treatment of cancer in ayurveda

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Dr. Prashant SawawntMD

[email protected] www.ayurlife.net

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Om Saha Nau-Avatu |Om, May we all be protectedSaha Nau Bhunaktu |Saha Viiryam Karavaavahai |Tejasvi Nau-Adhiitam-AstuMaa Vidvishaavahai |

Om Shaantih Shaantih Shaantih ||May we all be nourishedMay we work together with great energyMay our intellect be sharpenedLet there be no Animosity amongst usOm, peace (in me), peace (in nature), peace (in divine forces)Kathopanishad

Om Saha Nau-Avatu |Saha Nau Bhunaktu |Saha Viiryam Karavaavahai |Tejasvi Nau-Adhiitam-Astu Maa Vidvissaavahai |Om Shaantih Shaantih Shaantih || Kathopanisad

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Role of Ayurveda in Managing CancerDr. Prashant Sawant, M.D. (Ayurved)Ayusanjivani Chikitsa, [email protected]

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Role of Ayurveda in Managing Cancer

Case StudiesUnderstanding CancerAyurveda ConceptsAyurvedic ManagementQ & A

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Role of Ayurveda in Managing CancerCase StudiesBone metastases in renal cell carcinomaExtensive bone and lung metastases in cancer of unknown primary (CUP)Malignant Melanoma Severe ano-rectal Pain in a Case of Metastatic Breast Cancer

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RCC with Bone MetastasesRenal cell carcinoma (RCC) is the most common malignancy of the kidney [Jemal et al. 2009]Almost 30% of patients with RCC present with metastatic diseaseBone is the common site of distant metastatic spread in patients with advanced RCC[Motzer et al. 2007, 2008]. Metastatic bone disease causes significant morbidity through skeletal related events (SREs)

Renal cell carcinoma (RCC) is the most common malignancy of the kidney. In 2007, just under 58,000 people in the United States developed RCC and 12,980 died from the disease [Jemal et al. 2009]. The incidence of RCC has been increasing by about 3% per year in North Americans, with the highest rates now seen among African Americans [McLaughlin and Lipworth, 2000]. Almost 30% of patients with RCC present with metastatic disease, and furthermore, about 40% of patients who undergo resection of their primary with curative intent will relapse with disseminated disease [Motzer et al. 1996].Bone is the second most common site of distant metastatic spread (following lung) in patients with advanced RCC. About one-third of patients in modern randomized trials of targeted therapies for advanced RCC have bone metastases [Rini et al. 2008; Motzer et al. 2007, 2008].

http://www.cancer.gov/cancertopics/pdq/treatment/renalcell/HealthProfessional/page8#Reference8.16

RCC with Bone metastasesThe prognosis for any treated renal cell cancer patient with progressing, recurring, or relapsing disease is poor, regardless of cell type or stage. Almost all patients with stage IV renal cell cancer are incurable (Kidney. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010)

Kidney. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 479-897

RCC with Bone metastasesThe incidence of spontaneous regression of metastatic renal cell carcinoma is thought to be less than 1% of all cases. It is reported that complete regression is even rarer than partial regression Since 2005, when targeted agents with activity against RCC began to appear, the median survival for patients with metastatic RCC has increased from 10 months to more than 20 months

A new era in the treatment of metastatic RCC commenced around 2005, when targeted agents with activity against RCC began to appear. Since that time, the median survival for patients with metastatic RCC has increased from 10 months to more than 20 months.

Bone metastases in patients with renal cell carcinoma (RCC) are associated with a high risk of skeletal complications. About 40% of patients with RCC develop bone metastases. RCC is the fourth most common metastatic tumor of the spine and the most common cancer to present as a neurologic deficit secondary to an undetected primary malignancy. Chemotherapy and hormone therapy are ineffective, making radiation and surgery the mainstays of treatment. Failure to respond to or relapse after radiotherapy is common (American Journal of Neuroradiology 22:997-1003 (5 2001)The median survival time with distant metastatic RCC is around 6 months, and few cases survive beyond 2 years. The incidence of spontaneous regression of metastatic renal cell carcinoma is thought to be less than 1% of all cases. It is reported that complete regression is even rarer than partial regression We present a case of RCC with bone metastases, whose bone lesions were completely resolved after the ayurvedic multi-modality treatment.

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RCC with Bone Metastases

We present a case of RCC with bone metastases, whose bone lesions were completely resolved after the ayurvedic treatment.

A new era in the treatment of metastatic RCC commenced around 2005, when targeted agents with activity against RCC began to appear. Since that time, the median survival for patients with metastatic RCC has increased from 10 months to more than 20 months.

Bone metastases in patients with renal cell carcinoma (RCC) are associated with a high risk of skeletal complications. About 40% of patients with RCC develop bone metastases. RCC is the fourth most common metastatic tumor of the spine and the most common cancer to present as a neurologic deficit secondary to an undetected primary malignancy. Chemotherapy and hormone therapy are ineffective, making radiation and surgery the mainstays of treatment. Failure to respond to or relapse after radiotherapy is common (American Journal of Neuroradiology 22:997-1003 (5 2001)The median survival time with distant metastatic RCC is around 6 months, and few cases survive beyond 2 years. The incidence of spontaneous regression of metastatic renal cell carcinoma is thought to be less than 1% of all cases. It is reported that complete regression is even rarer than partial regression We present a case of RCC with bone metastases, whose bone lesions were completely resolved after the ayurvedic multi-modality treatment.

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RCC with Bone Metastases26/11/2004 Male, age 41 yrsC/o severe pain in the upper back, pain in the right flank and right side of the chest - over mid axillary line - since 15-20 days, which increased on cough impulse. He also complained of cough, pain and throat irritation Painful body movements and pain in the left knee joint

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RCC with Bone metastasesH/o Presenting Complaintsk/c/o right renal cell carcinoma (RCC) Grade II, with multiple bone metastases (Stage IV)Had pain in the ribcage bilaterally, since December 2001. His physician advised him some NSAIDs. However, even after 2 months of treatment, the pain persisted. He was then advised bone scan.

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RCC with Bone metastases21/2/2002 Bone scan : revealed focal lesions on the costochondral junction of 1st rib (both sides), 4th, 5th ribs (right side), 3rd rib (left side) and on D10, L1, L2, L3 vertebrae.

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RCC with Bone metastases23/2/2002 MRI of L.S. Spine: revealed definite lesions on spine, involving the D10 pedicals and D9 body. A mass was also seen in the right kidney (3.5 cm x 3 cm), strongly s/o a renal cell Ca.

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RCC with Bone metastases6/3/2002 : FNAC from the lesion confirmed RCC.

