Issue : 04
INTERNATIONAL
JOURNAL
OF
DIAGNOSTICS
AND
RESEARCH
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
1
P
ISSN No. : 2584-2757
Volume : 03
Issue : 04
DOI
: 10.5281/zenodo.21369257
Reg. No. : MAHA-703/16(NAG)
Year of Establishment – 2016
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH
Corresponding Author: Prof. Dr. Subhash Waghe
ORCID ID: 0009-0006-2776-5549
ISI Impact Factor (2025-26): 1.345
IIFS Impact Factor (2026-27): 6.0
Article Info: Article Received on : 09/05/2026 Article Reviewed on: 25/06/2026 Article Published on : 15/07/2026
Cite this article as: - Waghe, S. (2026). Clinical Study of Aetiology of Cirrhosis of Liver with special reference to Ayurvedic
Dietary and Lifestyle factors and Systemic Involvement. International Journal of Diagnostics And Research, 3(4), 1–18.
https://doi.org/10.5281/zenodo.21369257
Abstract
Background – Recent observations suggest that the true rate of chronic infection after clinically apparent acute
hepatitis B is as low as 1 per cent in normal individuals. Also, only 10 to 15 per cent of alcoholics develop Cirrhosis
of the liver, suggesting that other factors might be influencing the impact of the above factors on the liver. In view of
the above facts and the obscure concepts of Prakriti, Agni, Dincharya, Ritucharya, Ahar vidhi-visheshyatan, and
healthy lifestyle in modern medicine, it is essential to study cirrhosis of the liver with respect to the factors
mentioned above and to examine their role in its development.
Aims and Objectives - The aims and objectives of the present work is to study the aetiopathogenesis of
Kumbhakamala (Cirrhosis of liver) in terms of Ayurvedic dietary, lifestyle factors and systemic involvement.
Material and Method – 40 Patients having clinical features of cirrhosis of the liver were selected without any
prejudice from the O.P.D. & I.P.D. sections of Pakwasa Samanvaya Rugnalaya and All India Ayurveda Research
Institute, Hanuman Nagar, Nagpur.
Observations – Proper observations are recorded in tabular format, along with their analyses.
Discussion –Pittavardhak dietary and lifestyle regimen in conjunction with faulty dietary habits like samshan,
adhyshan, vishmashan, virruddhashan is commonly observed in patients of cirrhosis of the liver. Pitta dominance is
observed in the genetic body constitution of cirrhotic patients.
Conclusion - After assessing the clinical features, aetiological factors, and pathology explained in both Ayurvedic
and modern science, we can fairly correlate Kumbhakamala with cirrhosis of the liver. Ayurvedic pitta-enhancing
dietary and lifestyle factors may contribute to the severity of pathology.
Keywords: Cirrhosis of the liver, Pittvardhak ahar, pitta prakriti
Clinical Study of Aetiology of Cirrhosis of Liver with special reference to Ayurvedic Dietary and
Lifestyle factors and Systemic Involvement
Prof. Dr. Subhash Waghe
1
1
Dept. of Rog Nidan, SAM College of Ayurvedic Sciences, Raisen (MP) – 464 551
G
A
R
V
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
2
Introduction :
Ayurveda, the science of life, studies life with
respect to health and disease, as well as the various
factors that promote and deteriorate health. Ahara
(diet) and Vihara (lifestyle) are the two most
important factors. A healthy diet and lifestyle
promote health, and vice versa. Along with
Brahamacharya (celibacy and good conduct) and
Nidra (sleep), Ahar forms the three sub-pillars
(Trayopstambha) of life. In Ayurveda, the
unwholesome conjugation of sense organs and
objects (Asatmya Indriyartha Samyog), purposeful
intellectual errors (Pradnyapradh) and the
consequences of time (Parinam) with respect to
Ahar and Vihar have been told as the three basic
causes responsible for the development of the
disease. Ayurveda is of the view that "microbes, no
matter how virulent they are, will not create any
disease in the body, unless the equilibrium stage of
Doshas gets disturbed". This equilibrium is
governed by many intrinsic and extrinsic factors,
such as Ahara, Vihara, Agni, and Prakriti, related
to vyadhikshamatva (immunity), etc. According to
Acharya Vagbhata, all diseases are due to Mand-
Agni (decreased appetite), which in turn depends on
a number of factors, such as Ahara, Vihara,
Prakriti, Vikriti, Season, Time, etc. This Mand-
Agni is unable to digest the diet as a result of which
the accumulation (Sanchaya) of toxic material
(Ama) takes place, which is the first stage of
pathogenesis of any disease. This stage leads to
further stages of pathogenesis and causes the
disease at the site of affection. There are a number
of diseases that are caused by the vitiation of
specific doshas (basic humours), which in turn are
aggravated by specific dosha-aggravating diet and
lifestyle. Kamala is one of them. In Ayurveda,
Kamala is defined as a disease characterised by
deep yellow discolouration of the eyes, nails, skin,
and face, along with fatigue, malaise, indigestion,
anorexia, etc.
In modern science, a similar condition is called
jaundice, which can be caused by various factors.
Hepatitis Viruses like A, B, C, D, E, G and
alcoholic hepatotoxicity are the commonest causes
responsible for it.
[1]
The human knowledge of Kamala is as old as the
Vedas. The first reference to Kamala, along with its
treatment, is observed in the Atharvaveda, where it
is called 'Hariman'. (Hymen 1-22/1, 2 & 4). The
period of the Atharvaveda is approximately 2500-
3000 BC. For a long time, the disease kamala
(jaundice) has been affecting the masses and is one
of the major health problems throughout the world,
responsible for considerable morbidity and
mortality from its acute or chronic sequelae.
