Non-alcoholic fatty liver disease (NAFLD) is a broad term for a range of liver conditions affecting people who drink little to no alcohol. The main characteristic feature of NAFLD is too much fat being stored in liver cells. Considering the report showing elevated liver enzymes and bilirubin, the case was diagnosed as inflammatory stage of NAFLD that is Non- Alcoholic Steato Hepatitis (NASH). So, kapha vriddhi in pitta sthana can be considered as fatty liver. Virechana is good for both pitta and kapha thus, it was chosen.