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DIFFERENTIAL DIAGNOSIS IN YAKRITA VIKARA (LIVER DISEASES) DESCRIBED IN AYURVEDA

Authors:
DIFFERENTIAL DIAGNOSIS IN YAKRITA VIKARA (LIVER DISEASES) DE-
SCRIBED IN AYURVEDA
Neha Dubey1,Rashmi Pandey2, A.C. Kar3
1JR-iii, Vikriti Vigyan Department, 2JR-iii, KriyaSharira Department,3Professor, Vikriti Vi-
gyan Dept., Faculty Of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
INTRODUCTION
There is no description of liver disor-
ders as a separate entity in Ayurvedic texts.
Even the description about liver is also
very little. In Ayurvedic texts Liver has
given more importance in connection with
metabolic functions. Liver is said to be the
seat of Pitta. All the functions of Pitta,
especially Ranjaka Pitta are attributed to
liver. Again liver and spleen are consid-
ered as, the root of Raktavahasrotas. So
liver is very much important in all diseases
concerned with Raktavahaand PittavahaS-
rotas. Possible reasons for not describing
the YakritaVikara as a separate group of
disorders may be:
i. Most of the Ayurvedic classification of
diseases is based on symptoms.
ii. In pathogenesis more importance is
given to the physiology than structure
involved.
Differential Diagnosis:
1. On the basis of eight fold examina-
tion (Ashtavidha Pariksha)
I. On the basis of characteristic of
nadi(Pulse)1-In various diseases pattern of
Nadi is mentioned but in context to liver
disease, generally Pitta Dosha is involved.
Disease Condition
Character of Nadi
When Pitta Dosha is in-
volved
Like the motion of Manduka (Frog), Kaka( crow)andKulinga
(a type of Bird)
Pandu
Unsteady, fast, sometimes palpable and sometimes not palpa-
ble.
Kamala
Like PittajaNadi but specifically warm in touch.
II. On the basis of characteristic of
Mutra (Urine)-Findings of hepatic
disease in urine is described below-
A. PittajaPanduand Kamala2: The Pita
Varnais one of the natural colour of Pitta.
It has been mentioned that increase in Vik-
ritaPitta (pathogenic) causes yellow colour
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
For appropriate line of treatment for the disease, it is important to make a definitive
diagnosis. Study of various stages of disease and consequential changes can help in making
correct diagnosis. In Ayurvedic texts YakritaVikara (Liver Disorders) are not described as
separate entity because most of the Ayurvedic classification of the disease is based on symp-
toms. In this paper differentiation in various disorders like Pandu, Kamla of both types-
Shakhashrita, Kosthashrita, Different stages of Kamala,MadyajanyaYakritaVikara are dis-
cussed. Symptoms common in different disorders are also analysed for making differential
diagnosis.
Keywords: YakritaVikara, Kamla, Pandu, Liver disorder
DIFFERENTIAL DIAGNOSIS IN YAKRITA VIKARA (LIVER DISEASES) DE-
SCRIBED IN AYURVEDA
Neha Dubey1,Rashmi Pandey2, A.C. Kar3
1JR-iii, Vikriti Vigyan Department, 2JR-iii, KriyaSharira Department,3Professor, Vikriti Vi-
gyan Dept., Faculty Of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
INTRODUCTION
There is no description of liver disor-
ders as a separate entity in Ayurvedic texts.
Even the description about liver is also
very little. In Ayurvedic texts Liver has
given more importance in connection with
metabolic functions. Liver is said to be the
seat of Pitta. All the functions of Pitta,
especially Ranjaka Pitta are attributed to
liver. Again liver and spleen are consid-
ered as, the root of Raktavahasrotas. So
liver is very much important in all diseases
concerned with Raktavahaand PittavahaS-
rotas. Possible reasons for not describing
the YakritaVikara as a separate group of
disorders may be:
i. Most of the Ayurvedic classification of
diseases is based on symptoms.
ii. In pathogenesis more importance is
given to the physiology than structure
involved.
