Fatty liver is the fastest growing epidemic in the world now. There is no known drug available to treat. Ayurveda medicines can reverse liver damage and help cure fatty liver in the early stages.

1. LIVER DISEASE
Dr. Lima Mathew MD, FAO

4. LIVER DISEASES
Liver disease is a general term that refers to any condition affecting your liver.
These conditions may develop for different reasons, but they can all damage
your liver and affect its function.
4 stages of liver disease:
1. Inflammation
2. Fibrosis
3. Cirrhosis
4. Liver failure

7. NAFLD - TYPES
Nonalcoholic fatty liver disease has two types:
❖ Simple fatty liver: This is the more common type, which entails presence of fat
in the liver without any inflammation or cell damage. It doesn’t normally get
worse and turn into a serious condition.
❖ Nonalcoholic steatohepatitis or NASH: Afflicting nearly one-fifth of those
having NAFLD, NASH signifies inflammation of the liver and is a much more
serious condition than a simple fatty liver. The cell damage and inflammation
can even lead to scarring of the liver including fibrosis and cirrhosis and even
liver cancer.

10. Other risk factors for NAFLD or NASH include:
● The elderly are more prone.
● If you have polycystic ovary syndrome.
● If you have sleep apnea.
● If you have hypothyroidism.
● If you have hypopituitarism (underactive pituitary gland).
● Malnourishment.
● Sudden weight loss.
● Exposure to certain toxins or chemicals.
Having metabolic syndrome which makes one more prone to
diabetes and heart disease.

13. The liver’s job is to break
down alcohol. If you drink
more than it can process, it
can become badly
damaged.
The effects of alcohol on the
liver depend on how much
and how long you have been
drinking.

14. What are the problems precipitated by ALD?
While alcoholic fatty liver disease is preventable and generally gets better once
you kick the bottle, it can also cause complex conditions like:
● Enlarged liver: This might cause pain or discomfort in the right upper side of
the tummy, However, it may not show any symptoms at all.
● Alcoholic hepatitis: This is an inflammatory condition of the liver which may
cause nausea and vomiting, fever, tummy ache and jaundice.
● Alcoholic cirrhosis: This is a serious condition, involving scar tissue buildup in
the liver. Besides similar symptoms like hepatitis, cirrhosis can also lead to
ascites or massive fluid buildup in the tummy, elevated blood pressure in the
liver, bleeding, enlarged spleen, confusion, and even liver failure. Alcoholic
hepatitis can over time turn into alcoholic cirrhosis.

15. How ALD damages the liver…..

16. What are the symptoms of alcoholic liver disease?
Fatty liver:
Often causes no symptoms
Build-up of fat inside the liver cells
enlarges the liver, causing upper
abdominal (belly) discomfort on the
right side
Tiredness and weakness
Weight loss
Alcoholic hepatitis:
Pain over the liver
Fever
Weakness
Nausea and vomiting
Appetite loss
Yellowing of the skin and eyes
(jaundice
Alcoholic cirrhosis:
Portal hypertension (increased resistance
to blood flow through the liver)
Enlarged spleen
Poor nutrition
Bleeding in the intestines
Ascites (fluid build-up in the belly)
Kidney failure
Confusion
Liver cancer
The effects of alcohol on the liver depend on how much and how long you have been drinking
alcohol. These are the most common symptoms and signs:

17. What are the complications of alcoholic liver disease?
About 30% of people with alcoholic liver disease have hepatitis C virus.
Others have hepatitis B virus.
People with alcoholic liver disease are also at greater risk for liver cancer.
About 50% have gallstones.
Those with cirrhosis often develop kidney problems, intestinal bleeding, fluid in the
belly, confusion, liver cancer, and severe infections.

21. Treatment - NAFLD
● Lifestyle modifications.
● If you are overweight or have obesity, losing weight by making healthy food
choices, limiting portion sizes, and being physically active can improve
NAFLD—either NAFL or NASH. Losing at least 3% to 5% of your body weight
can reduce fat in the liver.
● Use dietary supplements like Vitamins.
● Comorbidities like Insulin resistance, Type II DM, Dyslipidemia has to be
treated.
● No medicines have been approved to treat NAFLD—either NAFL or NASH.

22. TREATMENT - ALD
The most important part of treatment is to completely stop drinking alcohol.
Sometimes diet changes are advised, too.
Vitamin - E supplements.
The liver is often able to repair some of the damage caused by alcohol so that you
can live a normal life. In some cases, liver transplant may be considered. But you
must complete a rehab program and go through alcohol detox before this is even
an option.

