Cancer is one of the most dreadful disease of the 20th century and spreading further with continuace and increasing incidence in 21st century. An integrated approach is needed to manage cancer. An alternative solution to western medicine embodied with severe side effects is the use of Ayurvedic preparations to arrest the insidious nature of the disease.Ayurveda, a science of long life, almost 6000 years old, can serve as a “goldmine” for novel drugs used for centuries to treat chronic diseases. Thousands of ayurvedic preparations are being screened worldwide to validate their use as anti-cancerous drugs. Hence, the broad aim of this article is to provide a general outline on description of cancer’s causes, pathogenesis and therapeutic management from an ayurvedic perspective underlying its scientific principles involved in treating these conditions with th euse of natural products.

INTRODUCTION

In the last few years there has been an exponential growth in the field of herbal medicine and these drugs are gaining popularity both in developing and developed countries because of their natural origin and less side effects. It is considered as an adversary of modernization and advanced pattern of socio-cultural life dominated by Western medicine. Multidisciplinary scientific investigations are making best efforts to comba tthis disease, but the sure-shot, perfect cure is yet to be brought into world medicine.More than 50% of all modern drugs in clinical use are of natural products, many of which have been recognized to have the ability to include apoptosis in various tumour cells.[1] Recently, a greater emphasis has been given towards the research on complementary and alternative medicine that deals with cancer management. The broad aim of this article is to provide a general outline ondescriptions of cancers and their management from an ayurvedic perspective underlying its scientific principles involved in treating these conditions with the use of natural products. This article reviews the available literature regarding researches on anti-cancerous ayurvedic herbs and also includes a summary of treatment strategies for various cancers. It is written with an intention to raise awareness and encourage implementation of ayurvedic therapies for combating cancer and suggesting an integrated approach in cancer management and treatment.Learning from the past, examining the present and advancing to the future, Because large population use ayurvedic medicine worldwide, there is an urgent need for additional, carefully conducted, high-quality intensive research to evaluate its efficacy and to develop this discipline to meet ever-new challenges of modern medicine in the field of oncology.

Ayurvedic concept of cancer

Although there is no illness listed in Ayurveda  as Cancer, there are disorders mentioned in Ayurvedic Texts which shows great similarity to Cancer. Modern medicine describes Cancer as the deformation of tissues and their undesired growth. Ayurvedic Texts describes the symptoms and their respective treatments for overcoming the dieseased condition. ‘KarkaRoga’ is a synonym to the word ‘Cancer’ disease. The disease shows similarities with following diseases described in Ayurveda  as DushtaShotha, Dushta Vrana, DushtaGranthi, DushtaArbud, DushtaVidradhi, DushtaVisarpa, DushtaNadivrana, DushtaManspradoshajaVikara etc. [21,22,23,24,25]. The above mentioned conditions that develop in certain parts of the body are very similar to those of Cancer, although all types of Shotha may not be cancerous. Impure or imbalanced doshas, Vata, Pitta or Kapha or infested Shothas could lead to Cancer. If care is not taken to cure the Shotha and if the causes which cause them are not taken care of, then these causes leading to Shotha may further lead to Cancer. Leukemia or Cancer of the blood – in ayurveda  we have found the following similarities – Rasa – RasagataJwara,RaktaDhatuJwara (Fever),  RaktadhatuPaka, Anaemia(Pandu), Bleeding disorders(Raktapitta), SannipatikJwara,  RaktajKrumi. Charaka [2] and Sushruta [3]samhitas, wellknownAyurvedic classics,describe cancer as inflammatory or non-inflammatory swelling and mention them as either Granthi (minor neoplasm)or Arbuda (major neoplasm).

Fundamental classification

Ayurvedic classification of neoplasm depends on various clinical symptoms in relation to Tridoshas.

