Tackling Cancer Through Treatment Concepts of AyurvedaCoronavirus, Ayurveda, Lifestyle, Prevention, immunity.

INTRODUCTION

Cancers are a large family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body.3 They form a subset of neoplasms. A neoplasm or tumour is a group of cells that have undergone unregulated growth and will often form a mass or lump, but may be distributed diffusely.⁴ Vayu is usually responsible for vibhajana and it is taken as cell division here⁵ . Uncontrolled cell division would refer to VataKarmatahaVrudhi.

All tumour cells show six hallmarks of cancer. These characteristics are required to produce a malignant tumour. They include:

• Cell growth and division isabsent and loss of proper signals – signals would mean again Vayu Vaiparitya that is GandhanaKarma⁶ is lost (circulating the information/ signals on the right time to the right cell).

• Continuous growth and division even given contrary signals – vayuchalaguna and karmatahavrudhi / uncontrolled vayu.

• Avoidance of programmed cell death.

• Limitless number of cell divisions- vata initiated vibhajana karma (karmatahavrudhi)

• Promoting blood vessel construction

• Invasion of tissue and formation of metastasis.

The progression of normal cells to cells that can form a detectable mass to outright cancer involves multiple steps known as malignant progression.[7]

Ayurvedic words for abnormal growth are based on the type and location, and are assigned in a similar fashion. Granthi, Arbuda, Gulma, Asthila, Balmika, Shalukaare some of the words. Thus, names assigned by both systems generally refers to neoplasms found within theparticular organ or body tissues[7]

Classification of Neoplasm[4]:

Neoplasms are divided into two pathogenic natures, benign and malignant.Cancers are classified by the type of cell that the tumour cells resemble and are therefore presumed to be the origin of the tumour. These types include:

• Carcinoma: Cancers derived from epithelial cells. This group can manifest many of the common cancers and include nearly all those in the breast, prostate, lung, pancreas and colon.

• Sarcoma: Cancers arising from connective tissue (i.e. bone, cartilage, fat, nerve), each of which develops from cells originating in mesenchymal cells outside the bone marrow.

• Lymphoma and leukaemia: These two classes arise from hematopoietic (blood-forming) cells that leave the marrow and tend to mature in the lymph nodes and blood, respectively.

• Germ cell tumour: Cancers derived from pluripotent cells, most often present in the testicle or the ovary (seminoma and dysgerminoma, respectively).

• Blastoma: Cancers derived from immature "precursor" cells or embryonic tissue.

Cancer can also be divided depending upon the oncogenes as Viral oncogenes and Cellular oncogenes. Ayurvedic words both‘Tridosaja’ abnormal growth or ‘Sannipataja’ abnormal growth can be used to indicate the malignant stage of the neoplasm; the word ‘Vataja’ or ‘Pittaja’ or ‘Kaphaja’ or a combination of any two of them (e.g. Vata-Pittaja or Vata-Kaphaja or Pitta-Kaphaja) can be used to signify a benign neoplasm[7].

Ayurveda explains that a malignant abnormal growth, or Tridosaja neoplasm, is one in which all the three major bodily control systems– Vata, Pitta and Kapha–which should have mutual coordination for normal functioning of the body, are out of control[7].

A cyst like bluish abnormal growth with neuralgic pain is the main symptom indicating the presence of a Vatajatype of neoplasm. A reddish or yellowish vascular growth with inflammation and burning pain characterizes the Pittaja type of neoplasm. A stone like hard abnormal growth with a little pain and itching is descriptive of a Kaphajatype of neoplasm. The Sannipataja or Tridosaja neoplasm manifests all the characters of Vataja, Pittaja and Kaphaja neoplasm. In the same way, a neoplasm with the name Vata-Pittaja, VataKaphaja, or Pitta-Kaphaja will have a mixture of symptoms [7].

General Signs and symptoms of Cancer:

Cancer can cause almost any type of symptom—everything from fatigue to pain to shortness of breath and more. In some cases, a person with cancer will notice symptoms during the early stages of the disease, but in other instances, the cancer can go unnoticed until the tumour has either grown in size (putting pressure on an organ, for example) or spread to other areas in the body[8].

