JSS INSTITUTE OF NATUROPATHY & YOGIC SCIENCES

NAVAKKARAI, COIMBATORE- 641105

DISSERTATION ON

MANAGEMENT OF FATTY LIVER THROUGH

NATUROPATHY AND YOGA

Submitted by : Mr. Kavin ram. R

Registration No : 821712035

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 DECLARATION

I hereby declare that the dissertation entitled Management of fatty liver

Disease through Naturopathy And Yoga submitted for partial
fulfilment of the requirement for Bachelor Of Naturopathy And Yogic
Sciences in JSS Institute of Naturopathy and Yogic Sciences is my
original work and the dissertation has not formed the basis for the
award of any degree, diploma, fellowship or other title, it has not been
submitted to any other university or institution for the award of any
degree of diploma.

PLACE: SIGNATURE OF THE INTERNEE

DATE:

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 CERTIFICATE

This is to certify the dissertation entitled Management of fatty liver

Through Naturopathy and Yoga submitted by Mr. Kavin ram .R in
partial fulfilment of the requirement for Bachelor of Naturopathy and
Yogic Sciences in JSS Institute of Naturopathy and Yogic Sciences,
done by his during the period of April 2023 - April 2024 under my
guidance, supervision and this dissertation or any part of these has not
been submitted elsewhere for any degree

SIGNATURE OF THE GUIDE SIGNATURE OF THE PRINCIPAL

(DR.ANJU PAILY) (DR.DHILIP VR)

PLACE:

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 ACKNOWLEDGEMENT
I would like to extend my gratitude and sincere acknowledgement to
Dr.DHILIP V.RAVINDRAN, for giving me such a good opportunity to do a
dissertation and learnt a lot during the internship period. I wish to express my
profound respect to my guide Dr.Anju, for his mentorship and his tireless
support throughout the dissertation. I'm deeply indebted to all the doctors at JSS
Institute of Naturopathy and Yogic Sciences, for their valuable guidance and
support without which this task would have been arduous.

SIGNATURE OF THE INTERNEE

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 INDEX

S.No CONTENTS PAGE

NO
1 Introduction 6

1.1Definition 7

2 Literature Review 7

2.1 Types of fatty liver 7

2.2 Anatomy and physiology of fatty liver 9

2.3 Pathophysiology 10

2.4 Signs and symptoms 15

2.5 Conventional Diagnostic methods 17

2.6 Naturopathy Diagnosis 21

2.7 Management through other system of medicine 25

3 Naturopathy and Yogic management of disease 27

3.1 Naturopathic understanding of disease 27

3.2 Yogic understanding of disease 27

4 Methodology 28
5 Naturopathy and yoga treatments 29
6 Results 51
7 Discussion 52
8 Conclusion 52
9 Appendices 53
10 Reference 68

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 FATTY LIVER
1. INTRODUCTION:

 Fatty liver is the build-up of excess fat in the liver cells. It is normal for the liver to
contain some fat, but if fat accounts for more than 10 per cent of the liver’s weight, then
you have fatty liver and you may develop more serious conditions. This condition, called
steatohepatitis, does cause liver damage.
 Lipid, mainly as triglycerides, can accumulate in the liver for a variety of reasons. It is
normal for the liver to contain some fat. However, if more than 5% - 10% of the liver’s
weight is fat, then it is called a fatty liver (steatosis). Sometimes, inflammation from a
fatty liver is linked to alcohol abuse. This is known as alcoholic steatohepatitis.
Otherwise, the condition is called non-alcoholic steatohepatitis, or NASH. An inflamed
liver may become scarred and hardened over time. This condition, called cirrhosis, is
serious and often leads to liver failure. NASH is one of the top three leading causes of
cirrhosis.
 Fatty liver disease is also known as Steatotic liver disease. “Steatosis” is a term
healthcare providers use to describe fat buildup.

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1.1. DEFINITION :
 ACCORDING TO WHO:

Fatty liver disease is considered to be the hepatic manifestation of the metabolic syndrome and
is characterized by ectopic accumulation of triglycerides in the cytoplasm of hepatocytes, i.e.,
steatosis.i
1.2. EPIDEMOLOGY:

The most common causes of cirrhosis worldwide are related to viral hepatitis, alcohol, and
non-alcoholic fatty liver disease. NAFLD is now the most common liver disease in the United
States and possibly worldwide. 30% of adult Americans and 25% of adult Italians have
NAFLD. This indicates that over 70 million adult Americans and 15 million adult Italians
suffer from NAFLD. Prevalence in China and Japan of 15 and 14% .The total number of
deaths attributable to alcoholic fatty liver disease has increased in developed countries in the
last decade, including in Europe, Asia Latin America ,and the US. The prevalence is higher
in white men than white women The highest prevalence of NAFLD is reported from the
Middle East (31.79%) and South America (30.45%) whereas the lowest prevalence rate is
reported from Africa (13.48%).Highest prevalence of NAFLD is seen in adults aged 40-60
years, but it also occurs in children and adolescents. With the increasing incidence of obesity,
diabetes, dyslipidaemia and hypertension that are called the diseases of civilization,
prevalence of NAFLD in our population is predicted to increase in the future.
EPIDOMOLOGY IN INDIA

In India, alcohol is the commonest cause of cirrhosis (34.3%) and almost 20% of all liver
disease patients (irrespective of etiology) are current alcohol consumers . Thus, alcohol
amounts for a significant part of the liver disease burden across the world approximately one
in three adults or children have NAFLD in India. 9–32% of people in India have fatty liver.

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 LITERATURE REVIEW
2.1.CLASSIFICATION:
Fatty liver disease has been classified into

 Alcoholic fatty liver disease (AFLD)

 Non-alcoholic fatty liver disease (NAFLD)

Alcoholic fatty liver disease (AFLD)

Alcoholic fatty liver disease (AFLD) is the most prevalent type of chronic liver
disease worldwide .Alcohol is a well-known cause of fatty liver disease in adults and can
manifest histologically as steatosis, steatohepatitis, and cirrhosis Excessive ethanol
consumption causes more than 60% of chronic liver disease in Western countries and
accounts for 40% to 50% of deaths due to cirrhosis. Between 90% and 100% of heavy drinkers
develop fatty liver (i.e., hepatic steatosis), and of those, 10% to 35% develop alcoholic
hepatitis, whereas only 8% to 20% of chronic alcoholics develop cirrhosis

Fatty Liver

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Non-alcoholic fatty liver disease (NAFLD):
Non-alcoholic fatty liver disease (NAFLD) is a condition in which excess fat builds up in
your liver. This buildup of fat is “not caused by heavy alcohol use”. A reversible condition
where large vacuoles of triglycerides accumulate in liver cells via process of steatosis is
known as fatty liver, which is also termed as fatty liver disease. Fatty liver disease has the
potency to progress towards the development of cirrhosis and hepatocellular carcinoma The
liver can show any of the three types of changes discussed earlier steatosis, steatohepatitis,
and cirrhosis syndrome, Although non-alcoholic fatty liver disease (NAFLD) is commonly
associated with obesity, it is increasingly being identified in non-obese individuals. It can be
divided into two subgroups:

 NAFL (Non-Alcoholic Fatty Liver) or simply Steatosis and NASH (Non- Alcoholic
Steatohepatitis). NAFL ( Non -Alcoholic Fatty Liver) is defined as the presence of
hepatic steatosis with no evidence of hepatocellular injury in the form of ballooning
of the hepatocytes.

 NASH (Non-Alcoholic Steatohepatitis) is defined as the presence of hepatic steatosis

and inflammation with evidence of hepatocellular injury in the form of ballooning of the
hepatocytes.

