Anti Cancer Treatment in Ayurveda
Onclolgy -in- Ayurveda
CANCER IN AYURVEDA.
One of the major reasons for redefining ayurvedic practices is the emergence of new diseases, whichare less amenable to conventional standard treatments. We may openly admit that, cancer, as we knowtoday, is not described in classic ayurvedic works such as Brhatrayi. In ancient times cancer had thestatus of an orphan illness. Orphan illness refers to a disease entity which was not taken up for elaboratestudies in terms of its etio-pathology, therapeutics and prognosis. It may be presumed that the neglectwas for want of large patient population. In the case of cancer the situation has thoroughly changed andit is now the major cause of fatality, second only to cardiac ailments. It is no more considered as anorphan illness as in the past. Naturally ayurveda too has to develop an oncology – both theoretical andapplied.No one can honestly claim to know the cure for cancer. Many of the questions related to etiopathologyof cancer remain unanswered.The therapeutic choices offered to a cancer patient are rather grim. The treatment strategies of cancerare mainly three. - Cut it out (surgery), Burn it out (radiation) and Destroy it (chemotherapy).There is a strong anti-surgery feeling among patients. Cancer patients want to move away from radiationand chemotherapy fearing of physical disfigurations that may result from the therapies. To many, traumaof the treatment is worse than that of the disease. They are therefore, put in a climate of opinion ruled byfear and uncertainty. As a safer option they turn to other systems of medicine. Unfortunately, we havenot so far succeeded in developing an effective ayurvedic methodology to deal with cancer cases.Because of this reason the patients often face agonizing dilemma. In this situation we are bound to takestock of the situation and improve ourselves to come up to the expectations of the ailing fraternity. We just can’t afford to wait to treat cancer patients until we evolve a definite system in oncology.Case StudiesKeeping this in view, our institution has started an exclusive clinic for cancer patients, where primarilywe act as service providers. Meanwhile, we are trying to document the case histories of cancer patientsin a systematic manner so that the data generated thereof can be retrieved for further studies. Our 6years old cancer clinic now has documented clinical case histories of about 2000 cancer patientsbelonging to different categories. The primary analysis of the clinical patient population reveals that fourgroups of patients are seeking ayurvedic treatment.There are patients who want to try ayurvedic treatment along with conventional anti-cancer treatments.They hope that combined therapy will be helpful to nullify the side effects of radiation and chemotherapy.They also hope that ayurvedic therapy would help prevent recurrence in a safer way. Terminally cancerpatients take recourse to ayurvedic treatment for supportive and palliative care. A third group of patientsare those who decide to try ayurvedic treatment on a regular basis for total and permanent cure thoughthey are temporarily released from the clutches of cancer with the help of surgery, radiation orchemotherapy. There is yet another group of patients on whom we are concentrating just because theyare fully dependent on ayurvedic treatment. Admittedly, this category of patients constitute only a minorpercentage of the patient population. Their decision to opt exclusively for ayurvedic treatment is essentially based on their understanding of limitations and risk of other treatment options. Our commitment towardsthis group of patients is relatively more because of the faith they have deposited in ayurveda.As of now we do not have statistically significant number of cancer cases, to establish the efficacy of ayurvedic treatment. But there are medical case histories of cancer patients suggestive of the scope andrelevance of ayurvedic treatment for management of malignant disorders. The guidelines for researchmethodologies designed by WHO include a specific clause which is very pertinent in this context. Itsays single case studies for evaluation of efficacy of herbal medicine should not be ignored because of its potential contribution to traditional medicine.I vividly remember the case of a patient who had adenocarcinoma of stomach. His brother who wasundergoing treatment in our hospital had a discussion with us about the possibilities of ayurvedic treatmentfor stomach cancer in which the western system had nothing much to offer in terms of a medicaltreatment. Based on the reports made available to us we suggested a course of treatment to be tried athis residence. In fact we did not get an occasion to see the patient personally even once before chalkingout the treatment profile. The medicines included Nimbamrithadi Panchathiktham Kashayam, SahadevyadiLeham and a few adjuvants. We too were not very hopeful in the initial stages of treatment. To oursurprise we were getting reports from the patient indicating the progress that he was making towardsrecovery. He made his own arrangement to continue the treatment at Gulf collecting medicines fromKottakkal. He continued the medication without any interruption for a period of more than five years.To him at least ayurveda has a cure for Cancer. Similarly I would now like to refer to another example.In this case the patient is a fifty year-old Keralite lady who was diagnosed as Ca. Lung. She approachedus for medical advice forwarding her full medical case history. In addition to NimbamrithadiPanchathiktham Kashayam, Sahadevyadi Leham, we prescribed Parthadyarishtam