I am Dr. Vikram Chauhan, MD – (Ayurveda) from India and practicing in Chandigarh from last 20 years. I strongly believe that nature has given us immense healing power. I am running my own Ayurveda healing center & website WWW.PLANETAYURVEDA.COM & WWW.ALWAYSAYURVEDA.COM The Clinic Location is - Plot No. 627, JLPL Indl. Area, Sec.82, Mohali - 160055, Punjab INDIA (Near Chandigarh). E-mail – support@planetayurveda.com or Call for appointments at +91-172-521-4040
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Dr. Vikram Chauhan - MD (Ayurveda)
Showing posts with label Liver cirrhosis. Show all posts
Showing posts with label Liver cirrhosis. Show all posts
Liver is one of the most important organ of body as it plays crucial functions in our body such as production of bile for fat breakdown and to carry away waste during digestion, controls blood sugar levels, production of protein and enzymes, metabolism, detoxification, storage of iron, vitamins, hormone regulation, regeneration and helps to control immune responses. Due to unhealthy diet and lifestyle, functions of the liver get disturbed which can cause a serious condition called liver cirrhosis. Fortunately, studies found out that Ayurveda has the potential to treat such conditions.
INTRODUCTION
Liver being a multitasker, has to perform various functions which are significant for our body. Any kind of damage or problems in the liver can disturb the body functions, therefore it becomes a necessity to keep it healthy and fit. But many unhealthy habits like unhealthy eating, lifestyle, alcohol intake, medications, diseases etc can cause damage to the liver which leads to liver cirrhosis. Liver cirrhosis is a chronic condition which is caused by the replacement of normal liver tissues with fibrous scar tissues, resulting in malfunctioning and deterioration of the liver. Although the liver has the ability to regenerate most of the damaged cells, but, with the end stage of cirrhosis, the liver loses its ability to replace the damaged cells which results in formation of blocks that hamper the flow of blood through the liver.
Liver cirrhosis impairs numerous other functions such as:
Infection control
Removal of toxins and bacteria from the blood
Process drugs, nutrients and hormones
Production of proteins which regulates blood clotting
Production of bile that metabolises fats, cholesterol and fat soluble vitamins
CAUSES OF LIVER CIRRHOSIS
There are many factors that leads to Liver cirrhosis such as:
Excessive Alcohol consumption
Viral infections such has hepatitis B,C virus or parasitic infection
Autoimmune disorders
Obesity
Diabetes
Prolonged use of steroids
Exposure and accumulation of toxic chemicals and fats
Protein deficiency
Coronary artery disease
Unhealthy diet and sedentary lifestyle
Genetic metabolism or digestive disorder
Wilson’s disease (condition caused due to accumulation of copper in the liver)
SYMPTOMS OF LIVER CIRRHOSIS
Most people do not develop any specific symptoms at initial stages in fact there were usually no signs till extreme damage. However as disease progress one may observe the following symptoms :
Fever
Loss of appetite
Fatigue, vomiting, bloating, nausea
Unexplained weight gain or weight loss
Itchy skin with bruises
Yellowing of skin and eyes (Jaundice)
Swelling due to fluid retention in different body parts such as ankles, legs and abdomen.
Abdominal pain
Blood in stool
Portal hypertension
Immune system dysfunction
Sensitivity to medications
DIAGNOSIS OF LIVER CIRRHOSIS
It can be diagnosed by using combinations of methods such as :
Abdominal Computed Tomography (CT) scan to determine the severity of cirrhosis as well as other liver disease.
Abdominal Ultrasound to create pictures of the internal abdomen including liver.
Elastography to examine the stiffness of liver.
Body magnetic resonance imaging (MRI) to evaluate the damage caused by liver disease.
Magnetic resonance cholangiopancreatography (MCRP) to evaluate parts of liver and gallbladder.
Biopsy to analyse extent of liver damage.
Liver Function Test to analyse presence of particular enzymes
TREATMENT FOR LIVER CIRRHOSIS
In modern medicine there is no permanent solution of Liver cirrhosis. Still the treatments that will be prescribed by Allopathic doctors may include any or combination of the following.
Immunosuppressive medications like corticosteroids can be prescribed.
Diuretics will be given or other medication.
Liver transplant might be considered if other treatments are not effective.
But these allopathic treatments can lead to adverse effects, when dealing with medications and intervention such as
Immunosuppressants can increase the risk of infections, osteoporosis, weight gain, hypertension.
Diuretics can cause dehydration, electrolyte imbalance and kidney dysfunction. These medications can cause nausea, fatigue, liver toxicity or resistance.
Liver transplantation is not actually a solution rather a bigger problem as the body may reject the transplanted liver. Also increase susceptibility to infections and could lead to complications like blood clots, bile duct issues, graft versus host diseases.
Due to the chances of all these adverse effects on a patient's body, it is better to go for Ayurveda, a traditional Indian medicine system that offers a holistic approach to treat liver cirrhosis.
TREATMENT IN AYURVEDA
Liver cirrhosis treatment in ayurveda is often helpful in preventing and managing complications like. It is one of the best ways to rectify damage in the liver due to scarring. Ayurveda has the capacity to heal every damaged cell in the body. There are herbs and remedies that can treat liver cirrhosis naturally and effectively. Most of the liver disorders are the result of aggravation of pitta dosha. Liver cirrhosis is called Kumbha Kamala, in ayurveda, which is caused because of excessive load on the liver, which becomes chronic and leads to roughness of liver.
HERBAL REMEDIES BY PLANET AYURVEDA FOR LIVER CIRRHOSIS
Liver cirrhosis is a condition that can impact a person's Quality of life. Planet Ayurveda is the most trusted and renowned name in the field of Ayurvedic clinic for Liver Cirrhosis treatment. Their very first objective is to address the underlying cause of the condition and to manage symptoms and complications by balancing the body doshas and other essential elements. They aim to improve liver function, reduce inflammation and overall health of Liver. The treatment includes a combination of herbal remedies, dietary changes and lifestyle modifications to maintain total health and well being. LIVER CARE PACK is a well known combination of herbal formulations designed by Planet Ayurveda that will help in the treatment of Liver Cirrhosis. This pack consists of Yakrit Plihantak Churna, Phyllanthus Niruri, Echinacea Capsules, Liver Detox Capsules.
PRODUCTS LIST
Yakrit Plihantak Churna
Phyllanthus Niruri
Indian Echinacea
Liver Detox Formula
PRODUCTS DESCRIPTION
1. Yakrit Plihantak Churna
This Churna is herbal formula designed to support liver and spleen health. It is made from the combination of potent Ayurvedic herbs such as Kalmegh (Andrographis paniculata), Kaasni (Cichorium intybus) along with other herbs that made it a potent formulation in the treatment of Liver cirrhosis. These herbs are known for their liver detoxifying, anti-inflammatory and antioxidant properties. It is used to manage liver cirrhosis in combination with other formulations.
Dosage - It is powdered form and can be taken at a dosage of 1-2 tsp twice a day with water after meals.
2. Phyllanthus Niruri
These capsules are made from standardized extract of bhumi amla (Phyllanthus Niruri). This Herb is widely recognised in Ayurveda for its Liver Supportive and detoxifying properties. In the treatment of Liver cirrhosis it helps by promoting liver regeneration, reducing inflammation and protecting Liver cells from further damage. It has hepatoprotective effects which can help reduce the fibrosis and scarring associated with cirrhosis. It also enhances liver function and overall detoxification as it is rich in antioxidants and anti-inflammatory properties.
Dosage - It is in capsule form and can be taken at a dosage of 2 capsules twice daily with warm water, 30 mins after meals.
3. Indian Echinacea
These capsules are made from standardized extract of Kalmegh (Andrographis paniculata), known for its immune-boosting, anti-inflammatory and antioxidant properties. These capsules help in supporting the immune system, reduce liver inflammation and provide antioxidant effects to combat oxidative stress. It also helps in detoxifying the Liver. Along with other herbal formulations it is very beneficial in the treatment of Liver cirrhosis.
Dosage - It is in capsule form and can be taken at a dosage of 2 capsules twice daily with warm water, 30 mins after meals.
4. Liver Detox Formula
These capsules are formulated by potent herbs like Kalmegh (Andrographis paniculata), Haritaki (Terminalia chebula), Himsra (Capparis spinosa), Jhavuka (Tamarix gallica) and many more. These herbs are known for their liver- protective, anti-inflammatory and detoxifying properties. These capsules are designed by Planet Ayurveda to support Liver health. They help in promoting Liver Regeneration, reducing Inflammation, supporting Detoxification and improving liver enzymes which are often elevated in liver cirrhosis.
