The Details of Yakrut Roga is cited clearly for Study & can be included in BAMS curriculum

1. 1
सुस्वागतम्

2. यकृ त ् रोग & लक्षण
- A CASE STUDY
BY
Dr. ABDUL SUKKUR M
M D ( Ayu. ) Scholar
Dept. Of P G Studies in Samhita
S D M College of Ayurveda , Udupi
Under the Guidance of
Dr. Shrikanth P H M D ( Ayu. )
Professor & Head
Dept. Of P G Studies in Samhita
S D M College of Ayurveda , Udupi 2

3. A RESEARCH PROBLEM ?
3

4. INTRODUCTION
 Ayurveda – the life science
 Gives good & elaborate knowledge of
many diseases
 Explaining the signs , symptoms & pathogenesis
 Yakrit Roga is one among them
 Can understand as liver disease
4

5. YAKRIT - POSITION , ORIGIN
अधो दक्षक्षणतश्चापि हृदयाद् यकृ तः स्स्िततः ।
तत्तु रञ्जकपित्तस्य स्िानं शोणणतजं मतम् ॥
[ भा. प्र. म. ख. ३३ / १० ]
गभभस्य यकृ त्प्लीहानौ शोणणतजौ .... [ सु. सं. शा. ४/३५ ]
o Situated in the right side inside the Abdomen
o Seat of Ranjaka Pitta
o Originated from Shonita ( Rakta )
o Susruta as one of प्रत्पयङ्ग & Charaka as कोष्टाङ्ग 5

6. LIVER - LARGEST GLAND
o 1400-1600Gram ( MALE ) ;
1200-1400 Gram (FEMALE) - WEIGHT
o 2 main anatomical lobes - RIGHT & LEFT
o 2 Lobes separated by fold of Peritoneum called FALCIFORM LIGAMENT
o Inferiorly a fissure for LIGAMENTUMTERES
o Posteriorly a fissure for LIGAMENTUMVENOSUM
 HISTOLOGY – 3 Zones i) Zone 1- Periportal or peripheral area
ii) Zone 2- intermediate mid zonal area
iii) Zone 3- centrilobular area
 Zone 1 – suffers effects fromTOXIC INJURY
 Zone 2 – suffers effects from HYPOXIC INJURY 6

7. LIVER FUNCTIONS
 Manufacture & Excretion of Bile
 Manufacture of Proteins - Albumin , Fibrinogen , Prothrombin
 Metabolism of Proteins , Carbohydrates , Lipids
 Storage ofVitamins ( A , D , B12 ) & Iron
 Detoxification of Toxic substances such as Alcohol & Drugs
 For Manufacture & Excretion of Bile
 Serum Enzyme Assays
 For Metabolic Functions
 ImmunoligicalTests
 Ancillary DiagnosticTests
LIVER FUNCTIONTESTS -
7

8. YAKRIT ROGA
 Explained as a separate Roga
in BhavaPrakasha
 Madyama Khanda in
PleehaYakritVikaara Adhyaya ( Chapter – 33 )
 Given importance to Pleeha Roga
Explained in relation with Pleeha Roga
 Other treatises explain under Udara Roga 8

9. तनदान , सम्प्प्रास््त of ्लीहा रोग
पवदाह्यभभष्यस्ददरतस्य जदतोः प्रदुष्टमत्पयिभमसृक् कशश्च ।
्लीहा ऽ भभवृद्धध कु रुतः प्रवृद्धौ तं ्रीहसञ्ञं गदमामनस्दत ॥
वामे च िाश्वे िररवृद्धधमेतत पवशेषतः सीदतत चातुरो ऽ त्र ।
मददज्वरास््नः कशपित्तभलङ्गैरुिद्रुतः क्षीणबलो ऽ ततिा्डुः ॥
[ भा. प्र. म. ख. ३३/२-३ ]
[ सु. सं. तन. ७/१४-१६ , मा. तन. ३५/१५-१६ ]
्लीहामयस्य हेत्पवादद समस्तं यकृ तामये ।
ककदतु स्स्िततस्तयोञेया वामदक्षक्षणिाश्वभयोः ॥
[भा. प्र. म. ख. ३३/१०]
9