andAgasthyarsayanam in view of the specific site of cancerous lesion. One cannot expect a tangibleimprovement in lung cancer cases. But this lady improved rapidly and she attained a near normalcondition. The improvement was not merely symptomatic. Radiological examination revealed theremarkable changes suggestive of the regression of the disease. (I have with me the X-ray films of thispatient).I may now refer to the treatment of one more case. It is about a sixteen year-old patient, diagnosed asAcute Myloid Leukemia M-1. The diagnosis was done at Nizam’s Institute of Medical Sciences,Hyderabad. The presenting symptoms were abdomen pain, low grade fever, dry cough, and generalizedbody ache. On examination there was detectable splenomegaly. Patient was advised to try NimbamrithadiPanchathiktham Kashayam, Chandraprabha vatika, Ayolipta thippali, Rasasindooram and combinationof Nityakalyani extract, Thippali choornam, Rajathabhasmam and Thalakabhasmam. Patient continuedthe treatment on a regular basis and intimated the progress at regular intervals. She was registeringimprovement gradually. Case was personally reviewed after three months. Patient was totally free fromall symptoms recorded initially and there was no splenomegaly. Her blood picture showed tremendousimprovement in every aspect. The patient has now resumed her studies as if she has totally recoveredfrom the ailment. She has been advised to continue the medication and send us the reports without failat regular intervals.These instances cannot be set aside as odd events or miracles. Any way the time is not ripe to make tallclaims about the curative effects of Ayurvedic treatment in cancer cases. I am sure many of you mighthave come across similar incidences. My request is that all of you should as far as possible try topreserve your findings for the future because ‘miracles are also extensions of normal capabilities’.
3Collaborative research activities also bring forth valuable data. I may now refer to a few of such activitiesundertaken by our institution joining hands with Calicut Medical College. Here the attempt was directedto provide terminally ill cancer patients with supportive palliative care. Primarily it was decided to splitthe goals and aim at achievable bits. To cite an example, Opioid induced constipation is a big menaceto the cancer patients who are receiving morphine therapy for pain relief. They cannot do away withopioid preparation because no therapeutically equivalent drug is available to replace it. The standardtreatment adopted to relieve constipation has many inadequacies. It was why doctors were willing totry some herbal preparation. A team of doctors studied the efficacy of well known ayurvedic preparationMisrakasneham to relieve constipation. The study brought out highly encouraging results including betteracceptance by patients. I am happy to say here that an international journal on pain managementpublished an article about this study. Similarly Viswamritham was tried for anorexia, Sathadhouta grithamfor oral mucositis. For various reasons the study could not yield statistically significant data but wecould prove that it is well worth considering ayurvedic medicaments in the treatment profile of cancer.Theoretical OncologyI would now like to touch upon a few hints that could be considered while developing an Ayurvedictheoretical oncology. What should be the starting point? We should have a clear-cut understandingabout contemporary knowledge on cancer. We may look at this information from an ayurvedic perspectiveto form an ayurvedic oncology with theoretical soundness. I have tried to pick up a few points fromclassical ayurvedic works which have relevance in forming an ayurvedic oncology. The booklet amongyou contains a brief account of this information. Kindly subject it for a critical analysisSystematic function of any biological entity requires three fundamental regulatory processes - input/ output (transport), transformation and storage. In other words, we may say -
Tridoshaconcept of ayurveda also has a sound basis of thissystemstheory.To obtain a fair idea about the basic structural and functional concepts of human body we may look intothe derivations of a few words commonly used to denote the human body in Ayurvedic classics.1):As far as our knowledge goes, cell is the basic structural unit of the human body. It may be rationallypresumed that there was some knowledge of the cell boundary and molecular traffic between the extracellular and intracellular fluids even before the advent of electron microscope. Human body is composedof between 50-100 trillion cells. Charaka says It essentially means that the basic body components are structurally atomic, innumerable and microscopicAn individual cell is on one of the two largely exclusive paths: division or differentiation. Cells capableof dividing are undifferentiated (stem cells) whereas terminally differentiated cells are unable to divide.Stem cells produce daughter cells that can either become new stem cells or undergo terminal differentiationdepending on tissue specific programming interacting with environmental signals. Both types of cellshave different patterns of gene expression.Each cell has unique characteristics (either inherited or acquired) to perform certain subset of functions.Integrity of human system is maintained by the synchronization of functions of sub-systems, which areorganically interconnected and biologically regulated by thetridoshas, biophysico chemical energies of the body. Of the three forms of energies,vayuacts as the master force.We may now have a brief overview of how cellular metabolism is governed by the threedoshas.
