This document discusses liver function tests (LFTs) and their role in diagnosing and managing different types of jaundice (kamala) according to Ayurveda. It covers: 1. The functions of the liver and an overview of LFTs and the values they indicate. 2. How LFT results can help distinguish between pre-hepatic, hepatic, and post-hepatic jaundice. Pre-hepatic jaundice shows elevated unconjugated bilirubin while hepatic jaundice shows elevated conjugated bilirubin and liver enzymes. 3. How correlating LFTs with clinical symptoms can aid in diagnosing koshtashakhas

1. Understanding
Liver Function Tests
in diagnosis and
management of
Kamala
KAMAL KISHORE
Post Graduate Scholar
Dept. of PG studies in Kayachiktsa
SKAMCH&RC Bangalore0

2. Contents
• Introduction
• Functions of Liver
• Liver Function Tests
• Liver Disease Classification
• Pre Hepatic Jaundice
• Koshtashakhasrita Kamala
• LFT in Koshtashakhasrita Kamala
1

3. 2
• Management of Koshtashakhasrita Kamala
• Hepatic Jaundice
• Shakhasrita Kamala
• LFT in Shakhasrita Kamala
• Alcoholic Liver Disease
• Management of Shakhasrita Kamala
• Post hepatic jaundice
• Ruddhapatha kamala
• Kumbhakamala
• Limitations of LFT
• Discussion
• Conclusion

4.  The liver is the second largest organ in the
body which plays central role in the
digestion & metabolism of proteins,
carbohydrates & lipids.
 The disease of the liver are a major cause for
the morbidity & mortality worldwide.
 One in forty deaths are due to liver diseases.3

5.  Liver function tests (LFTs) are group of
blood tests that give information about the
state of a patient's liver.
 These tests can be used to detect the
presence of liver disease, distinguish among
different types of liver disorders, gauge the
extent of known liver damage, and follow the
response to treatment.
4

6.  Most of the liver diseases cause only mild
symptoms initially, but these diseases must
be detected early
 Jaundice is a clinical sign of most of the
liver diseases.
 Medical Jaundice refers to any type of
Jaundice that can be managed by non-
surgical conservative measures.
5

7.  The liver disorders are seen in Ayurveda
mainly through the windows of Kamala.
6

8.  Liver is mainly responsible for the
production of bile (Bilirubin) and synthesis
of serum proteins (Albumin & Globulin).
 Breakdown of RBC in spleen leads to
unconjugated bilirubin production which is
transported to liver through blood where it
is converted to conjugated bilirubin.
7

9.  Bilirubin is stored in gall bladder as Bile
and is excreted into duodenum (s.intestine)
where it is converted into urobilinogen and
is excreted in stools(as stercobilinogen)
and in urine (as urobilinogen).
 A major portion of bilirubin is reabsorbed in
enterohepatic circulation.
8

10. Test Normal Values
Total Bilirubin 0.3 – 1.0 mg/dl
Conjugated B. (DB) < 0.3 mg/dl
Alkaline Phosphatase 30 – 120 mg/dl
Aspartate Transaminase (AST/SGOT) 5 – 40 IU/L
Alanine Transaminase (ALT/SGPT) 5 – 35 IU/L
S. Albumin 3.5 – 5.0 g/dl
S. Globulin 2.0 – 3.5 g/dl
A/G ratio 1.2 – 1.5
Prothrombin Time 12 – 15 sec
9

11. HEMOLYTIC JAUNDICE / PRE HEPATIC JAUNDICE
1.Inherited – Sickle cell Anaemia, Thalassemias,
Glucose6phosphate deficiency.
Gilbert Syndrome, Rotor’s Syndrome
3.Acquired – B12 deficiency, Folate deficiency.
10

12. HEPATOCELLULAR JAUNDICE / HEPATIC JAUNDICE
1.Viral Hepatitis – A, B, C, D, E
2.Parasitic Hepatitis – E. Histolytica
3.Autoimmune Hepatitis
4.Toxic Hepatitis – Drugs, Alcohol
11

