Ayurvedic Treatment of Alcoholic Disorders

1. WELCOME YOU ALL
DEPARTMENT OF MANO VIJYAN
EVAM MANASA ROGA
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2. AYURVEDIC TREATMENT OF
ALCOHOLIC DISORDERS
PRESENTOR: GUIDED BY:
Dr. PRABHAKAR MANU Dr. SUHAS KUMAR SHETTY
2ND YEAR PG SCHOLAR PROFESSOR
DEPT. OF MANO VIJYAN EVAM MANASA ROGA

3. CONTENTS
• INTRODUCTION TO MADYA AND MADATYAYA
• STANDARD ALCOHOL CONTENT
• PROPERTIES OF ALCOHOL VS OJUS
• STAGES OF MADA
• SAMPRAPTHI
• STAGES OF MADATYAYA
• DHAVAMSAKA AND VIKSHAYA
• ON DOSHIC BACKGROUND
• SHORT AND LONG TERM EFFECTS OF ALCOHOL
• COMPLICATIONS OF MADATYAYA
• GENERAL SIGNS AND SYMPTOMS
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4. CONTENTS……
• GENERAL LINE OF TREATMENT
• PRACTICAL APPROACH TO MADATYAYA
• SINGLE DRUGS – CLINICAL EXPERIENCE
• COMPOUND/CLASSICAL MEDICINES
• SATVAVAJYA CHIKITSA
• CASE STUDIES WITH STAGE WISE MANAGEMENT
• RECENT RESEARCH UPDATES
• DISCUSSION
• CONCULSION
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5. INTRODUCTION TO ALCOHOL (madya)
• Madya is defined as ‘Madyatyanena Karaņe Yat Madya ’i.e.,
which does the action of Mada is called Madya.
• The term alcohol originally referred to the primary
alcohol ethanol (ethyl alcohol), the predominant alcohol
in alcoholic beverages. It is classed as a CNS Depressant.
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6. INTRODUCTION TO ALCOHOLISM
(madatyaya)
मदेनात्ययो मदात्ययः
(अ.सं.नन.६ )
• Prevalence of Alcohol in India - 21.4%
Year : 2010 | Volume : 52 | Issue : 7 | Page : 189-199 Substance use and
addiction research in India National institute of mental health and
neurosciences, Bangalore
Pratima Murthy, N Manjunatha, BN Subodh, Prabhat Kumar Chand, Vivek Benegal
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7. STANDARD ALCOHOL CONTENT
Beer 5–8%
Cider 4–8%
Wine 8–20%
Tequila 40%
Rum 40% or more
Brandy 40% or more
Gin 40–47%
Whiskey 40–50%
Vodka 40–50%
Liquors 15–60%
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8. PROPERTIES OF ALCOHOL VS OJUS
• Laghu -------------------------- Guru
• Ushna -------------------------- Sheeta
• Amla -------------------------- Madhura
• Teekshna -----------------------Mridu
• Ashu -------------------------- Prasad
• Rooksha-------------------------Snigdha
• Vyavayi --------------------------Sthira
• Vikasi -------------------------- Kshlashna
• Visada -------------------------- Picchila
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9. 9

10. S
STAGES OF
MADA
LAKSHANAS B.A.C
BEHAVIORAL
CORELATES
SROTAS INVOLVED
PRATHAMA Happiness, relaxed.
Promotes good sleep.
25-100 mg%
Excitement Buddhivaha
DWITEEYA Impaired Speech, vision
and thought process.
Inappropriate activities.
100-200mg% Excitement
Confusion
Manovaha
Buddhivaha
Cheshtavaha
TRITEEYA Lack of self control. 200-300mg% Slurred speech
Confusion
incordination
Sanjnavaha
(Smrithi)
chestavaha
CHATURTHA
(Vangasena)
Hypothermia
Dysarthria
Cold sweats
Unconsciousness
>300mg% Respiratory
distress.
Coma.
Death.
Sanjnavaha
Chetanavaha

11. Samprapti
Excessive alcohol(madya)
Tikshna, ushna, vidahi, By vyavayi, vikasi, sukshma guna
Makes annarasa utkledha Hrudaya is the sthana of
Ojas, satva, buddhi, indriya,mana
Antardaha, trishna, jvara
Pramoha,vibhrama, and mada
causes obstruction of vayu
pt. suffers from pain…… . MADATYAYA
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12. SAMPRAPTI GHATAKA 12
DOSHA TRIDOSHAJA
DHATU RASADI DHATUS,
ESPECIALLY RASA,RAKTA
MANASIKA DOSHA RAJAS AND TAMAS
SROTAS MANOVAHA, RASADI SARVA SROTAS
SATVA AVARA
MULA STHANA HRIDAYA