According to one study, there are more than 200
million (20 crore) HBsAg carriers in the world. In
India, approximately 4.5 crore people are infected
with HBV, and 1 crore with HCV, and with a lack
of satisfactory treatment and awareness, it remains
the 5th single most important factor responsible for
mortality in the age group between 14 and 45 years,
averaging nearly 2.5 lakh deaths per year.
[2]
Kumbhakamala (Cirrhosis of liver) is a chronic
stage of the disease Kamala which can be fairly
correlated with modern syndrome of cirrhosis of
liver in which pathologically there is necrosis of
hepatocytes, followed by fibrosis and nodule
formation and the liver architecture is diffusely
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
3
abnormal interfering with the liver blood flow,
producing the features of portal hypertension like
hematemesis, malena, encephalopathy, ascites with
or without edema feet, etc.
[3]
which are also seen in
kumbhakamala.
Recent observations suggest that the true rate of
chronic infection after clinically apparent acute
hepatitis B is as low as 1 per cent in normal
individuals. Also, only 10 to 15 per cent of
alcoholics develop Cirrhosis of the liver, suggesting
that other factors might be influencing the impact
of the above factors on the liver.
[4,5]
In view of the
above facts and the obscure concepts of Prakriti,
Agni, Dincharya, Ritucharya, Ahar vidhi-
visheshyatan, and healthy lifestyle in modern
medicine, it is essential to study cirrhosis of the
liver with respect to the factors mentioned above
and to examine their role in its development. The
present literary and clinical study will also help in
understanding Kumbhakamala (cirrhosis of the
liver) and various other types of Kamala in the light
of modern science.
Review Of Literature:
Charaka in Chikitsasthan 16/34-37 described the
pathogenesis of Koshthashakhashrit Kamala,
Kumbhakamala. Haleemaka in 16/132-134 and
Shakhashrit Kamala in 16/124-126.
[8]
According to
him, if a patient of Pandu consumes Pitta
aggravating factors, then that vitiated Pitta burns
(dagdhwa) the blood and flesh, resulting in Bahu-
Pitta Koshthashakhashrit Kamala, which, after
chronicity, leads to Kumbhakamala.
Kaphasamurchhit Vayu, vitiated due to excess
intake of dry, cold, sweet, heavy diet, suppression
of natural urges, intense exercise, etc., forces out
Pitta from its obstructed site (Pittasya Patham
Kaphen Rudhham) and throws it into circulation,
causing Shakhashrit Kamala. In a patient of Pandu,
specific vitiation of Vata & Pitta results in a
greenish, yellowish, greenish-blackish complexion;
that stage is called Haleemaka.
Vagbhata followed Charaka's view, but he held that
Koshthashakhashrit Kamala can occur without the
preexistence of anemia in a person of Pitta Prakriti.
(A.S. Ni. 13/17-21, A.S. Chi. 18/40-43)
[10] [11]
Sushruta in Uttaratana 44/11-14 mentioned that if a
person, after Pandu roga or any other disease,
consumes alcohol, sour/rotten food, or
harmful/toxic/antagonistic food in excess, then
vitiated Pitta causes Kamala. If this patient of
Kamala develops generalised edema and arthralgia,
then that stage is called as Kumbhasahv
(Kumbhakamala - Dalhan)
[8]
If this patient of
Kumbhasahav develops fever, fatigue, listlessness,
giddiness, drowsiness, greenish, greenish-blackish
or bluish tint due to specific vitiation of Vata and
Pitta, then that stage is called as Haleemaka. After
analysing the views of Charaka, Sushruta,
Vagbhata, commentators like Chakrapani, Dalhan,
the pathogenesis of Koshthashakhashrit Kamala,
Shakhashrit Kamala, Kumbhakamala, and
Haleemaka can be given as:
In the first type of pathogenesis, the said patient of
Pandu is the patient of Pittaj Pandu (Hemolytic
anemia) where there is already jaundice is present
but to a lesser extent (indicated by the word 'peeta
chakshu') as we usually notice in patients of
hemolytic anemia (low serum bilirubin) But as
these patients consumes Pitta aggravating aetiology
like alcohol, smoking, hot, chilly, pungent food etc.
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
4
Pitta aggravates further, and weak, friable RBCs
begin to break down, resulting in a more
pronounced jaundice
[6, 7]
, indicated by the word
Haridra (deep yellow like turmeric), reflected in
yellow eyes, yellowish urine, etc. Here, the prime
pathology is of Asruk dagdhwa (Hemolysis). Prime
strotodushti is Atipravritti (excessive production).
This is Koshthashakhashrit Kamala Panduroga-
purvika. After cessation of the acute episode, when
the chronic sequelae of this pathology produce
extensive edema and bony pain, that stage is called
Kumbhakamala. And if repeated episodes produce
greenish, yellowish or greenish-blackish hue, then
that stage is called Haleemaka.
[9]
In the second type of pathogenesis, if a patient with
any Pitta-dominated disease or a person of Pitta
constitution consumes Pitta-aggravating factors like
alcohol, excess sexual intercourse, hot, chilly,
pungent diet, etc., then there occurs intense
vitiation of Pitta resulting in acute hepatic necrosis.
Here, the primary pathology is of the Mansa
dagdhwa type (Hepatolysis), as there is an
ashrayashrayi relationship between the liver and
Pitta. The term 'Mansa dagdhwa' here refers to
hepatic necrosis (hepatolysis). The predominant
strotodushti here is of Atipravritti and sang type.
(Excessive production and defective excretion)
This type of hepatocellular jaundice in Ayurveda is
called Koshthashakhashrit Kamala
Pandurogavina.