Differential Diagnosis:
1. On the basis of eight fold examina-
tion (Ashtavidha Pariksha)
I. On the basis of characteristic of
nadi(Pulse)1-In various diseases pattern of
Nadi is mentioned but in context to liver
disease, generally Pitta Dosha is involved.
Disease Condition
Character of Nadi
When Pitta Dosha is in-
volved
Like the motion of Manduka (Frog), Kaka( crow)andKulinga
(a type of Bird)
Pandu
Unsteady, fast, sometimes palpable and sometimes not palpa-
ble.
Kamala
Like PittajaNadi but specifically warm in touch.
II. On the basis of characteristic of
Mutra (Urine)-Findings of hepatic
disease in urine is described below-
A. PittajaPanduand Kamala2: The Pita
Varnais one of the natural colour of Pitta.
It has been mentioned that increase in Vik-
ritaPitta (pathogenic) causes yellow colour
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
For appropriate line of treatment for the disease, it is important to make a definitive
diagnosis. Study of various stages of disease and consequential changes can help in making
correct diagnosis. In Ayurvedic texts YakritaVikara (Liver Disorders) are not described as
separate entity because most of the Ayurvedic classification of the disease is based on symp-
toms. In this paper differentiation in various disorders like Pandu, Kamla of both types-
Shakhashrita, Kosthashrita, Different stages of Kamala,MadyajanyaYakritaVikara are dis-
cussed. Symptoms common in different disorders are also analysed for making differential
diagnosis.
Keywords: YakritaVikara, Kamla, Pandu, Liver disorder
DIFFERENTIAL DIAGNOSIS IN YAKRITA VIKARA (LIVER DISEASES) DE-
SCRIBED IN AYURVEDA
Neha Dubey1,Rashmi Pandey2, A.C. Kar3
1JR-iii, Vikriti Vigyan Department, 2JR-iii, KriyaSharira Department,3Professor, Vikriti Vi-
gyan Dept., Faculty Of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
INTRODUCTION
There is no description of liver disor-
ders as a separate entity in Ayurvedic texts.
Even the description about liver is also
very little. In Ayurvedic texts Liver has
given more importance in connection with
metabolic functions. Liver is said to be the
seat of Pitta. All the functions of Pitta,
especially Ranjaka Pitta are attributed to
liver. Again liver and spleen are consid-
ered as, the root of Raktavahasrotas. So
liver is very much important in all diseases
concerned with Raktavahaand PittavahaS-
rotas. Possible reasons for not describing
the YakritaVikara as a separate group of
disorders may be:
i. Most of the Ayurvedic classification of
diseases is based on symptoms.
ii. In pathogenesis more importance is
given to the physiology than structure
involved.
Differential Diagnosis:
1. On the basis of eight fold examina-
tion (Ashtavidha Pariksha)
I. On the basis of characteristic of
nadi(Pulse)1-In various diseases pattern of
Nadi is mentioned but in context to liver
disease, generally Pitta Dosha is involved.
Character of Nadi
Like the motion of Manduka (Frog), Kaka( crow)andKulinga
(a type of Bird)
Unsteady, fast, sometimes palpable and sometimes not palpa-
ble.
Like PittajaNadi but specifically warm in touch.
II. On the basis of characteristic of
Mutra (Urine)-Findings of hepatic
disease in urine is described below-
A. PittajaPanduand Kamala2: The Pita
Varnais one of the natural colour of Pitta.
It has been mentioned that increase in Vik-
ritaPitta (pathogenic) causes yellow colour
Review Article International Ayurvedic Medical Journal ISSN:2320 5091
ABSTRACT
For appropriate line of treatment for the disease, it is important to make a definitive
diagnosis. Study of various stages of disease and consequential changes can help in making
correct diagnosis. In Ayurvedic texts YakritaVikara (Liver Disorders) are not described as
separate entity because most of the Ayurvedic classification of the disease is based on symp-
toms. In this paper differentiation in various disorders like Pandu, Kamla of both types-
Shakhashrita, Kosthashrita, Different stages of Kamala,MadyajanyaYakritaVikara are dis-
cussed. Symptoms common in different disorders are also analysed for making differential
diagnosis.
