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Tanuja Nesari,MD, Ph.D. (Ayu.)
Professor & H.O.D.,( Dravyaguna ).,Ayurvedic Clinical Pharmacology
Principal,Tilak Ayurveda College,[email protected]
Mobile No.-9423007988
[email protected]/15/2010
Contents principal s & theory of Understanding the disease
Diagnosis
Etio-pathogenesis (Sampraptti)
Principals of management
Integrating the treatment
Rasayana
Summary
6,oo,ooo lacks licensed practitioner in India’
256 university affiliated Ayu. Colleges/school.
Apex body-Dept. of AYUSH-ministry of health-
Bachelors degree-B.A.M.S.-51/2 years –including 0ne year internship .(-Admission after 12 th + tr .CET )
Masters degree –M.D./M.S.(AYU.)-3 year Admission tr .CET
Ph,D -2-6 year
Legally accepted medical system in india-Ayurveda
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Fundamental principals of physiology, Pathology & Treatment
Law of UNIFORMITY
Five element theory
Earth/water/ Fire /Air/Eather
Drugs Human body
Taste (Rasa Dosha
Sweet(Earth/water) (Earth/water)Kapha
Diet tumor
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Fundamentals of physiology, pathology & Treatment
LAW OF SIMILARITY Similar increases similar& decreases dissimilar
.-
e.g.Sweet ,Sour, Salty- Increase kapha,-(Earth .Water)Pungent,Sour,Salty- Increase Pitta, (Fire)Pungent,Bitter,Astringent- Increase Vata (Air)
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Qualities of elements
Heaviness (Guru)
Coldness (Sheeta)
Oiliness (Snigdha)
Dullness (Manda)
Stability (Sthira)
Softness (Mrudu)
Sliminess (Picchila)
Smoothness (Shlakshna)
Macro (Sthula)
Viscocity (Sandra)
Lightness (Laghu)
Hotness (Ushna)
Dryness (Ruksha)
Sharpness (Tikshna)
Mobility (Sara)
Hardness (Kathina)
Clear (Vishada)
Roughness (Khara)
Micro/Minute (Sukshma)
Liquidity (Drava)
6
aahar
(PROPER DIET)
vihara
(PROPER LIFESTYLE)
nidra
(SOUND SLEEP)
brahma-charya
(CELIBACY)
PILLARS OF HEALTH
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PathologyEssential contributory factors of pathogenesis
• Agni -Digestive capacity
• Ama-Improperly metabolized material/toxins
• Vitiated Doshas
• Weakening of the tissues-Dhatudushti
• Srotasa Dushti(System damage/organic lesion)
• Disease 811/15/2010
EXAMINATION OF PATIENT
Three fold
• Pratyaksha-Actual examination
• Anuman-Logic
• Yukti- Analysis
Eight parameters
• Naadi (Pulse)
• Mutra (Urine)
• Mala (Stools)
• Jivha(Tongue)
• Shabda(Voice)
• Sparsha(Touch)
• Druk (Vision)
• Aakruti (Stature,gait)
Tenfold
• Prakriti(Constitution)
• Vikriti (Pathology)
• Saar(Strength )
• Samhanan(Compactness)
• Pramaan(Proportionality)
• Satva (Mental state)
• Saatmya(Homologation)
• Aaharshakti(Intake,digestion capacity)
• Vyayamshakti(Stamina to exercise)
• Vaya(Age)
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Perception-
Has Ayurveda described Cancer?
How is it diagnosed?
Is there any treatment for cancer in Ayurveda?
Does it cures the Cancer?
Ayurvedic approach • May be considered under broad spectrum of
“Shotha”.– Sa eva kupito doshah samutthan visheshatah
sthanantara gatachaiva janayanti amayan bahun
• Trishothiya (Ch. Su.)- ‘Vayu Prakupitah tvangmamsashonitadini abhibhooya shopham janayati’
– Vayu
– Shonita
Dr. Manoj Nesari Joint Adviser, AYUSH, Government of India
Granthi and Arbuda• Granthi: A round, hard, and bulging swelling,
produced owing to the aggravation of vata and kaphavitiating the Rakta, Mamsa and Meda tissues.
