Decoding the Yakrut-Medas Axis: A Contemporary Review of Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) in the Framework of Medovaha Sroto-Dushti

Abstract

The recent transition in nomenclature from Non-Alcoholic Fatty Liver Disease (NAFLD) to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) reflects a paradigm shift, emphasizing the multisystemic nature of hepatic steatosis linked to cardiometabolic risk factors. In Ayurveda, this metabolic derangement closely mirrors the pathology of Medovaha Srotodushti (vitiation of the adipose-carrying channels) and Yakrut-Roga (liver disorders) arising from Santarpanajanya (excessive nourishment) conditions. Objectives: This review aims to explore the pathophysiological "Yakrut-Medas Axis" by correlating the modern "Multiple-Hit Hypothesis" of MASLD with the Ayurvedic concepts of Agni Vaigunya (impaired metabolism) and Srotorodha (channel obstruction). Methods: A comprehensive literature review was conducted across classical Ayurvedic texts and modern medical databases, focusing on the updated 2023 MASLD diagnostic criteria and their intersection with Medas (adipose tissue) metabolism. Results: The study identifies a direct correlation between modern insulin resistance and the Ayurvedic concept of Ama (toxic metabolic by-products) resulting from Jatharagni and Dhatvagni dysfunction. The "Yakrut-Medas Axis" is elucidated as a functional unit where Yakrut (liver), as the Moolasthana (root) of Raktavaha Srotas, becomes the primary site for Abaddhameda (loose/unmetabolized fat) accumulation. This review highlights that Srotorodha in the Medovaha Srotas triggers a vicious cycle of Vata vitiation and further metabolic stagnation, mirroring the progression from simple steatosis to inflammatory fibrosis. Conclusion: Understanding MASLD through the framework of Medovaha Srotos-dushti provides an integrative diagnostic lens. This correlation suggests that therapeutic strategies targeting Agnideepana (metabolic stimulation) and Sroto-shodhana (channel purification) may offer synergistic benefits in managing the global burden of metabolic liver disease.