace the advice of your healthcare practitioner.

Infants Under 12 Months

Not suitable at any dose. The preparation contains honey, which must not be given to babies under one year because of the risk of infant botulism. There is no safe amount for this age group.

Children Aged 1 to 12 Years

Only on the advice of a doctor or a qualified Ayurvedic physician, who will set the dose based on the child's age and weight. Do not give an adult dose to a child, and do not use it as a routine daily supplement for a healthy child.

Teenagers Aged 13 to 17 Years

Usually a reduced adult dose, set by the practitioner. A teenager who is losing weight or has a cough lasting more than three weeks should be assessed by a doctor before any nourishing preparation is started.

Adults

Commonly 6 g to 12 g daily, taken in two divided doses after food with lukewarm water or milk. The CCRAS study in chronic bronchitis used a higher dose of 10 g twice daily for 12 weeks under supervision (Kale et al., 2018). Do not take the study dose on your own initiative.

Older Adults

Start at the lower end of the adult range. Older people are more likely to have diabetes or raised blood lipids, both of which matter with a sugar and ghee preparation, and are more likely to be taking other medicines that should be reviewed first.

Disclaimer: These dosages are general information only. Kushmanda Rasayana should be taken as advised by a registered medical practitioner or a qualified Ayurvedic physician, particularly by anyone with diabetes, and by children.

The CCRAS study reported no significant safety concerns during 12 weeks of use. The effects listed below are potential effects, with most relating to the formulation's sugar and ghee content.

Heaviness and Loss of Appetite

The most common complaint. A sweet, ghee-based preparation can feel heavy, particularly if digestion is already sluggish or if the dose is taken all at once. Splitting the dose and taking it after food may help reduce this discomfort.

Nausea and Loose Stools

These may occur if the dose is not well tolerated. Reduce it or stop and take advice rather than continuing at the same dose.

Raised Blood Glucose

Blood glucose may increase because sugar is a major ingredient. Anyone with diabetes or prediabetes who takes this should monitor their readings and tell their doctor they have started it.

Weight Gain

Weight gain may occur when the preparation is used for someone underweight, and may be unwanted otherwise. It is worth knowing in advance, since a daily energy-dense supplement adds up over a course of several weeks.

Allergic Reactions

Although uncommon, allergic reactions are possible with any multi-ingredient preparation. Stop using it and seek medical advice if you develop a rash, itching, swelling or wheezing after taking it.

Disclaimer: This list is not exhaustive, and the safety data for this preparation covers 12 weeks of supervised use. Report any unexpected reaction to your doctor or pharmacist and stop the preparation in the meantime.

Potential concerns relate mainly to the formulation’s sugar content and to possible interactions involving pepper-derived piperine. Tell your doctor and pharmacist that you are taking it.

Diabetes Medicines and Insulin

As this is a sugar-based preparation, regular use may increase blood glucose levels and affect diabetes management. If you have diabetes or are taking medicines to lower blood glucose, inform your doctor before starting it and monitor your blood glucose levels more closely.

Medicines Affected by Piperine

Long pepper and black pepper both contain piperine, which may affect the breakdown of some medicines in the liver and gut and can raise their levels in the blood. The amount in a normal dose is small, but tell your pharmacist if you take medicines that need careful dose control.

Treatments for a Chest Condition

Kushmanda Rasayana is used alongside treatment for a chest problem, not instead of it. Continue inhalers, antibiotics and any other prescribed medicine exactly as directed, and tell the prescriber you are also taking this preparation.

Other Sweet Ayurvedic Preparations

Chyawanprash, Draksharishta and similar preparations are also sugar based. Taking two or three together adds up quickly, which matters most for anyone watching their blood glucose or their weight.

Disclaimer: This is not a complete list of interactions. Tell your doctor and pharmacist about every prescription medicine, over-the-counter product and Ayurvedic preparation you take.

 Storage of Kushmanda Rasayana

An avaleha is a sugar-based preparation, so it keeps well when it stays dry and spoils when it does not. Store it as follows.

• Keep the jar tightly closed in a cool, dry place away from direct sunlight.
• Use a clean, dry spoon each time, since water carried into the jar is a common cause of spoilage.
• Do not store it in the refrigerator unless the pack says to, because condensation on a cold jar may introduce moisture.
• Note the date you open the jar. Once opened, follow the manufacturer's storage and use instructions, even if the printed expiry date is later.
• Discard it if you see mould, if it smells fermented or sour, or if the texture becomes watery or gritty.
• Keep it out of reach and sight of children, particularly because it tastes like a sweet preserve.
• Buy sealed, batch-labelled jars from a licensed manufacturer rather than loose or repacked product.

• Kushmanda Rasayana is a classical Ayurvedic avaleha made from ash gourd cooked with cow's ghee and sugar, then blended with warming spices and honey.
• It is traditionally used for persistent cough, wasting and depletion after illness, and as a nourishing Rasayana during recovery.
• It is a nourishing preparation, not a treatment for any diagnosed lung disease, and it must not replace an inhaler, an antibiotic or any prescribed medicine.
• Because Kushmanda Rasayana contains a high amount of sugar and ghee, people with diabetes, high blood lipid levels or excess body weight should consult their doctor before using it.
• It must not be given to babies under 12 months because it contains honey.
• It should not be used to self-treat bleeding of any kind. Unexplained bleeding requires medical assessment to identify the cause.
• Consult a doctor rather than continuing a tonic if a cough lasts more than three weeks, or comes with blood, fever, night sweats or weight loss.