ISSN 0976 - 0075
“It is often more important to know what kind of patient has the disease, than what kind of disease the patient has.”
- H.Flanders Dunbar,
“Psychosomatic diagnosis”
(1943)
The above fundamental principle holds strong resemblance to the philosophy of Ayurveda. The ancient wisdom of Ayurveda has immense potential to be explored in scientific light. Cancer being one of the leading cause of adult deaths worldwide
“It is often more important to know what kind of patient has the disease, than what kind of disease the patient has.”
- H.Flanders Dunbar,
“Psychosomatic diagnosis”
(1943)
The above fundamental principle holds strong resemblance to the philosophy of Ayurveda. The ancient wisdom of Ayurveda has immense potential to be explored in scientific light. Cancer being one of the leading cause of adult deaths worldwide, Ayurveda is being viewed with great hope for prevention and cure against the dreadful disease. In India, the International Agency for Research on Cancer estimated indirectly that about 635 000 people died from cancer in 2008, representing about 8% of all estimated global cancer deaths and about 6% of all deaths in India.1 Despite being non communicable, it can be called as epidemic of modern times.
The etio-pathogenesis of cancer is much better understood today than it was a few decades ago. Epidemiology has revealed that certain cancers are more common among people of some cultures than others. This phenomenon suggests a greater role for lifestyle than for genotype. The recent popular inclination towards traditional medical systems have prompted the US National Cancer Institute to examine the traditional concepts of lifestyle that play a role in cancer prevention. 2 With the limitations of modern medicine in treatment of cancer, an integrated approach is required towards its management. The authors observed that though the perspective of modern medicine on cancer may not completely concur with the Ayurveda theory, but there have numerous evidences of concurrence regarding Cancer between the two medical sciences. The authors have used oral administration of Praval Bhasma for patients undergoing Chemotherapy and observed that it increased patient’s tolerance to sustain more cycles of chemotherapy.
This article is an attempt to highlight the potential concurrence and explore the scope of understanding and management of Cancer through Ayurveda perspective.
Philosophy of Ayurveda :
The term “Ayurveda” derived from the Sanskrit words “ayur” (life) and “veda” (knowledge), takes a holistic approach to health and regards life as a equilibrium between body, sense organs, mind and soul.
शरिरेन्द्रियसत्त्वात्मा संयोगो धारि जीवितम् । नित्यगश्चानुबन्धश्च पर्यायैरायुरूच्यते ॥ - च. सू.१/४२
Thus, having a strong mind-body component, Ayurveda considers life-threatening diseases through a holistic standpoint. According to Ayurveda, there is no specific single entity termed as cancer. It is a group of chronic disorders related to long term underlying disturbances affecting various dosha and dhatu.A careful and critical review of Samhitas will reveal that though there is a general notion of correlating Arbuda or Granthi with Cancer, it would be rather agreeable to say that these represent different stages or types of the disease presently known as cancer, than the disease itself. According to certain school of thoughts among the Ayurveda Vaidyas, the pathology of cancer can be correlated with the following diseases mentioned in the samhitas.
|
Dushta Shotha |
Dushta Visarpa |
Sannipatik Jwara |
|
Dushta Granthi |
Dushta Nadivrana |
Pandu |
|
Dushta Arbud |
Dushta Mansapradoshaj vikara |
Raktapitta |
|
Dushta Vidradhi |
Rasa Rakta Dhatugat jwara |
Raktaj Krimi |
Hetu (Etiological factors) of Cancer :
नरो हिताहारविहारसेवी समिक्ष्यकारी विषयेष्वसक्तः ।
दाता समः सत्यपरः क्षमावानाप्तोपदेशसेवी च भवत्यरोगः ॥- च. शा. २/४६
Ayurveda advocates that, one who follows the rules of appropriate eating habits, behavioural code of conduct, vigilant about one’s actions, non indulgent, benevolent, balanced nature, truthful, forgiving and believes in the traditional wisdom, will be disease free. However, with present-day changes in lifestyle, we have remarkably deviated from these guidelines for a disease free life. According to Ayurveda, non compliance with guidelines of Dincharya, Ritucharya, Ratri charya, Aachar rasayana, etc. are deeply involved in etiology of cancer.