23. AYURVEDA approach to fatty liver.
Considering the basic concepts of Ayurveda, it may be related to Dhatwagni vikara
which may arise from santarpanotha or apatarpanotha nidana.
FLDs are caused by an imbalance between Kapha and pitta dosha or elevated
Kapha dosha in pitta-dominant regions.
Other correlations - Raktavahasrotomoola medavridhi. Pittasthane kaphameda
vriddhi, pittasthane dhatwagni dushti, pitta stane medasanchaya.
Increased synthesis of fatty acids to liver - Dhatwagni vridhi.
Fat from Medasthana to liver - Ashayapakarsha
Fibrosis and cirrhosis - Dhatupaka

24. Samprapti
The Ranjaka pitta, which turns Apya Rasa Dhatu into Rakta Dhatu, is based in Yakrit.
It is also associated to Raktavahi and Mamsavahi Dhamani and is the Mulasthana of
Raktavahasrotas. Yakrit is a significant Koshthanga that is closely linked to the Rasa, Rakta, and
Mamsa Dhatus and plays a significant part in the Dhatu Parinama.
Agnivikruti causes the creation of Apakva Anna Rasa, which causes the vitiation of Kaphadosha
and uneven formation and deposit of Medas in Yakrit.
Srotorodha is caused by vitiated Kapha and Meda - Vata prakopa.
Vata prakopa - Agnidushti, and the cycle continues.
Pitta involvement - Inflammation - NASH- 2nd step.
Extreme Vata prakopa - fibrosis develops, and the condition may advance to Cirrhosis, ascites, and
hepatocellular carcinoma, as well as other metabolic problems.

25. Samprapti ghataka
Dosha- Samanavayu, Apanavayu, Pachakapitta, Ranjakapitta, Kledaka kapha,
Dushya- Rasa, rakta, medo dhatu.
Srotas - Annavaha, Udakavaha, Rasavaha, Raktavaha, Medovaha, and
Pureeshavaha.

26. Agnideepana, Rookshana, Srotosodhana, pacification of Kapha, Meda and Vata should be the first line
of treatment in the management of Fatty Liver.
Here, the treatment principle adopted is almost similar to that of Sthaulya.
The probable treatment for Steatohepatitis includes:
"ushnam kaphamedoharam vyasaharam rasayanam"
Treatment protocol:
● Dipana-pachana-rukshana
● Snehapana
● Vamana,
● Virechana,
● Basti
● Rasayana prayoga
When the fatty liver reaches the next stage and the Dhatus get engaged, therapy should focus on the
purification of Rasa and Rakta, as well as Yakritshothahara.

27. Shodhana
● Pachana - Panchakola churna 5 gm twice a day before food. Arogyavardhini
vati 250mg twice a day after day (srotoshodhana).
● Snehana - Mahatiktaka ghrita/Panchatiktaka ghrita 10ml thrice a day before
food. Panchatiktaghrita formulation is Medanashana and Lekhana.
● VIRECHANA - Avipatti, Erandataila, Trivrit Avaleha, Misraka sneha etc.
SHAMANA
● Kashaya - Vasaguduchyadi, Phalatrikadi, Drakshadi, Patola
Katurohinyadi
● Arishta - Sudarshanaarishta, Rohitakarishta, Pippalyasava,
Bringarajasava.
● Churna - Hinguvachadi, Vaiswanara etc.

28. ALD TREATMENT IN AYURVEDA
Ayurveda treatment includes nidanaparivarjana, Vyadhipratyanikaaushadhis,
hepatoprotectives, Virechana drugs, use of Pathyapathya, dietetics, Rasayana ,
Nutritives, Pittaharadravyaprayoga, daily walking, changing lifestyle and practice
of Yogasanas and Pranayama.
Medicines having following properties:
Pittahara - Kharjuradimantha , Shadangapaniya, Usheerasava
Tiktarasayukta - Bhunimbadikashaya, Mahatiktakakashaya, Guduchyadikashaya
Mruduvirechana - Haritakichoorna, Triphalachoorna, Trivrutchoorna.
Brimhana & ojaskara - Kooshmandavaleha, Shatavariguda, Balarishtam,
Aswagandharishta etc.
Rasayana - Arogyavardhini rasa, Shatavariguda, Drakshadi lehya etc.