[12]
If this condition is left untreated,
then it becomes chronic, and although there is no
apparent jaundice, the internal pathology involving
the liver continues, leading to hepatic fibrosis,
indicated by the word 'Kharibhuta', giving rise to a
condition called Kumbhakamala. The meaning of
Kharibhuta given by Chakrapani is hardness
(kathortamup-gata) and intense dryness (Ati
rukshitaha). In Ayurveda, there are three types of
paka described viz. mridu, madhyam and khara. Of
these, mridu paka is one which formed by mild
heating, madhyam by moderate heating and khara
by excessive heating. The relevance of paka theory
here is very important because the term used in the
pathology of K.S.Kamala is dagdhwa (meaning 'to
Heat/burn'). Notably, one of Pitta's functions is
heating.From the above, one can understand the
nature of the pathology. The only difference
between ancient and modern science is the way it is
described and the terminology used. They have
used the terminology prevailing at the time, or
sometimes examples, to describe various aspects.
As of today, we know that liver fibrosis occurs in
cirrhosis, which in Ayurveda is known as Kumbha-
kamala. Extensive edema (Mahan Shofa), including
ascites at this stage, suggests hypoalbuminaemia
reflecting severe liver pathology. Hematemesis
(Sraktachhardi), Malena (Krishna Shakrita), and
encephalopathy indicate portal hypertension. In this
condition, an additional superinfection or acute
hepatic necrosis may produce features such as low-
grade fever, anorexia, malaise, and icterus. Or long-
standing jaundice (on oxidation of bilirubin to the
greenish-yellowish or greenish-blackish biliverdin)
produces a greenish-yellowish or greenish-blackish
hue; that stage is called Haleemaka.
[13]
Whenever in
patients of Kamala, Kumbhakamala or Haleemaka,
intense vitiation of Apan Vayu results in diarrhoea
and other G.I. disturbances, then that stage is called
Apanaki.
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
5
Material And Methods:
Place of the study
Patients having clinical features of cirrhosis of the
liver were selected without any prejudice from
O.P.D. & I.P.D. sections of Pakwasa Samanvaya
Rugnalaya and All India Ayurveda Research
Institute, Hanuman Nagar, Nagpur.
Sample Size
40 diagnosed patients of cirrhosis of the liver is
taken for the present study
Selection Of the Patient:
A detailed case history and clinical-pathological
findings were recorded on the clinical proforma
specifically designed for the present research study.
Diagnostic criteria
Diagnostic criteria were established to cover both
modern and Ayurvedic aspects of the disease. The
patients having a history of prolonged or excessive
alcohol intake or patients chronically infected with
the hepatitis B or C virus, having the following
clinical features and supported by radiological
findings as well as deranged liver function tests,
were termed patients of cirrhosis of the liver.
Clinical Features Of Cirrhosis of the Liver:
Symptoms:
Specific
 Abdominal distention due to ascites
 Ankle swelling due to fluid retention
 Haematemesis and melena due to
gastrointestinal haemorrhage.
 Pruritus
 Gynecomastia in males
 Loss of libido in males
 Amenorrhoea in females
 Confusion and drowsiness
Non-Specific
 Anorexia
 Fatigue
 Emaciation/weight loss
 Weakness
 Listlessness
 Indigestion
 Constipation
 Malaise
Signs :
General
compensated
Decompen-sated
Fever
Hepatomegaly
(initially)
Disorientation
Jaundice
Spleenomegaly
Drowsiness
Loss of
hairs
Gynaecomastia
Coma
Scratch marks
over
Flapping tremors
Spider naevi
Fetor hepaticus
Perpura
Ascites
Testicular
atrophy
Dilated veins over
the abdomen
Palmer erythema
Edema feet
Dupuytren's
contractures
History And Clinical Examination:
After confirming the diagnosis, the detailed history
with respect to age, sex, habitat, socio-economic
status, mode of onset of the disease, family history,
drug history, previous or associated disease history
with duration, dietary habits, addiction with
duration, and state of mind were recorded on the
specially prepared clinical proforma.
Examination Of Patients By Ayurvedic Method:
All patients were thoroughly examined for vitiated
Doshas, Dooshyas, Strotas, and Nidanpanchak.
Dash-Vidh and Ashta-Vidh pariksha were also
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
6
conducted as described in ancient Ayurvedic
classics.
Study Of Nidan:
Each case was carefully interviewed to assess the
presence of various risk factors in patients, as
explained by modern as well as Ayurvedic science.
Sannikrishta Nidan (acute) is a recent provoking
factor leading to the acute onset of the disease,
while Viprakrishta Nidan is an old (chronic) risk
factor.
General Examinations:
General clinical examinations were done for height,
weight, blood pressure, pulse rate, temperature,
pallor etc.
Systemic Examinations:
Under it following systems were examined and
special stress was given on gastrointestinal and
nervous system.
Respiratory system (RS):- It was examined for
breathing pattern, air entry, presence of any other
abnormality.
Cardiovascular system (CVS) :- Under it the
heart was examined for rate, rhythm, heart sounds
and any other abnormality.
Gastro-Intestinal system (GIS) :- It was examined
for the presence of hepatomegaly, spleenomegaly,
and ascites. The abdominal girth on, above and
below the umbilicus was noted in patients with
ascites.
Central Nervous System (CNS):- It was
examined for the presence of features of
encephalopathy, such as disorientation,
confusion, dysgraphia, drowsiness, coma, etc.
Laboratory Investigations
Hematological: - The routine hematological
examinations like Haemoglobin percentage (Hb%),
Total Leukocyte Count (TLC), Differential
Leukocyte Count (DLC), Erythrocyte
Sedimentation Rate (ESR), Peripheral Smear (PS)
to see the degree of anemia, its type and also for
evidence of infective pathology.