13. OBSTRUCTIVE JAUNDICE / POST HEPATIC JAUNDICE
1.Primary biliary cirrhosis, Primary sclerosing
cholangitis.
2.Choledocholithiasis, parasitic infection, carcinoma,
traumatic biliary strictures.
12

14. PRE HEPATIC/
HEMOLYTIC JAUNDICE
Clinical
Features
Abdominal pain Only present in Crisis
Itching Absent
Past history
Drugs, Blood
transfusion
On
Examination
Icterus - color Lemon yellow
Pallor Present
Palpable gall bladder Absent
Splenomegaly Present
Bleeding tendency Absent 13

15. PRE HEPATIC/
HEMOLYTIC JAUNDICE
Liver
Function
Tests
Unconjugated/
Indirect Bilirubin
Raised
Conjugated/Direct Normal
AST or ALT Normal
A:G A>G (N)
Alkaline phos.& GGT Normal
Bile Salts & Bile Pigments Absent
14

16. Often associated with Pandu (Anaemia)
Pitta kara ahara & vihara leading to dagdhata of pitta
asrik & mamsa.
Chronic & slow onset.
Haridra Netra Twak Nakhaanana
Raktha Peeta Shakrit Mootra
Bheka Varna, Krusha & Durbala
Indriya daurbalya
Daha ,Aruchi Avipaaka,
Clinical Features
15

17. Total Bilirubin ranges btw 4-6 mg/dl
Usually Unconjugated B. > Conjugated B.
Here liver enzymes may not be affected.
Bile Salts & Bile Pigments are absent in urine.
As Pandu is associated = Complete Blood picture required.
16

18. Mridu Shodhana
(Virechana)
Shamana Rx
17

19.  Samsarjana krama (3 – 5 days)
 Pathya Sevana & continuation with Shamana aushadhi.
 Snehapana for a max of 3 - 4 days with
 Mahatiktaka gritha
 Kalyanaka gritha
 Panchagavya gritha
 Indukantha gritha
 Vishrama kala – 3 days (Ushanajala snana for swedana)
 Virechana karma with
 Trivrut lehya ( 30gms) + Draksa / Triphala kashaya
 Manibhadra guda ( 30gms )
 Katuki churna ( 10gms )
18

20. HEPATIC/
HEPATOCELLULR JAUNDICE
Clinical features
Icterus - color Orange yellow
Itching Transient
Past History
Contact with jaundice
patient, Drugs
On examination
Pallor Absent
Palpable gall
bladder
Not palpable
Splenomegaly May be present
Bleeding
tendency
Present
19

21. HEPATIC/
HEPATOCELLULR JAUNDICE
Liver
Function
Test
Unconjugated/
Indirect Bilirubin
Normal
Conjugated/Direct Increased
AST or ALT Markedly Raised
ALP & GGT Normal
A:G G>A (Chronic diseases)
Bile Salts & Bile Pigments Present
20

22.  Haridra Netra Mutra Twak
 Tila Pista Nibha Varchas
 Jwara. Aruchi
 Alpa Agni, Atopa
 Hrut Gaurava
 Daurbalya
 Hikka,Swaasa
• Acute in onset.
• Ashayapakarshaka hetu
Clinical Features
21

23. AST & ALT is raised in hepato - cellular
conditions/infective hepatitis.
ALT is generally greater raised than AST.
Usually ALP is raised in cholestatic/malignant
infiltrations
Usually Conjugated B. > Unconjugated B.
Bile Salts & Bile Pigments are present
Serological testing needed for – Hepatitis A, B, C, D, E
22

24. AST & ALT is raised in Alcoholic Hepatitis.
AST is greater raised than ALT.
Usually ALP is raised.
Usually Conjugated B. > Unconjugated B.
Albumin : Globulin ratio reversed
GGT is raised and is important marker of alcoholic
hepatitis.
23

25. Kaphahara chikitsa
Mridu Shodhana
(Virechana)
Shamana chikitsa
24

26. Kaphahara chikitsa
Katu, Teekshna, Ushna, Lavana, Amla Rasa
Pradhana dravyas like
 Kulattha yusha, Mulaka yusha
 Lemon juice + maricha (long & black) + Ardraka
swarasa with madhu
 Trikatu choorna with Madhu/Ardraka swrasa
25