Dosage - It is in capsule form and can be taken at a dosage of 2 capsules twice daily with warm water, 30 mins after meals.
Holistic healing of Planet Ayurveda through herbs in the form of herbal supplements, wellness products and personalised consultations make it stand on the top among all Ayurvedic clinics for Liver Cirrhosis Treatment.
Dr. Vikram Chauhan started this company with an interest and passion to serve humanity. To heal them from the chronic disease through ayurveda. Their 100% pure and herbal product formulations and standardised extracts of herbs make them loved all over the globe for its quality and effectiveness. Their vision is to spread 5000 years of ancient knowledge of Ayurveda all over the world to spread awareness about how to live a healthier life.
WHY CHOOSE PLANET AYURVEDA?
The reason why Planet Ayurveda is considered as the best ayurvedic clinic for liver cirrhosis treatment :
Credentials and Experience: Along with Dr. Vikram and Dr. Meenakshi, The clinic has experienced team doctors/Ayurvedic practitioners with a good track record in treating all types of liver conditions, including liver cirrhosis.
Patient Reviews and Testimonials: The reviews and the testimonials from the patients to gauge the clinic's effectiveness and reliability is really enough to identify the reason why it is considered as the best Ayurvedic clinic for liver cirrhosis treatment.
Comprehensive Treatment Plans: Planet Ayurveda offers a holistic approach, including dietary recommendations, lifestyle changes, along with herbal treatments, so that you can live a healthy and a better life as these are crucial for overall well being.
Consultation and Follow-Up: Clinic provides thorough consultations and follow-up care to monitor progress and adjust treatments as needed to ensure continuous improvement in patients health.
Emphasis on Quality and Safety: Planet Ayurveda is committed to the quality and safety of their treatments. They use high quality, natural herbs and formulations that adhere to strict standards. Each remedy is prepared with intensive care to ensure its efficacy and safety.
Patient-Centred Approach: Planet Ayurveda prioritises patient education and involvement. The practitioners take the time to explain the treatment process, answer their questions, and provide guidance on lifestyle changes. This patient-centred approach helps in empowering individuals to take an active role in their health and recovery.
Summary
Ayurvedic treatment is a valuable part of a care plan for liver cirrhosis, particularly in supporting overall well-being and addressing specific symptoms of the liver. Planet Ayurveda is indeed a well-known clinic specialising in Ayurvedic treatments and offer a unique holistic approach to manage liver health and conditions for liver conditions like cirrhosis. They offer a range of herbal and natural treatments aimed at supporting liver health. The certification from different reputed authorities like ISO, GMP, certificate which is valid even in EU, HACCP, US FDA, USDA and many more make it the most reliable and authentic brand for Ayurvedic consultations and treatments. It's crucial to consult with a healthcare professional before starting any new treatment regimen.
Liver cirrhosis with ascites is a challenging medical condition. Ayurveda Clinical experiences suggest of a favourable role but lacks evidence. In a Retrospective cohort study, hospital records of patients with liver cirrhosis and ascites diagnosed though medical ultrasonography, treated at in patient division, department of Kayachikitsa, Medical Research Facility of KLE Ayurveda Hospital Belagavi were screened. Records with Nityavirechana procedure, minimum of 7 days of admission, proper documentation and meeting the other inclusion and exclusion criteria were selected for the study. Assessment were abdominal girth measurements at umbilicus, Xiphisternum to umbilicus measurement, Umbilicus to pubic symphysis measurement, weight, clinical global impression (CGI) scales (Severity, improvement and efficacy index), hemoglobin, liver function tests, Prothrombin time, INR and renal function tests. Fifty five case records met the methodological criteria of the study. Patients were suffering from stage 3, decompensated cirrhosis and Child-Turcotte-Pugh Score was in class C. Analysis of 15 days of interventions was carried out. Assessments were carried out at base line, 7th, 9th, 11th and 15th day of treatment. Interventions included nitya virechana, oral medicaments, diet, salt and fluid restrictions. Ayurveda interventions resulted in significant improvement (p<0.001) at all time points in various parameters of abdominal measurements, weight, CGI scales, hemoglobin, liver function tests, prothrombin time, INR and renal function tests. Study showed complex Ayurveda interventions through nitya virechana, oral medications, diet, fluid and salt restrictions improve the clinical profile, liver function, renal function, prothrombin time, INR parameters in patients of ascites with decompensated cirrhosis and warrants further studies.
Introduction
Liver cirrhosis is the end stage of many chronic liver diseases. It has compensatory and decompensatory phases. Compensated phase lasts for several years . Decompensated cirrhosis leads to major complications including jaundice, variceal hemorrhage, ascites, or encephalopathy . Ascites is the most common presentation. 50% of compensated cirrhosis develops ascites in 10 years of time Ascites treatment requires hospitalization, can lead to life threatening complications and need liver transplantation. The development of ascites marks the onset of worsened prognosis and increased mortality. Cirrhosis within first year of diagnosis causes death in 15% and 40% will die in first 60 months . 10 yrs mortality is 34–66% . Alcohol consumption, viral hepatitis B & C, metabolic syndrome related to obesity are the most common causes of cirrhosis. Liver cirrhosis is responsible for 1,70,000 deaths yearly in Europe . Liver diseases frequency is increasing and huge increase in the liver disease burden is expected. Health care costs of liver cirrhosis in United states is between 12 and 23 billion dollars annually . Hepatic cirrhosis incidence in India could be high due to high prevalence of Hepatitis B & C, fatty liver disease and even increasing trends of alcohol intake. Cost of hepatic cirrhosis on quality of life, loss of productivity, medical expenses are high . Treatments to stop progression from compensated to decompensated stage are being tried . Liver transplantation is the only treatment in the end stage liver disease. Liver transplantation has high costs, high mortality and has paucity of organ donors.
In Ayurveda Ascites can be correlated to Jalodara. All Udara diseases (morbid abdominal disorder) ends up into Jalodara stage . Ayurveda management protocol mainly aims in improving the Jatharagni (metabolism) and stimulating the hepatic function. Jalodara management includes nitya virechana (C.Chi.13.61), teekshna (strong, penetrating) drugs, kshara (alkali), gomutra (Cow's urine), fluid restriction, milk, buttermilk, diet, oral medicaments and rasayana (rejuvenative) drugs etc (C.Chi.13). Nitya virechana is a variant of virechana procedure in which preoperative procedures like snehapana (Internal oleation therapy), swedana (sudation therapy) are not carried out. Virechana is done in lesser intensity and more frequency. However there is scarcity in evidences of Ayurveda management of liver cirrhosis with ascites. A retrospective study in which case records of a tertiary care Ayurveda teaching hospital known for successful management liver cirrhosis with ascites were reviewed. Attempt was made to analyze the hospital data, treatment algorhythms, details of virechana procedure, prescription patterns, dietary considerations, clinical outcomes and biological assessments.
Materials & Methods
1. Settings
Setting of the current study was a 300 bed tertiary care KLE Ayurveda hospital, Belagavi situated in North Karnataka, India. Hospital caters to 7.38 lakhs of urban population directly and also to patients of 10 districts of Karnataka and Maharashtra.
2. Patient cohort
All patients receiving care for liver cirrhosis with ascites were included. Cases were identified retrospectively by evaluating manually and/or computer searches of hospital and laboratory databases from 2014 to 31 October 2020. Searches were carried out on specific terms like Kamala, Udara, Jalodara, Alcoholic liver disease, Cirrhosis and Ascites. Sonologically confirmed case of liver cirrhosis with ascites and records of patients treated in patient section, department of Kayachikitsa for a minimum of 7 days were included.
Initial screening revealed 255 case records. Cases with adequate recording of abdominal measurements, interventions (with virechana), vitals monitoring, observations etc. were included. Patients with concomitant illness like diabetes mellitus, hypertension, cardiovascular disorders were excluded (n = 65). Institutional ethics committee approval was obtained for the study.
(Reference no BMK/20/BRT/01 dated 25.11.2020)
3. Clinical and demographic data
Details of Socio demographic information along with the detailed case history, treatment history, habits, systemic and abdominal examinations, investigations, treatments administered, day to day observations, vitals examination, fluid input and output charts and adequate clinical notes were noted. Assessments noted were.
Abdominal measurements at umbilicus, 1 inch above and below the umbilicus, Xiphi sternum to umbilicus and umbilicus to pubic symphysis.
Body Weight
Blood parameters including haemoglobin, total bilirubin, indirect bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total protein, albumin, globulin, Albumin globulin (AG) ratio, alkaline phosphatase, prothrombin time & INR (International normalized ratio), serum creatinine and blood urea.
