Scientific Basis for Ayurvedic Therapies -20

Scientific Basis for

Ayurvedic Therapies 

edited by

Brahmasree Lakshmi Chandra Mishra

Benign Growths, Cysts, and Malignant Tumors

Manoranjan Sahu and Lakshmi Chandra Mishra

16.1 Introduction

Approximately 1.2 million new cases of invasive cancer are confirmed each year in the

U.S., and about 500,000 people die from the disease each year.

1

The second most deadly

disease is cancer and is expected to be the first in the early 21st century. Over the past

century there have been tremendous changes in the environment, both dietary and lifestyle,

resulting in the increase of lung cancer in both men and women. Melanoma,

non-Hodgkin’s lymphoma, and brain tumors have also increased, particularly among the

elderly. The overall mortality, esspecially with people under the age of 65, has declined

mostly due to increasingly effective therapy for cancers of fetal and hematopoietic origin.

1

In spite of progress in the science of medicine, the understanding of the cancerous

condition is still not complete. Although the knowledge has expanded considerably about

the etiology and treatments, the exact cause of the disease and an effective management

of cancer in general is still an unresolved mystery to the scientists. Cancer has been

recognized and characterized by the science of Ayurveda. The descriptions regarding this

disease are available in a scattered form under the context of various diseases. Compilation

of this information collectively, in a systemic manner, may help us in understanding the

etiology and the pathology of the disease in a better way. Numerous drugs have been

mentioned for the management of this condition; if evaluated methodically, they may

generate some curative or supportive remedy for the sufferers of this disease. The present

era of modern sciences has undergone many folds of technical advancement for the

diagnosis and confirmation of cancer by histopathological studies under light and electron

microscopes. Before this, doctors and researchers had to depend entirely on various clinical

symptomatology with

dosa

theory.

The purpose of this chapter is to review and summarize the available information on

Ayuravedic management of benign growths, cysts, and malignant tumors.

16.2 Historical Perspective

Cancer is derived from the Greek word meaning a crab, presumably because a cancer

"adheres to any part that it seizes upon in an obstinate manner like the crab.” The large

veins surrounding a malignant growth, which to the ancients suggested the claws of a

crab, medically inspired the use of this term.

The identification and description of malignant diseases are available in the literature

of ancient India and Ayurveda. The earliest and foremost records are cited in

Atharva Veda

(2200

B

.

C

.). During this period, the disease was probably described under the heading of

apachi

or

apachit

, which refers to the present knowledge of various types of lymph node

swellings. In a later period, Sushruta (400

B

.

C

.), in his classic

Sushruta Samhita

,

described

this apachi

as multiple lymph node swellings that may arise at different places such as

the neck, axilla, and groin.

The ancient Indian clinicians were aware of the malignant diseases and presented their

views regarding neoplasia as follows:

1. As a swelling on the body surface or situated in deeper structure in relation to

various systems and organs

2. As a chronic nonhealing ulcer

In classical texts of Ayurveda, the superficial swellings have been categorized under the

heading of tumors (

arbuda

), whereas nonhealing ulcers listed as incurable ulcers (a

sadhya

vrana

)

.

The word

arbuda

has been derived from the root “Arb” with suffix “Ena” along with

augmentation of “Nd,” which means “to destroy” (particularly

mamsa dhatu

). Grammatically,

it denotes the fleshy outgrowths.

Arbuda

has various meanings such as swelling,

number of 10 billions, a mountain, a fleshy mass, a serpent, clouds, or a demon (i.e., a

serpent). During the

Vedic

period,

arbuda

was considered as a serpentlike demon that was

conquered by “Lord Indra,” whereas the literary meaning of

arbuda

is a lump or a mass

or a polyp. According to Sushruta,

arbuda

are gradually increasing, big, globular, slightly

painful, fixed, deep-seated, fleshy masses that usually do not suppurate. They can arise

from any part of the body surface. They are caused by the derangement of

mamsa

and

rakta

vitiated by

tridosa.

The malignant lesions of deeper structures have been described in various contexts,

such as intra-abdominal lesions having been described in the name of g

ulma

.

Gulma

literally means a shrub (i.e., it can be understood as a lump or a mass in the abdomen

and many of these lumps have been described to be incurable). The description of neoplastic

growths is also available under the heading of

granthi

. The characteristic features

of

arbuda

and

granthi

are similar.

Granthi

literally means a knotty growth. The etiology

and clinical features of both

granthi

and

arbuda

are similar, with a difference that on

breaking open, the

granthi

gives various discharges based on the involvement of the

dosas

.

Thus, it can be understood that

granthi

may actually represent cystic growths.

The phenomenon of the spread of tumors or metastasis (

dwirarbuda

) was well known

to the ancient Hindu physicians and surgeons. Several references are available regarding

the local and distal spread of the tumor as well as its recurrence. Sushruta has described

metastasis (i.e., distal spread of tumor under the heading of

dwirarbuda

), and the recurrence

of tumor has been mentioned as

adhyarbuda.

Metastasis of tumors was described as an

occurrence of a couple of similar types of tumors simultaneously serially. When a tumor

arises on a preexisting site or near a primary tumor, it is called

adhyarbuda.

There are

several other descriptions available in Ayurveda regarding distal spread and recurrence

of tumor. While describing the treatment of tumors, Sushruta mentioned that all efforts

should be made for the complete removal of tumors, as incomplete removal causes recurrence

and ultimately destroys the person. To explain the graveness of recurrence, he gave

an example that a small remnant tumor can destroy the body just as a small spark of fire

can destroy a house. Distal spread of a tumor has also been described in connection with

malignant ulcer (

asadhya vrana

).