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2.2. ANATOMY AND PHYSIOLOGY OF LIVER

Anatomically the liver has four lobes: right, left, caudate, and quadrate. The quadrate lobe is
located on the inferior surface of the right lobe. The caudate lobe is located between the left
and right lobes in an anterior and superior location.

 The liver is the largest gland in the body and is ideally located to receive absorbed
nutrients as well as detoxify absorbed drugs and other noxious substances.
 It serves as both an exocrine organ and an endocrine organ.
 The exocrine functionality of the liver is mainly in the synthesis and excretion of bile
salts into the common hepatic duct as well as the conjugation of bilirubin and
excretion into the gut.
 The endocrine functions of the liver include involvement in glycaemic control via
insulin and glucagon.
 The liver participates in fatty acid metabolism and synthesizes lipoproteins,
cholesterol, and phospholipids
 The liver stores vitamins, and minerals such as iron. In summary, the liver is an
important mediator from the gut to the blood and plays a vital role in the metabolism
of macronutrients, hormones, components of blood plasma, and exocrine and
endocrine substancesii.

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2.3. PATHOPHYSIOLOGY:

PATHOPHYSIOLOGY OF ALCOHOLIC FATTY LIVER DISEASE:

Alcohol metabolism by the liver is primarily via two enzymes:

 Alcohol dehydrogenase

 Aldehyde dehydrogenase

Alcohol dehydrogenase converts alcohol into acetaldehyde, and aldehyde dehydrogenase

converts acetaldehyde into acetate. The metabolism of alcohol increases the production of
NADH by reducing NAD in the body. This shifting of metabolic balance toward the
production of NADH leads to the formation of glycerol phosphate, which combines with the
fatty acids and becomes triglycerides, which accumulate within the liver. When lipid
oxidation (lipolysis) stops due to alcohol consumption, fats accumulate in the liver and lead
to "fatty liver disease." Continued alcohol consumption brings the immune system into play.
Interleukins with the help of neutrophils attack the hepatocytes, and swelling of the
hepatocytes known as the "alcoholic hepatitis" takes place. Ongoing liver injury leads to
irreversible liver damage, the cirrhosis of the liveriii.

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PATHOPHYSIOLOGY OF NON-ALCOHOLIC FATTY LIVER
DISEASE:

 Insulin resistance gives rise to hepatic steatosis.

 Hepatocellular oxidative injury resulting in liver cell necrosis and the inflammatory
reactions to it.

Hepatic steatosis, like obesity in general, arises from an overabundance of calorie rich food,
diminished exercise, and genetic/epigenetic mechanisms. Individuals with NAFLD eat more
fast food and exercise less. High fructose corn syrup, a nearly ubiquitous, inexpensive
sweetener in manufactured foods, also appears to promote insulin resistance. In individuals
with established insulin resistance and metabolic syndrome, the visceral adipose tissue not
only increases, but also becomes dysfunctional, with reduced production of the lipid
hormone, adiponectin, and increased production of inflammatory cytokines such as TNF-α
and IL-6. These changes in turn promote hepatocyte apoptosis.

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Insulin resistance promote continuous synthesis of triglycerides in the liver. These two
sources of triglycerides result in accumulation of lipids in the hepatocytes causing
macrovesicular hepatic steatosis.ivv

Lipid accumulation in non-adipose tissue is a key factor for the progression of insulin
resistance, DM (Diabetes mellitus) and cardiovascular disease.vi

2.4. CAUSES:

CAUSES FOR ALCOHOLIC FATTY LIVER:

ALCOHOL is the only major cause for alcoholic fatty liver.

Globally, 43% of the population currently drinks alcohol. Heavy alcohol drinking is an
important risk factor for alcoholic fatty liver. Prolonged alcohol intake, drugs, and chemical
agents, Short-term ingestion of as much as 80 g of ethanol per day (5–6 beers or 8–9 ounces
of 80-proof liquor) generally produces mild reversible hepatic changes, such as fatty liver.
Chronic intake of 40 to 80 g/day is considered a borderline risk factor for severe injury. Other
rare causes include Hepatitis. Alcohol stimulates collagen synthesis in the liver, leading to
fibrosis and eventually cirrhosisvii

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CAUSES FOR NON-ALCOHOLIC FATTY LIVER:

 Overweight or obesity
 Insulin resistance or type 2 diabetes
 Abnormal levels of fats in your blood, which may include
 High levels of triglycerides
 Abnormal levels of cholesterol—high total cholesterol, high ldl cholesterol, or low hdl
cholesterol
 Metabolic syndrome or one or more traits of metabolic syndrome.
 Metabolic syndrome is a group of traits and medical conditions linked to overweight
and obesity.
 Doctors define metabolic syndrome as the presence of any three of the following
 Large waist size

 high levels of triglycerides in your blood

 low levels of HDL cholesterol in your blood

 high blood pressure

 higher than normal blood glucose levels or a diagnosis of type 2 diabetes

Obesity is a well-known risk factor for NAFL .Type 2 diabetes mellitus, metabolic
syndrome , dyslipidaemia , and hypertension increase worldwide, the prevalence of non-
alcoholic fatty liver disease (NAFLD) is increasing proportionatelyviii. Excessive intake of
simple sugars and physical inactivity. Metabolic syndrome is also a leading cause for Non-
Alcoholic fatty liver. Being overweight in childhood and adolescence is associated with
increased risk of NAFLD later in life; consequently, the threshold of liver-related morbidity
and/or mortality is reached at a younger age. This may lead to endocrine changes, kidney
stones, cancer (overall and specific), coronary artery disease, heart failure, myocardial
steatosis, cardiovascular stroke, venous thrombosis, hepatobiliary disease, osteoarthritis, skin
changes, gout, dementia, etc.

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SIGNS AND SYMPTOMS:
 Swollen belly
 Enlarged blood vessels underneath your skin
 Red palms
 Jaundice
 Nausea, weight loss, or loss of appetite
 Tiredness or mental confusion
 Feeling of fullness in the abdomen

SYMPTOMS IN ALCOHOLIC FATTY LIVER:

 Abdominal pain or a feeling of fullness in the upper right side of your abdomen
(belly).
 Extreme exhaustion or weakness fatigue.
 More commonly, people notice symptoms once SLD has progressed to cirrhosis of the
liver. When cirrhosis develops, you may experience:
 Nausea.

 Loss of appetite.

 Unexplained weight loss.

 Jaundice.

 Swelling in your abdomen (ascites).

 Swelling in your legs, feet or hands (oedema).

 Bleeding (oesophagus, stomach or rectum).

SYMPTOMS OF NON-ALCOHOLIC FATTY LIVER:

 Fatigue

 Weight gain

 Elevated liver enzymes

 Acites

 Dark urine

 Enlarged liver
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2.5. CONVENTIONAL DIAGNOSTIC METHOD:

Flow chart for diagnosis

Elevated liver enzyme

Serology to exclude viral hepatitis

Imaging study showing fatty infiltrate

Alcohol intake

Less than two drinks per day‡ More than two drinks per day‡

Nonalcoholic fatty liver disease likely Alcoholic liver disease likely

‡ Criteria for fatty liver disease:

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DIAGNOSIS OF ALCOHOLIC FATTY LIVER:
The diagnosis of Alcoholic fatty liver can generally be made based on
 History
 Clinical findings
 Laboratory findings.
However, the diagnosis of ALD can be clinically challenging as there is no single diagnostic
test that confirms the diagnosis and patients may not be forthcoming about their degree of
alcohol consumption. In addition, clinical findings may be absent or minimal in early ALD
characterized by hepatic steatosis.

