Liver Cirrhosis is one of the most complicated degenerative liver diseases caused due to long term damage of liver cells and irreversible scarring of liver, leading to deprived liver function. Scarring of liver inhibits it from infection control, poor metabolism of toxins and other drugs. The liver also fails to produce bile that is necessary in absorption of fat soluble vitamins and also to absorb fats that include cholesterol. Generally these symptoms in liver cirrhosis are not seen in early stage, as the manifestation of the disease takes months or even a year. In healthy condition liver is able to regenerate most of its damaged cells but in last stage of cirrhosis it is no longer able to replace the damaged cells resulting in failure of liver. Liver Cirrhosis is the 12^th leading cause of death by disease. According to data published by Global Burden of Diseases Study, cirrhosis has affected about 2.8 million people and resulted in 1.3 million deaths in 2015. The incidence is slightly higher in men than in women. Ayurveda and Liver Cirrhosis According to Ayurveda liver cirrhosis can be interpreted as Yakrit Vriddhi and Kumbhakamala. Yakrit or liver is said to be the seat of Pitta dosha. Pitta is responsible for metabolic activities that take place in liver. When the pitta dosha gets aggravated it leads to either excessive production of bile or obstruction in the flow of bile resulting in decreased enzyme activity and thus lowered metabolism. The agni (digestive fire) is hampered as a result of which there is improper digestion and low absorption rate. Vitiation of pitta dosha also leads to imbalance in the vata and kapha dosha. Lowering of agnibala (strength) and imbalanced pitta along with other dosha leads to intoxication of rasa and raktadhatu that causes cirrhosis. Acharaya Charak mentions that Kumbhakamala is an advanced condition of kamala or jaundice or hepatitis. It is a deep seated disease of the koshta where one can observe that the portal gets obstructed due to roughness of the liver. Cause of Liver Cirrhosis:

• Consumption of excessive alcohol – Alcohol consumption from several years lead to injury of the liver and it may lead to cirrhosis.
• Hepatitis B, C and D – The hepatitis virus leads to inflammation of the liver and further damages it causing cirrhosis.
• Unhealthy diet is also an important reason to increase the pitta dosha. Consuming of too spicy, salty, sour, oily food and preserved food imbalances the body dosha and may cause the disease.
• Nonalcoholic fatty liver disease (NAFLD) –This disease is associated with obesity, diabetes, protein malnutrition, coronary artery disease, and corticosteroid medications. The excessive fat deposit on the liver eventually leads to cirrhosis.
• Consumption of excessive drugs for arthritis, gout, skin problems, etc. may put too much pressure on the liver.
• Biliary cirrhosis, a liver condition caused by disturbance of the immune system, when the immune system begins to attack the bile ducts in the liver, also may lead to liver cirrhosis.

Other causes may be hereditary, auto-immune disorder, parasitic infection etc. The symptoms in liver cirrhosis are usually not easily noted in the early stages but as the disease progress the patient may experience the following symptoms:

• Decreased appetite
• Nausea, vomiting, fatigue and weight loss
• Jaundice and itching
• Anorexia
• Edema of the ankle, legs and abdomen
• Ascites and small spider like blood vessels underneath the skin
• Portal hypertension
• Light colored stools
• Dark urine
• Fever
• Confusion and personality changes may also be seen

These symptoms may further complicate the liver, if inappropriately managed. Some of the complication includes ascites, internal bleeding, kidney failure, splenomegaly, gall stones, esophageal varices, Hepatic encephalopathy, liver cancer and even death. Hence, diagnosing liver cirrhosis at early stage is very important. Several clinical tests including complete blood count, coagulation blood tests, albumin and liver function tests, alpha fetoprotein (a liver cancer screening test), Ultrascan of liver, MRI, CT of liver, biopsy may help in the diagnosis. Ayurveda Management of Liver Cirrhosis: Modern medication focuses on providing symptomatic relief using beta blockers, higher antibiotics, low protein diet and liver transplant, if necessary. Ayurveda on the other hand has many herbs that can strengthen the liver and treatments provided in Ayurveda help in removing the root cause of liver cirrhosis and simultaneously reducing the symptoms. Treatments are generally a combination of diet restrictions, life style changes, avoiding alcohol, Panchakarma procedures and internal medication. Dietary changes comprises of avoiding salt, spicy, sour and oily food. Fresh vegetarian diet is advised that includes consumption of whole wheat, red or brown rice, dry fruits such as resins, almonds, dry dates, fruits such as amla (gooseberry), grapes, mangoes, banana, etc. Avoiding preserved food, canned food and bakery products is a must. There are excellent herbs that are recommended in Ayurveda to help in the treatment of liver cirrhosis. Katuki (Picrorhizakurrooa), Bhringraja (Ecliptaabla), Bhumyamalaki (Phyllanthusniruri), Kakamachi (SolanumNigrum), Rohitaka(Tecomaundulata), Aragwadha(Cassia fistula), Punarnava (Boerrhaviadiffusa), Kiratatikta (Swertiachirata), Bhoonimba (Andrographispaniculata), Daruharidra (Berberisaristata) are some liver tonic drugs. Formulations such as ArogyavardhiniVati, Kumaryasava, Rohitakarishtha, Pippalyasava, Guduchisatwa, Punarnavasava, Bhoonimbadikhada, Patolakaturohinyadikashaya, Avipattikarachoorna, HaritakyadiKashayam, GuduchiKashaya, Trailokyanatha Rasa, ChandraprabhaVati, VasaguluchyadiKashayam, Lohasavam, Rohitakarishtam, Dantyarishtam, DrakshadiKashayam, Ayaskriti, PunarnavaMandura, KutajatriphalaLehyam are usually advised by an Ayurvedic doctor. Apart from internal medication, if there is severe imbalance of the doshas, Panchakarma treatments like Virechana is prescribed to eliminate the excessive pitta dosha. Vamana may also be given in case of an aggravated kapha dosha. Expelling the excessive kapha and pitta dosha helps in activating metabolism. Home Remedies to keep the Liver healthy:

• Take 5 to 15 ml of Bhumi Amalaki (Phyllanthusniruri) juice on an empty stomach every morning to help the liver function better.
• Consuming carrot, spinach, radish in the form of juice, daily is also beneficial.
• Consuming 5ml of Papaya seed juice with few drops of lemon juice (prepared fresh everyday) helps stimulate the liver function. This can be consumed for a period of 1 month.
• 5 ml of fresh juice of bhumyamalaki mixed with honey consumed on empty stomach twice daily for 1 month is also extremely beneficial.

It is very important that we do not neglect our health. Follow a healthy lifestyle and avoid any health hazards. If you are diagnosed with Liver Cirrhosis consult an expert Ayurveda physician for a better result and happy life.