16.3 Etiology

Sushruta has considered trauma and irritation precipitating or activating the formation

of tumors as one of the etiological factors of soft-tissue tumor (

mamsarbuda

)

and diseases

of external genitalia

(

sukaroga

) due to the use of irritants. Overeating of meat may lead to

vitiation of muscle tissue and soft tissue (

mamsa

), considered an important factor for

development of

mamsarbuda

. For the enlargement of external genitalia, local application

of certain irritable medicines has been advised. Although this condition is rare, improper

uses of these drugs used for the enlargement of external genitalia of male (

lingavridhikara

yoga

) may lead to development of soft-tissue tumors (

mamsarbuda

) in external genitalia.

The external application of irritable medicines and certain other internal medications have

both been advised for enlarging the external genitalia. These medications may shed some

light on the etiology of neoplasia, particularly the role of hormones in the development

of tumors.

Vagbhata

, another famous exponent of Ayurveda, also emphasizes that factors responsible

for excessive formation of muscle and soft tissue (

mamsa dhatu

) may lead to the

development of tumors and other pathological conditions. Examples include thyroid

swelling (

galaganda

), cervical lymphadenopathy (

gandamala

), cysts (

granthi

), and fleshy

growths (

adhimamsa

).

The genetic cause for the manifestation of cancer is also well documented in Ayurveda.

In the etiology of familial polyposis coli (

sahaja arsha

)

,

Sushruta

has described that defects

in ovum (

sonita

) and sperm (

shukra

) are responsible for the development of this disease.

From the above description, the factors responsible for the development of tumors

may

be categorized under the following headings:

1. Unwholesome diet (

mithya ahara

)

2. Unwholesome regimen (

mithya vihara

)

3. Trauma (

abhigata

)

4. Irritation

5. Genetic (

anuvanshaja

)

It can be concluded that unwholesome diet and lifestyle (

mithya ahara

and

vihara

) cause

local and systemic biochemical changes. At the same time, these factors may alter the

hemodynamics at the site of origin of tumors.

In conventional medicine, the common pathway in the induction (initiation) of cancer

is a cellular genetic mutation that converts normal cells to cancer cells. The genes controlling

normal cellular processes become mutated by a variety of chemical interactions with

the dexoribonucleic acid (DNA) initiation process. These initiated genes promote cancer

and are called promoter genes (oncogenes). The other normal genes suppress cancer and

are called suppressor genes. Oncogenes produce cancer by encoding proteins that are

further activated to induce cancer. The tumor suppressor genes cause cancer when their

normal tumor suppressor function is blocked. Chemical agents, physical agents, chronic

irritation, biologic agents, and even dietary factors contribute to carcinogenesis. Regulatory

agencies in the U.S. and other countries infect, monitor, and regulate environment

and dietary sources of carcinogens.

2

The single most important agent known to contribute

to increased incidence of cancer in the U.S. and Europe is tobacco, because it contributes

to one third of all cancers, primarily cancers of the lung, esophageal, head, neck, and

bladder.

1

Because genes define the cellular phenotype, this indicates that the mutational

profile of a cancer cell may predict the clinical outcome, and this has become a reality.

1

16.4 Pathogenesis

In contemporary medicine, cancer is considered essentially as a disturbance of normal cell

growth. Tumors of any cell type may show a wide range of behavior in their rate of growth,

power and mode of spread, and degree of toxic effects on the host. There are tumors that

grow slowly, remain quite localized, and do not invade the neighboring structures. They

usually cause no harm and are known as benign tumors or harmless tumors. The other

groups of tumors grow rapidly, penetrate the surrounding tissues, and spread to distant

areas. They are invariably fatal and are termed cancerous tumors or malignant tumors.

The pathogenesis of tumors has been described in Ayurveda based on the theory of

three

dosa

(

tridosa

). The vitiated

dosa

affects the local tissues (dhatu or dushya). Vata, pitta,

and kapha are considered as dosas; muscle and soft tissue (mamsa), adipose tissue (meda),

and blood (rakta) are termed dushyas (that which can be vitiated). Due to excess of kapha

and adipose tissue, tumors usually do not suppurate. It is justified to suggest that excess

of kapha might be responsible for the development of tumors. Moreover, as a tumor is a

disorder of growth and as kapha is an essential factor for growth, it can also be postulated

that preponderance of vitiated kapha is an essential factor for the manifestation of tumors.

In the etiopathogenesis of raktaja tumors, vitiated dosa cause the derangement of blood,

and as a consequence the vessels (siras) of the local site become constricted. This results

in a rapidly growing fleshy growth known as raktarbuda (ulcerated malignant tumor).

16.5 Clinical Manifestations of Tumors

Ayurveda has six major clinical manifestations of tumors. See Table 16.1 for an overview:

16.5.1 Benign Neoplasia of Fibrous Tissue and Hematoma (Vataja Tumor)

Various types of pain, such as pricking, stretching, and cutting, characterize vataja tumor.

The growth assumes a black color, appears rough, and is elevated like a bladder. These

tumors are mobile, soft in consistency, and change in size without reason.

16.5.2 Inflammatory State of Benign Neoplasia (Pittaja Tumor)

Pittaja arbuda are red or yellow and characterized by severe burning, fuming, and sucking

or throbbing pain. They undergo early suppuration.

Like neoplastic growth, tumors usually do not suppurate due to excess kapha and meda.

However, due to secondary infections, inflammatory changes may occur and cause suppuration.