Typical symptoms of cancer include:[9]

 The presence of unusual lump in the body

 Changes in a mole on the skin, such as size, colour or shape thickness

 A persistent cough or hoarseness

 A change in bowel habits, such as unusual diarrhoea or constipation

 Difficulty in swallowing or continuing indigestion

 Any abnormal bleeding, including bleeding from the vagina, or blood in urine or faeces

 A persistent sore or ulcer

 Difficulty in passing urine

 Unexplained weight loss

 Unexplained pain

 Unexplained tiredness or fatigue

 Skin changes such as an unexplained rash or unusual texture

 Unexplained night sweats

 Abdominal pain

 Unexplainable pains (headaches)

Stages of Cancer[10]:

Cancer staging can be divided into a clinical stage and a pathologic stage. In the TNM (Tumour, Node, and Metastasis) system, clinical stage and pathologic stage are denoted by a small "c" or "p" before the stage (e.g., cT3N1M0 or pT2N0). This staging system is used for most forms of cancer, except brain tumours and haematological malignancies.

Clinical stage is based on all of the available information obtained before a surgery to remove the tumour. This stage may include information obtained by physical examination, blood tests, radiologic examination, biopsy, and endoscopy.

Pathologic stage adds additional information gained by examination of the tumour microscopically by a pathologist after it has been surgically removed.

Understanding the Pathogenesis of Cancer according to Ayurveda:

In Ayurveda we have vivid description of Arbuda mentioned contradictory with special reference to Cancer as few signs & symptoms coincide with Arbuda. There are mainly 2 types of diseases mentioned i.e., Sama&Niram. Sama nearly explains the inflammatory condition &Nirama explains non-inflammatory condition. Sama condition is Santarpanottitha& the main reason behind this is over nutrition to the body which finally fails to provide balanced nutrients to the cell. Cancer is a Sama condition and is a SantarpanaJanyavyadhi where in there is rigorous uncontrolled growth of cells forming Aama. As an Ayurvedic Vaidya, it is important to know that according to ShatKriyaKala[11], Cancer is in Vyaktaavastha. So, before this forms into a fully staged disease, there are many stages crossed unfortunately unnoticed by the Vaidya due to lack of symptoms. According to modern, if we try to understand inflammation, it is a series of pathological changes associated with local vascular reaction and cellular response of the living tissue, to an injury, insufficient to kill the tissue. This stage would be a Samaavastha& also can be categorized in Sanchayavastha where the disease becomes treatable. The treatment explained in Sanchayavastha is Nidanaparivarjana[12], i.e., to get rid of causative factors. Ex.: getting rid of Tobacco, before it gets converted into oral cancer. But unfortunately human is self-destructive and avoids signal of body to heal it.

If the inflammatory process is not checked with proper treatment then, the fate of the cell can land into the next mode, i.e., Acute inflammation which can be said as Prakopavastha, where the inflammatory changes, may turn into surrounding cell destruction if not treated.

Next are Prasara & Sthaanasamsrayaa vasthas, which can totally be a pre invasive stage of cancer where just the given inflammatory cell with lot of Aama further proliferates turning into Metastasis. In between these two stages, there comes KhaVaigunya, a beautiful shloka quoted by Susrutacharya, i.e.,

“Kupitanam hi Doshanam Shareeram Paridhaavaatam|

YatraSanghahaKha Vaigunyat Vyadhistatropajaayate||”¹³

Which means, the kupitadosha circulates all over the body and gets settled in weaker points of the body to produce vyadhi. These doshas can make blockages in the weak srotas. In this stage, there is no morphological change as it is a preinvasive stage. e.g.,Buccal mucosa with white patches indicates initial stage. These patches become gradually ulcerated and that area slowly becomes hyperplastic i.e., getting regenerated and relapsing in 6 months. By 2 years or so the ulcer becomes malignant one. Preinvasive stage of Cancer is nothing butKhaVaigunya where, dosha and dushyachoose the weaker srotas of body to form the inflammatory changes and then the disease proper.

Suppose, if a Vaidya fails to treat the disease at this stage then it becomes a chronic inflammatory and autoimmune in nature where the uncontrolled proliferation of cells leads to thedestruction of surrounding tissues and organs whichalso involves nerves, muscles etc..,. Autoimmune in short means self-destruction. According to Ayurveda any disease which is Sama & is not treated for Aama for a longer duration gets converted into an autoimmune disease, best example is Aamavaata(RheumatoidArthritis) now, the cancer turns to invasive stage which may be 3rd or 4th stage where general line of treatment in Ayurveda are not sufficient. Now Cancer is fully formed i.e., Vyakta&Bhedaavastha.

