Friday, 25 March 2016

Nanatmaja Vyadhi

Qualities, Diseases, Treatment Of Vata, Pitta and Kapha – Charaka Samhita Sutrasthana 20

The 20th Chapter of Charaka Samhita Sutrasthana is called as Maharoga Adhyaya. This is one of the most important chapters. It enlists diseases caused by individual Tridosha – Vata, Pitta and Kapha, qualities of Tridosha, how they cause disease, patho-physiology and their line of treatment .
General classifications of diseases:

चत्वारोरोगाभवन्ति- आगन्तुवातपित्तश्लेष्मनिमित्ताः; तेषांचतुर्णामपिरोगाणांरोगत्वमेकविधंभवति, रुक्सामान्यात्; द्विविधापुनःप्रकृतिरेषाम्, आगन्तुनिजविभागात्; द्विविधंचैषामधिष्ठानं, मनःशरीरविशेषात्; विकाराःपुनरपरिसङ्ख्येयाः, प्रकृत्यधिष्ठानलिङ्गायतनविकल्पविशेषापरिसङ्ख्येयत्वात् ||३||
catvārorogābhavanti- āgantu vāta pitta śleṣma nimittāḥ; teṣāṃ caturṇāmapi rogāṇāṃ rogatvamekavidhaṃ bhavati, ruksāmānyāt; dvividhā punaḥ prakṛtireṣām, āgantu nija vibhāgāt; dvividhaṃ caiṣām adhiṣṭhānaṃ, manaḥ śarīra viśeṣāt; vikārāḥ punaraparisaṅkhyeyāḥ, prakṛtyadhiṣṭhāna liṅgāyatana vikalpa viśeṣāparisaṅkhyeyatvāt ||3||
There are four types of diseases viz.
Agantuja – due to exogenous causes such as injury, poison etc,
Vatika – Vata imbalance disorders,
Paittika – Pitta imbalance disorders and
Shlaishmika – Kapha imbalance disorders.
Pain being common to all, diseases are finally of one type (ruk samanyaat).
Diseases are again of two types depending on their nature,
Agantuja – that  is exogenous and
Nija – endogenous.
They are again of two types
Shareera Adhishtana – somatic and
Mano Adhishtana – psychic-depending on the sites of their  manifestation viz. body and mind.
Diseases are in fact innumerable in as much as the immediate causes, (like improper diet and regimen) Permutation and combination of various factors of Doshas are innumerable (Aparisankhyeya) . [3]
General  causative factors:

मुखानितुखल्वागन्तोर्नखदशनपतनाभिचाराभिशापाभिषङ्गाभिघातव्यध- बन्धनवेष्टनपीडनरज्जुदहनशस्त्राशनिभूतोपसर्गादीनि, निजस्यतुमुखंवातपित्तश्लेष्मणांवैषम्यम्||४||
mukhānitukhalvāgantornakhadaśanapatanābhicārābhiśāpābhiṣaṅgābhighātavyadha- bandhanaveṣṭanapīḍanarajjudahanaśastrāśanibhūtopasargādīni, nijasyatumukhaṃvātapittaśleṣmaṇāṃvaiṣamyam||4||
The Agantuja Roga – exogenous diseases are caused by
Nakha – nails,
Dashana – teeth,
Patana – fall,
Abhichara – spell,
Shaapa – curse,
Abhishanga – psychic afflictions including demoniac seizure,
Abhighata – injury,
Vyadha – piercing,
Bandhana – bandage,
Veshtana – rapping,
Peedana – application of pressure,
Rajju – binding by rope,
Dahana – fire,
Shastra – weapon,
Ashani – thunderbolt,
Bhuta – demoniac seizure,
Upasarga – natural calamities etc.
The Nija Rogas – endogenous diseases are caused by the imbalance ofTridosha – Vata, Pitta and Kapha. [4]
Three basic causative features all diseases:

द्वयोस्तुखल्वागन्तुनिजयोःप्रेरणमसात्म्येन्द्रियार्थसंयोगः, प्रज्ञापराधः, परिणामश्चेति||५||
dvayostukhalvāgantunijayoḥpreraṇamasātmyendriyārthasaṃyogaḥ, prajñāparādhaḥ, pariṇāmaśceti||5||

Asatmya Indriya Artha Samyoga – Unwholesome contacts between the sense organs and their objects,
Prajnaparadha – intellectual blasphemy, acting against one’s conscience
Parinama – Effects of time constitute the common causative factors for both the exogenous and endogenous types of diseases.[5]

सर्वेऽपि तु खल्वेतेऽभिप्रवृद्धाश्चत्वारो रोगाः परस्परमनुबध्नन्ति, न चान्योन्येन सह सन्देहमापद्यन्ते ||६||
sarve’pi tu khalvete’bhipravṛddhāścatvāro rogāḥ parasparamanubadhnanti, na cānyonyena saha sandehamāpadyante ||6||

All these four types of diseases when aggravated do share the symptoms of each other. Even then, the distinctive features of each one of them are too clearly manifested avoiding any confusion.[6]
Role of Doshas in the pathogenesis of exogenous and endogenous diseases:
The exogenous diseases (Agantu Roga) begin with pain and then they bring about the disturbance in the Tridosha balance.
The endogenous diseases begin with the disturbance in the Tridosha balance, and then result in pain.[7]
So, in both Njia and Agantu diseases, ultimately Tridosha balance is noted.
Physiological sites of Doshas in the body:
Place of Vata Dosha – 
बस्तिः पुरीषाधानं कटिः सक्थिनी पादावस्थीनि पक्वाशयश्च वातस्थानानि, तत्रापि पक्वाशयो विशेषेण वातस्थानं;
bastiḥ purīṣādhānaṃ kaṭiḥ sakthinī pādāvasthīni pakvāśayaśca vātasthānāni, tatrāpi pakvāśayo viśeṣeṇa vātasthānaṃ;

Basti – Urinary bladder, urinary system
Pureeshaadhaana – rectum,
Sakthi – waist,
Padau – thighs, legs,
Asthi – bones and
Pakvashaya – colon are the sites of Vata
Among them, Pakvashaya (colon) is the most important site.
Related: How Vata Dosha dominates different parts of the body
Place of Pitta Dosha –

स्वेदो रसो लसीका रुधिरमामाशयश्च पित्तस्थानानि, तत्राप्यामाशयो विशेषेण पित्तस्थानम्;
svedo raso lasīkā rudhiramāmāśayaśca pittasthānāni, tatrāpyāmāśayo viśeṣeṇa pittasthānam;

The important sites of location of these three Doshas are as below:
Svedo – Sweat,
Rasa – Rasa dhatu – end product of food digestion, containing all nutrients
Lasika – Lymph,
Rudhira – blood,
Amashaya – small intestine(lower part of Amashaya) are the sites of pitta;
Among them, small intestine (lower part of Amashaya) is the most important site of Pitta Dosha.
Related: How Pitta influences different body parts
Place of Kapha Dosha –

