Tanuja Nesari,MD, Ph.D. (Ayu.)

Professor & H.O.D.,( Dravyaguna ).,Ayurvedic Clinical Pharmacology

Principal,Tilak Ayurveda College,Punetnesari@hotmail.com

Mobile No.-9423007988

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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

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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)

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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.

Diet & life-style

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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

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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) 38tnesari@hotmail.com11/15/2010

Code of conductSadvrutta ch. Su. 8

PERSONAL SOCIAL

COMMUNITY SPIRITUAL

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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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THANK YOU !58

THANK YOU !tnesari@hotmail.com

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