E-ISSN:2456-3110

Case Report

Diabetes Mellitus

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 6 JUNE
Publisherwww.maharshicharaka.in

An Ayurvedic approach for Non-alcoholic fatty liver associated with Type 2 Diabetes Mellitus: A Case report

Khatri B1*, Methil G2, Bhakuni H3, Sahu AK4
DOI:10.21760/jaims.9.6.52

1* Bhavya Khatri, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

2 Gaurav Methil, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

3 Harish Bhakuni, Associate Professor, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

4 Ajay Kumar Sahu, Associate Professor, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.

Background: The term Non-alcoholic fatty liver (NAFLD) refers to the accumulation of excessive fat inside the liver cells when excessive alcohol use is not present. The presence of both NAFLD and T2DM increases the likelihood of the development of complications of diabetes (including both macro- and micro- vascular complications) as well as augmenting the risk of more severe NAFLD, including cirrhosis, hepatocellular carcinoma and death. Liver illness is also described quite well in Ayurveda. NAFLD may be seen as a Santarpanotha Vikar (illness) bought on by Pittasthan, Raktavahasrotomoola, Kaphmedodusti and Sthanasamsraya in Yakrut (liver).

Aim: To evaluate the efficacy of Ayurvedic intervention in NAFLD associate with T2DM.

Method and material: In this case report, effect of Ayurveda intervention in grade III fatty liver is reported. Fifty -eight -year-old obese male with grade III fatty liver presented with fatigue, heaviness in abdomen, belching and incomplete bowel evacuation. On examination, there was no significant clinical abnormality except a high body mass index and haematological parameters. The patient was diagnosed sonologically with a grade III fatty liver.

Observation and Conclusion: The patient was given Ayurveda treatment for two months. The patient was assessed for improvement in signs and symptoms, haematological parameters, and quality of life. Present case highlights the potential of Ayurveda interventions in managing non-alcoholic fatty liver disease with T2DM.

Keywords: Ayurveda, Non-alcoholic Fatty liver (NAFLD), T2DM, Santarpanotha Vikar

Corresponding Author How to Cite this Article To Browse
Bhavya Khatri, Post Graduate Scholar, Department of Kayachikitsa, National Institute of Ayurveda, Jaipur, Rajasthan, India.
Email: 		Khatri B, Methil G, Bhakuni H, Sahu AK, An Ayurvedic approach for Non-alcoholic fatty liver associated with Type 2 Diabetes Mellitus: A Case report. J Ayu Int Med Sci. 2024;9(6):318-323.
Available From
https://jaims.in/jaims/article/view/3306

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-04-15 2024-04-25 2024-05-05 2024-05-16 2024-05-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Authors state no conflict of interest. Non Funded. The conducted research is not related to either human or animals use. 14.55 All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

© 2024by Khatri B, Methil G, Bhakuni H, Sahu AKand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Bhavya Khatri et al. Ayurvedic approach for Non-alcoholic fatty liver associated

Introduction

Non-alcoholic fatty liver disease (NAFLD) consists of steatosis and non-alcoholic steatohepatitis (NASH). Steatosis is the accumulation of fat in the liver, and steatohepatitis is a condition with inflammation.[1,2] Estimates from our own studies and others have suggested that there is a significant burden of advanced fibrosis in asymptomatic individuals with type 2 diabetes ranging from 5% to 7%.[3,4]

There is therefore no doubt that these two common conditions co-exist and that there is significant amount of unrecognised advanced NAFLD within asymptomatic diabetic patients. Obesity and physical inactivity are interlinked risk factors for the development of diabetes and both are clearly implicated in an individual's risk of developing NAFLD. There is therefore no doubt that these two common conditions co-exist and that there is significant amount of unrecognised advanced NAFLD within asymptomatic diabetic patients. Liver is comparable to Yakrut, which is a significant Koshtanga that is referenced in Ayurvedic texts. It is Raktavahasrotas’s Moolasthan (root).[5]

taking Sthansanshrya in Yakrut with Kaphpradhana Tridosha Dushti. NAFLD can be viewed as Santarpanjanya Vyadhi.[6]

The ancient text of Yogratnakara described that Vidahi (spicy food) and Abhisyandi Ahara (food that blocks the channels) lead to Rakta-Kapha Dushti giving rise to Yakritodara (enlargement of the liver). This case report highlights the treatment effects of Ayurveda interventions in a patient with grade III NAFLD.

Case Report

A 58-year-old man from an urban region who has been diagnosed with type 2 diabetes mellitus since five years, is married, non-alcoholic, and obese (BMI = 31.9), came to national institute of Ayurveda hospital, Jaipur for the treatment.