• Arbuda: A round, large, muscular, immovable, deeply rooted slowly growing swelling produced owing to the aggravation of doshas vitiating the Mamsa, Rakta and Meda tissues.
• Various signs and symptoms arising owing to the progression of cancer have been described in detail, for example, anemia, cachexia, and loss of appetite.
Development and progression of cancer through different stages.
Description of various cancers in AyurvedaArbuda - Mamsa sanghaata, vritta, Manda ruja,
Mahantam, Analpamoolam
Raktarbuda- Mamsapindam, mamsankuraih achitam, ashu vriddhi, sravatyajasram rudhiram
Maamsarbuda- asmopamam, aprachalyam
Asadhya arbuda- aprachalyam,yajjayate anyat khalu purva jaate
Vrana- udvritta oshtha, kathina, goshringa vat udgatah
Factors involved in pathogenesisVitiated all Doshas with dominant Vaata
Rakta Dushti--- vitiation of Rakta
Ksheena Bala----depletion of Bala
Durbala agni---- impairment at Agni level
Guna Ruksha + Ushna (i.e. deterioration)
Milestones in pathogenesis Rakta dushti Oxidative stress
DNA damage
Damage to immune system
Vidaaha ---------
Vata Prakopa
Sthana sanshraya etc.
Vidaaha Inflammation
Alteration in structure and function
Increased internal heat
Turning acid
Diseased condition of bile
Twany or reddish-brown color
Necrosis or decomposition.
Role of Agni and Vaayu in development of cancer Gulma - Abdominal tumours
Mandegnau vardhate gulmodeepte chaaganu prashaamyati || ch.chi.5/112
Dominance of Vaata in the pathogenesis of cancers (Tam prakupitam vaayu aamaashayaika deshe samvartya- - - ), (Koshtham prakopam samupaiti vaayuh- - )
Role of Agni and Vaayu in development of cancer Gulma - Abdominal tumours
Mandegnau vardhate gulmodeepte chaaganu prashaamyati || ch.chi.5/112
Dominance of Vaata in the pathogenesis of cancers (Tam prakupitam vaayu aamaashayaika deshe samvartya- - - ), (Koshtham prakopam samupaiti vaayuh- - )
Stages of cancers where Ayurvedic intervention is opted On chemotherapy
After radiotherapy
After surgical removal and debulking
As an add on therapy
On relapse
As a palliative care
Rarely for prevention - Family H/O Ca.
Status of Doshaadi factors in these stages Chemotherapy & After radiotherapy - V P
surgical removal - V
relapse & add on therapy - V + P K
palliative care VPK Agni maandya and Dhaatu dushti/ Kshaya in all these stages.
Family H/o Ca - Beeja dosha, Vikaara vighaata bhaava
The expectations from Ayurvedic TherapyRelief in symptoms
No added side effects
Alleviating all the Doshas
Supportive to Dhatu
No extra load on impaired Agni
Deeper penetration
Sheeta and Snigdha (Normal Guna pattern)
Impact up to beeja (DNA)
TREATMENT
RATIONAL-Body
PURIFICATION
SUBSIDENCE
REJUVENATION
PSYCHOTHERAPY-Mind
CODE OF CONDUCT
COUNSELLING
DIVINE THERAPY-
Spirit
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RATIONAL TREATMENT
PURIFICATION
LIFE-STYLE
DIET-CostamisedREJUVENATION
SUBSIDENCE.