TABLE 16.1

Clinical Features of Various Tumors in Ayurveda

Symptom

Vataja

Arbuda

Pittaja

Arbuda

Kaphaja

Arbuda

Medaja

Arbuda

Mamsaja

Arbuda

Raktaja

Arbuda

Pain Variable Burning Mild pain with

itching

Mild pain

with itching

Painless or

mild pain —

Consistency Hard or soft

(variable)

— Stony or hard Soft Stony —

Mobility Mobile — — Freely mobile Fixed —

Skin over the

tumor

Black Red,

yellowish

No change in

color

Glossy Normal or

covered

by

prominent

veins

—

Surface Nodular Smooth Smooth Smooth Smooth Covered

with fleshy

projections

Discharge Nil Nil Nil Nil Nil Blood

Shape and

size

Raised above

the surface

like bladder

— Large globular Large Large Elevated

fleshy

growth

Growth rate — — Slow — Slow Rapid

Prognosis Curable Curable Curable Curable Incurable Incurable

16.5.3 Benign Neoplasia of Osseous, Other Soft Tissues, and Adenomas (Kaphaja Tumor)

These swellings are cold to the touch, relatively painless, stony in consistency, and develop

very slowly. The color of the tumor is similar to the color of the surrounding skin or is

slightly glossy.

Based on the signs and symptoms, vataja, pittaja, and kaphaja tumors can be correlated

to benign neoplastic conditions, irrespective of site. Examples include fibroma, hematoma,

and neurofibroma (vataja tumors); inflammatory state of any benign neoplasia (pittaja

tumor); and benign neoplasm of epithelial tissue, lymphoid tissue, and soft-tissue osteoma

(kaphaja tumors).

16.5.4 Benign Conditions of Mesenchymal Tissues Like Lipoma (Medaja Tumor)

This tumor is slow growing, arises with slight pain, and is associated with itching. The

tumor is freely mobile with a glossy appearance. The size varies according to the contents

of adipose tissue (medas) in the body. If the content of adipose tissue in the body increases,

the size of this tumor also increases and vice versa.

16.5.5 Ulcerated Malignant Lesions (Raktaja Tumor)

Raktaja tumors are very rapidly growing, slightly suppurated, exudating tumors covered

with projectile small fleshy masses. The person affected by this tumor becomes pale due

to continuous exudation of blood from this growth. This type of tumor is incurable.

16.5.6 Tumors of Muscle and Soft Tissues Like Breast Tissue (Mamsaja Tumor)

External trauma vitiates the soft tissues (mamsa) of any part of the body and gives rise to

a smooth, large, painless, nonsuppurative, stony, skin-colored, fixed swelling called a mams

tumor. Such swellings are usually covered with prominent veins. This is also an incurable

tumor.

16.5.7 Tumors of Mixed Variety (Tridoshaja Tumor)

This type of tumor is incurable. It has mixed features of vataja, pittaja, and kaphaja tumor

varieties.

16.6 Classification of Tumors

Based on the predominance of the vitiated dosa involved, tumors have been classified as

vataja arbuda, pittaja arbuda, kaphaja arbuda, tridoshaja arbuda, raktaja arbuda, mamsaja arbuda,

and medaja tumors. It is very difficult to give a specific modern nomenclature of each

tumor mentioned in Ayurveda. In one study, 50 patients with various types of tumors and

clinical features of different swellings mentioned in Ayurveda were compared with vataja,

pittaja, and kaphaja benign neoplastic conditions irrespective of site. It was observed that

the kaphaja tumor is benign neoplasm of epithelial tissue, lymphoid tissue, and soft tissue;

the medaja tumor is benign conditions of mesenchymal tissues like lipoma, fibrolipoma,

and hemangioma. A raktaja tumor is an ulcerated malignant lesion and includes carcinoma

of integument and other ulcerated malignant growth. The mamsaja tumor is a testicular

tumor, ductal carcinoma of breast, lymphoid tumor, follicular carcinoma of thyroid, and

soft-tissue sarcoma.3 Tumors classified according to conventional medicine are listed in

Table 16.2.

Tumors may arise from any part of the body; no site is exempt. Tumors of the eye,

TABLE 16.2

Classification of Tumors According to Conventional Medicine

Tissue of Origin

Type of Tumor

Benign Malignant

Tumors of Connective Tissue

Fibrous tissue Fibroma Fibrosarcoma

Cartilage Chondroma Chondrosarcoma

Bone Osteoma Osteosarcoma

Adipose tissue Lipoma Liposarcoma

Blood vessels Hemangioma Hemangiosarcoma

Sinovial tissue Sinovioma Sinoviosarcoma

Smooth muscle Leomyoma Leomyosarcoma

Striated muscle Rhabdomyoma Rhabdomyosarcoma

Reticulo-Endothelial Tissue

Lymphoid tissue Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma

Granulocytes Myeloid leukemia

Plasma cell Myeloma

Tumor of Epithelial Tissue

Sqamous Papilloma Sqamous cell carcinoma

Transitional Papilloma Transitional cell carcinoma

Glandular

Papillary Papilloma Papillary carcinoma

Solid Adenoma Adenocarcinoma

Cystic Cystadenoma Cystadinocarcinoma

Mixed Papillary cystadenoma Papillary cystadinocarcinoma

Neural Tissue

Glial tissue Glioma

Nerve sheath Neuroleimoma Neurogenic sarcoma

Meningis Meningioma Meningeosarcoma

Other Tissues

Placenta Hydatidiform mole Choriocarcinoma

Pigmented cells Nevus Malignant melanoma

Germ cell Benign teratoma Malignant teratoma

ear, nose, oral cavity, and external genitalia have been dealt with separately (Table

16.3).

16.6.1 Tumor of the Lip (Mamsaja Oshta Roga)

The lip becomes a heavy and thick projection of fleshy mass, subsequently leading to the

formation of an ulcer, which may be infested with maggots.