Clinical findings
Imaging
Transient elastography

Transient elastography (TE) is a technique that may supplement traditional USG. TE aims to
measure liver stiffness, a variable that is believed to be associated with the degree of fibrosis.
A mechanical pulse is generated at the skin surface, which is propagated through the liver.
The velocity of the wave is measured by ultrasound. The velocity is directly related to the
stiffness of the liver, which, in turn, affects the degree of fibrosis: the stiffer the liver is, the
greater the degree of fibrosis.

Computed tomography scanning: Computed tomography scanning have reported

differences between patients with NAFLD and NASH

Magnetic resonance imaging

Magnetic resonance imaging has also been used as a means of diagnosing.one of the most
sensitive modalities for detection and characterisation of fatty infiltration of the liver.
MRI is technique that has been investigated as a non-invasive means of diagnosing liver
fibrosis. It appears that the technique can distinguish between normal and cirrhotic liver, but
its ability to differentiate earlier stages of fibrosis.

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LABORATORY FINDINGS
Laboratory findings in ALD include transaminase levels with aspartate aminotransferase
greater than alanine aminotransferase as well as increased mean corpuscular volume, gamma-
glutamyl transpeptidase , and IgA to IgG ratio. The histological features of ALD can
ultimately define the diagnosis according to the typical presence and distribution of hepatic
steatosis, inflammation, and Mallory-Denk bodies. Because of the potential reversible nature
of ALD with sobriety, regular screening of the general population and early diagnosis are
essentialix.

DIAGNOSIS OF NON ALCOHOLIC FATTY LIVER:

The diagnosis of NASH can only be established with liver biopsy. Biopsy findings can reveal
the following.
 Type 1: fatty liver alone; macro vesicular steatosis
 Type 2: fatty accumulation and lobar inflammation
 Type 3: fat accumulation and ballooning degeneration
 Type 4: fat accumulation, ballooning degeneration and either Mallory hyaline of
fibrosis.

 Type 3 and Type 4 are NASH by definition.

 Laboratory studies lack specificity and cannot distinguish NASH from NAFLD;
however, initial evaluation should include an assessment of a complete hepatic panel,
lipid panel, and iron.
 Lab tests may be used to evaluate insulin resistance which include Homeostasis Model
Assessment (normal value<3.99)x
 The Quantitative Insulin Sensitivity Check Index
 If the patient has elevated liver enzymes chronically or has family history of cirrhosis,
additional tests should be considered like antinuclear antibody, smooth muscle antibody, a1-
antitrypsin, ceruloplasmin and thyroid-stimulating hormone levels.xi
 The absolute level of liver enzyme elevation does not related to the severity of alcohol
liver disease but the pattern of elevation in liver enzymes is helpful in making a
diagnosis alcoholic liver disease. AST level is typically two to three times greater than
ALT in alcoholic liver injury. Also, these patients have an elevated serum gamma-
glutamyl transpeptidase (GGT)xii

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ULTRASONOGRAPHY
 Imaging studies play a key role in the diagnosis of NAFLD.
 The mainstay is ultrasonography; it is least invasive, and relatively inexpensive. The
sensitivity for an ultrasound to detect NAFLD is in the range of 60% to 90% with a
specificity around 90%.

LIVER BIOPSY
Liver biopsy has moderate risk of complications and is invasive, subject to sampling error and
is expensive.xiii Diagnosis of NASH requires a liver biopsy; however, not all patients with
NAFLD require a liver biopsy. The decision to proceed with histological examination
depends on risk factors, laboratory workup, and disease severity

2.6. MANAGEMENT THROUGH OTHER SYSTEM OF MEDICINE:

METFORMIN: Due to the evidence of its limited efficacy in improving the histological
features of NAFLD, metformin is not recommended by any guidelines to specifically treat
NAFLD.

PIOGLITAZONE: Pioglitazone, a thiazolidinedione, is a peroxisome proliferator-activated

receptor (PPAR) gamma agonist with insulin-sensitising effects. Treatment with pioglitazone
improves insulin sensitivity, aminotransferases, steatosis, inflammation, and ballooning in
patients with NASH and prediabetes or T2DM .

VITAMIN E: Vitamin E is an anti-oxidant and has been investigated to treat NASH and
histological improvement in steatosis, inflammation, and ballooning and resolution of
steatohepatitis in adults with NASH.

SILYMARIN: Silymarinis a complex mixture of six major flavonolignans (silybins A and

B, isosilybins A and B, silychristin, and silydianin), as well as other minor polyphenol
compounds. Silymarin is mentioned as a potentially useful treatment for NASH .
BARIATRIC SURGERY: In patients unresponsive to lifestyle changes and
pharmacotherapy, bariatric surgery is an option for reducing weight and metabolic
complications, with stable results in the long-term. Bariatric surgery can also improve liver
histology, both regarding steatosis and ballooning and fibrosis

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 3. NATUROPATHY AND YOGIC MANAGEMENT OF DISEASE:

3.1. NATUROPATHY DIAGNOSIS:

IRIS DIAGNOSIS:
Iris diagnosis is one of the most efficient noninvasive diagnosis methods for determining the
health status of organs. is present in the Seventh zone of the iris.

PULSE DIAGNOSIS:
Pulse diagnosis is one of the most important methods for diagnosis. A pulse can be felt by
applying firm fingertip pressure to the skin where the arteries travel. There are about 29 pulse
types in a TCM pulse diagnosis, including the floating pulse, scattered pulse, hollow pulse,
deep pulse, hidden pulse, firm pulse, slow pulse, moderate pulse, swift pulse, surging pulse,
thready pulse, long pulse, short pulse, feeble pulse, weak pulse, faint pulse, replete pulse,
slippery pulse, stirred pulse, unsmooth pulse, wiry pulse, tight pulse, tympanic pulse, soggy
pulse, irregularly intermittent pulse, irregular pulse, irregular-rapid pulse, and intermittent
pulse. The key point of pulse-measuring instruments is to obtain important information from
the pulse in order to distinguish between different pulse types. on the wrist. Pulse over
Cunkou is divided into three parts: Cun, Guan and Chi, the part slightly below the styloid
process of radius is Guan pulse, the part anterior the Guan pulse is the Cun pulse, and the part
posterior the guan pulse is the Chi pulse. Both hands have three divisions of pulse. i. e. Cun
pulse, Guan pulse and Chi pulse. So altogether there are six divisions of pulse.

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The left Cun pulse is corresponding heart and Tanzhong (the part between the breasts).

 The left Guan pulse is corresponding liver and gallbladder.

 The left Chi pulse is corresponding kidney and the lower abdomen.
 The right Cun pulse is corresponding lung and thorax.
 The right Guan pulse is corresponding spleen and stomach.
 The right Chi pulse is corresponding the kidney and the lower abdomen.

Weak pulse can be felt over left guan pulse . Weak pulse (Xu Mai) Features: Weak pulse is
marked by weak beating of the pulse at all the guan .xiv

TONGUE DIAGNOSIS:

Tongue diagnosis is that the tongue reflects the general state of health of the individual, and a
corresponding system exists between the tongue's topography and the body's organ systems.
The tip of the tongue corresponds to conditions of the Heart and Lung; the centre to the
Stomach and Spleen; the sides to the Liver and Gallbladder; and the root to the Kidneys,
Intestines, and Urinary Bladder.

The left and right areas of the tongue shows some changes in the case of fatty liver.

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YOGIC DIAGNOSIS:

Yoga plays an important role in diagnosis as it helps to diagnose the person as a whole. The
diagnostic concerns in yoga are as below

SWARA DIAGNOSIS:
Swara yoga is a science which is about the realization of cosmic consciousness, through the
awareness and manipulation of the flow of breath in the nostrils. Swara yoga involves the
systematic study of the breath flowing through the nostril (or swara) in relation to the
prevailing phases of the sun, moon, time of day and direction.