Clinical global impression scale (CGI) (Severity, improvement, efficacy index)
4. Ayurveda management details
In all patients Nitya virechan (Daily therapeutic purgation) was planned as it is the prime Ayurvedic intervention in ascites. Other oral medications used were mild purgative, diuretic, blood purifier and hepatoprotective. These includes herbo-mineral formulations, decoctions, water extracts of herbs, diet and life style management. Virechana dosage was planned to obtain avara shuddhi of (3–6 vega) and for Sroto and purisha shodhana (cleansing). On starting days (1–3 days) only purisha shuddhi and later (>4 days) samyak virechan laxanas were observed. Shodhan of purisha, pitta and kapha was noticed and vata antiki was seen. After virechan, assessment was done on the basis of symptoms like hridaya shuddhi (feeling of clearness in chest), clarity in mind, senses and intellect, laghutva (body lightness), increase in thirst and appetite. Pattern of increment was decided by number of vega produced due to virechana. Dose producing 3–6 vega (purgation) with no signs of vata vruddhi, debility, dehydrative symptoms was retained for the next day. During the course, virechan dose was increased whenever there was decrease in virechan vega less than 3. Virechan dosage was decreased if patients develops more than 6 vega, weakness, vata vruddhi. As the virechan days increased, virechan effect was decreased and to retain shodhan effect dose escalations were done. Data showed, 8 patients had abdominal pain after continuous haritaki churna intervention for 3-4 days, hence one day rest was advised and again virechan was initiated by assessing the roga bala etc. factors. Average number of nitya virechan was 10.47 in patients with 15 days of hospital stay. Oral medications were administered post lunch and dinner. [Table 4]
In Ascites diet plays an important role and diet restrictions were advised. Fluid restriction was up to 1.5 L per day. It included 500 ml milk per day, boiled rice water ad linitum, green gram soup measures 100 ml twice a day and medicinal decoctions and juices which was approximately 20–100 ml twice a day. Complete salt restricted diet was administered. Post Nitya virechana (purgation) diet was Peya (boiled rice water) during day time and at night Khichadi (Dish of rice and legumes) was prescribed in all patients. In 23.63% of patients white part of one whole egg twice a day was prescribed as per serum albumin results. Slow walking was advised not producing exertion or vata vruddhi. Patients were advised to maintain psychologically relaxed state by do deep breathing exercise, music etc.
Conventional medication (diuretics- Spironolactone and furosemide) was continued in the initial days. Tapering and discontinuation was advised based on reduction of pedal edema, abdominal girth and increased urine out put. Tapering was observed in 96.3% of patients and it was discontinued in 80% of patients.
5. Statistical methods
Statistical analysis was carried using IBM SPSS version 25 (IBM Corporation, Chicago, Illinois, United States). Descriptive data is expressed in mean, standard deviation and percentages. Pre and post assessment was done with paired sample t test. Values are reported as mean ± standard deviation. All tests were considered statistically significant at p<0.05
Results
Total records extracted during the period of 7 years 10 months were 255. Two hundred records had incomplete documentation, lack of/vague/incomplete documentation of laboratory and sonological reports at the time of admission and discharge, lack of abdominal girth measurements, inadequate documentation of intervention, inadequate documentation of observations on day to day basis etc. 55 patient's data met the inclusion criteria. Virechana was the first preferred panchakarma procedure in patients fit for shodhan procedures. Treatments were planned according to roga, rogi bala (strength of disease and patient) and special precautions were taken to prevent increase of vata and decrease of patient's strength. Hence patients did not suffer from any dehydration symptoms and had no disturbance to their daily functioning. Most of the patients had laboratory and sonological data at baseline but data at the end of treatment were limited. This could be due to satisfactry clinical improvements, leading to treatment discontinuation to avoid financial burden to patients by physicians, reluctance by patients to repeat the investigations, and even due to poorer economic conditions of the patients. In many records clinical improvements could not be substantiated with sonological and blood parameter changes and remains major lacuna in creating evidences. [Fig. 1 ]
1. Patient characteristics
Patients characteristics: mean age (47 years), mean duration of the illness (3.5 months), male (94.5 %), and females (5.4 %), mean weight (64 kilograms). Alcohol history was found in all male patients. Mean abdominal girth at 1 inch above umbilicus was 91.9 cms, at umbilicus was 91.9 cms, and mean abdominal girth below 1 inch of umbilicus was 89.9 cms. Mean measurement from Xiphi sternum to umbilicus was 22.6 cms and mean umbilicus to pubic symphysis measurement was 14.8 centimeters. Mean clinical global impression scale - severity was 5.5. Mean duration of hospital stay was 13.2 days. Number of case records with 7 days admission were 5, with 9 days stay were 9, 11 days admission was 1 and 15 days admission were 40.
All patients were sonologically diagnosed with ascites due to liver cirrhosis. Ascites fluid was mild to moderate. Alcoholic liver disease (ALD) was in 94% and Non ALD was in 5.4%. Mean alcohol history in patients were 8 years. Hospital records did not show patients with any serious complications such as hepatic encephalopathy, gastro intestinal bleeding, hepato renal syndrome etc. at the time of admission and even during the course of intervention. Other baseline characterestics were mean systolic blood pressure (129 mm of Hg), mean diastolic blood pressure (78 mm of Hg), and mean pulse rate (76 beats per minute) were in normative limits.
In blood variables at baseline (n = 55) mean hemoglobin was 9.77 gm %. Mean erythrocyte sedimentation rate (ESR) was 59.41 mm in 1st hour, mean total bilirubin was 5.29 mg/dl, mean direct bilirubin 2.28 mg/dl and mean indirect bilirubin was 3.0 mg/dl mean AST was 89.76 and mean ALT was 45.61 mg/dl. Mean total protein was 6.19 mg/dl, mean serum albumin was 2.57 mg/dl, mean globulin was 3.49 mg/dl and mean A/G ratio was 0.75. Mean alkaline phosphatase was 139.08 IU/L, mean serum sodium levels were 142.2 mEq/L, mean serum potassium was 3.52 mmol/L. Mean serum creatinine levels were 1.48 mg/dl while mean blood urea was 40.43 mg/dl. On evaluation of PT INR at baseline average prothrombine time was 14.80 s while its control was 13.72 s. Mean INR levels was 1.25. These baseline parameters are indicators of hepatic insufficiency (jaundice), portal hypertension (Ascites), deranged renal functions and are diagnostic of decompensated liver cirrhosis [Table 1]
2. Results-Effect of interventions
Abdominal girth Gradual reductions in different mean abdominal girths were observed at different time points. Abdominal girth above 1 inch of umbilicus is decreased as follows 7th day 2.2 cms, 9th day 2.82 cms, 11th day 5.44 cms and by 15th day it was reduced up to 6.5 cms from the baseline. Abdominal girth at umbilicus showed reductions as follows 7th day 2.56 cms, 9th day 3.37 cms, 11th day 4.74 cms and on 15th day it was reduced by 6.06 cms from baseline. Abdominal girth below 1 inch of umbilicus decrease at 7th day by 2.17 cms, 9th day 3.02 cms, 11th day 3.98 cms and by 15th day it was dropped by 5.46 cms. Abdominal Girth from Xiphi sternum to umbilicus decreased on 7th day by 2.07 cms, 9th day 2.43 cms, 11th day 3.06 cms and on 15th day it was 4.00 cms. From Umbilicus to Pubic Symphysis decline of 0.99 cms on 7th day, 1.15 cms on 9th day, 1.34 cms on 11th day and 1.69 cms decline is seen on 15th day from baseline
(Table 2, Section A)(Fig. 2, Fig. 3).
