E-ISSN:2456-3110

Case Report

NAFLD

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 5 May
Publisherwww.maharshicharaka.in

Kaminee Nagraj et al. Effect of Kaphahara Basti and Rohitakadya Churna in Non-alcoholic Fatty Liver Disease

Nagraj K1*, Dash B2
DOI:10.21760/jaims.9.5.44

1* Kaminee Nagraj, Post Graduate Scholar, Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

2 Babita Dash, Lecturer, Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.

Non - Alcoholic Fatty Liver Disease (NAFLD) is the building of extra fat in the liver cells that is not caused by alcohol. NAFLD can be considered as Santarpanajanya Vyadhi (disease caused by to sedentary lifestyle, faulty dietary habits and lack of physical activities). Kapha, Ama and Meda play a major role in the pathogenesis of NAFLD. One such case of Non- Alcoholic Fatty Liver Disease came to Panchakarma OPD of Pt. Khushilal Sharma Govt. (Auto) Ayurveda College and Institute Bhopal. The patient was managed conservatively through Ayurveda medicine (Rohitakadya Churna) and Panchakarma therapy (Kaphahara Basti). After one month of treatment, all the subjective and objective parameters showed a remarkable response on both subjective and objective parameters. The patient’s condition got better and there was pathological remission shown on the ultrasound. This case study aims to investigate the Ayurvedic therapeutic method and mechanism of action of Kaphahara Basti and Rohitakadya Churna in the management of NAFLD. At the end of the study, it can be concluded that the treatment regimen has a significant role in the management of Non-Alcoholic Fatty Liver Disease.

Keywords: NAFLD, Ama, Santarpanjanya Vyadhi, Basti, Panchakarma, Kaphahara Basti, Rohitakadya Churna

Corresponding Author How to Cite this Article To Browse
Kaminee Nagraj, Post Graduate Scholar, Department of Panchakarma, Pt Khushilal Sharma Govt Auto Ayurveda College and Institute, Bhopal, Madhya Pradesh, India.
Email: 		Nagraj K, Dash B, Kaminee Nagraj et al. Effect of Kaphahara Basti and Rohitakadya Churna in Non-alcoholic Fatty Liver Disease. J Ayu Int Med Sci. 2024;9(5):258-264.
Available From
https://jaims.in/jaims/article/view/3405

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-03-11 2024-03-21 2024-03-31 2024-04-10 2024-04-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 23.85

© 2024by Nagraj K, Dash Band 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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Kaminee Nagraj et al. Effect of Kaphahara Basti in Non-alcoholic Fatty Liver Disease

Introduction

Fatty Liver Disease refers to a condition in which excess fat accumulates in the liver cells affecting the metabolic function of the liver leading to Liver damage. A healthy liver contains a small amount of fat. It becomes a problem when fat reaches more than 5% to 10% of the liver's total weight. There are two main types of fatty liver disease (1) Alcoholic Fatty Liver Disease (AFLD) and (2) Non-Alcoholic Fatty liver Disease (NAFLD). AFLD is caused by heavy alcohol consumption over an extended period. NAFLD is a build-up of extra fat accumulation in the liver cell that is not caused by alcohol. Non-alcoholic fatty liver Disease (NAFLD) is now more common than Alcoholic Fatty Liver Disease (AFLD) globally and is currently estimated to affect 38% of the global population. The prevalence of fatty liver in India 9-32% with an average of 25% in general population.[1] Nowadays NAFLD is one of the most common lifestyle disorders, The Pathogenesis of NAFLD is not fully elucidated. Beside weight gain and insulin resistance, many other factors seem to contribute, including adipokinese, gut microbiota and genetic predisposition. High saturated fat, low fiber and carbohydrate rich diets have been known as risk diet in Non -Alcoholic fatty liver disease. The disease starts as hepatic steatosis, which may proceed to Non-Alcoholic Steatohepatitis (NASH); if fibrosis is added, the risk of cirrhosis and / or hepatocellular carcinoma is augmented.[2]

According to Ayurveda NAFLD can be considered as the Santarpanjanya Vyadhi based on the aetiological component and symptoms complexes. Due to faulty dietary habits, lack of physical exercise and sedentary lifestyle Kapha and Meda Dhatu are specially vitiated in the body which leads to Jatharaagnimandhya and Ama formation. As a result, Dooshit Ras formed and the successive Dhatu formation is impaired. The vitiated Kapha Dosha and Ama causes the unequal formation of Meda Dhatu which is not Prakrit is called Abadha Meda, which deposits in the liver and this condition is called Fatty Liver.[3] This study aims to find a feasible solution to this problem, an effort is made to understand the disease for better clinical management by scientifically evaluating the effect of Kaphahara Basti[4] and Rohitakadya Churna[5] in Non-Alcoholic Fatty Liver disease.