16.6.2 Tumor of the Floor of the Mouth (Alas)

This tumor is a deep-seated mass on the under surface of the tongue due to vitiation of

blood (rakta) and kapha. It is considered an incurable tumor, which increases gradually in

size, fixes the tongue, and may suppurate. The tumor ultimately destroys the surrounding

structures and exudates discharge with fishy odor.

Carcinoma of the floor of the mouth may give rise a similar picture like that of alas.

Adenocystic and mucoepidermoid tumors of the salivary gland present themselves as an

ulcerated growth that gradually holds the tongue and leads to progressive difficulties in

TABLE 16.3

Tumors of the Head and Neck in Ayurveda

Name of the Tumor Site Dosa

Clinical

Presentation Prognosis

Tumors of the eyelid

(vartmarbuda)

Inner side of

the eyelid

Pitta and rakta Irregular, knotty,

reddish mass

with mild pain

May be

curable

Tumors of the ear (karnarbuda) External ear Involvement of any

one of the three dosas

or in combination

Features based

on the involved

dosa

May be

curable

Tumors of the nose (nasa

arbuda)

Nasal cavity Involvement of any

one of the three dosas

or in combination

Features based

on the involved

dosa

May be

curable

Tumors of Lips (oshtarbuda)

Cystic growths of lips

(jalarbuda)

Lips Vata and kapha The growth

appears like a

water bubble

Fatal

Ulcerated malignant growths

of lips (raktarbuda)

Lips Rakta Lips become red

and swollen

and discharge

blood

Fatal

Tumors of the palate

(talu arbuda)

Palate Rakta Swelling

resembling the

shape of lotus

Fatal

Tumors of the oral cavity

(mukharbuda)

Inner surface

of the mouth

Kapha Pale, blackish

mass that

persists even

after various

surgical

treatments

Fatal

Tumors of the throat

(galarbuda)

Root of the

tongue or in

the middle of

the throat

Nonuppurating,

painless, hard,

fixed and

reddish tumor

Incurable

Tumors of the head

(shiro arbuda)

Shiras General features

of arbuda

May be

curable

speech. These malignant lesions are usually complicated with secondary infection. Foulsmelling

discharge and destruction of the surrounding tissue are very often found in these

diseases.

16.6.3 Tumor of the Hard Palate (Mamsa Kacchapa)

The tumor develops on the palate because of vitiation of kapha and appears like a shell of

a tortoise. It is a slow growing, painless, and considered an incurable tumor.

The tumors of the hard palate are characterized by slow growth and are usually not

associated with pain. The tumors are smooth and hemispherical in shape, comparable

with the convex shell of a tortoise. Similarly, carcinoma of the maxillary antrum may

present as a convex mass in the hard palate.

16.6.4 Tumor of the Throat (Galugha)

This is considered an incurable tumor that is caused by vitiation of blood and kapha. The

disease is characterized by a large swelling that develops on the inner and outer sides of

the throat. It interferes with the functions of udana vata, resulting in the obstruction of

food and air passages. The disease is also characterized by feeling of heaviness in the

head, excessive salivation, and fever.

The oropharynx is the key structure for swallowing, breathing, and speaking. A malignant

growth at the oropharynx may give rise to the obstructive features like that of throat

tumor (galugha). Tumors at the oropharynx, palatine arch, and ulcerate become infected

easily, causing pain in this nerve-rich area. Headache and otalgia are also common due

to referred pain as the ninth cranial nerve supplies both the sites. Moreover, patients with

carcinoma of the base of the tongue or primary malignant lesions of the oropharynx

present with metastasis at the neck gland and may present only with neck gland swelling.

The above features of oropharyngeal cancer can be corelated with the features of galugha.

16.6.5 Tumor of the Oropharynx (Balaya)

This is considered a malignant tumor of the throat that develops due to deranged kapha.

The tumor is widespread and painless and ultimately obstructs the food passage.

These tumors could be malignant lesions of a deeper part of the oropharynx, which

ulcerate later. Pain is less because of fewer nerve endings. The features of food-passage

obstruction are found much earlier than the symptoms of airway obstruction due to their

close vicinity to the esophagus.

16.6.6 Tumor of the Thyroid (Asadhya Galaganda)

Thyroid swellings (galaganda) of long duration (more than a year) lead to breathing difficulty,

emaciation, anorexia, weakness, and hoarseness of the voice. This tumor is considered

an incurable and may be due to malignant lesion of the gland.

The first symptom of thyroid carcinoma is the enlargement of the thyroid gland. It

develops slowly, and choking attacks may occur due to pressure effect on the trachea.

Hoarseness may be caused by the displacement of the larynx or involvement of the

recurrent laryngeal nerve, which is found in a good proportion of cases. Weight loss and

anorexia are seldom present.

16.6.7 Intra-Abdominal Malignant Tumors (Tridoshaja and Asadhya Gulma)

Intra-abdominal malignant tumors (tridoshaja gulma) are characterized by an intra-abdominal

stony mass with severe burning pain. Such patients loose mental peace, strength, and

appetite.

Intra-abdominal malignant tumors (asadhya gulma) are gradually increasing, widespread,

and fixed. They have a tortoise shell-like mass associated with weakness, anorexia,

cough, vomiting, fever, and thirst. Multiple prominent veins usually cover the skin over

the mass. Both of the above varieties are considered incurable.

In contemporary medicine, these conditions can be correlated with intra-abdominal

malignant tumors, especially with tumors of liver. In hepatoma the lump is usually

solitary, big, fixed, and convex; it may be comparable with the convex shell of the tortoise.

The patient’s general condition, physical and mental strength, and appetite decrease.

Prominent abdominal veins may be due to portal hypertension or obstruction of the

inferior vena cava. Cough and painful respiration are common symptoms that may

result from pulmonary metastasis. Except primary hepatic carcinoma, a number of other

abdominal conditions, such as retroperitoneal malignancies, ovarian and uterine carcinomas,

lymphoma, and carcinoma of the stomach and bowels, may give rise to similar

features.

