Treatment Principles of Diseases of Yakrit: Liver disorders

Article by Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

Yakrit, according to Ayurveda, is definitely an important organ. Yakrit vis-à-vis liver has been almost always explained with another organ Pliha i.e. spleen. Ayurveda believes that though they are different anatomical structures, the functions they render in the body are almost the same.

In fact, we can see that Pliha has been given more importance in comparison to Yakrit. In the context of Udara Rogas – enlargement of abdomen, eight types of the disease have been explained. The Acharyas explain Plihodara i.e. enlargement of spleen / Splenomegaly in detail and skip detailing Yakrutodara i.e. enlargement of liver / Hepatomegaly. Later it is said that – ‘Just like the enlargement of the spleen, if the enlargement of the abdomen occurs on the right side, it should be considered that the liver located therein is enlarged’.

Both these organs are –

–        the roots of raktavaha srotas – blood carrying channels in the body
–        the abodes of raktadhara kala – layers or membranes responsible for formation of blood tissue located in the liver and spleen
–        the raktashayas – abodes or reservoirs of blood

The knowledge of these facts are very essential for understanding the principles of treating the ‘yakrit rogas’ – the liver disorders.

Related Reading – ‘Yakrit’ – pathological viewpoints and considerations – Ayurveda Perspective

Treatment principles of Yakrit Rogas – Liver Disorders

Garbhini Paricharya: Antenatal Care

Yakrut is a maternal organ – Matruja Avayava. It is formed, enriched and nourished by maternal factors. Therefore, the antenatal care of the pregnant woman is very important. As such, proper nutrition and lifestyle practices are essential for pregnant women for overall and proper growth and development of the fetus, which includes nourishment and proper development of the liver. The quality and quantity of maternal blood should be regularly evaluated. Diseases pertaining to raktavaha srotas, if any, should be promptly treated.

Management of vitiation of Raktavaha Srotas

Yakrit – liver, Pliha – spleen and Raktavahini Dhamanis – arteries carrying blood – are the roots of raktavaha srotas – channels which form and transport blood.

Principles of treating the diseases caused due to vitiation of raktavaha srotas

विधि शोणिते अध्याये रक्तजानां भिषक् जितम्॥(च.सू.२८/२५)

The diseases caused due to vitiation of raktavaha srotas should be managed on the lines of treatment and management explained in the chapter ‘Vidhi shonitiya’ of Charaka Sutra sthana.

कुर्यात् शोणित रोगेषु रक्त पित्त हरीं क्रियाम्।
विरेकं उपवासं च स्रावणं शोणितस्य च॥(च.सू.२४/१८)

The management includes:

1. Raktapittahara Chikitsa – Treatment on the lines of raktapitta chikitsa (treatment of bleeding disorders)
2. Virekam / Virechana – therapeutic purgation
3. Upavasam – therapeutic starvation / fasting
4. Raktamokshana – bloodletting

The same principles of treatment also fit into the treatment of Liver and Spleen disorders because they are roots of raktavaha srotas.

Pandu Roga and Kamala Roga Chikitsa

Pandu Roga, which has been compared to anemia, also encompasses the majority of liver diseases under the umbrella term. Pallor, tiredness and exertional dyspnea / shortness of breath while ascending stairs or uphill are the important symptoms among the lot.

If the symptoms of Pandu Roga are found, a liver or spleen condition shall be treated on the lines of treating Pandu Roga.

Kamala means Jaundice. Again, the haemopoietic organs – liver and spleen are involved in this disease. There are two pathways in which kamala occurs.

–        One, it may occur independently as mentioned in the context of Rakta Vriddhi Lakshanas. Kamala is one of the symptoms / disease or complication of pathological increase of blood tissue.
–        Two, it may occur as a complication of neglected Pandu Roga. In the pathogenesis of Kamala Roga, it is said that if the patient of pandu roga or the one who has recovered from it consumes in excess, the pitta aggravating causes, inclusive of foods and lifestyle practices, the pitta will burn the rakta – blood and mamsa – muscles and cause kamala roga.

If there is kamala, the functions of the liver, just like in pandu roga, will be compromised. If the symptoms of kamala are found, the patient should promptly be treated for the same. At the same time, the patient of pandu roga should be advised to take caution in the follow up maintenance and shall be alerted about further liver damage and occurrence of jaundice and other complicated conditions of liver and spleen if precautions related to food and lifestyle is not taken and if the etiological factors responsible for causation of pandu and kamala are not kept away.

Right balance of fat tissue

1. Medo Vriddhi – Pathological increase of fat tissue, obesity and overweight conditions cause a wide array of health issues and will also have a bad impact on liver and spleen health. In the context of medo roga – diseases caused due to errors of fat metabolism, it is said that when the increased fat blocks the channels of the body, all tissues of the body will not be nourished. In fact, only fat tissue will be nourished at the cost of other tissues. This also includes depletion or inadequate formation of blood tissue. This may eventually lead to anemia and other conditions. Deposit of meda – fat tissue inside the core of the liver may cause conditions like fatty liver which also meddles with functions of the liver.

2. Medo Kshaya – Pleeha or Pliha Vriddhi – enlargement of spleen has been mentioned among the symptoms of depletion of fat tissue in the body. The term pliha indirectly involves the liver also. So, a proportional balance of fat tissue is very much essential for the maintenance of optimum liver and spleen health.

Panchakarma in Liver Disorders

Virechana – therapeutic purgation is the best treatment for liver disorders since the liver is the seat of pitta and agni. Virechana expels morbid pitta and hence reduces further burnouts. Virechana also detoxifies the liver and spleen and restores their health.

Vamana – therapeutic emesis should be considered when there is kapha aggravation and is causing blocks in the liver and is disturbing the functions of the organ. It should also be administered in pitta predominant hepatomegaly and splenomegaly.

Vasti – enemas with milk processed with decoction of pitta alleviating herbs shall be administered in splenomegaly associated with or caused by vitiated pitta. Likewise bloodletting and emesis also shall be administered.

Ama Pachana and Deepana

Medicines which destroy ama and relieve the blocks occurring in the channels of the body and restores metabolism and functions of the organs and tissues should be administered. Similarly, medicines, foods and herbs which enhance the digestive power / fire should also be administered when there is agnimandya – reduced digestive fire leading to dysfunctions of the liver.

Yakrutodara / Plihodara Chikitsa

The general line of treatment prescribed for udara roga – abdominal enlargement and specific treatments prescribed for treating yakrutodara – hepatomegaly (enlargement of liver) and plihodara – splenomegaly (enlargement of spleen) should be considered in treating liver or spleen enlargement.

The principles of treatment for enlargement of spleen or liver are –

– Snehana – oleation
– Swedana – sudation
– Virechana – purgation
– Niruha – decoction enemas
– Anuvasana – oil / fat enemas
– Siravedha – bloodletting – when the above said treatments fail

Shatphala Ghrta and Arishtas should be used and also alkalis or combination of Haritaki – Terminalia chebula and jaggery.

All therapies, formulations and measures explained for treating

enlargement of spleen shall be administered for treating enlargement of the liver also. This is because the causes and symptoms of both these

conditions are similar.

Siravedha and Agnikarma: Vein section (venesection) and fire cautery for hepatomegaly

Siravedha – Bloodletting by venesection – If all the treatments including snehana, swedana, virechana, niruha and anuvasana fail to yield relief or cure for splenomegaly, then bloodletting through venesection of the vein located in the left arm should be done.

Agnikarma – cauterization – is done in a patient of spleen enlargement having vata and kapha predominance.

The same principles of treatment shall be followed for enlargement of liver also.