Background: Colorectal cancer (CRC) is a major global health challenge and remains one of the leading causes of cancer-related morbidity and mortality worldwide. According to GLOBOCAN 2022 estimates, approximately 1.93 million new cases and 904,019 deaths were attributed to CRC globally. Contemporary evidence suggests that colorectal carcinogenesis is a multifactorial process involving genetic and epigenetic alterations, chronic inflammation, dietary factors, gut microbiota dysbiosis, and toxin-mediated mutagenesis, including colibactin-induced DNA damage. Although Ayurveda does not describe CRC as a distinct disease entity, several classical concepts, such as Grahani, Gulma, and Arbuda, exhibit significant similarities with different stages of colorectal carcinogenesis. To critically analyse Ayurvedic concepts relevant to colorectal cancer and explore their correlation with contemporary understanding of colorectal carcinogenesis, with particular emphasis on the roles of Grahani, Gulma, Arbuda, Agni dysfunction, and Ama formation. Methods: A critical narrative review was conducted using classical Ayurvedic texts, including Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya, along with contemporary literature retrieved from PubMed, Scopus, and other indexed databases. Relevant studies addressing colorectal cancer pathogenesis, chronic inflammation, gut microbiota, integrative oncology, and Ayurvedic oncology were reviewed and synthesised. Conceptual correlations between Ayurvedic disease constructs and modern biomedical mechanisms were critically evaluated. Results: The review identified notable conceptual parallels between Ayurvedic pathophysiology and modern mechanisms of colorectal carcinogenesis. Grahani, characterised by Agnimandya and impaired gastrointestinal function, may represent an early functional-inflammatory state associated with chronic intestinal dysfunction and dysbiosis. Gulma, described as a localised abdominal mass resulting from Dosha accumulation and Srotorodha, may correspond to intermediate stages of localised pathological growth, including adenomatous or premalignant lesions. Arbuda, characterised by progressive growth, deep tissue involvement, recurrence, and poor prognosis, demonstrates the closest resemblance to malignant colorectal neoplasia. Furthermore, the Ayurvedic concepts of Agni impairment, Ama accumulation, Dosha-Dushya Sammurchana, and chronic inflammation exhibit significant conceptual overlap with contemporary understanding of microbiota-mediated inflammation, epithelial injury, and tumour progression. Conclusion: Ayurvedic concepts of Grahani, Gulma, and Arbuda provide a coherent theoretical framework for understanding various stages of colorectal carcinogenesis. Emerging evidence regarding gut microbiota dysbiosis, chronic inflammation, and metabolic dysfunction supports several of these conceptual correlations. Integrating Ayurvedic principles with modern oncological knowledge may offer valuable perspectives for disease prevention, risk stratification, and supportive care in colorectal cancer. Further translational and clinical research is warranted to validate these correlations and explore their potential applications in integrative oncology.