16.6.8 Malignant Ascites (Asadhya Udara Roga)

This is considered an incurable ascites associated with flank pain, marked anorexia, generalized

edema, and diarrhea. The recurrence of ascites is very fast even after removal of

ascitic fluid by paracentesis. This very early recurrence of ascitic fluid in asadhya udara

roga suggests the possibility of malignancy.

16.6.9 Familial Adenomatous Polyposis Coli (Sahaja Arsha)

The disease originates from defects in the genetic material (i.e., sperm and ovum). Such

fleshy masses (arsha) are hardly visible (high enough), rough, painful, yellowish in color

and directed inward.

The patients are emaciated and irritable, have a feeble voice and poor digestion, and

tend to develop diseases of head and neck. Cracking sounds and shiny skin are the other

symptoms of familial adenomatous polyposis. It is also considered an incurable disease.

Considering the etiology and clinical features of sahaja arsha, the disease can be compared

with familial adenomatous polyposis coli. It has been described in the texts of contemporary

medicine as a hereditary disease that is characterized by a large number of adenomatous

polyps in the colon and rectum; if left untreated, it will almost certainly change in

to adenocarcinoma of the large bowel. Here again the disease originates from defects in

the sperm and ovum. Bleeding, anemia, diarrhea, partial obstruction, pain in abdomen,

and indigestion are the presenting symptoms. It is similar to the symptoms mentioned

under sahaja arsha.

16.6.10 Tumor of the Lungs (Kshayaja Kasa)

This is considered an incurable tumor and may mimic other lung diseases (e.g., kshayaja

kasa). It initially starts with a dry cough and becomes complicated with hemoptysis after

a while. The patient feels a severe pricking pain in the chest and throat and suffers from

malaise and fever. The patient also experiences difficulty breathing, choking, and wheezing

during coughing. The disease is frequently associated with generalized body ache, fever,

and a burning sensation. The patient gradually becomes emaciated and thin, devoid of

fleshes and vitality. The person spits mucus, blood, and pus.

The symptomatology and the sequence of symptoms of kshayaja kasa is similar to the

symptomatology of carcinoma of the lungs. It has been described in the texts of conventional

medicine that the cough initially is nonproductive but subsequently becomes productive

with increasing amounts of mucoid expectoration, sometimes tinged with blood

and a possible development of hemoptysis. Chest pain is severe and pleuritic, characterized

by pinching pain. Paroxysmal hyperpnea may develop due to the presence of mucus

buildup in the secondary and tertiary bronchi. Pleural effusion and empyema may cause

dyspnea. Wheezing occurs when mucus partially obstructs the bronchus. Attacks of fever

are common because of repeated obstructive pneumonia. Weight loss is a rather constant

symptom of anorexia and metastasis.

16.6.11 Tumor of the External Genitalia of the Male (Lingarsha)

These lesions are ordinarily nonmalignant and do not grow like malignant tumors. Vitiated

dosas affect the local flesh and blood of external genitalia, causing an itching sensation

and ulceration. Such an ulcer usually grows over the foreskin or glans of the penis and

is covered with papillomatous growth. The ulcer discharges slimy blood, ultimately

destroys the penis, and halts the reproductive activity of the patients.

Penile neoplasms are very limited in number. Only two conditions, papilloma and

carcinoma, produce new growth. The description of lingarsha is very close to the clinical

features of carcinoma of the penis mentioned in conventional medicine. The patients with

penile carcinoma usually present with a papillomatous growth in the glans with delayed

features such as pain, hemorrhage, and discharge. The lesion initially is papillary, but

gradually ulcerates and subsequently the ulcerative process destroys the entire penis,

leaving a hornlike structure (penile horn) behind. Based on clinical presentation, course,

16.7 Prognosis of Tumors and Ulcers

The prognosis of tumors has been explained based on the response to various treatment

modalities. Depending upon the modality, the tumors that respond or are cured are

considered sadhya or benign. Those that do not respond or are incurable are considered

asadhya or malignant. Vataja, pittaja, and kaphaja tumors (benign neoplastic conditions) and

benign conditions of mesenchymal tissue (medaja tumors) of any site are curable (sadhya).

Tumors of muscle and soft tissue (mamsarbuda), ulcerated malignant growths (raktaja

tumors), mixed type of tumors (tridoshaja tumors) of any site, cystic growths of lips, tumors

of the palate and throat, and tumors of the oral cavity are considered incurable. Any tumor

treatment, and prognosis, the diseases listed in Table 16.4 can be considered malignant.

that reaches the stage of recurrence (adhya tumors) or metastasis (dwiraar tumor) is also

considered incurable.

Almost all clinical presentations of incurable class of ulcers described by Sushruta can

be included under malignant ulcers. Some of their specific features are:

1. Ulcers cropping up like a fleshy mass

2. Edges raised like those of external genitalia of a mare

3. Ulcers containing soft fleshy masses like the horn of a cow

4. Base of the ulcer being raised above the margins

5. Ulcers secreting various fluids, including vitiated blood and other substances

similar to fatty (vasa) substance, adipose tissue (meda), bone marrow (majja), or

brain matter

6. Ulcers manifested in an emaciated patient with discharge of blood and pus and

the patient’s condition being complicated by indigestion, cough, painful respiration,

and anorexia

7. An ulcer that does not heal in spite of proper medication

In modern medicine, the description of malignant ulcers is similar. For example, the

margins are raised above the base, rolled up, and hard in consistency; multiple fleshy

masses develop (as seen in fungating basal cell carcinoma); and the base is raised above

the margins many times. Cauliflowerlike ulcerative growths are an example of this type

of malignant ulcer. Malignant ulcers bleed severely even with slight trauma. In addition,

varieties of discharges are seen in malignant lesions. Painful respiration, cough, and

