Clinical evaluation of Nitya Virechana in Hepato cellular Jaundice – A Case Study

Kamala is a Vikar of the pittapradoshja. The symptoms are analogous to those of jaundice. Hepatocellular jaundice is an infectious condition which affects the liver.Due to lifestyle modi ication, society can’t follow these concepts about ‘Aahar’&Vihar’ (Diet and behavioural regime)(e.g. fast food, Chinese style food, late-night sleep and day sleep. So now the maximum people in a day are going to suffer from GIT problem. Pittakar-ahar likes Vada-Pav, highly spiced food and propensity to consume alcohol is also rising gradually. Ayurveda has historically been highly pro icient and has been treating liver disorders for centuries, and the drug toxicity tends to be lower than conventional medicine. Therefore the case study, like NityaVirechana, is based on Ayurvedic Medicine and Puri ication Therapy (Panchakarma Procedure). Acharya Charak stated the Classical Virechana is management, but the patient was lean, and his strengthwas not asmuch of, so incapable of performing classical virechan. His body structure and his strength and working pattern kept in mind, we planned Nityavirechan (daily purgation) and got a very good outcome and also saved his time for hospitalisation.


INTRODUCTION
In the current scenario of industrialisation, life becomes more threatening and brings lifestyle changes due to sedentary living, and many patients become sick and fatigued. Further, they may be diagnosed as Kamala (jaundice). This kind of incidences increased day by day. "Charkacharya is advised in 'Nidansthana', but because of fast life or changing lifestyle, society can't follow these concepts about ' Aahar'&Vihar'(Diet and behavioural regime)(e.g. Pav or Bread, fast food, Chinese, Ratri Jagarana.) Hence now a day's, people are suffering from the problem of GIT" (Parwe and Nisargandha, 2018).
"Pittakar-ahar like Vada-Pav spicy food, missal, etc., and a tendency to drink alcohol is also increasing day by day. Ayurveda has traditionally been skilful and has been treating liver diseases for centuries, and the drug toxicity appears to be smaller than traditional medicine. Nearly 290,000 cases of viral hepatitis were reported in India in 2013, i.e. 2.8 per cent of the population" (Jangid and Jadhav, 2017).
An Ayurvedic text stated hepatocellular jaundice as a Kamala (Kamala bahupitta). It is a severe form of jaundice which yellowish the skin and urine, indicating excess bilirubin, a bile pigment in the blood. Patients also complain of anorexia, nausea    Ardraka rasa (Rz.) Q. S. 2 times 7 Bhringaraja rasa (Pl.) Q. S. 2 times and exhaustion (Hall and Guyton, 2011).
Thus, ancient Acharya listed "kamalituvirechanama" as the main principle of treatment of Kamala (Jaundice) Treatment begins with purgation. This is one of the Panchakarma procedure, and it takes nearly a week to perform. And Nitya virechan (daily purgation) is a type of virechan (purgation therapy). Whenever there is a large number of toxins present in the body, we have to remove it in small quantities daily. So a daily purgation is recommended for the patient.

Case Presentation
A 26-year-old male patient residing at Sawangi Meghe, Wardha visited the OPD of Panchakarma in MGACH for a checkup, after the clinical examination, the following symptoms were noted, fatigue, anorexia, fever and he complained of weight loss, about 4 to 5kg in one month. Before treatment, he was advised to perform some routine investigations to rule out the cause for his weight loss.

History of Illness
One and a half month ago, the patient was healthy. After that, he had a fever, Anorexia and Nausea, Discolouration of the skin, and the urine was not found in his history.

Personal History
Addiction-alcohol consumption, frequent consumption of junk, oily and spicy food was observed.

Progress Of Treatment And Assessment
In this case study, we administered the treatment with a list of internal medicines with doses and duration as in Table 1.