Evidence suggests that most cancers are not of hereditary origin and that lifestyle factors, such as dietary habits, smoking, alcohol consumption, and infections, have a profound influence on their development.3
कालबुद्धीन्द्रियार्थानां योगो मिथ्या न चाति च ।
द्वयाश्रयाणां व्याधिनां त्रिविधो हेतुसंग्रहो ॥ - च. सू.१/५४
In Ayurveda, Trividha Karana are described as causative factors of disease i.e. Kaal, Asatmya Indriyartha Samyog & Pradnyaparadha. Kaal is the effect of age, seasons and life cycles on the health; Asatmya Indriyartha Samyog is overuse, non use or misuse of senses; Pradnyaa aparadha is misuse of intellect by making wrong or unhealthy choices.
Etio-pathogenesis of Cancer- Ayurveda perspective-
According to Ayurveda, Patho genesisCancer in each person differs according to the person’s exposure to pathogens and genetic constitutions which make each of them to react differently to the same diet. The Samprâpti (etio-pathogenesis) encompasses the Dosha, Dusya, and Adhisthanâ components (humors, body tissues, and seat of the disease, respectively). Though the causative factor or etiology of cancer is still obscure, from Ayurvedic point of view, it is a disease with the involvement of three doshas, mamsa, rakta and medas as principal dushyas.
The Samprapti (pathogenesis) of Cancer can be explained as follows:
Hetu sevan- i.e. Exposure to etiological factors
(Guru aahar, virudhdha dravya, Dushi-VishaVegvidharan,
Shadripu, pradnyaaparadh, etc.)
Vitiation of Tri dosha
Jathragnimandya, Dhatvagnimandya
Amotpati
Apaachit dhaatu sanshiti and dhatu vikriti
Shotha ,Vranashotha,Arbuda
A recent study on “shared pathology” between cancer and metabolic syndrome, reported that “ chronic inflammation”, correlated the biochemical aberrations of carcinogenesis with the Ayurvedic concept of “Aam”.4
Suppression of natural urges as described in Ayurveda, is an important factor in pathogenesis of specific diseases. Vega dhaarana typically vitiates Vaata dosha which is the “stimulator” or the “controller” of body metabolism. This vitiation in metabolic control is one of the major reasons for uncontrolled cell growth in cancer.
रोगाः सर्वेऽपि जायन्ते वेगोदीरणधारणैः ॥- वा. सू.४/२२
संचयं च प्रकोपं च प्रसरं स्थानसंश्रयं ।
व्यक्तिं भेदश्च यो वेत्ति दोषाणां स भवेद्भिषक् ॥- सु. सू. २१/३६
Sushruta has proposed six stages in the pathogenesis of any disease:
|
1. Sanchaya |
early stages of localized neoplastic changes |
|
2. Prakopa |
transformation of primary growths into metastatic tumours |
|
3.Prasara: |
metastasis |
|
4.Sthana samsraya |
complete metastasis and secondary growth |
|
5.Vyakti |
clinical signs and symptoms are expressed. |
|
6.Bheda |
the stage where differentiation of growth occurs on the basis of histopathology
|
Association between Psychological distress and cancer mortality
शरीर सत्त्वं च व्याधीनामाश्रयो मतः ॥- च. सू.१/५५
Psychological distress has been associated with a higher risk of incident cancer and poorer survival and is a predictor of cancer mortality. A study on ‘Psychological distress and cancer mortality’ by Hamer et al concludes that the stress-prone personality or unfavorable coping styles and negative emotional responses or poor quality of life were related to higher cancer incidence, poorer cancer survival and higher cancer mortality.5
The Complementary and Alternative Medicine Program at Stanford University (CAMPS) conducts special mind-body classes and treatments through the Stanford Center for Integrative Medicine .6
Prakriti and Cancer correlation:
In recent times data from several human epidemiological studies suggest positive correlation between prakriti and cancer. In a study conducted on “Breast cancer in relation to prakriti “ at Institute of Medical Sciences, Banaras Hindu University, Varanasi it was observed that the disease was more prevalent in Kaphaja Prakriti patients.7 Though this study was a small sample study and not published, it may still give a direction in early detection and assessment of prognosis in mass screening programme of breast cancer
In a study conducted by Venkataraghavan, S. et al. on “constitutional study of cancer patients, it was found that Pitta dominant prakriti has greater incidence of cancer followed by Kapha. Vata prakriti people show increased tendency to develop bone cancer, pitta prakriti people leukemia or blood cancer and Kapha prakriti people show increased tendency for cancer involving adipose tissue.8
|
Dosha |
Mukhya stana |
Organs (Sthan) |