13. 13

14. s
TYPES SIGNS AND SYMPTOMS CRITICAL ANALYSIS
PANAATYAYA • Sthambha, angamarda, hrudaya graha,
thodha, kampa, shiroruja- VATA
• Sweda, pralapa, mukhashosha, daha,
murcha- PITTA
• Vamathu, seeta, kapha praseka- KAPHA
• Presence of all symptoms -SANNIPATA
is considered to be samanya
madatyaya lakshanas ,differs
according dosa pradhnyatha.
PARA MADA Ushma, Angagurutha, virasanuntvam, Aruchi,
Malamutra sangam,Trushna and Shiroruja,
sandhibheda
Madya in vidahi avastha vitiates
the rasa dhatu, and rasa vaha
srotas.
PANAAJIRNA Adhmana, sour vomiting, daha- during
digestion – predominance of pitta.
Indigested madya, along with
vitiated pitta in amashaya without
parinama (alc. Ind. Gastritis)
PANAVIBHRAMA Hrudgatrathoda, chardi, jwara, murcha,
shiroruja, daha,
Dvesha- towards sura and food.
Hangover /withdrawal symptoms
Madya vitiates the rasa and raktha
dhatu and their srotas.

15. •When a person after quitting alcohol if
suddenly takes alcohol then
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16. DHVAMSAKA VIKSHAYA
• श्लेष्मप्रसेकः –
Excessive salivation
• कण्ठास्य शोषः –
Dryness of the throat and mouth
• शब्दासहिष्णुता –
Intolerance to noise
• तन्द्रा –
Excessive drowsiness
• ननरानतयोग – Excessive Sleep
• हृत्कण्ठरोगः
Cardiac & Throat disorder
• सम्मोि – Unconsciousness
• छहदि – Vomiting
•अङ्गरुजा – Pain in the limbs
•ज्वरः – Fever
• तृष्णा – Morbid thirst
• कासः – Cough
•शशरःशूल – Headache
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17. SIGNS AND SYMPTOMS OF MADATYAYA
IN GENERAL
शरीर दुःखः
सम्मोि
हृदय व्यथा
अरुचि
प्रतत तृष्णा
ज्वर
शीत उष्ण लक्षणा
शशरः पाश्वि अस्स्थ सन्द्धीनां ववध्यत्तुु्य वेदना
स्फु रणं
वेपनं
श्रमः
उरोववबन्द्धः
कास ,हिक्का ,श्वास
प्रजागरः
शरीरकम्पः
कणि अक्षक्ष मुख रोगः
त्रिक ग्रि
छहदि ,अनतसार ,हृ्लासा
भ्रमः
प्रलाप
रूपाणां असतां िैव दशिनम्
भ्रान्द्त िेताः
व्याकु लानमशस्तानां स्वप्नानां दशिनम्
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18. 18
VATA
PITTA
KAPHA
DOSHIC
BACKGROUND

19. DOSHA NIDANA SIGNS AND SYMPTOMS
VATAJA Indulges in sthri, shoka,bhaya
Heavy work, alcohol which is ruksha-
leads to impairment of sleep.
Hikka, shwasa, kampa, parsva
shula, prajagara, pralapa
PITTAJA Food intake which is tikshna, ushna,
having madya which is tikshna, amla.
Trushna, daha, jwara,
sweda,murcha, atisara, bhrama.
KAPHAJA Intake of madhura, sneha, guda, not
doing regular exercises, day sleep,
consumes alcohol not properly
fermented.
Chardhi, arochaka, hrillasa,
tandra, heaviness and chills.
SANNIPATA Mixed nidana of tridoshas, effect will
be as of visha, but not as powerful as
visha.
Mixed signs and symptoms, may
cause death or leads to disease.
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20. Long term effects
 Nervous system
 Muscles
 Lungs
 Liver
 Sexual organs
 Brain
 Heart
 Stomach
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21. COMPLICATIONS OF MADATYAYA
• FETAL ALCOHOL SYNDROME
• ALCOHOLIC LIVER DISORDERS- (FATTY LIVER, ALCOHOLIC
HEPATITIS, ALCOHOLIC CIRRHOSIS)
• ASCITES- JALODARA
• WERNICKE'S ENCEPHALOPATHY-VITAMIN B 1 DEFICIENCY
• KORSAKOFF SYNDROME
• ALCOHOL INDUCED PSYCHOSIS- VISHAJA UNMADA
• CANCER- LIVER
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22. GENERAL LINE OF TREATMENT
सवं मदात्ययं ववद्यात् त्रिदोषमचधकं तु यम ्
दोषं मदात्यये पश्येत् तस्यादौ प्रनतकारयेत्
कफस्थानानुपूव्याि ि क्रिया कायाि मदात्यये
वपत्तु मारुत पयिन्द्तः प्रायेण हि मदात्ययः
(ि.चि.२४/१०७-१०८)
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23. 27
Madatyaya
Approach
to
Practical