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RCC with Bone metastasesOn 11/3/2002, right radical nephrectomy was done. The histopathology report confirmed Renal Cell Ca Grade II, Stage IV

Table. TNM Classification for Renal Cell Carcinoma (Open Table in a new window)Primary tumors (T)TXPrimary tumor cannot be assessedT0No evidence of primary tumorT1Tumor 7 cm in greatest dimension, limited to the kidneyT1aTumor 4 cm in greatest dimension, limited to the kidneyT1bTumor >4 cm but 7 cm in greatest dimension, limited to the kidneyT2Tumor >7 cm in greatest dimension, limited to the kidneyT2aTumor >7 cm but 10 cm in greatest dimension, limited to the kidneyT2bTumor >10 cm, limited to the kidneyT3Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond the Gerota fasciaT3aTumor grossly extends into the renal vein or its segmental (muscle-containing) branches, or tumor invades perirenal and/or renal sinus fat but not beyond the Gerota fasciaT3bTumor grossly extends into the vena cava below the diaphragmT3cTumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cavaT4Tumor invades beyond the Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)Regional lymph node (N)NXRegional lymph nodes cannot be assessedN0No regional lymph node metastasesN1metastases in regional lymph node(s)Distant metastases (M)M0No distant metastasesM1Distant metastasesTable. Anatomic stage/prognostic groups (Open Table in a new window)StageTNMIT1N0M0IIT2N0M0IIIT1-2N1M0T3N0-1M0IVT4N2M0Any TAny NM1

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RCC with Bone metastasesMarch 2002:Conventional TreatmentInj. Disodium PamidronateInj. Intreferon alphaInj Interlukin II

In metasatic bone cancer, Pamidronate (Aredia) is used, along with cancer therapy. The dual benefits of Aredia are delay and reduction of bone complications, such as fractures, and the possibility of reducing bone pain. It is the only medication approved for the treatment of bone metastases. This medication acts on bone to help regulate blood calcium levels. It is used to treat Paget's disease of bone and to treat high blood calcium levels. The medication has also been used in the treatment of osteoporosis, to reduce bone pain associated with certain illnesses and to treat bone loss due to breast cancer.Immunotherapy was first introduced in the 1980s, and it provided another therapeutic alternative for distant metastatic RCC. The current regimens of immuno-therapy for distant metastatic RCC vary greatly but the main regimens are based on interferon alpha and interleukin-2. In comparison to cases without immunotherapy, interferon alpha can prolong the median survival time by 2.6 months.Interleukin-2 is one of the activators between T cells and natural killer cells. The overall survival time with interleukin-2 based adjuvant immunotherapy after a cytoreductive nephrectomy was 16.7 months in one study. To conclude, previously, the median survival of patients with distant metastatic RCC was only 6 months. Adjuvant immunochemotherapy can increase the median survival time to more than 20 months.

Inj. Disodium PamidronateInj. Intreferon alphaInj Interlukin II

Aredia (Inj. Disodium Pamidronate)15mg x VIAL - Aredia INJ 2579.00 Aredia 30mg x VIAL - Aredia INJ 5158.00 Aredia 60mg x VIAL - Aredia INJ 10316.00

Intalfa 3 MIU x 1mL 1 Intalfa PFS 603.00

Interferon alfa-2a is a protein. Interferons are released in the body in response to viral infections. Interferons are important for fighting viruses in the body, regulating reproduction of cells, and regulating the immune system.

Interferon alfa-2a is used to treat chronic hepatitis C, hairy cell leukemia, AIDS-related Kaposi's sarcoma, and some types of chronic myelogenous leukemia (CML).PharmacokineticsInterferon alfa-2a has antiviral, antitumour and immunomodulatory activity. It inhibits replication of a wide range of RNA and DNA viruses. It also exerts antiproliferative effects on normal and malignant cells. Interferon alfa-2a suppresses antibody formation through an effect on B-lymphocytes and inhibits onset of delayed hypersensitivity.

Absorption>80% is absorbed (IM); peak plasma concentrations within 4-8 hours (IM).

ExcretionVia urine (negligible amounts); 3.7-8.5 hours (elimination half-life).Interferon Alfa-2A Adverse Reactions / Interferon Alfa-2A Side EffectsDepressive illness, suicidal behaviour, irritability, insomnia, anxiety. Flu-like symptoms. Headache, dizziness, paraesthesia, confusion, impaired concentration, alteration in taste or smell. GI disturbances. Dryness of oropharynx, epistaxis, rhinitis, arrhythmia, sinusitis. Inj site reaction, alopecia, rash, dry skin or pruritus. Conjunctivitis, menstrual irregularity, visual disturbances. Coughing, dyspnoea. Myalgia, joint or bone pain, arthritis or polyarthritis. Bone marrow depression.

Potentially Fatal: Marked increase in triglyceride levels, GI haemorrhage, severe infections, pulmonary infiltrates or pulmonary function impairment. 16

Follow Up After Conventional Treatment1.11.02 : Bone scan: (@ 8 months)Show abnormal tracer uptake lateral end of left clavicle, right 10th rib postero laterally, L2 vertebra, tarsal region of the right foot and right calcaneum. The rest of the skeletal system shows normal tracer uptake. Left kidney is normal. Above mentioned osseous abnormalities appear like metastatic lesions

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Follow Up After Conventional Treatment13.11.04 : Whole body Bone Scan (31 months of Conventional Rx)Multiple skeletal metastases. Fresh lesions in 7th rib left tibial tuberosity on right side, left navicular bone and lytic lesion of the 11th rib are seen in addition to lesion reported earlier studies.

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RCC with Bone metastases

At this stage, the patient approached for ayurvedic treatment.

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Ayurvedic Treatment26th Nov 2004Ayurvedic poly-herbo-mineral formulations given as oral medicines twice a day with honey Yapan Basti; a polyherbal medicinal preparation administered as an Enema given for 30 consecutive daysFollowed by 8 Yapana Basti every 3 months.

No Conventional Medicines ?Ayurvedic poly-herbo-mineral formulations given as oral medicines twice a day with honey Therapeutic Panchakarma procedure viz Yapan Basti , a polyherbal medicinal preparation administered as an Enema given for 30 consecutive days

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Follow Up After Ayurvedic RxFrom the second week of treatment the pain and tenderness in the rib cage gradually reduced and was completely relived at the end of first cycle of Yapan Basti (30 basti)

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Follow Up After Ayurvedic Rx22.03.05 : Whole body Bone scan (@ 3 months): Multiple skeletal metastases. Lesion in left 7th rib, L2 vertebra, medial tuberosity of right Tibia are not visualized suggestive of regression of disease.

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Follow Up After Ayurvedic Rx26.08.05 : Bone scan (8 months after starting ayurvedic treatment) :No evidence of skeletal metastases

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Follow Up After Ayurvedic Rx31.08.05 PET scan (@ 8 of ayurvedic treatment) :Whole body survey is unremarkable.