Vatagoverning input/output is responsible for regulating transport across all membranes including entry of food and other molecules into the cell and elimination of waste materials. Governing motion (kinetics) itwould also be responsible for cell division and differentiation (samyogavibhage karanam vayu).Pittabeing responsible for metabolism (biochemical energy production and regulation) governs thekrebs cycle wherein assimilated food is used to create high energy molecules required for cell growthand sustenance.Pittais also responsible for all processess involving enzyme synthesis needed to bringabout transformation.Kapha,being responsible for storage can be identified with the cell membrane and cell wall, basicreserves for the cell to call upon in hard times. On a molecular levelkahpacan be identified with lipidsand polysaccharides the molecular basis for membrane and cell walls respectively. Mucus ispolysaccharide while other lubrication may use lipids.It may be of interest to note that the strategies, which maintain process of control in single cells possessan underlying continuity throughout their biologic development, starting from the microscopic level of regulation of biochemical processes in single cells, and proceeding to the macroscopic level of controlprocesses regulating whole body and its subsystems. It can be seen that the processes of biologicdevelopment have maintained similar strategies of control to those used in the original cells, adding toand building on them as appropriate, but without fundamental alteration.Cancer is a disorder of cellular behaviour, in which the structural/functional integrity is distorted.What is cancer?We come across descriptions of disease entities in ancient ayurvedic texts that have remarkable similaritieswith modern interpretations of cancer. However, one can hardly find a single comprehensive word inayurveda denoting a disease entity, which is fully comparable with concept of cancer.Etymologically the word ‘Arbuda’ represents an enormously growing mass encroaching and destroyingthe normal structural and functional status of an organ and on a larger scale the entire human body.On conducting a literature survey, we get a fairly good amount of information with regard to theunderstanding and interpretations of our predecessors about cancer. In this context, appropriate referencehas to be made to a variety of diseases which have this particular feature in onset, growth spread or
5manifestation. It includesgranthi,apachi,gulma,udara,vidhradianddustavrana. Benign forms of these diseases are likely to become malignant over a period of time where the standard treatmentsprove ineffective. We may say thatsannipathikastage of doshavitiation of diseases is comparablewith malignant conditions.One of the criteria adopted by the exponents of ayurveda in naming and grouping of diseases was theircommonalities in ethiopathogenesis, disease processes, clinical manifestations and terminal stages of the diseases. 5manifestation. It includesgranthi,apachi,gulma,udara,vidhradianddustavrana. Benign forms of these diseases are likely to become malignant over a period of time where the standard treatmentsprove ineffective. We may say thatsannipathikastage of doshavitiation of diseases is comparablewith malignant conditions.One of the criteria adopted by the exponents of ayurveda in naming and grouping of diseases was theircommonalities in ethiopathogenesis, disease processes, clinical manifestations and terminal stages of the diseases. The following descriptions with its appropriate interpretations provide a sound basis fordevelopment of ayurvedic oncologyBasic ApproachAyurvedic treatment for cancer should be basically holistic in approach and so modulated as to havethe following results.1) eradication of morbid tissues2) protection of healthy cells from toxicity and other unfavourable conditions.3) promotion of regeneration of healthy tissues.Anti cancer treatment has five major categories depending upon the level of medical care required –preventive, prophylactic, curative, palliative and supportive.Based on the current understanding of the biology of carcinogens preventive and prophylactic measurescan be adopted. It includes early identification of disease, avoidance of carcinogens and specificinterference to lower cancer risk. Ayurveda definitely has some important role to play in preventiveoncology because carcinogenesis is not an event but a process evolved over a considerable period of time. Manipulation of genetic, biologic and environmental factors in the causal pathway should beattempted. It could be made easy by adopting and updating the principles and practices laid down insvasthavrtta. It may perhaps be possible to influence the mutations leading to carcinogenesis at embryoniclevel by resorting to well designed prenatal care systems. The methods and materials recommended inayurveda in this regard could be subjected for indepth study. Life style modification in terms of diet,relaxation, exercise, attitude, and