Yakrut roga - liver disorders

The Details of Yakrut Roga is cited clearly for Study & can be included in BAMS curriculum

1. 1
सुस्वागतम्

2. यकृत् रोग & लक्षण
-A CASE STUDY
BY
Dr. ABDUL SUKKUR M
M D ( Ayu. ) Scholar
Dept. Of P G Studies in Samhita
S D M College of Ayurveda , Udupi
Under the Guidance of
Dr. Shrikanth P H M D ( Ayu. )
Professor & Head
Dept. Of P G Studies in Samhita
S D M College of Ayurveda , Udupi 2

3. A RESEARCH PROBLEM ?
3

4. INTRODUCTION
Ayurveda –the life science
Gives good & elaborate knowledge of
many diseases
Explaining the signs , symptoms & pathogenesis
Yakrit Roga is one among them
Can understand as liver disease
4

5. YAKRIT -POSITION ,ORIGIN
अधो दक्षक्षणतश्चापि हृदयाद् यकृतः स्स्िततः ।
तत्तु रञ्जकपित्तस्य स्िानं शोणणतजं मतम् ॥
[ भा. प्र. म. ख. ३३ / १० ]
गभभस्य यकृत्प्लीहानौ शोणणतजौ .... [ सु. सं. शा. ४/३५ ]
oSituated in the right side inside the Abdomen
oSeat of Ranjaka Pitta
oOriginated from Shonita ( Rakta )
oSusruta as one of प्रत्पयङ्ग & Charaka as कोष्टाङ्ग 5

6. LIVER -LARGEST GLAND
o1400-1600 Gram ( MALE ) ;
1200-1400 Gram (FEMALE) -WEIGHT
o2 main anatomical lobes -RIGHT & LEFT
o2 Lobes separated by fold of Peritoneum called FALCIFORM LIGAMENT
oInferiorly a fissure for LIGAMENTUM TERES
oPosteriorly a fissure for LIGAMENTUM VENOSUM
HISTOLOGY –3 Zones i) Zone 1-Periportal or peripheral area
ii) Zone 2-intermediate mid zonal area
iii) Zone 3-centrilobular area
Zone 1 –suffers effects from TOXIC INJURY
Zone 2 –suffers effects from HYPOXIC INJURY 6

7. LIVER FUNCTIONS
Manufacture & Excretion of Bile
Manufacture of Proteins -Albumin , Fibrinogen , Prothrombin
Metabolism of Proteins , Carbohydrates , Lipids
Storage of Vitamins ( A , D , B12 ) & Iron
Detoxification of Toxic substances such as Alcohol & Drugs
For Manufacture & Excretion of Bile
Serum Enzyme Assays
For Metabolic Functions
Immunoligical Tests
Ancillary Diagnostic Tests
LIVER FUNCTION TESTS -
7

8. YAKRIT ROGA
Explained as a separate Roga
in BhavaPrakasha
Madyama Khanda in
Pleeha Yakrit Vikaara Adhyaya ( Chapter –33 )
Given importance to Pleeha Roga
Explained in relation with Pleeha Roga
Other treatises explain under Udara Roga
8

9. तनदान, सम्प्प्रास््त of्लीहा रोग
पवदाह्यभभष्यस्ददरतस्य जदतोः प्रदुष्टमत्पयिभमसृक् कशश्च ।
्लीहा ऽ भभवृद्धध कु�तः प्रवृद्धौ तं ्रीहसञ्ञं गदमामनस्दत ॥
वामे च िाश्वे िररवृद्धधमेतत पवशेषतः सीदतत चातुरो ऽ त्र ।
मददज्वरास््नः कशपित्तभलङ्गै�िद्रुतः क्षीणबलो ऽ ततिा्डुः ॥
[ भा. प्र. म. ख. ३३/२-३ ]
[ सु. सं. तन. ७/१४-१६ , मा. तन. ३५/१५-१६]
्लीहामयस्य हेत्पवादद समस्तं यकृतामये ।
ककदतु स्स्िततस्तयोञेया वामदक्षक्षणिाश्वभयोः ॥
[भा. प्र. म. ख. ३३/१०]
9