1. Diseases that can be named as clear malignancy, which includes arbuda and granthi,e.g. mamsarbuda (melanoma) and raktarbuda(leukaemia), mukharbuda (oral cancer), etc.
2. Diseases that can be considered as cancer, such as incurable ulcers with e.g. tridosaj gulmas (abdominal tumors like carcinomas of the stomach and liver or lymphomas).
3. Diseases with the possibility of malignancy, e.g. Visarpa (erysipelas), asadhyakamala (incurable jaundice) and nadi vrana(sinusitis). [4,5,20,28]

Etiology

Cancer in each person differs according to the person’s exposure to pathogens and genetic constitutions which make each of them to react differently. The factors responsible for the vitiation of doshas are discussed here. [6]a. Vata aggravating factors: excessive intake of bitter, pungent, astringent, dry foods and stressful conditions.b. Pitta aggravating factors: excessive intake of sour, salty, fried foods and excessive anger.c. Kapha aggravating factors: excessive intakeof sweet, oily food and sedentary nature.d. Rakta aggravating factors: excessive intake of acid or alkali containing foods. Fried and roasted foods, alcoholic beverages, sour fruits are some examples. Excessive anger or severe emotional upset, sunbathing or working under scorching sun or near fire and hot conditions, etc.are some other causes.[7]e. Mamsa aggravating factors: excessive use of exudative  foods like meat, fish, yoghurt, milkand cream. Behaviours leading to exudation like sleeping during the day and overeating are someof the causes for pathogens invading the fatty tissues.f. Medo aggravating factors: excessive intake of oily foods, sweets, alcohol and lazy attitude.[7,8]

Pathogenesis of tumors

According to Ayurvedic principles, the disease cannot be named on its own because it differs between  person to person in terms of illness, clinical presentation and also the treatment required.[5]

In arbuda, the decreased state of dhatwagni (deranged metabolism) will result in excessive tissuegrowth. Vata can be correlated with the anabolic phase of growth whereas kapha to the catabolic phase. Cancer originates due to a metabolic crisis, i.e. aggravation of vata forces and suppression of kapha forces, both interacting with one another resulting in proliferation. Sushruta has proposed six stages in the pathogenesis of all diseases but his concept suits more to the pathology of the tumor than pathogenesis itself.

1. Sanchaya: early stages of localized neoplastic changes.
2. Prakopa: transformation of primary growth into metastatic tumors.
3. Prasara: metastasis.
4. Sthanasamsraya: 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.[6]

Diagnosis of the Disease (Vvadhivinishchava) from Ayurvedic Perspective

Signs & symptoms of :-

• Malignant Wounds / Ulcers (Dushta Vrana)
• Malignant Nodes (DushtaGranthi)
• Malignant Tumours (DushtaArbuda)
• Spreading Cellulitis (DushtaVisarpa)
• Malignant Abscess (DushtaVidradhi)
• Malignant Sinuses (DushtaNadivrana)
• Malignant abscess of Vitiated Mansa Dhatu (DushtaMansapradoshajaVikara)[9]

Stages (Avastha) :-

• Embedding in deeper and deeper tissues & vitiating them(Dhatugata)
• Loss of tissues (Dhatupaka)
• Unripped (Aama)
• Semi – ripped (Pachyamana)
• Ripped i.e. Acutely Tender(Pakwa)
• Malignant Sinuses(DushtaNadivrana)
• Malignant abscess of Vitiated Mansa Dhatu (DushtaMansapradoshajaVikara)[9]

Treatment of Cancer

The treatment is divided as :-

• Panchakarma (Shodhana Chikitsa)
• Pallative Treatment (Shamana Chikitsa)
• Rejuvenation Therapy (Rasayan Chikitsa)

A. Panchakarma (Shodhana Chikitsa) – It eliminates the vitiated doshas from the body. Common Indications -Vitiation of Doshas should be at large extend.[2,3]

1. Emesis (Vamana)
2. Purgation (Virechana)
3. Medicated enema (Basti)
4. Nasal Medication (Nasya)
5. Blood letting (Raktamokshana)

B. Pallative Treatment (Shamana Chikitsa)

Shamana Chikitsa of Cancer includes strengthing of Digestive power, promoting digestion, giving strength to Body tissues (Dhatus), rejuvenating the body tissues & controlling spread of the disease by controlling Dhatugata & Dhatupaka Avastha,  Mitigating 3 dosha (Tridosh – Shamak) according to dominance of doshas, Dhatvagni – Deepan :- Improving Metabolic Activities (dhatvagni) specially Rasa – Rakta& Mansa dhatvagni, Controlling Dhatugata Avastha :- (The nature of doshas of embedding in deeper & deeper tissues & vitiating them), and Prevention of DhatupakaAvastha by Pittashamak & Raktaprasadak treatment.[21,22]

C. Rasayan Chikitsa (Medicines) (immunotherapy)

Rejuvenation to affected organ (Rasayana) :- Depending upon strength of the patient and vitiated doshas. Medicines are given in various pharmaceutical forms like single herbs, herbal mixtures, various Guggulu, tablets, Medicated ghee, Kalpa (sugar base medicines), Alcoholic beverages (Asava&Arishta)[2,3,22].

