Article by Dr Raghuram Y.S. MD(Ayu)
We cannot find any disease or condition explained in Ayurveda which resembles Autoimmune Hepatitis. But in comparison to the modern aspect of the disease, we can try to correlate certain conditions explained in Ayurveda to Autoimmune Hepatitis.
High Pitta in Yakrit –
Autoimmune Hepatitis can be compared to high pitta in Yakrit or Liver.
Pitta is one among the 3 doshas. Pitta, like Vata and Kapha (other 2 doshas), when in normalcy (qualitative and quantitative balance) will participate in normal body activities, mainly those activities related to the metabolism in the gut (digestion process).
When this pitta gets vitiated, it starts destroying the body components, mainly the cells and organs in which it is produced and stored, in the areas and parts of the body where it is functional or in the channels in which it is carried.
In due course of the progression of its vitiated state, the aggravated pitta can trespass into the regions of the body (sites) which belong to vata and kapha. Whichever part of the body comes in contact with vitiated pitta would be burnt or inflamed. This produces active inflammation which becomes chronic over a period of time.
When this pitta gets aggravated in the liver, it will damage the liver anatomically and also disturbs its functions. When the effect of this pitta affects the whole body caused by the pitta in circulation, systemic symptoms like pains, fatigue, etc are seen.
The pitta which is supposed to be protective has now gone the destructive way. This is nothing but the ‘autoimmune process’ i.e. the pitta not differentiating between self and non-self and damaging the body components.
Liver is an important organ and gland in the body which not only participates in the digestion process, but also takes part in filtration mechanism. Liver filters any toxins or unprocessed things coming through it. This filtration process prevents those toxins going into circulation and consequently damaging the vital organs in the body. Liver also filters the toxins from the circulating food essence (rasa rakta) passing through it by means of portal circulation. Liver is also an important haemopoetic organ and helps in formation and maturation of blood cells.
According to Ayurveda, Liver or Yakrut (along with Pleeha) forms the roots of Raktavaha Srotas (channels responsible for carrying mature blood throughout the body). Yakrit is also the chief site of one of the subtypes of pitta namely Ranjaka Pitta. This pitta imparts colour to the blood and also helps in the digestion process. Ranjaka pitta is said to be responsible for the thrust with which the heart pushes the heart to various corners of the body. Ranjaka pitta along with vyana vayu helps blood to circulate throughout the body.
The Liver can be damaged setting an auto-immune process in the body following one or the more of the below said pathological processes according to Ayurveda –
The pitta getting vitiated in Yakrit or liver, the pitta causing inflammation of liver and other body parts and setting an autoimmune process in the whole body will cause autoimmune hepatitis
Autoimmune Hepatitis: Causes, Symptoms, Diagnosis, Treatment
Ranjaka pitta imbalance in the liver (vitiation of local pitta)
Ranjaka Pitta in the liver being influenced by the vitiation of core pitta in the gut, i.e. Pachaka Pitta can also set in the autoimmune process and cause autoimmune hepatitis. Pachaka Pitta is located in the stomach and small intestine and controls all its subtypes located in various parts of the body. When Pachaka Pitta gets vitiated, it imparts disturbing effect on its subtypes including Ranjaka Pitta in the liver.
Immunity is at its best and balanced when vata, pitta and kapha are functional and operational in their respective zones, without meddling with each other’s activities, in fact cooperating with each other and carrying on the body dynamics in a smooth way. The balance of 3 doshas is immunity and the vitiation and mutual affliction of the doshas leading to damages in the tissues and organs of the body is the onset of autoimmune process. Pitta represents fire, Vata represents wind and Kapha represents water bodies. When pitta is high in liver or in the system, it evaporates the kapha (water body) which is responsible for the integrity of the body and is the chief immune component. The tissues which are rich in kapha i.e. rasa (lymph or plasma), mamsa (muscles), meda (fat), majja (bone marrow) and shukra (semen) are vitiated by pitta wherein the inflammatory process sets in and the tissue integrity, strength and immunity is lost. The reverse is also possible (kapha depletion leads to lack of support and buffer system to the body and leads to vitiation of vata and pitta). With severe pitta vitiation and kapha depletion in the liver, excessive tissue degeneration and dryness sets in. the dry backdrop is helpful for vata vitiation. The vitiated vata further destroys the liver, damages and leads to conditions like cirrhosis of liver, which is irreversible. The reverse is also possible; vata getting vitiated further provokes pitta (like the combination of air and fire) and depletes the kapha components. Depletion of kapha or water components depletes the support system and buffer system of the tissues and organs, leading to many systemic disorders and loss of immunity. This sets in the autoimmune process in the liver causing autoimmune hepatitis. This pathological process simultaneously runs in the whole body.