उरः शिरो ग्रीवा पर्वाण्यामाशयो मेदश्च श्लेष्मस्थानानि, तत्राप्युरो विशेषेण श्लेष्मस्थानम्||८||
uraḥ śiro grīvā parvāṇyāmāśayo medaśca śleṣmasthānāni, tatrāpyuro viśeṣeṇa śleṣmasthānam||8||

Ura – Chest,
Shira – head,
Greeva – neck,
Parva – joint,
Amashaya – stomach (upper part of Amashaya) and
Meda – fat are the sites of Shleshma (Kapha).
Among them, chest is the most important site of Kapha Dosha. [8]
Related: How Kapha dominates different body parts <
General functions of balanced Doshas:

सर्वशरीरचरास्तु वातपित्तश्लेष्माणः सर्वस्मिञ्छरीरे कुपिताकुपिताः शुभाशुभानि कुर्वन्ति- प्रकृतिभूताः शुभान्युपचयबलवर्णप्रसादादीनि, अशुभानि पुनर्विकृतिमापन्ना विकारसञ्ज्ञकानि||९||
uraḥ śiro grīvā parvāṇyāmāśayo medaśca śleṣmasthānāni, tatrāpyuro viśeṣesarvaśarīracarāstu vātapittaśleṣmāṇaḥ sarvasmiñcharīre kupitākupitāḥ śubhāśubhāni kurvanti- prakṛtibhūtāḥ śubhānyupacayabalavarṇaprasādādīni, aśubhāni punarvikṛtimāpannā vikārasañjñakāni||9||

All the three Doshas are present in all parts of the body. These Doshas, in normal balanced condition, cause good health and in imbalanced condition, they cause illness.
When they are balanced, they cause
Upachaya – body nourishment
Bala – improvement of strength and immunity
Varna Prasada – improvement of skin health and complexion [9]
Diseases caused by Tridosha Imbalance: 
Endogenous diseases (Nija Roga) again are two types viz,
Samanyaja Vyadhi – diseases caused by Vata, Pitta and Kapha in different combinations and
Nanatmaja Vyadhi – specific diseases caused by individual Doshas – Vata, Pitta and Kapha.
Samanyaja Vyadhi – Diseases of the combined Doshas are explained in the preceding chapter and diseases caused by individual imbalanced Doshas are being explained here.
Nanatmaja Vyadhi –
Diseases caused by individual Doshas –
Vata when imbalanced alone, causes 80 types of disorders
Pitta when imbalanced alone, causes 40 types of disorders
Kapha when imbalanced alone, causes 20 types of disorders. [10]
Eighty diseases caused by Vata alone – Vataja Nanatmaja Vyadhi:
Though Vata imbalance diseases are innumerable, the following eighty diseases are the most commonly manifested ones:
1. Nakhabheda (cracking of nails)
2. Vipadika (cracking of feet)
3. Pada shoola (pain in foot)
4. Pada Bhramsha (foot Drop)
5. Pada Suptata (numbness of foot)
6. Vata khuddata (club foot)
7. Gulpha Graha (stiff ankle)
8. Pindikodveshtana (cramps in calf muscle)
9. Gridhrasi (sciatica)
10. Janu Bheda (Genu varum)- Bow leggedness, bandiness
11. Januvishlesha (Genu valgum) – Knock Knee
12. Urustambha( stiffness of thigh)
13. Urusada (pain in the thigh)
14. Pangulya (paraplegia)
15. Guda Bhramsa (prolapsed rectum)
16. Gudarti (Tenasmus)
17. Vrushanakshepa (pain in scrotum)
18. Shepha Stambha (stiffness of penis)
19. Vankshana anaha (tenstion of groin)
20. Shroni Bheda (pain around the pelvic girdle)
21. Vidheda (diarrhea)
22. Udavarta (bloating)
23. Khanjatva (lameness)
24. Kubjatva (kyphosis)
25. Vamanatava(dwarfism)
26. Trikagraha (stiffness of sacro-iliac joint)
27. Prsistagraha (stiffness of back)
28. Parshva Marda (pain in chest)
29. Udaraveshta (Gripping pain in abdomen)
30. Hrit Moha (braby cardia)
31. Hrit Drava (tachycardia)
32. Vaksha- Udgharsha (rubbing pain in chest)
33. Vaksha- Uparodha (impairment of thoracic movement)
34. Vakshastoda (stabbing pain in chest)
35. Bahu Shosha (atrophy of arm)
36. Greeva Stambha (stiffness of the neck)
37. Manyastambha (torticollis)
38. Kanthoddhvamsa(hoarseness of voice)
39. Hanu Bheda (pain in jaw)
40. Ostha Bheda (pain in lips)
41. Akshi Bheda (pain in eye)
42. Danta Bheda (toothache)
43. Danta Shaithilya (looseness of tooth)
44. Mookatva (aphasia / dumbness)
45. Vak Sanga(stalling speech)
46. Kashaya asyata (astringent taste in mouth)
47. Mukha shosha (dryness of mouth)
48. Arasajnata(ageusia) – loss of taste function
49. Ghrana Nasha(anosmia) – loss of smell function
50. Karna Shoola (ear ache)
51. Ashabda Shravana (tinnitus)
52. Ucchaih Shruti (hard hearing)
53. Badhirya (deafness)
54. Vartma Stambha (Ptosis of eye lid)
55. Vartma Samkocha (entropies)
56. Timira(amaurosis) – a type of vision loss
57. Akshi Shoola (pinching pain in eye)
58. Akshi Vyudasa (Ptosis of eye ball)
59. Bhru Vyudasa (ptosis of eye brow)
60. Shankha Bheda (pain in temporal region)
61. Lalata Bheda (pain in frontal region)
62. Shiro Ruk (headache)
63. Kesha bhumi sphutana (dandruff)
64. Ardita(facial paralysis)
65. Ekanga Roga (monoplegia)
66. Sarvanga Roga (polyplegia)
67. Pakshavaha (hemiplegia)
68. Akshepaka (convulsion)
69. Dandaka (tonic convulsion)
70. Tama (fainting)
71. Bhrama (giddiness, dizziness)
72. Vepathu (tremor)
73. Jrumbha (yawning)
74. Hikka (hiccup)
75. Vishaada(asthenia) – weakness, depression
76. Ati Pralapa (delirium) – excessive irrelevant talk
77. Raukshya (dryness)
78. Parushya (hardness)
79. Shyava Arunaava Bhasata (dusky red appearance)
80. Asvapna (sleeplessness)
81. Anavasthita chittatva (unstable mind). [9-11]
Qualities of Vata Dosha – how it is exhibited in Vata Nanatmaja diseases – 

