Abstract
Background: Decompensated chronic liver disease (DCLD) secondary to Non-Alcoholic Fatty Liver Disease (NAFLD) is a serious condition with limited therapeutic options beyond supportive care and liver transplantation. Ayurvedic medicine offers integrative approaches combining Shodhana and Shamana modalities, which have potential in managing advanced hepatic dysfunction.
Case Presentation: A 55-year-old male with a history of type-2 diabetes mellitus and hypothyroidism presented with abdominal distension, pedal oedema, jaundice, constipation, and insomnia. He was diagnosed with NAFLD-related DCLD with portal hypertension and oesophageal varices.
Intervention: Ayurvedic assessment identified features corresponding to Kamala and Udara Roga. The patient received multiple courses of classical Virechana with prior Rukshana and Snehapana preparatory procedures, along with supportive Panchakarma external therapies. Sustained Shamana therapy included formulations such as Punarnavadi Kashaya, Balaguduchyadi Kashaya, Chandraprabha Vati, Gokshuradi Guggulu, Mahakalyanaka Ghrita, Varanadi Ghrita, Guggulutikthaka Ghrita, and Punarnava Mandoora, combined with dietary and lifestyle guidance across periodic follow-ups.
Outcomes: With successive treatments, the patient experienced marked clinical improvement: resolution of abdominal distension and pedal oedema, improved appetite, and general well-being. Serial biochemical investigations demonstrated trends toward stabilization and normalization of liver function parameters (bilirubin, AST, ALT, albumin), and imaging showed resolution of ascites. The patient remained asymptomatic with sustained functional improvement and enhanced quality of life at later follow-ups.
Conclusion: This case illustrates that structured Ayurvedic management combining periodic Shodhana and targeted Shamana therapies supports symptomatic relief, biochemical improvement, and quality of life in DCLD secondary to NAFLD.

Key words: DCLD, Oesophageal varices, NAFLD, Udara, Kamala, Virechana