The term Non-Alcoholic Fatty Liver Disease (NAFLD) refers to the accumulation of excessive fat inside the liver cells when excessive alcohol use is not present. The WHO reports that there has been a consistent increase in the frequency of chronic liver diseases, including NAFLD, in recent years. NAFLD increases the chance of developing extrahepatic diseases, including osteoporosis, endocrine problems, colorectal cancer, CVD, and CKD. Liver illness is also described quite well in Ayurveda. NAFLD may be seen as a Santarpanotha Vikara (illness) brought on by Pittasthana, Raktavahasrotomoola, Kaphamedo Dushti, and Sthanasamsraya in Yakrut (liver). A 35-year-old male patient presented with a USG result indicating high liver echogenicity (Grade-2 Fatty Liver) with complains of dull stomach pain, discomfort, and low appetite for 2 Months. For two months, it was recommended that he take 500 mg of Chitrakadi Vati twice a day after meals along with Takra as Anupana. In NAFLD, the Maha-Tikta Ghrita and Arogyavardhini Vati shown to be beneficial. The patient's condition got better and there was pathological remission shown on the ultrasound. This case study aims to investigate the Ayurvedic therapeutic method and the mechanisms of action of the above-mentioned drugs. In the early stages of an illness, an effective approach to care might make all the difference in the world.

Keywords: non-alcoholic fatty liver disease, Chitrakadi vati, Maha-tikta ghrita, Arogyavardhini vati

NAFLD is a Group of diseases that are all associated with hepatic steatosis, or fatty liver, in people who either never drink alcohol or only drink very little (less than 20g of ethanol per week). According to the diagnosis of non-alcoholic fatty liver disease (NAFLD).¹ The World Health Organization² reports that the frequency of chronic liver illnesses, including NAFLD, has been steadily rising in recent years. In the Indian population, the prevalence of NAFLD varies from 8 to 35%. Non-alcoholic steato-hepatitis (NASH), which can lead to liver cirrhosis and hepatocellular cancer, is thought to affect 3–5% of the general population. It is becoming more and more prominent as a cause of liver disease in India. According to epidemiological research, the whole Indian population may have a 12–35% prevalence of NAFLD, with a greater frequency among individuals who are overweight or obese and those who have diabetes or pre-diabetes.^3,4 Liver is comparable to Yakrut, which is a significant Koshtanga that is referenced in Ayurvedic texts. It is Raktavahasrotas's Mulasthana (root).⁵ Taking Sthansamsraya in Yakrut with Kaphpradhan Tridosh dushti, NAFLD can be viewed as a Santarpanjanya Vyadhi.⁶

In the Charak Samhita Chikitsasthan Grahanidosha Chikitsa adhyaya, the Chitrakadi Vati is referenced. It is a Medohara, Deepan, Pachan, and Kapha vatahara.⁷ One of the main causes of chronic liver disease is non-alcoholic fatty liver disease (NAFLD), which has a close link to the metabolic syndrome. Additional hepatic illnesses including cardiovascular disease, chronic kidney disease (CKD), colorectal cancer, endocrine disorders like type-2 Diabetes Mellitus, thyroid dysfunction, and osteoporosis are all at increased risk due to non-alcoholic fatty liver disease (NAFLD). Therefore, a workable solution to this issue must be found.^8,9

To evaluate the efficacy of Chitrakadi Vati, Arogyavardhini Vati and Mahatikta Ghrita in Non- alcoholic fatty liver disease.

An obese 35-year-old man complained of lethargy, lack of appetite, itchy skin, and upper abdominal discomfort six months prior. The patient went to the Ayurvedic practitioner's outpatient department (OPD).

The patient had a Madhyama koshthi, Mandagni, and Madhyama bala Vata-kapha Prakruti. Both the heart rate and blood pressure were within acceptable bounds. The patient had a body mass index of 28.3 and was obese, weighing 77 kg. There was no abnormality observed in the cardiovascular or respiratory systems. It was found that he was feeling discomfort when the right hypochondrium was palpated during a gastrointestinal examination (Table 1).