तद्यथा- रौक्ष्यं शैत्यं लाघवं वैशद्यं गतिरमूर्तत्वमनवस्थितत्वं चेति वायोरात्मरूपाणि; एवंविधत्वाच्च वायोः कर्मणः स्वलक्षणमिदमस्य भवति तं तं शरीरावयवमाविशतः ; तद्यथा- स्रंसभ्रंसव्याससङ्गभेदसादहर्षतर्षकम्पवर्तचालतोदव्यथाचेष्टादीनि, तथा खरपरुषविशदसुषिरारुणवर्णकषायविरसमुखत्वशोषशूलसुप्तिसङ्कोचनस्तम्भनखञ्जतादीनि च वायोः कर्माणि; तैरन्वितं वातविकारमेवाध्यवस्येत्||१२||
tadyathā- raukṣyaṃ śaityaṃ lāghavaṃ vaiśadyaṃ gatiramūrtatvamanavasthitatvaṃ ceti vāyorātmarūpāṇi; evaṃvidhatvācca vāyoḥ karmaṇaḥ svalakṣaṇamidamasya bhavati taṃ taṃ śarīrāvayavamāviśataḥ ; tadyathā- sraṃsa bhraṃsa vyāsa saṅga bheda sāda harṣa tarṣa kampavarta cāla toda vyathā ceṣṭādīni, tathā khara paruṣa viśada suṣirāruṇa varṇa kaṣāya virasamukhatva śoṣaśūla supti saṅkocanastambha nakhañjatādīni ca vāyoḥ karmāṇi; tairanvitaṃ vātavikāramevādhyavasyet||12||
In all the pure Vata diseases, enumerated or implied, the inherent natural qualities and actions of Vata are quite obviously manifested wholly or partially and as such it is not difficult for a competent physician to correctly diagnose the Vatika type of diseases;
Raukshya – Rookshata – roughness,
Shaitya – Sheetata – coolness,
Laaghava – Laghu – lightness
Vaishadya – clarity, non-sliminess,
Gati – movement,
Amoortata – shapelessness,
Anavastitatva – instability- these are the inherent qualities of Vata.
Related: How to understand Tridosha by its qualities
Vata Dosha while moving moving from one part of the body, if abnormal, exhibits symptoms like –
Sramsa – looseness,
Bhramsa – dislocation,
Vyasa – expansion,
Sangha – obstruction,
Bheda – separation,
Saada – depression,
Harsha – excitation,
Tarsha – thirst,
Kampa – trembling,
Varta – circular movement,
Chaala – motion,
Toda – piercing pain,
Vyatha – aching pain,
Cheshta action, etc.
Khara – coarseness,
Parusha – harshness,
Vishada – non-sliminess,
Sushira – porousness,
Aruna Varna – reddishness, (colour of sunrise)
Kashaya – Astringent taste
Virasa Mukhatva – tastelessness in the mouth,
Shosha – wasting pain,
Shoola – pain,
Supti – numbness,
Samkocha – contraction,
Sthambhana- rigidity and
Khanjata – lameness, etc. – these are the actions that help a competent physician to diagnose the pure Vatik type diseases.[12]
General principles of treatment of Vata disorders:
Madhura, Amla Lavana Snigdha Ushna Upakrama – The vitiated Vata should be treated by drugs having sweet sour and saline taste and unctuous and hot qualities
Snehana – oleation,
Sveda – fomentation, sweating treatment
Asthapana – decoction enema
Anuvasana – oil enema
Nasyakarma – nasal instillation of drops,
Bhojana – healthy diet,
Abhyanga – massage,
Utsadana – unction,
Parisheka – sprinkling of oil / liquid  containing materials having anti-Vata properties.
This is to be done with due regard to the dosage and the season.
Importance of Basti treatment in Vata disorders – 
Of all the treatments stated above, the Asthapana (decoction enema) and Anuvasana (oil enema) are the treatment par excellence for the cure of Vatik diseases, because immediately after entering the colon, they strike at the very root of the vitiated Vata and when Vata is overcome in the colon, even the entire vitiated Vata dwelling in other parts of the body is automatically alleviated.
This can be likened to the cutting of the root of a tree which result in the automatic fall of the trunk, branches, sprouts, flowers, fruits, leaves, etc.[13]
Related: How to balance Vata Dosha
Forty specific diseases of Pitta – Pittaja Nanatmaja Vyadhi –Now we shall explain the forty varieties of diseases due to the vitiation of Pitta. Even though the diseases due to the vitiation of Pitta are innumerable, the following forty varieties are the most commonly manifested.
1. Osha (heating)
2. Plosha (scorching)
3. Daha (burning)
4. Davathu (boiling)
5. Dhoomaka (fuming)
6. Amlaka (acid eructation)
7. Vidaaha (pyrosis) – heart burn
8. Antar daaha (burning sensation inside the body)
9. Amsa daha ( burning sensation in shoulder)
10. Ushmaadhikya (excessive temperature)
11. Ati Sveda (excessive sweating)
12. Anga gandha (bad odour of thee body)
13. Angaavadarana(cracking pain in the body)
14. Shonita kleda(sloughing of the blood)
15. Mamsa kleda (sloughing of the muscle)
16. Tvak Daaha( burning sensation in the skin)
17. Charma dalana(itching of the skin)
18. Tvagavadarana (cracking of the skin)
19. Rakta kotha (urticaria)
20. Rakta visphota (red vesicle)
21. Rakta Pitta(bleeding tendency)
22. Rakta mandala (red wheals)
23. Haritatva (greenishness)
24. Haaridratva (yellowishness)
25. Neelika (blue moles)
26. Kaksha (herpes)
27. Kaamala (jaundice)
28. Tiktaasyata (bitter taste in month)
29. Lohita Gandhasyata (smell of blood from the mouth)
30. Pooti mukhata(foetid odour of mouth)
31. Trishnaadhikya (excessive thirst)
32. Atrupti (non-satisfaction)
33. Aasya Vipaka (stomatitis)
34. Gala paka(pharyngitis)
35. Akshi paka (conjunctivitis)
36. Guda paka (proctitis)
37. Medhra Paka(inflammation of the penis)
38. Jivadana(hemorrhage)
39. Tamah pravesha (fainting)
40. Harita haridra netra mutra varchas (greenish and yellowish coloration of eyes, urine & faeces)[14]
Patho- physiology of Pitta diseases:In all the Paittika type of diseases enumerated or implied, the inherent natural qualities and actions of Pitta are quite obviously manifested wholly or partially and as such it is not difficult for a competent physician to correctly diagnose the Paittika type of diseases.
Qualities of Pitta –

औष्ण्यं तैक्ष्ण्यं द्रवत्वमनतिस्नेहो वर्णश्च शुक्लारुणवर्जो गन्धश्च विस्रो रसौ च कटुकाम्लौ सरत्वं च पित्तस्यात्मरूपाणि;
auṣṇyaṃ taikṣṇyaṃ dravatvamanatisneho varṇaśca śuklāruṇavarjo gandhaśca visro rasau ca kaṭukāmlau saratvaṃ ca pittasyātmarūpāṇi;

