LIVER DISEASES & AYURVEDA

Article by Dr. SUNEET AURORA (Ayurveda Gastro & Liver Specialist)

The prevalence of liver diseases in Ayurveda hospital and clinic have been increasing day by day in spite of its high acceptance of folk practices for jaundice in rural India. Liver Diseases in Ayurveda are known as :
Yakrit Vridhi(Hepato megaly),
Yakrit dalludara,
Yakritdora,
Yakrit gata dosa ,
Yakrit Kshya( Cirrhosis Of Liver),
Yakrit Vidradhi(Liver abscess),
Yakrit granthi (hepatic cyst)
These are different diseases found in Ayurvedic literature based on its mass, architectures and morphology whereas Kamala, Kumbhakamala, Panaki, Halimala, alasa are clinical features based on the function of Liver diseases.

The role of tridosha, Meda, Krimi, Madhya , asatmya in pathogenesis of yakrit vikara are enumerated in the light of Modern medicine and classified it as per etiology. The diet, Yogic exercise, life style, Herbal, herbo-mineral medications along Panchakarma procedures are dealt separately with evidence.

HOW LIVER GETS DAMAGED
Liver controls our whole body activities. Liver cirrhosis is a most common medical problem today. One and the chief cause of it is chronic alcoholic consumption. Excessive and prolonged use of alcohol affects every organ of the body. Although liver, heart and kidney are most affected due to heavy consumption, alcohol induced liver cirrhosis is a life threatening condition in maximum cases. Liver is regarded as an important and an irreplaceable organ of human body as it controls multiple body functions. Currently liver disease is on high rise due to multiple causative factors of our sedentary lifestyle that damages liver. All most all liver diseases convert into chronic liver disease, hepatic encephalopathy and ascities. If remained untreated/unsuccessful, these conditions become incurable to treat in any stream of medical science.
More than 50% people of in India rely on Ayurveda and herbal medicine for liver diseases. Although some pharma-corporate hospitals lobby leave no effort to cry foul and even blame Ayurveda for liver diseases (sponsored yellow journalism in newspapers/ social media) but that is because they have not yet found any pharma medicine to cure, even to prevent liver failures; and over that, many pharma medicines are proven cause of liver damage. We understand that one gets upset when one's business is lost to other result oriented safe treatments.
 

On the other hand, more than three hundred herbo-mineral preparations are available in Ayurvedic system of medicine for the treatment of jaundice and chronic liver diseases. Ayurveda plays a master role in the fast and safe recovery of damaged liver.

AYURVEDA & LIVER DISEASE

An extensive description of hepatobiliary disorders are found in Ayurvedic classics. The distension of abdomen (Udara vrddhi) caused by the functional derangement of liver is known as Yakrddalyudara in Ayurveda. This disease has been described in the chapter of Udara Roga in Ayurvedic classics. Ayurveda texts have quoted that the liver diseases are induced by the intake of unwholesome/ Apathya ahara or diet predominantly alcohol/different types of Madya that leads to Pitta prakopa/ Dushti. Madya/Alcohol has the similar properties as Visha/Poison. In this study, an effort has been made to analytically review the role of Ayurvedic treatment in Liver cirrhosis, a liver disease.

Liver Cirrhosis in Ayurveda

Liver disease that can be correlated Kamala or Kumbhakamala in Ayurvedic system of medicine may be either due to Pitta prakopa or due progression of Pandu (Saadhak pitta) or multiple etiological factors that manifest at the end of any chronic disease such as Infective viral hepataitis namely HAV, HBV, HCV, HDV, HEV which leads to liver cancer on chronic/untreated conditions, Metabolic, hereditary polluted water as arsenic Copper, Vinyl chloride as in NCPE (Non-Cirrhotic Portal Fibrosis), fluorine and drug induced (ATT induced hepatitis).

Ayurvedic drugs helps in rejuvenating the liver and minimizing the complications of cirrhosis such a liver cancer, fulminant hepatitis and prevents the chronicity of the disease. Chemical pesticides induced (different types of liver cancer), self/over medication induced commonly paracetamol induced hepato-toxicity are the main causes.

There are three main forms of alcoholic liver disorders which are as follows:

1. Fatty liver: Usually asymptomatic, presence of soft and tender hepatomegaly. 30 % of patients show abnormal liver function tests (LFTs), most patients recover but further the disease progress in those patients who continue with alcohol consumption.

