Ayurvedic management of Hepatitis-B - A Case Study

Sumit Kumar; Ragini Kumari; Dharmendra Kumar; Vijay Bahadur Singh

Ayurvedic management of Hepatitis-B - A Case Study

Kumar S.^1*, Kumari R.², Kumar D.³, Singh V.⁴

DOI:

^1* Sumit Kumar, Second Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

² Ragini Kumari, Final Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

³ Dharmendra Kumar, First Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

⁴ Vijay Bahadur Singh, Assistant Professor, Guide & HOD, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India.

Hepatitis is inflammation of liver parenchyma mostly caused by viruses and other factors. It’s a non-specific prodromal illness characterized by headache, myalgia, arthralgia, nausea, anorexia, dark urine, yellow discoloration of skin, mucosa, sclera and other tissues etc. A diagnosed case of Hepatitis-B, 32yrs old Male patient, Came to OPD of Room No. 9, Government Ayurvedic College & Hospital, Kadam Kaun, Patna, Having R. No. 510, C. R. No. A02219. Based on symptoms, supported by blood investigation reports and Ayurvedic parameters, the condition diagnosed as Yakritsotha. Oral medicines given Aryogyavardhini Vati, Punarnava Akar, Akar Makoy, Shallaki, Liv 52 HB, Phaltrikadi Kwatha, Ashvaghanda Churna along with Pathya Apathya Ahara Vihara were prescribed. There was drastic decrease in all the symptoms. The effect of treatment was monitored during the follow up with routine blood examinations. The bilirubin level decreased from initial 6.2mg/dl to 1.0mg/dl. This article is a discussion about a case of Hepatitis which was successfully treated by Ayurvedic line of treatment. The signs and symptoms, causes, patho-physiology of Hepatitis, along with its co-relation in Ayurveda as Yakritsotha, its line of treatment and possible the mode of action of drugs were the main points of consideration. Use of medicines such as Aryogyavardhini Vati, Punarnava Arka, Shallaki, Akar Makoy, Liv 52 HB, Phaltrikadi Kwatha, Ashvagandha Churn along with Pathya Apathy Ahara Vihara showed good result without any complication in the present study.

Keywords: Hepatitis-B, Yakritsotha, Yakritvriddhi, Ayurveda

Corresponding Author	How to Cite this Article	To Browse
Sumit Kumar, Second Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurvedic College, Patna, Bihar, India. Email:	Sumit Kumar, Ragini Kumari, Dharmendra Kumar, Vijay Bahadur Singh, Ayurvedic management of Hepatitis-B - A Case Study. J Ayu Int Med Sci. 2022;7(4):116-120. Available From https://jaims.in/jaims/article/view/1773

Introduction

Hepatitis is an inflammation of the liver Parenchyma caused by a viral infection and non-infectious causes like toxicity, Alcohol intake, Drugs (overdose of PSM), several metabolic disorders. There are 5 main hepatitis viruses, referred to as types of A, B, C, D and E. Hepatitis B is considered acute when it is lasts less than 6 months, and chronic when it persists longer.

It is estimated that about 200 crores of the world’s populations have been exposed to the hepatitis B virus, of which 35 crores harbour it chronically. India falls in the intermediate endemicity zone, the prevalence is 2-7% and the average is 4%. Hepatitis B is a common disease all over the world, and countries have been divided into 3 groups High, Intermediate and Low according to its endemicity.^[1]

When the patient, first infected the warning signs include : Flu like symptoms initially along with malice, muscle and joint ache, Fever, Fatigue, Loss of appetite, Nausea and vomiting, Abdominal pain, Diarrhoea.^[2]

More specific symptoms include dark coloured urine and yellow discoloration of the skin, mucosa, sclera and other tissue fluids. Hepatitis B is caused by Hepatitis B Virus. It is transmitted from person to person through blood, semen and other body fluids. Common routes of transmission include sexual contact, sharing of needles, accidental needle sticks and placental transmission (3rd trimester of pregnancy).^[3]

The hepatitis B virus is constructed of an outer capsule containing HBsAg (Hepatitis B virus surface antigen), an inner core containing HBcAg (Hepatitis B Virus core antigen), and HBeAg (Hepatitis B Virus e antigen). Exposure to HBV, results in a cell mediated immune response by sending cytotoxic T cells and natural killer cells to the virus and releasing inflammatory cytokines. The greater the immune response, the greater will be the chance of fighting the virus. As the cytoplasm of hepatocytes are infiltrated by the HBV, they appear to have a ‘ground glass’ appearance under histological exam. This is unique for HBV and thus different from other forms of hepatitis. Because hepatocytes are continually proliferating, the virus is constantly being shed into the blood, which contributes to chronic infections.^[4]

Ayurvedic Review

In Ayurveda, Yakritsoth / Yakritvriddhi is described in Laghutryee that one who consumes irritating and spicy food and the food that obstructs the channels (by causing malabsorption and increasing thick secretions), the Raktadhātu (blood tissue) along with Kapha Dosha is excessively vitiated. It leads to enlargement of the liver i.e., Yakritvriddhi. The enlargement takes places in the right side (right hypochondriac area). The person afflicted by this disease loses his weight, suffers from low grade fever, loss of appetite, loss of immunity and physical strength and anemia. The Dosic signs and symptoms of Kapha and Pitta are observed here.