TRIGUNA:
Assess the nature of the person to find out whether the underlying nature is the cause of the
presenting disease before treating him /her. Assess whether the person is of tamasic (dull and
lazy), rajasic (overactive) or saatvik (calm and composed)

FACIAL DIAGNOSIS:
Facial diagnosis is the ability to determine the physical status of a person from external
appearances. Through this it is easy way to elicit the amount and location of morbid matter in
the body. This in turn reflects the ideology of naturopathy “the common cause of all disease
is the presence of foreign substances in the body”. This foreign matter is termed as
encumbrance .

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ENCUMBRANCE:

There four types of encumbrances,

• Front encumbrance
• Back encumbrance
• Side encumbrance
• Whole body encumbrance

3.1. NATUROPATHIC UNDERSTANDING OF DISEASE

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3.2. YOGIC UNDERSTANDING OF DISEASE :
 Impairment of health, a condition of the body in which its optimal functioning is
disrupted or deranged is called as disease.

THE PATANJALI YOGA SUTRAS:

Samadhi pada of the yoga sutras, a total of 13 obstacles in the path of Samadhi (antarayas)
are described. Vyadhi or disease is one of them. This is in reference to physical illness.
Five kleshas or afflictions are are described in the sadhanapada. They are said to be the root
of mental illnesses. They include:

 ignorance (avidya),

 ego (asmita),

 desire (raga),

 aversion (dvesha)

 fear of death (abhinivesha).

 Among these, ignorance (avidya) is said to be the root of all other afflictions.

THE YOGA VASHISHTA:

The yoga vashishta is a treatise on yoga that contains the teachings of sage Vashishta

to Lord Rama. In this text, the concept of disease is explained as follows:

 In the anandamayakosha (bliss body), an individual is healthiest with perfect

harmony and balance.
 In the vijnanamayakosha (intellectual body), there are movements but channelized in
the right direction.
 Imbalances start in the manomayakosha (emotional body). It is the root of all
diseases.
 These mental imbalances arise due to ajnana or ignorance. This leads to an
imbalance in the thought process called as adhi.
 The adhis manifest themselves as physical disease called as vyadhi.

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The physical manifestation of the adhis can take three forms:

 Ajeernatva: indigestion or decreased activity of digestive tract.

 Atijeernatva: excessive functioning of the digestive tract

 Kujeernatva: abnormal functioning of the digestive tract

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4. METHODOLOGY:

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5. NATUROPATHY AND YOGA TREATMENTS OF
FATTY LIVER:
Naturopathy is a rational and evidence-based system of medicine imparting treatments with
natural elements based on the theories of vitality, toxaemia and the self-healing capacity of
the body and the principles of healthy living. Indian Naturopathy includes Yoga along with
some ancient Indian concepts like – ‘Panchabhuta based understanding of health and disease.
Among these five elements, earth is an integral component of the human body and has a
specific effect on health and diseases. Naturopathy uses each one of these elements as a
therapeutic modality because of their properties to treat the diseases. In naturopathy, mud is
one of the core therapeutic components as an element of earth. Mud is a mixture of inorganic
and organic matter with water, which has undergone geological and biological processes
under the influence of various physicochemical factors.

5.1. HYDROTHERAPY:

Hydrotherapy is one of the basic methods of treatment widely used in the system of natural
medicine, which is also called as water therapy, aquatic therapy, pool therapy, and
balneotherapy.

GASTRO HEPATIC PACK

This is a type of hydrotherapy treatment in the fomentation is applied anteriorly from the
fourth rib till the umbilicus ,extending to the axillary line on each side, while a cold bag at
least eighteen inches long is applied to dorsal and lumbar spine.

Duration:10-15 mins

Physiological effect: Through the dilatation of the branches of mammillary artery and
associated veins, the blood is drawn from the stomach ,liver spleen and pancreas while the
reflex stimulation of the controlling vasomotor centres contracts the vessels of the arterial
circulation

DOUCHE :

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A douche consists of a single or multiple column of water directed against some portion of the
body. In the therapeutic employment of the douche, three factors are active:
(1) Temperature, (2) Pressure, (3) Mass
The range of temperatures employed in douches is from 45° to 125° F. The pressure
ordinarily employed is from 10 to 60 pounds, represented by a water column of 25 to 150
feet.

THE ALTERNATE DOUCHE:

The alternate douche employs both hot and cold water, first hot, then cold, while in the
alternate douche hot and cold water are repeatedly applied in alternation. The alternation may
be repeated as many times as is considered desirable in the particular case.

Duration: hot 2-3 mins, cold 30secs- 1 min

Physiological Effects: The alternate douche is perhaps the most exciting of all hydric
procedures. It combines with the primary excitant effects of heat the secondary excitant
effects of cold, thus the excitant effect of the hot application is intensified and extended in
which active inflammation of liver is ceased.

THE SCOTCH DOUCHE:

The Scotch douche consists in the application of hot water followed by a short cold
application. Any desired form of douche may be employed.

Duration: The hot application must be relatively long (1 to 4 min.), and the cold application
must be short (3 to 30 secs)

Physiological Effects. The physiological effects produced by the Scotch douche combine
those of both the very hot and the cold douche, though not in their entirety. influence
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produces a tonic reaction in which every cell and fibre of the whole body participates,
provided the intensity of the cold application is such that the tonic effect produced by it more
than counter- balances any atonic effects of the hot application.
THE REVULSIVE COMPRESS:

In the revulsive compress the hot application is applied for several minutes, while the time of
the cold application is only a few seconds. The hot application, or fomentation, remains in
place

Duration: 4 or 5 minutes.
The cold compress is instantly applied and allowed to remain in place Duration: 20 to 40
seconds.
Physiological effect: The purpose of this mode of procedure is to secure a strong circulatory
reaction without thermic reaction. The vascular dilatation resulting from heat is transient in
character. strong circulation is improved in the liver so that it can rejuvenate at a higher rate.

THE HOT AND COLD ABDOMINAL PACK:

The Hot and Cold Abdominal Pack . the moist bandage is placed around the trunk at the level
of the umbilicus. A rubber or aluminium coil is placed upon a wet towel just over the
epigastrium. The blankets are then tucked snugly about the patient, and a stream of hot water
is kept flowing through the coil continuously during the application, at a temperature as high
as the patient can bear.

Duration: 10 minutes

Physiological effect: effectively reduce the internal heat of the body thereby helping in
removal of toxins.

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HIP BATH

A Hip bath involves covering a person’s abdomen, buttocks, and upper thighs with enough
water. A special type of tub is used for the purpose.

Duration: 15-20 mins

Physiological effect : relieves constipation, indigestion and helps the eliminative organs to
function properly. It is also helpful in uterine problems like irregular menstruation, chronic
uterine infections, pelvic inflammation, piles, hepatic congestion, Cold hipbath is very
beneficial for diabetes. It reduces obesity, Constipation and indigestion.

5.2. MUD THERAPY

Mud therapy can be defined as the application of processed mud either directly or indirectly
in the form of packs to elicit therapeutic benefits. Mud therapy has proved to be successful in
the management of skin pathologies, rheumatic disorders, musculoskeletal disorders,

30
gynaecological conditions, neurological complaints and cardiovascular conditions. The mud
acts by diluting and absorbing the toxic substances of the body and ultimately eliminating
them from the body. The mud used for the treatment purpose should be very clean and pure
and free from all the contaminations. Mud is used in various ways to treat different diseases
like packs, compresses and full body applications.
Form of application :

 Mud packs

 Mud baths

Mud pack to eyes and abdomen

Duration: 20 minutes

Procedure : The mud should be taken from 3 feet deep from the ground.

