Ayurvedic Management Of Udar (Refractory Ascites) Secondary To Alcoholic Liver Cirrhosis With Umbilical Hernia: A Case Report

Abstract

Background: Jalodara (ascites), a severe presentation of Udar Roga, corresponds closely to refractory ascites secondary to decompensated liver cirrhosis. Conventional medical management relies heavily on long-term diuretics and recurrent therapeutic paracentesis. This case report documents the complete resolution of paracentesis dependency and significant clinical improvement in a geriatric patient using conservative Ayurvedic management (Shamana Chikitsa) and strict dietary intervention (Pathya Ahara).

Case Presentation: A 66-year-old male with a history of chronic alcoholism presented with severe abdominal distension (abdominal girth: 110 cm), generalized weakness, mild pedal edema, constipation, and anorexia. He was a known case of alcoholic liver cirrhosis, Type 2 Diabetes Mellitus, Hypertension, Hypothyroidism and a secondary umbilical hernia. The patient required abdominal paracentesis every 10 days prior to presentation. Baseline laboratory evaluations revealed anemia (Hb: 7.9 g/dL) and renal impairment (Serum Creatinine: 1.93 mg/dL, eGFR: 42.24 mL/min/1.73 m²).

Interventions: Following one initial therapeutic paracentesis for emergency decompression, the patient was managed purely with oral conservative Ayurvedic formulations: Arogyavardhini Vati, Punarnava Mandoor, Chitrakadi Vati, Gokshuradi Guggulu, and a custom Churna Yoga (Ashwagandha, Punarnava, Musta, Kutaki, Haritaki, and Shankh Bhasma). The intervention was coupled with a salt-free diet consisting of cow’s milk (Godugdha), pearl millet flatbread (Bajari Bhakri), and garlic (Lashuna) chutney.

Outcomes: Over a 5-month follow-up, the requirement for abdominal paracentesis was completely eliminated. Constipation and anorexia resolved within 15 to 30 days. Hemoglobin levels increased from 7.9 g/dL to 10.6 g/dL, Serum Creatinine reduced from 1.93mg/dL to 1.6 mg/dL, and pedal edema resolved fully without any adverse events.

Conclusion: Targeted Ayurvedic oral therapy (Shamana) combined with strict adherence to Pathya can break the disease pathogenesis (Samprapti Vighatana), manage fluid dynamics, and eliminate paracentesis dependency in high-risk, co-morbid cases of refractory ascites.