27. Once the Mala Ranjana occurs
 Swasthaanam Aagatam Pittam
(Bile Pigments & Bile Salts Negative)
 Vayuscha Prashamam Bhavet
 Nivrutha Upadrava- jwara, atopa, vistamba,
hrit gaurva, daurbhalya, alpagni, aruchi.
Go for Mridu Shodana
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28. Mridu Shodana
 Snehana
 Mrudu Abhyanga & Usna Jala Snana
 Virechana Yogas like Gomutra Hareetaki
 Samsarjana Krama
 Pathya sevana
 Continuation of the Shamana till vyadhi shamana.
27

29. POSTHEPATIC /
OBSTRUCTIVE JAUNDICE
Clinical features
Icterus - color Greenish yellow
Itching Present
Past History
Pain(stones), weight
loss(neoplasm, surgery
(strictures)
On examination
Pallor Absent
Palpable gall
bladder
Palpable
Splenomegaly Absent
Bleeding
tendency
Absent
28

30. POSTHEPATIC /
OBSTRUCTIVE JAUNDICE
Liver
Function
Test
Unconjugated/
Indirect Bilirubin
Normal
Conjugated/Direct Increased
AST or ALT Increased
ALP & GGT Markedly increased
A:G G>A (Chronic diseases)
Bile Salts & Bile Pigments Present
29

31.  Common causes for Post hepatic
jaundice/obstructive jaundice are choledocholithiasis,
biliary strictures, tumors and after LFT, USG
abdomen is the usual choice of investigation.
 It is managed surgically.
30

32. Kalantarat kharibhoota
Shoona/ Shootha
Krishna peeta shakrit mootra, Rakta netra
Tandra, Moha
Aruchi, Nashtagni
Advanced liver diseases like cirrhosis,
encephalopathy etc has similar signs & symptoms as
that of Kumbhakamala like oedema, ascites, mental
confusions, coma, anorexia etc
31

33.  False positive
 False negative
 Rarely suggest a specific diagnosis
 Assess limited number of functions
 One testing = no diagnosis
 Misnomer
 Battery testing
 Repeated testing
32

34.  Assessing most of liver diseases is easy through
LFT.
 The pattern of abnormalities found in LFT
generally points to
 Pre Hepatic/Hepatic/Post Hepatic jaundice.
 Acute/Chronic Liver disease.
 Staging of a disease .
33

35.  Despite of bahupaittika nature of the
koshtashakhasrita kamala, the amount of
pitta/bilirubin that comes to settle in shakha/skin
and conjunctiva is far minimal. Therefore it
becomes reasonable to interpret and treat the
conditions associated with haemolytic jaundice on
the lines of koshtashakhasrita kamala where
pandu/anaemia is the pre stage for it.
34

36.  Based on the tilapishtanibha varchas found in
shakhasrita Kamala, it can be interpreted more
correctly as cholestatic phase of hepatocellular
jaundice which is an umbrella term and includes
many underlying pathologies like viral, bacterial,
alcoholic, autoimmune, drugs, tumor, granuloma etc
 Kumbhakamala as explained in Ayurveda is
kaalantarat (long term standing/progressed kamala)
which can be taken under Advanced Liver disease.
35

37.  Based on LFT, nidana & samprapti can be better
understood and vighatana can be planned
accordingly.
 LFT are very important as a documentation part to
assess the disease progression or regression.
36

38.  LFT is the first choice of Laboratory
investigations whenever a patient approaches
with hallmark of Kamala.
 Til pishta nibha varchas and LFT are the prime
considerations to diagnose types of Kamala.
 Every Kayachikitsak has to rule out Surgical
jaundice through LFT & Imaging techniques
before planning treatment.
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39. 38
 It is not advisable to completely rely only on LFT.
 Lakshanas and imaging techniques are to be
considered along with LFT for the accurate
diagnosis and management of kamala in a better
way.
“Rogamaadou parikshet tato anantaram
aushadham” (Cha.Ch.20/20)

40. THANK YOU39