It is also characterized by Tiredness, Vertigo, burning sensation, Discoloration (due to anaemia), heaviness of the body, stupor and reddening of the abdomen as well as fever, thirst, burning sensation, yellowish discoloration of the body and less pain, larger size, hard on palpation, heaviness and loss of taste, persistent enlargement of the abdomen, continuous flatulence, reversed peristalsis and pain.^[5]

Case Report

A Male patient, 32yrs old, Came to OPD of Room No.-9, Government Ayurvedic college & Hospital, Kadam Kaun, Patna, Having R.No. 510, C.R.No. A02219 having fever, nausea, severe body pain, poor appetite and yellow discoloration of eye. The condition was diagnosed as Hepatitis-B as per his blood investigation reports.

The patient was following allopathic treatment prior to coming for Ayurvedic management. The assessment of the Patient’s conditions was done Based on symptoms, supported by blood investigation reports and Ayurvedic parameters, the condition diagnosed as Yakritsotha Ayurvedic treatment.

Showing the Aashtavidha Pariksha (Eight types of Examination) (Date: 20/12/2021)

1.	Nadi (Radial pulse)	108
2.	Mutra	Vikrutha Varna
3.	Mala	Vikrutha Varna
4.	Jihwa (tongue)	Coated
5.	Sabdha (voice)	Normal
6.	Sparsha (touch sensation)	Ushna
7.	Drik (colour of sclera)	Yellow
8.	Aakriti (built)	Madhya

Showing General Physical Examination Results (Date: 20/12/2021):

General condition	Medium
Pulse rate	108 /min
Respiratory rate	22/ min
Blood pressure	100/64 mm/Hg
Pallor	Present
Icterus	Present
Cyanosis	Absent
Lymph Nodes	Not palpable
Clubbing	Absent
Edema	Present

Showing Blood Investigation Report (Date: 20/12/2021)

Bio-chemical test	Values	Normal range values
Bilirubin total	3.2	up to 1.2mg/dl
Bilirubin direct	2.1	up to 0.2mg/dl
Bilirubin indirect	1.1	up to 1.0mg/dl
S.G.O. T	470.0	0-35U/L
S.G.P. T	498.0	0-45U/L
HBsAg Quantitative	8823.71	>0.05

Ayurvedic Management Protocol

At first, when patient was admitted in OPD of GACH, Patna, Shamana Chikitsa with following internal medicines for a period of 60 days was given as following:

1. Aryogyavardhini Vati = BD

2. Punarnava Akar = 20 ml

3. Akar Makoy = 20 ml

4. Liv 52HB = 2 tab twice a day.

5. Phaltrikadi Kwatha = 20 ml with water twice a day.

6. Shallaki 400 tab. = 2 tab. Twice a day.

7. Ashvagandha Churna = 3gm. Twice a day.

Pathya Ahara: Patient was advised to take her meal at proper timing. Dinner is advised to take early. Intake of fruits, green vegetables & salad should be increased. She was also advised Takra. Fatty items and spicy foods are prohibited.

Apathya Ahara: Patient was asked to avoid sleeping during daytime, not to consume the items prepared by refined flour (Maida), also avoid fast food etc.

Follow-up: It was done after 60 days with a review on the bilirubin level.

Result

By the end of 1 month, all symptoms like fever, weakness of body, body pain, yellow discoloration of the eye, and dryness of the body reduced completely. The following shows the blood report on the day of final visit.

Comparison of Blood Investigation Reports Before and After treatment

Bio-chemical Test	Before Treatment (20/12/2021)	After Treatment (24/02/2022)	Normal Values
Bilirubin total	3.20	1.00	up to 1.2mg/dl
Bilirubin direct	2.1	1.70	up to 0.2mg/dl
Bilirubin indirect	1.1	1.00	up to 1.0mg/dl
S.G.O. T	470.0	97.0	0-35U/L
S.G.P. T	498.0	146.0	0-45U/L
HBsAg Quantitative	8823.71	>250	<0.05

