Ayurveda    
Role of Ayurveda
in the Management of Cancer
by Dr. Joban Modha and Dr. Neha Modha

Today diseases like Cancer, HIV-AIDS, Hematological and Auto Immune disorders are increasing. They are very complicated as the complexity is at every level of Anatomy, Physiology, Biochemistry, Molecular Biology and Gene Expression. So treating such disease is a big challenge. Surgery, Radiotherapy, Chemotherapy, MDT, Hormone Therapy, Blood Transfusion etc. are being tried to cure such diseases.

But limited success in these diseases (like in cancer with all conventional therapeutics overall 2.4% survival for 5 years after diagnosis) due to various factors like resistance, difficulty in targeting the specific disease area and additionally, toxicity of the drugs, Ablative Surgery, Radiation Damage and Chemotherapy Hazards.

Moreover drug research is a very costly task now a day. Studies published in 2006 report an average pre-tax cost of approximately $ 500 million to 2,000 million dollars depending on the therapy or the developing firm. (1) These figures relate only to new, innovative drugs (drugs with a New Chemical Entity BCE, also called New Active Substance NAS). Each year, worldwide, only about 26 such drugs enter the market (2005: 26, 2004: 24, 2003: 26, 2002: 28). The $800 million quoted include the cost of all drug development which did not result in a new drug. It also includes some 400 million $ of opportunity costs.

In India, traditional medicinal knowledge is very scientific and rich due to it is in practice since more than 5000 years, where many natural products are used as medicine. After the famous bio-piracy case of U.S. patent “TURMERIC for healing” (patent No. 5,401,504 ), The "Council for Scientific and Industrial Research" (C.S.I.R) in India have digitalize more than 35,000 prescriptions and remedies for various diseases under the project Traditional Knowledge Digital Library (TKDL). (2)
It is a wise step to conserve the knowledge & to provide this data to mine as well to work upon to find out the solution for these complicated disorders and safe -standardized medicines for other less drastic but complicated disorders like R.A., B.P.H., C.R.F., Obesity, Asthma, Diabetes….etc., so the scientific community worldwide is looking at traditional holistic system of the medicines for a satisfactory approach in this direction.

On the other side, patients and the relatives of the patients start to search out alternate magical cure for cancer and mostly they meet quacks on the road. Being an Ayurveda practitioner, I have experienced the bitter truth that they expect MAGICAL CURE no matter whether the disease is in stage 4 or with or without metastasis. As there is a myth in society that Ayurveda can do magic and can cure any condition. But let me accept the truth that as an Ayurvedic Consultant we have our scope & limitations too. But there are many quacks claiming to cure all kinds of cancers & that to without examining the patients, without going through their reports. In fact such mal practice leads to mis-impression for entire pathy, Ayurveda.

Let me be honest that, in reality the classics of Ayurveda have never claimed such miracles. Ayurveda verbally means “science of life" is mostly based on timeless classics better known as Samhitas like Charaka Samhita, Sushrut Samhita etc. written by Rishis. The Rishis were aware of chronicity and complications of the diseases and they have honestly classified the diseases according to the prognosis in 4 categories.

• Saadhya: the disease which can be cured easily.
• Krichha Saadhya: the disease which can be cured after hard efforts and with the help of Panchakarma and other procedures.
• Yaapya: The diseases which cannot be cured, but can be stabilized with the help of medicines and Panchakarma or surgery.
• Asaadhya: the disease which cannot be cured.

The word "CANCER" may be new to the field of Ayurveda, but ancient Ayurvedic classics did mention the clinical features resembling - cancer with the titles of Apachi, Gulma, Granthi, and Arbuda. The disease was even prevalent during the Vedic period. The story of Acceptance of Matsyagandha - reveals that the King Shantanu was afflicted with a type of cancer (Pundrika Arbuda). Some of the conditions mentioned in Ayurvedic classics can be summarized as follows:

 
Keeping this truth in mind it can be stated that that Ayurveda can be helpful in the management of cancer many ways, as prophylactic, palliative, curative & supportive and no doubt it helps to improve quality of life (QOL) as follows:

1. As adjuvant or co-therapy along with chemotherapy or radio therapy; & Post surgery care :

            a. To minimize the side effects of these therapies.
            b. In reducing the therapeutic doze of the various drugs used
                as in some studies on cow urine.
            c. Can be helpful in targeting the specific tissues as in some studies
                on nano-particles of gold.
2. To slower the progress of the cancer, when chemo therapy, radio therapy or surgery is contra-indicated due to many reasons and patients have no other choice;

3. With anti tumor action with the help of herbal/herbo-mineral compounds found to be effective in some studies.

4. Cell protective activity of drugs prescribed in Rasayana therapy: to improve comfort and the quality of life for individuals with cancer.