Surgery – When medical treatment practices fail, then the case is left to surgeons.Surgical cancer management in Ayurveda include the principles of fomentation by means of external application,cleansing by internal medication, treatment to liquefy the contents of the swelling, opening the tumor surgically for evacuation of its contents,cauterization to avoid recurrence and post operative care for healing the wound. Cauterisation with alkalis and acids and other surgical procedures were performed with herbal and mineral medicines. Arbuda is excised completely from its deep root seat and cauterization done to destroy any of the remaining cell particles [19,36].

List of some Ayurvedic herbs used as Anticancer

Herbs which are widely used and scientifically proven of their anticancer properties, are present under, Agar (Aquilariaagallocha),Agnimantha (Premnaintegri folia), Amla (Emblicaofficinalis),Ashwagandha (Withaniasomnifera), Bala (Sidacordifolia),Basil (Ocimum sanctum), Bilva (Aegelmarmelos),BrihatKantakari (Solanumindicum), Bhumiyamalaki (Phyllantusamarus),Chandan (Santalum album), Draks (Vitisvinifera),Ela (Ellateriacardamomum), Gambhari (Gmelinaarborea),Gokshura (Tribulusterrestris), , Isabgol (PlantagoOvata Husk),Jeevanti (Leptadeniareticulata), Kachur (Curcuma zedoary),Karkatakashringi (Pistaciaintegerrima), Kushta (Saussurealappa) , LaghuKantakari (Solanumxanthocarpum), Mustak (Cyprus rotundus),Neem (Azadirachtaindica), Nagkeshar (Mesuaferrea),Neelotpala (Nymphaeastellata), Pippali (Piper longum) ,Punarnava (Spreading Hagweed), SalaiGuggul (BoswelliaSerrata),Vasa (Adathodavasica), Shatavari (Asparagus racemosus),Shilajit(Mineral Pitch), Shynaka (Oroxylumindicum),Tejpatra (Cinnamomumtamala), Varahikand(Dioscoreabulbifera)[10,11,32,33,34,35],Bhunimba(Andrographispaniculata)[27], Guggul (Commiphoramukul)[28],Turmeric(Curcuma longa)[29], Guduchi (Tinosporacardi folia)[30],Bhallataka (Semecarpusanacardium Linn.)[31].

The medicinal plants contain many antioxidants such as vitamins (A, C, E, K), carotenoids, flavonoids (flavones, isoflavones, flavonones, anthocyanins, catechins, isocatechins), polyphenols (ellagic acid, gallic acid, tannins), saponins, enzymes and minerals (selenium, copper, manganese, zinc, chromium, iodine, etc.).[12,13] , it also appears that many plants have some of these antioxidants. Several reports state that antioxidants possess remarkable antitumour/anticancer activity. [12,13,14]. And Ayurvedic drugs are efficient in cancer treatment[26]. 

Out of 15 plants screened by CCRAS, 9 plants shown anticancer activity against Different Cell lines.[15] The 15 drugs are Kantakari, Yastimadhu, Daruharidra, Pippali, Shunthi, Kutaki, Guduchi, Vidanga, Devdaru, Ashwagandha, Amalaki, Bhumyamalki, Vacha, Kanchnar, Haritaki. And 9 plants shown effect on some cell lines are Berberisaristata ( DWD cell line-Oral tissue, A549 – Lung tissue, A2780 – Ovarian tissue), Piper longum ( colo 205- colon), Picrorhizakurroa ( colo 205- colon), Cedrusdeodara ( pc 3 – prostate, A2789 – ovary, MCF7 – breast ), Withaniasomnifera ( A 549 – Lung, K 562 – Leukemia), Phyllanthusembelica ( DU 145 – Prostate ), Acoruscalamus( DU 145 – Prostate ), Bauhinia variegate  ( DU 145 – Prostate ), Terminaliachebula ( DU 145 – Prostate, K562 – Leukemia ) [15]

Some Preparations used in ayurvedic anticancer treatment.