motivation can be effectively practiced. Patient education and publicawareness programmes enlightening the need of upkeeping positive health could be contributory.Chemoprevention is a relatively new concept. It involves the use of natural agents (chemical agents arealso considered in western medicine) to reverse, suppress or prevent carcinogenesis before thedevelopment of invasive malignancy. The purificatory treatment regimen of ayurveda followed by theregular use of rasayanas may prove an effective mode of chemoprevention.The inbuilt health potentials of human body could be appropriately channeled to inactivate the carcinogenicproliferation. It may perhaps be possible to influence the mutation leading to carcinogenesis at cellularTable IIThe various stages of development of arbudaDwirarbudam(Distant metastasis)Vidhradhi(abscess)Vrana(Malignant ulcers)Sopha(Oedema)Granthi/Gulma(Glandular swellings)Arbudam(Tumour)Adhyarbudam(Metastasis - Primary site)Dwirarbudam(Distant metastasis)
7level. This appears to be one of the basic axioms of the biologic therapy which is aimed at manipulatingthe host-tumour interaction in favour of the host. The very existence of a cancer in a person is testimonyto the failure of the immune system to deal effectively with the cancer. Tumour cells have inherentcapabilities to escape the attention of the defensive mechanism of the host. This could be comparedwith underground terrorism. In the initial phase tumour cells do not exhibit notable difference fromnormal cells so that they are not identified as possible culprits. Tumour activity at this level is too downregulated to be recognized by the cells so that normal antigen-antibody complex does not develop.Tumour cells can cloak themselves in a protective shell of fibrin to minimize contact with surveillancemechanisms. In short the entire purpose of immune mechanism is thus defeated by the tumour cellsmoving in a hidden path. It is unfortunate that most of the universally accepted anti-caner treatmentsalso suppress the immune mechanism adding to the misery of the individual affected. This may perhapsbe one of the demerits of the cancer therapy.There are guidelines in ayurvedic classics to deal with neoplasia of various types. But therapeuticefficacy of such measures to counteract the process of carcinogenesis remains to be established. Thecentres of advanced studies in ayurveda and allied sciences are equipped with the infrastructure capableof isolating drugs having anti-mutagenic, anti-proliferative activity. There is every reason to believe thatin the near future ayurvea would have an Arbudaharaganam to be incorporated into the chapter of Sodhanadigana sangrahaneeyam..Ayurvedic practitioners have already started using classical formulation such as GulguluthikthamKwatham, Kanchanaragulgulu, Rasasindooram, Gandhira rasayanam etc. of treatment of malignantdisorders. Guided by my experience, I may make an incidental mention about auto-urine therapy too.My personal observation is that urine contains some anti-cancerous ingredients. As scholar of bothwestern medicine and ayurveda, Dr. K. Rajagopalan holds the view that medicaments recommended inArshochikitsa have specific role in the treatment of colon cancer. In a way we are finding clinicallymeaningful anti-tumour and anti-cancerous effect of ancient classical preparations. The observationaland empirical data so obtained would be helpful to form a medical oncology of ayurveda.Palliative care refers to the medical or comfort care that reduces the severity of a disease, slows itsprogress rather than providing a cure. In the case of cancer, palliative care becomes the focus of thetreatment in certain conditions. This helps management of pain and other distressing symptoms
One of the major reasons for redefining ayurvedic practices is the emergence of new diseases, whichare less amenable to conventional standard treatments. We may openly admit that, cancer, as we knowtoday, is not described in classic ayurvedic works such as Brhatrayi. In ancient times cancer had thestatus of an orphan illness. Orphan illness refers to a disease entity which was not taken up for elaboratestudies in terms of its etio-pathology, therapeutics and prognosis. It may be presumed that the neglectwas for want of large patient population. In the case of cancer the situation has thoroughly changed andit is now the major cause of fatality, second only to cardiac ailments. It is no more considered as anorphan illness as in the past. Naturally ayurveda too has to develop an oncology – both theoretical andapplied.No one can honestly claim to know the cure for cancer. Many of the questions related to etiopathologyof cancer remain unanswered.The therapeutic choices offered to a cancer patient are rather grim. The treatment strategies of cancerare mainly three. - Cut it out (surgery), Burn it out (radiation) and Destroy it (chemotherapy).There is a strong anti-surgery feeling among patients. Cancer patients want to move away from