The inherent natural qualities of Pitta are
Aushnya – Ushna – heat,
Taikshnya – Teekshna – sharpness,
Dravatva – liquidity,
Anati Sneha –  slight unctuousness, mild oiliness,
all colors except white and red,
Visra Gandha – fishy smell,
Katu, Amla – acrid and sour tastes
Saratva – fluidity.
Pitta imbalance symptoms –
Daaha – burning sensation,
Aushnya – ushna – heat,
Paaka – suppuration,
Sveda – perspiration,
Kleda – sloughing,
Kotha – putrification,
Kandu – itching,
Srava – discharge,
Raaga – redness,
and exhibition of its inherent smell, color and taste.
General principles of treatment for Pitta diseases:
Madhura, Tikta Kashaya – Pitta is treated with herbs having sweet, bitter and astringent tastes
Sheeta – cooling qualities and
Snehana – oleation
Virechana – purgation,
Pradeha – unction,
Parisheka – effusion,
Abhyanga – massage, etc. procedures done with herbs havin anti Pitta qualities.
This is of course to be done with due regard to the dosage and season.
Importance of Virechana in Pitta imbalance –Of all the devices stated above, the purgation is the treatment par excellence for curing the Paittika diseases because, immediately after it is administered, it eliminates the vitiated Pitta from its very root from the level of intestines. When it is overcome in the Amasaya (small intestine), it alleviates the entire vitiated Pitta dwelling in other parts of the body. This can be likened to a hot chamber being cooled by removing the fire from inside it.[16]
Related: How to balance Pitta Dosha 
Twenty types of kaphaja diseases – Kaphaja Nanatmaja Vikara
Now we shall explain the twenty verity of diseases due to the vitiation of Kapha. Even though, the diseases due to the vitiation of Kapha are innumerable; the following are the twenty varieties which are most commonly manifested.
1. Trupti (anorexia nervosa)
2. Tandra (drowsiness)
3. Nidraadhikya(excessive sleep)
4. Staimitya (timidness)
5. Guru Gatrata (heaviness of the body)
6. Alasya (laziness)
7. Mukha Maadhurya (sweet taste in mouth)
8. Mukha Srava (salivation)
9. Shleshmodgirana (mucus expectoration)
10. Malaadhikya (excessive excretion of excreta)
11. Balasaka (loss of strength)
12. Apakti (indigestion)
13. Hrudayopalepa (feeling as if heart is wrapped up with moisture)
14. Kantopalepa (phlegm adhered to throat)
15. Dhamani Pratichaya (hardening of vessels)
16. Galaganda (goiter)
17. Ati Sthaulya (obesity)
18. Sheetaagnita(suppression of digestive powder)
19. Udarda (urticaria)
20. Shvetaavabhasata (pallor), Shveta Mutra Netra Varchastva (whiteness of urine, eye and faces)[17]
Pathophysiology of kaphaja diseases:

एवंविधत्वाच्च श्लेष्मणः कर्मणः स्वलक्षणमिदमस्य भवति तं तं शरीरावयवमाविशतः; तद्यथा- श्लेष्मणः कर्माणि; तैरन्वितं श्लेष्मविकारमेवाध्यवस्येत्||१८||
In all the Shlaishmika (Kaphaja) type of diseases enumerated or implied, the inherent natural qualities and actions of Kapha are quite obviously manifested fully or partly and as such it is not difficult for a competent physician to correctly diagnose the shlaishmika type of diseases.
Qualities of Kapha –

तद्यथा- स्नेह शैत्य शौक्ल्य गौरव माधुर्य स्थैर्य पैच्छिल्य मार्त्स्न्यानि श्लेष्मण आत्मरूपाणि;
tadyathā- sneha śaitya śauklya gaurava mādhurya sthairya paicchilya mārtsnyāni śleṣmaṇa ātmarūpāṇi;
Sneha – Unctuousness,
Shaitya – coolness,
Shauklya – whiteness,
Gaurava – heaviness,
Maadhurya – sweetness,
Sthairya – steadiness,
Paicchilya – sliminess
Maartsnya – viscosity- three are the inherent qualities of kapha.
Kapha brings about following attributes to the body

श्वैत्य शैत्य कण्डू स्थैर्य गौरव स्नेह सुप्ति क्लेदोपदेह बन्ध माधुर्य चिरकारित्वानि;
śvaitya śaitya kaṇḍū sthairya gaurava sneha supti kledopadeha bandha mādhurya cirakāritvāni;

Shvaitya – Shveta – whiteness
Shaitya – Sheeta – coolness
Kandu – itching
Sthairya – steadiness, stability
Gaurava – heaviness,
Sneha – unctuousness, oiliness,
Supti – numbness,
Kleda – moistness, stickiness,
Upadeha – sliminess, as if being anointed with oil,
Bandha – binding, obstruction
Madhurya – sweetness,
Chirakaritva – slowness, delay in manifestation- these are the actions that help a competent physician to diagnose diseases caused by kapha.[18]
General principal of treatment for Kaphaja diseases:
They (diseases due to vitiated Kapha) should be treated with
Katu Tikta Kashaya – herbs having pungent, bitter, astringent taste,
Teekshna Ushna Rooksha – treatments and medicines having sharp, hot and dryness qualities
Sveda – fomentation, sweating
Vamana – emesis, vomiting therapy,
Shiro Virechana – elimination of Doshas from the head by Nasya procedure,
Vyayama – exercise etc, which should all contain materials having Anti- Slaismika properties.
This is of course to be done with due regard to the dosage and season. Of all the devices stated above, emetic therapy is the treatment par excellence for the cure of diseases due to Kapha because immediately after entering the Amashaya – stomach, it strikes at the very root cause of the vitiation of Kapha and when it is overcome in the stomach, even the entire vitiated Kapha dwelling in other parts of the body is automatically alleviated. This can be likened to the withering away of paddy, barley, etc. for want of barrier of the cornfield (full of water) being broken.[19]
Related: How to balance Kapha Dosha
Importance of diagnosis in treatment:

रोगमादौ परीक्षेत ततोऽनन्तरमौषधम्|
ततः कर्म भिषक् पश्चाज्ज्ञानपूर्वं समाचरेत्||२०||
यस्तु रोगमविज्ञाय कर्माण्यारभते भिषक्|
अप्यौषधविधानज्ञस्तस्य सिद्धिर्यदृच्छया||२१||
यस्तु रोगविशेषज्ञः सर्वभैषज्यकोविदः|
देशकालप्रमाणज्ञस्तस्य सिद्धिरसंशयम्||२२||
rogamādau parīkṣeta tato’nantaramauṣadham|
tataḥ karma bhiṣak paścājjñānapūrvaṃ samācaret||20||
yastu rogamavijñāya karmāṇyārabhate bhiṣak|
apyauṣadhavidhānajñastasya siddhiryadṛcchayā||21||
yastu rogaviśeṣajñaḥ sarvabhaiṣajyakovidaḥ|
deśakālapramāṇajñastasya siddhirasaṃśayam||22||
Thus it is said:
A physician should first of all diagnose the disease and then he should select proper medicine. Thereafter, he should administer the therapy applying the knowledge of the science of medicine, he had already gained.
A physician who initiates treatment without proper diagnosis of the diseases can accomplish the desired object only by chance (he cannot be sure of his success);
The fact that he is is well- acquainted with the knowledge of application of medicine does not necessarily guarantee his success. On the other hand, the physician who is well-versed in diagnosing diseases, who is proficient in the administration of medicines and who knows about the dosage of the therapy that varies from place to place and season to season, is sure to accomplish the desired objective.[20-22]
To sum up:-
In this chapter – Maha Roga Adhyaya, the enlightened sage has fully dealt with the following subjects: classification, nature, sites of manifestation, specific and general causative factors, interchangeability and specific identity of diseases, sites of Doshas, enumeration of specific diseases due to Doshas, invariable signs and actions of Doshas separately along with their treatment.[23-25]
Thus ends the twentieth chapter of Charaka Samihta Sutrasthana, of Agnivesa’s work as redacted by Charaka.[20]