1. The mixture of Terminaliachebula, grape juice and sugar cane juice has been used . Resveratrol, a natural product derivative from grape juice has been proved to possesscancer chemo preventive activity. [17]
2. The paste comprising of Baliospermummontanum, Plumbagozeylanica, Euphorbia nerifolia, Calotropisprocera, jaggery, Semecarpusanacardium applied over the tumours.[17]
3. Paste is prepared from the barks of Madhucaindica, Syzygiumcumini, arjuna Terminaliaarjuna and Salix caprea and prescribed for local application[17]
4. The Barleriaprionitis oil prepared with whole plant is indicated for external application during acute stages of cyst in blood vessels[17]
5. The Paste made up of Prosopis cineraria seeds, Raphanus sativa, Moringaoleifera, barley and mustard with sour buttermilk was applied locally for disintegrating cysts[17]
6. The paste of Moringaoleifera seeds, Solanumxanthocarpum, Sinapisdichotoma, Holarrhenaantidysenterica and Neriumodorum roots prepared with buttermilk is used for arbuda tumors[17]
7. Curcuma domestica – The Curcuma domestic powder in combination with Symplocosracemosa, Soymidafebrifuga, is mixed with honey and this is used as an external remedy[17]

Ayurvedic treatment minimizes toxicities of Chemotherapy

Though Cancer Chemotherapy is highly effective in many Cancers, in Modern medical science, toxicities of Chemotherapy are severe in many patients, Chemotherapy medicines produce side – effects like Diarrhoea, Loss of appetite, Anorexia, Vomiting, Constipation, Stomatitis, Burning sensation, Fever, Weakness, Loss of weight, Alopecia. It mainly hamper Gastrointestinal tract. In this condition, Ayurvedic line of treatment improves appetite, promotes digestion & relives associated symptoms like Nausea, Vomiting, Loss of appetite, Stomatitis, Diarrhoea, Constipation, Hyperacidity. The sideeffects of Chemotherapy are remarkable reduced with Ayurvedic treatment & patient can tolerate Chemotherapy.Some Ayurvedic medicines have cooling property. Thus patients get relief in Burning sensation in chest, palms, soles& in eyes.It improves blood count & removes toxicities in blood are also beneficial.Diet like rice, moong dal, boiledvegetables, vegetable soup, fresh sweet fruits, cow’s milk, cow’s ghee, buttermilk, butter is recommended during the course of Chemotherapy.

Insomnia (Disturbed sleep) is a common problem during Chemotherapy. Shiropichu (Application of gauze soaked in medicated oil) is observed to be beneficial in this problem.[18]

Ayurvedic treatment minimizes toxicities of Radiotherapy

Radiotherapy produces side effects like Local burning, itching, discoloration, ulcers, rashes, Herpes, Loss of appetite, Anorexia, Stomatitis, Weakness, Loss of weight. The sideeffects of Radiotherapy are remarkable reduced with Ayurvedic treatment & patients can tolerate Radiotherapy & relieves symptoms like local burning, ulcers, rashes.Patients undergoing Radiotherapy also suffer from Loss of appetite, Anorexia & Vomiting. Mainly liquid diet like soup of green gram, rice gruel, semolina porridge, vegetable soup, fresh fruit juices, buttermilk, coconut water, medicated water are recommended. Skin discoloration is a common side effect of Radiotherapy so application of some medicated oils or ghee after completing Radiotherapy is useful to improve texture & colour of skin. Cancer patients are definitely benefited with this type of integrated approach of treatment. [18]

CONCLUSION AND FUTURE DIRECTIONS

It is estimated that more than 80% of the world’spopulation cannot afford modern medicines. In addition to cost, current cancer therapies areminimally effective and exhibit toxicities that are intolerable in most cases. This review presentsevidence that drugs used inAyurvedic medicine can be used not only toprevent cancer, but also to treat cancer. These agents canenhance therapeuticeffects and minimizes Chemotherapy/Radiotherapy inducedtoxicity. Because cancer is primarily a disease ofolder age, finding less toxic therapies is a majorpriority. The molecular targets of chemo preventive agents are similar tothose currently being used to treat cancer. Tumour cells use multiple cell survival pathwaysto prevail, and agents that can suppress thesemultiple pathways have great potential in thetreatment of cancer. The evidence indicates that most of the plant-based agents used in Ayurvedic medicine do indeed suppress multiple pathways. Ayurvedic Panchkarma ( Shodhana ) Therapy can be beneficial for cancer management.  More research is needed in order for theseagents and therapies to reach their full therapeutic potential.