10. सव्यादयिाश्वे यकृ तत प्रवृधे ञेयं यकृ द्दाल्युदरं तदेव ॥
[ सु. सं. तन. ७ , मा. तन. ३५/१७ ]
उदावतभरुजानाहैमोहतृड्दहनज्वरैः ।
गौरवारुधचकादिदयैपवभद्यात्तत्र मलान् क्रमात् ॥
[ अ. हृ. तन. १२ , मा. तन. ३५/१८ ]
्लीहोदरं - यकृ द्दाल्युदरं
10

11. लक्षण of ्लीहा रोग
वातिक पैत्तिक कफज रक्िज
तनत्पयमानधकोष्िःस्िान् सज्वर मददव्यिः क्लम
तनत्पयोदावतभिीडडतः सपििास स्िूल भ्रम
वेदनाभभः िरीतः सदाह कदिनः पवदाह
मोहसंयुत गौरवास्दवतः वैव्यं
िीतगात्र अरोचके न संयुक्त गात्रगौरवं
मोह
रक्तोदरत्पवं
[ Ref. भा. प्र. म. ख. ३३/ ४-७ ]
11

12. LIVER DISEASES
VIRAL HEPATITIS - A , C , D , E , G ( RNAVIRUS )
- B ( DNAVIRUS )
 OTHER INFECTIONS
& INFESTATIONS - Cholangitis , Pyogenic Liver Absess
- Amoebic Liver Absess , HepaticTuberculosis
- Hydatid Disease , Hepatotoxicity
 CIRRHOSIS - ALCOHOLIC ( Common )
Features - 3 Types - Alcoholic Steatosis / Fatty Liver
- Alcoholic Hepatitis
- Alcoholic Cirrhosis ( most common , 60-70%)
12

13. LIVER DISEASES
 JAUNDICE - Prehepatic / Haemolytic
- Hepatic
- Posthepatic cholestatic
 NEONATAL JAUNDICE
 HEPATIC FAILURE - Acute & Chronic
 LIVER CELL NECROSIS - Diffuse , Zonal , Focal
 PORTAL HYPERTENSION
 HEPATIC TUMOURS - BENIGN & MALIGNANT 13

14. साध्यासाध्यता
दोषत्रत्रतयरूिाणण ्लीह्दयसाध्ये भवदत्पयपि ।
[भा. प्र. म. ख. ३३/८]
जदमनैवोदरं सवं प्रायः कृ च्छ्रतमं मतम् ।
बभलनस्तदजाताम्प्बु यत्तत्पसाध्यं नवोस्त्पितम् ॥
[ च. सं. धच. १९ , मा. तन. ३५/१९ ]
14

15. ्लीहा – यकृ द् रोग धचककत्पसा
्रीहोद्ददष्टाः कक्रया सवाभ यकृ द्रोगे समाचरेत् ।
कायभञ्च दक्षक्षणे बाहौ तत्र शोणणतमोक्षणम् ॥
[ भा. प्र. म. ख. ३३/२० ]
क्षारं पवदडङ्गकृ ष्णाभयां िूतीकस्याम्प्भु तनःसृतम् ।
पिबेत्पप्रतयभिावस्ह्न यकृ त्प्लीहाप्रशादतये ॥ [ भा. प्र. म. ख. ३३/२१ ]
• उदधध शुस्क्त क्षार + दु्ध , पि्िली चूणभ + दु्ध
• शङ्खनाभभरजः + जम्प्बीरशलरस ( शाण प्रमाणं = ¾ Gram )
• दहङ्गु + त्रत्रकटुकं + कु ष्िं + यवक्षारं + सैधवं + मातुलुङ्गरस
• सुिक्व सहकार रस ( well ripened Mango juice ) + क्षौद्र
• यवातनका + धचत्रक + यावशूक + षड्रस्दि + ददती + मगधोत्पभवं ( सवं चूणं )
in उष्णाम्प्भु or मस्तु or सुरा or आसव
• पि्िली भापवता in िलाशक्षारतोय – ्लीहागुल्मापत्तभशमनी & वस्ह्नमादद्यहरी
Rx
15