Home Remedies for AIH –
Since AIH is an autoimmune process, we can’t find many options of home remedies as it is not a simple issue to revert autoimmune process through home remedies. It would also be risky to experiment treating these conditions with home remedies. Home remedies, on the other hand may also worsen the existing condition. But below mentioned are some of the home remedies which are found mentioned –
Milk Thistle – It contains an active compound known as Silymarin. This compound helps protect the liver from damage and reduces inflammation.
Turmeric – It contains a compound known as curcumin. This helps cleanse the liver, purify the blood and provide energy. It also helps alleviate inflammation and reduce pain.
Apple Cider Vinegar – High ammonia in the blood is one of the causes of liver damage. ACV helps alkalinize the body and reduce ammonia levels.
Treating Autoimmune Hepatitis on the lines of treating High Pitta
Avoiding pitta vitiating foods and lifestyle practices – High pitta in the liver or anywhere in the body predisposes for inflammation. This inflammation causes autoimmune disorders. When this process occurs in the liver it causes autoimmune hepatitis. Therefore, all the possible causative and triggering factors of high pitta or pitta vitiation shall be avoided. Below mentioned are the causative factors of pitta vitiation –
- Katu – excessive consumption of pungent foods
- Amla – excessive consumption of sour foods
- Ushna – excessive consumption of hot foods
- Vidahi – excessive consumption of corrosive foods
- Teekshna – excessive consumption of intense acting foods and medicines
- Lavana – excessive consumption of salt or salty foods
- Krodha – excessive anger
- Upavasa – excessive fasting, starvation
- Atapa – excessive exposure to heat of Sun
- Stree samparka – excessive indulgence in sexual intercourse
- Tila – excessive consumption of sesame and foods prepared with sesame
- Atasi – excessive consumption of flax seeds and foods prepared with flax
- Dadhi – excessive consumption of curds
- Sura – excessive consumption of fermented herbal drinks
- Shukta and Aranala – excessive consumption of sour and fermented medicated drinks
- Bhukte jeeryate – during the process of digestion of food
- Sharadi – in autumn season
- Greeshma – in summer season
- Madhyahna – during afternoon
- Ardha ratre – mid night etc.
Managing vitiated Pitta in AIH
General management of Pitta with treatments like Virechana is useful. Read related:
How To Balance Pitta Dosha? Line Of Treatment
Raktavaha Srotas Dushti –
Rakta dushti leads to depletion of nutrition and oxygen to the tissues and vital organs, inflammation and degeneration, loss of immunity and long standing infections. The whole set of symptoms relate to the liver damage and autoimmune process. Thus raktavaha srotas dushti can be readily correlated to autoimmune hepatitis.
Read related: Raktavaha Srotas: Description, Vitiation Symtpoms, Treatment
Treatment of AIH on the lines of management of Raktavaha Srotas Dushti
The first and foremost strategy to treat or address the raktavaha srotas at the root of formation of rakta i.e. liver and spleen and remove the contamination leading to autoimmune process is the avoidance of the causative factors. Below mentioned are the causes of Raktavaha Srotas vitiation. These should be avoided so as to keep the liver health intact.
Treatment of Autoimmune Hepatitis on the lines of Pandu and Kamala Chikitsa (Treatment line up of Anaemia, Liver Disorders and Jaundice) –
The treatments and formulations mentioned in Pandu and Kamala Chikitsa are good for Liver health and also help in improving the liver immunity and gross immunity of the body. They also detoxify not only the liver but also the entire body thus aborting the autoimmune process. The body and liver will be trained to work smoothly since a sterile and healthy environment would have been provided after the cleansing process, effective disease modifying formulations, immune modulators and good diet. Thus these strategies would work in handling Autoimmune Hepatitis.
Role of Panchakarma in handling Autoimmune Hepatitis:
Among the Panchakarma (5 cleansing treatments) treatments of Ayurveda, Virechana has an important role in correcting the Autoimmune process. There is a good chance of giving good relief and possible cure in Autoimmune Hepatitis through administration of Virechana or therapeutic purgation.