Ayurvedic aspect of FLD and treatment

Ayurvedic aspect of FLD and treatment

It is very difficult to compare any particular condition explained in Ayurveda with FLD. In fact I have tried to get some extracts from different contexts so as to compile some approximate material which falls into the discussion area with FLD.
In Ayurveda, Yakrit is a name given to the Liver. Pleeha / Pliha is the name given to the Spleen. According to Ayurvedic science Yakrit and Pleeha are both inter-related organs which serve the same physiology and are related to the formation and maturation of blood. The roots of Raktavaha Srotas (channels which are related to the formation and carrying of matured blood) lie in Yakrit and Pliha.
Yakrit is said to be the place of origin or production and maintenance centre for Pitta. A subtype of Pitta called Ranjaka Pitta is said to be located in Yakrit vis-à-vis Liver and Pleeha vis-à-vis Spleen. Ranjaka means to colour. When the Rasa Dhatu (the first tissue formed in the gut in the form of essence of food, as a result of action of the Agni or digestive fire over the food – lymph / chyle) enters the Yakrit and Pleeha, it is subjected to action by Ranjaka Pitta i.e. Ranjaka Pitta acts on the Rasa Dhatu and imparts red colour to it and transforms it into Rakta Dhatu or blood tissue. Thus Yakrit and Ranjaka Pitta are responsible for the formation and maturation of Rakta.
In this context we shall discuss only about Yakrit as the Pitta sthana (seat of Pitta).
Kapha and Pitta link in FLD
Cold environment in Hot ZoneSince Yakrit is a Pitta Sthana, it should be a seat of Agni or fire. Because according to Ayurvedic theory the fire is located in our body in the form of Pitta and there is no other Agni apart from Pitta. Thus the basic temperature of Yakrit is hot owing to the presence of Pitta, a form of fire. Yakrit controls many activities in our body including emotions and thought processing. As long as its area remains hot, its immunity and physiology is at its best. But when it loses its heat due to some reason and if cold prevails and dominates this hot zone of Yakrit, it slows or shuts down in terms of its functions. This forms a point of origin for many systemic diseases.
This Ranjaka Pitta when gets diminished in its quantity and quality along with its neighbouring Pachaka Pitta (subtype of Pitta located in the stomach and intestines), the whole Pitta zone or Zone of Fire gets weak, thus reducing their micro-fragments located in each and every cell and also influencing negatively on their other subtypes. Thus the whole metabolism becomes sluggish, immunity of cells take a dip and leads to wide array of health issues, some stubborn and long standing ones too.
What do we mean by cold building in the hot zone?As per Ayurveda theory all the 3 factors which rule and control our life, the Tridosha’s i.e. Vata, Pitta and Kapha are moving all through the body through blood media, being motivated and pushed by Vata.
Vata and Kapha are cold elements which balance and buffer the body and cellular heat. On the contrary they have the capacity to reduce the heat when they gain pathological increase and to empower the heat zone. Thus when the heat of Yakrit gets reduced by the predominant cold of Kapha and Vata passing through Yakrit, the liver tends to slow down in its functions and get lazy. Vata being a self motivated entity doesn’t get stagnant at one place but it is Kapha which has a tendency to accumulate and get stagnant in areas and conditions favourable to it.
Every cell of our body is also an abode of Vata, Pitta and Kapha. If the Pitta located in the liver cells decrease it leads to favourable conditions for the kapha to get increased.
Other than Rakta (blood) and Asthi (bones) all other tissues of the body are predominant in Kapha bhava or cold factors (more fluidity). This includes Rasa dhatu (essence of food or primary nutrient), Mamsa dhatu (flesh), Meda dhatu (fat), Majja dhatu (marrow) and Shukra dhatu (semen). All these tissues (or nutrients or forming elements of these tissues – parinamamapadhyamaana dhaatu) in their micro-form are also passing through the Liver before entering into the circulation to nourish the tissue proper. When the liver fails to metabolize or process these Kapha predominant dhatus, mainly abaddha medas (unbound fat or free fat) they tend to accumulate in the liver (liver cells) and cause local blocks, further deteriorating the liver physiology.
Thus according to Ayurveda we can put forth a hypothesis that Fatty Liver occurs when there is excess concentration or accumulation of the below said (by reducing the heat in the liver):
  • Kapha in circulation
  • Local Kapha
  • Kapha predominant dhatus especially the free medas (fat)
Thus FLD can be termed as a ‘Kaphavrita Pitta’ (Kapha blocking or enveloping Pitta, cloud around the sun or snow around fire condition) condition taking place in Liver. The concealed Pitta or fire within the envelope of Kapha also does some pathological damage in the form of causing inflammatory changes in the liver. The Vayu getting blocked by both Pitta and Kapha or aggravated due to the destructive process within the liver tends to destroy the liver cells and cause fibrosis and cirrhosis, though this part of pathology is expected to take place in a later context.
Note: Kapha accumulates due to its Guru (heavy), Snigdha (unctuous), Picchila (Slimy or sticky) etc nature
Avoid Kapha increasing foods and lifestyle activities in FLD
Kapha Prakopaka Hetu (Factors influencing pathological increase of Kapha) –
Among many causative factors leading to pathological increase of Kapha the below said also influence the progression of FLD:
  • Divasvapna – Day sleep, sedentary lifestyle
  • Avyayama – Absolutely doing no exercise or activities
  • Alasya – Spending the day lazily, Procrastination
Excessive consumption of the food predominant in:
  • Madhura – Sweet taste
  • Amla – Sour taste
  • Lavana – Salt
  • Sheeta – Cold
  • Snigdha – Oily or fatty
  • Guru – Heavy to digest
  • Picchila – Slimy or sticky
  • Abhisyandi – Those which cause blocks in the body passages Ex. Curds etc
Good Exercise, Healthy and digestible and balanced food, Avoiding Sweet and Fat predominant foods are also recommended as lifestyle changes to be adapted in the treatment and management of FLD.
Thus we can infer that the Kapha increasing foods and activities can cause or trigger the progression of FLD and on the contrary avoiding or minimising them can help in the progression of the disease.