TABLE 16.4

Neoplastic Diseases in Ayurveda

Arbuda (Neoplasia)

Asadhya-Vrana

(Incurable

Ulcers)

Arbudavat Anya

Vyadhi (Diseases

Comparable with Malignancy)

Tumors of muscle and soft tissue

(mamsarbuda)

Ulcerated malignant lesions

(raktarbuda)

Mixed types of tumors

(tridosaja arbuda)

Tumors of the palate (talu arbuda)

Tumors of the oral cavity (mukharbuda)

Tumors of the throat (galarbuda)

Head and neck

Tumors of the lip (mamsaja oshta roga)

Tumors of the floor of the mouth (alas)

Tumors of the hard palate

(mamsakacchapa)

Tumors of the throat (galugha)

Tumors of the oropharynx (balaya)

Tumors of the thyroid (asadhya

galaganda)

Gastrointestinal tract

Intra-abdominal malignant tumors

(tridoshaja gulma, asadhya gulma)

Malignant ascites (asadhya udara roga)

Familial adenomatous polyposis coli

(sahaja arsha)

Respiratory system

Tumors of the lungs (kshayaja kasa)

External genitalia of male

Tumors of the penis (lingarsha)

anorexia are additional symptoms of malignant ulcers that suggest metastasis of the tumor

in the lungs.

16.8 Principles of Diagnosis

Ayurvedic diagnosis of tumors is carried out based on clinical manifestations, physical

examination, and systemic examination. Apart from these methods, various diagnostic

methods used by physicians of contemporary medicine are also adopted for a correct

diagnosis.

The general condition of the patient (rogi) is examined after the standard eight-point

examination procedures (i.e., pulse, feces, urine, various auscultatory findings, palpation,

skin, eyes, and body strength).

Additional examinations includes history, type of pain, specific signs and symptoms,

size and shape of the tumor (akriti of arbuda), consistency, color, tissue involved, site, and

TABLE 16.5

Diagnosis

History/Interrogation Signs and Symptomsa Investigation

Family history

Occupational history

Change in wart or mole

Lump in the breast

Hemogram

TLC, DLC, Hb%, ESR, GBP,

LFT, etc.

Dietary habits

Geographical relation

History of previous illness

(may be predisposing factor

etc.)

Nonhealing sore

Persistent cough

Unusual bleeding or

discharge from any source

Indigestion or difficulty in

swallowing

Radiogram

Plain x-ray

Barium contrast

IVP, USG

CT scanning

MRI etc.

Change in bowel and urinary

habits

Histopathological and biochemical

Aspiration

Cytology

Biopsy

Enzyme

Hormone

Immunity factor

Certain tumor markers

Endoscopy

Gastroscopy

Colonoscopy

Cystoscopy

Bronchoscopy

Laparoscopy

Mediastinoscopy

Histeroscopy

a

Seven danger signals by the American Cancer Society.

stage of the tumor (Tables 16.1 and 16.5).

In conventional medicine, the first principle of diagnosis is that adequate tissue for a

biopsy be obtained from the tumor to establish the specific diagnosis and type of cancer.

The second diagnostic principle is to establish the extent of the disease through physical

examination, laboratory tests, and diagnostic imaging. In solid tumors, surgery is required

to determine the extent of the disease or the stage of the tumor.1

Early detection of cancer is very helpful in treating cancers. The following procedures

and tumor markers have been proven useful as a secondary strategy in an attempt to

reduce cancer mortality:1

Ayurvedic physicians also use these detection procedures and tumor markers for diagnosing

and assessing the effect of therapeutic agents.

16.9 Management

16.9.1 Principle of Cancer Therapy

In Ayurveda, detoxification (shodhana therapy) is a major part of the treatment not only

for arbuda, but also for all other diseases. The main principle of this procedure is to

eliminate vitiated dosas to maintain their equilibrium, preserving the immunity (rogibala)

of the patients. Detoxification is the pretherapy in the actual line of management, but not

all patients are fit to undergo these procedures. The procedures are contraindicated in

emaciated and severely ill patients who cannot tolerate therapeutic emesis or purgation.

The role of detoxification therapies on cancer patients as pretherapy to conventional

line of treatment has been studied.3,4 The study showed that these procedures increased

body weight, improved serum immunoglobulins, increased hemoglobin levels, and normalized

liver functions. It was found helpful in minimizing the adverse effects of chemotherapeutic

agents. The study concluded that the following procedures were helpful:

1. Oleation therapy (snehana) using medicated ghee prepared with triphala (Terminalia

chebula, Terminalia bellerica, Emblica officinalis) in patients with breast cancer

2. Therapeutic purgation (virechana) in malignant conditions of hepatobiliary system

3. Medicated enema (basti karma) in malignancy of the genitor-urinary system

Sushruta has indicated that a patient's natural resistance or immunity to the disease (i.e.,

rogibala) is one the essential factors that should be preserved for the arrest of the progress

of the disease. Fasting (langhana) is one of the principles of treatment for kapha-predominant

diseases but has not been recommended because it may reduce the ability to defend

Procedures Tumor markers

Sigmoidoscopy

Fecal occult blood test

Digital rectal exam

Prostate exam

Papanicolaou test

Pelvic exam

Breast self-exam

Mammography

Colorectal — CEA

Ovary — Ca-125

Testicle — hCG, AFP

Prostate — PSA

Breast — CA15-2, CEA

Non-Hodgkin’s lymphoma — LDH

Myeloma — Beta2-M

Hepatoma — AFP

against the disease process (rogibala). Various drugs and formulations have been mentioned

in Ayurveda for the management of tumors, but they have not been proven to have

a direct cytotoxic effect on humans (Table 16.6).