It should be wrapped around the cloth and keep it over the yes and abdomen.

Effect: Cold applications like mud pack to abdomen effectively reduce the internal heat of the
body thereby helping in removal of toxins. The application of mud on the body increases the
immunity thereby helping the body to combat diseases
FULL MUD BATH

Duration: 30 minutes.

Procedure: The mud is applied throughout the body and the patient is made to sit under the
sunlight for half and hour.

Effect: Mud therapy decreases pro-inflammatory factors like interleukin I,TNFα. Patient felt
rejuvenated after application.

31
5.3. MAGNETOTHERAPY:

Magneto therapy a clinical system in which human ailments are treated and cured through the
application of magnets to the body of the patients magneto therapy is the simplest, cheapest
and entirely painless system of treatment with almost no side or after effects magnet.

 Magnetic field exhibits the following activities:

 Vasodilatation;

 Analgesic action;

 Anti-inflammatory action;

 Spasmolytic activity;

 Healing acceleration;

 Anti-oedematous activityxv.

In the case of fatty liver” North Pole under the palm of the right hand and South Pole under
the sole of the left foot is given.

Duration: 20 minutes.

North Pole under the palm of the right hand and South Pole under the sole of the left foot
This diagonal application affects liver, spleen, stomach and intestines Has a curative effect on
the digestive system and cures gastric troubles

32
5.4. CHROMOTHERAPY:

Chromo therapy is a method of treatment that uses wavelengths in the visible region for
curing different diseases and medical conditions Wavelengths in the visible region produce
biological effects in molecules, living cells, tissues and enzymes.

 Colour charged water: Solarised water has been a simple method of using the healing
power of colour for at least a hundred years. Pure water in a glass or jug is placed in full
sunlight with a coloured filter over it. The effect of the sunlight passing through the colour
into the water charges the water with the energy pattern of that colour.

 Yellow and green coloured water is used for fatty liver.

Colour treatments:

 Lemon yellow -It is a laxative and diuretic. It is a stimulant for the brain, the liver and the
spleen

 Green- is nature’s colour helps in pituitary gland, which in turn stimulates the thyroid
gland. It also stimulates the elimination of the toxic matters. Green charged water in the
morning in the empty stomach and before major meals Gargling with green charged water
and washing of the eyes with this water is also suggested.

 Blue colour soothes and calms the mind, Hence beneficial for mental agitation and stress.


33
5.5. AROMATHERAPY:

Aromatherapy is a modern name for the ancient knowledge of healing and improving health
using fragrant, natural ingredients. These ingredients, called essential oils, are found in
Herbs, plants, flowers, fruits and the bark, roots or resin of some trees. They have been used
for their beneficial properties such as insecticidal, antibacterial and antifungal activities.

Some essential plant oils are used to treat and manage different diseases as well as the liver
damages. Indeed, many researches were done on certain of these oils, reported that these
components have a hepatoprotective action.

AROMA OILS FOR LIVER DISEASES:

 Peppermint Essential Oils

 Ginger Essential Oils

 Fennel Essential Oils

 Lemon Essential Oils

 Geranium Essential Oils

 Rosemary Essential Oils

 Lavender Essential Oils

34
5.6. MASSAGE THERAPY
Massage is "a form of passive exercise by systematic manipulation of the body for definite
therapeutic ends. Massage has one of its most important effects on the circulatory system.
The flow of the blood and lymph is improved both in quantity and speed.

Massage for abdomen:

 To Encourage Activity of the Liver. The liver requiring oxygen in the various branches of
its work as an eliminative organ, its action is greatly encouraged by the increased amount
of oxygen brought into the blood by massage. The increased activity of the portal
circulation produced by abdominal massage especially aids the liver.

 Hepatic activity may also be directly stimulated by the application of massage to the liver-
especially by vibratory movements and percussion applied over the organ.

 Various other toxic substances normally produced in the body, into less toxic forms,
preparing them for elimination by the kidneys

 Massage promoting these important activities in the liver, not only aids elimination
through both liver and kidneys, but contributes to purity of blood by the destruction of
poisons.

35
5.7. HELIO THERAPY

SUN BATH:

Duration: 5 minutes;

Procedure: Stay hydrated and stay in sun with minimum clothing.

Effect: Exposure to sun rays reduces the CD4+ and CD8+ T-cells and rejuvenates the skin.
Patient felt relaxed after treatment.

PLANTAIN LEAF BATH:

Duration: 30 minutes

Procedure: Stay hydrated and the patient should make to lie down on the plantain leaf. Then
the patient is covered with plantain leaf and tied completely with the help of rope except the
nose to avoid suffocation.
Effect: Polyphenol- Detoxifies the body and aids in weight loss.

5.8. ACUPRESSURE

Acupressure is a complementary treatment method performed using fingers and hands to

maintain the body's energy balance by stimulating acupuncture points.

 Acupressure to feet (manual) Duration- 10 mins

Effect - Acupressure is usually given to the acupuncture points, on the certain
meridians. When given Qi Stagnation is released and therefore enabling healthy flow of

prana through-out the body.

36
  Acupressure is given on three finger widths below the belly button on the body’s
midline is where the Lower Qi sea is situated.
Duration :10 mins

Effect: The immune system is strengthened and weariness is relieved by stimulating this spot.
In addition, it aids in boosting the immune system, easing fatigue and general weakness as well
as headaches, body pains, abdominal cramps, constipation, and menstrual cramps.
 Acupressure is given between the big and second toes is where this point is situated on the
webbing. The liver is the most important detoxifying organ

Duration :10 mins

Effect: stimulating this area on both feet alternately aids in regulating and rejuvenating it.
This point can also be encouraged to treat other health issues, including headaches, lower
back discomfort, eyesight issues, menstrual cramps, migraines, and sleeplessness.

5.9. ACUPUNCTURE

Acupuncture is a system of medical treatment and ideology based on the principle of

applying small needles or pressure to specific points in the body. Under this ideology, health
stems from the alignment of Qi, which means “vital energy” and encompasses the yin/yang
dichotomy that flows through all of the physical worlds.

Acupuncture aims to open the blockage or reduce the excess of “Qi” flowing through specific
channels in the body, known as meridians. xvi

37
MAIN POINTS:

 LR3/ TAICHONG

LOCATION: On the dorsum of the foot, in the depression proximal to the 1st metatarsal
space

USES: Promotes the Smooth Flow of Liver Qi, Dispels Liver Congestion, Subdues Liver
Yang, Expels Internal Wind, Calms Spasms & Muscle Cramps, Calms the Shen, Spirit,
and/or Mind, Nourishes Liver Yin and Liver Blood, Regulates Menstruation, Moves Stagnant
Qi and Blood Purges Cold from the Liver Channel

 ST36/ Zu San Li

LOCATION: ST36 is located four finger widths down from the bottom of your knee cap,
along the outer boundary of your shin bone.
xvii
USES: ST36 has anti-inflammatory Stomach Pain, Digestive Issues, Chronic diarrhoea,
Nausea, Abdominal Distention , Internal Dampness

 ST40/ FENGLONG
LOCATION: On the anterior aspect of the lower leg, 8 T-cun superior to the external
malleolus, lateral to ST 38, two finger-breadth (middle finger) from the anterior crest of the
tibia.

USES: increase the activity of lipoprotein lipase and hepatic lipase, then improve liver
steatosis, Asthma, Cough, Depression.

 SP6/ SANYINJIAO

LOCATION: on the inside of the lower leg, 3 T-cun (or one hands' breadth) above the
prominence of the medial malleolus (i.e. the highest point of the ankle bone)

USES: Strengthens the Spleen and Stomach, resolves dampness, harmonizes the Liver,
strengthens the Kidneys.