Treat Excess Kapha in FLD:Food which are antagonistic to Kapha –
  • Katu – Hot / Spice / Pungent taste
  • Tikta – Bitter taste
  • Kashaya – Astringent taste
  • Ushna – Hot
  • Ruksha – Dry
  • Teekshna – Sharp, penetrating, intense
  • Laghu – Light
  • Anabhisyandi – Those which do not cause blocks in the body passages
Activities antagonistic to Kapha –
  • Vyayama – Exercise
  • Vyavaya – Sexual activities
  • Jagarana – Vigil or keeping awake at night
  • Dhavana – Running
  • Plavana – Leaping
  • Langhana – Jumping / Jolting
  • Niyuddha – Wrestling
  • Unmardana – Rubbing and thumping the body
  • Snana – Hot bath
  • Parisarana – Walking, Brisk Walking
  • Ushna Vasa – Staying in warm places
  • Sukha pratisheda – Abstinence from comforts
Therapeutic:
  • Vamana – Therapeutic Emesis
  • Teekshna Ushna Samshodhana – Intense, vigorous cleansing of the body by administering Vamana (therapeutic emesis) and Virechana (therapeutic purgation)
  • Utsadana – Application of Kapha reducing pastes on the body and rubbing them
  • Dhoomapana – Smoking (with kapha alleviating drugs)
  • Upavasa – Fasting
  • Pipasa – withholding the urge of thirst (not drinking too much water)
  • Atapa – exposure to sun
  • Pachana – Medicines which have Katu, Tikta rasa, hot and intense in action to improve digestion and to digest the ama (metabolites) and get rid of excessive fluid / moisture / toxins from the cells
  • Udwartana – Massaging with medicated powders and pastes in the reverse direction of the hairs
Note: Also avoid the Kapha prakopaka hetu’s mentioned above
Meda (Fat) Link in ALD
Medo-vriddhikara hetu: Foods and activities which increase fatOther cause for the manifestation of ALD might be the excessive consumption of foods and activities which tend to increase fat in the body and also reduce the capacity of the liver to process and digest Fat.
But in the above said context we have found that Meda or fat is a Kapha element (rich in kapha). Therefore the same causes which bring about a pathological increase in Kapha also will increase Meda in the body. In theMedo-roga context (chapter dealing with fat related disorders and treatment – Ref- Yoga Ratnakara, Medoroga Nidanam) among many causes, Shleshmanahara Sevanam  (consumption of Kapha increasing food and activities) is one chief cause which is said to cause a disturbance in fat metabolism leading to fat related disorders.
Thus the same treatment, food and lifestyle changes which are advised in tackling excess Kapha and Kapha related diseases also hold good in tackling excess Meda and Meda related diseases including ALD.
Other avoidable foods (avoid excessive usage):
  • Masha – Black grams, Godhuma – Wheat
  • Tila pishta vikruti – Preparations and dishes made up of paste of sesamum
  • Dadhi – Curds, Dugdha – Milk
  • Payasa – Sweet dish prepared on milk base
  • Ikshu Vikara – Derivatives of Sugarcane like sugar, jaggery etc
  • Anupa Mamsa – Flesh of animals living in marshy land
  • Audaka Mamsa – Flesh of aquatic animals etc.
Treat Excess Meda:The same measures which have been mentioned above in treating excess Kapha shall be adapted in treating Excess Meda too.
Care should be taken while following Upavasa (fasting) in Sthoulya or Medo Roga (metabolic fat disorders including obesity and excessive weight) and should be done with the consent and in the observance of the doctor.
स्थूले स्युर्दुस्तरा रोगा विसर्पाः सभगन्दराः।
ज्वरातिसारमेहार्शःश्लीपदापचे अकामलाः॥{यो.र.मेदोरोग}
sthūle syurdustarā rogā visarpāḥ sabhagandarāḥ|
jvarātisāramehārśaḥślīpadāpace akāmalāḥ||{yo.ra.medoroga}
Kamala (jaundice) is one among the complications of Medo Roga. Kamala is a disease which takes its origin from the liver and often due to negligence or improper treatment of PanduRoga (Anaemia). This points towards the relationship between liver and fat (fat metabolism and fat related diseases) as proved by Ayurvedic literature.
Treat Excess Meda and Medo Roga (Sthoulya) in FLDThe treatment principles and medicines explained in the context of MedoRoga should be tried in FLD. They are highly effective. The below mentioned are the treatment and medicines of MedoRoga:
Preferred treatments in Medo Roga:
  • Udwarthana – Medicated powder, pastes are used to massage in the reverse direction of the hairs
  • Vamana – Therapeutic emesis
  • Virechana – Therapeutic Purgation
  • Vasti (Teekshna Kashaya Vasti) – Strong enemas with decoctions which reduce fat should be given
  • Lekhana Vasti – Enemas prepared with drugs having a capacity to scrap the excess fat accumulated in the body
  • Shiro Dhara – streamed pouring of medicated oils, buttermilk or milk for a scheduled period on head / body / head and body
Classical and home remedies for Medo Roga:
  • Triphala Kashaya with Honey
  • Boiled and cooled water mixed with honey
  • Hot gruel of rice taken regularly
  • Guduchi Churna (powder of Tinospora cordifolia) + Musta Churna (Powder of Cyperus rotundus)
  • Triphala churna
  • Takrarishta (fermented medicated buttermilk)
Good foods in Medo Roga:
  • Purana Shali – Old rice
  • Mudga – Green grams
  • Kulattha – Horse gram
  • Yava – Barley
  • Kaphahara Ahara – All food and diet which can reduce Kapha.
Pandu Roga and Kamala Roga link in FLD
Adapt treatment of Pandu Roga and Kamala:Already we have seen the relationship between Liver, Fat related disorders, Anaemia and Jaundice as established by Ayurveda literature. The medicines and treatment concepts which have been explained in the context of Pandu Roga Chikitsa (Treatment of Anaemia) and Kamala Roga Chikitsa (Jaundice treatment) shall be adapted in treating FLD.
Madhya (excess alcohol) and Divaswapna (Excessive sleeping during day which denotes sedentary activities, lack of exercises etc) are the important ones among the causative factors mentioned for Pandu Roga. This also proves the link between alcohol consumption and liver disorders as explained byAyurveda texts. The same are the causative or aggravating factors of ALD.
Good foods for Liver:Yava – Barley
Godhuma – Wheat
Jangala Mamsa Rasa – Flesh or meat soup of animals living in dry lands
Mudga – Green Gram
Aadhaki – Cajanus cajan (Pigeon pea)
Masura – Red lentils
Bad things for Liver:Vahnim-aatapam – Exposure to fire, sun,
Ayasa – Excessive / strenuous exercises or activities
Pittalam – Food and activities which increase Pitta
