Introduction

Viral Hepatitis is becoming a public health issue in India, where 1% of the population has the condition. They are quiet carriers in large numbers. Hepatitis is an inflammation of the liver Parenchyma caused by a viral infection and non-infectious causes like toxicity, alcohol intake, drugs and several metabolic disorders. Viral hepatitis is caused by a number of viruses some of which have already been characterized and named as hepatitis viruses A, B, C, D, E and G, respectively.^[1-3]

In addition, there are patients who are not accounted by these viral infections but show all clinical symptoms suggestive of viral hepatitis. Such cases are assumed to be caused by a group of viruses classified as non-A-G hepatitis viruses. Nearly 15% patients of viral hepatitis belong to this group. These viruses need to be characterized for their molecular structure and types of disease caused. Viral hepatitis is a serious problem in India too with a high proportion of liver ailments caused by hepatitis viruses.^[4-6] Based on various studies, all types of known and unknown viruses causing hepatitis have been reported in Indian populations.^[7]

In Ayurveda, hepatitis or jaundice is acknowledged as Kamala roga, caused due to impairment of Pitta Dosha and Rakta Dhatu. The condition occurs due to Kostha Gata Pitta, Pitta-Rakta Dusti, and Yakrit Asrita Pitta Dusti. In this condition, aggravated Pitta Dosha further vitiates Rakta and Mamsa and produces Kamala. It has two variations, namely Kosthasrita Kamala/Bahu Pitta Kamala and Sakhasrita Kamala. The chronic form of Kamala leads to Kumbha Kamala, Halimaka, Panaki Roga. The diagnosis of Kamala consisting of an evaluation of the types of Kamala through examination of skin, mucous membrane, and stool color.

Assessment of Agni, Bala, Dosha Vriddhi, Dhatus involvement is required to decide the therapeutic measures. In Kosthasrita Kamala,Tikta Rasa (drugs with bitter taste) Prayoga and Virechana are recommended. However, in Sakhasrita Kamala,Kaphahara treatment is required at initial stages to bring the Pitta Dosha from Sakha (skin and periphery) to Kostha (alimentary canal).^[8] Few studies have also proved the efficacy of Ayurvedic medicines in hepatobiliary disorders.^[9,10]

Table 3: Showing the Ashtavidha Pariksha (Eight types of examination) (Date: 26/06/2023)

27/06/2023 -USG Abdomen and Pelvis

Impression - Mild Hepatomegaly, GB wall edema-Infective etiology

Chikitsa (Treatment)

Table 4: Shamana Chikitsa

Pathya Ahara advised

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

Apathya Ahara advised

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

Result

Table 5: Liver Function Test

Discussion

Kamala is one of the important, common clinical entities in Ayurveda, whose description appears to be most comprehensive and incorporates the disorders of Hepato-Biliary System of Modern Medicine. The hepatobiliary system is the seat of Pitta Dosha and numbers of Pitta dominant diseases are known to be occur other than Kamala. Kamala as a somatic disease has been described according to unique principles of Ayurveda such as different anatomical components and physiological components are identified in relation to Kamala. Ayurveda body parts are enumerated and described according to Srotas, Koshta, Koshtanga, Shaka, Kala, Ashaya and Roga Marga, Marma, Yakrit, Pleeha etc. and physiological components: Sharirika Dosha, Manasika Dosha, Dhatu, Agni, Ama, and Mala etc. are important factors related to Kamala Roga. According to the Roga Rogi Pariksha of Ayurveda its aetiopathogenisis and its management are vividly discussed by the great Acharyas in the Pandu and Kamala Roga Chikitsa Adhikarana.

Due to increase in Bala of Rasadhatwagni and Raktadhatwagni, both these Dhatu start getting properly nourished. Dhatushaithilya which develops in Pandu, is reduced by Arogyavardhini. Being Malashodhaka it is helpful to reduce Shotha associated with Pandu. Arogyavardhini is more useful in Margavarodhjanya Kamala. By virtue of Lekhana property, it removes any obstruction in natural pathways of Yakrut, PrakupitaPitta and propels its flow in its normal pathway. This leads to relief from symptoms such as whitish coloured stools, Agnimandya, Chhardi etc. Pitta shamaka medicines should be used after the stools obtain normal colour.

Chitrakadi Vati is a potent digestive stimulant. It is a traditional remedy for treating indigestion, constipation, flatulence and stomach pain. The active ingredient Chitraka prevents Mandagni i.e., lack of stomach fire, and in turn, alleviates the symptoms that happen due to it. Kalmegh might be beneficial in the management of liver problems. It has antioxidant, anti-inflammatory and hepatoprotective properties. It prevents the damage of liver cells caused by the free radicals. It might also be effective against chronic hepatitis B viral infection.

Syrup Liv52-It is commonly used for the diagnosis or treatment of Jaundice, Improves appetite, digestion, liver damage, and viral hepatitis. It has some side effects such as dizziness, allergic reaction, rectal bleeding and weight gain.

Amritarishta is highly valuable in low grade fever or chronic fever, where a person may experience fatigue, loss of stamina, body pains and restlessness. This wonder syrup helps to mitigate the symptoms and eliminates the toxins, which is responsible for inflammation and fever. It helps to build a robust immune system and beats off infection causing pathogens. While it lessens the duration of fever and speeds up the recovery process. Additionally as fever settles it aids in restoring stamina, strength and improves appetite.

Conclusion

Koshtashakarita Kamala (alcoholic hepatitis) is managed significantly by Shamana therapy and PathyaApathya management. Oral Ayurvedic drug like Arogyavardhini Vati, Chitrakadi Vati,