1.  As adjuvant or co-therapy along with chemotherapy or radio therapy:

Chemotherapy is the first and significant medical modality of cancer, which involves introduction of strong medicines. The target is fast growing cells. However the important obstacle is the toxicity it causes to normal tissues of the body and presence of mutations that confer resistance to these chemotherapeutic agents.

The use of antioxidants during chemotherapy enhances therapy by reducing the generation of oxidative stress induced aldehydes. Natural drugs which are used as Rasayans have been proved earlier to have antioxidant activities.

Rasayana (rejuvenation) is one of the 8 specialize branches of Ayurveda. In therapeutic process Rasa is concerned with the conservation, transformation, and revitalization of energy. Rasa nourishes our body, boosts immunity and helps to keep the body and mind in best of health. (22)

Rasayana therapy enriches rasa with nutrients to help one attain longevity, memory, intelligence, health, youthfulness, excellence of luster, complexion & voice, optimum development of physique and sense organs, mastery over phonetics, respectability and brilliance. (23)

Rasayana herbs and formulas are similar to adaptogens but although the categories overlap, they are not identical. Adaptogens are nontoxic herbs that work in a nonspecific way to balance the normal physiology of the body, by acting upon the HPA axis and the neuroendocrine system. Rasayanas are nontoxic herbs or formulas which balance the body in a generalized way although they may work on a specific organ or function and do not necessarily affect the HPA axis. Rasayanas also overlap with tonics but are amphoteric in that they will not over-tonify organs. ( 24)

Most commonly all the drugs which are used in Rasayana therapy have property like Tridoshashamana. The most commonly prescribed Rasayana drugs are Triphala (Terminalia Chebula, Embellica officinale, Terminalia ballarica), Guduchi (Tinospora cordifoia) and Punarnava (Bohhervia diffusa). According to my clinical experience such drugs have shown very impressive effect to protect body from the side effects (of chemo and radio therapy) like Alopecia, Nausea, Nail changes, Constipation, Anorexia and Vomiting. Myelo-suppression one of the fatal toxicity of chemotherapy led to delay in the schedule of chemotherapy. The patients who are receiving the Ayurveda Rx along with CT have also shown more regularity in maintaining the chemotherapy cycles as the hematological levels can be maintained up to normal state. More than 50 research work has been carried out at M.D. and Ph.D. level on cancer at various Ayurvedic institutes including Gujarat Ayurveda University, which has shown the very effective action as chermo-preventive radio-preventive agents. (25)

Interestingly, Snehana i.e. intake of various medicated ghee or oil preparations in a classical way a week or 10 days prior to chemo therapy or radio therapy have also shown less toxic effects during RT/CT.

There is need is to establish biomarkers to assess the effect of Rasayan therapy in terms of apoptosis. Cyto-protection, cell recovery, anti-neoplastic activity and vital of all immune augmentation. (26)

2. To slower the progress of the cancer:

There are many conditions when chemo therapy, radio therapy or surgery are contra indicated or not prescribed due to many reasons like the age factor, body resistance, severe side effects, location etc. In that case doctor or patients have no other choice left. Many patients do not prefer such modern management or some have deep faith in Ayurveda. Such patients more often comes to Ayurveda practitioner. Few cases are presented here:

3. Anti-tumor Plant drugs:

Comprehensive reviews of the technical and folklore literature have been published (27), wherein citations are recorded for the use of different plant species which have been used or recommended in various parts of the world for the treatment of cancer or other conditions such as warts and tumors. In the USA, the Cancer Chemotherapy National Service Centre (CCNSC), now incorporated into the Development Therapeutic Programme (DTP) has screened thousands of plant extracts against standard tumor systems consisting of solid tumors and leukemias.