Discusscion On Samprapti Sambandha Lakshana:

Typical symptoms of cancer include:⁹

• The presence of unusual lump in the bodyKaphadosha, Guru, Snigdha, Manda & Sthiraguna14, Vyanavayu involvement because it circulates Aama.

• Changes in a mole on the skin, such as size, color, shape orthickness- Kaphadosha, Guru, Snigdha, Manda & Sthiraguna.

• A persistent cough or hoarseness- Kapha & VataDosha, Sheetagunavriddhi, Prana & UdanaVayu involvement.

• A change in bowel habits, such as unusual diarrhoea or constipation- Apanavayu involvement & Ama.

• Difficulty in swallowing or continuing indigestion- Sama condition.

• Any abnormal bleeding, including bleeding from the vagina, or blood in urine or faecesDhaatuPaakai.e., Destruction of Dhatu by exaggerated proliferation of Cancerous cells.

• A persistent sore or ulcer- SamaPitta condition.

• Difficultyin passing urine- Apana Vayu.

• Unexplained weight loss- due to Atisantarpana of Cancerous cells will lead to under nutrition of Saptadhatus leading to weight loss, involvement of Udanavata as its role is to maintain Strength.

• Unexplained pain- due to aggravated Vatadosha.

• Unexplained tiredness or fatigue- due to AamayuktaKaphadosha.

• Skin changes such as an unexplained rash or unusual texture- aggravated Pitta dosha.

• Unexplained night sweats- Samanavayudushti.

• Abdominal pain- involvement of Vata.

• Unexplainable pains (headaches)- involvement of Vata.

By this above discussion we can come to a conclusion that Cancer is due to continuous  inflammatory changes due to Aama, Kapha, & uncontrolled proliferation of cells as a result of vayudushti. So treatment should be done on the basis of gunasiddhanta¹⁵ & doshasiddhanta.

Treatment possibilities according to Ayurveda:

Criteria for Samanyachikitsa:

Guna involved are guru × then we need to treat it with laghuguna dravyas (langhanadi)

Snigdhaguna × then we need rukshachikitsa

Sthiraguna × chalaguna,

Manda guna × tikshnaguna

By this we can treat patients of cancer with Langhana and rukshanachikitsa. Laghana here means absolute Aamarahitaaaharavihara (light easily digestible food), avoidance of Virudhaaahara (unwholesome diet like combination of milk and fish or milk and salt) which are the main cause for Aama formation. Avoidance of intake of kaphakaraaaharavihara(like oil, milk, dairy products etc.). Ayurvedicyogas like Shaddharachoorna¹⁶s for Aamapachana, and rukshachikitsa with varunadikashaya¹⁷, navakaguggulu¹⁸ etc., can be used with strict Pathyaaaharaha. The main intension behind this is to take out long standing Aama without disturbing the nutrition of the body.

Probable Steps of Cancer treatment:

1. Precancerous Stage / Preventive measures for Cancer: usually if we see according to WHO¹⁹

• In 2008, 7.6 million people died from cancer accounting for 13% of all deaths worldwide.

• The number of global cancer deaths is projected to increase by 45% between 2008 and 2030.

• About 70% of the cancer deaths in 2008 occurred in low- and middle-income-countries.

• About 30% of the cancer deaths could be avoided by a change of life style and more healthy behaviours.

• The vast majority of cancer deaths are preventable: every year 1.5 million people die from cancer linked to tobacco.

• Cancer is the second leading cause of death globally, and is responsible for an estimated 9.6 million deaths in 2018. Globally, about 1 in 6 deaths is due to cancer. (alreadymentionedearlier)

• Approximately 70% of deaths from cancer occur in low- and middle-income countries. (alreadymentionedearlier)

• Around one third of deaths from cancer are due to the 5 leading behavioural and dietary risks: high body mass index, low fruit and vegetable intake, lack of physical activity, tobacco use, and alcohol use.