24. STAGES OF EVALUATION
SCREENING
•
ASSESSMEN
T
TREATMEN
T
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25. SCREENING – CAGE QUESTIONAIRE
• Have you ever felt you needed to Cut down on your drinking?
• Have people Annoyed you by criticizing your drinking?
• Have you ever felt Guilty about drinking?
• Have you ever felt you needed a drink first thing in the morning
(Eye-opener) to steady your nerves or to get rid of a hangover?
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26. ASSESSMENT
INTOXICATION
WITHDRAWAL
DEPENDENCE

27. TREATMENT-INTOXICATION
• If fit for Vamana - SADYO VAMANA
Yastimadhu Phanta, Saindhava Jala
• Santarpana- If unfit for Shodhana other symptoms
like anidra can also be managed symptomatically.
(Shamana Aushadhi like Kharjura
Draksha,Dadima, Sreekhandasava,Draksharista)
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28. TREATMENT- WITHDRAWAL
• First line of Treatment –SANTARPANAJANYA CHIKITSA
• Deepana, Pachana, Abhayanga, Takradhara
• Dadima, kharjura, uses of anticraving, medhya and sedative
ayurvedic drugs, First Vamana then Virechana and at last
Basti…
• Satvavajaya chikitsa
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29. TREATMENT - DEPENDENCE
• First line of Treatment – USES OF ANTI CRAVING AND SEDATIVE DRUGS
• Deepana, Pachana , Takradhara, Abhayanga, Panchakarma……..
• Psychotherapy- Cognitive Behaviour Therapy
• Motivational Counselling
• Group Counselling
• Bhayadarshana about the disease……………
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30. Practical approach of
Management
• Shamana - Symptomatic and emergency management
• Shodhana - Purification and detoxification
• Adravya Chikitsa - Non Pharmacological
Manonigrahana- De addiction
Apunarbhava - Relapse prevention
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31. SINGLE DRUGS- CLINICAL
EXPERIENCE
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32. BRAHMI ASHWAGANDHA
 CNS relaxant
 Decreased GABA receptor [ANTI
CRAVING]- effect of Bacopa monnieri and
Bacoside-A-
• Useful in alcohol induced & aspirin induced ulcers (J Exp
Bio, 2001, Feb, 39(2), 137-42)
• Jobin Mathew,1 Savitha Balakrishnan,2 Sherin Antony,2 Pretty
Mary Abraham,2 and CS Paulose2 J Biomed Sci. 2012; 19(1): 25.
Published online 2012 February 24. doi: 10.1186/1423-0127-
19-25
 Anxiolytic-antidepressant –
glycowithanolides
 Anti craving
 Leaf – Hepato protective (As effective as
hydrocortisone)
 Root – Anti stress activity (Phytother Res
2003, 531-6) (AHP) (NMCD)
• Bhattacharya SK, Bhattacharya A, Sairam K, Ghosal S.Source-Department
of Pharmacology, Institute of Medical Sciences, Banaras Hindu University,
Varanasi, India. salil@banaras.ernet.in Phytomedicine. 2000
Dec;7(6):463-9.
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33. JATAMAMSI SHANKAPUSHPI
 Dry rhizomes – Insomnia,
disturbed mental state (API)
 Decreases serotonin level
 Jatamansone – hyperactivity,
restlessness, aggressive almost at
par with D - amphetimine
 Nootropic, anxiolytic and CNS-
depressant
Pharm Biol. 2011 Dec;49(12):1234-42. Epub 2011 Aug
16.Malik J, Karan M, Vasisht K.Source-Department of
Herbal Drug Research, ISF College of Pharmacy, Moga,
Punjab, India.
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34. BHRINGARAJA KUSHMANDA
 Wedelolactone & demethyl
wedelolactone – hepatoprotective
 Liver cell regeneration
 Immunoactive property
 Fruit juice – tranquilizing activity,
mild CNS depressant (amino
acids)
 Best medhya ahara
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35. MANDUKAPARNI GUDUCHI
 HERAPONIN – SEDATIVE
TRANQUILIZING EFFECT ON ALBINO RATS (50
MG/KG ALCOHOL EXTRACT)
 HEPATOPROTECTIVE
Decrease in LFT in hepatic toxicity in mature rats (J
Toxicol Sci 2002, 27(3), 139-46)
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36. COMPOUND PREPARATIONS40

