Dhootapapeshwar Pittashekhar Rasa is a potent Ayurvedic formulation traditionally used to support liver function, but there is limited strong clinical evidence for its effectiveness in fatty liver disease. In cases of fatty liver with elevated liver enzymes, diabetes, and hypertension, management should primarily focus on controlling blood sugar and blood pressure, reducing liver inflammation, and adopting appropriate dietary and lifestyle changes, along with regular medical follow-up to prevent further liver damage. It is advisable to consult your doctor or a qualified Ayurvedic practitioner before starting this medicine to ensure it is safe and does not interact with your current blood pressure or diabetes medications.