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Background: Uterine fibroids are the most common benign tumours of the female genital tract and a leading cause of heavy menstrual bleeding, pelvic pressure, infertility and hysterectomy. Current medical therapies are mainly short-term or hormonally suppressive, and many women seek non-surgical, fertility-sparing alternatives. Ayurvedic practitioners commonly interpret fibroids as Garbhashaya granthi, a Kapha-Medas dominant encapsulated growth of the uterus, and treat them with Kanchanara guggulu and drugs with scraping (Lekhana) action. Objective: To review the classical basis for treating uterine fibroids as Granthi, to describe the rationale for Kanchanara guggulu and Lekhana dravyas, and to appraise the clinical and experimental evidence for these interventions. Methods: Classical texts (Sushruta Samhita, Charaka Samhita and Sharangadhara Samhita) were reviewed for descriptions of Granthi, Raktaja gulma, Lekhana drugs and Kanchanara guggulu. PubMed was searched for reviews, trials, case series and experimental studies on uterine fibroids, Ayurvedic management, Kanchanara guggulu and guggulsterone. Findings were synthesised narratively. Results: The Ayurvedic model of a slowly growing, firm, painless Kapha-Medas mass corresponds broadly to the clonal, extracellular matrix-rich and steroid-dependent leiomyoma. One randomised single-blind trial from Sri Lanka reported reduction of fibroid volume with one of two Ayurvedic regimens, while case series, case reports and a small pilot study of oral medicines with Uttara basti reported symptomatic improvement and shrinkage or disappearance of small fibroids. Experimental studies show that Kanchanara guggulu is chemically complex and suppresses PI3K/AKT/mTOR signalling in cancer cells, and that guggulsterone has anti-inflammatory and antiproliferative actions, but no study has examined leiomyoma cells directly. Conclusion: Kanchanara guggulu and Lekhana dravyas offer a coherent and biologically plausible strategy for small symptomatic fibroids, but the clinical evidence is preliminary. Controlled trials with standardised products, imaging-verified volume outcomes and safety monitoring are required.