Shamana,
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TREATMENT ACCORDING TO PATHOPHYSIOLOGY
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Vitiated Doshas
Agni(Digestive capacity)
Ama(Improperly metabolized material)-
Weakened tissues
Srotasa Dushti(Systemwise damage)
Disease
Purification,subsidence
- Stimulation of Agni ,Deepana
Pachana
Rasayana
Rejuvenation
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PURIFICATION (SHODHAN-Panchakarma)
EmesisVaman
PurgationVirechan
EnemaBasti
Blood letting
Raktamoksha
Nasal instillation
Nasya
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Operative treatment(Shastra - Pranidhana )
1) Excision(Chedana)
1) Incision (Bhedana)
2)Puncturing (vedhana)
3)Scrapping or erosions (Lekhana)
4)Suturing (seevana)
5)Sounding(Eshana)
6)Application of leeches
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Cancer treatment in Ayurveda
Surgical removal- --
Shodhana- -- Tumor regression
Pachana.Deepana-- Intiinflamatory
Shamana- -, Tumor inhibition,
Symptom management
Apunarbhava-Rasayana--- Immunomodulation
Imunoprotection
Q.O.L.
Cancer treatment in Ayurveda
Surgical removal- Sa shesha hi doshani ----tasyashupunarbhavanti, tasmat asheshani samuddharet---
Shodhana— Medicated enemas,Purgatives,-
Triphala,,Castor oil,Resins etc.
Pachana.Deepana—Ginger,Guduchi, Termeric
,Cumin.
Shamana—Antidosha-Tulasi,Chitraka,Bhallataka
Rasayana- Amalaki,Liqorish .Ashvagandha,
Shtavari etc
How to integrate Ayurveda in Cancer management• Alleviation of Side Effects:
– Fatigue and Stress: Withania somnifera, Asparagus racemosa, Tribulus terrestris, Zingiber officinalis,
– Inflammation of oral mucosa:,Jasminum,Acacia catechu
Kandudha Rasa
– Bleeding: Cynodon ductylon ,Adhatoda Vasica
– Platelet depletion: Tinospora Cordifolia
– Cancer Cachexia: Withania somnifera, Sida cordifolia,
– Cancer-associated diarrhea: Aegle Marmelos
– Skin Rash and others: Chandan Bala Oil
– Anorexia-
Factors to be considered during
therapeutic administration of herbs • Dosage form,- Milk, ghee ,
oil based dosage forms
• Dose,-Decoction-80 ml,powder-1-3gms
• Vhehicle-milk,ghee,honey,water
• Time of administration-
as per dosha involvement
• Duration-
How to integrate Ayurveda in Cancer management• Use of herbs every day in the diet eg,
ginger, turmeric, garlic, pepper, cloves, tulsi, saffron and taking seasonal detoxifiers and antioxidents suitable to
• Individual constitution.
Wholesome Diet
“
Wholesome Diet-.Six taste,four forms,at right time,
Fresh
Fruites-Ghee,Milk, resins etc
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Life style
DAILY REGIMEN- DAILY MASSAGE-,Gentle, oil
massage
BODY SCRUB
EXERCISE - walking etc.
YOGA,
MEDITATION ,
PRAYERS.
PROPER REST
SLEEP
Psycho-therapy SATVA-AVAJAY
Psychological treatment consist of restraining one self from the desire of (ahita) unwholesome objects . -
Cognitive behavioral therapy
in the form of
1-Dhivigyana (Knowledge about limitation
& scope, how to cope up ?)
2-Dhairya (Will power, Moral support)
3-Atmagyana (Spiritual consciousness ,
self confidence) [email protected]/15/2010
Daiva - vyapasraya chikitsaDivine – Therapy /spiritual healing
Divine Therapy consist of following
Incantation (mantras,Prayers)
Certain divine herbs
Gems
Rituals (mangala)
Oblation (Bali)
Offerings (Uphahara)
Sacrifice (Homa)
Ceremonial Pretence (Prayaschitta)
Fasting (Upavasa)
Prostration (Pranipata)
Pilgrimages (Gamana)
Bows (Niyama)
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Rejuvenation therapy-Rasayana
To maintain health
To promote health
To prevent diseases
To cure diseases
To prevent recurrence
of the diseases
To improve host mechanism
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Different aspects of Rejuvenation (Rasayana)
RASAYAN
Immunomodulators
Anti oxidant
Anabolic
Psychotropic
Neutropic
Adapotogenic
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Rasayana for prevention & treatment of Cancer.