|
Vata |
BelowUmbilicus (Adho Nabhi) |
Pakwashaya,Basti ,Garbhashaya,Kati,Sakhti, Karna ,Asthi. e.g. bone cancer, colonic cancers |
|
Pitta |
Between Nabhi and Hrudaya |
Nabhi ,Amashaya ,Sweda .Lasika,Rakta,Rasa ,Drushti e.g. leukaemia, cancers of small intestine, liver, skin, etc. |
|
Kapha |
Above Hrudaya |
Ura,Kantha ,Shir,Fuffus,Sandhi ,Amashaya,Rasa ,Meda,Nasa,Jivha e.g. cancers of breast, lung, adipose tissue involvement, etc |
Sattva and Cancer correlation:
Sattva is the unique concept of Ayurveda. It resembles the integrity of mind. In a study on Breast Cancer patients (Infiltrating Duct Carcinoma) it was observed that Sattva of an individual is not only responsible for development of disease but also the prognosis of disease. Pravara Satva patients are less prone to the disease due to their superior mental strength. Avara Satva patients show poor compliance and prognosis. 9
Triguna (Manasa Dosha) and Cancer correlation:
In a study on 150 patients of Breast Cancer patients (Infiltrating Duct Carcinoma), it was observed that maximum number of patients were of Rajas Pradhan Tamas Prakruti (109 patients), out of which 81 patients (74.31 %) were lying in stage III. This study reflects more incidence of Breast Cancer patients with Rajasa Pradhan Tamasa Prakriti. 9
The Ayurveda philosophy propounds that; Raja Guna is “the stimulator”.i.e. it is responsible for Paramanu Bhedana (Cell division) due to its Pravartakatva. Vitiation of Raja Guna is responsible for abnormal cell division leading to Cancer. Tama Guna is inactive in the absence of Raja Guna Raja & Tama Guna are always associated with each other. Thus this phenomenon of uncontrolled cell growth is more common in Rajasa Pradhan Tamasa Prakriti.
Tamo guna predominance in hetus (etiology) of Cancer:
Madakari dravya (narcotic drugs) have the predominance of Tama guna. Tobacco possesses properties of Visha like Madakara (Causes narcosis), Agneya (Ushna) & Tikshna. These properties are responsible for Rakta Dushti, Dhatu Paka Avastha & Oja Kshaya which are the main factors involved in Samprapti of Dushta Stanarbuda. Oja having the properties just opposite to Visha, get affected by excessive & frequent intake of Tobacco. It has been mentioned in Cancer that tobacco & tobacco smoke contain at least 4000 chemicals of which 55 are known carcinogens identified by the International Agency for research in cancer.
World Health Organisation, in one of its facts sheets in 2014, mentioned that there are more than 4000 chemicals in tobacco smoke, of which at least 250 are known to be harmful and more than 50 are known to cause cancer.10
Underlying philosophy of Ayurveda in Cancer management-
Ayurveda regards that, "it is neither possible nor necessary to 'name' every disease because every patient is unique in terms of the nature of his or her illness and its precise clinical presentation and thus the required treatment,”
विकारनामाकुशलो न जिर्हियात्कदा च न ।
न हि सर्वविकाराणां नामतोऽस्ति ध्रुवा स्थिति ॥- वा. सू.१२/६४
Therefore, the treatment is designed to match the nature, or pathogenesis (Samprâpti), of the illness, rather than the specific name of the illness (such as cancer or diabetes).
The therapeutic approach of Ayurveda has various approaches depending upon the type and stage of the disease. E.g. Nidaan parivarjan, Prakriti vighaat, apunarbhava Rasayana chikitsa (restoration Naishthiki chikitsa).
Ayurvedic anticancer therapy includes recommendations for lifestyle and use of specific foods and herbs which are very helpful not only in preventing the progression of the disease but also makes boosts immunity. Various ayurvedic drugs e.g. Bacopa monniera , Withania sominifera, Glycyrrhiza glabra, Ocimum sanctum , Curcuma longa, Terminalia chebula, Asparagus racemosa, Hydrocotyle asiatica, Nardostachys jatamamsi, Elettaria cardamomum, Tribulus terrestris, Zingiber officinalis eclipta alba are found to be effective as prime medicine or as adjuncts in anti cancer therapy. 11
Ayurvedic medicinal plants with anti-cancer properties:
A report was published in 2009 on “screening of single herbal drug extracts for potential anti-cancer activity “ by ACTREC (Advance Centre for Treatment, Research and Education in Cancer) and CCRAS(Central Council for Research in Ayurveda and Siddha), Dept. of AYUSH, Ministry of Health & family welfare. This report created monographs of potential anti cancer activity in 15 Ayurvedic drugs against different cancerous cell lines.
