The role of Pancakarma in the management of liver diseases

Dr. Abhay Kulkarni

Introduction
Liver is the most important and the largest internal organ of our body, essential for our survival. It performs more than 500 functions combined with other organs. Because of its strategic location and multidimensional functions it is connected to almost every organ in our body. Its function cannot be replaced or outsourced; in terminal cases Liver transplant is the only option to which unfortunately not many people have an access.

Liver diseases are a considerable burden on the family and the society. Liver Diseases are the fifth highest killer of mankind. Conventional medicine has limited options when it comes to conservative treatment and Ayurveda amongst the Alternative systems has the upper edge owing to Panchakarma therapy a unique tool in its arsenal.

Ayurveda and liver diseases
Liver is referred to as ‘Yakrut’ in Ayurveda. It is appropriately discussed in Ayurvedic texts, and it is important to note that Ayurveda’s understanding of the anatomy, physiology and pathology of Liver is quite different from conventional medicine, obviously Ayurveda’s approach to the diagnosis and treatment of Liver diseases will be and is very different. It is essential to be conversant with Ayurvedic understanding of Liver in order to treat its diseases with Ayurvedic approach.

The description of diseases of organs like Liver, Kidney, Brain etc and their diseases in Ayurveda is not like that of conventional medicine; hence we don’t find a separate mention of those diseases in separate chapters, they are dealt with Dosha Philosophy. The methodology of applying it is elaborately mentioned in classical Ayurvedic texts like Charaka Samhita. This philosophy if applied correctly leads to successful management of not only Liver diseases but also many other diseases which are mentioned very briefly or even those which are not at all mentioned in Ayurvedic texts. This paper will discuss the application of Dosha philosophy and methodology in diagnosis and treatment of various Liver diseases.


Most important questions that arise in this context are; can Liver diseases be cured with Ayurvedic treatments? If yes, which? to what extent? and in how much time? Recent cases of various liver diseases treated at Ayushree Ayurvedic Hospital & Research centre that will be presented will discuss in detail the modalities used for the Ayurvedic diagnosis and treatment of liver diseases and role of Panchakarma in its treatment. This evidence based presentation will prove the point that Liver diseases can be treated with Ayurveda but it is also important to share the methodology (Ayurvedic Diagnosis and principles of treatment) of successful management of liver diseases so that the results can be replicated by others and more and more people are benefitted with Ayurvedic Treatments.

Diagnosis of Liver Diseases in Ayurveda
Since Liver is connected to almost all organs, impairment of its functions can be caused by various causes. Infections, incorrect lifestyle and eating habits, alcohol abuse, drugs, pollution etc are the main causes identified as responsible for liver diseases. The arena of liver diseases is extensive ranging from acute hepatitis to cirrhosis and carcinoma of Liver. Conventionally Blood investigations, Ultrasound, MRI etc are used to diagnose the exact cause and type of liver disease.

These investigations are essential but not enough to treat them with Ayurvedic medicines. Ayurvedic treatment does not mean merely using herbs in place of chemicals. It is the thought process based on Doshic philosophy involved in interpreting the symptoms and deciding the pathogenesis by ascertaining the causes and choosing medicines or modes of treatment accordingly that makes the differentiation, for this Ayurvedic interpretation of these diseases is essential because Ayurvedic medicines are designed to act according to Ayurvedic Diagnosis. Hence it is essential to make an Ayurvedic diagnosis of these diseases.
The liver diseases and their probable Ayurvedic Diagnosis is enlisted in the table below:

Sr. No   Type of Liver disease Details  Ayurvedic Diagnosis 
 1  Infections –  Acute Hepatitis (A, B, C, D, E)  Pittaja Jwara
 2    Chronic Hepatitis (A, B, C, D, E)   Pandu – Shotha
 3  Fulminant Hepatic Failure    Kumbha Kamala
 4  Cirrhosis / Portal Hypertension  With or without Ascites  Yakrutodar/ Pleehodar
 5  Non alcoholic Fatty liver Disease -  Cholesterol or triglycerides may accumulate  Impaired lipid metabolism
Meda dhatwagni mandya
 6  Bile flow can be obstructed –  Cholestasis, Obstructive Jaundice  Rudhapatha Kamala
 7  Liver tissue can be damaged –  by minerals, chemicals etc  Gara Visha - Intoxication
8 Cancer, space occupying lesion   Arbuda, Granthi
9 Alcoholic Liver Disease Alcohol abuse Madatyaya
10 Liver abscess   Yakrut Vidradhi

In these diagnoses it is also important to understand the Dosha Dominance as the treatment will vary according to the dominance of Dosha. It may be noted that different types of Liver diseases are diagnosed as different diseases. It is done due to interpretation of pathogenesis and symptoms according to Doshic philosophy and the method of understanding diseases in Ayurveda, e.g. Acute hepatitis the causative factor is infection manifested as fever the pathogenesis and symptoms are very similar to Jwara that to of pitta type.

Role of Panchakarma
Panchakarma which can be described as the cleansing therapy or way of detoxification in Ayurveda, but it has a bigger role in treating diseases. It is a unique way of treating diseases which has no parallel in other pathies of medicine. In Ayurvedic way of treatment Panchkarma is advised when the extent of Dosha imbalance is very high, when the physician expects faster recovery and complete cure. It is believed that diseases and conditions treated with Panchakarma do not recur. Panchakarma is used for prevention, cure and rejuvenation. In liver diseases role of Panchakarma is manifold, it expels the excess pitta from the blood circulation and the system, restores the Agni i.e. the digestive fire, increases the efficiency and rejuvenates the hepatic cells. In addition it serves the main purpose of stopping the disease process and reversing the pathogenesis. In Ayurveda’s terminology it is called as breaking the chain of pathogenesis i.e. samprapti vightana. It is due to Panchakarma that Ayurvedic treatments are able to treat many liver diseases fully and completely.

In case of Panchakarma choice of right type of procedure and the condition in which it will be done matters a lot also deciding how much cleansing needs to be done is the key decision. Not every type of Panchakarma is suitable / required to every patient in every condition and in every climate, it is important to watch for and remember the contraindications for Panchakarma, as wrong decision may cause sufficient harm to the patient. While deciding any type of Panchakarma, the strength (Bala) of the patient, his age and physical as well as mental capacity is the prime thing that needs to be taken into consideration.

Generally Virechana is the type of Panchakarma useful for most of the liver conditions, Basti, yapana basti is very useful in conditions of cirrhosis. Raktamokshan is useful in conditions of hepato-splenomegaly. Wamana is also helpful in certain diseases particularly fatty liver diseases.

Diet, internal medication and right Panchakarma can successfully treat major liver diseases.

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