World Hepatitis Day 2022: Expert Opinion On Ayurvedic Management Of Hepatitis

Viral hepatitis has "intermediate to high endemicity" in India with approximately 40 million chronic hepatitis B infections that are 11% of the global burden. It is estimated that every three-four patients out of 100 suffer from viral hepatitis. According to the World Hepatitis Alliance records, every 30 seconds, one patient dies of hepatitis or hepatitis-related disorder or complications. In 2022, the World Hepatitis Alliance is concerned with reducing the burden of disease and death by hepatitis or hepatitis-related disorders. Thus, the theme of the 2022 World Hepatitis Day on July 28, as given by the World Hepatitis Alliance, is 'I Can't Wait'.

Viral hepatitis is a significant risk for liver diseases like cirrhosis and liver cancer. As per the website world hepatitis alliance, "we can't wait to act on hepatitis" as patients remain undiagnosed and even diagnosed patients are unaware of life-saving health care. The campaign has been launched to make people aware.

The conventional medical system adopts inoculation of microbial agents or fragments to sensitise humans to disease prevention and uses antivirals and supportive therapy to prevent cirrhosis due to HBV infection and promote health.

The primary objective is to cure the disease. Still, if not achieved, the second objective is to delay the onset of complications of cirrhosis and improve quality of life. It is observed that holistic Ayurveda medicine, with its unique personalised approach, can be effectively used to prevent disease, promote life quality and wellbeing, cure in the early phase of illness or delay the onset of a complication.

As per fundamental concepts of Ayurveda, any disease can be considered curable if and only if the original and healthy status of diseased tissues is restored. Else it is not considered curable but is narrated as Asadhya - incurable, which were further classified as palliative where proper planning of treatment, medicines, medical procedures, periodical purification & detoxification, diet and lifestyle planning improves the quality of life and enhances the wellbeing of the patient and person can perform their routine activities without significant difficulty.

The author has attempted to inform the readers of Ayurveda management options in managing the medical condition.

Why Ayurveda?

The medical fraternity is concerned with Viral hepatitis as it bears a major risk to individual health and wellbeing. The liver is an important organ for an individual's health, wellbeing, and longevity. The liver performs the vital function of detoxication, protein synthesis, and immunity over and above digestion. The liver is the most important organ for life and health. It is commonly opined that digestive disorders are well managed with holistic management and herbs. Ayurveda has primary evidence of managing the ailment, and the first description of cirrhosis is narrated day's back in 1500 BC in Charaka Samhita as follows:

"कालान्तरात् खरीभूता कृच्छ्रा स्यात् कुम्भकामला|
कृष्णपीतशकृन्मूत्रो भृशं शूनश्च मानवः||३७||"

Translation - when the patient is suffering from a liver ailment for a prolonged period (evident clinical illness, subclinical illness and carrier state illness), the hepatocytes, i.e. tissues, undergo a transformation and become hard (cirrhotic changes). This medical condition is named Kumbha Kamala, which is presented with black, blackish, blackish-yellow, yellowish-black discolouration with progressive weakness; later, there is the development of ascites (Kumbha means pot and ascites that develops in cirrhosis is similar to pot like the appearance of belly).

The above reference suggests that the functions of the liver and its disease, including complications and sequels, were understood and managed by the scholars of ancient India; the description may not be as per the present norms. Still, a definite indication of the knowledge of disease and its complication were known in Ayurveda.

This suggests that Ayurveda management ought to be used for a better quality of life and to reduce the burden of transplants. Transplant medicine is gaining acceptance, but there are many limitations too, like the use of immune-suppressive, availability of organs, cost of the procedure, etc., making it difficult to reach the majority of the population of the economically weaker section, lower income and middle-income group.

The disease is of the infective origin, but factors like food habits, alcohol, and medicines may have an adverse impact on the disease. They may favour speeding up of pathological processes leading to cirrhosis or cancer. The consumption of liquor and misuse of medication (especially hepatotoxic medications), including self-medication, increases complications.

Ayurveda Management Options

As narrated above, the disease has been narrated, i.e. there is primary evidence that the disease can be managed with Ayurveda medications. The management options available in Ayurveda were as follows:

Anti-viral care - the primary objective is to eliminate or detox viral toxins with medicinal herbs. Various herbs possess anti-viral properties that can be utilised for managing the condition. Charaka Samhita narrates the unique treatment of Prakruti Vighat. It is among the three-treatment modality for microbial illness, viz. Apakarshana - illumination, Nidan Parivarjana - avoidance of causative factors, and Prakruti Vighata - creating an internal environment unfavourable for the growth of microbes and helminths.

Prakruti Vighata treatment option can be adopted for almost all chronic infections, secondary infections and helminths. This is done using medicaments possessing certain characteristics, i.e., spicy, bitter & pungent taste, and alkalis for a longer period. This is typically useful for chronic infections and helminths that remain in the body for years in the dormant phase. When the body's immunity decreases or favourable conditions arise, they infect and produce disease (like autoinfection, labile illness, or latent disease/ latent infection).

Periodical purification or circadian purification helps to detox the body. Typically therapeutic emesis is performed in spring for Kapha, and therapeutic purgation & bloodletting are performed in autumn to eliminate Pitta and Basti - therapeutic enema for elimination or pacifying Vata. As per the fundamental concept of Ayurveda, the accumulation of morbid material and intermediate product of metabolism produce hindrance in body physiology; they adversely affect the function of metabolism of the cell (especially mitochondria - foci for Agni); this accumulation of metabolic and microbial toxins, free radicals microbial fragments were collective narrated as Ama, and this Ama is the root cause of all disease. Digestion and metabolism convert these intermediate products into the final product by the action of Agni (mitochondrial functions at the tissue level and grossly by the liver), which is later driven out of the body. The purification of the body thus detoxifies the body, improves host defence, and improves longevity.

Popularly used antiviral and antimicrobial that improves liver functions were Katuki, Kalmegha, Bhumyamalki, Ghrutkumari, Gorochana, etc.; wide spectrum antimicrobial Mahasudarshana can also be used for managing the condition with other medicine as per individualised health care.

Promotive liver care - disease manifestation depends on the interaction of three factors Nidan (causative factors), Dosha (morbid material) and Dhatus (body tissue and host factors); if there is rapid amalgamation leads to full blow of disease, if they amalgamate with delay or incomplete then the disease wouldn't occur or mild form of illness would occur. The status of Dhatus and Doshas can be improved with the use of Rasayana treatment that promotes the good health of the organ. This can be done using medicines like Ginger, Trikatu, Maricha, Triphala, Katuki, Rohitak, Kiratikta, etc. diet regulation is also necessary for managing the condition.

Diet planning by Astha Aahara Vidhi Visheshayatana (protocol for selection of food) and Aahara Vidhi Vidhan (protocol of eating - consuming food) and individual constitution is to be prescribed. Certain food items and foodstuff ought not to be consumed, viz. foodstuff made up of the white floor, complex cooking methods, excessive fried, deep fried, fermented foodstuff, liquor, cold beverages, sprouts (conventional science recognises it as healthy food as it contains fibres but sprouts are grain with roots these is due to a chemical change in the grain leads to complex in digestion), ready to cook, ready to serve food, Kusumbha Sneha, buffalo milk, buffalo ghee, groundwater, etc. needs to be avoided.

Statutory instructions: The article is presented to increase the awareness about Ayurveda on the traditional knowledge of Ayurveda from old Ayurveda texts and applicable as per interpreting the ancient Ayurveda text. Readers can read and get informed about Ayurveda; for more details and consultations, do contact an Ayurveda physician or Ayurveda Hospital.