Virechana, the best strategy – Virechana not only corrects the metabolic process, it also combats high pitta. Virechana is the best treatment for expelling high pitta. Once this is achieved, the inflammatory process comes down and pitta gets settled.
Yakrit or liver is one of the prime sites of Pitta (as already discussed). Yakrit is also the root of Raktavaha Srotas. Thus virechana cleanses the root of Raktavaha Srotas and enables formation of rakta or blood in good quality and quantity. Virechana, at the same time cleanses the Liver of its morbidity by removing excess pitta which has been responsible for autoimmune process. Virechana is also a good treatment for Kapha. Virechana removes the blocks removed by kapha in the Liver and at different parts of the body. This will enable free circulation of nutrients, blood and oxygen to different parts of the body and also help in recovery of liver cells.
The rectification of blood morbidity and in turn the pitta morbidity associated with it will bring good blood back into circulation. The cells and organs will be enriched with good nutrition and oxygen. The autoimmune process will come down and the immunity of the body as a whole and liver in particular will improve. Moreover, Virechana would expel the morbid pitta from the system. All these process put together will contribute towards health restoration and rehabilitation of Liver.
Thus, Virechana proves a vital strategy in combating Autoimmune Hepatitis.
Moreover we have seen Virechana as the preliminary line of treatment, be it in expelling high pitta or in combating Raktavaha sroto dushti or in treating Pandu and Kamala with which we have compared Autoimmune Hepatitis.
Vamana (therapeutic emesis) – Vamana too is indicated in the treatment of Pandu vis-à-vis AIH. This is applicable when there is high kapha in liver disorders. Morbid Kapha blocks the srotases (channels) all over the body and also in the liver. Kapha also envelopes pitta and kapha and blocks their smooth functioning. Stomach is the chief site for production of high quantities of kapha and the controlling center for kapha. When Vamana is given, the morbid kapha is removed and thus all the obstruction. Pitta and Vayu will start functioning easily.
Vamana is not a direct approach to cleanse the liver or cure liver disorders but an indirect approach. High kapha will obliterate the smooth functioning of pitta. Vamana is a good treatment for not only morbid kapha but also to combat vitiated pitta. But vamana shall be selectively and skilfully used.
Raktamokshana – Raktamokshana or bloodletting is the best treatment for removing or expelling rakta morbidity (vitiated blood). The rakta is a site for pitta. If pitta gets vitiated, the rakta gets vitiated and vice versa. Rakta essentially is a carrier and transporter of vitiated pitta (just like it transports normal pitta) and thus carries inflammation from one place to the other. Rakta is thus a connector of liver and other parts of the body (liver being its production unit) and tends to contaminate both liver and other parts of the body when it is carrying vitiated blood. The blood carrying vitiated pitta contaminates the place of its production also i.e. liver and causes autoimmune hepatitis. When excess blood (quantitatively and qualitatively vitiated) having high pitta is removed from the circulation through bloodletting, the inflammation and autoimmune process are brought to a halt. Thus, raktamokshana forms an important strategy in handling Autoimmune Hepatitis.
