A case of Splenomegaly with cirrhosis of liver

Dr Sridevi C:
A case to ponder.
Female-21years.
Came with H/o hair fall. Then said she has some reports and said her abdomen is always HARD. So asked her to come with her previous reports. She is the receptionist so was sure that she will get her reports.

Summary of her reports. Will post a few pics of reports too
2001 - 3 year old-had intestinal obstruction due to Ascariasis
2005 - Portal vein HTN-Ascitis-Splenic calcification-cirrhotic liver changes wth multiple calcific foci
2006-Same above findings with oesophageal varices
2007-Extra hepatic portal vein HTN and h/o haematemesis
2009 to 2013 suffered with complaint of 2007 and so on and off treatment
2016-Splenomegaly with Siderofic nodules and minimal ascites

O/E gross splenomegaly and liver too just palpable. Couldn't elicit fluid thrill. Earlier couldn't eat much. But 2 years back took homoeopathic medicine and from then on appetite is good.
BP, temperature etc normal.

Advised
AVR
Bhunimbadi kashaya

Please go through the investigation report- sending herewith.

Vinaya Ballakur:
Very challenging case Vd. Sridevi ji.
Godugdha is pathya in such cases.
I think all the pathya apathya of yakritodara are a must.

Vd. Surendra Sharmaji prepares yakrid pippali . You may consult him. 
Gomutra hareetaki and bhumyamalaki, punarnavadi kwatham , rohitakarishtam are some preparation you might consider , as you have seen the patient and have an idea what might be helpful for her.

Age is on her side and liver is one organ that successfully regenerates.

Symptomatically, yashti ksheer paka, shatavari churna with milk will help.

Venkatacharya PBA:
I think it’s Asdhya at the most we can make it as yapya
Only plus point is her jathragni is good and food intake is there
If fluid is more tha 3lts you can find fluid thrill
My Advise is
Nirocil tab three times a day it is Ghana of Bhumyamalaki
Nirocil syrup
Yakrit plihari louha
Three times a day
Jalodarari one tab twice it contains Danti beeja dose should as per rigid Bala otherwise you can Punarnava mandoora
Gomutra fresh or arka also helpful
Laghu Aahara
Go dugdha is also good

I thought in this case purely herbal for liver so advised Norocil  ie bhumyamalaki ghana

And jalodara pt needs theeshna Sodhana

Arogya vardhani is also very good its name itself indicates it improves genaral health
Combination of in addition of rasa Gandhka guggulu shilajat Tamra Bhasma  and more quantity of kutuki because of shilajat Rasayana Tamra in liver guggulu as medohara and kutuki as Rechana no doubt it is drug of choice but because of pt condition I thought Nirocil that all

Dr Sridevi C:
Thanks a lot for your valuable time and suggestions🙏 Venkatacharya Sir.

Dr Manik Dixit:
1)Ardhavilwam kashayam ( Kottakkal)
2) Patolakaturohinyadi kashayam

3) Tab. Laghu sut Sekhar

4) Avipathi churnam

Dr,Dilkhush (DK) Tamboli:
What about LFT

Dr Manik Dixit:
May get blood counts done with emphasis on abnormal cells

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