radiationand chemotherapy fearing of physical disfigurations that may result from the therapies. To many, traumaof the treatment is worse than that of the disease. They are therefore, put in a climate of opinion ruled byfear and uncertainty. As a safer option they turn to other systems of medicine. Unfortunately, we havenot so far succeeded in developing an effective ayurvedic methodology to deal with cancer cases.Because of this reason the patients often face agonizing dilemma. In this situation we are bound to takestock of the situation and improve ourselves to come up to the expectations of the ailing fraternity. We just can’t afford to wait to treat cancer patients until we evolve a definite system in oncology.Case StudiesKeeping this in view, our institution has started an exclusive clinic for cancer patients, where primarilywe act as service providers. Meanwhile, we are trying to document the case histories of cancer patientsin a systematic manner so that the data generated thereof can be retrieved for further studies. Our 6years old cancer clinic now has documented clinical case histories of about 2000 cancer patientsbelonging to different categories. The primary analysis of the clinical patient population reveals that fourgroups of patients are seeking ayurvedic treatment.There are patients who want to try ayurvedic treatment along with conventional anti-cancer treatments.They hope that combined therapy will be helpful to nullify the side effects of radiation and chemotherapy.They also hope that ayurvedic therapy would help prevent recurrence in a safer way. Terminally cancerpatients take recourse to ayurvedic treatment for supportive and palliative care. A third group of patientsare those who decide to try ayurvedic treatment on a regular basis for total and permanent cure thoughthey are temporarily released from the clutches of cancer with the help of surgery, radiation orchemotherapy. There is yet another group of patients on whom we are concentrating just because theyare fully dependent on ayurvedic treatment. Admittedly, this category of patients constitute only a minorpercentage of the patient population. Their decision to opt exclusively for ayurvedic treatment is essentially based on their understanding of limitations and risk of other treatment options. Our commitment towardsthis group of patients is relatively more because of the faith they have deposited in ayurveda.As of now we do not have statistically significant number of cancer cases, to establish the efficacy of ayurvedic treatment. But there are medical case histories of cancer patients suggestive of the scope andrelevance of ayurvedic treatment for management of malignant disorders. The guidelines for researchmethodologies designed by WHO include a specific clause which is very pertinent in this context. Itsays single case studies for evaluation of efficacy of herbal medicine should not be ignored because of its potential contribution to traditional medicine.I vividly remember the case of a patient who had adenocarcinoma of stomach. His brother who wasundergoing treatment in our hospital had a discussion with us about the possibilities of ayurvedic treatmentfor stomach cancer in which the western system had nothing much to offer in terms of a medicaltreatment. Based on the reports made available to us we suggested a course of treatment to be tried athis residence. In fact we did not get an occasion to see the patient personally even once before chalkingout the treatment profile. The medicines included Nimbamrithadi Panchathiktham Kashayam, SahadevyadiLeham and a few adjuvants. We too were not very hopeful in the initial stages of treatment. To oursurprise we were getting reports from the patient indicating the progress that he was making towardsrecovery. He made his own arrangement to continue the treatment at Gulf collecting medicines fromKottakkal. He continued the medication without any interruption for a period of more than five years.To him at least ayurveda has a cure for Cancer. Similarly I would now like to refer to another example.In this case the patient is a fifty year-old Keralite lady who was diagnosed as Ca. Lung. She approachedus for medical advice forwarding her full medical case history. In addition to NimbamrithadiPanchathiktham Kashayam, Sahadevyadi Leham, we prescribed Parthadyarishtam andAgasthyarsayanam in view of the specific site of cancerous lesion. One cannot expect a tangibleimprovement in lung cancer cases. But this lady improved rapidly and she attained a near normalcondition. The improvement was not merely symptomatic. Radiological examination revealed theremarkable changes suggestive of the regression of the disease. (I have with me the X-ray films of thispatient).I may now refer to the treatment of one more case. It is about a sixteen year-old patient, diagnosed asAcute Myloid Leukemia M-1. The diagnosis was done at Nizam’s Institute of Medical Sciences,Hyderabad. The presenting symptoms were abdomen pain, low grade fever, dry