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Follow Up After Ayurvedic Rx18.07.06 Whole body PET (@ 19 months)No definitive suggestion of any active disease on the present whole body 21.08.06 (@ 20 months)Ayurvedic medicines were stopped

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Follow Up After Ayurvedic Rx27.07.10 Whole body PET scan (@ 6 years) :No suggestion of any active disease

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Follow Up After Ayurvedic RxBone Scan 09.11.2011 (@ 6 years)No e/o osteoblastic skeletal metastases

Sept 2014 (@ 9 years)AsymptomaticClinically disease free

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ConclusionThe disease was progressing even after 2 years of conventional treatmentThe disease regressed after 3 months of ayurvedic treatmentThe disease completely resolved after 8 months of ayurvedic treatmentThe patient has DFS of over 8 years The QOL is maintainedThere were no adverse effects of treatment

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Case 2 Extensive bone and lung metastases in cancer of unknown primary (CUP)

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Cancer of unknown primary (CUP)CUP is diagnosed at the metastatic stage and despite extensive diagnostic work-up the primary tumor often remains unidentified.80-85% of CUP have very aggressive potential and unpredictable pattern of metastatic spread. The largest group of these tumors is refractory to standard chemotherapyThe overall prognosis of CUP patients is generally very poor with a median survival of 4-12 months[ Hainsworth JD, Gereco FA: Treatment of patients with cancer of unknown primary site. N Engl J Med 1993, 329(4):257-263]

Cancer of unknown primary (CUP) is diagnosed at the metastatic stage and despite extensive diagnostic work-up the primary tumor often remains unidentified. Limited population-based survival data are available for metastatic location and none are available that link the location with the cause of death, which might give clues about the tissue-of-origin. A total of 9,306 CUP patients with extranodal metastases of adenocarcinoma and undifferentiated histology were identified from the Swedish Cancer Registry. Hazard ratios (HRs), mean survival times and Kaplan-Meier survival curves were provided according to CUP location at diagnosis and cause of death. The median survival was shortest (2 months) for patients with liver and longest (5 months) for those with nervous system metastases. Lung cancer was the most common cause of death in patients with CUP metastases in the respiratory system, nervous system, bone and skin, with a median survival of 3 months. Patients with peritoneal/retroperitoneal and pelvical metastases died not only of ovarian cancer, with a favorable median survival of 8 months, but also of pancreatic and colorectal cancers. Patients with pancreatic, liver, biliary and colorectal cancers with liver metastases succumbed quickly. The data show that the location of metastases predicts site-specific cancer deaths which in turn may point to the hidden primary tumor. The results should facilitate the management of CUP in proposing that the diagnostic arsenal should target the lungs when metastases are diagnosed in the respiratory or nervous system, bone or skin; ovarian tumors should be suspected after diagnosis of pelvical metastases.Copyright 2012 UICC.PMID:23233409[PubMed - in process]

very aggressive potential and unpredictable pattern of metastatic spread. The largest group of these tumours is refractory to standard chemotherapy and the median survival of CUP patients is very low.

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Case Report - Extensive bone and lung metastases in CUPMale Age 57 years, resident of GoaHe was having right pelvic pain since Jan 08He was treated by his family physician with NSAIDs for over 1 yearAs his symptoms worsened he was advised CT scan of pelvis in June 09

Mr. AK is a 50 year old male residing in Goa. He is having right pelvic pain since last 1.5 years (since Jan 08). He was treated by his family physician with NSAIDs. As his symptoms worsened even after taking medicines for long, he was advised CT scan of pelvis in June 09. In this CT scan multiple osteolytic pelvis lesions are noted in the right iliac bone extending to the acetabulam (s/o metastases). CT scan of thorax was done, which revealed multiple nodular lesions in both lung parenchyma (s/o metastases). On 23 June09 patient was referred to tertiary care center in Mumbai (Tata Hospital) for further management. After extensive investigations TATA hospital doctors 08.07.09 remarked Extensive (metastatic) disease to unknown primary, tumour markers were non-contributoryPlan for symptomatic careOption of Alternative medicine (Ayurveda) given by the oncologist Advised to consider palliative Chemo Therapy for symptom control and to maintain good general condition if symptoms are severe On 10 July 09 patient approached for ayurvedic treatment. He was able to walk with support, walking was very painful as slight pressure on right leg worsened pain. He can manage to walk on plain surface. He cannot slip on right side as it worsens his pain.He also complains of right hip joint pain and dribbling micturation since about last 1.5 years.

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Case Report - Extensive bone and lung metastases in CUP

06 June 09CT scan Pelvis : multiple osteolytic pelvis lesions in the right iliac bone extending to the acetabulamCT scan Thorax : multiple nodular lesions in both lung parenchyma (s/o metastases)

CT scan multiple osteolytic pelvis lesions are noted in the right iliac bone extending to the acetabulam (s/o metastases). CT scan of thorax was done, which revealed multiple nodular lesions in both lung parenchyma (s/o metastases)

CT Pelvis- 06.06.09Multiple osteolytic pelvic lesions, s/o metastases. Expansile osteolytic lesions are noted in the right iliac bone extending into the acetabulum with destruction of the overlying cortex at places with extraosseus tissue component. Similar osteolytic lesions also noted in the sup pubic ramus on the right side.CT Thorax - 06.06.09Multiple nodular lesions are noted in both lung parenchyma s/o hematogenous metastases no lymphadenopathy.

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Case Report - Extensive bone and lung metastases in CUPTumor markers : non-contributory23 June09 patient was referred to tertiary care center in Mumbai for further management.

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Case Report - Extensive bone and lung metastases in CUP23.06.09 : CT Thorax / Abdomen and pelvis Multiple lung parenchymal metastases are seen. Expansile osteolytic lesions are seen in the right iliac blade, accetabulum and sup pubic ramus. 01.07.09 : FNAC aspiration cytology of Lt lung -Consistent with metastases of adeno-carcinoma

CT Thorax / Abdomen and pelvis (P+C) at TATA Hospital: 23.06.09Multiple lung parenchymal metastases are seen. Expansile osteolytic lesions are seen in the right iliac blade, accetabulum and sup pubic ramus. FNAC aspiration cytology of Lt lung- 01.07.09Consistent with metastases of adeno carcinoma

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Case Report - Extensive bone and lung metastases in CUP08.07.09 : After extensive investigations Oncologist remarked : Extensive (metastatic) disease to unknown primary (CUP), tumor markers were non-contributoryPlan for symptomatic careTo consider palliative ChemoTo try Ayurveda treatment

23 June09 patient was referred to tertiary care center in Mumbai (Tata Hospital) for further management. After extensive investigations TATA hospital doctors 08.07.09 remarked Extensive (metastatic) disease to unknown primary, tumour markers were non-contributoryPlan for symptomatic careOption of Alternative medicine (Ayurveda) given by the oncologist Advised to consider palliative Chemo Therapy for symptom control and to maintain good general condition if symptoms are severe35


10 July 09 : Patient approached for ayurvedic treatment

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Case Report - Extensive bone and lung metastases in CUP10 July 09: C/oSevere pain in right hip joint Could walk on plain surface with support with extreme difficultySevere pain in both hip joint while walking

On 10 July 09 patient approached for ayurvedic treatment. He was able to walk with support, walking was very painful as slight pressure on right leg worsened pain. He can manage to walk on plain surface. He cannot slip on right side as it worsens his pain.He also complains of right hip joint pain and dribbling micturation since about last 1.5 years.