Pathya (wholesome foods and lifestyle practices) in AIH
- All pitta alleviating measures and foods (explained above)
- Vamana – therapeutic emesis
- Virechana – therapeutic purgation
- Raktamokshana – bloodletting
- Vyayama – exercise on regular basis
- Purana Shaali – old rice
- Purana Yava – old barley
- Purana Godhuma – old wheat
- Mudga yusha – green gram soup
- Aadhaki yusha – Pigeon pea soup (Cajanus cajan)
- Masura yusha – Lentil soup (Lens culinaris)
- Jangala mamsa rasa – meat soup of animals and birds living in the desert regions
- Tikta Ghrita – ghee processed with bitter tasting herbs
Apathya (unwholesome foods and lifestyle practices) in AIH
All pitta vitiating foods and activities
Chinta – stress, worries, grief
Single herbs effective in Autoimmune Hepatitis
The single herbs useful in AIH have been dealt in various sub-topics of this article. Some of the important herbs are –
- All Pitta alleviating herbs
- Haritaki – Terminalia chebula
- Argwadha kalpa – Cassia fistula
- Pippali – Long pepper
- Shunti – Ginger
- Maricha – black pepper
- Vidari – Pueraria tuberosa
- Shatavari – Asparagus racemosa
- Guduchi – Tinospora cordifolia
- Amalaki – Emblica officinalis
- Triphala – 3 fruits
- Trivrit – Operculina turpethum
- Haridra – Turmeric
- Daruharidra – Berberis aristata
- Mandura bhasma – Iron oxide or Ferric oxide calx or ash
- Vidanga – Embelis ribes
- Loha Bhasma – iron calx or ash
- Katuki – Picrorhiza kurroa
Effective Classical formulations for AIH
Kashayam (herbal decoction)
- Drakshadi Kashayam
- Guluchyadi Kashayam
- Phalatrikadi Kashayam
- Vasaguluchyadi Kashayam
- Patolakaturohinyadi kashayam
Asava-Arishtam (fermented herbal drinks)
Churnam (herbal powders)
- Avipatti churnam
- Navayasa churnam
- Panchakola churnam
- Mandura vatakam
- Sudarshana churna
- Pathyadi churnam
Ghritam (medicated ghee)
- Dadimadi ghritam
- Dhatryadi ghritam
- Dhanwantaram ghritam
- Sukumara ghritam
- Vidaryadi ghritam
- Shatavaryadi ghritam
- Patoladi ghritam
- Tiktakam ghritam
- Kalyanaka ghritam
- Brahmi ghritam
- Saraswatha ghritam
- Mahatiktaka ghritam
Avaleha and Rasayanas (Confections and immune-modulators)
- Agastya haritaki rasayanam
- Brahma rasayanam
- Ashwagandha raasayanam
Vati, Gulika, Lauha and Rasa (tablets, iron and herbo-mineral preparations)
- Chandrakala rasa
- Chintamani rasa
- Kamadudha rasa (muktayukta)
- Navayasa loham
- Swarna suryavarti
- Shulavarjini vati
- Nagarjunabhra rasa
- Trailokya chintamani rasa
- Dhatri lauha
- Shotari lauha
- Yakrit-plihari lauha
- Tapyadi lauha
- Vidangadi lauha
- Vishamajwarantaka lauha
- Sarvajwarahra lauha
- Punarnavadi guggulu
- Kaishora guggulu
- Arogyavardhini rasa / gutika
- Shiva gulika (laghu)
- Punarnavadi manduram
Bhasma (ash preparations)
- Abhraka bhasma
- Mandura bhasma
- Loha bhasma
- Kanta bhasma
- Kasisa bhasma
- Swarnamakshika bhasma
- Vanga bhasma
- Sphatika bhasma
- Muktashukti bhasma
- Rajata bhasma
- Lauha parpati
Proprietary Medicines for AIH
- Cap Ayuliv (Ayulabs)
- Syrup Ayuliv (Ayulabs)
- Cap Feroliv Forte (BAN)
- Cap Forliv (Ayurchem)
- Cap Hepa capsule (Capro)
- Cap Hepajaun (Phyto Pharma)
- Cap Heptoliv (Rudradeo)
- Cap Jaduna (J& S)
- Cap Optiliv (Envin)
- Cap Livplus (Bacfo)
- Tablet and Syrup Liv 52 (Himalaya)
- Tab Livomyn (Charak)
- Tab Livotrit (Zandu)
- Tab Livpar (Gufic)
- Tab and Syrup Nirocil (Solumiks)
- Tab Stimuliv (Franco-Indian)
- Tab / Syrup Tonoli (Cadila)
- Tab / Syrup Vasuliv (Vasu)
- Tab / Syrup Vimliv (Solumiks)
- Tab Hepatab (Nagarjuna)
- Tab Heptin Forte (Alopa)
- Syrup Heposem (KAPL)
- Syrup Jaundex (Sandu)
- Syrup Kalamegha Strong (Swadeshi)
- Syrup L-Guard (Fizikem)
- Syrup Heptin Forte (Alopa)
- Syrup Livion Forte (IMIS)
- Syrup Livisyp (Dhanwantri)
- Syrup Livomyn (Charak)
- Syrup Pittarechak Kwata (Pentacare)
- Syrup and Drops Heptoliv (Rudradeo)
My clinical experience in handling Autoimmune Hepatitis
Frankly, I should admit that I have not encountered cases of Autoimmune Hepatitis. But I have dealt with a lot of liver disorders, cases of anaemia, jaundice and hepatitis. I would have missed out diagnosing that condition as autoimmune hepatitis or might not have thought in terms of modern terms. For an Ayurvedic physician like me, the term of the disease doesn’t matter much because we treat not according to modern diagnosis but based on the pathogenesis and diagnosis we make through Ayurvedic methods and approach. I would have looked at my patients with ‘sluggish liver’ or ‘stubborn liver conditions’ or conditions diagnosed as ‘hepatitis’ or ‘anaemia’ with an Ayurvedic perspective and would have handled it. Thus, there is a big chance that I would have unknowingly addressed a few cases of autoimmune hepatitis and also treated them effectively. I would proudly state that I have always found good results by 4 fold approach –
Virechana – I have never missed out administering Virechana in handling liver conditions. But I have been selective in administering virechana to the patients whose bala (strength, tolerance and endurance) has been good and who willingly accepted undertaking Virechana. I am also lucky to have had patients, most of whom have accepted my recommendations. I have always seen stubborn and chronic cases of high dosha as autoimmune cases. Thus, I have also seen chronic and stubborn liver conditions with high pitta and low immunity as autoimmune liver disease. Thus, I have handled these cases in Ayurvedic way.