cough, and generalizedbody ache. On examination there was detectable splenomegaly. Patient was advised to try NimbamrithadiPanchathiktham Kashayam, Chandraprabha vatika, Ayolipta thippali, Rasasindooram and combinationof Nityakalyani extract, Thippali choornam, Rajathabhasmam and Thalakabhasmam. Patient continuedthe treatment on a regular basis and intimated the progress at regular intervals. She was registeringimprovement gradually. Case was personally reviewed after three months. Patient was totally free fromall symptoms recorded initially and there was no splenomegaly. Her blood picture showed tremendousimprovement in every aspect. The patient has now resumed her studies as if she has totally recoveredfrom the ailment. She has been advised to continue the medication and send us the reports without failat regular intervals.These instances cannot be set aside as odd events or miracles. Any way the time is not ripe to make tallclaims about the curative effects of Ayurvedic treatment in cancer cases. I am sure many of you mighthave come across similar incidences. My request is that all of you should as far as possible try topreserve your findings for the future because ‘miracles are also extensions of normal capabilities’.
3Collaborative research activities also bring forth valuable data. I may now refer to a few of such activitiesundertaken by our institution joining hands with Calicut Medical College. Here the attempt was directedto provide terminally ill cancer patients with supportive palliative care. Primarily it was decided to splitthe goals and aim at achievable bits. To cite an example, Opioid induced constipation is a big menaceto the cancer patients who are receiving morphine therapy for pain relief. They cannot do away withopioid preparation because no therapeutically equivalent drug is available to replace it. The standardtreatment adopted to relieve constipation has many inadequacies. It was why doctors were willing totry some herbal preparation. A team of doctors studied the efficacy of well known ayurvedic preparationMisrakasneham to relieve constipation. The study brought out highly encouraging results including betteracceptance by patients. I am happy to say here that an international journal on pain managementpublished an article about this study. Similarly Viswamritham was tried for anorexia, Sathadhouta grithamfor oral mucositis. For various reasons the study could not yield statistically significant data but wecould prove that it is well worth considering ayurvedic medicaments in the treatment profile of cancer.Theoretical OncologyI would now like to touch upon a few hints that could be considered while developing an Ayurvedictheoretical oncology. What should be the starting point? We should have a clear-cut understandingabout contemporary knowledge on cancer. We may look at this information from an ayurvedic perspectiveto form an ayurvedic oncology with theoretical soundness. I have tried to pick up a few points fromclassical ayurvedic works which have relevance in forming an ayurvedic oncology. The booklet amongyou contains a brief account of this information. Kindly subject it for a critical analysisSystematic function of any biological entity requires three fundamental regulatory processes - input/ output (transport), transformation and storage. In other words, we may say -
Tridoshaconcept of ayurveda also has a sound basis of thissystemstheory.To obtain a fair idea about the basic structural and functional concepts of human body we may look intothe derivations of a few words commonly used to denote the human body in Ayurvedic classics.1):As far as our knowledge goes, cell is the basic structural unit of the human body. It may be rationallypresumed that there was some knowledge of the cell boundary and molecular traffic between the extracellular and intracellular fluids even before the advent of electron microscope. Human body is composedof between 50-100 trillion cells. Charaka says It essentially means that the basic body components are structurally atomic, innumerable and microscopicAn individual cell is on one of the two largely exclusive paths: division or differentiation. Cells capableof dividing are undifferentiated (stem cells) whereas terminally differentiated cells are unable to divide.Stem cells produce daughter cells that can either become new stem cells or undergo terminal differentiationdepending on tissue specific programming interacting with environmental signals. Both types of cellshave different patterns of gene expression.Each cell has unique characteristics (either inherited or acquired) to perform certain subset of functions.Integrity of human system is maintained by the synchronization of functions of sub-systems, which areorganically interconnected and biologically regulated by thetridoshas, biophysico chemical energies of the body. Of the three forms of energies,vayuacts as the master force.We may now have a brief overview of how cellular metabolism is governed by the threedoshas.