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Case Report - Extensive bone and lung metastases in CUP10.07.09 : (1 month after diagnosis): Ayurvedic treatment Herbo-mineral formulation, twice a dayMatra Basti fortnightly (from Oct 09)

started onHerbo-mineral formulation, twice a day with Honey and cows ghee, after food, Chandraprabha vati 2-2-2Matra Basti fortnightly since Oct 09

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X-Ray Pelvis :12..11.11

CXR :12..11.11

Conclusion:Disease is in status-quo condition which is important in view of extensive bone and lung metastases.

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Case Report - Extensive bone and lung metastases in CUP29 Jan 2014Patient was under treatment for around 4 years 9 monthHe was not taking any NSAIDs or other analgesics or any other conventional medicineThere were no SREs despite of extensive bone metastases Though the patient had moderate pain and restricted movement of the hip, he was managing all his routine work comfortably

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ConclusionNo conventional medicines usedNo SREs despite of extensive bone metastasesNo drug related side-effects The progression of disease was curtailed and the patient survived with minimum morbidity for 5 years

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Case 3 Metastatic Malignant Melanoma

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Case Metastatic Malignant MelanomaMale Age 63 yrsOct 2007Boil (lesion) of skin of Rt. Heel, thigh and lower legInguinal Lymphadenopathy 3 Nov 07 Histopathology Spindle cell melanoma of the skin of the heel

The incidence of melanoma is increasing at a dramatic rate worldwide. One in 75 Americans will have developed melanoma in the year 2000. [1] Most patients present with early-stage disease that is potentially curable with surgery alone in up to 90% of patients. However, the prognosis for patients with more advanced disease with involvement of regional lymph nodes or distant metastasis is poor, with median survival rates of 24 and 6 months, respectively. In the last few 43

Case - Metastatic Malignant Melanoma26 Nov 07 - CT Abdomen & PelvisEnhancing Rt. Inguinal lymphnodes likely to be metastasis29 Nov 2007 : Whole Body PETe/o Rt. Inguinal LN metastasisDec 2007 > ImmunotherapyLesions increased gradually

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Case - Metastatic Malignant Melanoma7 August 2008 PET ScanActive disease in multiple nodules in right heel HP: Rt. Thigh and leg biopsyMalignant MelanomaAdvised Hip Articulation > Pt. refused

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Case - Metastatic Malignant Melanoma8 July 09 R/o the patient came for consultation NEc/o Multiple nodular lesions & sever pain in the rt. LegLarge nodular ulcerative lesion on Rt. heel Oozing ++Foul smell ++Swelling ++15 July 2009 Ayurvedic treatment startedNo Chemotherapy,No Radiation

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2 Months After Treatment 17 Sept 09No foul smellNo oozingReduction in swellingRelief in pain50 % reduction in Lesions No new lesionsPatient could walk with support

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Before Treatment 4 July 092 Months After Treatment 17 Sept 09Case - Malignant Melanoma

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ConclusionIn this case of metastatic malignant melanoma the skin lesions reduced to around 50 % in 2 months of ayurvedic treatment

No CT, RT or immunotherapy was used

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Case 4 - Severe ano-rectal Pain in a Case of Metastatic Breast Cancer

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast CancerFemale Age 63 yrsRetired Professor28/02/14 c/oSevere perianal & rectal pain not relived with anti-inflamatory analgesics or opioid analgesic (morphine) since 4 months The pain lasted for 4-5 hours The severity of pain compelled patient to lie in bed. She could not even stand or walk during these episodes

Mrs RS is a 63 yr old, Christian lady. She got retired as a college professor. yrs back.

As pain was severe, unbearable with all oral analgesics and Morphine patch since last 4 months, pt consulted us on 28.2.13C/O:Sev PR pain continuous with acute onset of nature which lasts for 5-6 hr and pt has to lie in bed as difficulty in standing / walking. In supine lying position also pt doesnt get relief. Pt describes this pain as andar se kuch khichata hai n so sev that she unable to move/eat during pain. There was polyurea and mild dysurea . bowl was N, sleep less/disturbed as pain use to start at any time of the day. There was mild pain in low back and hips since last 2 months. No weight loss or pain in breast or lump noted, anxiety++ and her gait was exhausted and very slow due to pain. She was unable to sit in clinic for 15-20 mins also.

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast CancerH/oDM since 5 years on OHAHT since 15 yearsHysterectomy 2010Fracture lt. femur 2011

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast CancerH/o Presenting IllnessNov 12 she had palpable painful lump in left breast and a few palpable axilary lymph nodesFew days later she developed severe ano-rectal pain which worsened after bowel movement The pain continued even after a course of antibiotics and analgesics

Till 1st week of November 12 she was asymptomatic.In second week of Nov 12 she developed boil over Lt breast and few axillary nodes were palpable. The lump was palpable and painful. She consulted @ Fortis Hosp, finding were inflammatory? - Infected sebaceous cyst in Lt breast. Treatment given was course of antibiotics for 5 days. After medications there was regression in axillary nodes. By the time she developed sev pricking pain in perianal region more on Rt side which gets worse after defecation, the pain was continuous, intense and nagging in nature. She did MRI pelvis on 15.12.12 which showed multiple sub centric bilateral iliac nodes s/o metastasis.[Q- ?? PR pain/lump was prim symptom. If pain sev then why late in consultation, what Rx did initially]On 17.12.12 she consulted in Fortis for PR pain. There was no PR bleed, PR burning, piles or fissures. Pain severity has increased now- continuous daily pain. There was h/o constipation and straining type 1-2 on BRISTOL scale. Loss of sleep , polyurea and dysurea . There was no weight loss. PR exam/ proctoscopy were normal. She was advice T Tryptomer and further Investigation. S Creat came 1.4 with LDH 208.Whole body PET CT Scan done on 18.12.12 showed suspicious multiple bone lesions.As there was no relief in pain on 5th Jan 13 they consulted in SevenHills hosp.There was PR tenderness in perianal R from 3O clock till 6O clock, o/e no PR spasm, ? intersphincteric abscess on the Lt side, Lt breast lump palpable LT upper and inner quadrant 3x3 cm, inflammation+ with bloody discharge. Treatment started T Ultracet, Proxyvon and Tryptomer with Softovac poder 2tsf, HS. On 8th Jan she went in Tata. 3 mobile hard, ipsilateral lymph nodes were palpable with Lt breast lump in upper outer quadrant 2x1cm, matted. Histopath of same was advised. She was advised biopsy of Lt breast lump by both Tata n Seven hills hosp which she did on 9th Jan. Histopath of Lt axillary lymph node biopsy report showed metastatic cancer suspicious of breast origin. IHC panel confirmed the diagnosis as metastatic duct cancer of Lt axillary node ER/PR positive, HER2neu negative, GCDFP15 positive.As pain was very severe which was not relived by analgesics and she diagnosed as cancer, for further opinion she again consulted in SL Raheja and Tata hosp oncology dept on 14.1.13 Drs remark on her status is pain does not correlate with the radiology findings of accetabular lesion, may be due to infective focus. Like to review Xray PBH, if no lesion appreciated RT might not be indicated. On same date after opinion from Joint clinic, Dr Badwe advised Inj Zyphos 4mg/ IV once a month, T Tamoxifen 20 mg oncex 3 month, no RT suggested at present, pt ref to pain clinic for pain managementPt seen in pain clinic @ Tata. Proctoscopy, PS, PV, PR, cervical examinations were normal. X ray PBH was normal. They have advised T Durogesic 25, PCM 625 qds, Tryptomer 10 mg HS, Pan40 od as creat was 1.4, in addition to Morphine patch (when gave??? ) as pain was sev & continuous.As pain was severe, unbearable with all oral analgesics and Morphine patch since last 4 months, pt consulted us on 28.2.13