Biochemical:
Liver Function Tests:
1. Serum Bilirubin (Conjugated & Unconjugated):
To assess the severity of jaundice and to know its
type.
2 Serum AST & ALT: To assess the severity of
hepatocellular damage.
3. Serum Alkaline Phosphatase: To assess the
severity of cholestasis wherever thought necessary.
4. Serum Proteins (Albumin & Globulin): To assess
the severity of functional pathology of the liver.
5 Serum Prothrombin Time: To assess the severity
of dysfunction of the liver and the coagulopathy.
6. Serum Viral Marker: - To know the type of
hepatitis virus.
Serum Electrolytes:
1. Serum Sodium: To assess the severity of
hyponatremia.
2. Serum Potassium: To assess hypo or
hyperkalemia.
Kidney Function Tests:
To assess the presence of hepato-renal failure and
the severity of functional pathology of the kidneys.
1. Serum Creatinine
2. Blood urea
Peritoneal Fluid Examination:
To assess the fluid for transudation or exudation,
and also for evidence of bacterial peritonitis and
other pathologies.
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
7
Miscellaneous:
Blood sugar and other appropriate investigations as
required and based on the presence of associated
disease.
Radiological:
Ultrasound: To assess the type of liver pathology,
as well as for evidence of portal hypertension and
the presence of ascites.
Endoscopy:
For evidence of varices.
Result & Observations:
The results and observations of the present study
are given as follows.
1. Age incidence in cirrhotic patients:
Table No. 1 (n = 40)
Sr
Age
group
(years)
No. of
patients
%
1
20-40
6
15%
2
40-60
29
72.5%
3
60-80
5
12.5%
Total
40
100%
Age incidence in cirrhotic patients
2. Sex incidence in cirrhotic patients:
Table No. 2 (n=40)
Sr
Sex
No. of
patients
Percentage
1
Male
36
90 %
2
Female
4
10 %
Total
40
100%
Sex incidence in cirrhotic patients
Habitat (Desha) in cirrhotic patients:
Table No. 3 (n = 40)
Sr
Area
No. of patients
%
1
Rural
13
32.5 %
2
Urban
27
67.5 %
Total
40
100%
Out of 40 patients registered in the present study,
the majority of patients (72.5%) were in the age
range of 40 to 60 years, 90% of the patients were
male, and the majority of them (67.5%) were from
an urban area.
Incidence Of Socio-Economic Status:
The patients with an annual income of less than Rs.
35,000/- were placed in the lower-income group.
The annual Income between Rs. 35,000 and
65,000/- were placed in the middle-class income
group. And patients having an annual income of
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
8
more than Rs. 65,000/- were categorised under the
higher-class income group.
4. Table No. 4 (n=40)
Socio-Economic Status
Sr
Sex
No. of patients
%
1
Lower
15
37.5%
2
Middle
12
30 %
3
Higher
13
32.5%
Total
40
100%
Although the percentage of cirrhosis in the lower
income group is slightly on the higher side, no
significant variation is seen in the occurrence of
cirrhosis as far as socio-economic status is
concerned.
5. Incidence Of Dietary Habits (Ahar)
Table No. 5 (n = 40)
Sr
Dietary habit
No. of patients
%
1
Vegetarian
5
12.5%
2
Non-Vegetarian
0
0 %
3
Mixed
35
87.5%
Total
40
100%
In the present study, out of 40 patients suffering
from cirrhosis, 35 (87.5%) were having a mixed
diet
6. Incidence Of Addiction:
Table No. 6 (n=40)
Sr
Addiction
No. of
patients
%
1
Only alcohol
6
15%
2
Alcohol with
smoking
21
52.5%
3
Alcohol with
tobacco
4
10%
4
Only smoking
1
2.5%
5
No addiction
7
17.5%
6
Other
1
2.5%
Total
40
100%
Alcohol addiction is found in 77.5% patients. Out
of which 52.5% were also addicted to smoking and
10% with tobacco chewing. No addiction was
found in 17.5% patients. The other addiction 2.5%
found was of Fortwin. The duration of alcoholism
was in the range of 10 to 25 years. The mean
duration of alcoholism was 17.5 years.
7. Incidence of State of Mind (Mansic hetu)
Table No. 7 (n = 40)
Sr
Mental status
No. of patients
%
1
Anxious
8
20 %
2
Tense
11
27.5%
3
Irritable
9
22.5%
4
Relaxed
12
30%
Total
40
100%
A stressful state of mind was observed in 70%
patients with cirrhosis of the liver.
Incidence Of Aetiological Factors (Nidan):
Table No. 8 (n = 40)
Sr
Aetiological factors
No. of patients
%
1
Alcohol
26
65%
2
HBV
10
25%
3
HCV
4
10%
Total
40
100%
Incidence Of Aetiological Factors
(Nidan):
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
9
In 65% of the patients, alcohol was directly
responsible for the development of cirrhosis, while
in 25% patient main aetiological factor was
hepatitis B virus, and in the remaining 10%, it was
hepatitis C virus.
9. Ahar Hetu (Dietary factors):
The criteria for specific dosha aggravation were as
follows:
Vatvardhak ahara :
Katu, Tikta, Kashay rasatmak and Laghu, Ruksha,
Vishtambhi gunatmaka etc.
Pittavardhak ahara:
Katu, Lavan rasatmak and Ushna, Tikshna, Vdahi,
gunatmak etc.
Kaphavardhak ahara:
Madhur, Amla rasatmak and Shit, Guru, Vishyandi
gunatmaka etc.
