Ayurveda management against Non-Alcoholic Fatty Liver Disease: A Case Report

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[Find the meaning and references behind the names: Kumar, Prakash, Asia, Rajendra, Soni]

CASE REPORT October 2024 Journal of Ayurveda and Integrated Medical Sciences | October 2024 | Vol. 9 | Issue 10 239 Ayurveda management against Non-Alcoholic Fatty Liver Disease: A Case Report Drishti Aggarwal 1 , Rajendra Kumar Soni 2 1 Post Graduate Scholar, Post Graduate Department of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi, India. 2 Assistant Professor, Post Graduate Department of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi, India. I NTRODUCTION The prevalence of non-alcoholic fatty liver disease (NAFLD), which ranges from 11.2% to 37.2% in the general population, is rising due to an increase in obesity [1] Between 1990 and 2017, the number of cases with NAFLD worldwide grew from 19.34 million to 29.49 million. East Asia has the most burden, with South Asia, North Africa, and the Middle East that follows [2] Address for correspondence: Dr. Drishti Aggarwal Post Graduate Scholar, Post Graduate Department of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, Khera Dabar, Najafgarh, New Delhi, India. E-mail: aggarwaldrishti 96@gmail.com Submission Date: 09/09/2024 Accepted Date: 21/10/2024 Access this article online Quick Response Code Website: www.jaims.in DOI: 10.21760/jaims.9.10.39 Fatty liver disease is classified into: ▪ Non-alcoholic fatty liver disease (NAFLD) ▪ Alcoholic Liver Disease (ALD) Non-alcoholic steatohepatitis (NASH) and nonalcoholic fatty liver (NAFL) are the two different types of non-alcoholic fatty liver disease. A particular type may initially be diagnosed, followed by another. NAFL stands for non-alcoholic fatty liver with minimal to no inflammation or damage to the liver. Due to liver enlargement, this ailment may cause pain, even though it usually doesn't damage the liver. NASH A more severe kind of NAFLD is called NASH. It denotes not only excess fat but also inflammation in the liver, possibly even causing harm to the liver. This injury may result in liver scarring. If NASH is not treated, it may eventually result in cirrhosis, which can cause liver cancer if it is not addressed [3] The disease Yakritodar cited in Ayurvedic treatise has symptomatic similarity with Non-alcoholic fatty liver disease (NAFLD) with symptoms of abdominal A B S T R A C T Fatty liver disease is the accumulation of fat in the liver that can damage the organ and lead to serious health problems. It affects about one in ten people. It is normal for the liver to contain some fat. But if fat makes up more than 10 percent of the liver's weight, it means a fatty liver. This study shows the effectiveness of Ayurvedic medicine and its control measures in the management of Non-alcoholic Fatty Liver Disease, where the size of liver as 17 cm was diagnosed through ultrasonography. A 36-year-old patient presented to the OPD of Department of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi with complaints of alteration in bowel habit, pain in abdomen and recurrent fever in the last one year. This case was diagnosed as Nonalcoholic Fatty Liver Disease on the basis of ultrasonography (USG) report. The patient was treated with Ayurvedic oral drugs and got satisfactory results. Satisfactory results were noted at the follow up after 2 months. This study bear out that fatty liver disease can be successfully reversed with Ayurvedic treatment. Key words: Bhumyamalaki, Ayurveda, Aarogyavardhini Vati, Non-Alcoholic Fatty Liver Disease.

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[Find the meaning and references behind the names: June, Vega, Mala, April, Sama]

