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. Ayurveda medicine offers integrative approaches combining Shodhana (bio-purification therapy) and Shamana (Doshapacifying therapy) modalities, which have potential in managing advanced hepatic dysfunction. Objective: 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: Ayurveda assessment identified features corresponding to Kamala (hepato-cellular jaundice) and Udara Roga (ascites). The patient received multiple courses of classical Virechana (therapeutic purgation) preceded by Rukshana (desiccation therapy) and Snehapana (oleation therapy) 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. Results: With successive treatments, the patient experienced marked clinical improvement including the resolution of abdominal distension and pedal oedema, an improved appetite, and overall well-being. Serial biochemical investigations demonstrated trends toward stabilisation and normalisation 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 Ayurveda management combining periodic Shodhana and targeted Shamana therapies supports symptomatic

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