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast Cancer15.12.12 MRI PelvisMultiple small sub cm bilateral iliac nodes seen.Multiple altered signal intensity lesions in Lt lateral mass of S3, bilateral iliac bones, Rt acetabulum, Rt ischium and neck and intertrochentric region of Lt femur-possibly marrow infiltrative lesions eg- metastasis/ myeloma.

15.12.12 MRI Pelvis: (Jaipur)No obvious collection/fistula seen in perirectal region or ischiorectal fossa. Multiple small sub cm bilateral iliac nodes seen. Multiple altered signal intensity lesions in Lt lateral mass of S3, bilateral iliac bones, Rt acetabulum, Rt ischium and neck and intertrochentric region of Lt femur-possibly marrow infiltrative lesions eg- metastasis/ myeloma.

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast Cancer18.12.12 Whole body PET CT:A moderate sized nodular lesion in the anterior chest wall 3.7x2.2 cm infiltrating the skine/o Lt axillary and sub pectoral adenopathyOsseous lesion Rt. acetabulum

Histopath of Lt axillary lymph node biopsy report showed metastatic cancer suspicious of breast origin. IHC panel confirmed the diagnosis as metastatic duct cancer of Lt axillary node ER/PR positive, HER2neu negative, GCDFP15 positive.

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast Cancer15.1.13 Bone scan:Abnormal osteoblastic activity involving the Rt acetabulam and Lt anterior superior iliac spine, s/o skeletal mets. Lt SI joint and Lt humeral head are suspicious for metastatic involvements.

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast Cancer10.1.13Histopathology Lt axillary LN biopsy: Metastatic cancer, suspicious of breast origin.11.1.13Histopathology IHC panel: Lt axillary LN biopsy ER positive(60% tumour cells), PR positive (40% tumour cells), HER2neu negative, GCDFP 15- positive.

10.1.13Histopathology Lt axillary LN biopsy: Metastatic cancer, suspicious of breast origin.11.1.13Histopatholgy IHC panel: Lt axillary LN biopsy ER positive(60% tumour cells), PR positive (40% tumour cells), HER2neu negative, GCDFP 15- positive.IHC panel confirms metastatic duct cancer of Lt axillary node.

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast Cancer14.1.13 : The pain continuedRxInj Zyphos 4mg/ IV once a month, Tab Tamoxifen 20 mg od x 3 month, Refereed to pain clinic for pain managementTab Durogesic 25 tdsTab PCM 625 qds Tryptomer 10 mg HS No CT or RT was advised

As pain was very severe which was not relived by analgesics and she diagnosed as cancer, for further opinion she again consulted in SL Raheja and Tata hosp oncology dept on 14.1.13 Drs remark on her status is pain does not correlate with the radiology findings of accetabular lesion, may be due to infective focus. Like to review Xray PBH, if no lesion appreciated RT might not be indicated. On same date after opinion from Joint clinic, Dr Badwe advised Inj Zyphos 4mg/ IV once a month, T Tamoxifen 20 mg oncex 3 month, no RT suggested at present, pt ref to pain clinic for pain managementPt seen in pain clinic @ Tata. Proctoscopy, PS, PV, PR, cervical examinations were normal. X ray PBH was normal. They have advised T Durogesic 25, PCM 625 qds, Tryptomer 10 mg HS, Pan40 od as creat was 1.4, in addition to Morphine patch (when gave??? ) as pain was sev & continuous.As pain was severe, unbearable with all oral analgesics and Morphine patch since last 4 months, pt consulted us on 28.2.13

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast CancerThe pain continued 28/2/13Approached for ayurvedic treatment Severe anorectal pain ++Patient was restless due to pain O/eP : 100, BP- 220/120, RS/CVS- N, Wt- 78, PR- sentinel tag @ 3O clock, pain ++No piles/fissure/fistula noted

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast CancerAs the ano-rectal pain was very severe and was not relieved with opioid analgesic decided to give Anuvasan Basti followed by 30 Yapana bastiAbout an hour after giving anuvasana basti the pain was considerably reduced and patient went homeBy night the pain subsided

Yapana basti and Medicines started from 29/02/13

O/E:P 100, BP- 220/120, RS/CVS- N, Bowl- 1 or 2 , soft, Mictu- every 2-3 hrly with mild pain, wt- 78, Lt ankle swelling (H/O # Lt femur), PR- sentinel tag @ 3O clock, pain more on 12-3 O clock position and somewhere mid to 3-6 Oclock position, n piles/fissure/fistula noted, not much tender to touch, no breast lump/ axillary LN palpableAs pt was in terrible pain we decided to give Matra basti stat and asked her to start yapan basti asap. Matra basti of 40 ml of Sahachar tel with lower abdominal and perianal snehan swedan done at about 4pm. Pt retained the basti oil for 4-5 hrs and passed one soft motion around 9pm. While going home in hour she felt pain intensity is less and become lesser till night.As she had relief in pain and severity was reduced, from next day she opt for 30 days course of YapanB.Next day we gave her YapanB, that day she experienced severe acute onset pain twice in a day but severity was less. On 3rd Dy she came for basti saying there is no pain since morning, again we gaved her Yapan B.On 4th day there was moderate pain since morn but with 60% relief in pain intensity and frequency.On 5th Dy she told there is no pain since yest eve after B and she not took any single pain killer since morning (she took Nts dose as routine), her BP was settled to 140/70 with P 88 now, which we have recorded daily was 180-190 systolic and 110-100 diastolic prev (due to pain n stress)[On 8th Dy she had C/O PR burn and sudden current like PR pain since yest eve which lasts for seconds and disappears basti continued]From 5th day onwards, pt didnt complain about PR pain as she got 100% relief with basti and medicines. She removed Morphine patch on her own on 9th day and not took single pain killer for any pain till date.