Keywords: YakritaVikara, Kamla, Pandu, Liver disorder
Neha Dubey et al: Differential Diagnosis In Yakrita Vikara (Liver Diseases) Described In Ayurveda
2111
www.iamj.in IAMJ: Volume 3; Issue 7; July- 2015
of stool, urine, eyes and
skin.PittajaPandupatient passes light yel-
low coloured (Pita) urine while Kamala
either passes the RaktaPitai.e. reddish
yellow coloured urine in case of Kost-
hashrita Kamala and Haridra i.e. deep
yellow coloured urine in Shakhashrita
Kamala. These patients can be further dif-
ferentiated each other by taking clinical
history as there is difference in symptoms
of both the disease.
B. Kamala and Jwara: In some types of
Jwara, yellow colour of urine is found so
while dealing with Kamala, Jwara should
be kept in mind.
HaridrakaJwara3- Mentioned by Astan-
gaSangraha. In this Jwaracolour of skin is
Bheka Varna/Haridra Varna (deep yel-
low), urine becomes Haridra Varna, may
cause death. Sannipatika Jwara4(Hi-
naVata-MadhyamaKapha-Pittadhika). In
this fever along with symptoms of Daha,
Trishna, Bhrama, AruchiandHaridra Var-
naof eyes and urine are present.
PaittikaJwara- Patient develops
Harita/Haridracolour of nails, urine and
stool.In all the above varieties ofJwara-
high temperature is the dominant symptom
while high temperature is not dominant in
any type of Kamala. Fever may occur in
the case of ShakhaAshritaKamalabut not
of severe nature.
C. Kamala and Haridrameha5: In the Pat-
tikaPramehaone variety is Haridrameha.
In this disease patient passes Haridra col-
our urine along with the other general
symptoms of Prameha, which are absent
in Kamala.
III. On the basis of colour of
Mala(Faeces)2-Colour of faeces in
Liver disorders as found in Ayurvedic
classics is given below-
Disease
Colour of Mala
SakhashritaKamala
Shweta(Tilapistanibham)
Kostha-Sakhashraya Kamala
Rakta-Pita
Halimaka
Harita
Udara
Shyava/Pita/Shweta
Kumbhakamala
Krishna-Pita
Panaki
Pita
Pandu
Krishna-Pandu/Pita/Shukla
IV. On the basis of characteristic of Jhihwa (Tongue)2-
Colour of faeces in Liver disorders as found in Ayurvedic classics is given below-
Characteristic
Observations
Colour
yellowish / reddish
Surface
soft,coated
Taste feeling
bitter/pungent
Nature
warm
Other Complaint
yellow
Sama-Nirama
Sama
V. On the basis of characteristic of
Shabda (Sounds): In Jalodara6- Ab-
domen looks like a leather bag full of
water-vibrates, irritates and makes
sounds.
VI. On the basis of characteristic of
Sparsha (Palpation)-Characteristic of
Sparshain Liver disorders as found in
Ayurvedic classics is given below-
In Vata predominance- dryness
In Pitta predominance- softness
Neha Dubey et al: Differential Diagnosis In Yakrita Vikara (Liver Diseases) Described In Ayurveda
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www.iamj.in IAMJ: Volume 3; Issue 7; July- 2015
In Kapha predominance- solid and cold
VII. On The Basis Of Characteristic Of
Drika(Eyes)2: Characteristic of eyes in
Liver disorders as found in Ayurvedic
classics is given below-
Pandu-Paleness
Kamala-Haridra Varna (yellowish)
Incurable Pandu-Shweta Varna (whit-
ish) Incurable Kamala- presence of
blood in eyes
VIII. On The Basis Of Characteristic
OfAkriti (Appearance): Findings re-
lated to Akritiin Liver disorders are not
found in Ayurvedic classics but
enlargement of liver and spleen is
spleen is mentioned as the names of
Yakritadalyodara7and Plihodara.