Blood pressure and pulse Interventions produced significant changes in Systolic blood pressure but not on diastolic blood pressure and pulse. Systolic blood pressure showed significant change at 7th, 9th and 15th day. There was a significant decrease compare to base line but were in the normative ranges (Table 2, Section A)
Body weight There was gradual decrease observed in body weight. From baseline it reduced by 1.7 kg on 7th day, 2.1 kg on 9th day, 2.7 kg on 11th day and by 15th day it was reduced by 4.9 kg (Table 2, Section A) (Fig. 3)
Blood parameters Ayurveda intervention produced significant increase in heamoglobin levels. Significant reduction in elevated liver function tests including total bilirubin, indirect bilirubin, AST, ALT, total protein, albumin, globulin, alkaline phosphatase, prothrombin time and INR values were observed. Interventions produced normalcy in few parameters like total protein, globulin and alkaline phosphatase. Renal functions including serum creatinine (p = 0.04) and blood urea (p = 0.03) levels showed significant decrease as a result of interventions. However they were still in the pathological range (Table 3, Section A)
Clinical Global impression scale At baseline mean CGI severity of illness scale was 5.56 which was reduced on 7th day by 1.56, 9th day by 2.08, 11th day by 2.53 and by 15th day it decreased by 2.56 compared to baseline. CGI- Global improvement scale showed that mean improvement was 3 on 7th day, on 9th day it was improved by 0.29, on 11th day 0.70 and on 15th day mean improvement was by 0.94. CGI-Efficacy index scale showed, mean score was 5.51 on 7th day which improved by 1.06 on 9th day, 3.34 on 11th day and improvement by 2.82 was seen on 15th day (Table 2, Section A) (Fig. 4)
Effect of Nitya virechana, Guduchyadi yoga, diet and life style on parameters Intervention (n = 32) showed improvement simlar to cumulative assessments (n = 55). Significant reductions in abdominal measurements such as at umbilicus, and 1 inch above and below the umbilicus. Xiphi sternum to umbilicus and umbilicus to pubic symphysis measurments, body weight, systolic and diastolic blood pressures, pulse and Clinical global impression scale (CGI) (Severity, improvement, efficacy index) (Table 2, Section B). Blood variables (n = 10) assessment indicated that intervention produced significant increase in hemoglobin levels, Significant decrease in elevated liver function tests like total bilirubin, indirect bilirubin, AST, ALT, total protein, albumin, globulin, Alkaline phosphatase, prothrombin time and INR values were observed. Interventions produced normalcy in few parameters like Globulin and Alkaline phosphatase. Renal functions like serum creatinine and blood urea levels showed trends of decrease but were non significant and were in the pathological range. Improvements in most of the parameters were similar to the cumulative sample (Table 2, Section B and Table 3, Section B)
Discussion
The present study has shown that complex intervention with Nitya Virechana, oral medicaments, diet, fluid and salt restriction proved to be efficacious in the management of decompensated cirrhosis with ascites. It has shown reduction in abdominal girth measurements, body weight, clinical global impression scales of severity, improvement and efficacy index. Improvement was also observed in blood variables, liver function tests, prothrombin time, INR values and renal function tests.
All the patients were sonologically diagnosed case of liver cirrhosis with mild to moderate ascites. Patients had stage 3, decompensated cirrhosis and Child-Turcotte-Pugh Score (CTP) score (calculated through serum bilirubin, serum albumin, prothrombin time, severity of ascites, and grade of encephalopathy) was 10 and was in class C. In Class C, 1 year survival is observed in 45% and 2 year survival is observed in 38% cases. Majority (94%) were due to chronic Alcoholic liver disease. Patients were suffering from these symptoms since 3.5 months. More number of patients were between 45 and 50 years of age. All male patients (94.54%) had chronic alcoholic liver disease. Mean alcohol consumption history was 7.76 years.
Administration of Nitya Virechan (daily mild purgatives) with either haritaki churna (fine powder of terminalia chebula retz.), Trivruta leha (compound formulation of operculina turpethum Linn), Goarka (distilled product of cow's urine) or milk can lead to fluid loss. These drugs works as osmotic and stool wetting agents. It increases water content in gut by changing the fluid dynamics of mucosal cells. These drugs may change the fluid dynamics leadings to impairment in water and electrolytes absorption of villous cells inhibiting Na+, K + ATPase , resulting into draining of peritoneal fluid into gut through process of osmosis . Virechan drugs are ushna (hot), tikshna (piercing quality), sukshma (reach up to minute part), vyavayi (spreads all over body), vikashi (flowing capacity) sara (flowing), anu (reaching to cellular level) & vicchina (scrapping and excising) and dosha sannghatahara (dismentaling compactness of dosha) in nature (C.S.K.1.5). By this qualities, virechan drugs may have moved the peritoneal fluid to the intestines and then evacuation through rectal route. Haritaki (Terminalia chebula retz.) contains anthraquinones which is mild and gentle laxative in nature. Anthraquinones metabolize the active aglycones which by impairing epithelial cells, deploys its lenitive action leading to the modification in intestinal absorption, secretion and motility . Trivruta (operculina turpethum Linn) contains Resin glycosides which has aperient property of the purified resin glycoside fraction. It attributes to NF-κB activation in the colon resulting in increment of COX-2-mediated secretion of PGE2 which further decreases AQP3 expression leading to purgative action by absorbing water from intestine to the blood vessel . Cow's Milk has various qualities including guru (heavy), sara (spreading and flowing), prithvi, jala mahabhuta dominanance, mild laxative, rasayana (reguvinative), jeevana (nutritive), balya (strength promoting). Goarka has purgative action because of its ushna (hot), tikshna (penetrating), sara (spreading and flowing) and bhedana (piercing) properties. Frequently used oral formulation was G. yoga and Guduchyadi kwatha. These formulations were derived from the clinical experiences of the departmental faculty. Other oral formulations were also used. These formulations and their ingredients can potentiate the rasayana effect on liver, kidney and nootropic, hepatotropic action, rakta pittahara (bleeding and clotting indices), anti anaemic, correcting hypoproteinaemia and diuretic effects. These drugs are tikta (bitter) in rasa, laghu (light), dravashoshaka (dring up fluid content), kapha hara, rasayana (rejuvenation quality) in nature. Various studies have reported Punarnava (Boerhavia diffusa Linn.) to be effective in improving the urine formation, hepatoprotective and anti-inflammatory in both in vivo and in vitro studies ,.. Nimba (Azadirachta indica A. Juss.) leaf extract has hepatoprotective effect as it contains phytochemicals such as Azadirachtin, Nimbidin, Nimbin, Nimbinin. Guduchi (Tinospora cordifolia Miers.) has anti-inflammatory, immunomodulatory, hepatoprotective, antioxidant and antidiabetic effects. Bhringaraj (Eclipta alba Hassk.) has shown hepato-protective effect. Bhumyamalaki (P. niruri Linn) in animal model has shown to decrease hepatomegaly, visceral fat weight, serum total cholesterol, low-density lipoprotein, free fatty acids (FFAs), Alanine aminotransferases, aspartate aminotransferases, insulin concentration, homeostatic model assessment of insulin resistance (HOMA-IR), hepatic content of cholesterol, triglyceride, malondialdehyde, prevented fibrosis, and has anti NAFLD effect. Fluid and salt restriction is recommended in Ascites as it is a condition of increase of Apa mahabhuta, kleda and mala. Dietary items such as milk has balya, jeevaniya, rasayana, and is indicated in kshina (debilitated individuals). Green gram soup and egg white also have balya and jeevaniya effect. Through these actions improvement in hemoglobin, total proteins and globulins could have been produced.
Comprehensive clinical assessment was through clinical global impression Scale. This intervention shown significant (p-0.001) improvements in severity of illness, global improvement and efficacy index. This may happened due to clinical improvement in the manifestations of liver cirrhosis with ascites, decrease in the abdominal fluid, effect of drugs like immunomodulatory, anti-inflammatory, hepatoprotective, anti-anemic, diuretic, rasayana effects. Improvement in clinical manifestations can help in improving the quality of life and decrease the risk of complications like spontaneous bacterial peritonitis (SBP).
Similarly a prospective study with a complex polyherbal regimen inclusive of purgation with P. kurroa, piper longum Linn administration, punaranvadi kwath, compound powder, diet and life style modifications for 24 weeks showed improvement in liver child-pugh grade scores and clinical manifestations of liver cirrhosis with ascites. A case report of sonologically diagnosed ascites with nitya virechan (therapeutic purgation daily) intervention with Abhayadi modaka, cow's urine Sharapunkha Swarasa, Punarnava Kwatha, Arogya vardhini and restricted diet for 3 months showed improvement in ascites, decrease in abdominal girth and clinical improvements. Another case report of liver cirrhosis with ascites with intervention in the form of nitya virechana (hingu triguna taila with milk for 10 days), punaranvadi Kashaya, panchakola churna, gomutra haritaki, diet, vardhamana pippali regimen for 60 days showed decrease in ascites and no recurrence of ascites after 1 year of observation. The present study shows the evidences for use of different virechana, anupana, oral medications and diet in decompensated cirrhosis.
Study has many merits. Treatment regimen being practiced in the clinical scenario were analyzed and hence has a strong external validity. Thorough evaluation of Ayurveda physicians' thought process, Ayurvedic assessment of the patient, critically analyzing the treatment algorhythm, whole system approach, integrating Ayurveda treatment modalities (virechana, oral medication and diet). Assessments with abdominal measurements, weight, clinical global impression scales, liver function tests, renal function tests, prothrombin time and INR values are the notable components of the study. Study has several limitations including retrospective cohort study. Lack of histopathological assessments through liver biopsy is a lacuna and these would have given better biological action of interventions. Limited study duration (15 days) is relatively shorter period for this disease condition.