Patient has no history of HTN and thyroid dysfunction and any CVD. The patient appeared ill and exhausted, standing 5.6" tall and weighed 90 kg. The patient's primary complaints were of abdominal distension, bodyache, anorexia and incomplete bowel evacuation. The patient has experienced these symptoms for last six months.

Clinical finding
The patient had Madhyam Koshti, Mandagni and Madhyam Bala, Vata Kapha Prakruti Both the heart rate and blood pressure were within acceptable bounds. The patient body mass index 31.9 and was obese, weighing 90 kg. There was no abnormality observed in the cardiovascular or respiratory system and gastrointestinal examination.

General and Vitals examination
General condition : Ill looking
Diet : Vegetarian
Appetite : Poor
Bowel : Incomplete evacuation
Bladder : Normal
Sleep : Sound
Addiction : Not any Pulse : 80/min., regular
BP : 130/80mm Hg
Weight : 90 kg
Height : 168cm
Temperature : 98.6°F
Past illness : T2DM since 5 years

Family history:

Not any NAFLD increases the chance of developing extrahepatic diseases, including osteoporosis, endocrine problems, colorectal cancer, CVD, and CKD. Liver illness is also described quite well in Ayurveda. NAFLD may be seen as a Santarpanotha Vikara (illness) brought on by Pittasthana, Raktavahasrotomoola, Kaphamedo Dushti, and Sthanasamsraya in Yakrut (liver).

NAFLD increases the chance of developing extrahepatic diseases, including osteoporosis, endocrine problems, colorectal cancer, CVD, and CKD. Liver illness is also described quite well in Ayurveda. NAFLD may be seen as a Santarpanotha Vikara (illness) brought on by Pittasthana, Raktavahasrotomoola, Kaphamedo Dushti, and Sthanasamsraya in Yakrut (liver).

Table 1: USG Grading

SNGradeFeatures
1.No fatty liver---
2.Grade ISlightly diffuse increase in the fine echoes. Liver appears bright as compared to the cortex of the kidney. Normal visualization of diaphragm and intra hepatic vessel borders.
3.Grade IIModerate diffuse increase in fine echoes. Slightly impaired in visualization of the intrahepatic vessels and diaphragm
4.Grade IIIMarked increase in the fine echoes. Poor or no visualization of intra hepatic vessels border, diaphragm and the vessels.

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Bhavya Khatri et al. Ayurvedic approach for Non-alcoholic fatty liver associated

Diagnosis
The patient was referred to a sonologist for ultrasonography of the whole abdomen, and the patient was found to be having grade III fatty liver (Figure A.). The patient was thus diagnosed with grade III NAFLD with mild hepatomegaly. The Ayurvedic diagnosis was Santarpanotha Vikar with Madhumeha.

Before treatmen
jaims_3306_1.png

After treatment
Jaims_3306_1.png

Intervention

Table 2: Interventions

Treatment reg.DurationDrugDose and frequencyRoute of administrationAnupana
OneDays 1 - 30Arogyavardhini Vati 500mg twice a dayOral, after mealLuke warm water
Triphala Guggulu 750mg twice a dayOral, before mealLuke warm water
Patokaturohinyadi Kashayam 40ml twice a dayOral, before mealLuke warm water
TwoDays 31- 60Arogyavardhini Vati 500mg twice a dayOral, after mealLuke warm water
Triphala Guggulu 750mg twice a dayOral, before mealLuke warm water
Patokaturohinyadi Kashayam 40ml twice a dayOral, before mealLuke warm water
Triphala Churna +
Kutaki Churna		4gm + 1 gmOral, at bed timeLuke warm water

The patient was given Ayurvedic medication for 60 days. All the interventions are presented in Table 3.

Diet
No specific diet or exercise schedule was given to the patient during the treatment period of two months.

Timeline of treatment
The patient had treatment for two months. The time of assessment in each 15 days.

Observations and Results

Table 3: Showing difference in different parameters before and after treatment.

SNParametersBefore treatmentAfter treatmentFollow-up (after one month)
1.USGGrade III fatty liverGrade II fatty liverGrade II fatty liver
2.Fibroscan
A.Stiffness (%)14.18.64.1
B.UAP (Db/m)341286264
Biochemical
3.SGOT (AST)(U/L)49.6825.721.67
4.SGPT (ALT)(U/L)87.3831.9722.37
5.S. triglycerides (mg/dl)227.12199190
6.S. HDL(mg/dl)33.8931.230
7.S. LDL (mg/dl)163.8150.8146.7
8.FBS (mg/dl)162.73103.995
9.HBA1C (%)6.15.95.6
Sign and symptoms
10.Weight (kg)908583
11.BMI kg/m231.930.129.32
12.AnorexiaModerateNormalNormal
13.Abdominal symptomsSevereNormalNormal

Patient perspective
The patient was satisfied with the treatment given and the improvement in his digestion, appetite, bowel evacuation, lethargic condition, and weight reduction. After two months of the treatment, the patient was feeling energetic, and actively doing his daily activities.