16. ्रीहा – यकृ द् रोग धचककत्पसा
 सवभमेवोदरं प्रायो दोषसङ्गातजं मतम ् ।
तस्मास्त्पत्रदोषशमनीं कक्रयां सवभत्र कारयेत् ॥
दोषैः कु क्षौ दह वस्ह्नमभददत्पवमृच्छ्छतत ।
तस्माद् भोज्यातन भोज्यातन दीिनातन लघूतन च ॥
[ च. सं. धच. २३/९५-९६ ]
 दोषाततमात्रोिचयात्परोतोमागभतनरोधनात् ।
सम्प्भवत्पयुदरं तस्मास्दनत्पयमेवं पवरेचयेत् ॥ [ अ. हृ. धच. १५/१ ]
 अग्र्यौषधं – ......्लीहामये पि्िली [ अ. हृ. उ. ४०/४८ ]
 Formulations –
 नारायणं चूणं
 िटोलाद्यं चूणभ
 हिुषाद्यं चूणं
 नीभलदयाद्यं चूणं
 रोहीतक घृतं
 स्नुदहक्षीरघृतं
Rx
16

17. THE RESEARCH PROBLEM WAS KNOWN
AND
THE SOLUTION IS WITH YOU
17

18. A Case Study
PERSONAL DATA
AÉiÉÑU lÉÉqÉ : Mr. R OP No. : 3014
वय: : 26 years IP No. : 529
ÍsÉ…¡ : Male Ward: Male
(Gen.Ward-57)
ÌlÉuÉÉxÉ xjÉÉlÉ : Baindoor,
Kundapur mÉëuÉåzÉ ÌSlÉɃ¡û :
Sidkuli, Udupi. 19/07/2014
eÉÉÌiÉ : Hindu
ÌlÉaÉïqÉlÉ ÌSlÉɃ¡ :
10/09/2014
ÌuɱÉprÉÉxÉ : 9th Standard
व्यवसाय : Coolie Worker Data Collected-
24/08/2014
वैवाहिकि : Married
18

19. प्रधान वेदना
C/O कटीशूल since 1 Year
सन्धध वेदना since 8 months
गमनकष्टिा & कृ च्छ्रश्वास since 6 months .
अनुबधध वेदना
शोफ in पाद उपरर भाग , आनन & उदर
दौबबल्य (General Weakness)
Difficulty in movement of body parts & in
Walking .
Case Study Contd...
19

20. Case Study Contd...
mÉëkÉÉlÉ uÉåSlÉÉ वृिÉliÉ
The patient was said to be normal 18 months before he was
a normal coolie worker and worked for 8 years, the work includes carrying
loads in the head like bricks, etc.. One day while he was working and
carrying load when going upside suddenly he felt uneasiness and by fainting
fell down.
After some days he had वेदना in both जानु सन्धधs and
elbow joints. For this he consulted a physician in Udupi. At that time he also
developed अन्ननमाध्य and शरीर भारक्षय. During the treatment in Udupi he
had शोफ in the उदर and upper side of the पाद for which they instructed the
patient to walk more ; but by walking more the पाद शोफ increased .
The patient also had शरीर दौबबल्य. The patient was poor
and hence he can’t afford the expenses of medicines prescribed in the
Clinic in Udupi. Then he consulted us. 20

21. Case Study Contd...
पूवब व्याधध वृिाधि:
 H/O No DM , HTN
कु ल वृिाधि:
 Father : Died 3 years before due to Heart Attack
 Mother : Alive, no major complaints
 He was married & had 2 daughters ( studying for B.com & SSLC )
 Wife : Said to be with no complaints
He had 5 brothers and 2 sisters.He was the 2nd son.
No other member in the family had other diseases.
21

22. Case Study Contd...
xÉÉqÉÉÎeÉMü uÉרÉÉliÉ
The Patient was a coolie worker and belongs to low
economic status. He was treated in clinics and he can’t afford the
expenses as Hospital charges and medicines. Then he consulted
us. The Patient was very co-operative.
uÉærÉÌ£üMüवृिाliÉ
mÉÔuÉïMüÉsÉÏlÉ A±iÉlÉMüÉsÉÏlÉ
AÉWûÉU Vegetarian Vegetarian
ÌlÉSìÉ अतनद्रिा सम्यक्: (7 to 8 hours)
AÎalÉ qÉlSÉÎalÉ xÉqÉÉÎalÉ
कोष्ठ मध्यम कोष्ठ मध्यम कोष्ठ 22

23. Case Study Contd...
UÉÍzÉ
mÉÔuÉïMüÉsÉÏlÉ A±iÉlÉMüÉsÉÏlÉ
BREAK FAST
Idli or Dosa
with vegetable curry
Rava Upputtu
LUNCH
Ganji Rice with
curry
Ganji Rice with curry
DINNER
Ganji Rice with
curry
Ganji Rice with curry
23