Discussion

Hepatitis is an inflammation of the liver Parenchyma. The infected patient is observed with the warning signs like symptoms initially along with malaise, muscle pain and joint ache, fever, fatigue etc. More specific symptoms include dark coloured urine and yellow discoloration of the skin, mucosa, sclera and other tissue fluids. According to Ayurveda, hepatitis or jaundice is acknowledged as Yakritsoth, caused mainly due to impairment of Pitta Dosha and Rakta Dhatu. The diagnosis criteria for Hepatitis consist of examination of skin, mucous membrane, and stool colour, liver function test though blood investigation. In Yakritsoth, Ashtavidha Pariksha forms the diagnostic index. Assessment of Agni, Bala, Dosha Vriddhi, Dhatu concerned is required to decide the Ayurvedic therapeutic measures. In Yakritsoth, Shamana Chikitsa followed by Pathya Ahara Vihara (wholesome food and activities) are recommended. In the present case scenario, A, 32yrs old Male patient, OPD in at Government Ayurvedic college & Hospital, Kadam Kaun, Patna, Having R.No.=510, C.R.No.=A02219 having fever, nausea, severe body pain, poor appetite and yellow discoloration of eye. The condition was diagnosed by blood investigation reports. The patient was following allopathic treatment prior to coming for Ayurvedic management. The assessment of the patient’s conditions was done Based on symptoms, supported by blood investigation reports and Ayurvedic parameters, the condition diagnosed as Yakritsotha.

Based on the assessment of the patient’s conditions by the Ashtavidha Pariksha, General Examination and Routine blood Investigations a Samprapti Ghatak was determined and diagnosed as Yakritsoth and an Ayurvedic treatment protocol was designed. Primarily as Shamana Chikitsa, oral medications including Aryogyavardhini Vati, Punarnava Arak, Arak Makoy, Shallaki, Liv 52 HB, Phaltrikadi Kwatha, Ashwagandha Churn which have liver protective in nature, anti-inflammatory, regenerative in action also Tikta Rasa Pradana with mild Virechana Karma, was given.

These Ayurvedic formulations have already been proved as very effective for hepatitis (Yakritsoth) management. Aryogyavardhini Vati (contains mainly Katuki 50%) is anti-inflammatory and anti-viral property. Katu Tikta Rasa of Aryogyavardhini Vati, which is also Pittarechana in property in general helped in reducing the Srotoavarodha. Aryogyavardhini Vati is considered as a liver tonic, and in healing the tissues. This drug is extensively used in Hepatic disorders.^[10] Punarnava Akar, which have actions such as Tridosha Hara specifically Pittahara, Pittarechana, anti-inflammatory, heptoprotective, Deepana, Jwarahara, neuroprotective, Rasayana, Rakta Shodhana, Srotoshodhana properties. It has the property of anti-viral, anticancer, anti-inflammatory, antibacterial, hepato-protective effect.^[11]

Pathya Ahara, Patient was advised to take her meal at proper timing. Dinner is advised to take early. Intake of fruits, green vegetables & salad should be increased. She was also advised Takra. Fatty items and spicy foods are prohibited. Apathy, Patient was asked to avoid sleeping during daytime, not to consume the items prepared by refined flour (Maida), also avoid fast food, non-vegetarian, curd etc. The above-mentioned drugs along with Pathya Apathy were advised for a period of 1 week. Regular follow-up for every 60 days was done, and the bilirubin level was taken on these days to assess the respond to the management.

Conclusion

In this case study, hepatitis was acknowledged as Yakritsoth and oral medications such as Aryogyavardhini Vati, Punarnava Arak, Shallaki, Arak Makoy, Liv 52 HB, Phaltrikadi Kwatha, Ashwagandha Churn along with Pathya Apathy Ahara Vihara proved to be very effective,

without any complication. The patient got relief in the symptoms and the bilirubin level reduced. Symptoms like fever, nausea, severe body pain and appetite and yellow discoloration of eye reduced within 2 months.

Reference

1. Epidemiology of hepatitis B infection in India-research gate, 1996, from https://www.researchgate.net/publication/14416930_ Epidemiology of hepatitis B infection in India. Accessed on 6/2/2020.

2. P. S. Byadgi, A. K. Pandey, A textbook of Kayachikitsa, Volume II, Chaukhambha publications, New Delhi, 2014, Pp: 547-553

3. P. S. Byadgi, A. K. Pandey, A textbook of Kayachikitsa, Volume II, Chaukhambha publications, New Delhi, 2014, Pp: 547.

4. Harsh Mohan, Textbook of pathology 5th edition, Jaypee Brothers Medical Publishes (P) Ltd, New Delhi, 2005, Pp: 624

5. Dr. Bulusu Sitaram, Bhavaprakasa 0f Bhavamisra, English translations Vol.2, Chaukhambha Orientalia, Varanasi; page no. 385.

6. MZ Siddiqui, Shallaki(Boswellia Serrata)-A Potential Antiinflammatory Agent: An Overview, Indian J Pharma Sci. 2011 May-Jun;73(3):255-261.

7. G N Chturvedi, Clinical Studies on Kalmegh (Andrographis Panniculata) in infective hepatitis; Anc Sci Life. 1983 Apr-Jun;2(4):208-215.

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2022-04-01	2022-04-02	2022-04-09	2022-04-16	2022-04-23
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	19%

Case Report

Hepatitis-B

Journal of Ayurveda and Integrated Medical Sciences