Vatagoverning input/output is responsible for regulating transport across all membranes including entry of food and other molecules into the cell and elimination of waste materials. Governing motion (kinetics) itwould also be responsible for cell division and differentiation (samyogavibhage karanam vayu).Pittabeing responsible for metabolism (biochemical energy production and regulation) governs thekrebs cycle wherein assimilated food is used to create high energy molecules required for cell growthand sustenance.Pittais also responsible for all processess involving enzyme synthesis needed to bringabout transformation.Kapha,being responsible for storage can be identified with the cell membrane and cell wall, basicreserves for the cell to call upon in hard times. On a molecular levelkahpacan be identified with lipidsand polysaccharides the molecular basis for membrane and cell walls respectively. Mucus ispolysaccharide while other lubrication may use lipids.It may be of interest to note that the strategies, which maintain process of control in single cells possessan underlying continuity throughout their biologic development, starting from the microscopic level of regulation of biochemical processes in single cells, and proceeding to the macroscopic level of controlprocesses regulating whole body and its subsystems. It can be seen that the processes of biologicdevelopment have maintained similar strategies of control to those used in the original cells, adding toand building on them as appropriate, but without fundamental alteration.Cancer is a disorder of cellular behaviour, in which the structural/functional integrity is distorted.What is cancer?We come across descriptions of disease entities in ancient ayurvedic texts that have remarkable similaritieswith modern interpretations of cancer. However, one can hardly find a single comprehensive word inayurveda denoting a disease entity, which is fully comparable with concept of cancer.Etymologically the word ‘Arbuda’ represents an enormously growing mass encroaching and destroyingthe normal structural and functional status of an organ and on a larger scale the entire human body.On conducting a literature survey, we get a fairly good amount of information with regard to theunderstanding and interpretations of our predecessors about cancer. In this context, appropriate referencehas to be made to a variety of diseases which have this particular feature in onset, growth spread or
5manifestation. It includesgranthi,apachi,gulma,udara,vidhradianddustavrana. Benign forms of these diseases are likely to become malignant over a period of time where the standard treatmentsprove ineffective. We may say thatsannipathikastage of doshavitiation of diseases is comparablewith malignant conditions.One of the criteria adopted by the exponents of ayurveda in naming and grouping of diseases was theircommonalities in ethiopathogenesis, disease processes, clinical manifestations and terminal stages of the diseases. 5manifestation. It includesgranthi,apachi,gulma,udara,vidhradianddustavrana. Benign forms of these diseases are likely to become malignant over a period of time where the standard treatmentsprove ineffective. We may say thatsannipathikastage of doshavitiation of diseases is comparablewith malignant conditions.One of the criteria adopted by the exponents of ayurveda in naming and grouping of diseases was theircommonalities in ethiopathogenesis, disease processes, clinical manifestations and terminal stages of the diseases. The following descriptions with its appropriate interpretations provide a sound basis fordevelopment of ayurvedic oncologyBasic ApproachAyurvedic treatment for cancer should be basically holistic in approach and so modulated as to havethe following results.1) eradication of morbid tissues2) protection of healthy cells from toxicity and other unfavourable conditions.3) promotion of regeneration of healthy tissues.Anti cancer treatment has five major categories depending upon the level of medical care required –preventive, prophylactic, curative, palliative and supportive.Based on the current understanding of the biology of carcinogens preventive and prophylactic measurescan be adopted. It includes early identification of disease, avoidance of carcinogens and specificinterference to lower cancer risk. Ayurveda definitely has some important role to play in preventiveoncology because carcinogenesis