Table No. 9 showing Ahar hetu (Dietary factors)
in cirrhotic patients. (n = 40)
Sr
Ahara
No. of patients
%
1
Vatavardhak
0
0%
2
Pittavardhak
4
10%
3
Kaphavardhak
4
Vata-Pittavardhak
20
50%
5
Kapha-Vatavardhak
2
5%
6
Pitta-Kaphavardhak
10
25%
7
Tridosh Prakopak
4
10%
Total
40
100%
Incidence Of Ahar Hetu
The diet of 50% patients with cirrhosis of the liver
was Vat-Pittavardhak. In 25% of patients, it was
Pitta-Kaphavardhak, and only 10% followed a
plain Pittavardhak diet.
10. Ahar Paddhati (Dietary Habit) :
The dietary habit was divided into four parts as
follows:
1. Samshan:- Eating a healthy and an unhealthy
diet together.
2 Vishmashan - Irregularity of diet with respect to
time and quantity.
3. Adhyshan:- Taking a diet before the digestion of
the earlier one.
4. Viruddhashan :- Consuming an antagonistic
diet.
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
10
Table. 10 (n=40) Showing Ahar paddati of the
patients
Sr
Ahar Paddhati
No. of
patients
%
1
Samshan
0
0%
2
Vishmashan
0
0%
3
Adhyashan
0
0%
4
Viruddhashan
4
10%
5
Combination of 1 & 2
5
20%
6
Combination of 1 & 3
6
15%
7
Combination of 1, 2
& 3
14
35%
8
All The Above
8
20%
9
None of The Above
4
10%
Total
40
100%
The combination of samshan, vishmashan and
adhyshan was observed in 35% patients of cirrhosis
of the liver. The combined Ahar Paddhati of
Samshan and Vishamshan was observed in 20%
patients. While in 20% of patients, it was a
combination of samshan, vishmashan, adhyashan,
and viruddhashan.
11. Vihar Hetu (Lifestyle factors):
Lifestyle factors like Vegvidharan (forceful
suppression of natural urges), Ativyayam (intense
exercise), and Marutsevan (e.g., excessive driving)
were the Vatavardhak vihar hetu. Ativyavay,
Atapsevan (e.g. working in hot conditions), etc.,
were the Pittavardhak hetu and Diwaswap,
Avyayam, etc., were the observed Kaphaprakopak
vihar hetu.
Table No. 11 (n = 40) Vihar Hetu
Sr
Vihar
No. of patients
%
1
Vatavardhak
2
5 %
2
Pittavardhak
4
10 %
3
Kaphavardhak
0
0%
4
Vata-Pittavardhak
22
55%
5
Kapha-Vatavardhak
5
20%
6
Pitta-Kaphavardhak
--
---
7
Tridoshaj
14
35%
Total
40
100%
Incidence of Vihar Hetu
The lifestyle of 55% patients of cirrhosis was Vata-
Pittavardhak. In 20% patients, it was observed as
Pitta-Kaphavardhak. In 10% it was Pittavardhak.
The rest of the lifestyle accounted for only 5%
each.
12. Incidence Of Strotas Involved:
Table No. 12 (n = 40)
Sr
Strotas
No. of patients
%
1
Pranwaha
6
15%
2
Annawaha
36
90%
3
Udakwaha
19
47.5%
4
Rasavaha
40
100%
5
Raktawaha
40
100%
6
Manswaha
40
100%
7
Medowaha
19
47.5%
8
Asthivaha
2
5%
9
Majjavaha
10
25%
10
Shukravaha
25
69.4%
11
Malavaha
38
95%
12
Mutravaha
5
12.5%
13
Swedvaha
19
47.5%
Total
40
100%
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
11
Incidence Of Strotas Involved
The Rasavaha, Raktavaha, and Mansvaha strotas
were involved in all patients with cirrhosis of the
liver. Malavaha in 95% of patients, Annavaha in
90% of patients, and the Swedvaha and Medovaha
strotas were involved in 47.5% of patients. While
Majjavaha was involved in 25% of patients,
Mutravaha in 12.5%, and Pranvaha strotas in 15%.
The Shukravaha strotas were involved in 69.4% of
the 36 male patients.
13. Prakriti Parikshan (constitution):
The criteria of specific Prakriti were based on the
features of a particular Prakriti observed in the
patient. The separate chart showing features of
different Prakrities is given in the 'appendix'
Table No. 13 (n = 40)
Sr
Prakriti
No. of patients
%
1
Vataj
1
2.5%
2
Pittaj
2
5%
3
Kaphaj
--
--
4
Vata-Pittaj
11
27.5%
5
Kapha-Vataj
14
35%
6
Pitta-Kaphaj
12
30%
7
Tridoshaj
--
---
Total
40
100%
Pitta-Kaphaj Prakriti was observed in 35% patients.
Pitta-Vataj was observed in 27.5% of patients, and
Kapha-Vataj in 30%. Single Doshaj Prakriti was
observed in only three patients. Of which, 5% were
Pittaj Prakriti and only 2.5% were Vataj Prakriti.
14. Associated Complications
Table No. 14 (n = 40 )
Complications
No.
of
patients
%
Encephalopathy
10
25%
Bacterial peritonitis
5
12.5%
Renal Failure
3
7.5%
Pleural Effusion
4
10%
Hematemesis
11
27.5%
Encephalopathy was observed in 25% of patients,
Bacterial peritonitis in 12.5%, Hematemesis in 27.5%,
and renal failure in 7.5%. Pleural effusion in 10%
cases.
15. Incidence Of Associated Disease:
Table No. 15 (n = 40)
Disease
No. of patients
%
Encephalopathy
2
5%
Diabetes
4
10%
Myxoedema
1
2.5%
Malaria
3
7.5%
Active Hepatitis
6
15%
Diabetes was associated with 10% cases, Pulmonary
Tuberculosis was associated with 5% cases,
Myxoedema and Thyrotoxicosis with 2.5% cases.
