WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES

Vijay et al. World Journal of Pharmacy and Pharmaceutical Sciences

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Volume 6, Issue 4, 1197-1204 Case Study ISSN 2278 – 4357

MANAGEMENT OF ALCOHOLIC LIVER CIRRHOSIS THROUGH

AYURVEDA -A CASE STUDY
1
Dr. Pratyush Kumar, 2Dr. Priyanka Sharma, 3Dr. Alok Kumar Srivastva, 4Dr Amit
Kumar Shukla, 5Dr Shambhu Kumar, 6Dr Himangshu Baruah and 7Dr Vijay Kumar*

1
Associate Professor, Dept. of Swasthvritta & Yoga, Patanjali Ayurvedic College,Haridwar.
2
Assistant professor, Dept. of Swasthvritta & Yoga, Patanjali Ayurvedic College,Haridwar.
3
Professor, Dept. of Panchkarma, Rishikul Campus, Uttarakhand Ayurveda University,
Haridwar, UK.
4
Professor, Dept.of Sharir Rachana, J.D.Ayurvedic Medical College,Aligarh.
5
Associate Professor, Dept. of Samhita Siddhanta, Patanjali Ayurvedic College,Haridwar
6
Lecturer, Dept. of RSBK, NEIAH, Shillong.
7
Associate Professor,Department of Swasthyavritta & Yoga,NEIAH Shillong.

ABSTRACT
Article Received on
26 Jan. 2017, Alcohol is a toxin in higher Doses, it is associated with
Revised on 15 Feb. 2017,
polyunsaturated fatty acids (PUFA) induces oxidative stress &
Accepted on 08 March 2017
DOI: 10.20959/wjpps20174-8868 hepatotoxicity Alcoholic liver disease (ALD) encompasses a spectrum
of injury, ranging from simple steatosis to frank cirrhosis . A case of
Alcoholic liver disease (ALD) with portal hypertension (cryptogenic
*Corresponding Author
Dr. Vijay Kumar
cirrhosis) is discussed in this paper. The clinical picture was that boy
Associate Professor, Dept. of age 27 come to opd with yellowish discoloration of eyes, skin and
of Swasthveitta & Yoga, dark urine, generalized itching, pale stools. Reduced appetite, nausea
North Eastern Institute of and disturbed sleep accompanied by an uncomplicated cirrhotic ascites
Ayurveda &
with mild encephalopathy. Based on Ayurvedic tradition, a
Homoeopathy (NEIAH),
Shillong.
standardized treatment protocol was developed and implemented,
consisting of Nitya virechana (regular purgatives), shamanoushadhi
(palliative drugs) oral administration of single and compound herbal preparations combined
with purificatory shatkarma measures as well as dietary and lifestyle regimens. The
outcomes were assessed by measuring liver functions through specific clinical features and
laboratory parameters. The total duration of the treatment including follow-up was 30 days.
After the comprehensive Ayurvedic intervention, there was a complete remission of

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symptoms with normal hematological parameters. Hence presenting this case is an evidence
to demonstrate the effectiveness of Ayurvedic treatment in ALD.

KEYWORDS: Alcoholic liver disease, udar roga, Kamala, Nitya virechana.

