Indian Journal of Health Sciences and Biomedical Research KLEU

CASE REPORT
Year
: 2015  |  Volume : 8  |  Issue : 2  |  Page : 142--146

Clinical profile of a case of alcoholic liver disease - An ayurvedic management


Vittal G Huddar, Mahadev P Mangane, Shweta Sheshappa Mumbaraddi 
 Department of Kayachikitsa, KLEU's Shri B M Kankanwadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka, India

Correspondence Address:
Vittal G Huddar
Department of Kayachikitsa, KLE University«SQ»s Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belgaum, Karnataka
India

Abstract

A 35-year-old male diagnosed with alcoholic liver disease (ALD) presented in outpatient department of Kayachikitsa with the complaints of yellowish discoloration of eyes, skin and dark urine, generalized itching, pale stools. Reduced appetite, nausea and disturbed sleep as alcohol withdrawal symptoms since 1-month. The modalities of treatment adopted were Nitya virechana (regular purgatives), Dronapushpi (Leucas cephalotes Spring.) Anjana (medicated collyrium) and shamanoushadhi (palliative drugs). The total duration of the treatment including follow-up was 80 days. After the comprehensive Ayurvedic intervention, there was a complete remission of symptoms with normal hematological parameters. Hence presenting this case is an evidence to demonstrate the effectiveness of Ayurvedic treatment in ALD.



How to cite this article:
Huddar VG, Mangane MP, Mumbaraddi SS. Clinical profile of a case of alcoholic liver disease - An ayurvedic management.Indian J Health Sci Biomed Res 2015;8:142-146


How to cite this URL:
Huddar VG, Mangane MP, Mumbaraddi SS. Clinical profile of a case of alcoholic liver disease - An ayurvedic management. Indian J Health Sci Biomed Res [serial online] 2015 [cited 2021 May 12 ];8:142-146
Available from: https://www.ijournalhs.org/text.asp?2015/8/2/142/174254


Full Text

 Introduction



Hepatobiliary disorders are the major concern in present gastrointestinal specialty practice contributed to a poor lifestyle and increasing use of alcohol. Chronic consumption of alcohol leads to a condition termed alcoholic liver disease (ALD). Even though the prevalence of this condition is seen more in western countries, it is also increasingly seen in countries such as India and Japan where traditionally there is a low prevalence of the disease. [1] The three most widely recognized forms of ALD are alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Alcoholic hepatitis may be presented in the form of increased level of bilirubin in the blood and are characterized by features of jaundice. Alcoholic hepatitis can vary from mild elevation of liver enzymes to even liver failure.

 Case Report



A 35-year-old, 56 kg moderately built male, belonging to a middle class household, suffering with ALD presented to Kayachikitsa outpatient department (OPD) for the complaints of yellowish discoloration of eyes, skin and dark urine, pale colored stool associated with generalized itching [Figure 1] and [Figure 2]. Reduced appetite, nausea and disturbed sleep were seen as symptoms of alcohol withdrawal, since 1-month. For the past 10 years, he had consumed approximately 360-540 ml of alcohol daily. He approached a local physician with these symptoms and was diagnosed with alcoholic hepatitis and treated for 10 days with standard of care. As the complaints were not satisfactorily reduced he opted for the Ayurvedic treatment. He was admitted for 17 days and discharged with follow-up advice which included oral medicines [Table 1]. Further five follow-ups at the interval of 15-20 days were done on OPD basis up till complete remission of the clinical symptoms. During the treatment and follow-ups the patient was completely abstaining from alcohol.{Figure 1}{Figure 2}{Table 1}

On physical examination

Icterus - +++, yellowish discoloration of oral mucosa, nasal mucosa, nails and skin, P/A - mild splenomegaly, no tenderness, pitting edema B/L LL, and slight puffiness of face.

Ultrasonography abdomen impression

Hepatitis, mild splenomegaly. Modified Maddrey's discriminant function calculation [2] value was 105.3 (value ≥32 is considered as poor prognosis). [3]

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), Peya (porridge) and Khichdi as Pathya were advised. Vegetable prepared out of Mulaka (radish), and Kulatha (horse gram) was advised initially for 6 days to help remove the Kaphavarodha. The fresh juice of Dronapushpi (Leucas cephalotes Spring) swarasa anjana[5] was done to eliminate the morbid sthanika pittadosha from the netra. Dronapushpi (Leucas cephalotes Spring.) is having pittarechana properties. Swadishta virechana choorna was administered for the purpose of pittarechana and anulomana [Table 1].

 Observations and Results



Clinical parameters: As the foremost, after the 3 rd day of the treatment the improvement was seen in the withdrawal symptoms (reduced appetite, nausea, and disturbed sleep) followed by gradual decrease in the yellowish discoloration of eyes, skin, and dark urine was seen [Figure 3]. After 8 days the pale colored stool regained normalcy. Generalized itching lasted for 1-month and did not recur later. On examination yellowish discoloration of sclera, mucus membrane, and skin were reduced to almost normalcy after the treatment [Figure 4]. Laboratory parameters: Liver Function Test almost came to normalcy after the treatment [Table 2]. The dark and brown urine color gained to normal color[Table 3]. Except the borderline increase in prothrombine time other parameters were within normal limits as shown in [Table 4].{Figure 3}{Figure 4}{Table 2}{Table 3}{Table 4}

 Discussion



The severe acute cases of alcoholic hepatitis, if not managed timely may land into complications such as hepatic encephalopathy and even early death at a rate of 50% or greater within 30 days. [6] The response will be accelerated with proper treatment along with alcohol cessation for longer period. The immediate attention and intervention is needed in the severe forms of hepatitis, as in the present case to avoid the complications. Bilirubin more than 20 mg/dl is considered as dangerous which may lead to complications, associated with poor prognosis, and even death. In such conditions, the glucocorticosteroids are widely used with some contraindications for 6-9 weeks in contemporary medicine, although their benefits have not been proven unequivocally. [6] In this case, significant reduction in bilirubin and other liver parameters were seen, without any steroid therapy within a span of 80 days. Thus faster recovery without the usage of glucocorticoids is documented here. During the treatment no supplements of thiamine and folate were given. As there was no evidence of bleeding tendency, the Vitamin K was also not considered in the management.