Conclusion
Complex Ayurvedic treatment regimen consisting of Nitya virechana, Ayurveda medicaments, diet, salt and fluid restrictions have shown beneficial effect in the management of decompensated stage of liver cirrhosis with ascites. Study gives leads in the Ayurvedic patient assessments, treatment principles, treatment algorhythms, customization, medications and diets in liver cirrhosis with ascites. Proper documentation of all the observations, correlating the clinical changes with the appropriate biological investigations, maintaining the long term follow up records, recording the ayurveda interpretations etc needs to be strongly advocated to the Ayurvedic clinicians.
Conflict of Interest
None
Source of Funding
Nil
Author Contributions
B R Tubaki: Conceptualization, Methodology, Writing - Original draft preparation, Writing- Reviewing and Editing, Statistical analysis. Saish Gawas: Supervision, Data curation, Writing - Reviewing and Editing. Himani Negi: Supervision, Visualization, Data collection, Writing - Reviewing and Editing.
Acknowledgement
We acknowledge the contribution of staff of Kayachikitsa department past and present in admitting and successfully managing the patients of liver cirrhosis with ascites from whom the data was collected. Contributing staff were Dr Sameer Naik, Dr Sukumar Nandigoudar, Dr Kiran Mutnalli, Dr V G Huddar and Dr B R Tubaki. We acknowledge the support and guidance of Dr B S Prasad, Ex Principal Shri BMK Ayurveda Mahavidyalaya Belagavi.
Footnotes
Peer review under responsibility of Transdisciplinary University, Bangalore.
References
×
1. Garcia-Tsao G., Lim J.K., Members of Veterans Affairs Hepatitis C Resource Center Program Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the department of veterans affairs hepatitis C resource center program and the national hepatitis C program. Am J Gastroenterol. 2009 Jul;104(7):1802–1829. doi: 10.1038/ajg.2009.191. Epub 2009 May 19. Erratum in: Am J Gastroenterol. 2009 Jul;104(7):1894. Lim, Joseph [corrected to Lim, Joseph K]. PMID: 19455106.
×
2. D'Amico G., Garcia-Tsao G., Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006 Jan;44(1):217–231. doi: 10.1016/j.jhep.2005.10.013. Epub 2005 Nov 9. PMID: 16298014.
×
3. Fisher N.C., Hanson J., Phillips A., Rao J.N., Swarbrick E.T. Mortality from liver disease in the West Midlands, 1993-2000: observational study. BMJ. 2002 Aug 10;325(7359):312–313. doi: 10.1136/bmj.325.7359.312. PMID: 12169508; PMCID: PMC117772.
×
4. Planas R., Montoliu S., Ballesté B., Rivera M., Miquel M., Masnou H., et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol. 2006 Nov;4(11):1385–1394. doi: 10.1016/j.cgh.2006.08.007. PMID: 17081806.
×
5. Sørensen H.T., Thulstrup A.M., Mellemkjar L., Jepsen P., Christensen E., Olsen J.H., et al. Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol. 2003 Jan;56(1):88–93. doi: 10.1016/s0895-4356(02)00531-0. PMID: 12589875.
×
6. Blachier M., Leleu H., Peck-Radosavljevic M., Valla D.C., Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013 Mar;58(3):593–608. doi: 10.1016/j.jhep.2012.12.005. PMID: 23419824.
×
7. Peery A.F., Crockett S.D., Murphy C.C., Lund J.L., Dellon E.S., Williams J.L., et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018 [published correction appears in Gastroenterology. 2019;156(6):1936]. Gastroenterology. 2019;156(1):254–272. e11.
×
8. Schuppan D., Afdhal N.H. Liver cirrhosis. Lancet. 2008 Mar 8;371(9615):838–851. doi: 10.1016/S0140-6736(08)60383-9. PMID: 18328931; PMCID: PMC2271178.
×
9. Grattagliano I., Ubaldi E., Bonfrate L., Portincasa P. Management of liver cirrhosis between primary care and specialists. World J Gastroenterol. 2011 May 14;17(18):2273–2282. doi: 10.3748/wjg.v17.i18.2273. PMID: 21633593; PMCID: PMC3098395.
11. Busner J., Targum S.D. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry. 2007;4(7):28–37.
×
12. Planas R., Ballesté B., Alvarez M.A., Rivera M., Montoliu S., Galeras J.A., et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol. 2004 May;40(5):823–830. doi: 10.1016/j.jhep.2004.01.005. PMID: 15094231.
×
13. D'Amico G., Garcia-Tsao G., Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231.
×
14. Pugh R.N., Murray-Lyon I.M., Dawson J.L., Pietroni M.C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–649.
×
15. Kanti kar Pulak. Chaukhamba Sanskrit Pratishthan; 2013. Mechanism of panchakarma and its module of Investigation; pp. 53–54. ISBN: 978-81-7084-516-9, Part 1- mechanism of virechan.
×
16. Keele Cyril A., Neil Eric, Norman Joels. 13th ed. Oxford University Press, printed in India by Ramko Press New Delhi; 2015. Samson Wright's applied physiology; p. 9. Indian Reprint. ISBN-13: 978-0-19-561625-5, Part I the internal environment, nsport.
×
17. Shastry J.L.N. Reprint Edition. Chaukhamba Orientalia Varanasi; 2017. forwarded by prof. K.C. Chunekar, Dravyaguna-Vijnana, Vol. vol. II (Study of essential medicinal plants in ayurveda) p. 210. ISBN: 978-81-7673-093-6.
×
18. Gordon M., MacDonald J.K., Parker C.E., Akobeng A.K., Thomas A.G. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev. 2016;8 doi: 10.1002/14651858.CD009118.
×
19. Shanth Kumar Lucas D. 1st ed. vol. II. Chaukhamba Visvabharati Varanasi; 2008. Dravyaguna-Vijnana, (Study of dravya-materia medica) p. 156.
×
20. Zhu Dongrong, Chen Chen, Bai Lijuan, Kong Lingyi, Luo Jianguang. Downregulation of aquaporin 3 mediated the laxative effect in the rat colon by a purified resin glycoside fraction from pharbitis semen, Hindawi. Evid-Based Compl and Alternative Med. 2019;2019 doi: 10.1155/2019/9406342. PMID: 30733814, 10 pages.
×
21. Mudgal V. Studies on medicinal properties of Convolvulus pluricaulis and Boerhaavia diffusa. Planta Med. 1975;28(1):62–68. doi: 10.1055/s-0028-1097830. PMID: 1178789.
×
22. Mishra S., Aeri V., Gaur P.K., Jachak S.M. Phytochemical, therapeutic, and ethnopharmacological overview for a traditionally important herb: boerhavia diffusa Linn. BioMed Res Int. 2014;2014 doi: 10.1155/2014/808302. Epub 2014 May 14. PMID: 24949473; PMCID: PMC4053255.
×
23. Chattopadhyay R.R. Possible mechanism of hepatoprotective activity of Azadirachta indica leaf extract: part II. J Ethnopharmacol. 2003 Dec;89(2–3):217–219. doi: 10.1016/j.jep.2003.08.006. PMID: 14611885.
×
24. Upadhyay A.K., Kumar K., Kumar A., Mishra H.S. Tinospora cordifolia (willd.) Hook. F. and Thoms. (Guduchi) e validation of the ayurvedic pharmacology through experimental and clinical studies. Int J Ayurveda Res. 2010;1(2):112–121. doi: 10.4103/0974-7788.64405. PMID: 20814526; PMCID: PMC2924974.
×
25. Singh B., Saxena A.K., Chandan B.K., Agarwal S.G., Anand K.K. In vivo hepatoprotective activity of active fraction from ethanolic extract of Eclipta Alba leaves. Indian J Physiol Pharmacol. 2001;(4):435–441. Oct;45PMID: 11883149.
×
26. Al Zarzour R.H., Ahmad M., Asmawi M.Z., Kaur G., Saeed M.A.A., Al-Mansoub M.A., et al. Phyllanthus niruri standardized extract alleviates the progression of non-alcoholic fatty liver disease and decreases atherosclerotic risk in sprague-dawley rats. Nutrients. 2017 Jul 18;9(7):766. doi: 10.3390/nu9070766. PMID: 28718838; PMCID: PMC5537880.
×
27. Patel M.V., Patel K.B., Gupta S., Michalsen A., Stapelfeldt E., Kessler C.S. A complex multiherbal regimen based on ayurveda medicine for the management of hepatic cirrhosis complicated by ascites: nonrandomized, uncontrolled, single group, open-label observational clinical study. Evid Base Compl Alternative Med : eCAM. 2015 doi: 10.1155/2015/613182. Epub 2015 Aug 3. PMID: 26339267; PMCID: PMC4539059.