I have selectively used virechana in 2 ways –
Krama virechana – Administration of Virechana after having administered snehapana (oral intake of medicated ghee) and swedana (sudation) is a systematic way of giving virechana. This, I found to be highly effective in treating chronic liver conditions, to cleanse and detoxify the system, to strengthen the liver and body, to expel morbid pitta and halt the autoimmune process.
Nitya Virechana – Daily administration of small quantities of herbal purgation in the form of kashayam (herbal decoctions), ksheera (processed milk) and pittahara ghrita (pitta alleviating or expelling medicated ghee) is called krama virechana. I have used this form when there is less possibility of administering krama virechana or in reluctant patients. This too has helped in curing liver disorders, though not very effectively in comparison to krama virechana.
Roga and Dosha Pratyaneeka Chikitsa – I have always accessed the involvement of predominant dosha in causing an autoimmune disease, be it systemic or liver related. Disease and dosha modifying medicines always help in restoring liver health
Rasayana – I have never failed to include a Rasayana (immune-modulating medicine or compound) in my prescription, especially after the recovery of the disease and after shodhana (virechana) to be precise. This helps in recovery of the liver and restoration of its health. These medicines will also help in regaining the immunity. Some of the Rasayanas I have regularly used are – Chyavanaprash, Kushmanda Rasayana, Drakshadi Leham, Agastya Haritaki Rasayana, Punarnava Mandura, Brahma Rasayana, Brahmi Ghrita, Saraswatha Ghrita, Kalyanaka Ghrita etc.
Pathya Ahara and Vyayama – Regular exercise and light digestible and nutritious diet will help in speedy recovery of liver. In autoimmune hepatitis, the liver will be sluggish and the digestion process will be low. The body cannot process the food and convert it into useful components. Thus light food need to be supplied to the system which can easily be digested, absorbed and utilised. I usually advise use of simple and nutritious diet in the form of gruels and soups prepared using medicinal herbs, rice and green gram.
Limitations in treating Autoimmune Hepatitis, Ayurvedic way
Ayurvedic vision of seeing an autoimmune process is totally different. It is only the body’s entities with misguided information missiled against its own elements that constitute auto-immune process. The concept of Dosha is the earliest explanation of autoimmunity. When doshas are balanced they take care of the body and when vitiated they attack the same body and damage the system leading to many psycho-somatic disorders.
Auto-immune disorders can be effectively tackled by –
Avoidance of exposure to the causative factors which vitiate the doshas (pitta in this disease) or trigger the vitiation of doshas
Expelling the vitiated doshas at right time through administration of shodhana (vamana, virechana etc) and
Administration of disease modifying and immune-modulator medicines will take care of autoimmune disorders
These options give an Ayurvedic doctor to tackle the autoimmune diseases with special reference to autoimmune hepatitis with well planned strategy
I would tell that Ayurveda would definitely tackle and cure autoimmune hepatitis effectively through a broad spectrum of treatment strategies and skilful amalgamation of effective methods
But the limitations lay in the below said conditions –
Patients who have given up hopes, i.e. weak minded
Various disease complexes, complications and syndromes associated with AIH which prevent recovery
Click to Consult Dr Raghuram Y.S. MD (Ayu)