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Case - Severe ano-rectal Pain in a Case of Metastatic Breast CancerBy 5th day the ano-rectal pain completely relievedShe removed Morphine patch on her own on 9th day and did not take single pain killer for any pain till dateYapana basti x 8 repeated on 6/7/13 & 28/1/14Last F/u 20/09/14@ 19 months Asymptomatic No further investigation

O/E:P 100, BP- 220/120, RS/CVS- N, Bowl- 1 or 2 , soft, Mictu- every 2-3 hrly with mild pain, wt- 78, Lt ankle swelling (H/O # Lt femur), PR- sentinel tag @ 3O clock, pain more on 12-3 O clock position and somewhere mid to 3-6 Oclock position, n piles/fissure/fistula noted, not much tender to touch, no breast lump/ axillary LN palpableAs pt was in terrible pain we decided to give Matra basti stat and asked her to start yapan basti asap. Matra basti of 40 ml of Sahachar tel with lower abdominal and perianal snehan swedan done at about 4pm. Pt retained the basti oil for 4-5 hrs and passed one soft motion around 9pm. While going home in hour she felt pain intensity is less and become lesser till night.As she had relief in pain and severity was reduced, from next day she opt for 30 days course of YapanB.Next day we gave her YapanB, that day she experienced severe acute onset pain twice in a day but severity was less. On 3rd Dy she came for basti saying there is no pain since morning, again we gaved her Yapan B.On 4th day there was moderate pain since morn but with 60% relief in pain intensity and frequency.On 5th Dy she told there is no pain since yest eve after B and she not took any single pain killer since morning (she took Nts dose as routine), her BP was settled to 140/70 with P 88 now, which we have recorded daily was 180-190 systolic and 110-100 diastolic prev (due to pain n stress)[On 8th Dy she had C/O PR burn and sudden current like PR pain since yest eve which lasts for seconds and disappears basti continued]From 5th day onwards, pt didnt complain about PR pain as she got 100% relief with basti and medicines. She removed Morphine patch on her own on 9th day and not took single pain killer for any pain till date.

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ConclusionThe presenting complaint of severe anorectal and perineal pain, which was not relieved with morphine, etc. Had complete relief in pain in only 5 days of treatmentNo CT or RT was givenOn her last visit 19/09/14 , 22 months post detection of metastatic CA, she is asymptomaticThere is no clinical evidence of disease

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What is Cancer?leading cause of deathEstimated 14.1 million cancer cases around the world in 2012Expected to increase to 24 million by 2035.

CA: A Cancer Journal for CliniciansVolume 64, Issue 1, pages 9-29, 7 JAN 2014 DOI: 10.3322/caac.21208http://onlinelibrary.wiley.com/doi/10.3322/caac.21208/full#caac21208-fig-0001Cancer statistics, 2014

Cancer is a leading cause of death worldwide and the total number of cases globally is increasing.

There were an estimated 14.1 million cancer cases around the world in 2012, of these 7.4 million cases were in men and 6.7 million in women. This number is expected to increase to 24 million by 2035.63

What is Cancer?Diseases in which abnormal cells divide without control and are able to invade other tissues.Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Cancer cells can spread to other parts of the body through the blood and lymph systems.Most cancers are named for the organ or type of cell in which they start e.g. breast CA, Colon CA, Lung CA, etc.

Cancer is a term used for diseases in which abnormal cells divide without control and are able to invade other tissues. Cancer cells can spread to other parts of the body through the blood and lymph systems.Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.

Cell Lifespan50 and 75 trillion cells in the bodyEach type of cell has its own life spanStomach 2 daysSpermatozoa 2-3 daysColon 3-4 daysPlatelets 10 daysSkin 19-34 daysBone 25-30 yearsBrain Lifetime

There are between 50 and 75 trillion cells in the body.... Each type of cell has its own life span,Cell typeLength of timeRed blood 120 daysLymphocytes Over one yearOther white 10 hoursPlatelets 10 daysBone 25-30 yearsBrain LifetimeColon 3-4 daysSkin 19-34 daysSpermatozoa 2-3 daysStomach 2 days

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Thus cancer often explodes in something akin to a chain reaction caused by a few errors, which compound into more severe errors. Errors which produce more errors are effectively the root cause of cancer, and also the reason that cancer is so hard to treat: even if there were 10,000,000,000 cancerous cells and one killed all but 10 of those cells, those cells (and other error-prone precancerous cells) could still self-replicate or send error-causing signals to other cells, starting the process over again. This rebellion-like scenario is an undesirable survival of the fittest, where the driving forces of evolution itself work against the body's design and enforcement of order. In fact, once cancer has begun to develop, this same force continues to drive the progression of cancer towards more invasive stages, and is called clonal evolution.[6]

When normal cells are damaged beyond repair, they are eliminated by apoptosis (A). Cancer cells avoid apoptosis and continue to multiply in an unregulated manner (B).

Conventional Cancer Treatment

Surgery (for local and local-regional disease)Radiation therapy (for local and local-regional disease)Chemotherapy (for systemic disease)Other important methods includeHormonal therapyImmunotherapyTargeted drugs

Curing cancer requires eliminating all cancer cells. The major modalities of therapy areSurgery (for local and local-regional disease)Overview of Cancer Therapy

Radiation therapy (for local and local-regional disease)Chemotherapy (for systemic disease)Other important methods includeHormonal therapy (for selected cancers, eg, prostate, breast, endometrium)Immunotherapy (monoclonal antibodies, interferons, and other biologic response modifiers and tumor vaccinessee Immunotherapy of Cancer)Differentiating drugs such as retinoidsTargeted drugs that exploit the growing knowledge of cellular and molecular biology

Modalities of Cancer Therapy : Principles of Cancer Therapy

Surgery Primary tumor resection Resection of metastases Cytoreduction Palliative surgery Reconstructive surgery Radiation Therapy Types of radiation therapy Adverse effects Chemotherapy Cytotoxic drugs Hormonal therapy Biologic response modifiers Differentiating drugs Antiangiogenesis drugs Signal transduction inhibitors Monoclonal antibodies Vaccines Multimodality and Adjuvant Chemotherapy Adjuvant therapy Neoadjuvant therapy Bone Marrow/Stem Cell Transplantation Gene Therapy

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Defining Response to Cancer TreatmentCure : Long-term absence of symptoms or signs Complete remission : Disappearance of clinical evidencePartial response : 50% reduction in size of tumor mass or massesStable disease : Neither improvement nor worseningDisease-free survival : Interval between disappearance of the tumor and relapseProgression-free survival : Time from initiation of treatment to time of overt progression in a surviving patient Survival time : Time from diagnosis to death

Defining Response to Cancer Treatment Term

Cure Long-term absence of symptoms or signs of a disease, although patients who appear to be cured may still have viable tumor cells that eventually cause relapse