At the Cancer Research Institute (CRI) in Bombay, more than 600 species of indigenous (drugs) plants have been screened using standard transplantable tumors. Eight plants have exhibited meaningful anti-cancer properties. The Central Drug Research Institute (CDRI) at Lucknow started in 1964, a programme for the screening of plant extract for a wide range of biological activities. CDRI has found out about 70 plants whose anti-cancer activity has been confirmed.[Certain common drugs in Ayurveda like Ginger (Ardrakao, Tagar, Antamoola, Bala, Sapotaparna, Shallaki have been reported for their specific anti-tumor activities by various researchers (28)

Cell protective activity:

There are many herbs which can protect cells from various toxic effects. For example: Regular blood transfusions at regular intervals develop chronic iron overload in the body, which ultimately produces many hazardous effects like cirrhosis of liver, cardiac problems etc. in the body. During my Ph.D. research work, the cellular protective effect of two poly herbal compounds against iron sorbitol induced chronic iron overloading was studied in Charles foster rats (150-250 gm). The test drugs showed remarkable cell protection against the toxicity. Such drugs can also be useful for the cell protection against detrimental effects of RT-CT. (The photographs of histological slides and other results will be discussed in details during the presentation.)

Drugs and herbs of Ayurveda can be used in treatment of cancer

Every plant contains thousands of various alkaloids, steroids, flavinoids, terpinoids and other molecules with bioactivity, and Ayurveda preparations may consist of many different plants. The presence of such a wide variety of ligands suggests that the preparation may be acting on a wide variety of tissues through a number of different mechanisms. So it is always advisable to prescribe drug as a whole instead of specific derivative. Here is the list of some important poly-herbal, herbo-mineral compounds which are proven as very useful in different types and stages of cancer:

Drugs and herbs of Ayurveda used according to specific system location:

• Brain Cancer -Shatavari (Aparagus), Yashtimadhu (licorice), Mandukaparni (Bacopa ) & Kastoori Bhairav Rasa, Brahmi Vati, Smritisagar Rasa etc.
• Oropharyngeal Cancers – Pathyadi kwath, Varunadi Kwath, Kaishor guggulu, Kasamarda (Cassia oxidentalis), Mahalaxmivilas Rasa etc. 
• Lung Cancers – Malla sindura, Samir pannaga Rasa, Somal Bhasma, Kantakari, Vyaghri, Vasasava, Kanakasava, Chitraka Haritakiavaleha, Bhallatakavaleha, Pippali (Piper longum), Hirak Rasayana etc.  
• Stomach Cancers: Shatavari (Asparagus resimosus), Amlaki (Philanthus amblica), Aloe Vera, Changeri Ghrita, Mahakalyanaka Ghritam, Bhomi Amalaki, (Philanthus nurare), Avipattikara Churnam, etc. 
• Intestinal Cancers: Shigru (Moringa olifera), Panchamrit parpti, Brihada Gangadhara Churnam, Kutaja Ghanavati, Kutaja avaleha, etc.  
• Female Genital Cancers: Ashoka (Saraka Ashoka), mukta panchamrita rasa, Fala Ghrita, Dhanvantara Tailam etc. 
• Mail Genital Cancers: Shilajit, vanga Bhasma, Chandrodaya Rasa, chyawana prash, Triphala, Makardhvaja etc. 
• Liver Cancers; Bhumvamalaki, Bhallataka, Triphala, Guduchi, Arogyavardhini, Phalatrikadi Kwatha etc.
• Blood Cancers: Somala Bhasma, Ashvagandha, Samirpannaga rasa, Anantmula (Hermidesmus indicus)-Suvarna Vasant Malti Rasa etc.   
• Bone Cancers: Aabha Gugglu, Madhu Malini Vasant Rasa, Sariva etc.    
• Breast Cancers: Gojivha, Chinchabhallataka, Jivaniya gana etc.    
• Skin Cancers: Manjishtha (Rubia cordifolia), Sameera Panaga Rasa, Kaishor Guggulu, Gandhak Rasayan etc.

Drugs for Symptomatic Relief:

• All Gugglu preparations for pain relief, and tumor reducing.
• Chhardiripu Vati, Sutshekhar ras, Shatavari etc. for nausea and vomiting
• Gandhak Rasayan, Mahalaxmivilas Ras etc.for recurrent infections
• Bilva, Mayurpichha, Kutaja, Tankan, etc. for loose motions
• Shankhavati, aamapachana Vati, Shigru, Chitrakadi vati etc.for pain in the abdomen
• Katuki, Rohitaka, Shamaka yoga etc.for pain in pancreas and renal colic.
• Pathyadi Kwatha, Navajivana Rasa, Shirashooladi vajra rasa, etc.for headaches
• Phalatrikadi Kwatha, Katuki, Triphala, Beejapuraka, trikatu etc. in jaundice
• Praval panchamit, Vasa+Goat milk etc. in epistaxis, bleeding
• Ashvagandha Tailam, Guggulu, Aabha+Madhumandura etc.in bone pain