24. Case Study Contd...
अनुक्रम परीक्षााः
Respiratory System : श्वसनवेग -22 times/min.
Cardio vascular System: नाडी -84 times/min.
रक्ि मदब-140/90 mm of Hg.
हृदय वेग-84 beats/min.
Per Abdomen : शूल by self
शूल onpalpation in right side
abdominal distension present
Skeletal System : शूल present in all सन्धध s
Movements – of body parts with difficulty
- difficulty observed in walking
long distance & long time
24

25. Case Study Contd...
Face : NAD Neck : NAD
Chest : NAD Skin : NAD
25
अष्ट स्थान परीक्षा:
1. नाडड परीक्षा: स्पंदन - प्राकृ ि: (84 beats/min)
2. मूत्र परीक्षा: - प्राकृ ि: - 3-4times/day - 2 times/night
3. मल परीक्षा: - प्राकृ ि: - Once in a day
4. न्जह्वा परीक्षा: -- लेप: - ललप्ि , वर्ब: - लाला वर्ब
5. शब्द परीक्षा: - प्राकृ ि 6. स्पशब परीक्षा: - शीि स्पशब
7. दृक् परीक्षा: - वैकृ ि with शोफ
8. आकृ ति: - मध्यम

26. Case Study Contd...
 दशत्तवध पररक्षा:
 1. प्रकृ तत: - वात पित्त
 2. पवकृ तत: WåûiÉÑ-Due to intake of excess EwhÉÉ, MüOÒû रस AÉWûÉU,
दधध, qÉÉwÉ xÉåuÉlÉ andअततव्यायाम
 दोष: - वात, पित्त ; दूष्य - रस, रक्त
 3. सार: - मध्यम सार , 4. सत्पव: - मध्यम ( वेदना सहः)
 5. संहनन: - मध्यम ( qÉkrÉiuÉÉiÉç xÉÇWûlÉlÉxrÉqÉkrÉoÉsÉÉ pÉuÉÎliÉ|)
6. xÉÉiqrÉ: - मध्यम (bÉ×iÉ, ¤ÉÏU, iÉæsÉ iÉjÉÉ xÉuÉïUxÉ, mÉëuÉU xÉÉiqrÉ
äÉxÉÉiqrÉ iÉjÉÉ LMü UxÉ, AuÉUxÉÉiqrÉ)
7. प्रमाण: - मध्यम (Height- 5.5 feet )
 8. आहार शस्क्त: - अभयवWûरण शस्क्त: - मध्यम
 जरण शस्क्त: - मध्यम
 9. व्यायाम शस्क्त: िूवभकालीन: - प्रवर , अध्यतन: - मध्यम
10. वय: - oÉÉलं – 16 to 30 ( cÉ.ÌuÉ8/ 122 )
26

27. Case Study Contd...
 कोष्ठ परीक्षा:
 - मध्यम कोष्ठ
 - Patient feels hungry after the previous food is digested.
 - Patient daily passes the stools without any difficulty.
xÉëÉåiÉÉå mÉUϤÉÉ
 1. रसवि - अरूधि, आस्यवैरस्य, दौबबल्यिा
 2. ESMüuÉWû -ÌmÉmÉÉxÉ
3. A³ÉuÉWû - A³ÉÉÍpÉsÉÉwÉ,AUÉåcÉMü
( स्रोिो दुन्ष्ट लक्षर्: - त्तवमागब गमन )
 तनदान mÉÇcÉMü
 1. तनदान: - आिार
- Excess intake of EwhÉÉ,कटु रस
- Intake of दधध
- Intake of qÉÉwÉÉProducts like Idli, Dosha, etc
27

28. Case Study Contd...
त्तविार - आिप सेवन andsheetala अम्बु mÉÉlÉ
- अतिव्यायाम(Coolie worker- carrying load)
 MüqÉïeÉ - AkÉïqÉ,- पूवब जधमकृ ि , - पररर्ाम , - प्रभाव
 2. mÉÔuÉïÃmÉ - शरीर uÉåSlÉ ,- मूत्रSÉW
 3. ÃmÉ - AlaÉqÉSï,- ÌlÉSìÉlÉÉzÉ,- दौबबल्य , उदर शोफ
4. xÉÇmÉëÉÎmiÉ
ÌlÉSÉlÉ xÉåuÉlÉ
uÉÉiÉ त्तपि mÉëMüÉåmÉ along withU£ü mÉëMüÉåmÉ
mÉëMÑüÌmÉiÉ SÉåwÉÉ moves from their place
ZÉ वैaÉÑhrÉiÉ in रस , U£ü
SÉåwÉ SÕwrÉxÉqqÉÔcNïûlÉ take place
Leading to उदर शोफ , दौबबल्य, गमनकष्टिा 28

