Management of Hepatitis B (Carrier stage) through Ayurved – A Case report

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. On the basis of clinical features, Hepatitis B can be correlated with Kamala. Kamala is caused due to aggravation of Pittadosha. Ayurvedic management of Kamala includes samshodhan and samshaman therapy which leads to break the samprapti of the disease and hence provides complete cure. In this case study 53 years old male patient having complaints of yellowish colored urine and reduced appetite along with generalized weakness, nausea and mild pain in right hypochondriac region was treated with herbomineral preparations ( Phalatrikadi Kwath, Arogyavardhini Vati, Liv52 HB, Rohitakarishta etc.) described in classical texts of Ayurveda for 6 months. Assessment was done on the Subjective & Objective (Pathological) Parameters Before, after and during treatment. Significant improvement was observed in subjective and objective parameters after completion of treatment. From this study it can be concluded that Hepatitis B can be successfully managed with principles of Ayurveda.


Introduction
Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV). It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer. (1) Most cases of chronic hepatitis B among adults, however, occur in patients who never had a recognized episode of clinically apparent acute viral hepatitis. The degree of liver injury (grade) in patients with chronic hepatitis B is variable, ranging from none in inactive carriers to mild to moderate to severe. The spectrum of clinical features of chronic hepatitis B is broad, ranging from asymptomatic infection to debilitating disease or even end-stage, fatal hepatic failure. (2) There is a serious dearth of data regarding the true prevalence of HBV in India. HBsAg positivity has been reported to range between 2% and 8% in most studies.
(3) On the basis of clinical features, Hepatitis B can be correlated with Kamala Kamala is caused due to aggravation of Pittadosha. A yurveda offers reference points for managing treatment decisions specific to each and every case and to project a vision or goal for a whole state of health, again unique to each and every case. Ayurvedic management of Kamala includes samshodhan and samshaman therapy which leads to break the samprapti of the disease and hence provides complete cure. This case can be helpful for the management of Hepatitis B by using herbomineral formulations given in Ayurveda.(4)

Case report
A 53 years old male patient came to Kayachikitsa OPD (OPD No.1812180021) of Mahatma Gandhi Ayurveda College Hospital & Research Centre, Salod (H), Wardha with chief complaints of yellowish colored urine and reduced appetite. He also had associated complaints like generalized weakness, nausea and mild pain in right hypochondriac region.

History of present illness
Patient was apparently alright before 3 months. Then he developed anorectal disease for which he was advised surgery and during investigations for the same, he was diagnosed as HBsAg Positive. After that he had developed symptoms like yellowish discoloration of urine with loss of appetite so he came to MGAC Hospital for the management. He gave history of nursing care of his father who had suffering from HBsAG since 5 years.

Past history
There was no past history of Diabetes mellitus, Hypertension and Asthma.

Family history
Father had history of HBsAG positive since 5 yrs. He had the history of blood transfusion prior to it.

Clinical examination
Ashtavidha pariksha was within normal limit except mutra and netra were yellowish in color. Patient had madhyam akruti. Dashavidha pariksha was within normal limit except aharshakti (abhyavarana, jaranshakti) and vyayamshakti were awar.

Systemic Examination P/A -Abdomen was soft and mild Tenderness was present in right hypochondriac region.
Investigation -Blood investigation revealed raise levels of SGOT, SGPT, Sr.bilirubin, etc.  Various research studies conducted proved its hepatoprotective, immune modulatory, anti-allergic, anti inflammatory and choleretic action.

Diagnosis-From clinical features, physical examination and investigations patient was diagnosed having Hepatitis B (Kamala)
Hence Phalatrikadi kwath have hepato-cellular regeneration capacity, Cholegogue and cholertic activity, Membrane stabilizing effect, Antiviral and antioxidant effect, Molecular nutrient effect and property to correct metabolic activities due to enzymatic action. ()
In this case study HBV Viral Load was not performed and where HBV DNA is unavailable, patients with hepatitis B can be assessed by liver ultrasound and routine laboratory tests. 12 In this case the improvement was assessed on the basis of reduction in symptoms and value of LFT with improvement in USG abdomen & fibro scan of liver after completion of treatment. All these parameters showed significant improvement hence, it can be stated that these drugs helps in improving the condition of patient suffering from hepatitis B.

Conclusion
Formulations used in this case study helps in improving symptoms, causes reduction in values of liver function test with improvement in USG and fibroscan of patient. Hence it can be concluded that Hepatitis B can be successfully treated with formulations described in Ayurveda. They mainly contain drugs which act on liver and helps in improving the functioning of liver. This single case study hence to prove the efficacy of these drugs further study on large sample size is recommended.