Mode of action of Rasayana….It’s effects:
i)Regeneration of cells.ii)Immunomodulatoryiii)Anti-oxidant.iv)Adaptogenic.v)Anabolic. vi)Anti-stress.vii)Builds tumour suppressor genesviii)Chemo, radioprotection
Cellular damageat DNA level in
Cancer.
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Methods of integration• Immunomodulation and Adaptogen: Withania somnifera
and Tinospora cordifolia are also proven to be powerful immunostimulants, which could increase body resistance power during cancer-associated immunosuppression
• Radioprotection and Chemoprotection: Brahma rasayanahas been shown to be myeloprotective against chemotherapy and radiotherapy in cancer patients. The use of this nontoxic preparation as an adjuvant in cancer therapy will prove to be highly beneficial.
• Radiosensitization and Chemosensitization: Various herbs, such as guduchi, ashwagandha, amla, neem, bael, Plumbago rosea, and curcumin,and polyherbals, such as semecarpus lehyam,have been shown to possess radio- and chemosensitizing properties.
Rasayana herbs for treating cancer
Guduchi
Mandukaparni
Abhaya
Ashvagandha
Amalaki
Punarnava
yashtimadhu
Shatavari
Pippali
Gokshura
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GUDUCHI(Tinospora cordifolia)
Imunomodulatory properties.(N Singh, SM Singh… - Immunopharmacology …, 2005)
The antioxidant activity,(Mathur and Kuttan, 1997)
Dichloromethane extract of guduchi in the mice transplanted with Ehrlich ascites carcinoma showed antitumor activity. (GC Jagetia… - Biological & pharmaceutical bulletin, 2006 )
Chemo preventive potential & antitumor activity on skin carcinogenesis in mice has been proved.
(R Chaudhary, S Jahan… - Journal of environmental …, 2008 - ncbi.nlm.nih.gov)
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CHITRAK(Plumbago zeylanica)
Plumbagin in lower conc. Inhibits cell mitosis & higher conc. Exhibits radio-mimetic , nucleo-toxic & cyto-toxic effects.(V SivaKumar, R Prakash… - Drug and chemical …, 2005 -informahealthcare.com)
Tumor regression effect in fibro sarcoma in rats.(PU Devi, FE Solomon- Pharmaceutical Biology, 1999)
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ABHAYA(Terminalia chebula) Free radicals react with biological molecules and destroy
the structure of cells, which eventually causes free-radical induced disease such as cancer, renal failure,aging, etc
The antioxidant activity (HY Cheng, TC Lin, KH Yu, CM Yang pharmaceutical bulletin, 2003 - J-STAGE)
Free Radical Scavenging activity (HY Cheng, TC Lin, KH Yu, CM Yang pharmaceutical bulletin, 2003 - J-STAGE)
Hydrolysable tannins and related compound have cytotoxic activity from the fruits of Terminalia chebula.
(SH Lee, SY Ryu, SU Choi, CO Lee, Z No… - Archives of Pharmacal …, 1995 )
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BHALLATAKA(Semecarpus anacardium)
Strong antioxidant capacity
(B Premalatha, V Muthulakshmi… - Pharmaceutical …, 1997 )
Antitumour activity of Semecarpus anacardium nut extract, a flavonoid containing drug.