INTRODUCTION
The liver is an important organ responsible for: Filtering the blood. Making bile, a substance
that helps digest fat and excrete certain fatty substances. Processing and hooking fats to
carriers (including cholesterol) and storing sugars, helping the body transport and save
energy. Making important proteins, such as most of those involved in blood clotting
Metabolizing many medications, such as barbiturates, sedatives and amphetamines Storing
iron, copper, vitamins A and D and several of the B vitamins Making important proteins like
albumin that regulate fluid transport in the blood and kidneys .Helping break down and
recycle red blood cells. Cirrhosis is a serious disease that changes the structure of the liver so
that it cannot function properly. One of the biggest problems with cirrhosis is that less blood
flows through the liver and the toxins that are normally eliminated can now poison the body.
About 20 percent of heavy drinkers eventually develop cirrhosis and alcoholic hepatitis is
often a precursor of cirrhosis. This condition can also be caused by poor nutrition (especially
too little protein), poisonous substances, or a previous viral or bacterial infection that
inflamed and weakened the liver. Alcohol destroys the cells lining in the stomach and
intestines that mediate the absorption of nutrients. Alcohol greatly increases lead absorption.
Low concentration of lead may disturb normal biochemical process in the hepato billary
system. Lead overload causes liver cells to become enlarged into hyperplasia (initiating the
formation of tumours in the liver); Liver cells die more rapidly and are replaced by fatty
deposits. Acetaldehyde, a major toxic metabolite, is one of the principal culprits mediating
fibrogenic and mutagenic effects of alcohol in the liver. Liver cirrhosis leads to depletion of
nutrients The by-products of alcohol metabolism generate oxidants that can contribute to cell
damage. An imbalance between oxidants and antioxidants (substances that neutralize
oxidation) can create oxidative stress, a state marked by continued production of oxidizing
agents and escalation of cell damage, The cumulative result is that hepatotoxicity develops,
liver becomes unable to neutralize oxidants’ scavenging capacity is lost. There is escalation
of cell damage leading to degeneration of liver cells; regenerative capacity is lost under such
critical situation. we need the drugs which have scavenging capacity to detoxify the liver,
bioavailability is high and is anti oxidant. Fatty liver develops in about 90% of individuals

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who drink more than 60 g/day of alcohol, but may also occur in individuals who drink less.
These are often grouped into three histological stages of ALD: fatty liver or simple steatosis,
alcoholic hepatitis and chronic hepatitis with hepatic fibrosis or Cirrhosis. In Ayurveda, FLD
may be understood as Yakṛt Roga (liver disease) and Medoroga (obesity). According to the
Yogratnākara, vidāhī (spicy food) and abhiṣyandī āhāra (food which blocks the channels)
leads to Rakta-kapha duṣṭi which may lead to Yakrtodara. FLD can be termed in ayurveda as
a Kaphavrita Pitta condition taking place in Liver. The concealed Pitta or fire within the
envelope of Kapha also does some pathological damage in the form of causing inflammatory
changes in the liver. The Vayu getting blocked by both Pitta and Kapha or aggravated due to
the destructive process within the liver tends to destroy the liver cells and cause fibrosis and
cirrhosis. A number of ayurvedic drugs and formulations having hepatoprotective properties.
are described in texts that have been used traditionally for the cure of hepatic disorders for
example, Bhumyamalki, Nagarmotha, Giloya, Rohitaka, Daruharidra, Kalmegha, Amaltasa,
Sanaya, Haritaki etc. These drugs have Deepana, Lekhana. Amapachana, Virechaka,
Rasayana properties by virtue of which these drugs are effective in various liver disorders.

CASE PRESENTATION
Presenting complain and history- A 27 years old, 68kg male patient, belonging to a higher
class household, suffering with ALD presented to swasthrakshan outpatient department
(OPD) for the complaints of yellowish discoloration of eyes, skin and dark urine, pale colored
stool associated with generalized itching. Reduced appetite, nausea and disturbed sleep and
altered mood. For the past 10 years, he had consumed approximately 360-540 ml of alcohol
daily. He approached a many physician with these symptoms and was diagnosed with
alcoholic hepatitis and treated with standard of care. As the complaints were not satisfactorily
reduced he opted for the Ayurvedic treatment. He was admitted for 3 weeks and discharged
with follow-up advice which included oral medicines. During the treatment and follow-ups
the patient was completely abstaining from alcohol. His OPD registration no is 14846331551
of 17/01/2017. His total serum bilirubin 5.5, direct s. bilirubin 2.4, indirect s. bilirubin 3.1,
SGOT-219, SGPT-47, serum alk. Phosphatase 606 and serum globulin 5.4. ESR 57. The
patient is a student, taking mixed diet and history of taking alcohol.