38
SUPLEMENTARY POINTS:

 Baihui-(GV-20)

 Quchi- (LI-11)

 Yanglingquan-(GB-34)

 Zusanli- (St-36)

 Neiting-(St-44)

 Dannang- (Ex-35)

Earpoints:

 Lung

 Liver

 Spleen

5.10. HERBAL TREATMENTS:

Herbs are applied to the treatment of chronic and acute conditions and various ailments and
problems such as cardiovascular disease, prostate problems, depression, inflammation, and to
boost the immune system, Herbs and plants can be processed and can be taken in different
ways and forms, and they include the whole herb, teas, syrup, essential oils, ointments,
salves, rubs, capsules, and tablets that contain a ground or powdered form of a raw herb or its
dried extract. Many of these compounds have antioxidant properties on antioxidants in herbs
and spices.xviii

39
 HERBAL TREATMENTS FOR FATTY LIVER:

LYCII FRUCTUS (WOLFBERRY, GOJI BERRY)

Wolfberry is the fruit of plant Lycium barbarum of the family Solanaceae. It is a famous drug
or supplement in traditional Chinese medicine in which it holds beneficial properties on liver.
 Benefits: antioxidant effect, immunoregulation, neuroprotection, control of glucose
metabolism, anti-tumor activities, reduced fat accumulation, fibrosis, oxidative stress,
inflammation, and apoptosis.

GARLIC:

The protective effect of oral consumption of whole garlic attenuates high-fat diet caused
abnormal lipid profile through AMP-activated protein kinase (AMPK) pathway.
Administration of raw garlic homogenate along with the diet induction.
 Benefits: improves insulin resistance, oxidative stress, and lipid metabolism.

40
 GREEN TEA:

Green tea is one of the best documented plants that have been used in the prevention of liver
diseases. Extracts from green tea found the beneficial or even therapeutic effects of green tea
on liver diseases.
 Benefits: In alcoholic person with liver injury, co-treatment of whole green tea extracts with
ethanol administration effectively attenuated hepatic oxidative stress through cytochrome
P450 2E1 (CYP2E1)

RESVERATROL:

Resveratrol (RSV; 3, 5 4′-trihydroxystilbene) is a phytoalexin extracted from red grapes. It is

one of the most well-documented and accepted herbal derivatives in the world.

 Benefits: strong capacity against oxidation and inflammation.

41
 MILK THISTLES

Both silybin and silymarin are derivatives of plant milk thistle (Silybum marianum), a
flowering plant of the daisy family.

 Benefits: In the liver cells, the common beneficial effects of silybin and silymarin include
antioxidative effects, direct/indirect effects on inflammation and fibrosis, as well as
modulation of metabolic pathwaysxix.

5.11. DIET THERAPY

 GLASS OF LUKEWARM WATER: Warm water helps in relieving the GIT spasm and
therefore helps in stimulating the peristalsis.
 WHEATGRASS JUICE: Wheatgrass is also known as green blood and is considered to
be the superior source of chlorophyll (Co Enzyme Q10) which aids in immunomodulation
role. The consumption of juice on a daily basis helps to improve the digestion aids in
general detox of the body.
 CARROT JUICE: It has got potent anti-inflammatory effect and this wonderful liver
detox drink
 CUCUMBER JUICE: It contain an appreciable amount of antioxidant properties,
vitamins, minerals and macronutrients which are required for the proper functioning of the
body and to fight against inflammation

42
 BEETROOT JUICE: Bioactive compounds such as polyphenols, betalains in beetroot
reduce the inflammatory markers. Increased amount of potassium and manganese helps to
decrease the inflammation detox the liver and improve its function. They are high in
antioxidants and help to cleanse the blood. They also promote healthy liver function by
helping to break down toxins.
 Vegetables such as broccoli, cauliflower, brussels sprouts, cabbage and kale contain
glutathione, which kickstarts the liver’s toxin cleansing enzymes of the liver. Eating them will
increase production of glucosinolate in the body , which helps flush out carcinogens and other
toxins
 WATERMELON JUICE: High amount of vitamin-B and Beta carotene ,excellent source of
immune-supportive vitamin C and vitamin A, triterpene
 Orange juice is rich in potassium and vitamin C which protect the cells of liver from toxic
substances.
 LEMON JUICE : the most inexpensive fruits for detoxification is lemon. As lemons are low
in sugar and high in purifying substances, lemon juice is an ideal way to keep liver healthy.
mix turmeric with lemon juice to get its anti-inflammatory benefits and detox your liver.

The following diet chart was given, considering the regional and seasonal food.

Time Diet
Bowl = 100 gm; 1 glass = 250 ml)
On waking up A glass of Lukewarm water
Half an hour after waking up Wheat grass juice/ carrot juice/
beetroot juice
Breakfast 1 Sorghum roti, mixed vegetable
curry
11.00am Whole fruit [papaya, watermelon]
Lunch 1 Sorghum roti, mixed vegetable
curry
4.00pm Papaya juice/ watermelon juice
Dinner 1 Sorghum roti, mixed vegetable
curry

43
Juice diet for 7 days

Day Diet
(1 glass = 250 ml)

1 Carrot juice

2 Beetroot juice

3 Tender coconut

4 Watermelon juice

5 Papaya juice

6 Carrot juice

7 Water fasting

Raw diet for 6 days

Day Diet
1 Beetroot
2 Carrot
3 Watermelon
4 Papaya
5 Carrot
6 Beetroot

5.12. FASTING THERAPY:

INTERMITTENT FASTING :
Intermittent fasting is a dietary approach where there are timed periods of fasting without any
restriction of a particular macronutrient. The overall rationale for weight loss based on
intermittent fasting relies on broad caloric restriction. There are not many randomized
controlled trials showing evidence of weight loss from intermittent fasting. Intermittent
fasting could be alternate day fasting or time-restricted eating, where nutritional intake
happens only during a fixed time window.

44
5.13. YOGIC MANAGEMENT:

 Yoga therapy is defined as the use of yoga practices for the prevention and treatment of
medical conditions.

 Beyond the physical elements of yoga, which are important and effective for
strengthening the body, Yoga therapy also incorporates appropriate breathing
techniques,Mindfulness meditation in order to achieve the maximum benefits.

 Multiple studies have shown that yoga can positively impact the body in multiple ways,
including helping to regulate the blood glucose levels, improve musculoskeletal ailments
and keeping the cardiovascular system in tune.

 It also has been shown to have important psychological benefits, as the practice of yoga
can help to increase mental energy and positive feelings, and decrease negative feelings of
aggressiveness, depression and anxiety.

 The yogic definition of health or “svastha” is when the functions of the body and mind
are in harmony so that they can turn inward to reach the goal of Self-realization.

SURYA NAMASKAR

45
  Surya Namaskar is said to be the complete body workout for weight loss. One round
of Surya Namaskar consists of 12 yoga poses.

 One set consists of 2 rounds of Surya Namaskar: first stretching the right side of your
body and then the left side.

 So, when you do 12 sets of Sun Salutation, you are completing 12 sets x 2 rounds in
each set x 12 yoga poses in each = 288 yoga poses in 12 to 15 minutes.

 Surya Namaskar, also known as Sun Salutation, is a common sequence of 12 body

postures or asanas. These postures range from flexing and bending to stretching the
muscles, while continually breathing in and out rhythmically. It is a complete body
workout in itself.

 Yoga experts call it the base of Power Yoga as it aims at achieving more health
benefits in less time. One round of Surya Namaskar consists of 12 yoga poses. One set
consists of two rounds of Sun Salutations, where you stretch your right side of the
body first and then the left one.