37. 41
PREPARATIONS INGREDIENTS INDICATIONS
KHARJURADI
MANTHA
Kharjura, Mridvika, Vriksamla, Amalaki,
Dadima. (Bhai.Ratnavali)
ALCOHOL WITHDRAWAL
MRUDVIKADI
KASHAYA
Mrudvika, madhuka, yastimadhu,
pippali, kharjura, candana, sariva,
musta, laja, ushira- (SaharsaYoga)
ALCOHOL WITHDRAWAL
DRAKSHARISTA Draksha, twak, patra, ela, nagakesara,
pippali, vidanga, dhataki -
(Shar. Samitha)
ALCOHOL DEPENDENCE
& WITHDRAWAL BOTH
SREEKANDASAVA Sweta chandana, jatamamsi, haridra,
musta, ushira, amalaki, maricha,
lodhra, dhataki, guda.- (Bhai.Ratnavali)
IN ALL CONDITIONS OF
MADATYAYA

38. 42
PREPARATIONS INGREDIENTS INDICATIONS
ASHVAGANDHARISTA Ashvagandha, manjista, haritaki,
haridra, madhuka, arjuna, musta,
candana, trikatu.-
( Bhai.Ratnavali)
ANTI CRAVING EFFECT
SUMUKTI Triphala, Kirata tikta, Draksha,
Katuki, Bhrngaraja, Mandukaparni,
Guduchi, Ashwagandha,
Yashtimadhu
SDM, Hassan
ALCOHOL DEPENDENCE
HERBADICT Bhoomyamalaki, Bhrngaraja,
Punaranava, Khadira, Vidanga,
Katuki, Trikatu, Kiratatikta,mukta
Shukti Bhasma, Mandoora Bhasma,
Rajata Bhasma - Muniyal Ayurveda
ANTI CRAVING EFFECT

39. SATVAVAJAYA CHIKITSA
43

40. SATVAVAJAYA
ASHWAASANA (REASSURANCE)
VIJNANA: Insight building( Lab reports, Photos, Videos, Previous
cases)
DHAIRYA: Motivation enhancement therapy, self realization
SMRITHI: Motivating the patient to overcome difficult situations
with out alcohol abuse
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41. Adravya Chikitsa
• बन्द्धनं
• तमोगृिवास In Delirium
• तजिनं : Scolding
• िासनं : Scaring about the health complications
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42. CASE
STUDY
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43. Case - 1
• Pt.name: XYZ Age-35 yrs. Sex: male. OP-001724
Presenting complaints:
Pt. was brought by his friends with c/o generalized body
ache, pain in the sides of chest, tremors, severe thirst,
sweating with burning sensation, irrelevant talk.
History of present illness:-
 k/c/o of alcoholic since 1 year. pt. had consumed around
300-400ml of alcohol with out taking food since from 4 days.
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44. Systemic examination:
CNS: Conscious., partially oriented
Vitals: BP: 118/70mmhg, PR: 88/min.
A- reduced B- irregular M- mild burning sensation
S- disturbed
Diagnosis: PANATYAYA (Vatapitta pradhana)
Treatment given:
1. Ashwasana
2. Shirodhara with Brahmi taila
3. Kharjuradi mantha 100ml bd 2days.
4. Mrudvikadi kashaya 20ml tid
5. Ksheera pathya
Result :
Body ache, pain in the sides of chest, tremors- reduced
Thirst, sweating ,burning sensation, irrelevant talk- relived
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45. Case-2
Pt. name: abc Age: 26yrs sex: male OP-001715
Presenting complaints:
Pt. was brought by his father c/o distension of abdomen, nausea,
vomiting, burning sensation
H/o of present illness:
pt. is k/c/o alcoholic since from 5yrs, last intake - on same day
around 250ml
O/E: physical injuries+
CNS: partially disoriented, clouding of consciousness
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46. Vitals: BP: 110/70mmhg, PR: 80/min.
A- reduced B- irregular M-normal S- disturbed
Diagnosis: PANAAJIRNA(kapha pitta pradhana)
Treatment given:-
Sadyo vamana: with Milk+ Yastimadhu phanta
Pt. got 5 vegas. Samsarjana karma advised
Pt. was comfortable; distension of abdomen, nausea, vomiting,
burning sensation relived.
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47. Case 3
Pt. name: xyz Age: 36yrs sex: male OP- 031981
Presenting complaints:
pt. came with c/o chest pain, nausea, headache, giddiness, aversion
to food and alcohol
H/O of present illness:
pt. is known case of alcoholic since from 6yrs, last intake of alcohol-
1day back around 350ml.
S/E: CNS: clouded consciousness, oriented
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48. Vitals : BP 130/80mmhg ,
A-reduced B-not passed from 2days M-normal S-disturbed
Diagnosis: Panavibhrama.
Treatment given:
• Sreekandasava 20ml tid
• Kharjuradi mantha 100ml tid
• Panchakola phanta 50ml tid 2days
• Ksheera pathya
Results:
Headache, Giddiness, aversion towards food- relived.
Appetite increased.
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49. 53