16.9.2 General Treatment

The following treatments are used according to the involvement of dosa and the type of

the tissues:

1. Detoxification therapies (samshodhana chikitsa) are advocated for the management

of tumors based on the involvement of dosa. Oleation (snehana) is advised for vata

dosa, purgation (virechana) is advised for pitta dosa, and emesis (vamana) is advised

for kapha dosa.

2. After detoxification, administration of dosa subsiding drugs (samshamana oushadha)

is advised as per involvement of dosa.

3. Local treatments like medicated poultice (upanaha), sudation (swedana), and local

application of various drugs (lepana) are also indicated.

4. Parasurgical measures such as bloodletting (raktamokshana), application of caustics

(kshara karma), and cauterization (agnikarma) are also mentioned.

5. Surgical excision (shastrakarma) of the tumor is performed.

6. Postoperative wound management by various Ayurvedic drugs is conducted.

7. Parasurgical approaches include bloodletting (raktamokshana), therapeutic cautery

(agnikarma), application of caustics (ksharakarma), and maggotification.

TABLE 16.6

Common Ayurvedic Formulations to Treat Tumors

Name of the

Formulation

Main

Constituents Indication Dose Ref.

Rudra rasa

(arbudahara rasa)

Mercury and

sulphur ground

with the

decoctions of

betel leaf,

boerhavia, cow's

urine, Piper

longum, and

amaranthus

Mentioned in all

types of cancer

125–250 mg twice/

day

58

Lokanatha rasa

(brihat)

Mercury, sulphur,

mica, aloe, iron

oxide ground

with Solanum

nigrum

Mentioned in liver and

spleen disorders

125–250mg twice/

day

59

Tamra basma Colloidal copper Used in all types of intraabdominal

swellings (gulma)

15–125 mga 60

Abhraka basma Mica Mentioned in all types of

debilitating diseases

125–250 mga 61

Suvarna basma Gold dust Used to improve immunity,

strength, and body weight

2.5–6.0 mga 62

Manashila Arsenic

disulphide

For external application on

tumors

Quantity sufficient 63

a As directed by the physician.

16.9.3 Specific Treatments

In vivo and in vitro studies have been carried out on different Ayurvedic drugs in various

institutions all over the world. The purpose of these studies is to evaluate drugs’

cytotoxic action, their role in improving the hemopiesis, and level of immunity. Studies

have also been used to show how drugs reduce the toxic effects of conventional therapies

and improve the well-being of the patient, as an adjuvant to chemotherapy and radiotherapy.

1. A compound Ayurvedic drug containing bhallataka (Semicarpus anacardium), rohitaka

(Amoora rohitaka), and yastimadhu (Glyceriza glabra) along with other conventional

treatment modalities plays an important role in immunological alteration

in cancer. This compound helps in terms of increases in mean lymphocyte count,

improvements in cell-mediated immunity, increases in T-cell count, decreases in

positivity to C-reactive protein, and increases in the levels of serum immunoglobulins

(Ig) such as IgA, IgG, and IgM.5

2. Rohitaka and bhallataka reduce the hepatotoxicity induced by chemotherapy in

hepatobiliary, gastrointestinal malignancy,6 and squamous cell carcinoma.7 These

drugs normalize the liver functions after chemotherapy.

3. Various other clinical and experimental investigations have been done to evaluate

the role of various Ayurvedic drugs as an adjuvant therapy. They were found

effective in reducing the chemotherapy- and radiotherapy-induced toxicities in

various types of cancers.8

4. Studies indicate that Withania somnifera (ashwagandha) could reduce the cyclophosphamide

induced toxicity and hence be useful in cancer therapy.9 W. somnifera

produces immunopotentiating and myeloprotective effects, as seen from the

enhancement of cytokine production and stem-cell proliferation and its differentiation.

10

5. The tablet Cystone, a polyherbal Ayurvedic preparation, protects against cisplatininduced

nephrotoxicity without interfering with its antitumor activity.11

6. Certain vegetable oils rich in linoleic acid (e.g., sesame oil) that are recommended

for topical use by Ayurveda may contain selective antineoplastic properties; these

properties are similar to those demonstrated for essential polyunsaturated fatty

acids and their metabolites. This suggests that vegetable oils may have potential

clinical usefulness.12

16.9.3.1 Treatment of Vataja Tumors

Vataja tumors are treated locally by medicated poultice (upanaha), fomentation with steam

(nadi sweda), and bloodletting (raktamokshana). They are treated systemically by medicated

dehydrated butter and herbal formulations.

16.9.3.2 Medicated Poultice

Various medicated poultices are mentioned for the management of vataja tumors. Kushmanda

(Benincasa cerifera), ervaruka (Cucumis utilissimus), narikela (Cocos nucifera), priyala

(Buchanania lanzan spreng), and eranda (Ricinus communis) seeds that are boiled with milk,

water, and ghee and mixed with oil should be applied. Another medicated poultice made

up of boiled meat has also described as effective.13

© 2004 by CRC Press LLC

290 Scientific Basis for Ayurvedic Therapies

16.9.3.3 Fomentation

Fomentation of local part in the form of nadi sweda is advised. Drugs such as moringa

pterygosperma (shigru) and the juice of meat (mamsa rasa) are boiled and steam is to be

passed through a tube over the site.14

16.9.3.4 Bloodletting (Raktamokshana)

Bloodletting with the help of horns (shringa) has been described to be effective in the

treatment of vataja tumors.14

16.9.3.5 Systemic Treatment

Medicated ghee boiled with decoction of drugs that fix the aggravated vata (Table 16.7)64

is given with milk or kanji.