Drishti Aggarwal et al. Ayurveda management against Non-Alcoholic Fatty Liver Disease ISSN: 2456-3110 CASE REPORT October 2024 Journal of Ayurveda and Integrated Medical Sciences | October 2024 | Vol. 9 | Issue 10 240 discomfort, loss of appetite etc. while symptoms of Yakritodar includes Manda Jwara, Agnimandya etc. Here is a case report where we treated a patient of (NAFLD). The patient sought Ayurvedic treatment for the same and internal medicine was provided to the patient. A IM AND O BJECTIVE To assess the efficacy of Ayurvedic intervention in the management of Yakritodar w.s.r. to Non-Alcoholic Fatty Liver Disease. M ATERIALS AND M ETHODS A Single Case Study. Patient Information A 36-year-old, female patient visited the OPD of Dept. of Kayachikitsa, Ch. Brahm Prakash Ayurved Charak Sansthan, New Delhi, on 8 April 2022 (I.D. no. 18888) with the complaint of alteration in bowel habit, pain in abdomen with recurrent fever. The patient had this pain for one year. Initially, the patient had fever and alteration in bowel habits which affected her daily activities. With these complaints she went for an USG in which impression of Grade II fatty liver was detected. So, patient consulted at institute OPD for Ayurvedic care for her ailment. Clinical Findings The patient took medication on OPD basis. The general condition of the patient was normal, moderate appetite, and tongue appeared coated. The blood pressure was 110/70 mm Hg, Pulse rate was 78 per minute, and was full in volume and regular. The patient had no significant past medical history as well as surgical and accidental history. None of the family members had any disease related with her disease. The patient was well oriented to time, date, and place. There was alteration in bowel habit but no difficulty in micturition. The body temperature was normal. No abnormal clinical finding for cardiovascular and respiratory systems were observed on examination. Her abdomen was distended due to fat and was normally moving with respiration. On palpation, no tenderness was found. Dull sounds were recorded during the percussion on the right lumbar region, and Bowel sounds were normal on auscultation. She was presently not on any medication while the Ayurvedic intervention was ongoing. She was very calm and supportive during the treatment. Ashta Vidha Pariksha Nadi - 78 beats per minute Mala - Altered bowel habit with Sama Mala Mutra - 2-3 times a day, normal colour Jihwa - Coated Drika - Normal Sparsha - Sama Sheetoshna (Normal) Aakriti - Sthoola (Obese) Shabda - Spashta (Clear) Samprapti Hetu/ Nidana Sevana in the form of Vidahi, Tikshna, Ushna Aahar, Chinta, Vega Dharana etc. causes aggravation of Pitta and Rakta , which leads to Agnimandya and furthermore vitiation of Pitta , Rakta and Kapha . Now, all of the above process leads to Vikrit Meda Sanchaya (accumulation of vitiated Meda Dhatu ) either directly or through Tiryak Gati of Ambu and Sweda (caused by Annavaha and Swedavaha Sroto Avarodh ). All of the above process finally leads to Yakrit Shoth and hence, Yakritodara. Timeline of Case: is presented in Table no.1 as following: Table 1: Timeline Date Clinical events/ Investigation Intervention June 2022 First episode of recurrent alteration in bowel habit. Home remedies and Antibiotics

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[Find the meaning and references behind the names: Bala, Sara, Shakti]

Drishti Aggarwal et al. Ayurveda management against Non-Alcoholic Fatty Liver Disease ISSN: 2456-3110 CASE REPORT October 2024 Journal of Ayurveda and Integrated Medical Sciences | October 2024 | Vol. 9 | Issue 10 241 Accompanied with Fever and pain in abdomen. August 2022 Further increase in alteration of bowel habit accompanied with fever. Pain in abdomen. USG Whole Abdomen: Figure-1 Mild hepatomegaly with fatty liver G-II with size of liver equal to 17 cm (June 27, 2022) Weight - 80 Kg 1) Tab. Bhumyamalaki 2 BD 2) Arogya Vardhini Vati 2 BD 3) Ark Ajwain 2 tsf BD 4) Punarnavadi Mandoor 2 BD September 2022- November 2022 Follow up -1 Improvement in above complaints. Reduction in body weight (Wt. -70 Kg) Tab. Bhumyamalaki 2 BD Arogya Vardhini Vati 2 BD Giloy ghan Vati 2 BD Punarnavasava 3 tsf BD with equal amount of water. December 2022- March 2023 Follow up -2 Improvement in above complaints. USG Whole abdomen was advised. Tab. Bhumyamalaki 2 BD Giloy Ghan Vati 2 BD Punarnavasava 3 tsf BD with equal amount of water Lashunadi Vati 2 BD April 2023 Follow up -3 No alteration of bowel habits and Fever. No associated complaint. USG Whole Abdomen: Figure 2 Fatty liver G-I with size of liver equal to 13.5 cm (April 10, 2023). Aarogya Vardhini Vati 2 BD Figure 1: Before Treatment Figure 2: After Treatment Dashvidha Pariksha (tenfold examination of patient) was done for patient assessment. The patient has: Vata-Kaphaja in Prakriti, Vikriti Pitta - Kaphaja, Vishama Pramana (anthropometry) , Madhyama Sara, Madhyam Satva, Madhyam Satmya, Avara Aahar Shakti, Madhyam Vaya, Avara Vyayam Shakti , and Avara Bala (strength).