2. Alcoholic Hepatitis: This is a serious form of disease. It presents with fever, anorexia, nausea, vomiting, weight loss, jaundice, pain in the right hypochondrium, due to enlargement of liver (tender hepatomegaly), splenomegaly, ascites and encephalopathy (altered metal state), hepatorenal syndrome in which liver and kidney failure lead to death. Approximately 40% of patients get converted into liver cirrhosis within five years.

3. Alcoholic Cirrhosis: This has a wide spectrum of clinical presentation. Some patients remain asymptomatic while others with present alcoholic hepatitis with acute symptoms. Few patients have the classical presentation of chronic liver disease such as; Jaundice, anorexia, anaemia, vomiting, weight loss, renal failure, hepatic encephalopathy, coma and ultimately death.

Management of Liver Cirrhosis/Kamala

Avoidance of causative factors

1. Alcohol – Complete abstinence from alcohol is the most important part of treatment.
2. Drugs like NSAIDS (pain killers), Antipyretics paracetamol (most damaging to liver); steriods- (might lead to water retention and oedema.); Sedative and tranquilizers- (anti-stress meds depress the central nervous system and progress into hepatic encephalopathy/ coma); Loop diuretics- (frusemide)- Can precipitate the hepatic encephalopathy.

3. Complete bed rest
4. Protein rich food
5. Treatment of infection
6. Regularly evacuation of bladder, bowel or putrification of stool increases the ammonia and other toxins that increase the hepatic encephalopathy.
   
   AYURVEDA MEDICINE TREATMENT
   Ayurvedic preparations- In Ayurvedic texts there are many single herbo-mineral preparations (compound drugs) available for the successful treatment and prevention of the complications in the case of liver cirrhosis and other conditions.
   Among single herbs- Hareetaki, Vibheetaki, Amlaki, Daruharidra, Kalmegh, Katuki, Bhumyamlki, Nimba, Makoya, Vasa, Chirata, Amrita, Ghritkumari, and Punarnava are the prominent but many more may be added to it like Arogyavardhini and Phaltrikadi kwath- Described in Sharangdhara samhitha is one of the most popular and effective preparation that contains the eight herbs namely.
   Kayakalp LIVER KALP capsules/ tablets/ kwath has been found very effective in our 30 yrs of clinical practice. 

References of this article:

Rita Kumari. Ayurvedic Management of Chronic Liver Disease (CLD) - An Analytical Review. International Journal of Ayurveda and Pharma Research. 2021;9(5):103-108.
World Health Organization. Global Health Observatory Data Repository. Available from: http://apps.who.int/gho/data/view.main.G HECTRYASDRGHE123v?lang5en. [Last accessed on 2015 Dec 21].
Mukherjee PS, Vishnubhatla S, Amarapurkar DN, Das K, Sood A, Chawla YK, et al. (2017) Etiology and mode of presentation of chronic liver diseases in India: A multi centric study. PLoS ONE 12(10): e0187033. https://doi.org/10.1371/ journal.pone.0187033
Patel MV, Patel KB, Gupta S, Michalsen A, Stapelfeldt E, Kessler CS. A Complex Multiherbal Regimen Based on Ayurveda Medicine for the Management of Hepatic Cirrhosis Complicated by Ascites: Nonrandomized, Uncontrolled, Single Group, Open-Label Observational Clinical Study. Evid Based Complement Alternat Med. 2015; 2015: 613182. doi: 10.1155/2015/613182. Epub 2015 Aug 3. PMID: 26339267; PMCID: PMC4539059.
Deka D. Cirrhosis of liver: Review from Ayurvedic literature. J Ayu Herb Med 2017;3(2):98-101.
Chakradutta vaidya prabha commented by Dr. I.D. Triphathi and edited by Acharya R.N. Dwivedi, chapter 8 published by Chaukhambha sanskit sansthan, Varanasi 4th edn 2002 page no. 79-81
Ashtang hridya, commented by Dr.A.M Kunte and Pt. Krishna shastri nvare, nidan chapter 13/15- 18, published by Chaukhambha Sanskrit sansthan, 2009, page no.519
Charak samhita uttrardha/11”vidyotini” hindi tika, By Kashinath shashtri and Dr, G.N.Chaturvedi, chikitsa page no., published by chaukhambha bharti academy, reprint in yr 1998 Page no.486 – 493
Sharandhar samhita, “jeevan prada“ commented by Dr.Shailza srivastava, chapter 2/77 madhyam khand, published by chaukhambha orintalia, Varanasi, 2015, page no 147

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