E-ISSN:2456-3110

Case Report

Alcoholic Liver

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 8 AUGUST
Publisherwww.maharshicharaka.in

Ayurvedic management of Alcoholic Liver Disease : A Case Report

Arali S1*, Guled S2, Mythrey RC3
DOI:10.21760/jaims.9.8.44

1* Shruti Arali, Final Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurveda Medical College and Hospital, Mysuru, Karnataka, India.

2 Sidram Guled, Assistant Professor, Department of Kayachikitsa, Government Ayurveda Medical College and Hospital, Mysuru, Karnataka, India.

3 Mythrey RC, HOD and Professor, Department of Kayachikitsa, Government Ayurveda Medical College and Hospital, Mysuru, Karnataka, India.

Alcoholic liver disease (ALD) is one of the most prevalent types of liver disease worldwide. According to a 2023 study, the prevalence rate of alcoholic liver disease in India is 4.8%. This case report deals with a 51-year-old male patient initially came to OPD with complaints of yellowish discoloration of eyes, skin, and urine, loss of appetite, anorexia, distention of the abdomen, bilateral pedal edema, easy fatiguability, weakness and weight loss. Liver function test shows-high bilirubin and high transaminase, USG of the abdomen shows-Moderate Hepatomegaly with signs of Hepatitis. It was diagnosed as Kostha-Shakhashrita/Bahupitta Kamala based on the etiopathology and investigations. The patient was treated with Ayurvedic interventions viz, NABB Swarasa, Arogyavardini Vati, Phalatrikadhi Kashaya with Katuki Churna, Patolakaturohinyadhi Kashaya, Laghusoothshekara Rasa and Tab Nirocil were prescribed. After 68 days of treatment protocol, there was marked relief in the symptoms and a reduction in bilirubin and transaminase levels. The above-mentioned oral medications have shown significant results in the present study.

Keywords: Kostha-Shakhashrita Kamala, ALD, Shamana Chikitsa, NABB Swarasa, Phalatrikadhi-Kasahay, Katuki Churna, Arogyavardhini Vati, Tab Nirocil

Corresponding Author How to Cite this Article To Browse
Shruti Arali, Final Year Post Graduate Scholar, Department of Kayachikitsa, Government Ayurveda Medical College and Hospital, Mysuru, Karnataka, India.
Email: 		Arali S, Guled S, Mythrey RC, Ayurvedic management of Alcoholic Liver Disease : A Case Report. J Ayu Int Med Sci. 2024;9(8):287-293.
Available From
https://jaims.in/jaims/article/view/3539

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-07-09 2024-07-19 2024-07-29 2024-08-09 2024-08-17
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 13.21

© 2024by Arali S, Guled S, Mythrey RCand 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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Shruti A et al. Ayurvedic management of Alcoholic Liver Disease

Introduction

Alcohol is major cause of liver disease. The severity and prognosis of alcohol-induced liver disease depend on amount, pattern, and duration of alcohol consumption.[1] There are mainly three histological stages of ALD they are Alcoholic fatty liver, Alcoholic hepatitis, and Alcoholic cirrhosis.[2] ALD is characterized by loss of appetite, yellowish discoloration of eyes, skin, urine, and bilateral pedal edema mainly at ankle area, and is associated with increased levels of bilirubin and transaminase in blood.[3] In Ayurvedic literature, it can be considered as Kostha-Shakhashrita/Bahupitta Kamala. Madya (alcohol) is considered as one of Nidana for Kamala. Teekshna, Ushna, Vyavayi, Vikasi, Sukshma, Ruksha, and Vidhahi properties of Madya does Annarasa Utkleda and Vidagdha, ultimately it vitiates Rakta and causes Kamala.[4] It is one of Pittaja Nanatmaja Vyadhi[5] and Rakta Pradoshaja Vikara.[6] It has been classified into two types Bahupitta Kamala/ Kosthashakhashrita Kamala and Alpa-Pitta/Shakhashrita Kamala.[7] This is due to vitiation of Rakta and Mamsa by aggravated Pitta. Common symptoms of Kamala include yellowish discoloration of eyes, skin, and nails, skin colour resembling a frog in rainy season, loss of appetite, indigestion, and weakness.[8]

Case Report

A 51-year-old married male patient, belonging to the middle economic class, with no known history of any co-morbidities came to Kayachikitsa OPD, Government Ayurveda Medical College & Hospital, Mysuru with the chief complaints of Peeta Netrata (yellowish discoloration of eyes), Peeta Mutrata (yellow discoloration of urine), Kshudha-Mandhya (loss of appetite), Adhmana (Distension of abdomen), Padashotha (Bilateral pedal edema non-pitting in nature), Daurbalya (weakness), anorexia and weight loss since 2 months.

History of present illness

The patient was asymptomatic before 2½ months, since 2-months patient gradually developed a loss of appetite followed by yellowish discoloration of eyes & urine, since one and half month he developed distension of abdomen, bilateral pedal edema non-pitting in nature, associated with generalized weakness.