As adjuvant or co therapy with RT-CT:

Triphala Rasayana, Chyawanprash, Aamalaki Rasayana, Amrit Rasayana, Brahm Rasayana, Kamdugdha Ras, Laxami Vilas Ras, Laxman Vilas Ras, Makrdhawaj vati, Mukta Panchamrit Rasayana, Nari Kalyan Pak, Navjeevan Ras, Navratna Ras, Navratnakalp Amrit, Panchamrit Ras, Smritisagar Ras, Suvarna Vasant Malti, Swapanmehtank, Vasant Kusmakar Ras, Visha Rasaayana, Brihada Vangeshwar Rasa, Chandanadi powder, etc.

In nut shell, it can be concluded with a word that Ayurveda can be very useful both ways; to add years to life, and to add life to years. To combat cancer and combining traditional healthcare knowledge with conventional systems will make complete health care setup under one roof. With sincere pulled efforts and with a multidisciplinary approach of devoted Ayurvedic physicians, Oncologists, surgeons, Pharmacologist, experimental biologists an appropriate solution may be find out for the cancer.

References:
1. Adams C, Brantner V. "Estimating the cost of new drug development: is it really 802 million dollars?". Health Aff (Millwood) 25 (2): 420-8. PMID 16522582.
2. Johnston, Barbara and Webb, Ginger (1997). "Turmeric Patent Overturned in Legal Victory". HerbalGram Fall 1997 (41): 11.
3. Sushrut Samhita Nidana Sthanam 13
4. Sushrut Samhita Nidana Sthanam 13
5. Charaka Samhita Chikitsa Sthanam 16.
6. Sushrut Samhita Nidana Sthanam 11
7. Sushrut Samhita Nidana Sthanam 11
8. Sushrut Samhita Nidana Sthanam 10
9. Charaka Samhita Chikitsa Sthanam. 13.
10. Charaka Samhita Chikitsa Sthanam 13
11. Charaka Samhita Chikitsa Sthanam 5
12. Sushrut Samhita Nidana Sthanam 16
13. Sushrut Samhita Nidana Sthanam 11
14. Sushrut Samhita Nidana Sthanam 16
15. Sushrut Samhita Nidana Sthanam 16
16. Sushrut Samhita Nidana Sthanam 16.
17. Sushrut Samhita Nidana Sthanam 11
18. Sushrut Samhita Uttara Tantram 17
19. Sushrut Samhita Nidana Sthanam 29
20. Sushrut Samhita Nidana Sthanam 29
21. Sushrut Samhita Nidana Sthanam 29.
22. Tillotson, Alan, AHG, PhD D.Ay, Understanding Herbs.
23. Charaka Samhita Chikitsa Sthanam 1
24. Winston, David & Maimes, Steven. Adaptogens: Herbs for Strength, Stamina, and Stress Relief, Healing Arts Press, 2007
25. Bhavana Bhoot et al, Poorvi Vyas et al, I.P.G.T. & R.A. Gujarat Ayurveda University Jamnagar.
26. Zankhana Mankad et al, I.P.G.T. & R.A. Gujarat Ayurveda University Jamnagar.
27. Hartwell 1971.
28. Chitnis, M.P. et. al : Ind-J. Med. Res : 60:359 (1972).Dhar M.L., et. al : Ind. J. Expt. Biol. 6 : 232 (1968).Mukerji B. et. al: Ind. Med. Gaz. 77-723 (1942), Chem. Abstra, 37-3877 (1943).;Mukerji S. et. al. Ind. J. Pharm. 32, 48 (1970); Indian Medicinal Plants: chemexil; Bulletin of the Jaslok Hospital and Research Centre – Vol. XVII No. 23, Jan (1993).            

December 2, 2007

Dr. Joban Modha, M.D. (Ph.D.) Ay. is Consultant Ayurveda Physician
Dr. Neha Modha, M.D. Ph.D is Lecturer, International Centre for Ayurveda Studies, Gujarat Ayurveda University, Jamnagar

Disclaimer
The above article is educational and informative in nature, and is not intended to diagnose, treat, cure or prevent any disease. If you have a medical condition, please consult your physician. 

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