Efficacy and Safety of Kharaliya Rasayanas for Fever Management: A Systematic Review of Classical Literature and Contemporary Research

Background: Kharaliya Rasayanas are herbo-mineral formulations prepared by trituration (Khalva Yantra) and are extensively indicated for Jwara (fever) in classical Ayurvedic texts. Despite their historical use, a systematic synthesis of classical foundations with contemporary clinical evidence is lacking. Objective: To systematically review classical references and modern clinical evidence (2015–2025) on the efficacy and safety of Kharaliya Rasayanas in Jwara management. Methods: A systematic search was conducted in PubMed, Scopus, AYUSH Research Portal, and Google Scholar (January 2015–April 2025). Classical texts were manually searched. The review followed PRISMA guidelines. Risk of bias was assessed using the Cochrane RoB 2 tool and a modified CONSORT for Ayurveda. Data were synthesized narratively. Results: Twelve classical texts and eight contemporary studies met inclusion criteria. Classical texts describe over 30 formulations specifically indicated for various fever subtypes including Sannipataja Jwara, Vishama Jwara, Navajvara, and Jirna Jvara. Contemporary studies (n=8) predominantly evaluated Tribhuvankirti Rasa, reporting antipyretic efficacy up to 96.6% and favorable safety profiles when classical preparation methods were followed. Methodological heterogeneity and small sample sizes were noted. Risk of bias was high in the single clinical trial. Conclusion: Classical principles of Kharaliya Rasayana preparation and use are supported by emerging contemporary evidence. However, robust, large‑scale, multicenter clinical trials with standardized protocols and rigorous toxicological evaluation are required for integration into mainstream practice.