×
28. Bhagiya S.G., Shukla R.B., Joshi N.P., Thakar A.B. A single-case study of management of Jalodara (ascites) Ayu. 2017 Jul-Dec;38(3–4):144–147. doi: 10.4103/ayu.AYU_176_17. PMID: 30254395; PMCID: PMC6153904.
×
29. Aswathy G., Dharmarajan P., Sharma A.R., Sasikumar V.K., Vasudevan Nampoothiri M.R. Ayurvedic management of cirrhotic ascites. Ancient Sci Life. 2016 Apr-Jun;35(4):236–239. doi: 10.4103/0257-7941.188183. PMID: 27621523; PMCID: PMC4995860.
1. Garcia-Tsao G., Lim J.K., Members of Veterans Affairs Hepatitis C Resource Center Program Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the department of veterans affairs hepatitis C resource center program and the national hepatitis C program. Am J Gastroenterol. 2009 Jul;104(7):1802–1829. doi: 10.1038/ajg.2009.191. Epub 2009 May 19. Erratum in: Am J Gastroenterol. 2009 Jul;104(7):1894. Lim, Joseph [corrected to Lim, Joseph K]. PMID: 19455106.
2. D'Amico G., Garcia-Tsao G., Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006 Jan;44(1):217–231. doi: 10.1016/j.jhep.2005.10.013. Epub 2005 Nov 9. PMID: 16298014.
3. Fisher N.C., Hanson J., Phillips A., Rao J.N., Swarbrick E.T. Mortality from liver disease in the West Midlands, 1993-2000: observational study. BMJ. 2002 Aug 10;325(7359):312–313. doi: 10.1136/bmj.325.7359.312. PMID: 12169508; PMCID: PMC117772.
4. Planas R., Montoliu S., Ballesté B., Rivera M., Miquel M., Masnou H., et al. Natural history of patients hospitalized for management of cirrhotic ascites. Clin Gastroenterol Hepatol. 2006 Nov;4(11):1385–1394. doi: 10.1016/j.cgh.2006.08.007. PMID: 17081806.
5. Sørensen H.T., Thulstrup A.M., Mellemkjar L., Jepsen P., Christensen E., Olsen J.H., et al. Long-term survival and cause-specific mortality in patients with cirrhosis of the liver: a nationwide cohort study in Denmark. J Clin Epidemiol. 2003 Jan;56(1):88–93. doi: 10.1016/s0895-4356(02)00531-0. PMID: 12589875.
6. Blachier M., Leleu H., Peck-Radosavljevic M., Valla D.C., Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013 Mar;58(3):593–608. doi: 10.1016/j.jhep.2012.12.005. PMID: 23419824.
7. Peery A.F., Crockett S.D., Murphy C.C., Lund J.L., Dellon E.S., Williams J.L., et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2018 [published correction appears in Gastroenterology. 2019;156(6):1936]. Gastroenterology. 2019;156(1):254–272. e11.
8. Schuppan D., Afdhal N.H. Liver cirrhosis. Lancet. 2008 Mar 8;371(9615):838–851. doi: 10.1016/S0140-6736(08)60383-9. PMID: 18328931; PMCID: PMC2271178.
9. Grattagliano I., Ubaldi E., Bonfrate L., Portincasa P. Management of liver cirrhosis between primary care and specialists. World J Gastroenterol. 2011 May 14;17(18):2273–2282. doi: 10.3748/wjg.v17.i18.2273. PMID: 21633593; PMCID: PMC3098395.
11. Busner J., Targum S.D. The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry. 2007;4(7):28–37.
12. Planas R., Ballesté B., Alvarez M.A., Rivera M., Montoliu S., Galeras J.A., et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol. 2004 May;40(5):823–830. doi: 10.1016/j.jhep.2004.01.005. PMID: 15094231.
13. D'Amico G., Garcia-Tsao G., Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44:217–231.
14. Pugh R.N., Murray-Lyon I.M., Dawson J.L., Pietroni M.C., Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646–649.
15. Kanti kar Pulak. Chaukhamba Sanskrit Pratishthan; 2013. Mechanism of panchakarma and its module of Investigation; pp. 53–54. ISBN: 978-81-7084-516-9, Part 1- mechanism of virechan.
16. Keele Cyril A., Neil Eric, Norman Joels. 13th ed. Oxford University Press, printed in India by Ramko Press New Delhi; 2015. Samson Wright's applied physiology; p. 9. Indian Reprint. ISBN-13: 978-0-19-561625-5, Part I the internal environment, nsport.
17. Shastry J.L.N. Reprint Edition. Chaukhamba Orientalia Varanasi; 2017. forwarded by prof. K.C. Chunekar, Dravyaguna-Vijnana, Vol. vol. II (Study of essential medicinal plants in ayurveda) p. 210. ISBN: 978-81-7673-093-6.
18. Gordon M., MacDonald J.K., Parker C.E., Akobeng A.K., Thomas A.G. Osmotic and stimulant laxatives for the management of childhood constipation. Cochrane Database Syst Rev. 2016;8 doi: 10.1002/14651858.CD009118.
19. Shanth Kumar Lucas D. 1st ed. vol. II. Chaukhamba Visvabharati Varanasi; 2008. Dravyaguna-Vijnana, (Study of dravya-materia medica) p. 156.
20. Zhu Dongrong, Chen Chen, Bai Lijuan, Kong Lingyi, Luo Jianguang. Downregulation of aquaporin 3 mediated the laxative effect in the rat colon by a purified resin glycoside fraction from pharbitis semen, Hindawi. Evid-Based Compl and Alternative Med. 2019;2019 doi: 10.1155/2019/9406342. PMID: 30733814, 10 pages.
21. Mudgal V. Studies on medicinal properties of Convolvulus pluricaulis and Boerhaavia diffusa. Planta Med. 1975;28(1):62–68. doi: 10.1055/s-0028-1097830. PMID: 1178789.
22. Mishra S., Aeri V., Gaur P.K., Jachak S.M. Phytochemical, therapeutic, and ethnopharmacological overview for a traditionally important herb: boerhavia diffusa Linn. BioMed Res Int. 2014;2014 doi: 10.1155/2014/808302. Epub 2014 May 14. PMID: 24949473; PMCID: PMC4053255.
23. Chattopadhyay R.R. Possible mechanism of hepatoprotective activity of Azadirachta indica leaf extract: part II. J Ethnopharmacol. 2003 Dec;89(2–3):217–219. doi: 10.1016/j.jep.2003.08.006. PMID: 14611885.
24. Upadhyay A.K., Kumar K., Kumar A., Mishra H.S. Tinospora cordifolia (willd.) Hook. F. and Thoms. (Guduchi) e validation of the ayurvedic pharmacology through experimental and clinical studies. Int J Ayurveda Res. 2010;1(2):112–121. doi: 10.4103/0974-7788.64405. PMID: 20814526; PMCID: PMC2924974.
25. Singh B., Saxena A.K., Chandan B.K., Agarwal S.G., Anand K.K. In vivo hepatoprotective activity of active fraction from ethanolic extract of Eclipta Alba leaves. Indian J Physiol Pharmacol. 2001;(4):435–441. Oct;45PMID: 11883149.
26. Al Zarzour R.H., Ahmad M., Asmawi M.Z., Kaur G., Saeed M.A.A., Al-Mansoub M.A., et al. Phyllanthus niruri standardized extract alleviates the progression of non-alcoholic fatty liver disease and decreases atherosclerotic risk in sprague-dawley rats. Nutrients. 2017 Jul 18;9(7):766. doi: 10.3390/nu9070766. PMID: 28718838; PMCID: PMC5537880.
27. Patel M.V., Patel K.B., Gupta S., Michalsen A., Stapelfeldt E., Kessler C.S. A complex multiherbal regimen based on ayurveda medicine for the management of hepatic cirrhosis complicated by ascites: nonrandomized, uncontrolled, single group, open-label observational clinical study. Evid Base Compl Alternative Med : eCAM. 2015 doi: 10.1155/2015/613182. Epub 2015 Aug 3. PMID: 26339267; PMCID: PMC4539059.
28. Bhagiya S.G., Shukla R.B., Joshi N.P., Thakar A.B. A single-case study of management of Jalodara (ascites) Ayu. 2017 Jul-Dec;38(3–4):144–147. doi: 10.4103/ayu.AYU_176_17. PMID: 30254395; PMCID: PMC6153904.
29. Aswathy G., Dharmarajan P., Sharma A.R., Sasikumar V.K., Vasudevan Nampoothiri M.R. Ayurvedic management of cirrhotic ascites. Ancient Sci Life. 2016 Apr-Jun;35(4):236–239. doi: 10.4103/0257-7941.188183. PMID: 27621523; PMCID: PMC4995860.