10. सव्यादयिाश्वे यकृतत प्रवृधे ञेयं यकृद्दाल्युदरं तदेव ॥
[ सु. सं. तन. ७ , मा. तन. ३५/१७ ]
उदावतभ�जानाहैमोहतृड्दहनज्वरैः ।
गौरवा�धचकादिदयैपवभद्यात्तत्र मलान् क्रमात् ॥
[ अ. हृ. तन. १२ , मा. तन. ३५/१८ ]
्लीहोदरं -यकृद्दाल्युदरं
10

11. लक्षण of ्लीहा रोग
वातिक पैत्तिक कफज रक्िज
तनत्पयमानधकोष्िःस्िान्सज्वरमददव्यिः क्लम
तनत्पयोदावतभिीडडतः सपििासस्िूल भ्रम
वेदनाभभःिरीतः सदाह कदिनः पवदाह
मोहसंयुतगौरवास्दवतः वैव्यं
िीतगात्रअरोचकेनसंयुक्तगात्रगौरवं
मोह
रक्तोदरत्पवं
[ Ref. भा. प्र. म. ख. ३३/ ४-७ ]
11

12. LIVER DISEASES
VIRAL HEPATITIS -A , C , D , E , G ( RNA VIRUS )
-B ( DNA VIRUS )
OTHER INFECTIONS
& INFESTATIONS -Cholangitis , Pyogenic Liver Absess
-Amoebic Liver Absess , Hepatic Tuberculosis
-Hydatid Disease , Hepatotoxicity
CIRRHOSIS -ALCOHOLIC ( Common )
Features -3 Types -Alcoholic Steatosis / Fatty Liver
-Alcoholic Hepatitis
-Alcoholic Cirrhosis ( most common , 60-70%)
12

13. LIVER DISEASES
JAUNDICE -Prehepatic / Haemolytic
-Hepatic
-Posthepatic cholestatic
NEONATAL JAUNDICE
HEPATIC FAILURE -Acute & Chronic
LIVER CELL NECROSIS -Diffuse , Zonal , Focal
PORTAL HYPERTENSION
HEPATIC TUMOURS -BENIGN & MALIGNANT
13

14. साध्यासाध्यता
दोषत्रत्रतय�िाणण ्लीह्दयसाध्ये भवदत्पयपि ।
[भा. प्र. म. ख. ३३/८]
जदमनैवोदरं सवं प्रायः कृच्छ्रतमं मतम् ।
बभलनस्तदजाताम्प्बु यत्तत्पसाध्यं नवोस्त्पितम् ॥
[ च. सं. धच. १९ , मा. तन. ३५/१९ ]
14

15. ्लीहा –यकृद् रोग धचककत्पसा
्रीहोद्ददष्टाः कक्रया सवाभ यकृद्रोगे समाचरेत् ।
कायभञ्च दक्षक्षणे बाहौ तत्र शोणणतमोक्षणम् ॥
[ भा. प्र. म. ख. ३३/२० ]
क्षारं पवदडङ्गकृष्णाभयां िूतीकस्याम्प्भु तनःसृतम् ।
पिबेत्पप्रतयभिावस्ह्न यकृत्प्लीहाप्रशादतये ॥ [ भा. प्र. म. ख. ३३/२१ ]
•उदधध शुस्क्त क्षार + दु्ध , पि्िली चूणभ + दु्ध
•शङ्खनाभभरजः + जम्प्बीरशलरस ( शाण प्रमाणं = ¾ Gram )
•दहङ्गु + त्रत्रकटुकं + कुष्िं + यवक्षारं + सैधवं + मातुलुङ्गरस
•सुिक्व सहकार रस ( well ripened Mango juice ) + क्षौद्र
•यवातनका + धचत्रक + यावशूक + षड्रस्दि + ददती + मगधोत्पभवं ( सवं चूणं )
in उष्णाम्प्भु orमस्तु or सुरा or आसव
•पि्िली भापवता in िलाशक्षारतोय –्लीहागुल्मापत्तभशमनी& वस्ह्नमादद्यहरी
R
x
15