2. Differentiation In Different Stages Of
Kamala: According to pathogenesis,
Kamala is described to be of different
types as Kosthashrita kamala, Shak-
hashrita kamala, Kumbha kamala,
Halimaka, Lagharaka and Panaki. Dif-
ferent symptoms of these types are de-
scribed as follows:
KosthashritaKamalasymptoms: It is
characterized by Haridramutrata
(urine), Netrata (eyes), Tvak (skin),
Nakha (nails), Mukha(face), Shakrit
(faeces), Bhekabha (frog skin like ap-
pearance), Daha (burning sensation),
Avipaka (indigestion), Daurbalya
(weakness), Hatendriya (emaciated),
Aruchi (tastelessness), Sada (malaise).
Shakhashrita Kama1a symp-
toms:Hridramutrata (yellow urine),
netrata (eyes), tvak (skin), Mala Ti-
lapistanibha (clay coloured) or Shweta
Varna (white stool), Atopa, Vistambha
(flatulence), HridayaGaurava (heav-
inss in chest), Daurbalya (weakness),
Alpagni (decreased digestive power),
ParsvaArti (flank pain), Hidhma (hic-
cough), Swasa (respiratory trouble),
Aruchi (tastelessness),Jvara (fever),
Kumbha Kamala: Kumbha Ka-
malaoccurs when the Svatantra Ka-
malain Pitta predominant patient is left
untreated. The prognosis is poor.
Kalantara (produced after long stand-
ing kamala). It is characterized by
KrishnaMutra (blackish urine), Krish-
naShakrit (blackish stool), Bhrisham-
Shunata (profuse oedema), Sarakta-
Mukha (reddish face), saraktaaksi
(reddish eyes), SaraktaChhardi (blood
vomiting), SaraktaShakrit (blood in
stool), SaraktaMutra (haematuria),
Daha (burning sensation), Aruchi
(tastelessness), Trit (thirst), Tandra
(drowziness), Moha (fainting),
Nastagni (loss of appetite), Nastasan-
gya(unconsciousness).
Halimaka:Halimaka is also known as
Lodhara or Alasa. It occurs due to
Vata Pittavitiation, It is characterized
by HaritaVarna (Greenish appear-
ance), ShyavaVarna (Blackish appear-
ance), PitaVarna (Yellowish appear-
ance), Bhrama (dizziness), Trishna
(thirst), StrishvaAharsha (loss of li-
bido), Mrdujvara (mild fever), Tandra
(drowsiness), Balabhramsa (weak-
ness), Ananabhilasha (decreased appe-
tite), Utsahaksaya (depression), Anga-
marda (body ache), Aruchi (tasteless-
ness).
Panaki:It is characterized bySantapa
(fever), Pandu (pallor), Bhinnavarchas
(loose stools), Bahiraantashchapitata
(external and internal yellow discolora-
tion), Netraraga (sub-
conjunctivalhaemorrhage).
Lagharaka:It is mentioned by Suru-
taand characterized by Jvara (fever),
Angamarda (body pain), Sada (tired-
ness), Bhrama (dizziness), Tandra
(drowsiness), Ksaya (emaciation).
Differential diagnosis in stages of Ka-
mala:
Neha Dubey et al: Differential Diagnosis In Yakrita Vikara (Liver Diseases) Described In Ayurveda
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Kamala
Kumbha Kamala
Halimaka
Nakha, Netra, Tvak,
MutraPitata
Nakha, Netra, Tvak,
MutraPitata
Nakha, Netra, Tvak, MutraPitata,
Tvakpita, Nila, Harita.