Active hepatitis was seen in 15% cases. Falciparum
Malaria was present in 7.5% cases.
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
12
16. General Clinical Findings
Table No. 16 [n=40]
weight of the patients (Kg):
Weight
No. of patients
%
35-55
20
50%
55-75
17
42.5%
>75
3
7.5%
Total
40
100%
The weight of 50% patients with cirrhosis of the
liver was less than 50Kg. The mean weight of
42.5% of patients was 60.3 kg. The mean weight of
92.5% patients was less than 55 kg, indicating
weight loss in patients with cirrhosis of the liver.
Table No. 17 [ n = 40]
pulse rate of the patients:
Pulse
No. of patients
%
60-80
16
40%
80-100
15
37.5%
>100
9
22.5%
Total
40
1005
The mean pulse rate was 76/min in 40% of patients,
86/min in 37.5%, and 100/min or more in only
22.5%.
Table No. 18 [n=40]
temperatures of the patients (°F)
Temperature (°F)
No. of patients
%
99-100
11
27.5%
100-102
3
7.5%
>102
2
5%
Total
40
100%
In all 40% patients of cirrhosis of the liver were
febrile, but usually there is a low-grade temperature,
as evident from the above table
Table No. 19(a) [ n = 40]
systolic B.P. of the patients(mmHg)
Systolic B.P. (mmHg)
No. of patients
%
90-110
11
27.5%
110-130
21
52.5%
>130
8
20%
Total
40
100%
The systolic blood pressure of 52.5% patients was
in the range between 110-130 mmHg and the blood
pressure of 27.5% patients was in the range
between 90-110 mmHg.
Pathological Investigations:
20. Serum Bilirubin and Cirrhosis:
Table No. 20 (n = 40)
Total Bilirubin
(mg/dl)
No. of
patients
%
Mean
Bilirubin
Mild
(1.5-5)
15
37.5%
2.6
Moderate
(5-10)
6
15%
6.2
Severe
(>10)
4
10%
24.3
Conjugated
Bilirubin
(mg/dl)
No. of
patients
%
Mean
Bilirubin
Mild
(0.5-2.5)
26
65%
1.2
Moderate
(2.5-5)
6
15%
3.6
Severe
(>5)
4
10%
17.4
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
13
The mild increase in total serum bilirubin was
observed in 37.5% patients, moderate increase in
15% and severe increase in 10% cases, and their
mean value is shown in the table. The rise in total
serum bilirubin may not be obvious all the time, as
the sum of conjugated and unconjugated bilirubin
may reach the normal level, but the above table
shows the relative increase of conjugated bilirubin,
though total serum bilirubin may remain normal.
The above findings also indicate a relative rise in
conjugated bilirubin over unconjugated bilirubin in
cirrhosis of the liver.
Serum Bilirubin & Cirrhosis of Liver
21. Serum AST & ALT and Cirrhosis of the
Liver:
Table No. 21 (n=40)
Serum Aminotransferase IU/L
AST
(IU/L)
No. of
patients
%
Mean
AST
Mild
(40-80)
17
42.5%
61.7
Moderate
(80-120)
5
12.5%
113.2
Severe
(>120)
4
10%
130.2
ALT
(IU/L)
No. of
patients
%
Mean
ALT
Mild
(40-80)
17
42.5%
54.8
Moderate
(80-120)
2
5%
92.5
Severe
(>120)
4
10%
174.3
The mild increase in serum AST and ALT was
observed in 42.5% patients. A moderate increase in
serum AST was observed in 12.5% patients. Serum
ALT was moderately elevated in 5% of patients. A
severe increase in serum AST and ALT was
observed in 10% patients. The mean increase in
each category is shown in the table. In contrast to
hepatitis, where a higher increase (> 2 to 300 IU/L)
in serum aminotransferase levels occurs, only a mid
to moderate (< 200 IU/L) increase in
aminotransferase levels occurs in cirrhosis of the
liver.
Serum Aminotransferase
& Cirrhosis of Liver
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
14
22. Serum Proteins And Cirrhosis Of Liver:
Table No. 22(a) ( n = 40 ]
Serum Proteins (total)
Total Proteins
(g/dl)
No. of
Patients
%
Mean
Proteins
Mild
(6-5.5)
12
30%
5.8
Moderate
(5.5-4.5)
14
35%
5.2
Severe
(<4.5)
2
5%
3.0
Albumin
(g/dl)
No. of
Patients
%
Mean
ALB
Mild
(3.5-3)
8
20%
3.2
Moderate
(3-2.5)
18
45%
2.7
Severe
(<2.5)
10
25%
1.9
Serum Albumin
& Cirrhosis of Liver
A mild decrease in total serum proteins was
observed in 30% of patients, and a moderate
decrease in 35%. A severe decrease was noted in
5% of patients. A mild decrease in serum albumin
was observed in 20% of patients, and a moderate
decrease in 45%. A severe decrease was noted in
25% of patients. The mean decrease is shown in the
table. As many as 90% patients with cirrhosis of the
liver show a decrease in serum albumin level,
indicating a relative decrease in hepatic function.
23. Serum Prothrombin Time And Cirrhosis Of
Liver:
The serum prothrombin time was measured in 26
patients with liver cirrhosis. Findings are
summarised in the following tables:
Table No. 23(a) (n = 26)
Pro-thrombin (S)
PT
(S)
No. of
Patients
%
Mean
PT
Mild
(75-95)
8
30.7%
84.7
Moderate
(55-75)
14
53.8%
65.3
Severe
(< 55)
4
15.3%
51.6
Serum Prothrombin Time Difference
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
15
A mild increase in the serum prothrombin time was
observed in 34.61% of patients. Moderate increase
in 38.46% patients. A severe increase was observed
in 23.07% of patients. The mean prothrombin time
difference for each category is shown in the table.