The majority of patients diagnosed with NAFLD are commonly asymptomatic and frequently detected incidentally by blood-liver function tests or imaging performed for other reasons. Subjects with NAFLD have a higher mortality rate than the general population and are at increased risk of developing cardiovascular disease and diabetes. Patients with NAFLD have such signs and symptoms are like Fatigue, loss of Appetite, Constipation, Nausea, Flatulence, Abdominal pain, Hepatomegaly and Hepatic tenderness.[6-7]

In modern medicine, NAFLD / NASH is treated with Insulin sensitizers (Thiazolidinediones) Antioxidants, Lipid-lowering drugs, Pentoxifylline, Angiotensin receptor blockers, n-3 Polyunsaturated fatty acids drugs etc. Several side effects have been reported because of these drugs, so also these drugs have a limited role in preventing complications.[8] But Ayurveda has the potential to not only manage Non-Alcoholic Fatty Liver Disease but to reverse it and bring the Liver into a normal state. The protocol of Santarpanajanya Vyadhi with required lifestyle modification is useful for managing NAFLD. Basti appears to be the best treatment modality amongst all Sanshodhana therapies mentioned under the Panchakarma procedure. Kaphahara Basti (Ch.Si.10/23) mentioned by Acharya Charaka for treating Kapha Dosha. The drug of this Basti are Lekhana in nature thereby reducing Meda and Kapha. Rohitakadya Churna (Bha.Rat.41/10-11) mainly possess Kapha Pittahara along with Bhedana, Anulomana, Deepana and Pachana, Balya activities and Hepatoprotective action which protects the Liver from cellular damage.

Case Report

A 49year-old Non-Alcoholic, married female patient from an urban area, came for Ayurveda treatment in Panchakarma OPD at Pt. Khushilal Sharma Govt. (Auto) Ayurvedic Hospital Bhopal. The patient mainly complained about incomplete bowel evacuation, abdominal distension, gaseous trouble, fatigue, anorexia and nausea. These symptoms have been persisting in the patient for the past 6 months. No H/O P/R bleeding or pain during defecation. No H/O Hypertension/ Diabetes Mellitus/ Thyroid disorder.

Past History

According to the patient, she was quite healthy


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Kaminee Nagraj et al. Effect of Kaphahara Basti in Non-alcoholic Fatty Liver Disease

before 6 months. The patient had consulted for similar medical complaints with an allopathic physician 6 month back. Laxatives and Antacids were given to control the bowel evacuation and abdominal distension. During this period patient was not recovered completely and due to the reoccurrence of the symptoms, she came for Ayurveda treatment.

Personal History

AppetiteDecreased
BladderNormal
BowelNot clear
SleepSound
DietVegetarian
Height5’3”
Weight64 kg

Rogi Pariksha

Abdominal Examination

Inspection - Centrally placed umbilicus, surgical scar present at lower abdomen, no redness or discolouration.

Palpation - superficial- no tenderness, no rise in temperature, no rigidity.

Deep Palpation - Liver is palpable and slight tenderness present.

Percussion - tympanic note heard over the abdominal area.

Auscultation - normal bowel sound heard.

On Examination

General body builtMedium
Pulse rate74/min
Respiratory rate16/min
Blood pressure130/70 mm of Hg

Assessment criteria

The following criteria were adopted -

A) Subjective Criteria

Fatigue

GradeScore
Routine activity without feeling fatigued0
The feeling of fatigue after doing extra work1
The feeling of fatigue after routine work2
The feeling of fatigue even without doing any work3

Loss of appetite

GradeScore
Normal appetite0
One meal and one breakfast, per 24 hrs1
Eat only once in 24 hrs2
Have no feeling of appetite3

Constipation

GradeScore
No constipation0
Occasional constipation 1 to 2 times in a week1
Occasional constipation 3 to 4 times in a week2
Continuous constipation and feeling of incomplete evacuation3

