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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 3  |  Issue : 1  |  Page : 37-40

Nonalcoholic fatty liver disease from an ayurvedic perspective: A challenging paradigm for practitioners


Department of Rasa Shastra, Sri Sai Ayurvedic Medical College, Aligarh, Uttar Pradesh, India

Date of Submission06-Jan-2022
Date of Decision27-Mar-2022
Date of Acceptance29-Mar-2022
Date of Web Publication15-Jun-2022

Correspondence Address:
Manjiri Anil Ranade
Staff Quarters, Sri Sai Ayurvedic Medical College Campus, Aligarh, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijaim.ijaim_1_22

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  Abstract 


Nonalcoholic fatty liver disease (NAFLD) is a metabolic dysfunction. If left untreated, it can proceed to cirrhosis of the liver and hepatocellular carcinoma. This condition can further lead to other metabolic problems, such as diabetes and eventually, coronary artery disease. Modern medicine can only provide limited assistance with a basic treatment plan that includes lifestyle and dietary adjustments. Ayurveda, with its comprehensive range of medicines, can cure the disease at an early stage and prevent serious complications. We present a case of stage 3 NAFLD, which was treated with Arogyavardhinivati, Panchakolachurna, and Mahatiktaghrita. The patient's condition improved, and ultrasound evidence of pathology remission was seen. The purpose of this case study is to explore the mechanism of action of the medications indicated above, as well as the Ayurvedic approach to treatment. Effective approach to disease care could make a world of difference in the early stages of disease.

Keywords: Arogyavardhinivati, nonalcoholic fatty live disease, Yakrutodara


How to cite this article:
Ranade MA. Nonalcoholic fatty liver disease from an ayurvedic perspective: A challenging paradigm for practitioners. Indian J Ayurveda lntegr Med 2022;3:37-40

How to cite this URL:
Ranade MA. Nonalcoholic fatty liver disease from an ayurvedic perspective: A challenging paradigm for practitioners. Indian J Ayurveda lntegr Med [serial online] 2022 [cited 2022 Dec 3];3:37-40. Available from: http://www.ijaim.in/text.asp?2022/3/1/37/347494




  Introduction Top


NAFLD (nonalcoholic fatty liver disease) is a widespread disorder in the Indian population, with the prevalence rate ranging from 9% to 32%.[1] With recurrent stomach aches, the symptomatology can be rather debilitating. The condition is also a precursor to a variety of metabolic disorders, including diabetes and eventually, coronary artery disease. Modern medicine has a lot less to give, and treatment options are mostly limited to lifestyle and nutritional adjustments.[2] As per classics, NAFLD can be correlated to Yakrutodara (~liver disease). According to Ayurveda, the etiopathogenesis could be Mandagni[3] (~less digestive fire). This results in Medodhatuvikruti (~impaired fat metabolism) and the development of Vikrutakleda (~impaired moisture created for replenishment and nourishment of every Dhatu), which is then deposited in the Yakruta (~liver), causing Yakrutodara.[3] The main causes of Yakrutodara are Mandagni and Malasanchaya (~accumulation of toxic metabolites) in Yakruta.[3] Treatment should include Strotoshodhana (~cleansings of microchannels) and Vikrutmedopachana[4] (~corrects excess accumulation of fat). Patients present with Arochaka (~anorexia), Hrullas (~nausea), Klama (~fatigue), and Udarshoola (~abdominal pain), and when investigated, showed fatty infiltration of the liver. Hereby, a case of stage 3 NAFLD was treated successfully with Ayurvedic medications, with clinical improvement and ultrasonographic confirmation of disease regression.


  Case Report Top


Patient information

A 40-year-old obese male patient presented with the complaints of discomfort in the upper abdomen, fatigue, lack of appetite, and itchy skin for 6 months. The patient approached the outpatient department (OPD) of Ayurvedic practitioner. The patient was previously evaluated by a gastroenterologist.

Clinical findings

The patient was of Pitta kaphaprakruti (~psychosomatic constitution) with Madhyamakoshta (~normal bowel nature SAT-B.508), Mandagni, and Madhyamabala (~medium physical strength). Blood pressure and pulse rate were within the normal limits. The patient was obese, weighing 82 kg and having a body mass index of 35.

The respiratory and cardiovascular systems were found to be normal. During an examination of his gastrointestinal system, it was discovered that he was experiencing pain on palpation in the right hypochondrium.