16. ्रीहा –यकृद् रोग धचककत्पसा
सवभमेवोदरं प्रायो दोषसङ्गातजं मतम् ।
तस्मास्त्पत्रदोषशमनीं कक्रयां सवभत्र कारयेत् ॥
दोषैः कुक्षौ दह वस्ह्नमभददत्पवमृच्छ्छतत ।
तस्माद् भोज्यातन भोज्यातन दीिनातन लघूतन च ॥
[ च. सं. धच. २३/९५-९६ ]
दोषाततमात्रोिचयात्परोतोमागभतनरोधनात् ।
सम्प्भवत्पयुदरं तस्मास्दनत्पयमेवं पवरेचयेत् ॥ [ अ. हृ. धच. १५/१ ]
अग्र्यौषधं –......्लीहामये पि्िली [ अ. हृ. उ. ४०/४८ ]
Formulations –
नारायणं चूणं
िटोलाद्यं चूणभ
हिुषाद्यं चूणं
नीभलदयाद्यं चूणं
रोहीतक घृतं
स्नुदहक्षीरघृतं
R
x
16

17. THE RESEARCH PROBLEM WAS KNOWN
AND
THE SOLUTION IS WITH YOU
17

18. A Case Study
PERSONAL DATA
AÉiÉÑUlÉÉqÉ: Mr. R OP No. : 3014
वय: : 26 years IP No. : 529
ÍsÉ…¡ : Male Ward: Male
(Gen.Ward-57)
ÌlÉuÉÉxÉxjÉÉlÉ: Baindoor,
Kundapur mÉëuÉåzÉÌSlÉɃ¡û:
Sidkuli, Udupi. 19/07/2014
eÉÉÌiÉ: Hindu
ÌlÉaÉïqÉlÉÌSlÉɃ¡ :
10/09/2014
ÌuɱÉprÉÉxÉ: 9th Standard
व्यवसाय: Coolie Worker Data Collected-
24/08/2014
वैवाहिकि: Married
18

19. प्रधान वेदना
C/O कटीशूलsince 1 Year
सन्धध वेदना since 8 months
गमनकष्टिा& कृच्छ्रश्वासsince 6 months .
अनुबधध वेदना
शोफin पाद उपरर भाग , आनन& उदर
दौबबल्य (General Weakness)
Difficulty in movement of body parts & in
Walking .
Case Study Contd...
19

20. Case Study Contd...
mÉëkÉÉlÉ uÉåSlÉÉ वृिÉliÉ
The patient was said to be normal 18 months before he was
a normal coolie worker and worked for 8 years, the work includes carrying
loads in the head like bricks, etc.. One day while he was working and
carrying load when going upside suddenly he felt uneasiness and by fainting
fell down.
After some days he had वेदनाin both जानुसन्धधs and
elbow joints. For this he consulted a physician in Udupi.At that time he also
developed अन्ननमाध्यand शरीरभारक्षय. During the treatment in Udupihe
had शोफin the उदरand upper side of the पादfor which they instructed the
patient to walk more ; but by walking more theपादशोफincreased .
The patient also had शरीरदौबबल्य.The patient was poor
and hence he can’t afford the expenses of medicines prescribed in the
Clinic in Udupi. Then he consulted us.
20

21. Case Study Contd...
पूवब व्याधध वृिाधि:
H/O No DM , HTN
कुलवृिाधि:
Father : Died 3 years before due to Heart Attack
Mother : Alive, no major complaints
He was married & had 2 daughters ( studying for B.com & SSLC )
Wife : Said to be with no complaints
He had 5 brothers and 2 sisters.He was the 2
nd
son.
No other member in the family had other diseases.
21

22. Case Study Contd...
xÉÉqÉÉÎeÉMü uÉרÉÉliÉ
The Patient was a coolie worker and belongs to low
economic status. He was treated in clinics and he can’t afford the
expenses as Hospital charges and medicines. Then he consulted
us. The Patient was very co-operative.
uÉærÉÌ£üMü वृिाliÉ
mÉÔuÉïMüÉsÉÏlÉ A±iÉlÉMüÉsÉÏlÉ
AÉWûÉU Vegetarian Vegetarian
ÌlÉSìÉ अतनद्रिा सम्यक्: (7 to 8 hours)
AÎalÉ qÉlSÉÎalÉ xÉqÉÉÎalÉ
कोष्ठ मध्यम कोष्ठ मध्यम कोष्ठ
22

23. Case Study Contd...
UÉÍzÉ
mÉÔuÉïMüÉsÉÏlÉ A±iÉlÉMüÉsÉÏlÉ
BREAKFAST
Idlior Dosa
with vegetablecurry
RavaUpputtu
LUNCH
GanjiRicewith
curry
GanjiRice with curry
DINNER
GanjiRicewith
curry
GanjiRice with curry
23