Ayurveda, from western modern medicine. Yakrt (liver) is supposed to be the seat of
Raktavaha Srotasa and Pitta is believed to be the Mala of Rakta. Hence the line of treatment
adopted for the Yakrt-Rogas comprise of the measures used for the pacification of Pitta Dosa.

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Therefore, it is evident from the treatment measures described in classical texts, the
maximum herbs are bitter (Tikta) is taste, which pacify the Pitta Dosa.

TREATMENT AND ASSESSMENT OF PROGRESS

Agnideepana (To increase digestive fire), Srotosodhaka (Channel clearance), Sodhana
(Purification) by mutrala (diuretics) and virechana (purgation), RASYANA was planned in
this case. During the treatment and follow-ups, the patient was completely on cessation of
alcohol. Throughout the treatment, the patient was advised to avoid the spicy, oily, salty food,
and advised to take excess milk as possible during Nitya virechana. Mudgayusha (gruel
prepared of green gram), Pe Peya (porridge) and Khichdi as Pathya were advised. Vegetable
prepared out of Mulaka (radish) and Kulatha (horse gram) was advised. YOGNIDRA AND
TRATAKA was added in dialy lifestyle.

TABLE NO.1 DIET CHART

Diet plan
Early
Divya peya - 1 cup
morning
Aarogya Daliya/oats - 1 bowl
Breakfast chapatti , vegetables, poha, upma
Milk -1 cup
Mid
Fruits
morning
Rice - 1 cup
Chapathi - 2 nos
Lunch
Moong Dhal - 1/2 cup
French beans Veg - 1 cup
Mid
Divya Peya - 1 cup
evening
Chapatti 2-3 nos
Vegetables 1 bowl
Dinner
Dal 1 bowl
salad
Skim milk
Bed time
with crushed garlic - 3/4 cup

Pathya apthya advice

Various Pathya aaharas for Udara roga mentioned in the Classics are peya prepared out
of shookadhanya, such as purana shali, yava or goodhooma. Shooka, which are rich in
Carbohydrates. yusha of shamidhanya diet rich in protein.. Mamsarasa can be considered as

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meat soup, consisting of Proteins and a little amount of Fat. Milk has also been used from
time immemorial as the sole food for infants and as a supplement for children and adults.[8]
Milk is almost a complete food except for deficiencies of Iron as well as Vitamins C and D. a
litre of cow’s milk provides about 35 gms of Protein, 35 gms Fat, 1 gm Calcium, 1.5mg
Riboflavin, 1500 IU of Vitamin A and substantial amounts of other Vitamins and Minerals
result in life line in nutrient deficient stage of ald. Shakha varga also benefits people
suffering from Yakrit Vihara. Green leafy vegetables are very rich in Carotene (pro. Vit. A),
they are good sources of Calcium, Riboflavin, Folic acid as well as Vitamin c.[9]

Shooka - Shali (rice), Raktha

dhanyas (monocotyledons) shali (redrice), Godhuma (wheat).
One-year-old Kulatha (horse
gram), Mudga (green gram).- Meat of
Shamidhanya (dicotylendons)
animals living in marshy areas and of
those living in
Meat of animals living in marshy
Mamsa varga
areas and of those living in water.
Milk of cow, goat, buffalo and
Ksheera varga
camel.
Urine of cow, goat, buffalo and camel
Mootra varga
are advised for conditions of Udara.
Shakha Varga Green Leafy vegetables

Apathyas
Apathyas in the context of Udara are Ambupana or toyapana (This refers to restricted fluid
intake. In the presence of hyponatremia (condition where the level of sodium is very low),
fluid restriction is necessary. Lavana Sevana - Intake of salt. Low serum sodium is common
in Hepatic Cirrhosis with ascities. Diwaswapna, Guru bhojana - Sleeping during day-time as
well as heavy food causes agnimandya. Vayayama -Exercise, walking as well as other
physical activities cause increase of Vata which again may cause obstruction to udakavaha
srotas and may lead to increase in ascitis. Vidahi - As madya or alcohol is vidahi, which is
the culprit of ALD, hence it is contraindicated.