Complete remission (complete response) Disappearance of clinical evidence of disease

Partial response > 50% reduction in size of tumor mass or masses, sometimes leading to significant palliation and prolongation of life but with inevitable regrowth of the tumor

Stable disease Neither improvement nor worsening

Disease-free survival (disease-free interval)Interval between disappearance of the tumor and relapse

Progression-free survivalTime from initiation of treatment to time of overt progression in a surviving patient

Survival time Time from diagnosis to death

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Ayurveda Concepts

69

Aims and Objectives

Prevention

Cure

All powers in the Universe are already ours- Swami Vivekanand

Space

Air

Fire

Water

Earth

Pinda Bamhanda

Human beingUniverse

71

Ayurvedic Concepts of Disease Manifestation and Treatment Health = Equilibrium of DoshaDhatu MalaAgniAtma Indriya - Mana

72

Ayurvedic Concepts of Disease Manifestation and Treatment

Kapha

Vata

PittaDosha

SwedaPurishaMutraMala

Rasa

Rakta

Mansa

Meda

Asthi

Majja

ShukraDhatu

Dosha Dhatu Mala Mulam73


TransformationAgniPitta

The word agni is Sanskrit for "fire" (noun), cognate with Latin ignis (the root of English ignite), Russian (ogon), Polish "ogie", Slovenian "ogenj", Serbo-Croatian oganj, and Lithuanian ugnisall with the meaning "fire", with the reconstructed Proto-Indo-European root being hgni-. Agni has three forms: fire, lightning and the Sun.[4]In Hindu scriptures, Agni is the God of Fire, and is present in many phases of life such as honouring of a birth (diva lamp), prayers (diva lamp), weddings (Yagna where the bride and groom circle 7 times) and death (cremation).

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Ayurvedic Concepts of Disease Manifestation and Treatment Movement = VataEnergy = Pitta > AgniBond = Kapha

Structure = Cell, physical dhatu =tissue

Equilibrium of dosha and dhatu = Normal cellular functions and structureDosha at Cellular Level

75

Ayurvedic Concepts of Disease Manifestation and Treatment Molecular Basis of Rx

Dosha = Function = Physiological activities

Dhatu = (Davya) = Structure = Anatomy

Disease = Vitiated Dosha + Dushya blending

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Ayurvedic Concepts of Disease Manifestation and Treatment Dosha vaishamya = imbalance of the function of the respective dosha Dhatu vaishamya = disruption of the cellular structureAgni vaishamya = failure of proper transformation

77

Physiological Changes In DoshaExcitationPrakopa 2NormalcyPrashama 3AccumulationChaya 1AgeDayNightMeal

Vaya Aho Ratri BhuktaSeasonAntya Madhya Adi

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ExcitationPrakopa 2NormalcyPrashama 3AccumulationChaya 1Ayurvedic Concepts of Disease Manifestation and Treatment Vitiation

SpreadPrasara 3Occupying Dhatu Sign / SymptomsVyakti 5DifferentiationBheda 66 Stages of disease manifestation

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DOSHA

DUSHYA

Causative Factors

Kapha

Vata

Pitta

Rasa

Rakta

Mansa

Meda

Asthi

Majja

Shukra

Vyadhi Utpatti80

Khavaigunya - Vulnerability

Kupitanam hi doshanam sharire paridhavatam ..81

Khavaigunya - Vulnerability

Rasa

Mansa

Meda

Asthi

Majja

Shukra

Kapha

Vata

Pitta

Rakta

82

Blending of Vitiated Dosha and Dhatu

Kapha

Vata

Pitta

Rasa

Rakta

Mansa

Meda

Asthi

Majja

Shukra

Meda

Kapha

Vata

Pitta

Rasa

Rakta

Mansa

Asthi

Majja

ShukraDisease

Vyadhi Utpatti83

Dissociation of Dosha and Dushya Blend

Kapha

Vata

Pitta

Rasa

Rakta

Mansa

Meda

Asthi

Majja

Shukra

Meda

Kapha

Vata

Pitta

Rasa

Rakta

Mansa

Asthi

Majja

ShukraDiseaseHealth

Vyadhi Utpatti84

Normal Cell GenerationNormal Cell

Genetic Information(Shukra Dhatu)

Control Mechanism(Vata Dosh)

According to ayurved, regeneration of cells is carried out by the shukra dhatu and is controlled by the vata dosha. The uncontrolled cell division is a result of imbalance of vata dosha, which results into neoplasm (The hypothesis of cancer).As shukra dhatu is sarvadehik, every cell in the body has an inbuilt potential of replication / reproduction, in favorable situations. The akasha provides space for accommodation of such multiplying cells (as garbhashaya uterus provides space for growth of embryo). Any space or akasha (Kha) is therefore a potential garbhashaya (e.g. test-tube baby). However, if such situation is created in space other than the one designated for the purpose, it is abnormal- Kha-vaigunya.Some of the cancerous cells may be carried to such distant places with the circulation, and if they find a suitable place for harboring, they may replicate in that place if the condition is favorable (Yatra Sanga: Khavaigunyat Vyadhi: tatropjayate). Therefore, a cancer cell can migrate to any place in the body and start multiplying and produce metastatic cancer. Embryologically, the kidneys are created from the essence of Rakta dhatu and Meda dhatu (Rakta Meda Prasadajou Vrukou). In ayurvedic therapeutics, this reference needs to be viewed in terms of probable mode or route of samprapti (etio-pathology) and its reversal (chikitsa - treatment). Medicines which act on rasa dhatu and meda dhatu would therefore probably be helpful in treating any pathology of Kidney. In the metastatic bone cancer, Asthi predisposed by kha vaigunya acts as a site which allows the growth of cells from a distant tissue. This space (kha) also requires special attention while treating metastatic cancer. Therefore, to achieve khavaigunya less perfect asthi dhatu, rasayana treatment (labhopayo hi shastanam rasdinam rasayanam) of ashti becomes inevitable.Asthi dhatu and vata dosha have ashraya- ashrayee (interdependent) relationship. Basti is an ideal treatment for vata dosha related diseases. Therefore, basti is an ideal procedure to treat kha vaigunya in asthi dhatu. Rajayapana basti is a type of basti in which a specific formulation, as described in treaties of ayurved, is administered per rectum. It is useful in controlling the cell division.In the hierarchy of production of dhatu, Asthi dhatu is produced from the Meda dhatu by removing sneha from it through process of khara paka (Medasa: sneham Aadaya sira snayutvam aapnuyat snayunam ch mridu paka siranam ch tat: khara) Therfore, rasayana treatment directed at mada dhatu should also benefit as rasayana for asthi dhatu. The herbomineral formulation used internally, is a combination of generic formulations described in ayurvedic treaties. Each of these formulations has a specific role in the management of neoplasm and prevention of its relapse.85

Cancerous Cell GenerationCancerous Cell

Faulty Genetic Information(Shukra Dhatu)

Defective Control Mechanism(Vitiated Vata Dosha)


Ayurvedic ManagementExcitationPrakopa 2NormalcyPrashama 3AccumulationChaya 1Vitiation

SpreadPrasara 3Occupying Dhatu Sign / SymptomsVyakti 5DifferentiationBheda 66 Stages of disease manifestation

Kupitanam hi doshanam sharire paridhavatam ..