(Chitnis, M.P., K.G. Bhatia, M.K. Pathak and K.V. Keshara Rao, 1980 Published in: IJEB 18, 6—8)
Glutathione, total thiols, non-protein thiols, vitamin E, vitamin C and cytochrome P450 are the antioxidants found to be increased after administration.(B Premalatha, V Muthulakshmi… - Pharmaceutical …, 1997 )
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ASHWAGANDHA(Withania somnifera)
Imunomodulatory properties.(Ramesh Agarwal, Sham Diwanay, Pralhad Patki and Bhushan Patwardhan, J. Of ethanopharmacology,vol67.issue 1., October 1999, Pages 27-35 )
A significant increase in white blood cell counts and platelet counts
An increase in hemagglutinating antibody responses and hemolytic antibody responses towards sheep red blood cells. .(Ramesh Agarwal, Sham Diwanay, Pralhad Patki and Bhushan Patwardhan, J. Of ethanopharmacology, vol67. issue 1., October 1999, Pages 27-35 )
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AAMALAKI (Emblica officinalis )
The antitumor activity of fruit extract was found against different human leukemic cell lines, ML-2, U-937, and K-562.
Significant cell growth inhibition was observed in all the cell lines. (Pratima Sur , D. K. Ganguly, Y. Hara, and Y. Matsuo, Functional foods for disease prevention I,Chapter 10, pp 104–113,Vol. 701, September 24, 1998)
Balb/C mice, inoculated with Ehrlich Ascites Carcinoma (EAC) cells showed significant cell growth inhibition.JK Jose, G Kuttan… - Journal of ethnopharmacology, 2001
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YASHTIMADHU(Glycirrhiza glabra)
The active constituent, isoliquiritigenin was demonstrated to prevent the incidence of colon and lung tumors in mice when administered at a dose of 300 mg/kg. (Young-Won Chin, Hyun-Ah Jung, Yue Liu, Bao-Ning Su,John A. Castoro, William J. Keller, Michael A. Pereira, and A. Douglas
Kinghorn J. Agric. Food Chem., 2007, 55 (12), pp 4691–4697)
Licochalcone-A, a novel flavonoid isolated from licorice root (Glycyrrhiza glabra), causes G2 and late-G1 arrests in androgen-independent PC-3 prostate cancer cells Yue Fu, Tze-chen Hsieh, Junqiao Guo, Jan Kunicki, Marietta Y.W.T. Lee, ZbigniewDarzynkiewicz and Joseph M. Wu,Biochemical & biophysical research communications,
vol322, issue1., 10 September 2004, Pages 263-270
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PIPPALI (Piper longum)
The effect of piperine on the inhibition of lung metastasis induced by B16F-10 melanoma cells was found in C57BL/6 mice. (C.R. Pradeep & G. Kuttan∗ Clinical & Experimental Metastasis 19: 703–
708, 2002.)
immunomodulatory
antitumor activity (ES Sunila, , G. Kuttan J Ethnopharmacol. 2004 Feb;90(2-
3):339-46.)
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SAARIVA (Hemidesmus indicus)
Protective effect of Hemidesmus indicus R.Br. root extract against cisplatin-induced cytogenetic damage in mouse bone marrow cells.(Rajagopal Ananthi; Nallathambi Chandra; Sathiyavedu T. Santhiya, Genet. Mol. Biol. vol.33 no.1 São Paulo 2010 Epub Feb 26, 2010)
Anti-hepatocarcinogenic.(SS Iddamaldeniya, MI Thabrew,SMDN Wickramasinghe,N Ratnatunge,and MG Thammitiyagodage .J Carcinog. 2006; 5: 11. )
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SOME USEFUL FORMULATIONS
Vardhamaan pippali rasayan, (with milk ;in the morning)
Bhallataka rasayan ,(with milk/honey ;in the morning)
Ashwagandha rasayan,
Brahma rasayan,
Narasimha rasayan
Amrutaprasha,
Rakta vardhak (formulation of Ayurveda Rasashala,Pune)
Heerak bhasma,
Swarna bhasma.
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CARRY HOME MESSAGE
Add in your daily diet & treatment
Pinch of Termeric,Ginger & Tulasi ( Holy basil)
asDeepana & Pachana
& Combination of
Amalaki,Gudughi & Gokshuraas
Rasayana
for prevention & treatment of cancers
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A journey of a thousand miles starts with one small step!
Let us put that step ahead!......
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