16.9.3.6 Treatment of Pittaja Tumors

The local treatment of the tumor includes rubbing with the leaves of udumbara (Ficus

glomerata Linn.) or other leaves having a rough surface. This is followed by sprinkling of

fine dust of sarjarasa (Viteria indica), priyangu (Callicarpa macrophylla), raktachandana (Pterocerpus

santalinus), arjuna (Terminalia arjuna), and yastimadhu (Glycyrhiza glabra) mixed with

honey.

A plaster composed of aragvadha (Cassia fistula), soma (Sarcostemma acidum), and shyama

(Callicarpa macrophylla) is also prescribed. The above local application of medicaments is

usually advised after bloodletting (raktamokshana).

TABLE 16.7

Drugs Having a Vata Mitigating Effect (Vatahara Dravya)

Name of Plant Botanical Name Family Name Parts Used

Devadaru Cedrus deodara Roxb. Pinaceae Heart wood

Kusta Saussurea lappa C.B Clarke. Compositae Root

Haridra Curcuma longa Linn. Zingiberaceae Tuber

Varuna Crataeva nurvala Buch-Ham. Capparidaceae Bark

Meshashrungi Gymnema sylvestre R.Br. Asclepiadaceae Leaf, root

Bala Sida cordifolia Linn. Malvaceae Root, seed

Atibala Abutilon indicum Linn. Malavaceae Root, seed

Kacchura Curcuma zedoaria Rose. Zingiberaceae Tuber

Sallaki Boswellia serrata Roxb. Burseraceae Bark, latex

Kuberaksha Caesalpina crista Linn. Caesalpinioideae Seed

Arjuna Termenalia arjuna Roxb. Combretaceae Bark

Sahachara Barleria prionitis Linn. Acanthaceae Whole plant

Kulattha Dolichos biflorus Linn. Papillionatae Seeds

Kola Zizyphus jujuba Lam. Rhamnaceae Leaf, fruit

Shatavari Asparagus racemosus Wild. Lilliaceae Tuber

Punarnava Boerhavia diffusa Linn Nyctaginaceae Root, seed, whole plant

Eranda Ricinus communis Linn. Euphorbiaceae Root, leaf

Arka Calotropus procera R.Br. Asele piadaceae Root bark, flower, leaf

Source: Ganekar, B.G. and Vaidya, L.C., Samshodhana samshamaneeya Adhyaya in sutrasthana of Sushruta Samhita

by Acharya Sushruta, 5th ed., 1994, chap. 40, p. 142, verse 7. With permission.

16.9.3.7 Systemic Treatment

Medicated ghee prepared with madhuyasthi (Glycyrhiza glabra), draksha (Vitis venifera),

shyama (Callicarpa macrophylla), girihwa (Clitoria ternatea), anjanaki (Strychnus colubrina), and

yavatikta (Erythraea roxburgii) is given internally.

16.9.3.8 Treatment of Kaphaja Tumors

Local application of various medicated pastes are used after detoxification (samshodhana

chikitsa) especially after emesis (vamana). The paste of the drugs used for emesis (vamana)

and purgation (virechana) may also be applied locally to arrest the disease.

Caustics (kshara) in a cow’s urine are also prescribed as a local application for kaphaja

tumors after the bloodletting procedure.

16.9.3.9 Treatment of Medaja Tumors

Surgical and parasurgical approaches for the management of medaja tumors are emphasized

in Ayurveda. Nevertheless, medicated paste containing haridra (Curcuma longa),

lodhra (Symplocos recemosa), patanga (Caesalpinia sappan), manashila (real gar), and haritala

(opiment) mixed with honey is also used as a local application.

16.9.3.10 Bloodletting (Raktamokshana)

Bloodletting is indicated after detoxification in the management of vataja, pittaja, kaphaja,

and medaja tumors. The use of cow’s horn, nonpoisonous leeches, and gourd (Lagenaria

vulgaris) for bloodletting has been advised in vataja, pittaja, and kaphaja tumors, respectively.

In medaja tumors, bloodletting has been advised after making an incision over the

tumor.

16.9.3.11 Use of Cautery and Application of Caustics (Agnikarma and Ksharakarma)

Thermal cauterization (agnikarma) and application of caustics (ksharakarma) is used alone

or in combination with surgery for the management of kaphaja tumors, medaja tumors, and

tumors that do not respond to medical treatment.

The recurrence of a tumor after surgical excision was recognized by Sushruta. His idea

was that even the last particle of dosa of a tumor left over would lead to a fresh growth

and bring death, just like the last spark of an unextinguished fire. A radical excision was

advised to avoid recurrence. Because it may not be possible to remove an entire tumor

mass by surgery, therapeutic cautery and the application of caustics (ksharakarma) have

been advised especially after surgery.

16.9.3.12 Maggotification

Maggotification (currently not practiced) is another important parasurgical treatment of

tumors that was practiced by early Ayurvedic practitioners. In this unique technique, the

gradual destruction of a tumor mass was achieved by maggotification of tumor. To attract

the flies, kulattha (Dolichos biflorus), oil cakes of sesamum, and powder of dry meat are

mixed with curd. This solution should be applied over the arbuda so that worms and

parasites either grow locally or are attracted toward the tumor. They feed upon the tumor,

and when only a small part of the tumor remains, the worms and the paste should be

washed off the area and the remnant mass should be treated with cautery.

 

Om Tat Sat

                                                        

(Continued...) 

(My humble salutations to H H Maharshi ji,  Brahmasri Sreeman Lakshmi Chandra Mishra ji and other eminent medical scholars and doctors   for the collection)