 Doing Surya Namaskar not only acts as a cardio workout but also strengthen the
immunity and calms the body and mind.

SURYA NAMASKAR CALORIE CALCULATION:

 One round of Surya Namaskar burns up to 13.90 calories for an average weighing
person. Take a look at the 30-minute workout calorie meter for Surya Namaskar

 Surya Namaskar : 417 calories

POINTS TO KEEP IN MIND:

 The ideal time to practice Surya Namaskar is during the early morning, on an empty
stomach. Also, this should be performed facing the rising sun.
 Keep an interval of a minimum of two hours between eating and performing the
Namaskar.
 It is very important to perform all the asanas correctly. Take your time to learn all the
poses properly and you will see yourself doing it perfectly in less than two weeks,

46
  Increase the number of rounds once you have built enough strength.
 End your practice with five minutes of stretching exercises or relaxation poses such as
Shavasana.

CONTRA INDICATION:
 Individuals with a hernia, high blood pressure, and back conditions.
 Menstruating women.

YOGA ASANAS FOR FATTY LIVER:

 Trikonasana
 Ardha Matsyendrasana
 Bhujangasana
 Meru Vakrasana
 Naukasana
 Gomukhasana
 Dhanurasana
 Mandukasana

PRANAYAMA
 Kapalbhati Pranayama
 Suryabhedan Pranayama with Kumbhak for 10 minutes.
 Bhastrika Pranayama with Kumbhak for 10 minutes
 Anulom Viloma with or without Kumbhak, Right Nostril Breathing

CLEANSING PRACTICES

 Eye wash

 Jala neti

 Sutra neti

 Vaman dhauti

47
6. PRE AND POST TREATMENT RESULTS:

48
 7. DISCUSSION
 Fatty liver can be reversed in certain conditions like simple fatty liver and inflammatory
condition of the liver by reducing the consumption of alcohol, reducing the high
cholesterol diet.
 Physical activities like yoga and exercise reduces the fatty acids in the body which is
major cause for the fatty liver.
 Healthy diet improves the lipid oxidation there by reducing quantity of lipids in the body.
 Naturopathy plays a vital role in preventing the progression towards the cirrhosis of the
liver which cannot be reversed .Proper lifestyle modification improves the physical and
mental health

49
 8. CONCLUSIONS AND RECOMMENDATIONS:

 Follow-up Appointments: Attend all scheduled follow-up appointments to monitor

progress , improvements in the health and also to make any necessary adjustments to your
treatment and diet plan.
 Lifestyle Modifications:
 Including adopting a balanced diet rich in fruits, vegetables, whole grains,
and lean proteins
 Limit consumption of sugary foods and beverages, high cholesterol diet,
processed foods.
 Engage in regular physical activity such as walking , yoga, pranayama and
exercise.
 Should stop consumption of alcohol , smoking and drugs.
 Must monitor the weight regularly.

50
10.CASE SHEETS

CASE SHEET NO – 1

Name : Mr. XYZ

Age : 52 years
Sex : male Address : Pune
Occupation : Business
Marital status : married
Diet : mixed
Appetite : Normal
Bowel : Regular
Micturition : Normal
Habit : 2 cups coffee per day
Sleep : sound
Addiction : Alcohol
Allergy : Nil

PERSONAL HISTORY :
Pulse rate : 88 bpm
Respiratory rate : 16cpm

Blood pressure : 140/90mmhg

Temperature : Afebrile

GENERAL PHYSICAL EXAMINATION :

Height : 162 cm Weight : 67 kgs BMI : 25.5 kg/ms
Built : obese Gait : normal Edema : present Cyanosis : Absent
Pallor : Absent Tongue : not coated Nails : clear
Icterus : Absent Lymphadenopathy : Absent Clubbing : Absent
Varicosity : Absent

51
SYSTEMIC EXAMINATION :

Cardiovascular system : Normal S1 and S2 heard

Respiratory system : Normal Broncho vesicular sound is heard

Central nervous system : Conscious and well oriented

Abdomen : Mild tenderness in right upper quadrant

ENT : No inflammation detected

LOCOMOTOR EXAMINATION:
GAIT : Normal ARM : Normal LEG : Normal Spine: Normal

INVESTIGATION :
Liver Function Tests: Elevated AST, ALT, AST/ALT ratio > 2.
Complete Blood Count: Mild macrocytosis, elevated MCV. Lipid Profile: Elevated
triglycerides and cholesterol levels.

FINAL DIAGNOSIS :

Alcoholic Fatty liver disease.

52
Case 2
Name : Mr. XYZ
Age : 55 Yrs
Sex : Male
Address : saswad
Occupation : construction worker
Marital status : Married

CHIEF COMPLAINT :

C/O pain in the right upper side of the abdomen C/O fatigue for 6 months

HISTORY OF PRESENTING COMPLAINT : The patient reports experiencing fatigue

for the past six months, which has progressively worsened. He also notes intermittent
discomfort in the upper right quadrant of his abdomen, occasionally accompanied by mild
nausea. There is no history of jaundice, fever, or significant weight changes.

PAST HISTORY :
K/C/O chronic alcoholic for past 30 years MEDICAL HISTORY : Nil
FAMILY HISTORY : Father – heart attack

PERSONAL HISTORY :
Diet : Mixed
Appetite : Normal
Bowel :Normal
Micturition : Normal in frequency
Habit : 2 cups tea per day
Sleep : Disturbed
Thirst : Increased
Addiction : chronic alcohol intake and smoking
Allergy : Nil
Temperature : Afebrile
Pulse rate : 80 bpm
Respiratory rate : 16 cpm
Blood pressure : 142/90 mmhg

53
VITAL DATA :
Height : 178cm Weight : 84 kgs BMI : 26.5 kg/ms
Built : moderate Gait : Normal Edema : Absent
Cyanosis : Absent Pallor : Absent

GERAL PHYSICAL EXAMINATION :

Tongue : cleae Nails : Clear

Icterus : absent Lymphadenopathy : Absent Clubbing : Present

SYSTEMIC EXAMINATION :

Cardiovascular system : Normal S1 and S2 heard

Respiratory system :Normal bronchovesicular sound is heared
Central nervous system : Conscious and well- oriented

Gastro Intestinal system: : Mild tenderness in right upper quadrant, liver palpable 3 cm below
right costal margin

Ear Nose Throat :No Inflammation is detected

LOCOMOTOR EXAMINATION :

GAIT : Normal ARM : Normal LEG : Normal SPINE : Normal

INVESTIGATIONS:

Laboratory Tests:
Liver Function Tests: AST 90 U/L (normal range 10-40 U/L), ALT 120 U/L (normal range
7- 56 U/L), AST/ALT ratio > 2.

Complete Blood Count: Mild macrocytosis, MCV 100 fL (normal range 80-96 fL). Lipid
Profile: Elevated triglycerides and cholesterol levels.
FINAL DIAGNOSIS :
Alcoholic fatty liver disease.

54
CASE SHEET NO – 3
Name : Mrs. XYZ
Age : 35 years
Sex : Female
Address : hubli
Occupation : school teacher
Marital status : married
CHIEF COMPLAINT :

C/O persistent fatigue

C/O Increase in weight over past few years

HISTORY OF PRESENTING COMPLAINT : Patient reports gradual weight gain over

the past year, despite no significant changes in diet or exercise. She also complains of
persistent fatigue, especially in the afternoons and evenings. She denies any abdominal
discomfort, nausea, vomiting, or changes in bowel habits. patient's sleep pattern has been
disturbed lately, with difficulty falling asleep and waking up feeling unrefreshed.