• Tobacco use is the most important risk factor for cancer and is responsible for approximately 22% of cancer deaths.²⁰

If we see these statistical data, its more clear that cancer is because of unhealthy and toxic habits, total lifestyle disorganisation, also contaminated food habits i.e., increased intake of oncogenes triggering cancer in healthy cells. Hence, solution given by our classics is Dinacharyapalana²¹ (daily regimen), which includes, rules to be followed on day to day basis to keep one’s body free from diseases.Ritucharyapalana²² is another concept where according to ritu, do’s & don’ts have been mentioned. What to eat and what not to eat according to particular ritu, arementioned. Sadvrittapalana²³ that includes all good things to be done, good habits to be habituated like, avoid using Tobacco.

2. Pre invasive stage Treatment:

The possible treatment in this stage would be Sh odhanachikitsa(Doshapratyanikachikitsa) at first, taking out the morbid Kapha&Vatadoshas out of body & clearing Aama. Note: Deepanadravyas usage should be contra-indicated, only Aamapachana is indicated.

Next would be Vyadhipratyanikachikitsa where in anti-cancerous medicines can be given.

Dhaatwagnichikitsa is important as dhatus are undernourished. So, Dhatwagnivyaparadushti has to be corrected.

Lakshanikachikitsa should be carried out for generalised symptoms to reduce the pain of the patient. Sometimes, only medicines do not work and it should be noted that for the betterment of patient, the adhikara should be given to Dhanwantari for proper chikitsa i.e., Shastra(Surgical removal especially Benign tumours), Kshara, Agni Karmas.

3.Invasive stage treatment:

In this case modern treatment is more beneficial because, in this stage the cancer will be moved to 3rd or 4th stage. Only Ayurvedic treatment wouldnot be helpful for successful eradication of disease. So both Ayurvedic& Modern intervention should be carried out simultaneously. Here, Pratyakheyachikitsa can be done i.e., the stage of the disease whether treatment done or not, there is no further progression & can result into increase in life expectancy by regression of growth of cancer.

4.Post Chemotherapy side effect management:

Post Chemotherapy side effect such as

• Loss of total body weight

• Lean stature of the patient

• Loss of body hair due to radiation therapy

• Continuous vomiting & dehydration

• Loss of body mass

• Discoloration of the body, etc..,

These all indicate, Nissarata of the body. The body has lost Vital nutrients needed for proper growth & here is the time we use Rasayana Chikitsa²⁴.

There is rule that, KoshtaSuddhi²⁵ should be done with haritakyadichoorna before promoting anykind of RasayanaChikitsa(Rejuvenating, immune modulatory therapies).

Few Ayurvedic Medicines which can be used in Cancer Management:

Rasa sindhura( can be added with every medicine used orally to enhance the potency of the yoga)

Makaradhwajarasayana, Hemagarbhapottali Rasayana, parpatikalpas especially vardhamana parpatikalpas can help Heerakabhasma, Vaikrantabhasma, Tamra Sindhura, Somanatheeya TamraBhasma, ShilajitRasayana, Vardhamana ParpatiRasayana,

Shivagutika (widely used as rasayana) Shaddharanachurna, Varunadi Kashaya, Panchatiktaka Kashaya, Kaishoraguggulu Ekamoolikachikitsa like Haridra, Guduchi, Hingu, Sadapushpi, Hareetaki, Vibhitaki, Aamalaki, Pippali,

CONCLUSION:

According to Ayurveda cancer can be Tridoshaja and also because of Aamayuktainflammatory process where the treatments through Ayurveda can be successful in the initial pre-invasive stages and we can also help people prevent cancer through awareness camps. Ayurveda has always been claimed as life science and it is a way of living. Reducing pollution will reduce carcinogens in the environment leading to cancer. Need of an hour is to have more and more research in management of cancer through Ayurvedabecause; it is the only science having whole system study, preventive approachandhas capacity to reverse the pathogenesis.A clear cut explanation of disease manifestation accordingto Ayurveda is needed. Holistic approach towards cancer would serve the purpose. Areas where Ayurveda has scope in cancer are, preventive measures (where swasthavrutta has lot to do in this regard), post chemotherapy side effects management, Rasayana dravyas usagefor prevention of further deteriorationorientation of the body and also to increase sara in shareeraand cancer as disease proper andits management in Ayurveda.