is not an event but a process evolved over a considerable period of time. Manipulation of genetic, biologic and environmental factors in the causal pathway should beattempted. It could be made easy by adopting and updating the principles and practices laid down insvasthavrtta. It may perhaps be possible to influence the mutations leading to carcinogenesis at embryoniclevel by resorting to well designed prenatal care systems. The methods and materials recommended inayurveda in this regard could be subjected for indepth study. Life style modification in terms of diet,relaxation, exercise, attitude, and motivation can be effectively practiced. Patient education and publicawareness programmes enlightening the need of upkeeping positive health could be contributory.Chemoprevention is a relatively new concept. It involves the use of natural agents (chemical agents arealso considered in western medicine) to reverse, suppress or prevent carcinogenesis before thedevelopment of invasive malignancy. The purificatory treatment regimen of ayurveda followed by theregular use of rasayanas may prove an effective mode of chemoprevention.The inbuilt health potentials of human body could be appropriately channeled to inactivate the carcinogenicproliferation. It may perhaps be possible to influence the mutation leading to carcinogenesis at cellularTable IIThe various stages of development of arbudaDwirarbudam(Distant metastasis)Vidhradhi(abscess)Vrana(Malignant ulcers)Sopha(Oedema)Granthi/Gulma(Glandular swellings)Arbudam(Tumour)Adhyarbudam(Metastasis - Primary site)Dwirarbudam(Distant metastasis)
7level. This appears to be one of the basic axioms of the biologic therapy which is aimed at manipulatingthe host-tumour interaction in favour of the host. The very existence of a cancer in a person is testimonyto the failure of the immune system to deal effectively with the cancer. Tumour cells have inherentcapabilities to escape the attention of the defensive mechanism of the host. This could be comparedwith underground terrorism. In the initial phase tumour cells do not exhibit notable difference fromnormal cells so that they are not identified as possible culprits. Tumour activity at this level is too downregulated to be recognized by the cells so that normal antigen-antibody complex does not develop.Tumour cells can cloak themselves in a protective shell of fibrin to minimize contact with surveillancemechanisms. In short the entire purpose of immune mechanism is thus defeated by the tumour cellsmoving in a hidden path. It is unfortunate that most of the universally accepted anti-caner treatmentsalso suppress the immune mechanism adding to the misery of the individual affected. This may perhapsbe one of the demerits of the cancer therapy.There are guidelines in ayurvedic classics to deal with neoplasia of various types. But therapeuticefficacy of such measures to counteract the process of carcinogenesis remains to be established. Thecentres of advanced studies in ayurveda and allied sciences are equipped with the infrastructure capableof isolating drugs having anti-mutagenic, anti-proliferative activity. There is every reason to believe thatin the near future ayurvea would have an Arbudaharaganam to be incorporated into the chapter of Sodhanadigana sangrahaneeyam..Ayurvedic practitioners have already started using classical formulation such as GulguluthikthamKwatham, Kanchanaragulgulu, Rasasindooram, Gandhira rasayanam etc. of treatment of malignantdisorders. Guided by my experience, I may make an incidental mention about auto-urine therapy too.My personal observation is that urine contains some anti-cancerous ingredients. As scholar of bothwestern medicine and ayurveda, Dr. K. Rajagopalan holds the view that medicaments recommended inArshochikitsa have specific role in the treatment of colon cancer. In a way we are finding clinicallymeaningful anti-tumour and anti-cancerous effect of ancient classical preparations. The observationaland empirical data so obtained would be helpful to form a medical oncology of ayurveda.Palliative care refers to the medical or comfort care that reduces the severity of a disease, slows itsprogress rather than providing a cure. In the case of cancer, palliative care becomes the focus of thetreatment in certain conditions. This helps management of pain and other distressing symptoms
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