Discussion

The prevalence of NALFD and type 2 diabetes is increasing, and obese patients with type 2 diabetes and elevated LFTs are regularly referred to outpatient clinics. This case illustrates the necessity for both diabetologists and hepatologist to be aware, and together take part in the diagnosis and treatment of NAFLD.


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In this study, we have treated a non-alcoholic, obese patient who had grade III fatty liver with T2DM. According to Ayurveda, Santarpana (overeating and sedentary lifestyle) is responsible for the vitiation of Kapha and Meda, which are the main Dosha and Dushya involved in the pathogenesis of Sthaulya (obesity).[7]
our practice shows that persons with vitiated Kapha and Meda (fat) are prone to develop fatty liver and altered lipid profiles. A similar clinical picture was observed in the present case. Agni Deepana (enhancing the digestive fire), Ama Pachana (eliminating the toxins from the body), and Virechana (laxative) were the main principles applied in this case.

Arogyavardhi Vati[8]: Arogyavardhini vati consists of many ingredients among which Haritaki (Terminalia chebula), the chief is an astringent and laxative is effective in relieving liver disorders and very effective in fatty liver and cirrhosis of liver. Bibhitaki (Terminalia belerica) is a laxative, anthelmintic and effective in digestive disorders. Amalaki (Emblica officinalis) being an astringent, antibacterial, carminative, hypoglycaemic, stomachic, hypotensive is effective because of its anti-hepatotoxic, anti- oxidative, and immuno-modulatory properties. Along with the herbal ingredients Guggulu (Commiphora mukul) is an oleo-gum-resin helps in reducing cholesterol by converting it into bile.
This is also effective in removing the unwanted fats and balancing the cholesterol levels. The formulation also consists of Chitraka (Plumbago zeylancia) that is effective in relieving loss of appetite, indigestion, piles, liver diseases, worms, colitis and various.
Including Picrorrhiza kurroa to the formulation makes it effective in liver disorders. Picrorrhiza kurroa (Pitta Rechank/ Bhedana property) effective in hepatitis B infection and promising effect on bilirubin, SGOT, SGPT, preventing liver toxicity and improves hepatic glycogen preservation.

Triphala Guggulu[9]: Triphala Guggulu is a mixture of: i) Triphala (Haritaki - Terminalia chebula; Vibhitaki - Terminalia bellerica and Amalaki - Emblica officinalis) ii) Pippali (Piper longum) and iii) Guggulu (Commiphora mukul). Triphala has Deepaniya action of improving metabolic fire, Slesma- Pittaghani, Meha - Shothagni (improving urinary disorders and swelling), Rasayani (improving rejuvenating power).

Pippali is Medah-Kaphakanashak (reducing body fat) and so the drugs which possess Lekhaniya and Medohara Karma (fat reducing action) would be beneficial in NAFLD patients because they decrease the body fat and thus not only improve lipid profile and BMI but also may be helpful in improving the liver function.

Patokaturohinyadi Kashayam:
Patola Katurohinyadi Kashayam[10] is a classical Ayurvedic herbal formulation explained in Ashtanga Hridaya and which has been used by Ayurvedic practitioners in the management of Pitta Vikaras and liver disorders. It contains 6 ingredients those are Patola (Trichosanthes dioica Roxb), Katurohini (Picrorhiza kurroa Royle Ex Bonth), Raktachandan (Pterocarpus santalinus L), Murva (Marsdenia tenacissima Roxb), Guduchi (Tinospora Cordifolia) and Patha (Cissampelos pareira var. hirsuta). The main properties of all these herbal medicines are Pittagna, Kamalahar, Vishagna, and Raktaprasadhak.[11] Patola (Trichosanthes dioica) is proved for its hepatoprotective and lipid lower property. Hepatoprotective activity of the Patola was assessed based on the reduction in ALT, AST, and ALP towards normal values by the administration of the extract (ETD) which indicates the repairment of hepatocytes.[12] Mechanism of the lipidemic lowering activity of TD could be the inhibition of lipid absorption due to the presence of saponins and tannins in the aqueous extract.[13]

Conclusion

On the basis of the results, we can conclude that Ayurvedic interventions used in the present case have shown a significant effect on weight reduction and management of non-alcoholic fatty liver. The results observed in this case are encouraging, and further well-designed clinical trials may be carried out to test the efficacy of these interventions in similar conditions.

Declaration of patient consent
Informed consent for the publication of the data was taken from the patient.

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