Nausea

GradeScore
Normal0
Occasionally1
Moderate but does not disturb the routine work2
Severe disturbing the routine work and a small amount of fluid regurgitating from the mouth3

Flatulence

GradeScore
Not present0
Occasional feeling of Flatulence1
Flatulence after intake of a heavy meal2
Flatulence intake of a light meal3

Pain in the right upper quadrant

GradeScore
Not present0
Mild pain occurs in the upper right side of the abdomen1
Moderate pain occurs in the upper right side of the abdomen2
Severe pain occurs in the upper right side of the abdomen3

B) Objective Criteria

Table 1: USG Grading

GradeUSG Findings
Grade 0
No fatty liver		Normal
Grade 1
Fatty Liver		Slight diffuse increase in the echogenicity. The liver appears bright as Compared to the cortex of the kidney. Normal Visualization of Diaphragm and intra-hepatic vessel borders.
Grade 2
Fatty Liver		Moderate diffuse increase echogenicity. Slightly impaired Visualization of the intra-hepatic vessels and diaphragm.
Grade 3
Fatty Liver		The marked increase in echogenicity, obstructed penetration.
Poor or no visualization of Intra-hepatic vessel borders, diaphragm and the vessels.

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Liver Function Test

Treatment protocol

Total treatment duration - 1 month

Table 2: Treatment procedure

SNProcedureDurationDrugDoseTime
1.Basti Karma - Kala Basti plan according to Acharya Vagbhat
(As.Hr.Su.19/63-64)
1-15days		NiruhaKaphahara
Basti		480mlEmpty stomach in the morning
AnuvasanaMurchit
Tila Taila (4th Day)		120mlAfter meal
2.Shamana drug1-30 daysRohitakadya Churna3 gm
twice a day		After meal with normal water

(Note - The Niruha and Anuvasana Basti will be administrated in 3:1 ratio in the plan)

Result

Table 3: Effect of therapy

Subjective parametersBefore Treatment (15/02/24)After Treatment (02/04/24)
Fatigue30
Loss of Appetite20
Constipation30
Nausea10
Flatulence31
Pain in abdomen10

Table 4: Assessment of USG

Assessment parameterBefore treatment (15/02/24)After treatment (02/04/24)
USG gradingMild hepatomegaly with grade 2 fatty liverMild hepatomegaly with grade 1 fatty liver

Table 5: Assessment of LFT

Assessment parameterBefore treatment (15/02/24)After treatment (02/04/24)
LFTBilirubin - Total: 0.8mg/dl
Bilirubin - Direct: 0.2mg/dl
Bilirubin - Indirect: 0.7mg%
SGOT - 17.4 mg/dl
SGPT - 20.6 mg/dl
ALP - 174 U/L		Bilirubin - Total: 0.7mg/dl
Bilirubin - Direct: 0.1mg/dl
Bilirubin - Indirect: 0.6mg%
SGOT - 14.3 mg/dl
SGPT - 17.2 mg/dl
ALP - 152.3 U/L

Table 6:

WeightBefore treatmentAfter treatment
64kg61.6kg

Discussion

Liver disorder is one of the major problems and it is among the top ten causes of death in the world. NAFLD is now one of the most common diseases that is present worldwide. NAFLD is estimated to affect approximately 1 billion individuals worldwide. According to the latest W.H.O. data published in 2020 liver disease deaths in India reached 268,580 or 3.17% of total death. Hence the need of timely intervention can be well understood. In Charaka Samhita, lack of physical activity and unhealthy eating habits which are the causes of lifestyle disease are mentioned in Santarpaneeyam Adhyayam.[9] According to Ayurveda NAFLD can be categorized under the Santarpanajanya Vyadhi. The aetiology and symptomatology of Santarpanajanya Vyadhi show a remarkable similarity with NAFLD. As a consequence of urbanization and accompanying changes, like a high fat and carbohydrate rich diet, sedentary lifestyle, and a higher hereditary predilection for diabetes mellitus, NAFLD is one of the most common lifestyle disorders and commonly associated with metabolic comorbidities such as obesity, diabetes mellitus, and dyslipidaemia.