Local examination Per Abdomen:

• Palpation – liver and spleen- non palpable, non-tender
• Percussion – tympanic note heard
• Auscultation – normal bowel sound Table 2

Table 3.

Following an extensive evaluation, the patient was given oral medications for 4 months in an outpatient department setting. During this time, regular follow-ups were conducted, and the patient's Vaya, Agni, Bala, Koshta, Prakriti, Ritu, and Satmya were all taken into account Table 4.

Arogyavardhini Vati is added to Medo-Pachaka, just as it does Pachana of Drava and Kleda. This results in a reduction in Dravata and Snigdhata of Meda dhatu Pancha-Tikta Ghrita was employed for the purposes of pacifying the three Doshas, specifically Stroto-shodhana and Tridoshaghna. Bitter-tasting drugs reduce fat mass, reignite the tissue fire, and balance fat metabolism. Lekhana, Meda‑shleshma‑vasa Upashoshan, Laghu, and Ruksha are the characteristics of Tikta rasa.

Because of its Yogavahiguna (~which bears the properties of that entity or material with which it is related in the combination), the Pancha-Tikta ghrita formulation is Medanashana and Lekhana. The medications were made right away at our college i.e. Vivek College of Ayurvedic Teaching Pharmacy (Rasa Shastra and Bhaishajya Kalpana) GMP Lab certified, utilizing all accepted ancient techniques. In addition to taking the prescribed drugs, the patient was advised to adhere to certain dietary guidelines, such as consuming laghu Bhojana (which is easily digested), kshudvan (when there is adequate appetite), and kale Bhojana (eating meals on time).

An essential organ for food metabolism is the liver. Acharyas have conjectured about the formation of Yakrita from Raktadhatu as Ayurveda explains the fundamental principles of embryology and organogenesis, including Pancha-Mahabhoota, Tridosha, Saptadhatu, and others. The body's many organs are composed of various combinations of Raktadhatu and Mahabhuta.

In terms of Nidana and Samprapti, NAFLD, like Sthaulya (obesity), is a Santarpana Janya vyadhi (disease induced by overnutrition). Agni-Vikruti (vitiation of the digestive process) is the first step in the disease. It creates Apakvaannarasa (an imperfectly digested end product), which in turn vitiates Kapha-dosha and causes uneven development and deposit of Meda (fat tissue) in Yakrita.

This disease may be associated with fatty liver. The primary component of Arogyavardhini Vati is kutuki (Picrorhizakurroa Royle ex Benth). Through performing Pachana karma, Kutuki, a Titka rasa Pradhana, can assist in reducing Ama.¹⁰ Many studies have demonstrated the hepatoprotective properties of Kutaki. Arogyavardhini Vati has been demonstrated to assist individuals with NAFLD in improving their liver function because it is primarily a hepatoprotective.¹¹

Pancha Tikta ghrita is a polyherbal Ayurvedic formula. This medicine is prepared using five bitters: Guduchi (Tinosporacordifolia Thunb), Neem (Azadirachtaindica A.), Patol (Trichosanthescucumerina anguina), Kantakari (Solanumvirginianum L.), Vasa (Adhatodaadhatoda L.), together with Ghrita and Triphala. Pancha Tikta ghrita balances Pitta, Kapha, and Vata.^12,13 It also kindles Agni and helps the body rid itself of impurities.¹⁴

When treating fatty liver, Arogyavardhini Vati with Medapachana karma, Strotoshodhana, Pancha Tikta ghrita, and Chitrakadi Vati has good results in terms of Radiological, biochemical, and symptomatic resolution. If NAFLD symptoms are addressed early enough, Ayurvedic treatment can reduce them and stop any irreparable consequences. Research using modern diagnostic methods like ultrasonography has confirmed that Ayurveda is a successful treatment for fatty liver disease Grade -2.

The patient has granted permission for the case, photos, and other clinical data to be published in the journal, and the authors attest to having received this authorization. The patient is aware that although every attempt will be made to hide his identify and that his name and initials will not be published, anonymity cannot be ensured.

The authors declare that there have no conflicts of interest associated with this publication.

The authors are grateful for the support of the University of Science Arts and Technology, Montserrat for the resources to develop this manuscript.

None.

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