Ruddhapathaand
Bahupitatypes
Further Stage Of
Bahupitta Kamala
--
Ruddhapatha
Pittadhikya
Vayu and Pitta
Kaphadhikya
Bahupitta- Pittadhikya
3. Differentiation between KosthashritaandShakhashrita Kamala-Difference in these two
can be easily understand by following table-
Ruddhapatha Kamala (Shakhashrita)
Bahupitta Kamala (Kosthashrita)
Formation of Pitta from Yakrit is normal
Increased Pitta formation
Obstruction in the passage of Pitta
No obstruction
Vimargagamana of Pitta in Shakha, hence
called Shakhashrita Kamala
Pitta increases in Kostha and Shakha hence
called Kostha-Shakhashrita Kamala
Mala Tilapistanibha
Mala Pitata
Treatment with Ushna, Tikshnadrugs
Treatment with Madhura, Shitadrugs
First KaphaghnaChikitsa, followed by Pit-
taghnaChikitsa
PittaghnaChikitsaonly
Difficult to cure (Kastasadhya)
Easily curable (Sukhasadhya)
4. Madatyaya8and YakritaVikara-
Ayurvedicclassics have described Madat-
yaya or effect of excessive intake of alco-
hol, but they have never mentioned its ef-
fect on liver or have never described it as a
separate disease. In Samhita we can see
description of Kamala, Udarawhich can
be the sequele of alcoholic liver disease.
Very few direct references are available in
Samhitas, which mention of effect of alco-
hol causing hepatitis or cirrhosis.
i. In AsadhyaLaksanaof Madatyaya, yel-
low colouration of the eyes is consid-
ered as the sign of incurability. This can
be correlated with alcoholic hepatitis.
ii. Parshvashula is one of the symptoms of
VatajaMadatyaya.Parshvashula (pain
in right hypochondric region) can be
due to hepatitis.
iii.Parshva Shulais also one of the compli-
cations of Madatyaya.
iv.Only one direct reference of Madya (al-
cohol) causing liver disease is in the ae-
tiology of Pandu.
DISCUSION AND CONCLUSION
For doing treatment of the disease it is im-
portant to diagnose the disease first. When
the diagnosis is correct then the treatment
is effective. Complete finding is the way to
arrive at a definite diagnosis, to estimate
prognosis and to adopt appropriate line of
treatment. Eight fold of examination is the
best way to diagnose a disease.The most
characteristic point of differential diagno-
sis of both types of Kamala is the colour of
stool and urine. Patient with Kosthashrit-
Kamala passes Rakta Pita coloured urine
and Pita colour stool while Sakhashrita
Kamala passes Tilapistanibha Mala (whit-
ish stool) and Haridra coloured urine.
Clinical symptoms are also differ-
ent.InAyurvedic texts it is mentioned that
any substance, which is Amlarasa, Ushna,
Tikshna, Vidahi, etc. can cause vitiation of
Pitta leading to these diseases. These all
qualities can be seen in alcohol.Vitiated
Pitta leads to vitiation of Rakta. As Yakrit
Neha Dubey et al: Differential Diagnosis In Yakrita Vikara (Liver Diseases) Described In Ayurveda
2114
www.iamj.in IAMJ: Volume 3; Issue 7; July- 2015
is the Mula of Raktavahasrtotas, vitita-
tionof Rakta leads to vitiation of Yakrit.
Thus alcohol can cause various liver disor-
ders. According to Ayurvedic symptoma-
tology we can correlate these stages as-
Fatty liver may be asymptomatic or Pur-
varupaof Kamala, Alcohol hepatitis -
symptoms of Bahupitta Kamala,Alcoholic
cirrhosis - symptoms of Udara.
REFERENCES
1. VaidyaG. P. Upadhyaya, Science of
Pulse examination in Ayurveda.1st edi-
tion.Delhi:SriSatguru Publications;
1997.p.35,70
2. Agnivesha, Charaka, Dridha-
bala, Charaka Samhita. KashinathShas-
tri and GorakhnathChaturvedi, edi-
tors.2nd edition. Varanasi: Chaukhamba
Sanskrit Sansthan; 1990.p.490-493.
3. Vaghbhatta, Indu, AstangaSangraha,
A. D. Athavale,
Pune:AyurvidyaMudranalaya.
4. Agnivesha, Charaka, Dridha-
bala, Charaka Samhita (Uttarardha).