According to Ashtanga Hridaya “Rogah Sarveapi Mandaagnau” Agni plays a major role in the process of digestion and metabolism. Due to sedentary life style and faulty dietary habits Kapha Dosha become aggravated in the body, which probably leads to Jatharagnimandhya, derangement of Dhatvagni and Ama formation. As a result, Ama Rasa is formed and successive Dhatu formation is hampered. Kapha and Meda are the main Dosha and Dooshya involved in the pathogenesis of NAFLD. Therefore Agnideepana, Amapachana, Kapha Medo Vatahara and Srotoshodhana Chikitsa are beneficial to manage the Disease. It is a great pleasure to say that Ayurveda defines the exact aim of treatment should be “Swasthasya Swasthya Rakshanam and Aturasya Vikara Prashamanam.” Here this concept is also applied to the treatment of the disease that arises due to Santarpana, Chikitsa Sutra for Santarpanajanya Vyadhi primarily comprises Samshodhana Chikitsa and Apatarpana Chikitsa. Basti appears to be the best treatment modality amongst all Samshodhana therapies mentioned under Panchakarma Chikitsa since it is the fastest Aptarpana Chikitsa that can eliminate excessively high Meda when made with Aptarpaka medications.


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Basti is administered through the anal route, Basti Dravya is absorbed from superior hemorrhoidal veins in the rectal mucosa, passes through the duodenum, enters systemic circulation, and then portal circulation, corrects liver metabolism, facilitates bile salt synthesis and results in the emulsification of fats, thereby avoiding fatty accumulation in the liver and blood cells.

Tila Taila is effective in Kapha and Meda Pradhan conditions. Due to Snehatva Guna lubricates the Srotasa, protects the mucous membrane from the irritating effect of Tikshana drugs in the Basti Dravya helps in easy removing of waste substance by Srotovishodhana.

Murchita Tila Taila acquiring Vyavayi Guna, facilitates easy absorption and transportation in the body, performs Lekhana and Rukshana removes excess Meda.

Basti Chikitsa is said to be Ardha Chikitsa by Acharya Sushruta. According to Acharya Charaka, Achintya Prabhava of Basti, it pulls out all the vitiated Doshas even from head to the Pakvashaya.[10] Kaphahara Basti comprising of Madhu, Saindhava, Tila Taila, Triphala, Haridra, Musta, Daruharidra, Yavkshara, Gomutra and Shyonaka Chaal mentioned by Acharya Charaka which is most effective therapy for Kapha and Meda Pradhan Dushti Janaya Roga. The drugs components of this Basti are Lekhana in nature. Ushana, Tikshana, Laghu, Ruksha Guna, Ushna Veerya, Katu Vipaka and Tejo Guna Pradhan drugs used to prepare Basti, act at the level of Jatharagni, thus correcting the Dhatvagni and reducing the formation of Ama. Proper formation of Uttarottara Dhatu and reduction in Medodhatu production. The metabolism is enhanced as a result of the removal of vitiated Doshas and Ama via Basti.

The components of Rohitakadya Churna (Bhai. Rat., Pleehayakritrogadhikara 41/10-11) are Rohitaka, Yavakshara, Bhunimba, Kutaki, Mustaka, Navasadar, Ativisha and Shunthi. Rohitakadya Churna has Deepana - Pachana, Bhedan, Anulomana, Yakrituttejak and Balya action. Ushna Veerya of the drugs helps in Srotorodha caused by Ama. Apart from this, it is also believed to regulate the metabolic function and correct the Jatharagnimandhya and regulates the Dhatvagni.

Conclusion

jaims_3405_01.JPG
Image 1: Before treatment
Image 2: After 1 month of treatment

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Kaminee Nagraj et al. Effect of Kaphahara Basti in Non-alcoholic Fatty Liver Disease

There is no direct reference to NAFLD in Ayurveda classics but it would be thought-wise considered under the Santarpanajanya Vyadhi. Kapha, Meda and Ama, are the main Doshas and Dooshya involved in the pathogenesis of NAFLD. Ayurveda medicine and therapies have gained popularity because of their safety, efficacy and cost-effectiveness. Based on the result, we can conclude that the Kaphahara Basti and Rohitakadya Churna have shown a significant effect on weight reduction. This treatment regimen also helps to reduce the size of Subserosal uterine fibroid and all the subjective and objective parameters showed a noteworthy response to the treatment. There were no tropical and systemic adverse drug effects were found throughout the treatment. Thus, it can be concluded that the Kaphahara Basti and Rohitakadya Churna have significant role in the management of NAFLD. The study should be carried out on large sample size for long period.

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