24. Case Study Contd...
अनुक्रम परीक्षााः
Respiratory System : श्वसनवेग-22 times/min.
Cardio vascular System: नाडी-84 times/min.
रक्ि मदब-140/90 mm of Hg.
हृदय वेग-84 beats/min.
Per Abdomen : शूलby self
शूलonpalpation in right side
abdominal distension present
Skeletal System : शूलpresent in all सन्धधs
Movements – of body parts with difficulty
- difficulty observed in walking
long distance & long time
24

25. Case Study Contd...
Face : NAD Neck : NAD
Chest : NAD Skin : NAD
25
अष्टस्थानपरीक्षा:
1.नाडडपरीक्षा: स्पंदन-प्राकृि: (84 beats/min)
2.मूत्रपरीक्षा: -प्राकृि: -3-4times/day -2 times/night
3. मलपरीक्षा: -प्राकृि:-Once in a day
4. न्जह्वापरीक्षा:--लेप:-ललप्ि, वर्ब: -लालावर्ब
5. शब्दपरीक्षा:-प्राकृि6. स्पशबपरीक्षा: -शीिस्पशब
7. दृक्परीक्षा:-वैकृिwith शोफ
8. आकृति: -मध्यम

26. Case Study Contd...
दशत्तवध पररक्षा:
1. प्रकृतत:-वातपित्त
2. पवकृतत: WåûiÉÑ-Due to intake of excess EwhÉÉ, MüOÒû रसAÉWûÉU,
दधध, qÉÉwÉ xÉåuÉlÉ andअततव्यायाम
 दोष: -वात,पित्त;दूष्य-रस, रक्त
3. सार: -मध्यम सार, 4. सत्पव:-मध्यम(वेदना सहः)
5. संहनन: -मध्यम( qÉkrÉiuÉÉiÉç xÉÇWûlÉlÉxrÉ qÉkrÉoÉsÉÉ pÉuÉÎliÉ |)
6. xÉÉiqrÉ: -मध्यम(bÉ×iÉ, ¤ÉÏU, iÉæsÉ iÉjÉÉ xÉuÉïUxÉ, mÉëuÉU xÉÉiqrÉ
Ã¤É xÉÉiqrÉ iÉjÉÉ LMü UxÉ , AuÉU xÉÉiqrÉ)
7. प्रमाण: -मध्यम(Height-5.5 feet )
8. आहार शस्क्त: -अभयवWûरण शस्क्त:-मध्यम
 जरण शस्क्त: -मध्यम
9. व्यायाम शस्क्त:िूवभकालीन:-प्रवर, अध्यतन:-मध्यम
10. वय: -oÉÉलं–16 to 30( cÉ.ÌuÉ8/ 122 )
26

27. Case Study Contd...
कोष्ठपरीक्षा:
 -मध्यम कोष्ठ
 -Patient feels hungry after the previous food is digested.
 -Patient daily passes the stools without any difficulty.
xÉëÉåiÉÉåmÉUϤÉÉ
 1. रसवि-अरूधि, आस्यवैरस्य, दौबबल्यिा
 2. ESMüuÉWû -ÌmÉmÉÉxÉ
3. A³ÉuÉWû -A³ÉÉÍpÉsÉÉwÉ, AUÉåcÉMü
( स्रोिो दुन्ष्ट लक्षर्: -त्तवमागब गमन)
तनदानmÉÇcÉMü
1. तनदान: -आिार
-Excess intake of EwhÉÉ, कटुरस
-Intake of दधध
-Intakeof qÉÉwÉÉProducts like Idli, Dosha, etc
27

28. Case Study Contd...
त्तविार-आिप सेवनandsheetalaअम्बुmÉÉlÉ
-अतिव्यायाम(Coolie worker-carrying load)
MüqÉïeÉ-AkÉïqÉ, -पूवब जधमकृि, -पररर्ाम, -प्रभाव
2.mÉÔuÉïÃmÉ-शरीरuÉåSlÉ, -मूत्रSÉW
3.ÃmÉ-AlaÉqÉSï, -ÌlÉSìÉlÉÉzÉ, -दौबबल्य, उदर शोफ
4. xÉÇmÉëÉÎmiÉ
ÌlÉSÉlÉ xÉåuÉlÉ
uÉÉiÉत्तपिmÉëMüÉåmÉ along withU£ü mÉëMüÉåmÉ
mÉëMÑüÌmÉiÉ SÉåwÉÉmoves from their place
ZÉ वैaÉÑhrÉiÉin रस, U£ü
SÉåwÉ SÕwrÉ xÉqqÉÔcNïûlÉ take place
Leading toउदरशोफ, दौबबल्य, गमनकष्टिा
28