29. Case Study Contd...
 5. उपशय and अनुपशय
 उपशय - आिार ( Vata Pitta shaamaka aahara,etc)
- औषधध , - ÌuÉ´ÉqÉÇ
 अनुपशय - आिार( Vata Pitta vardhaka aahara,etc)
- AÉrÉÉxÉ
INVESTIGATIONS
Hb 11.8 gm%
TOTAL WBC COUNT 6900 cells/cumm
PLATELET 3.77 lakhs/cumm
NEUTROPHILS 60%
LYMPHOCYTES 32%
MONOCYTES 5%
EOSINOPHILS 3%
R.B.C COUNT 3.79 millions/cumm
M.C.H 31.0 picogram
P.C.V 37.8%
M.C.V 100.0 fl
M.C.H 31.0 picogram
M.C.H.C 31.1%
R.D.W 12.4%
RBS 87 mg/dl
29

30. Case Study Contd...
ESR 17.0mm in 1st hour
MPV 6.70cu.mm
PERIPHERAL SMEAR Normocytic
Normochromic Blood Picture
BLOOD UREA -SERUM 15.0 mg/dl
S.CREATININE 1.1 mg/dl
S.POTASSIUM 5.1mEq/L
HIV SPOT SERUM Non Reactive
HbS Ag SPOT TEST Non Reactive
INVESTIGATIONS
USG-ABDOMEN(Dtd. 10/06/2014)
Liver – Enlarged (Hepatomegaly)
USG- SCROTUM(Dtd.10/06/2014)
Left Testes is enlarged, ill defined
Hypoechoic Lesion in Upper Pole.
Increased Vascularity is seen.
Left Epididymis is enlarged with
Hypoechoic Lesion –moderate
 urÉÉÍkÉ ÌuÉÌlɶÉrÉ - यकृ ्दाल्युदरम ् 30

31. Case Study Contd...
Treatment given :-
 Padolakaturohinyadi Kashayam 15ml Bd
 Gorochanadi gutika 1-1-1
 Lavana – amla varjita food - all for 1 week.
 Padolamoolaadi Kashayam 15ml Bd
 Gorochanadi gutika o-1-o , Vilvadi gutika 1-o-1
 Trivrit lehya 1 & 1/2 tsp. with warm water Hs.
 Eishad lavana – amla sahita food - all for next 1 week.
 Guloochyaadi Kashayam 15ml Bd , Dhanvantharam gutika 1-o-1
 NavayasaChoornam 5 gm Bd with warm and cooled water
 Trivrit Choornam 5 gm with warm water Hs. – all for next 1 week.
 Balaguloochyaadi Kashayam 15ml Bd , Dhanvantharam gutika 1-o-1
 TriphalaadiChoornam 5 gm with warm water Hs. – on Discharge. 31

32. CONCLUSION
 The Liver Diseases are explained
along with the Spleen Diseases inAyurveda .
 This can be understood by incorporating the
knowledge of contemporary Medical Science .
 A few references are now available in Ayurveda
regarding Liver Diseases as a separate entity .
 So a detailed Study and Researches are necessary
for the proper understanding of the Disease .
 Liver Disorders can be treated with the better
understanding the treatment concepts inAyurveda
considering the health condition of the whole body.
32

33. Acknowledgements:
 Dr. Shrikanth P H , Guide
 All the teaching staff of the Department
 Classmates and freinds
 My parents and family members.
33

34. REFERENCES :
 भावप्रकाशः मध्यम ख्डं अ – ३३
 सुश्रुत संदहता तनदान स्िानं अ – ७
 चरक संदहता धचककत्पसा स्िानं अ – २३
 माधव तनदानं अ – ३५
 अष्टाङ्ग हृदयं धचककत्पसा स्िानं अ – १५
 Text Book of Pathology 6th Edition By Harsh Mohan
Chapter 21 , Page Numbers 592 – 648
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35. 35
लोकाः समस्ताः सुणखनो भवदतु।
धदयवादः