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[Find the meaning and references behind the names: Deep, Medo, Bright]

Drishti Aggarwal et al. Ayurveda management against Non-Alcoholic Fatty Liver Disease ISSN: 2456-3110 CASE REPORT October 2024 Journal of Ayurveda and Integrated Medical Sciences | October 2024 | Vol. 9 | Issue 10 242 Diagnostic Assessment The diagnosis was done based on symptoms and USG findings. In Ayurveda , this condition resembles Yakritodara . In USG findings, Liver measured 17 cm in size, normal in outline, bright and altered echotexture. In overall impression USG showed Fatty Liver Grade II. There were no signs of fluid accumulation, abnormal pattern of blood flow, sustained increase in temperature or formation of cyst. So, these things were excluded from the differential diagnosis. Intervention The patient was given Ayurvedic medication for 9 months with intermittent stoppage. All the interventions are already presented above. Pathya (wholesome) and Apathya (unwholesome) guidelines mentioned below were followed during the treatment and the follow-up. Pathya: Plant based diet which is rich in Fruits, vegetables, whole gram and healthy fat. Maintain a healthy weight, Exercise most of the days of week. Apathya: Oil fried food, Deep fried items like Sweets, Fries. Bakery items, non-vegetarian diet, Cold drinks [4] Milk, milk products, rice items Follow Up and Outcomes The patient was observed for improvement in symptoms related to Yakritodar Roga and Medo Roga on the four-point grading system (none, mild, moderate, and severe). The changes observed in subjective criteria are depicted in the Table no.2 below. Her condition was satisfactorily stable during the follow-up period of 2 months. Parameter Month 1 Month 4 Month 9 Yakritodar Roga related signs and symptoms Udarshoola (pain in the abdomen) Mild None None Sama Purisha Severe Mild None Jwara (Fever) Mild Mild None Aruchi (loss of appetite) Mild Mild None Height, weight, and BMI Height (cm) 162 162 162 Weight (kg) 80 70 70 Body Mass Index (BMI) 30.5 26.7 26.7 Obesity-related signs and symptoms Ayusho Hrasa (deficient in longevity) Moderate Mild None Javoparadha (Slow in movement) Moderate Mild None Krichchavyavaya (difficult to indulge in sexual intercourse) Moderate Mild None Daurbalyam (weak) Moderate Mild None Daurgandhya (Bad smell) Severe Moderate None Swedabadha (much sweating) Severe Moderate None Ati Kshudha (excessive hunger) Severe Moderate None Ati Pipasa (excessive thirst) Severe Moderate None DISCUSSION The medical profession routinely addresses individuals that have fatty liver. While the majority of incidents do not have significant symptoms, but some may develop towards fibrosis, steatosis, and steatohepatitis.

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[Find the meaning and references behind the names: Zhang, Liu, Benedict, Vargas, Colon, Main, Rasa, Market]