29. Case Study Contd...
5. उपशयand अनुपशय
 उपशय -आिार( Vata Pitta shaamaka aahara,etc)
-औषधध, -ÌuÉ´ÉqÉÇ
अनुपशय -आिार( Vata Pitta vardhaka aahara,etc)
-AÉrÉÉxÉ
INVESTIGATIONS
Hb 11.8 gm%
TOTAL WBC COUNT 6900 cells/cumm
PLATELET 3.77lakhs/cumm
NEUTROPHILS 60%
LYMPHOCYTES 32%
MONOCYTES 5%
EOSINOPHILS 3%
R.B.C COUNT 3.79 millions/cumm
M.C.H 31.0picogram
P.C.V 37.8%
M.C.V 100.0 fl
M.C.H 31.0picogram
M.C.H.C 31.1%
R.D.W 12.4%
RBS 87 mg/dl
29

30. Case Study Contd...
ESR 17.0mmin 1
st
hour
MPV 6.70cu.mm
PERIPHERALSMEAR Normocytic
NormochromicBlood Picture
BLOOD UREA -SERUM 15.0 mg/dl
S.CREATININE 1.1 mg/dl
S.POTASSIUM 5.1mEq/L
HIV SPOT SERUM Non Reactive
HbSAg SPOT TEST Non Reactive
INVESTIGATIONS
USG-ABDOMEN(Dtd. 10/06/2014)
Liver–Enlarged (Hepatomegaly)
USG-SCROTUM(Dtd.10/06/2014)
Left Testes is enlarged, ill defined
Hypoechoic Lesion in Upper Pole.
Increased Vascularity is seen.
Left Epididymis is enlarged with
Hypoechoic Lesion –moderate
urÉÉÍkÉ ÌuÉÌlɶÉrÉ -यकृ्दाल्युदरम्
30

31. Case Study Contd...
Treatment given :-
Padolakaturohinyadi Kashayam 15ml Bd
Gorochanadi gutika 1-1-1
Lavana –amla varjita food -all for 1 week.
Padolamoolaadi Kashayam 15ml Bd
Gorochanadi gutika o-1-o , Vilvadi gutika 1-o-1
Trivrit lehya 1 & 1/2 tsp. with warm water Hs.
Eishad lavana –amla sahita food -all for next 1 week.
Guloochyaadi Kashayam 15ml Bd , Dhanvantharam gutika 1-o-1
Navayasa Choornam 5 gm Bd with warm and cooled water
Trivrit Choornam 5 gm with warm water Hs. –all for next 1 week.
Balaguloochyaadi Kashayam 15ml Bd , Dhanvantharam gutika 1-o-1
Triphalaadi Choornam 5 gm with warm water Hs. –on Discharge.
31

32. CONCLUSION
The Liver Diseases are explained
along with the Spleen Diseases in Ayurveda .
This can be understood by incorporating the
knowledge of contemporary Medical Science .
A few references are now available in Ayurveda
regarding Liver Diseases as a separate entity .
So a detailed Study and Researches are necessary
for the proper understanding of the Disease .
Liver Disorders can be treated with the better
understanding the treatment concepts inAyurveda
considering the health condition of the whole body.
32

33. Acknowledgements:
Dr. Shrikanth P H , Guide
All the teaching staff of the Department
Classmates and freinds
My parents and family members.
33

34. REFERENCES :
भावप्रकाशः मध्यम ख्डं अ –३३
सुश्रुत संदहता तनदान स्िानं अ –७
चरक संदहता धचककत्पसा स्िानं अ –२३
माधव तनदानं अ –३५
अष्टाङ्ग हृदयं धचककत्पसा स्िानं अ –१५
Text Book of Pathology 6
th
Edition By Harsh Mohan
Chapter 21 , Page Numbers 592 –648
34

35. 35
लोकाः समस्ताः सुणखनो भवदतु।
धदयवादः