Not to allow vitiationNot to allow spreadNot to allow dosha-dusha samurchana87

Bala Immunity

General

Rasa

Rakta

Mansa

Meda

Asthi

Majja

ShukraSpecific

Inherent Strength

inherent Bala Kapha moolam balam

General Specific

Sahaja InnateKalaj Yuktikruta Acquired 88

Bala - Immunity

By birthSeasonal

Acquired

Bala Kapha moolam balam Sahaja InnateKalaj Yuktikruta Acquired 89

Target of Treatment

Control of Cell divisionPromoting ApoptosisImproving Tissue ImmunityFortifying defense of probable target tissue of metastases Preventing Recurrence

90

Basic Treatment Modalities

Reducers (Langhana)Augmenters (Bruhana)

91


Augmenters (Bruhana)

Water

Earth

Reducers (Langhana)

Space

Air

Fire

MadhuraAmlaLavana92


Reducers (Langhana)Pacifiers(Shamana)Purifiers(Shodhana)Medicines that balances vitiated dosha without removing them from body

Medicines that dislodge and expel vitiated dosha from body

PanchakarmaVamana, Virechana, Basti, Nasya, Raktamokshana

ShamanaMedicines that reduces increased dosha without interfering with normal dosha

Shodhana

93

Pharmacokinetics Taste (Rasa)Change in rasa after digestion (Vipaka) Change in Properties (Gunantara)Potency (Veerya)Character (Swabhava)Incomprehensible (Vichitra pratyarabdha)

RasaVipakaGVeeryaVipaka

94

Rasa PropertiesAugmentersReducers

Sweet

EarthWater

Salty

Water

Fire

Amla

Earth

Fire

Bitter

Space

Air

Pungent

Fire

Air

Astringent

Earth

Air

Absolute bruhanaAbsolute langhanaRelative langhana

Absolute bruhana Relative bruhanaAbsolute langhana95

ReducersChange of taste post digestion - VipakaPotency - VeeryaSweetAcidicSaltyHotColdIndependent of Digestive Fire

96

TreatmentDosha balancing PanchakarmaMedicineRasayana

Dhatu Specific Panchakarma MedicinesRasayana

97

Now lets apply these concepts to our case

98

Cancerous Cell GenerationCancerous Cell


Defective Control Mechanism(Vitiated Vata Dosha)Little Recap


Kapha

Vata

PittaCase 1 RCC + Bonemets

KidneysEmbryologyDhatu constituentsDosha

Rakta

Meda

AsthiMetastasis

ShukraCell replication

100

Dosha Balancing TreatmentBastiPanchakarma of choice for vata balancingMedicines given through rectal rout Large intestine main place of vatadosha Not for evacuation of bowlVatadosha balancing

Shodhana of DoshaNo Shodhana of Dhatu101

Dosha Balancing Treatment

Yapana Basti Mustadi Yapana basti - Cha. Si 2/27 Yapana = Prolonging life, supportive to life, curing Benefits Improves quality shukra, mansa and agniInstantly strengtheningCures vata pitta kapha and rakta mediated diseasesRasayana

Shodhana of DoshaNo Shodhana of Dhatu102

MedicineHerbo-mineral formulation Containing:Sitopaladi Churna Hirak Bhasma ShankhabhasmaAbhrak bhasmaSuvarna bhasmaRajata bhasmaTamra bhasmaBruhatvata chintamani rasaMakardhwaja rasaSheelajeet

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Properties of Ingredients

MedicineMain PropertiesSitopaladi ChurnaImproves dhatu-agni, Hirak bhasmaBest rasayana, rejuvenator, fertility promoter, aphrodisiac

Shankha bhasmaUseful in reducing tumor mass

Sitopaladi Churna Hirak BhasmaAbhrak bhasmaSuvarna bhasmaRajata bhasmaTamra bhasmaBruhatvata chintamani rasaMakardhwaja rasaSheelajeet

104


MedicineMain PropertiesAbhrak bhasmaPromotes strength, useful in diseases of nervous system Suvarna bhasmaRasayana, Increases oja, Vayasthapana (enhances quality of life), Rajata BhasmaLekhana (removes excess cells), Vata pacifier, rejuvenator,


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MedicineMain PropertiesTamra BhasmaLekhana, useful in vata-kapha diseases, useful in reducing tumor mass

Bruhat Vata Chintamani Rasa Rasayana, strength promoter, fast acting, vata dosha balancing

Makaradhwaja rasaRasayana, improves fertility, restores physical and psychological strength, improves cell regeneration

Tamra bham: Tikta, Kahay, Madhur, Ushnaveerya, Vishahara, sarak, laghu, tridhsha hara, anti-obesity,Yakrut-plihodara, 1/8 to ratti106


MedicineMain PropertiesSheelajeetRasayana, balances meda dhatu, Praval Pishti Tridosha shamak, strength enhancer, Mukta PishtiRejuvenator, helps regeneration, medahara, prevents bone resorption


107

Outcome Normal Cell


Defective Control Mechanism(Vitiated Vata Dosha)

According to ayurved, regeneration of cells is carried out by the shukra dhatu and is controlled by the vata dosha. The uncontrolled cell division is a result of imbalance of vata dosha, which results into neoplasm (The hypothesis of cancer).In the metastatic bone cancer, Asthi predisposed by kha vaigunya acts as a site which allows the growth of cells from a distant tissue. This space (kha) also requires special attention while treating metastatic cancer. Therefore, to achieve khavaigunya less perfect asthi dhatu, rasayana treatment (labhopayo hi shastanam rasdinam rasayanam) of ashti becomes inevitable.Asthi dhatu and vata dosha have ashraya- ashrayee (interdependent) relationship. Basti is an ideal treatment for vata dosha related diseases. Therefore, basti is an ideal procedure to treat kha vaigunya in asthi dhatu. Rajayapana basti is a type of basti in which a specific formulation, as described in treaties of ayurved, is administered per rectum. It is useful in controlling the cell division.In the hierarchy of production of dhatu, Asthi dhatu is produced from the Meda dhatu by removing sneha from it through process of khara paka (Medasa: sneham Aadaya sira snayutvam aapnuyat snayunam ch mridu paka siranam ch tat: khara) Therfore, rasayana treatment directed at mada dhatu should also benefit as rasayana for asthi dhatu. The herbomineral formulation used internally, is a combination of generic formulations described in ayurvedic treaties. Each of these formulations has a specific role in the management of neoplasm and prevention of its relapse.108

110

treatment of cancer in ayurveda

Healthcare