Table 2: Treatment administere

Divya Sarvkalp Kwath
1. 60 ml BD EMPTY STOMACH
Divya Kaya-Kalpa Kvatha
Divya Pravala Pancamrta 10 GM
Divya Kasisa Bhasma 5GM 60 PUDIYA WAS MADE OF TOTAL
2. Divya Swarna Maksika Bhasma 5 GM AND 1 PUDIYA ADVICE BD BEFORE ½
Amrta / Giloy Satva 20 GM HR OF MEAL
Divya Svarna Basanta Malati 1 GM

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3. Divya Arogyavardhani Vati 2 TAB BD AFTER ½ HR OF MEAL

4. Divya Udaramrta Vati 1 TAB BD ½ HR AFTER MEAL
5. Divya Totla Kwath 60 ML BD

ASSECMENT OF TREATMENT
TABLE NO.

Before After
Test
treatment treatment
Day 0 Day 15
SerumAlkaline
606 388
Phosphatase(IU/L)
SGPT (IU/L) 47 38
SGOT (IU/L) 219 106
TotalBilirubin (mg/dL) 5.5 2.7
DirectBilirubin (mg/dL) 2.4 1.5
IndirectBilirubin(mg/dL) 3.1 1.2

DISCUSSION
Ayurveda has a unique understanding of human physiology and pathology that offers a
different perspective in diagnosis and the treatment. In Ayurveda, the condition is either said
to be as one of the Udara roga i.e Yakrittdaludara and clinically present as Jalodara and
Kumbhakamala. Alcohol causes Vitiation of Doshas and Srotosanga (Blockage of circulatory
channels). The condition is Tridoshaja, involving the all the three doshas in pathogenesis. The
Kapha dosha is responsible for Steatosis (Fatty changes) which is an important pathological
condition prior to development of cirrhosis. Further, clinical features like Ascites, Oedema
etc. are Kaphaja symptoms. Vata dosha is responsible for fibrotic changes. Shrunken liver,
genital atrophy, dyspnoea and pain are due to Vata. Vitiated Pitta dosha is responsible for
inflammatory changes and recurrent hepatitis is another important cause of liver cirrhosis.
Many important symptoms indicating the active Pitta involvement are jaundice and
hemorrhagic tendencies. Although patients living with ALD are mostly treated with strategies
to encourage abstinence from alcohol. Alcohol is a toxin in higher doses and when it is
associated with polyunsaturated fatty acids (PUFA) induces oxidative stress &
hepatotoxicity. This can be efficiently reduced by administered treatment through its
antioxidant potentials and protective action for liver cells.[10] ayurvedic tretmenytalso involve
cleansing of GI tract and rasayans herbs which has property of regeneration of liver tissues

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and cells. These therapeutic uses have now been confirmed by studies and with regards to its
liverprotective properties researchers have found that they are able to shield liver cells and
protect them against harmful toxins, trataka and yognidra decreses the sress and stablise
proper parasympathetic outflow with adequate metabolic effect.

CONCLUSION
When, body is overloaded with toxins such as alcohol or are exposed to increased levels of
heavy metals, at a certain point the protective detoxifying capacity of the liver runs out. The
healthy liver cells dysfunction or die Excessive and chronic alcohol consumption is the most
common cause of liver cirrhosis. Ayurvedic management includes detoxification of body
maintences of proper metabolism and specific herbal drug show regeneration in fatty liver.
Diet control and Yoga help in parasympathetic out flow in body which in turn regains healthy
state of patient. Thus Ayurveda provides a holistic care to alcoholic liver disese.

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