The overall increase in serum prothrombin time
was observed in 25 of 26 patients, reflecting
hepatic dysfunction in cirrhosis.
Discussion:
The majority of patients (72.5%) were aged 40 to
60 years. The mean duration of alcoholism in
patients of alcoholic cirrhosis was observed as 17.5
years. This long period required to develop
cirrhosis of the liver after alcoholism explains the
chronic nature of the disease and the reason behind
the majority of patients falling in the above age
group.
The high prevalence of cirrhosis in males compared
to females (10%) was observed, which can be
understood (90%) by the fact that the habit of
alcoholism is much more common in males than in
females in Indian society.
Our study shows that the urban population was
more affected (67.5%) than the rural population
(32.5%). No particular reason was obvious for this
variation. However, several factors, such as the
relatively high risk of HBV or HCV infection in the
urban population, and Faulty dietary habits and
lifestyle, may be responsible for the high urban
susceptibility.
The socio-economic status does not seem to
influence the occurrence of cirrhosis as it was
almost equally present in different socio-economic
groups
The habit of a mixed diet was seen in 87.5%
patients of patients with cirrhosis of the liver.
Although at present no particular line of
demarcation could be sketched to show why
cirrhosis is common in people having mixed dietary
habits, there may be some influencing idiopathic
dietary factors that need to be explored through
extensive research in this regard
A stressful state of mind was observed in 70% of
patients, suggesting that it may also contribute to
disease susceptibility through mechanisms such as
decreased immune response and altered physiology.
Alcohol addiction was seen in 77.5% patients of
patients with cirrhosis of the liver. Out of this
alcohol was directly responsible in 65% cases for
developing cirrhosis. This definite contribution of
alcohol in the development of cirrhosis of the liver
is well documented by many other researchers.
Amongst aetiological factors, alcohol was directly
responsible for the development of cirrhosis in 65%
cases. While HBV was responsible in 25% cases
and HCV in 10% cases.
Our study shows that female patients are more
likely to develop cirrhosis from chronic HCV
infection, as all the 10% cases of HCV-induced
cirrhosis were females. The association of alcohol
and HCV has been suggested by many researchers,
but in our study, we did not notice such an
association. However, the association of alcohol
was found in 40% cases of HBV-induced cirrhosis
of the liver. The interactions between alcohol and
hepatotrophic viruses may cause a greater extent of
hepatic injury, and it may also affect the course of
the disease.
The Vata-Pittavardhak diet was found in 50% of
patients. While Pitta-Kaphavardhaka was observed
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
16
in 25% of patients, and plain Pittavardhak in 10%
of patients. Although mixed doshvardhak dietary
training was observed, the relative preponderance
of Pittavardhak diet in patients of cirrhosis of the
liver could well be assessed
The more or less combination of Samshan,
Vishmashan, Adhyashan, Viruddhashan,
aharpaddhati was observed in as many as 90%
patients. The high prevalence of these faulty dietary
habits among cirrhotic patients should prompt
researchers to analyse their role in detail.
The Vat-Pittavardhak lifestyle was observed in
55% patients. While Pitta-kaphavardhak was
observed in 20% of patients, plain Pittavardhak
was observed in only 10%. Although the adoption
of a mixed lifestyle was observed, the Pitta
aggravating lifestyle was predominantly seen in
cirrhotic patients.
The involvement of the Rasavaha, Raktavaha, and
Mansvaha strotas was the most consistent finding
regarding strotasic involvement. The other
significantly involved strotas were Annavaha
(90%), Malavaha (95%), Shukravaha (69.4%),
Swedvaha (47.5%), Udakvaha (47.5%), Majjavaha
(25%), Mutravaha (12.5%). Our study shows that
the Rasavaha, Raktavaha, and Mansvaha strotas
are essentially involved in liver cirrhosis. The
involvement of other strotas indicates the extent
and severity of the disease.
The Pitta-Vatik prakriti was seen in 27.5% patients.
While. Pitta-Shleshmik prakriti was observed in
35% of patients, and plain Paitik prakriti in 5%. It
shows that Pitta predominates in the genetically
determined body constitution of the majority of
patients with cirrhosis of the liver. Hence, persons
having Pitta dominant prakriti should exercise
caution while consuming alcohol and other Pitta-
aggravating diet and lifestyle.
Our study recorded the presence of the following
clinical features with their frequency in patients
with cirrhosis of the liver:
Samhanan, Praman, Aharshakti and Vyayamshakti
in patients with cirrhosis of the liver. The Pitta-
Vatik prakriti was seen in 27.5% patients. While
Pitta-Shleshmik prakriti was observed in 35% of
patients, plain Paitik prakriti was observed in 5%.
It shows that Pitta predominates in the genetically
determined body constitution of the majority of
patients with cirrhosis of the liver. Hence, persons
having Pitta dominant prakriti should exercise
caution while consuming alcohol and other Pitta-
aggravating diet and lifestyle. Our study recorded
the presence of the following clinical features with
their frequency in patients with cirrhosis of the
liver:
From the above findings, it can be said that patients
with established features of portal hypertension and
a history of chronic alcohol consumption or chronic
infection with HBV or HCV can be labelled as
patients with cirrhosis of the liver. Amongst
associated complications (Upadrava) of cirrhosis,
encephalopathy was observed in 25% patients,
hematemesis in 27.5% patients, bacterial peritonitis
in 12.5% patients, pleural effusion in 10% patients
and renal failure in 10% patients
The association of cirrhosis with other diseases
(Vyadhisankar) was also observed in our study,
including pulmonary tuberculosis in 5% of patients,
diabetes in 10% of patients, myxoedema and
thyrotoxicosis in 2.5% of cases each, and
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
17
Falciparum malaria in 7.5% of patients. These
vyadhisankara affect the prognosis of the disease.