Drishti Aggarwal et al. Ayurveda management against Non-Alcoholic Fatty Liver Disease ISSN: 2456-3110 CASE REPORT October 2024 Journal of Ayurveda and Integrated Medical Sciences | October 2024 | Vol. 9 | Issue 10 243 Hepatocellular carcinoma may arise in certain contexts. The most frequent cause of liver dysfunction is fatty liver, and fewer cases of non-alcoholic fatty liver disease (NAFLD) appear to progress to chronic liver disease compared to alcoholic fatty liver. In this study, we predominantly used Bhumyamalaki, Arogyavardhini Vati, Punarnavasava, and Samshamani Vati to treat a non-alcoholic patient with grade II fatty liver. Their probable mechanism of action is outlined below. Bhumyamalaki (Phyllanthus niruri ) , is Pitta- Kaphahara, Ruchya and Mutrala with Madhura-Tikta- Kashaya in Rasa, Madhura Vipaka and Sheeta Virya [5] Phyllanthus niruri's antioxidant and hepatoprotective properties may be attributed to the abundance of antioxidative flavonoids, tannins, lignans and terpenes found in the plant [6] It contains active ingredients like phyllanthin and andrographolide, which help reduce bilirubin levels. Presumably, P. niruri contains bioagents that stop excessive superoxide synthesis and inhibit lipid peroxidation as a result of chronic hyperglycaemia. Therefore, P. niruri may lessen abnormalities in lipoprotein metabolism, lower cholesterolphospholipid ratios, regulate damage to biomembranes, and lower lipid peroxidation linked to reactive oxygen species. Additionally, aqueous extracts are superior to methanolic preparations in terms of their ability to normalize ALT levels. Arogyavardhini Vati is mentioned in Rasaratna Samucchaya under Kushtha Visarpa Rogaadhikara. It alleviate all types of Kushtha (skin disorders) and is Tridoshaj Jvara Nashaka Katuki (Picorrhiza kurroa) , being one of the main ingredients of the Arogyavardhini Vati has also been studied to assess its effect in liver disorders. Katuki is bitter in taste, cooling, removes excessive Pitta from the body via colon and helps in restoration of Liver functions by overcoming fatty liver changes [7] Punarnavasava is mentioned in Bhaishajya Ratnavali under Shotha Rogadhikara. Main ingredient is Punarnava (Boerhaavia diffusa ). As the name suggests Punarnava (Punah + Nava ). Punah means - once again, Nava means becoming new. It is Mootrala (diuretic), Sothaghna (Anti-inflammatory), Kasahara (Antitussive), Jwarahara (antipyretic), Rasayana (rejuvenator). Numerous reports have supported its protective activity on liver diseases [8] Samshamani Vati is mentioned in A.F.I (Ayurvedic Formulary of India), Part II. Main Ingredient is Guduchi (Tinospora cordifolia). It has hepatoprotective effect due to its rejuvenation property. It also works as strength giving and appetizer [9] Guduchi can be administered as a single agent and is a component in more than a third of hepatoprotective formulas available on the Indian market [10] CONCLUSION The rate at which non-alcoholic fatty liver disease is affecting society’s productive population is concerning. We can infer from the findings that the Ayurvedic treatments employed in this instance have a noteworthy impact on managing non-alcoholic fatty liver disease. The outcomes in this instance are promising and more carefully planned clinical trial could be conducted to see if these interventions work well under comparable circumstances. Declaration of Patient Consent Authors certify that they have obtained patient consent form, where the patient has given her consent for reporting the case and other clinical information. REFERENCES 1 Benedict M, Zhang X. Nonalcoholic fatty liver disease: an expanded review. World J Hepatol 2017;9(16):715 e 32. 2 Zhang X, Wu M, Liu Z, Yuan H, Wu X, Shi T, et al. Increasing prevalence of NAFLD/NASH among children, adolescents and young adults from 1990 to 2017: a population-based observational study. BMJ Open 2021;11(5): e 042843. 3 Pouwels, S., Sakran, N., Graham, Y. et al. Non-alcoholic fatty liver disease (NAFLD): a review of pathophysiology, clinical management and effects of weight loss. BMC Endocr Disord 22, 63 (2022). 4 El Mahātēva n , Dr. L. Mahadevan’s Principles & Practice of Ayurvedic Clinical Medicine, Sarada Mahadeva Iyer Ayurvedic Educational & Charitable Trust,2021, pg 171. 5 Bhav Prakash Nighantu, Guduchyadi Vargas, Shloka No: 278,8 th Edition.

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[Find the meaning and references behind the names: Sitaram, Mahesh, Narendra, Vishwanath, Nil, Rao, Med, Naik]

Drishti Aggarwal et al. Ayurveda management against Non-Alcoholic Fatty Liver Disease ISSN: 2456-3110 CASE REPORT October 2024 Journal of Ayurveda and Integrated Medical Sciences | October 2024 | Vol. 9 | Issue 10 244 6 K. Narendra et al. / Journal of Pharmacy Research 2012,5(9),4681-4691 7 Dasi Padmaja, T Maheshwar, D Anuradha, ChVS Koteswara Rao. Review article; Arogyavardhini Vati - a boon for liver disorders from Ayurveda (Fatty Liver). AYUSHDHARA, 2021;8(4):3418-3425. 8 Santhosha DU, Manasa R, Vishwanath S, Shekhara Naik R, Mahesh MS 1. Review article; Hepatoprotective activity of Boerhaavia diffusa L. IP Journal of Nutrition, Metabolism and Health Science 2020;3(4):109 – 113. 9 Sitaram Bulusu, Bhavprakash of Bhavmishra, published by Chowkhamba Orientalia, Varanasi, first edition, 2006; 229. 10 A.S. Pleehaakushtharog Chikitsa (15 th ed.), Bhaishajyaratnavali 14/1214, 542, Chaukhamba Sanskrit Sansthan, Varanasi, India (2002), pp. 12-14. ******************************* How to cite this article: Drishti Aggarwal, Rajendra Kumar Soni. Ayurveda management against Non- Alcoholic Fatty Liver Disease: A Case Report. J Ayurveda Integr Med Sci 2024;10:239-244. http://dx.doi.org/10.21760/jaims.9.10.39 Source of Support: Nil, Conflict of Interest: None declared. Copyright © 2024 The Author(s); Published by Maharshi Charaka Ayurveda Organization, Vijayapur (Regd). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc-sa/4.0), which permits unrestricted use, distribution, and perform the work and make derivative works based on it only for non-commercial purposes, provided the original work is properly cited

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