KashinathShastri and Gorakhnath-
Chaturvedi, editors.2nd edition. Vara-
nasi: Chaukhamba Sanskrit Sansthan;
1990.p.119.
5. Agnivesha, Charaka, Dridha-
bala, Charaka Samhita (Uttarardha).
KashinathShastri and Gorakhnath-
Chaturvedi, editors.2nd edition. Vara-
nasi: Chaukhamba Sanskrit Sansthan;
1990.p.231.
6. Prof. UpadhyayaYadunandana, editor,
commentary Madhukosha of Vijaya-
rakshit on MadhavaNidanam of Mad-
havakara (Uttarardha). Varanasi:
Chaukhamba Publication.2006.p.43.
7. Prof. UpadhyayaYadunandana, editor,
commentary Madhukosha of Vijaya-
rakshit onMadhavaNidanam of Mad-
havakara (Uttarardha). Varanasi:
Chaukhamba Publication.2006.p.38.
8. Agnivesha, Charaka, Dridha-
bala, Charaka Samhita (Uttarardha).
KashinathShastri and Gorakhnath-
Chaturvedi, editors.2nd edition. Vara-
nasi: Chaukhamba Sanskrit Sansthan;
1990.p.681-682
9. Dr.Gopalani Ajay G.,Dr.BhushanA.
Sarmandal, Hepatopathy- a study on
liver disorders. 2nd edition.Kottakal:
Dept of Publication of AryaVaidya
Sala.2006.
CORRESPONDING AUTHOR
Dr. Neha Dubey
JR-iii, Vikriti Vigyan Department,
Faculty of Ayurveda, IMS, BHU,
Varanasi, Uttar Pradesh, India
Email: ayuneha312@gmail.com
Source of support: Nil
Conflict of interest: None Declared
... Liver is very much important in all diseases concerned with 'Raktavaha and Pittavaha Srotas'. [9] The above verse denotes 'Cirrhosis of liver' (Yakruddalyudara), [10] with poor prognosis (ipTtaNmr[mîu te ). ...
Science of Pulse examination in Ayurveda.1 st edition
  • . P Vaidyag
  • Upadhyaya
VaidyaG. P. Upadhyaya, Science of Pulse examination in Ayurveda.1 st edition.Delhi:SriSatguru Publications;
Varanasi: Chaukhamba Sanskrit Sansthan
  • Agnivesha
  • Charaka
  • Charaka Dridhabala
  • Samhita
Agnivesha, Charaka, Dridhabala, Charaka Samhita. KashinathShastri and GorakhnathChaturvedi, editors.2 nd edition. Varanasi: Chaukhamba Sanskrit Sansthan; 1990.p.490-493.
UpadhyayaYadunandana, editor, commentary Madhukosha of Vijayarakshit on MadhavaNidanam of Mad- havakara (Uttarardha)
  • Prof
Prof. UpadhyayaYadunandana, editor, commentary Madhukosha of Vijayarakshit on MadhavaNidanam of Mad- havakara (Uttarardha).
Sarmandal, Hepatopathy-a study on liver disorders
  • Dr
  • G Gopalani Ajay
  • Dr
  • Bhushana
Dr.Gopalani Ajay G.,Dr.BhushanA. Sarmandal, Hepatopathy-a study on liver disorders. 2 nd edition.Kottakal:
KashinathShastri and GorakhnathChaturvedi, editors.2 nd edition. Varanasi: Chaukhamba Sanskrit Sansthan
  • Charaka Agnivesha
  • Charaka Dridhabala
  • Samhita
Agnivesha, Charaka, Dridhabala, Charaka Samhita. KashinathShastri and GorakhnathChaturvedi, editors.2 nd edition. Varanasi: Chaukhamba Sanskrit Sansthan; 1990.p.490-493.
Varanasi: Chaukhamba Sanskrit Sansthan
  • Gorakhnath-Chaturvedi Kashinathshastri
KashinathShastri and Gorakhnath-Chaturvedi, editors.2 nd edition. Varanasi: Chaukhamba Sanskrit Sansthan; 1990.p.681-682