Maithunam – Excessive indulgence in sex
Krodha – Anger and extremes of emotions
Adhwagamanam – Excessive walking
Best medicines for Pandu and Kamala :Guluchyadi Kashayam
Drakshadi Kashayam
Ardhavilwam Kashayam
Lodhrasavam
Drakshasavam
Draksharishtam
Shotari Mandura
Madhu mandura
Yakritpleehari Lauha
Navayasa Lauham
Svarnamakshika bhasma etc.
Other classical medicines and home remedies for Pandu-Kamala
  • Loha Bhasma (ash of iron) – with honey and ghee
  • Shunti churna (ginger powder) with Loha Bhasma
  • Loha bhasma with Gomutra (urine of cow)
  • Powders of Ela (cardamom), Jeeraka (cumin seeds), Bhumyamalaki (Phyllanthus niruri) and Sita (sugar) – taken in equal quantities and mixed with ghee should be taken early in the morning
  • Haridra churnam (turmeric powder) with curds early in the morning
Herbs beneficial for Liver:Bhumyamalaki – Phyllanthus niruri
Amalaki – Emblica officinalis
Sharapunka – Tephrosia purpurea
Katuki – Picrorrhiza kurroa
Punarnava – Boerhavia diffusa
Kakamachi – Solanum nigrumhttp://easyayurveda.com/2012/12/08/licorice-benefits-medicinal-qualities-complete-ayurveda-details/
Kalamegha – Andrographis paniculata
Loha – Iron
Kumari – Aloe vera
Guduchi – Tinospora cordifolia
Yashtimadhu Licorice– Glycyrrhiza glabra
Haridra – Curcuma longa
Bhringaraja – Eclipta alba
Vasa – Adhatoda vasica
Kiratatikta – Swertia chirayata
Daruharidra – Berberis aristata etc
Yakrutodara and Pleehodara link in FLD
Yakrutodara / Pleehodara:
Udara Roga’s are a set of disorders explained in Ayurvedic Texts wherein different abdominal disorders have been dealt with along with their treatment.
The main symptom (sign) of Udara Roga is the protuberance or enlarged abdomen (belly). They are of 8 types. Yakrutodara / Yakruddalyudara (enlargement of liver) and Pleehodara (enlargement of spleen) are 2 among those 8 types.
Atisanchita Dosha (excess accumulation of dosha’s or contaminants) is said to be one of the chief causes that gives origin to all the types of Udara Roga. In FLD,  Atisanchita Dosha can be taken as excessive accumulation of Kapha and Abaddha Medas in Liver. Likewise excessive consumption of Abhishyandi (food causing blocks in the body’s transport system) and Vidahi (foods which cause excessive burning leading to pathological increase of Pitta) food is said to be the chief causative factors in Yakrutodara and Pleehodara. These foods are said to aggravate Kapha and Rakta and cause Yakrutodara and Pleehodara. Both these types of Udara will present signs and symptoms of Kapha (steatosis) and Pitta (Hepatitis). We have already discussed ALD as a condition called Kaphavrita Pitta (Kapha obstructing Pitta) taking place in the Liver.  Abhishyandi foods are known to increase Kapha and Kapha group of tissues especially Fat leading to their accumulation in the Liver and consequentially causing Liver Disorders, FLD in this case.
Adapting Yakrutodara and Pleehodara treatments in ALD:
Treatments preferred in Yakrutodara and Pleehodara:
  • Vamana – Therapeutic Emesis
  • Virechana – Therapeutic Purgation
  • Raktamokshana – Blood-letting from the veins of the forearm
Medicines preferred in Yakrrutodara and Pleehodara:
The same medicines explained in the treatment of Pandu Roga and / orKamala shall be used in these 2 conditions.
Other medicines:
  • Dashamoolapanchakoladi Kashayam
  • Vizhalveradi Kashayam
  • Dantiharitaki Leham
  • Dashamulaharitaki Leham
Other classic preparations and home remedies for Enlargement of Liver and Spleen:
Shalmali Pushpa Kwatha:
  • Decoction prepared by steam heating the flowers of Shalmali (Bombax malabaricum) tree is given after mixing it with mustard powder
Sharapunkhamula Kalka:
  • Paste of the roots of Sharapunkha (Tephrosia purpurea) mixed in buttermilk
Yavanyadi Churna:The powder of the below said is given with hot water or curd water:
  • Yavani – Trachyspermum ammi
  • Chitrakamula – Roots of Plumbago zeylanica
  • Yavakshara – Alkali of Hordeum vulgare plant
  • Pippalimula – Root of Piper longum
  • Pippali – Piper longum
  • Dantimula – Root of Baliospermum montanum
Sindhwadi Churnam:Powder of:
Shobhanjanadi Yoga:Shigru Kwatha (Decoction of Moringa oleifera bark) should be taken mixed with Saindhava Lavana (powdered rock salt), Chitrakamula Churna (Powder of roots of Plumbago zeylanica) and Pippali churna (Piper longum powder). To this the Kshara (alkalies) of Palasha (Butea monosperma) or Yava (Hordeum vulgare plant) should be added and mixed.
Lashunadi Yoga:The powder of Lashuna (Alium sativum, Garlic), Pippalimula (Root of Piper longum) and Haritaki (Terminalia chebula) should be consumed. Later gargling should be done with Gomutra (Cow’s urine).
Shigru Kwatha:Shigru kwatha (Decoction of Moringa oleifera, Drumstick) should be taken mixed with powders of Pippali (Piper longum), Maricha (Piper nigrum), Saindhava Lavana (Rock salt) and Amlavetasa (Garcinia pedunculata)
The Prameha Link in FLD
We know that Obesity and Diabetes predispose to the formation of fatty liver.
The below mentioned are the causative factors of Prameha vis-à-vis Diabetes Mellitus:
  • Asyasukham – Comfortable seating (luxury, sedentary lifestyle, lack of physical activities and exercise)
  • Svapnasukham – comforts of sleeping
  • Dadheeni – Excessive consumption of Curds and its preparations
  • Gramya-oudaka-anupa mamsa – flesh or meat soup of animals living in water and marshy regions
  • Payamsi – Excessive consumption of milk, its derivatives and preparations
  • Navaannapanam – Food, drinks and dishes prepared from new grains etc
  • Guda vaikruti – Jaggery, its derivatives and dishes made out of it
  • Kapha krut cha sarvam – All foods and lifestyle activities which increase Kapha
Most of these causes match with the causative factors leading to FLD. We have seen that FLD is caused by excessive Kapha elements and Medasaccumulating in the Liver.
We have also learnt that the Kapha aggravating factors can cause or trigger the progression of FLD because the same causes increase Meda (fat) too. Thus the causative factors of Kapha and Medas are the same. By cutting off on the Kapha increasing diet and lifestyle activities we can reverse FLD and obesity.
Even the Prameha (Diabetes) is said to be caused by the same causes that increase Kapha. Thus Ayurveda has proved the link between the causes of Diabetes, Obesity and FLD. The causative, aggravating and relieving link to all these diseases is the same Kapha.