The patient had a history of chronic drinking for 4-5 years, which included a daily intake of 180ml of alcohol (whisky) with non-vegetarian food at night and occasional smoking of 3-4 cigarettes per week.

The patient had abstained from alcohol and non-vegetarian food for 6 months. Again the patient began consuming alcohol daily, along with frequent intake of non-vegetarian, spicy, and oily food.

As a result, the patient gradually developed yellowish discoloration of eyes, urine, and skin, loss of appetite, bilateral non pitting pedal edema, distension of abdomen, anorexia and weight loss.

For these complaints patient approached Government Ayurveda Medical College & Hospital Mysuru.

History of past illness: No Significant

Personal History

  • Bowel: constipation
  • Bladder: yellowish discoloration of urine
  • Appetite: poor
  • Sleep: altered
  • Built: Normal
  • Habit: addiction to Alcohol

Asthavidha Pariksha

Assessment of the general condition of the patient:

NadiKaphaja (78/min)
MalaVibandha
MutraPeeta Mutratha
JiwhaLiptatha
ShabdhaPrakruta
SparshaPeetavarniya, Anushnasheeta
Drik Peeta Netratha
AakritiMadhyama

Systemic Examination

The patient was systematically examined for the central nervous system, cardiovascular system and Respiratory system, and no significant findings were found.

P/A - Mild tenderness over the right hypochondriac area and the epigastric area was elicited.

Urogenital system - yellowish discoloration of urine


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Shruti A et al. Ayurvedic management of Alcoholic Liver Disease

Investigations

jaims_3539_01.JPG

USG Abdomen & Pelvis on 14/02/2024Moderate Hepatomegaly with signs of hepatitis Relatively small Right Kidney

jaims_3539_02.JPG

LFT (Liver function test) on 14/02/2024
Total Bilirubin - 7.6mg/dl
Direct Bilirubin - 6.5 mg/dl
Indirect Bilirubin - 1.10mg/dl
AST/SGOT - 110U/L
ALT/SGPT - 19U/L
Alkaline Phosphate - 239IU/L
Total protein - 7.5g/dl
Serum Albumin - 2.9g/dl
Serum Globulin - 4.6g/dl
A/G Ratio - 0.6

jaims_3539_03.JPG

LFT (Liver function test) on 28/02/2024
Total Bilirubin - 3.9mg/dl
Direct Bilirubin - 3.6mg/dl
Indirect Bilirubin - 0.30mg/dl
AST/SGOT - 127U/L
ALT/SGPT - 78U/L
Alkaline Phosphate - 242IU/L
Total protein - 6.8g/dl
Serum Albumin - 3.5g/dl
Serum Globulin - 3.3g/dl

jaims_3539_04.JPG


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LFT (Liver function test) on 23/03/2024
Total Bilirubin - 1.4mg/dl
Direct Bilirubin - 1.0mg/dl
Indirect Bilirubin - 0.40 mg/dl
AST/SGOT - 67U/L
ALT/SGPT - 52U/L
Alkaline Phosphate - 137IU/L
Total protein - 6.3g/dl
Serum Albumin - 3.0g/dl
Serum Globulin - 3.3g/dl

Treatment Given

Table 1: Shows Shamanoushadhi were administered during the Hospital stay for the first 7 days.

DateTreatment (Shamanoushadhi)DosageDuration
15/2/2024
to
21/2/2024		NABB Swarasa (Nimba, Amrita, Bhrigaraja, Bhumyamlaki)15ml BD B/F7 days
Arogyavardini Vati500mg, 2BD A/F7 days
Laghusoothsekhara Rasa250mg, 2BD B/F7 days
Phalatrikadi Kwatha + Katuki Churna15ml BD+ 2gm of Katuki Churna as a Prakshepaka Dravya B/F with one cup of water7 days
Tab Nirocil1000mg BD A/F7 days

Advice on discharge

  • Arogyavardini Vati: 500mg, 2BD A/F
  • Laghusoothsekara Rasa:250mg, 2BD B/F
  • Phalatrikadi Kwatha:15ml BD with 2gm of Katuki Churna B/F with one cup of water
  • Nirocil:1000mg, BD A/F

Pathya Ahara and Vihara

Ahara

Cereals: Purana Yava, Purana Godhuma, Purana Shali, Mudga.

Vegetables: Patola, Kushmanda, Karavellaka, Methika, Shigru.

Others: Amlaki, Ikshurasa, Grutha, Jangala-Mamsa Rasa etc.