In a study to evaluate anti-cancer and anti-tumor properties of indigenous medicinal plants, extracted in ethyl alcohol and tested to measure their cytotoxicity against tumor (COLO 320) cells, Arka (Calotropis procera) flowers and Bhallâtaka (Semecarpus anacardium) nuts appeared to have the greatest cytostatic activity. 12 The study concluded that the method using data from Ayurveda was shown to provide possible new leads for products, In particular, nutrition-based and immunologic mechanisms that might be useful for treatment of cancer." Clustering of certain properties (such as bitter, pungent, and astringent tastes [Rasas] and hot biopotency [Virya]) among these plants suggested that plants with these properties may hold promise as anti-cancer agents.
Ayurveda- evidence-based management of Cancer:
Memorial Sloan Kettering Cancer Center, the world's oldest and largest cancer center, has advocated the anti-cancer properties of Triphala in their integrative medicine approach.13 Triphala is found to inhibit both in vitro and in vivo xenograft growth of pancreatic tumor cells by inducing apoptosis and by its anti oxidant properties.14
Vaidya Balendu Prakash, has scientifically established the role of Ayurvedic herbo-metallic formulations in certain form of blood cancers e.g. Acute promyelocytic leukemia (AML). The prospective potential in this evidence is being explored by the Office of Cancer Complementary and Alternative Medicine (OCCAM) in National Cancer Institute, by evaluating the available case report documentation of unconventional cancer approaches. 15
Conclusion and future directions
The ancient wisdom of Ayurveda needs to be explored in a scientific light. The safety and toxicity profiles of numerous anticancer agents are unexplored scientifically. The Vaidyas, researchers, scientists have to work together to generate various levels of evidence as per WHO guidelines to describe the strength of the results observed in a clinical trial or research study. Leads from sound documentation from Ayurveda practitioners with Case study as the research design can form basis for future research direction. Case studies have also been suggested by the NCCAM (National Center for Complementary and Alternative Medicine, Bethesda, USA) as a means to determine whether a traditional anticancer therapy demonstrates potential efficacy against particular cancer. 16
We need to initiate multi disciplinary, yet unified efforts towards establishing Ayurveda as an evidence based medical science towards management of Cancer.
About Authors:
1Prof. Dr. Arun Jamkar, Vice Chancellor, Maharashtra University of Health Sciences, Nashik
2. Vd. Shweta Telang, Asst. Professor, Dept. of AYUSH, Maharashtra University of Health Sciences, Nashik
3. Vd. Sharmili Suryavanshi, Asso. Professor, Dept.of AYUSH, Maharashtra University of Health Sciences, Nashik
4. Vd. Pradip Awale, Asso. Professor & Head of the Department, Dept.of AYUSH, Maharashtra University of Health Sciences, Nashik
Bibliography-
9 A study on Breast Cancer patients (Infiltrating Duct Carcinoma) through Ayurveda perspective available online at http://shodhganga.inflibnet.ac.in/bitstream/10603/27127/16/16_chapter%207.pdf
10 Information available online at http://www.who.int/mediacentre/factsheets/fs339/en/ last accessed on 09/02/2015
11 Balachandran, P., & Govindarajan, R. (2005). Cancer—an ayurvedic perspective. Pharmacological research, 51(1), 19-30.
12 Smit HF, Woerdenbag HJ, Singh RH, Meulenbeld GJ, Labadie RP, Zwaving JH J Ethnopharmacol. 1995 Jul 7; 47(2):75-84.
13 Information available online at http://www.mskcc.org/cancer-care/herb/triphala last accessed on 09/02/2015
14 Shi Y, Sahu RP, Srivastava SK. Triphala inhibits both in vitro and in vivo xenograft growth of pancreatic tumor cells by inducing apoptosis. BMC Cancer. 2008 Oct 10;8:294.
15 A review on an Ayurvedic Approach for Cancer Treatment developed by Vaidya Balendu Prakash Sanjoy Kumar Pal School of Animal & Range Sciences, College of Agriculture & Environmental Sciences, Haramaya University, Ethiopia
16 Office of Alternative Medicine. Office of alternative medicine workshop on the collection of clinical research data relevant to alternative medicine and cancer[M]. Bethesda: Office of Alternative Medicine, 1994.