According to Ayurveda, Liver is also known as Yakrit and is one of the most important and largest glands of the human body. Liver secretes bile which helps in the digestion of fats and also aids in metabolization of proteins, fats, and carbohydrates. According to Ayurveda, spleen is also known as Pliha and liver is known as yakrit. All the severe disorders of spleen and liver nowadays are common due to poor diet and modern sedentary lifestyle. Therefore one should take care of our vital organs like liver and spleen by removing all the toxins from the body. Due to improper lifestyle and unhealthy diet most of the people are suffering from Liver related disorders. One of the most common liver disorders known nowadays is Fatty liver. Other liver related disorders are liver cirrhosis, fibrosis, and jaundice which are also very common among people nowadays. Planet Ayurveda provides a very effective and beneficial herbal formulation i.e. Yakrit Plihantak Churna which aids in various liver and spleen disorders. This churna helps in providing relief to the liver as well as the spleen.
INTRODUCTION
Yakrit Plihantak Churna is a polyherbal formulation made up of more than one herb by Planet Ayurveda. It is a powder form which is made up of eight herbs. In Ayurveda, Yakrit means the liver and Pliha means the spleen and this herbal formation helps in eliminating the toxins from the liver and the spleen. The diseases in which Yakrit plihantak churna is very effective are Alcoholic liver disease (ALD), fatty liver, constipation, pitta (Excessive heat) disorders in body, high Cholesterol level in body, diabetes, gallbladder Stones, hormonal imbalances, jaundice, hepatitis (B and C) etc. Yakrit Plihantak churna is very effective in restoring the normal function of the liver and also helps in rejuvenating the liver cells. Yakrit Plihantak churna is a patent herbal formulation by Planet Ayurveda and has shown positive results on liver and spleen disorders. Yakrit Plihantak Churna is a very effective herbal formulation as it helps in detoxification of liver and spleen.
INGREDIENTS
Yakrit Plihantak Churna is a polyhedral formulation that means it is made up of more than two ingredients. Planet Ayurveda’s herbs are 100% natural and pure vegetarian. All the herbal products are free from chemicals and additives. All the products are manufactured under Ayurvedic board guidelines. Ingredients of Yakrit plihantak churna are listed below:-
Bhumi amla (Phyllanthus niruri)
Kutki (Picrorhiza kurroa)
Makoy (Solanum nigrum)
Punarnava (Boerhavia diffusa)
Kalmegh (Andrographis paniculata)
Kaasni (Cichorium intybus)
Sarpunkha (Tephrosia purpurea)
Bhringraj (Eclipta Alba)
INGREDIENTS DESCRIPTION
1. Bhumi Amla
Bhumi amla (Phyllanthus niruri) is a very effective drug as it acts as a powerful antioxidant and aids in removing toxins from the body. Bhumi amla strengthens the liver and spleen. Bhumi amla also acts as diuretic so helps in kidney stones. Bhumi amla is also effective in hair growth and also aids in skin related disorders as it has blood purifying properties.
2. Kutki
Kutki (Picrorhiza kurroa) is very effective in liver related disorders like jaundice etc and also helps in maintaining the blood sugar level in the body. It is also effective in skin disorder vitiligo, asthma, rheumatoid arthritis. It also helps in asthma related problems and also in bronchial disease.
3. Makoy
Makoy (Solanum nigrum) is very beneficial in skin related disorders like psoriasis, eczema and even makoy paste is also used for the herpes, severe burns etc. Makoy is also helpful in reducing pain, inflammation and also helpful in dysentery. Makoy is also effective in relieving ear pain and also helps in mouth ulcers.
4. Punarnava
Punarnava (Boerhavia diffusa) is very effective in pacifying the tri doshas of the body. Punarnava also acts as diuretic which helps in reducing swelling in the body as well as helps in removing excessive water from the body. Punarnava has anti-inflammatory properties. It also helps in increasing the hemoglobin level in the body.
5. Kalmegh
Kalmegh (Andrographis paniculata) is very effective in pacifying Kapha and Pitta dosha in the body. Kalmegh has very effective results in the liver and spleen disorders as it helps formation of free radicals. Kalmegh aids in treating tonsillitis and tuberculosis.
6. Kaasni
Kaasni (Cichorium intybus) is effective in gall bladder stones. Kaasni is very effective in pacifying the pitta dosha in the body. Kaasni helps in relieving constipation as it acts as a mild laxative. Kasani is very effective in fatty liver, enlarged liver etc. It also helps in improving the digestive fire in the body.
7. Sarpunkha
Sarpunkha (Tephrosia purpurea) is very effective in treating problems related to liver and spleen like obstructive liver disorder, splenomegaly etc. It also helps in maintaining the hemoglobin level in the body. Sarpunkha is very effective in liver cirrhosis and helps in healing the wounds.
8. Bhringraj
Bhringraj (Eclipta alba) is very effective in reversing liver damage and beneficial in liver related problems. Bhringraj also helps in hair growth and premature graying of hairs. Bhringraj is effective in skin related disorders and aids in strengthening hair roots. Bhringraj is effective in making the scalp dandruff free and making the hair roots more strong.
METHOD OF PREPARATION
The first step of making Yakrit Plihantak Churna is to wash and clean all the herbs. Dry them in direct sunlight as it helps in removing the moisture. Then grind all the herbs together until powder form is obtained. After grinding, filter the prepared powder via a sieve. Finally, collect the finally prepared Yakrit Plihantak churna in an airtight container and store it in a cool and dry place. After storing, the Yakrit Plihantak churna can be used.
INDICATIONS
The diseases in which Yakrit Plihantak Churna is very effective are listed below:-
Alcoholic liver disease (ALD)
Fatty liver
Constipation
Pitta (Excessive heat) disorders in body
High Cholesterol level in body
Diabetes
Gallbladder Stones
Hormonal imbalances
Jaundice
Hepatitis (B and C)
SIDE EFFECTS
There are no side effects of Yakrit Plihantak Churna. When Yakrit plihantak churna is taken in high doses only then it may cause gastritis. One should have Yakrit Plihantak churna as prescribed by an Ayurvedic doctor.
DOSAGE
1 teaspoon twice daily with lukewarm water after a meal or boil the 1 teaspoonful of Yakrit Plihantak Churna in 4 cups of water, keep it boiling until it remains 1 cup. Strain it and drink the decoction. Leave the residue. Do it twice daily. Make it fresh every time.
CONCLUSION
Yakrit Plihantak Churna is a patent herbal formulation by Planet Ayurveda and has shown positive results on liver and spleen disorders. Yakrit Plihantak churna is a very effective herbal formulation as it helps in detoxification of liver and spleen. This herbal formulation is pure vegetarian and has no side effects over the body as it is made up of natural herbs. Planet ayurveda's herbal formulations are 100% herbal, pure vegetarian, and natural. For more details of our products, you can check our website www.PlanetAyurveda.com. For more queries, you can send your queries to our email id herbalremedies123@yahoo.com.
Liver is a large, meaty organ that sits on the right side of the belly. It is a beautiful half moon shaped organ and in Ayurveda it is compared to Lord Shiv who has half-moon over his head.
An interesting statement in Yajurveda Reveals, "Yatha pinde tatha brahmande, yatha brahmande tatha pinde".
That is ---As is the human body, so is the Cosmic body (Universe), as is the cosmic body so is the human body"----- OUR HUMAN BODY IS MINI COSMOS
So keeping these statements valid--we can say with strong conviction that liver is one organ that is so much like Shiva in Universe, As Shiva consumed toxic Poison to save the Deva and Universe, It is believed that when Lord Shiva consumed Halahala, the toxic poison, his body temperature started rising. Because the moon is cold in its demeanor, Lord Shiva placed the moon on his head to lower his body temperature.
In the similar manner we have liver --moon shaped organ in our body that is important sit of PITTA--- Pitta is primarily composed of the fire and water elements. It is the source of all heat in the body. Not surprisingly, the liver and the gallbladder are both considered important sites of pitta.
Liver is one important organ that works day in and day out to keep our body healthy, Everyone believes that Heart is what keep our clock ticking but the fact remains that we can keep human body alive today on ventilators but if liver -kidney fail, everything fails you.
As in Hindu literature --- The crescent moon is shown on the side of the Lord's head as an ornament. The waxing and waning phenomenon of the moon symbolizes the time cycle through which creation evolves from the beginning to the end.
Similarly Liver is the Shiva inside human body that symbolizes the time cycle inside---metabolism going inside, it hold the complete mechanism inside, the enzymes produced and the nutrition passed on to all the cells of body , be it heart or brain. They all rely on Liver for all nourishment sent to them.