Assessment Of Treatment
In this patient, blood investigations were carried out, and we found the changes before and after the treatment in Table 2 Discussion "In the Ayurvedic literature, Kamala is described as a pitta dominating liver disease. 'Charaka describes that Kamala is a predominant stage (Purva Rupa) of Pandu but, Susruta has mentioned it is as a complication (Upadrava) of Pandu rogas as well as other diseases also where Vagbhata also describes it as a separate disease" (Parauha et al., 2017).
It refers to the situation that causes excessive bile pigmentation to discolour the body's lustre and enhances the skin's complexion, ensuing in yellowish staining of the bile (Pitta) into the blood (Moritz, 2007). Thus, hepatoprotective drug treatment is given along with NityaVirechana with mild virechaka drug treatment.
The basic idea is that there is no load on the liver, so nityavirechana therapy is suggested for that. Excessive bilirubin in the process of developing jaundice contributes to increased development of stercobilin. The Nitya virechana procedure helps eliminate excess stercobilinogen and helps reduce hyperbilirubinemia and ultimately hepatocellular jaundice.
'Virechana is seen as the most appropriate practice for Kamala's management. In Jalodar, Charaka had explained, "DoshatimatropchayatStotomarganirodhanat ... tasmatnityamevaVirechayet II" Nitya Virechana (daily purgation treatment) Jalodara's Chikitsa Sutra is "Nitya Virechana." Virechana is essential to break down all Dosha's Sanga and keep it smooth and separate it. Mula Sthana (main site) is Rakta's Liver (Yakrita). Ashraya and Ashrayi Sambandha (mutual interdependence) are present in Rakta-Pitta, thus purging is the best treatment for removal of vitiated Pitta Dosha' (Bhagiya et al., 2017). Bearing this principle in mind, we rewarded the patient with Nityavirechana with the drug Yakritapliaharilauha which is shown as a gentle laxative.

YakritaplihariLauha
Composition of Yakrit Plihari lauha, which is used for Nitya virechana in Table 3.
There are seven Dravya which is used as Bhavana for Yakrita plihari lauha in Table 4.

Arogyavardhini vati
It is a traditional plan of polyherbal-minerals recorded in the Ayurvedic model. It has been utilised for a considerable length of time in the treatment of jaundice, hepatic issue and different skin issue with phenomenal viability and security. It is made out of Terminalia chebula (Haritaki) Terminalia bellerica (Bibitaka), Emblicao icinalis (Amalaki), Aspalitum (ShilajatuSuddha), Commiporawightill (GugguluShuddha), Ricinus Communis (Eranda), Picrorrhiza kurroa (Katuka) Azadiracta indica (Nimba) leaf squeeze and metals like Shuddha Rasa ( iltered mercury), Shuddha Gandhaka (sanitised sulfur), Laua Bhasma (debris formed iron compound), Abhraka Bhasma (debris moulded mica), and Tamra Bhasma (debris moulded copper mixes). A trial concentrate settled the defensive impact of notable Arogyavardhini vati on CCI4incited hepatotoxicity in rodents that it has demonstrated cell reinforcement properties. It is protected to utilise; however, it contains mercury and copper. Arogyavardini vati and Bhumyamlaki 's left squeeze (Phyllanthus frataruns L.) and Triphlachurna assume a crucial job in HBsAg freedom and regularisation of the liver (AK et al., 2017). (Kothavade et al., 1996) has purgative activity and it was improving the recovery and utilitarian recuperation of beta cells; demonstrating sti ling activity on hepatic medication utilising chemicals; hindering the carcinogenesis procedure. It has a property to bringing down the serum levels of hepatic chemicals and diminishing the blood glucose levels and delivering the antimicrobial action.

CONCLUSIONS
Based on clinical and biochemical indings, it is concluded that Yakritpliharilauha's Nitya Virechana is successful in treating Hepatic Cellular Jaundice. It signi icantly relieved all symptoms of Hepatic Cellular Jaundice. And so, the level of bilirubin also reduced substantially by Nitya virechana. Upon ifteen days, the patient was relaxed, and his appetite increased, and Nitya virechana increased his weight too. So Nitya virechana is the most exceptional treatment for Kamala, this study has proved very well.