Diagnostic assessment

The patient had Grade III fatty liver [Figure 1], according to the ultrasound findings, and the liver function tests revealed abnormally elevated liver enzymes, with serum bilirubin levels of 1.8 mg/dl, aspartate transaminase (AST) of 140 μ/l, alanine transaminase of 136 μ/l, and alkaline phosphatase of 160 μ/l. After a comprehensive assessment, when administering orals medications to the patient, Vaya (~age), Agni (~digestive power), Bala (~patient strength), Koshta (~bowel), Prakriti (~constitution), Ritu (~season), and Satmya (~habituation) were all taken into consideration, and the patient was administered medications for 3 months in an OPD setting, with regular follow-up during the intervention and also follow-up after 1 month of intervention.
Figure 1: Grade III nonalcoholic fatty liver disease ultrasound image in initial visit

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The drugs that were provided are listed in [Table 1].
Table 1: Posology of medications and Anupan

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Therapeutic intervention

As a Deepana (~appetizer) and Pachana (~digestive), Panchakolachurna was used since it increases Agni. It is also indicated in Aruchi (~loss of taste), Anaha (~fullness of abdomen), Gulma (~abdominal tumor), Shula (~pain), and Plihavruddhi (~enlargement of the spleen).[5],[6] As Medopachaka, Arogyavardhinivati is added as it does Pachana of Drava and Kleda,[7] Arogyavardhinivati reduces Dravata (~liquidity) and Snigdhata (~smoothness) of Medadhatu.[8],[9] For Strotoshodhana and Tridoshaghna (~pacifying all three Doshas) effects, Panchatiktaghrita[8] was utilized. Drugs with bitter taste deplete fat tissue, rekindle the tissue fire, and correct fat metabolism.[7] The qualities of Tikta (~bitter taste) rasa include Lekhana (~scraping), Meda-sleshma-vasa upashoshan (~drying), Laghu (~light), and Ruksha (~dryness quality).[8] Panchatiktaghrita formulation is Medanashana and Lekhana,[9] due to its Yogavahiguna (~which carries the qualities of that thing or substance with which it is associated in the combination). The medicines were prepared in the Ayurvedic medical college's Rasa shastra and bhaishajya kalpana laboratory using all standard classical methods and were used immediately.

Apart from the medications, the patient was asked to follow the dietary recommendations such as taking kale bhojana (~taking food on time), kshudvan (~when there is sufficient hunger), laghu bhojana (~which is easy to digest), and avoiding excess oily and spicy foods.

Timeline

Following a thorough evaluation, the patient was given formulation for 3 months in an OPD setting and then monitored for another month. The pharmacological treatment timeline and patient progress are listed in [Table 2].
Table 2: Timeline of medications used in the treatment

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Follow up and outcome

After 3 months of follow-up, the patient's symptoms had significantly improved, with abdominal pain and anorexia resolved. Ultrasound showed resolution of fatty liver from Grade III to Grade I [Figure 2]. During the fourth follow-up, serum bilirubin levels were of 0.8 mg/dl, AST – 32 μ/l, alanine aminotransferase – 34 μ/l, and alkaline phosphatase – 39 μ/l. There were no adverse events reported during the follow-up. The patient's medicines were stopped on the fourth visit in view of the overall resolution of symptoms, biochemical values, and radiological evidence of disease, and the patient was asked to abide healthy lifestyle.
Figure 2: Grade I nonalcoholic fatty liver disease after 3 months of ayurvedic intervention

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  Discussion Top


The liver is an important organ for the Chayapachaya (~metabolism) of food. As Ayurveda tells the basic principles of embryology and organogenesis, including Panchamahabhoota (~five elements), Tridosha (~three humors), Saptadhatu (~seven body tissues), and others, Acharyas have speculated about the origin Yakrit from Raktadhatu (~blood). The numerous organs in the body are formed from diverse combinations of Mahabhuta and particularly, Raktadhatu.

NAFLD, such as Sthaulya (~obesity), is a Santarpanajanyavyadhi (~disease caused by over nourishment) with respect to Nidana (~etiology) and Samprapti (~pathogenesis). The pathology begins with Agnivikruti (~the vitiation of the digestive process), which leads to the creation of Apakvaannarasa (~an improperly processed digestive end product), which further does vitiation of Kaphadosha and unequal formation and deposit of Meda (~fat tissue) in Yakrit.[9] Fatty liver may be correlated to this condition.