Anupana: Drakshajala

Follow-up

Table 2: Shows 1st Follow-up details

1st Follow-upShamanoushadhiDuration
1st follow-up on 28/02/20241.  Arogyavardini Vati - 500mg, 2BD A/F
2.  Patolakaturohinyadhi Kashaya - 15ml BD with 2gm of Katuki Churna as a Pakshepaka Dravya B/F with one cup of water
3.  Laghusoothsekara Rasa - 250mg, 2BD B/F
4.  Tab Nirocil - 1000mg BD A/F		1 month

Table 3: Shows 2nd Follow-up details

2nd Follow-upShamanoushadhiDuration
2nd fallow-up on 23/03/20241.  Arogyavardini Vati - 500mg, 2BD A/F
2.  Patolakaturohinyadhi Kashaya - 15ml BD
3.  Laghusoothsekara Rasa - 250mg, 2 BD B/F
4.  Tab. Nirocil - 1000mg BD A/F		1 month

Results

Objective outcome

Table 4: Showing Changes in Blood Investigation during Treatment

Assessment Parameters14/02/202428/2/202423/03/2024
Sr. bilirubin7.6mg/dl3.9mg/dl1.4mg/dl
Direct bilirubin6.5 mg/dl3.6mg/dl1.0mg/dl
Indirect bilirubin1.10mg/dl0.30mg/dl0.40 mg/dl
SGOT110U/L127U/L67U/L
SGPT19U/L78U/L52U/L
Alkaline Phosphate239IU/L242IU/L137IU/L

Subjective outcome

After 68 days of treatment, patient showed significant improvement in all symptoms. These included: colour of eyes and urine returned to normal, increased appetite, reduced abdominal distension and bilateral pedal edema. Patient gained strength and his liver profile returned within normal limits. Patient improved gradually during treatment, and there has been no recurrence of symptoms during follow-up. Positive results were significantly noticeable in both clinical and laboratory criteria.

Discussion

Discussion on disease Samprapti

Patient indulging in heavy Madya and Ahara having Ushna, Teekshna, Katu, Vidahi and Amla properties results in vitiation of Pitta[9] and Rakta.[10] Yakrit being Mulasthana of Raktavaha Srotas[11] gets vitiated by Pitta and Rakta.


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Malarupi Pitta of Raktadhatu increased in excess entering the Shakha leading to yellowish discoloration of eyes, skin, nails and urine, reduced appetite, anorexia, and generalized weakness.[12]

Discussion on the mode of action of drugs

NABB Swaras[13]: Nimba, Amruta, Bringaraja, Bhumyamlaki all have Katu, Tikta Rasa, Katu Vipaka, Laghu and Ruksha Guna. These drugs have Pitta-Rechana, Rakta Shodhana and Yakrut-Uttejaka properties. Amrita itself is Pandu and Kamala Nashaka. It acts like hepatocellular regeneration, Antiviral activity, and immunomodulation. In reviewing the dissertation on the role of NABB Swaras in viral hepatitis, the results and conclusions show that there was a complete reduction in Twakpeetata after 14 days of treatment. Nakhapeetata was completely reduced after 21 days, while Mootra-Peetata, Netra-Peetata, and liver enlargement took 4 weeks for recovery. The changes in LFT values between pretest and post-test were highly significant.

Katuki[14]: It is Pittashamaka because of Sheeta Virya and Tikta Rasa. It is helpful in Yakrut Vikara, Agnimandya, Raktavikara, and acts as Malabedhini.

Phalatrikadi Kashaya[15]: It acts as Pittahara, Pitta Rechana , Yakruta-Uttejaka, Deepana, Tridoshahara, and Rasayana.

Tab. Nirocil[16,17,18]: It contains Tamalaki, Guduchi, Erandand Yashad Bhasma, so it acts as Yakrituttejaka, immunomodulator, Jwaraghana, and Rechaka.

Arogyavardhani Rasa[19]: Deepana. Pachana, Agnidipana, Malashuddhikara, Kshudhavardhaka & Sarvarogaprashamani. It balances & maintains liver Function as well as a healthy digestive system.

Patolakaturohinyadhi Kashaya[20]: Ingredients of Patolakaturohinyadhi Kashaya are Tikta Rasa Pradhan and predominantly Ushna Veeryatmak which are useful Kapha-Pittahara and Tridoshahara property. which act on liver as Yakritottejaka and Yakrit Shodhana.

Laghusoothsekara Rasa[21]: It acts as Mandagni-Nashaka, Shoola-Amayapaham and Tridosha-Shamaka. Nagavalli Patra Swarasa is Bhavana Dravya, it acts as gastroprotective and carminative properties and promotes healthy digestion.

Conclusion

In the patient of Kamala, the elimination of Sanchit Dosha through Mrudu Shodana by using Tikta Rasa Pradhana Dravyas. NABB Swarasa, Katuki Churna, Phalatrikadhi Kashaya, Patolakaturohinyadhi Kashaya etc. are Tikta Rasa Pradhana Dravyas and act as Mrudu Virechaka.

All the above-explained oral medicines and Pathya Ahara were beneficial in improving symptoms such as yellowish discoloration of skin, urine, and eyes, increased appetite, reduced bilateral pedal edema, weakness, and reduction in serum bilirubin level. So, these herbal formulations are effective in the management of Kamala.

References

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