From a pathological investigation point of view,
hyperbilirubinemia was observed in as many as
62.5% patients. Of these, 60% of patients were in
the mild range. Conjugated bilirubin was
predominantly increased. Hence, it can be said that
in cirrhosis, a usually mild increase in serum
bilirubin occurs, resulting in conjugated
hyperbilirubinemia.
Conclusions:
ï‚·
Pittavardhak dietary and lifestyle regimen in
conjunction with faulty dietary habits like
samshan, adhyshan, vishmashan,
virruddhashan is commonly observed in
patients of cirrhosis of the liver.
ï‚·
The dominance of Pitta is observed in the
genetic body constitution of the cirrhotic
patients.
ï‚·
Cirrhosis of the liver is common in males as
compared to females.
ï‚·
Alcoholic cirrhosis is more prevalent than
postviral cirrhosis.
ï‚·
Females are more prone to developing postviral
cirrhosis.
ï‚·
The pathological findings observed in the
present study support the established view.
References:
1. Sleisenger & Fordtran's "Gastrointestinal and
Liver Diseases", Sixth Edition, Volume II,
Publisher W.B. Saunders Company, The
Curtis Centre, Independence Square, West
Philadelphia, Pennsylvania 19106.
2. B N Tandon, S.K. Acharya. A Tandon,
Epidemology of hepatitis B virus infection in
India, Gut, 1996,;38(suppl2);S56-S59,
doi:10.1136/gut.38.suppl2.s56
3. Harrison's "Principles of Internal Medicine"
Fourteenth Edition - 1998 International
Edition, Volume I & II, Editors: Anthony S.
Fauci, (Eugene Braunwald, Kurt J.
Isselbacher, Jean D. Wilson, Joseph B.
Martin, Dennis L. Kaspar, Stephan L.
Hausen, Dan L. Longo) etal Published by
The McGraw-Hill Companies, Inc.
4. Textbook of Medical Physiology, Ninth
Edition, 1996, by Guyton & Hall, Published
By Prism Book (Pvt.) Ltd. Bangalore - India
- 560019.
5. Basic Pathology Sixth Edition 1997 Edited
By Vinay Kumar, Ramzi Ctran, Sranley
Robbins Published By - Prism Books (Pvt.)
Ltd. Banglore, India - 560019.
6. Clinical Medicine: A Textbook for Medical
Students & Doctors, Third Edition, 1994,
Edited by Praveen Kumar & Michael Clark,
Publisher - Bailliere Tindall, 24-28 Oval
Road, London NW17DX.
7. Textbook Of Pathology by William Boyd
Eight Edition 1970 (Reprint 1979), Publisher
- Henry Kimpton, London, Copyright by Lea
& Febiger, Philadelphia
Issue : 04
INTERNATIONAL JOURNAL OF DIAGNOSTICS AND RESEARCH [ISSN No.: 2584-2757]
Volume : 03
Copyright @ : - Dr.Subhash Waghe Inter. J.Digno. and Research IJDRMSID0125 |ISSN :2584-2757
18
8. Priyavrat Sharma (editor and translator)
Charak Samhita Text with English
Translation, Fifth Edition 1998, Volume I &
II Publisher - Chaukhamba Orientation,
Varanasi.
9. Ambikadutta Shastri (translator), Sushrut
Samhita of Maharshi Sushruta, edited with
Ayurved Tattva Sandipika, Eighth Edition,
1993 (Volume 1 & 11), published by
Chaukhamba Sanskrit Sansthan, Varanasi.
10. Atridev Gupt (Editor) Ashtanghridaya
Commentator -- Tenth Edition 1989 (V.S.
2048) Publisher chaukhamba Sanskrit
Sansthan, Varanasi
11. Ashtangsangraha (Vagbhatacharya Virachit)
With First Edition - Feb. 1989 Sharir, Nidan,
Chikitsa, Kalpasthanam) Publisher - Shri
Baidyanath Ayurved Bhavan Pvt. Ltd. Great
Nag Road, Nagpur-9.
12. Sudarshanshastri & Shri Yadunandan
Upadhyay (translators) Shri Madhavkar
Virachit ' Madhavnidanam' With 'Madukosh'
Commentary by Shri Vijay Rakshit &
Shrikanthadutta & With 'Vidyotini'
Commentary (Volume 1), Twenty Second
Edition 1993 (V.S.2050), Publisher
Chaukhamba Sanskrit Sansthan, Varanasi-
221001
13. Satyapala Bhishagacharya (commentator)
Kashyap Samhita by Vriddha Jivaka Revised
by Vatsya with Sanskrit introduction by
Hemraj Sharma With 'Vidyotini' Hindi
Commentary, Third Edition 1982 Publisher
Chaukhamba Sanskrit Sansthan Varanasi.
Declarations
Funding: This research received no specific grant
from any funding agency in the public, commercial,
or not-for-profit sectors.
Conflict of Interest: The authors declare no
conflict of interest.
Ethical Approval: Not applicable (no primary
human or animal data collected).
Data Availability: All data supporting the findings
of this review are available from published
literature cited within the manuscript.
ISSN: 2584-2757
DOI : 10.5281/zenodo.21369257
Dr. Subhash Waghe
Inter. J.Digno. and Research
This work is licensed under Creative
Commons Attribution 4.0 License
Submission Link : http://www.ijdrindia.com
Benefits of Publishing with us
Fast peer review process
Global archiving of the articles
Unrestricted open online access
Author retains copyright
Unique DOI for all articles
https://ijdrindia.com