PAST HISTORY : No relevant past history MEDICAL HISTORY : Nil

FAMILY HISTORY :
Mother: Type 2 diabetes mellitus
Father: Hypertension.
OBSTETRIC HISTORY :

Gravida -2
Parity – 2
Live -2
Abortion -0

GYNAECOLOGICAL HISTORY :

Menarche – 13 years
Menstrual cycle – 30 days cycle
No of days – 3 days

55
PERSONAL HISTORY :

Diet : Mixed Appetite : Normal Bowel : Constipated

Micturition : Normal in frequency Habit : 2 cups tea per day
Sleep : Disturbed Thirst : Normal
Addiction : Occasional social drinking, 1-2 drinks per week. Allergy : Nil
Pulse rate : 72 bpm Respiratory rate : 14cpm Blood pressure : 120/80 Temperature : Afebrile

VITAL DATA :
Height : 162 cm
Weight : 74kg BMI : 28.2 kg/ ms

GENERAL PHYSICAL EXAMINATION :

Built : obese Gait : Normal Edema : Absent
Cyanosis : Absent Pallor : Absent Tongue : non coated
Nails : Clear
Icterus : -ve Lymphadenopathy : -ve Clubbing : -ve Varicosity : -ve
SYSTEMIC EXAMINATION:

Cardiovascular system : S1 and S2 sound is heard

Respiratory system : Normal bronchovesicular sound is heard

Central nervous system : Conscious and well oriented

Gastro Intestinal system: No abnormalities is detected
Ear Nose Throat : No Inflammation is detected
LOCOMOTOR EXAMINATION :

GAIT : Normal ARM : Normal LEG : Normal SPINE : Normal

NATUROPATHIC DIAGNOSIS :

Facial diagnosis: mixed encumbrance

INVESTIGATION

Diagnostic Evaluation:
Laboratory Tests: Liver Function Tests (LFTs): Elevated ALT (80 U/L), AST (70 U/L), GGT (85
U/L); normal bilirubin and alkaline phosphatas

56
Fasting Blood Glucose: Elevated (115 mg/dL), consistent with impaired fasting glucose.
Imaging:

Abdominal Ultrasound: Hepatic steatosis with moderate diffuse fatty infiltration, consistent
with non-alcoholic fatty liver disease; no evidence of liver cirrhosis or masses.

FINAL DIAGNOSIS :

Non alcoholic fatty liver disease .

57
CASE SHEET NO – 4
Name : Mr. XYZ
Age : 50 years
Sex : Male
Address : Sirsi
Occupation : Truck driver
Marital status : Married
CHIEF COMPLAINT :
C/O Elevated liver enzymes discovered during routine blood work C/O Decreased interest in
eating
C/O Dark coloured urine.

HISTORY OF PRESENTING COMPLAINT : Patient reports occasional fatigue, which

he attributes to his demanding work schedule as a truck driver. There is no history of
abdominal pain, nausea, vomiting, jaundice, or changes in bowel habits. Decreased interest in
eating and the patient complaints that urine is in dark colour.

PAST HISTORY :

Hypertension, diagnosed 7 years ago, managed with antihypertensive medication.

Overweight, BMI 32, with a history of obesity since adolescence.
MEDICAL HISTORY :
Tab. Telmisartan 1-0-1

FAMILY HISTORY :

Not relevant

PERSONAL HISTORY :

Diet : Mixed Appetite : increased Bowel : Normal

Micturition : Normal in frequency Habit : 3 cups tea per day
Sleep : increased Thirst : Normal
Addiction : Alcohol regularly Allergy :Nil

58
VITAL DATA :

Pulse rate : 80 bpm Respiratory rate : 16 cpm

Blood pressure : 138/ 88 mm Hg Temperature : Afebrile
GENERAL PHYSICAL EXAMINATION :
Height : 170cm Weight : 90 kg BMI : 31.1 kg/ms
Built : obese Gait : normal
Edema : Absent Cyanosis : Absent Pallor : Absent Tongue : Clear Nails : clear Icterus :
Absent
Lymphadenopathy : Absent
Clubbing : Absent Varicosity : Absent

SYSTEMIC EXAMINATION :

Cardiovascular system : Normal S1 and S2 sound is heard Respiratory system :Normal

bronchovesicular sound is heard Central nervous system : Conscious and well oriented
Gastro Intestinal system: No abnormalities is detected Ear Nose Throat :No Inflammation is
detected

LOCOMOTOR EXAMINATION :

GAIT : Normal ARM : Normal LEG : Normal SPINE : Normal

INVESTIGATION :

Laboratory Tests:
Liver Function Tests (LFTs): Markedly elevated ALT (200 U/L), AST (180 U/L), GGT (250
U/L); normal bilirubin and alkaline phosphatase.

Lipid Profile: Elevated triglycerides (220 mg/dL), normal cholesterol levels.

Imaging:

Abdominal Ultrasound: Hepatic steatosis with severe diffuse fatty infiltration, consistent with
non-alcoholic fatty liver disease; no evidence of liver cirrhosis or masses.

FINAL DIAGNOSIS :

Non-Alcoholic fatty liver disease .

59
CASE SHEET NO – 5
Name : Mr.XYZ
Age : 42
Sex : Male

Address : Bangalore

Occupation : Truck mechanic

Marital status : Married

CHIEF COMPLAINT :

c/o bloody stools

c/o Abdominal Swelling or Bloating

c/o Unexplained loss of weight despite adequate food intake.

HISTORY OF PRESENTING COMPLAINT :

Patient reports feeling increasingly fatigued over the past few months, especially after work.
He also complains of discomfort in the upper right quadrant of his abdomen, which he
describes as fullness . He admits to significant alcohol consumption, averaging 6-8 drinks per
day for the past 20 years. There is blood in the stools
PAST HISTORY : Nil
MEDICAL HISTORY : Nil
FAMILY HISTORY :

Father: Alcohol-related liver disease

PERSONAL HISTORY :

Diet : Mixed Appetite : Normal Bowel : constipated

Micturition : Normal in frequency Habit : 2 cups coffee per day
Sleep : sound Thirst : Normal Addiction : Alcohol, 6-8 drinks per day
Allergy : Nil
VITAL DATA :

Pulse rate : 84bpm Respiratory rate : 18 cpm Blood pressure : 130/90 mm hg

Temperature : Afebrile

60
GENERAL PHYSICAL EXAMINATION :

Height :167cm Weight : 65kgs BMI : 23.3kg/ms Built : moderate

Gait : Normal Edema : Absent Cyanosis : Absent Pallor : Absent

Tongue : clear Nails : Clear Icterus : Absent

Lymphadenopathy: Absent Clubbing : Absent Varicosity : Absent

SYSTEMIC EXAMINATION :
Cardiovascular system : Normal S1 and S2 sound is heard
Respiratory system : Normal bronchovesicular sound is heard
Central nervous system : Conscious and well oriented
Abdomen: Mild tenderness in the right upper quadrant, no hepatomegaly or splenomegaly
appreciated

Ear Nose Throat : No Inflammation is detected LOCOMOTOR EXAMINATION :

GAIT : Normal ARM : Normal
LEG : Normal SPINE : Normal

INVESTIGATION :

Laboratory Tests:

Liver Function Tests (LFTs): Elevated ALT (180 U/L), AST (200 U/L), GGT (300 U/L);
normal bilirubin and alkaline phosphatase.

Complete Blood Count (CBC): Mild thrombocytopenia

Abdominal Ultrasound: Hepatic steatosis with moderate diffuse fatty infiltration, consistent
with alcoholic fatty liver disease; no evidence of liver cirrhosis or masses

FINAL DIAGNOSIS:

Alcoholic fatty liver disease.

61
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