Irrespective of the different factors causing jaundice, the characteristic features of jaundice are akin to Kamala [Table 5] as explained in Ayurveda.{Table 5}

While discussing the causative factors for pandu (same for Kamala), the ushna, vidahi, and tikshna ahara have been considered. The Madhya (alcohol) can be considered as one among these, which causes pitta vriddhi, dagdhata of Asrik, Mamsa leading to Pitta/Raktapradoshajavikara pandu which finally roots Kamala. However, Kamala can occur as a swatantravyadhi (Independent disease) also.

Treatment principle

The treatment for the patients with severe alcoholic hepatitis is directed toward reducing liver injury, enhancing hepatic regeneration, and suppressing inflammation. Alcohol use must be stopped, and care should be taken to ensure good nutrition. The expected symptoms of alcohol withdrawal are to be managed appropriately. [6]

By considering the dosha (Pitta) and dushya (rakta, mamsa including twacha) the line of treatment was selected mainly as pitta and rakta shamana which in turn pacifies the Kamala. In this case, the steps followed in the management were koshtashodhana, Anjana, Shamana, and Pathyasevana. Treatment started with Katurasa, Katuvipaka, and Ushna virya drugs [9] and were followed by the Tikta, Madhura rasa, Madhura, vipaka, and Sheeta viryapradhana drugs to alleviate the Pravriddha Pitta.

Rationale of treatment

The initial treatment given was intended for the vriddhi[9] of pitta at Shaakha and to remove the obstruction caused by the Kaphadosha. It is understood that after the removal of the avarodha by Kapha with Katu rasa, Katu vipaka and Ushna veerya drugs, and the Shakhagata (deep seated, in tissues) vriddha pitta begins to move toward Koshtha (gastrointestinal tract). Once the Pitta reaches the Koshtha, it re colors the stool. At this stage, the patient is treated with Tikta, Madhura rasa, Madhura vipaka, Sheeta veerya and Anulomana drugs which will help in pacifying the vriddha pitta and mitigate the Kamala. Decrease in the bilirubin level at different intervals of treatment indicates the resolving state of the hepatic dysfunction.

 Conclusion



Ayurveda medicines have been known for their benefits in hepatobiliary disorders. This Ayurvedic treatment modality seemed feasible to apply in ALD, as it is both safe and effective. In the present practice, the patients with moderate hyperbilirubinemia were managed successfully with the part of the management strategy adopted here. In the present case where high increase in bilirubin was managed with little modification in the routine strategy of management of hyperbilirubinemia cases. The same line of treatment can be up taken for original research work to claim statistically. More in depth investigations and closer monitoring may help to further fine tune the regimen as needed.

Acknowledgment

I express my deep sense of gratitude to the Dr. B. S. Prasad, MD, PhD, Principal, KLE University's Shri B M Kankanawadi Ayurveda Mahavidyalaya, Shahapur, Belgaum for his encouragement and support. I also thank Dr. Shivakumar Harti for reviewing the article.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Walsh K, Alexander G. Alcoholic liver disease. Postgrad Med J 2000;76:280-6.
2Maddrey WC, Boitnott JK, Bedine MS, Weber FL Jr, Mezey E, White RI Jr. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978;75:193-9.
3Forrest EH, Morris AJ, Stewart S, Phillips M, Oo YH, Fisher NC, et al. The Glasgow alcoholic hepatitis score identifies patients who may benefit from corticosteroids. Gut 2007;56:1743-6.
4Nayak B. Ayurvedline. 8 th ed. Bangalore: Seetharam Prasad; 2005. p. 474.
5Dwivedi R, editor. Chakradatta of Indradev Tripathi, Paandurogachikitsa. 4 th ed., Ch. 8, Ver. 25. Varanasi: Chowkhambha Sanskrit Sansthan; 2002. p. 81.
6Heuman DM, Mukherjee S, Mihas AA. Alcoholic Hepatitis Treatment and Management; November 24, 2014. Available from: . [Last assessed on 2015 Jan].
7Sharma PV. Sushruta Samhita (Uttarardha). Uttara Tantra. 7 th ed., Ch. 44, Shloka no. 3. Varanasi: Chaukhamba Orientalia; 2002. p. 728.
8Acharya VJ. Charaka Samhita. Chikitsa Sthana. 5 th ed., Ch. 16, Shloka no. 34-36. Varanasi: Choukhamba Sanskrit Samsthana; 2001. p. 528.
9Acharya VJ. Charaka Samhita. Chikitsa Sthana. 5 th ed., Ch. 16, Shloka no. 130-31. Chakrapani Commentary. Varanasi: Choukhamba Sanskrit Samsthana; 2001. p. 532.