Katuki (Picrorhizakurroa Royle ex Benth) is the main ingredient of Arogyavardhinivati. Katuki is Titka rasa pradhna that can help alleviate Ama by doing Pachana karma.[10] Katuki is a hepatoprotective drug,[11] as shown by numerous studies. Since Arogyavardhinivati is primarily a hepatoprotective, it has been shown to help patients with NAFLD improve their liver function.[11]

Panchakola is a medication mix formed from fine powders of five different drugs Pippali (Piper longum Linn.), Pippalimula (Piper longum Linn.), Chavya (Piper mullesua Buch.), Chitrak (Plumbago zeylanica L.), and Shunthi (Zingiber officinale Roscoe). It is frequently used as a digestive aid, carminative, and appetizer, as well as to correct metabolic imbalances (~Agnidushti).[12] Panchatiktaghrita is an Ayurvedic polyherbal composition. Five bitters, Neem (Azadirachtaindica A.), Patol (Trichosanthescucumerina anguina), Kantakari (Solanumvirginianum L), Vasa (Adhatodaadhatoda L.), and Guduchi (Tinosporacordifolia Thunb), Ghee, and Triphala are used to make this medication. Vata, Pitta, and Kapha are all balanced by Panchatiktaghrita.[13] It aids in the elimination of toxins from the body as well as kindles Agni.[13]


  Conclusion Top


Aarogyavardhini vati doing Strotoshodhana and Medapachana karma with Panchatiktaghrita and Panchakolachurna provides good outcomes in fatty liver in terms of radiological, biochemical, and symptomatic resolution. Early Ayurvedic intervention can alleviate the symptoms of NAFLD and prevent future irreversible sequels if presented early enough. Ayurveda has been found to be an efficient therapy for fatty liver disease, with contemporary diagnostic techniques such as ultrasonography validating findings.

Declaration of patient consent

Authors certify that they have obtained patient's consent, where the patient has given his consent for reporting the case along with the images and other clinical information in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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de Vries M, Westerink J, Kaasjager KH, de Valk HW. Prevalence of nonalcoholic fatty liver disease (NAFLD) in patients with type 1 diabetes mellitus: A systematic review and meta-analysis. J Clin Endocrinol Metab 2020;105:dgaa575.  Back to cited text no. 1
    
2.
Pereko KA, Setorglo J, Steiner-Asiedu M, Maaweh Tiweh JB. Nutrition and lifestyle modifications in the prevention and treatment of non-alcoholic fatty liver disease. In: Valenzuela R, editor. Non-Alcoholic Fatty Liver Disease – Molecular Bases, Prevention and Treatment. London: IntechOpen; 2018. Available from: https://www.intechopen.com/chapters/57894. [Last accessed on 2021 Dec 24].  Back to cited text no. 2
    
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Agrawal N, Khajuria N, Dadhich O. Management of jalodar (ascites) and yakritpleehodar (hepatosplenomegaly) – A case report. Int Ayurvedic Med J 2018;6:1327-31. Available from: http://www.iamj.in/posts/ images/upload/1327_1331.pdf. [Last accessed on 2021 Dec 24].  Back to cited text no. 4
    
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Kadam K, Kotangale Y, Kotangale S. Conceptual study of ayurvedic approach in the management of Udar. Asian J Sci Technol 2020;12:11461-3.  Back to cited text no. 5
    
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Rabb UN. Shadrasas (six types of tastes) according to different ayurvedic texts – A literary survey. Galore Int J Health Sci Res 2019;4:42-8.  Back to cited text no. 7
    
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Kumar D, Singh P. Nidanatmaka study on meda sanchaya in liver w.s.r to non alcoholic fatty liver disease (NAFLD). World J Pharm Med Res 2020;6:128-33.  Back to cited text no. 8
    
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Kumar G, Srivastava A, Sharma SK, Gupta YK. Safety and efficacy evaluation of Ayurvedic treatment (Arjuna powder and Arogyavardhini Vati) in dyslipidemia patients: A pilot prospective cohort clinical study. Ayu 2012;33:197-201.  Back to cited text no. 9
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Khandekar S, Pansare T, Pachpor A, Maurya S. Role of katuka (Picrorhiza kurroa Royle ex Benth) in obesity WSR to Ayurvedic and modern aspect: A review. Int J Herb Med 2019;7:31-5.  Back to cited text no. 10
    
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Shamsi TN, Parveen R, Fatima S. Panchakola reduces oxidative stress in MCF-7 breast cancer and HEK293 cells. J Diet Suppl 2018;15:704-14.  Back to cited text no. 11
    
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Munshi R, Patil T, Garuda C, Kothari D. An experimental study to evaluate the antiosteoporotic effect of Panchatikta Ghrita in a steroid-induced osteoporosis rat model. Indian J Pharmacol 2016;48:298-303.  Back to cited text no. 12
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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