These days we see that people are relying too much on packed food and artificial flavors. The custom of consuming junk food is increasing day by day and making our future sad and diseased especially our future generations.
Fresh fruit and juices have been replaced by preservative diet and color, young generation rely too much on colorful attractive packing of junk food and snacks. The INSTANT culture--of Maggi and similar tastes are ruling the campus of universities all over.
Be it any occasion people prefer to eat out --- they enjoy special time with family like birthday party, marriage anniversary, etc. eating JUNK. They easily become used to taking soft drinks, wafers, chips, noodles, burgers, pizza, french-fries, Chinese dishes, and other varieties of fast food available in the market. But this JUNK is harmful and is a slow poison that we are giving to our body.
If we look at the dictionary meaning of JUNK it means old and discarded stuff but people fail to realize that we are polluting the beautiful gift of GOD, our BODY with waste and unwanted items.
When these waste or toxic items are bombarded on our LIVER----THIS humble organ takes all the chemical reaction on itself and tries to squeeze out the nutrient value even from waste.
But Alas---slowly the saturation point of LIVER is reached and it is unable to feed itself on toxic stuff and starts giving signs of---IT IS ENOUGH, I CAN"T take it more.
That is the stage when----our Ultrasound reports come out with diagnosis like-- Fatty liver, Liver cirrhosis, NASH, Jaundice and the list seems endless with interesting titles of disease and google is flooded with information about them.
But the cause is simple---We need to just water the Moon shaped organ with cooling stuff---as its original nature is cooling.
We need to give the balanced diet of coconut water, fresh fruits, salads, green leaves and right herbs like Punarnava, Bhrigraj, Gokshru, Ghrit kumari, Kasni, Kalmegh.
Yakritplihantak churna is a very balanced combination given to cater to LIVER at its best!!!
YAKRIT PLIHANTAK CHURNA BY PLANET AYURVEDA
Yakrit Plihantak Churna is blended with mixture of herbs that improve overall liver & spleen functions. The powder regenerates liver cells, prevents liver damage due to toxins, infections & alcohol. Yakritplihantak churan increases bile production & excretion. This is a wonderful herbal remedy for all liver disorders.
It contains herbs like Bhumiamla (Phyllanthus niruri), Katuki (Picrorhiza kurrao), Makoy (Solanum indicum), Punarnava (Boerrhavia diffusa), Kalmegh (Andographis paniculata), Kaasni (Cichorium intybus), Sharpunkha (Tephrosia purpurea) & Bhringraj (Eclipta alba) that shows result in liver disorders.
Bhumiamla (Phyllanthus niruri): This herb is an effective herb for all liver disorders. It helps in detoxification of liver that brings down SGOT & SGPT levels. The herb regenerates liver cells & cures liver failure.
Katuki (Picrorhiza kurrao): This is a most effective herb that corrects metabolism within the liver. It clears gall bladder stones so acts as a gall bladder cleanser.
Makoy (Solanum indicum): Makoy has amazing liver healing properties. This herb helps in regeneration of liver cells, beneficial in all types of hepatitis & useful in alcoholic liver damage, fatty liver etc.
Punarnava (Boerrhavia diffusa): This herb removes excessive fluid from the body. It helps to maintain albumin & globulin ratio in blood. The herb acts as a natural diuretic.
Kalmegh (Andrographis paniculata): This herb shows effective results in liver problems, fatty liver, alcoholic liver, jaundice & all types of hepatitis. It contains alkaloids that help in regeneration of damaged liver cells.
Kaasni (Cichorium intybus): The herb has healing power that cures liver disorders. It shows effective result in liver failure.
Sharpunkha (Tephrosia purpurea): This herb shows effective result in spleen & liver problems. It helps to decrease gas & acidity problem associated with liver. The herb helps in regeneration of liver cells.
Bhringraj (Eclipta alba): Bhringraj is a wonderful herb that regenerates liver cells & shows effective result in alcoholic liver disease, liver damage, fatty liver & liver failure. It helps to remove excessive toxins from body.
Recommended Dosage: Take ½ to 1 teaspoonful twice daily, with plain water, 30 min after meals.
Ascites is a medical term used to describe the accumulation of the fluid in the peritoneal cavity which leads to the abdominal distension. Generally, a severe liver cirrhosis and heart failure is a common cause for this disease. It must be cured in proper time otherwise it may lead to severe complications. In this condition, the fluid secreted by the liver is exceeded on large scale and the abdominal cavity is distended with such fluid.
WHAT ARE THE CAUSES OF ASCITES?
Depending on the accumulation of fluid and the level of water, the causes may be described in 3 ways.
The most common type of Ascites is SAAG is due to the high Serum Ascites Albumin Gradient (SAAG). It is transudate in nature which means that the fluid which passes through the membrane filters out of the cells and there is much proteins yielding watery solution. It has considerable low proteins. It is caused due to viral, cryptogenic or alcoholic cirrhosis, heart failure and veno-occulsive disease.
Another type of ascites is caused due to low SAAG, in which a fluid with high proteins and cellular debris including pus cells, blood, plasma protein, white blood cells and platelets may be present which escapes from the vessels and gets deposited in tissues. It has considerably high proteins. It is mainly caused by carcinogenesis, disease like pancreatitis, tuberculosis, nephritic disease.
Other rare causes are thyroid disorder, dialysis and vascular disorder.
Ayurveda goes into much detail while discussing the causative factors. According to Ayurveda, the contributing factors for ascites are:
Low digestive fire
Production of endotoxins (ama)
Vitiation of Prana and Apana Vata
Obstruction in sweat and water carrying system.
There are 8 types of ascites (jalodara) described in Ayurveda due to vitiation of Vata, Pitta and Kapha doshas in the body and due to liver and spleen disorders.
WHAT ARE THE SIGNS AND SYMPTOMS OF ASCITES?
Enlarged abdominal cavity
Progressive abdominal heaviness
Feeling of pressure and stiffness of the abdomen
Shortness of breath due to pressure on the diaphragm
During the pressing of abdomen on one side, it will generate a wave like movement through the fluid which can be noticed on the other side.
Edema
Dilated veins on either side of the abdomen.
DIAGNOSIS
Various tests such as complete urine examination, ultrasound examination confirm the diagnosis.
TREATMENT OF ASCITES ACCORDING TO AYURVEDA
Planet Ayurveda offers best effective remedies for Ascites. It may be cured through herbal remedies without dialysis or tapping if the treatment is started in early stage.
Punarnava Capsules are very helpful in ascites as it is very helpful in water retention. It helps in the elimination of excess fluid in the abdominal cavity through urine. It is a safe herbal supplement for the patients suffering from ascites. These capsules help in reducing swelling and inflammation in a natural way. It has diuretic properties and supports the body's ability in removing fluids. Thus, this herb is better than most of the diuretics available in the market.
Punarnava Mandoor tablets are used in various health conditions such as they are used to improve blood count, for removing toxins from the blood, help in decreasing urea or creatinine, cholesterol and toxins from the blood. These tablets are very useful for the patients suffering from ascites, liver failure, fluid accumulation, puffy eyes, anaemia, fatty liver and many other problems related with accumulation of fluid in the body tissues.
As the name suggests, Water Ex-tablet is a unique herbal formulation for the patients suffering from water retention. These tablets help in handling excess of fluid retention in the body. These tablets are natural and safe way to manage the problem.
Tripanchmool Ghan Vati is an Ayurvedic medicine frequently used for relieving urinary tract infections, scanty urination, water retention due to any cause. It reduces vitiated Pitta in the body. It consists of extract of five grass roots. Tripanchmoolghan Vati eliminates excess water and toxins from the body without unbalancing the electrolytes.
'Yakrit' means churna and 'Pliha' means spleen. This churna is a unique product of Planet Ayurveda and is a mixture of various herbs that help in improving the liver function. This churna helps in regenerating liver cells as well as improves its functions. It is a very useful remedy for the patients suffering from ascites as it is a mixture of wonderful herbs formulated by Ayurvedic experts of Planet Ayurveda.
These tablets are prepared from Saral (Pinus roxburghii). These tablets act as a natural diuretic, useful in inflammatory conditions, improves renal function and beneficial in the diseases of liver and spleen.
Dose: 1-2 tablets twice daily.
Avoid alcohol, excess use of salt, excess starch food products like rice, wheat, potato, milk derivatives, fast foods.
Various digestives such as cumin seeds, black pepper, chitrak, ginger should be included in the diet.
Contact my assistant to provide you the costing / ordering and delivery information at - costing.planetayurveda@gmail.com or call at +91-172-5214030
