Fatty Liver: A Modern Disease, Ancient Solutions

Metabolic dysfunction–associated steatotic liver disease (MASLD), earlier termed NAFLD, has emerged as one of the most common liver disorders worldwide. Strongly linked to obesity, diabetes, poor diet, and stress, MASLD can silently progress to fibrosis, cirrhosis, or liver cancer.

Modern medicine emphasizes lifestyle modification as the cornerstone of treatment. Some agents such as Pioglitazone (in diabetics) and Vitamin E (in non-diabetics) are used off-label, but long-term safety concerns limit their widespread use. This therapeutic gap has revived interest in AYUSH systems of medicine, where traditional wisdom, regimental therapies, and Yoga offer complementary strategies supported by modern evidence.

AYUSH Wisdom and Classical Insights

Across AYUSH systems — Ayurveda, Yoga, Unani, Siddha, and Homeopathy — liver health has long been a focus.

1. Unani scholars such as Ibn Sina (Al-Qanun fi’l-Tibb), Rhazes (Al-Hawi), and Jurjani (Zakhira Khwarazmshahi) described liver ailments as Warme Kabid (inflammation), Suda-e-Kabid (congestion), and Istisqa (dropsy). They advised light diets of barley, vegetables, and fruits — principles echoed today in the Mediterranean diet, now validated for MASLD.
2. In Ayurveda MASLD is described as yakrit roga (Liver disease) and Medorogya (Obesity and metabolic syndrome) recommending, pathya (diet and lifestyle), Shodhana (detoxification), and Shamana (use of herbs such as Kutki, Bhumyamalaki, and Triphala for liver health.
3. Homeopathy approaches MASLD as a chronic constitutional imbalance rather than only a local liver disorder and does not aim at removing fat from the liver directly, but at restoring the body’s metabolic harmony so that liver function gradually improves.

4.Siddha does not mention fatty liver directly, but correlates MASLD with conditions described as Karuppu noi/Karuppai Kurai (Liver Disorders) also emphasizes detoxification and dietary moderation to maintain life principles.

Together, these classical insights show remarkable foresight into lifestyle-related liver disorders centuries before MASLD was recognized.

Herbal Remedies with Modern Validation

Several AYUSH formulations and botanicals have shown Hepatoprotective effects:

Qurs-e-Istisqa (Unani): Reported safe, with early recovery in liver enzymes and reduction in fibrosis markers.

Liv.52 (Ayurveda): A Phase-IV trial demonstrated significant improvement in symptoms and biochemical parameters. It has also been beneficial in drug-induced hepatitis, underscoring its Hepatoprotective role.

Other Botanicals: Silymarin (milk thistle), berberine, and curcumin exhibit antioxidant, anti-inflammatory, and insulin-sensitizing effects, aligning well with MASLD’s mechanisms.

Regimental Therapies (Ilaj-bil-Tadbeer and Panchakarma)

AYUSH systems emphasize non-drug interventions that are strikingly relevant for MASLD management.

Riyazat (Exercise): Enhances metabolism; modern trials confirm exercise reduces hepatic fat and insulin resistance.

Dalak/Abhyanga (Massage): Improves circulation, digestion, and stress resilience.

Hammam/Swedana (Steam Bath): Traditionally used for detoxification; studies show sauna reduces cholesterol, triglycerides, and weight.

Hijama (Cupping): Classical Unani texts recommend it for hepatic congestion. A 2020 RCT in NAFLD patients showed significant improvement in liver enzymes, insulin resistance, and ultrasound findings.

Idraj-e-Ghiza & Pathya-Apathya: Gradual, light diets like barley water or savory liquid flavored with vegetables echo modern dietary protocols.

Nutool & Shirodhara: Medicated decoction pouring induces relaxation and stress control — important since cortisol imbalance worsens MASLD.

These regimens illustrate how AYUSH anticipated the importance of detoxification,  circulation, stress reduction, and diet in chronic metabolic disorders.

Yoga for Liver Health

Yoga is both a stand-alone therapy and an integral part of AYUSH. Postures such as Bhujangasana (Cobra Pose) stimulate abdominal circulation, while Anulom Vilom (Alternate Nostril Breathing) enhances oxygenation and stress resilience. Clinical studies demonstrate that Yoga reduces triglycerides, improves insulin sensitivity, and supports weight management, making it a valuable adjunct in MASLD care.

A Holistic Way Forward

At the Government Unani Hospital, Shalteng, Srinagar, patients are managed through integrative care: herbal medicines, regimental therapies, dietary counselling, and Yoga. This multidimensional approach not only improves biochemical parameters but also empowers patients to adopt sustainable lifestyle changes.

Dr. Mohammad Sultan Paray is In-Charge Officer, Government Unani Hospital, Shalteng Srinagar