Having a common aetiology means to tell that all these diseases share a common platform and is linked by the same pathological process. This also means to tell that the above said diseases can predispose to the formation of the other disease. Thus through common aetiology, Prameha can predispose to the formation of FLD just like the MedoRoga does. When Prameha and Medoroga are kept under control by giving good treatment and medicines, FLD can be checked and reversed. The modern view also tells the same.
The pathogenesis of Prameha is explained as below said:‘When the Meda (fat), Mamsa (flesh), Shareera kleda (Fluids of the body) and Kapha on entering the Basti (Urinary apparatus) causes Prameha’
Here too we see the involvement of fat, kapha and body fluids causing Prameha just as they had caused blocks in the Liver and caused FLD.
Fat and Kapha are thus linked both in the pathogenesis of FLD and Diabetes.
Meda is mentioned in the Dushya Varga (one of the tissue to get contaminated in the pathogenesis of Prameha) of Prameha and Kapha in the Dosha Varga (contaminants). Acharya Charaka has mentioned that Abaddha Medas (free fat) causes Prameha.
Medovaha sroto dushti:…मेदःसंश्रयांस्तु प्रचक्ष्महे।
निन्दितानि प्रमेहाणां पूर्वरूपाणि यानि च॥{च.सू.स्था.२८/१५}
…medaḥsaṃśrayāṃstu pracakṣmahe|
ninditāni pramehāṇāṃ pūrvarūpāṇi yāni ca||{ca.sū.sthā.28/15}
When the cells and channels related to the formation and maintenance of Fat (structures and factors controlling fat metabolism) get contaminated it leads to the manifestation of Ashtanindita’s and Prodromal (premonitory) symptoms of Prameha.
Ashtanindita means 8 categories of body frame which are said to be socially unfit. Atisthoulya (Obesity) is one among the Ashtanindita’s.
Here Ayurveda establishes a link between Obesity, Diabetes and Disturbance of Fat deposition (resulting in conditions like FLD).
When the channels related to fat metabolism are contaminated, Sthoulya and premonitory symptoms of Prameha are formed. Sthoulya and Prameha further contaminate Medas and predispose for its accumulation in the liver forming FLD.
The patient of Prameha is also classified as:
  • Sthula Pramehi (obese patient)
  • Krusha Pramehi (thin patient)
This also shows that Sthoulya and Prameha are interrelated diseases.
Since Prameha, Sthoulya and Medas are inter-related we shall try to implement Prameha Chikitsa too in FLD.
Treat Prameha in FLD:Prameha Chikitsa –
Beneficial Treatments in Prameha:
Depending on the type and condition of Prameha and considering its Dosha-Dushya dushti (pathogenesis and pathological elements) and strength of the patient the below said Shodhana procedures can be skilfully adapted under strict supervision of a qualified Ayurvedic doctor.
  • Vamana – Therapeutic Emesis
  • Virechana – Therapeutic Purgation
  • Vasti – Enema treatment
Brimhana Therapy (Bulk promoting treatment) is a treatment of choice in the patient of Prameha who is thin and debilitated. On the other hand Samshodhana is a treatment of choice in the patient of Prameha who is obese and strong.
Best Medicines for Prameha:
Nishakathakadi Kashayam
Ayaskriti
Chandraprabha vati
Vasantakusumakar ras
Amalaki rasayanam etc.
Other classical and home remedies:Triphaladi kwatha:Decoction prepared from equal quantity of
  • Triphala (Terminalia chebula, Terminalia bellirica, Emblica officinalis)
  • Devadaru – Cedrus deodara
  • Daruharidra – Berberis aristata
  • Musta – Cyperus rotundus
It should be taken mixed with honey
Guduchi Kwatha:Decoction or juice of Tinospora cordifolia mixed with honey
Nisha kalka: Paste of Nisha (Curcuma longa) mixed with juice of Amalaki (Emblica officinalis)
Kataka beeja: Powder of Strychnos potatorum should be taken mixed in buttermilk and honey
Nisha-triphala Yoga: The powders of the below said should be kept in water over night and should be strained through a sterile cloth or sieve in the morning. It should be consumed mixed with honey.
  • Nisha – Curcuma longa
  • Daruharidra – Berberis aristata
  • Haritaki – Terminalia chebula
  • Bibhitaki – Terminalia bellirica
  • Amalaki – Emblica officinalis
Other simple and effective remedies:
  • Triphala Churna with honey
  • Shilajit with honey
  • Haritaki (Terminalia chebula) Churna with honey
  • Loha Bhasma (ash of iron) with honey
  • Vanga bhasma with Amrita satwa and honey
  • Abhraka bhasma with Triphala churna and honey
Useful drugs in Prameha:
  • Haridra – Curcuma longa
  • Daruharidra – Berberis aristata
  • Amalaki – Emblica officinalis
  • Haritaki – Terminalia chebula
  • Kataka – Strychnos potatorum
  • Guduchi – Tinospora cordifolia
  • Lashuna / Rasona – Allium sativum
  • Jambu – Eugenia jambolana
  • Karavella- Momordia charantia (Bitter melon or bitter gourd)
  • Tulasi – Ocimum sanctum
  • Bhumyamalaki – Phyllanthus niruri
  • Beejaka / Vijayasar – Pterocarpus marsupium / Indian Kino
  • Methika – Trigonella foenum-graecum (fenugreek)
  • Nimba – Azadirachta indica (neem)
  • Meshashringi – Gymnema sylvestre
  • Ashwagandha – Withania somnifera etc
Good foods in Diabetes:
  • Shyamaka – Setaria italic
  • Kodrava – Echinochloa frumentacea
  • Godhuma – wheat
  • Chanaka – Cicer arietinum
  • Aadhaki – Cajanus cajan (Pigeon pea, Red gram)
  • Mudga – green gram
  • Kulattha – horse gram
  • Tikta shaka – Vegetables which are bitter in taste
  • Patola – Pointed gourd
  • Jangala rasa – Flesh / meat of animals living in dry lands
  • Saindhava lavana – rock salt
  • Maricha – Black pepper
The drugs until Kulattha also destroy excess fat in the body and thus beneficial in FLD
To sum up:Fatty Liver Disease (FLD) is not just a disease entity. It is a syndrome by itself because it is related to many systemic, hormonal and lifestyle diseases like Obesity, Diabetes, Metabolic syndrome etc. it is not enough to treat the Liver. In fact dealing with the diseases at the backdrop of FLD will also help in the later.
While dealing FLD via Ayurveda too we need to remember the same rules and regulations of treatment, diet, lifestyle and medicinal protocol. Ayurvedawould have possibly been the first medical science to establish a relationship between disturbed fat metabolism, liver disorders, diabetes and obesity.
FLD treatment in Ayurveda involves:
  • Treating morbid Kapha and Pitta
  • Treating on the lines of Medo Roga and Sthoulya
  • Treating on the lines of Pandu Roga and Kamala Roga
  • Treating on the lines of Yakrutodara and Pleehodara
  • Treating on the lines of Prameha.