50. 54

51. • Vamana
In acute intoxicated stage
Kapha pradhana lakshana
Alcohol present in
Amashaya
• Virechana
Chronic cases of Abuse
Patient not fit for Vamana
Less Kaphadushti
• Nasya:
Altered consciousness
Delirium, Depression
• Basti:
In chronic Stage
शोधन, ब्य, मेध्य
When Ojas is affected
Where other shodhana
are contraindicated
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52. Significant improvement in the Astanga Lavana Group after
treatment compared to Placebo group.
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53. Madhutriphala and gudardraka yoga which is used for seven
days is clinically significant in subsiding withdrawal
symptoms of alcohol.
57

54. • Dr. Niranjan L. Hegde in 2012 done clinical study on role of
Satwavajaya chikitsa and Guduchyadi yoga in management of
Madatyayaja Yakrit Vikaras, PG dissertation. The study shows
Satvavajaya chikitsa and Guduchyadi Yoga combined group is better
than Guduchyadi Yoga group and Guduchyadi Yoga group is better
than Satvavajaya chikitsa with placebo group.
• Dr. Unnikrishnan in 2013 done a clinical study on efficacy Sumukti an
indigenous compound on madaatyaya w.s.r. alcoholic dependence.
Clinically significant result was found in both subjective and objective
parameters. It is was used for a duration of three months was found be
clinically significant in management of alcoholic dependency.
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55. • Dr. Ashok J -Efficacy of Mridveekadi Kashaya in the management of
madaatyaya w.s.r. Alcohol withdrawal symptoms. Study shows
Mridveekadi Kashaya significant results on mild to moderate alcohol
withdrawal by 3rd to 4th day along with improved liver functions.
• Ongoing Clinical study on the efficacy of patoladi gana kashaya in the
management of madaatyaya janya yakrithvikara (alcoholic liver
disease) by Dr. Sushruth kumar jain.
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56. Discussion
• Alcohol abuse leads to different conditions of Alcohol
related disorder, but the timely interventions on the
causative factors of abuse can prevent person from
abusing.
• During stages of MADA, person will not come for
treatment, if he brought, we are treating on the basis of
dosha.

57. • Intoxication is transient condition following the administration
of psycho active substances. it may be taken as Panatyaya,
Paramada, Panajeerna or Panavibhrama.
• Withdrawal is characterized by a cluster of symptoms often
specific to the drug used, which develop on total or partial
withdrawal of drug usually after repeated use of drug. Mostly it
is vata pradhana - samanya madatyaya lakshanas are seen and
management is accordingly.
• Dependence is a Cluster of psychological, behavioral, and
cognitive phenomena in which there is a desire, which is often
strong to take the psycho active substance on a continuous or
periodic basis.

58. • Once the stage of madatyaya is diagnosed and managed on
the basis of dosha, next aim of treatment is Shodhana,
Manonigraha and Apunarbhava.
• Usually Snehapana followed by Vamana/ Virechana is
done and Shamanoushadhi which is Medhya and
Anticraving are advised.

59. Conclusion
• Pharmacological treatments plays a major role in stage wise
management of madatyaya, but Non pharmacological treatment
like counselling, motivation and family therapy has greater role in
supportive measures and relapse prevention and for better
treatment outcomes.
• Decide Shodhana & Shamana based on Bala
• Motivation is the key factor +
• Family support & follow up at primary level is important
• Wide range of potent Hepatoprotective drugs +++
• Prevention is better than cure
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60. THANK YOU……
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