Cancer Medicine in an Ayurvedic Perspective: A Critical Overview

Cancer is a leading cause of mortality among the world’s population. Worldwide, 19.3 million new cancer cases and almost 10 million cancer deaths occurred in 2020. Cancer-like conditions are described in Ayurveda texts under the nomenclature of Arbuda and Asadhya Vrana (Non-healing ulcers). Mithya Ahara and Vihara vitiate Tridosha, responsible for different types of Arbuda. According to dhatu involvement, various types of Arbuda are defined. If Arbuda is left untreated, it is ultered into Asadhya Vrana. Acharya Sushruta has also advised multiple surgeries for Arbuda.

The characteristics of cancer cells are continuous cell growth due to their non-responding nature to the signals of stopping the growth or apoptosis, the ability to spread in other parts of the body, and immortality of cells because of their capacity to restore their telomeres. The clinical features depend on the size and location of cancer and the presence or absence of metastasis. Local and systemic symptoms rely on the tumor mass and the body’s response to cancer, respectively. Cancer is classified according to the tissue involved, like Carcinomas, Sarcomas, Myeloma, Leukemia, Lymphoma, Germ cell tumor, and blastoma. The globally recognized standard to classify the extent of cancer spread is called T.N.M. Classification. It applies to many solid tumor cancers but is not relevant to leukemia and the central nervous systems tumor. The tumor can be diagnosed with tests like mammograms, Pap smears, Tumor markers, Bone scans, MRI, Tissue biopsies, and PET-CT scans. The treatment depends on the type and stage of cancer and the patient's overall health. Common treatment modalities are surgery, radiation, and chemotherapy. Other treatments are targeted/biological therapies, hematopoietic stem cell transplants, angiogenesis inhibitors, cryosurgery, and photodynamic therapy. Every treatment has its risks, benefits, and side effects. 

Epigenetics is the term that comes before genetics. DNA is not able to determine the characteristics of a human being. The genotype corresponds to Prakriti by birth, and the phenotype corresponds to the psychophysiological constitution of Prakrit. The features and properties of RNA represent the Tridosha at the cellular level, which can be identified under the heading of mRNA, tRNA, and protein. There are four significant factors, i.e., lifestyle and behavior, diet and digestion, stress, and environmental factors responsible for changes in the phenotype that led to changes in the genotypic expressions without changing the basic structure of DNA. Nowadays, changing lifestyles, food habits, stress factors, uncontrolled pesticides used in the agricultural field, global warming, and undue environmental changes lead to epigenetic changes in humans. Ayurveda addresses solutions to the affecting factors by adopting the basic principles of Ayurveda, including daily routine, behavior, diet plan, exercise, meditation, medications, purification therapies, etc. The integration of the Indian system and the current medical system facilitates optimum health and stability for humanity. Further research on modalities, drugs, formulations, and herbs explained in Ayurveda for affective gene expression is needed to fulfill various cancers' desired management.

Currently, there is a lot of talk about cancer (arbuda) at all levels of society. It includes both benign and malignant tumors. Our body is made up of Tridosha, the three fundamental energies or principles that govern our body function on the physical and emotional levels. The three energies are known as Vata, Pitta, and Kapha. Each individual has a different constitution from others. Prakriti is a unique concept of Ayurveda that explains individuality and has a role in maintaining health & prevention, of diseases, and achieving longevity. Each person must know their Prakriti constitution to determine the correct food, exercise, yoga, lifestyle, and environment to remain healthy and achieve longevity. Our Prakriti in Ayurveda roughly resembles DNA or genes in western medicine. Most of the theories offered regarding cancer cause fall into the following categories: embryonic,bio-chemical, infectious agents, and genetic. Ayurveda can play a big role in the last causative factor, genetics. Cancer in each person differs according to the person's exposure to pathogens and Prakriti (genetic constitutions), assessment of Prakriti is very useful in prognosis & therapeutic management of cancer. It is also helpful in prescribing suitable Ahar, Vihar, Yoga & Rasayana therapy. 

In the present era, because of changing lifestyles and stress, various new diseases are emerging as a major health problem worldwide. Fields like medicine and technology are also getting more advanced, but mortality and morbidity rates are still increasing. In India, after cardiac diseases, cancer is the second leading cause of morbidity and mortality and mainly accounts for 9% of all deaths. Because of a lack of awareness, diagnostic facilities, and screening programs, nearly 75-80% of cancer patients approach hospitals at an advanced stage (stage 3-4). If cancer is detected in the early stage then it is treated easily. Screening is an essential and effective preventive measure in cancer control. The main aim of cancer screening is to detect cancer before the manifestation of symptoms. It is advised for various cancers like breast, cervical, colorectal, prostate, etc. Cancer screening is mainly helpful in cancer prevention, early detection, and subsequent treatment. Multiple tools like urine tests, blood tests, medical imaging or DNA tests, etc., are mainly used for screening. They help to decrease the total number of people dying of cancer through its early detection and better treatment.

 In the present era of modernization, the new generation differs from the lifestyle maintained in the ancient period. A few decades ago, it was a regular practice of major community, i.e., Early to bed and early to rise, where the body’s clock and nature's clock were more or less similar. During this period of modernization, there was a tremendous change in lifestyle, including daily activities. This results in an early facing of severe problems. Modern medicines very well deal with such issues, but long-term regular use of such medication can affect vital organs in the future. Medicinal herbs have been used worldwide as supportive treatment to minimize the toxic effects of chemotherapy and radiotherapy. Many clinical studies have reported the beneficial results of herbs in combination with conventional therapeutics on the patients' survival, immune modulation, and quality of life. One such disease is cancer, wherein medicines have various side effects and immunity suppression effects. The present chapter deals with different herbs, their role in cancer treatment, and the side effects of their treatment. Here in this chapter, herbs are briefly reviewed that are used for treating various cancers. Different research work and clinical studies are mentioned here that showed the anticancer activities and their effect on various biological pathways. The use of a dietary regime along with medicinal herbs for better results is also a part of Ayurveda to be followed. The state of balance between doshas and dhatus is essential while using herbs in all aspects. This review may help to provide the utility of various herbs in various aspects of cancer and its treatment.

Rasoushadhis are special Ayurveda pharmaceutical formulations prepared from metals, minerals, potent herbs, and animal products. These medicines are preferred for severe chronic illnesses which are difficult to cure and life-threatening. Cancer is one such disease that ancient seers of Ayurveda noted. Several Rasoushadhis with potential cytotoxic and cell growth inhibitor actions are recommended for cancer treatment. The present chapter aims to disseminate such formulations, the basis behind their activity, and relevant other formulations that Ayurveda practitioners use to manage Bhaishajya Ratnavali and Rasayogasagar are two important compendia of Ayurveda formulations. Therefore in the present work, the anti-cancer formulations narrated in these two texts are reviewed and compiled. It can be said that the prevalence of cancer in the ancient Indian population was far less, and this may be why the number of anti-cancer formulations is limited. The use of metals and minerals in the form of chelation therapy for cancer can be correlated with Ayurveda anti-cancer Rasoushadhis. Several modern kinds of research on metals, minerals, and herbs contain supportive evidence indicating the rightness of the classical claim of the anti-cancer effect of herbominetal preparation. Relevant information from such research is also presented here. This chapter may be a brief illustrator of the ancient wisdom of anti-cancer formulations.

Cancer is a group of diseases having an uncontrolled unregulated division of abnormal cells that tend to spread to all other parts of the body. It is observed that about 80-90 percent of the causes of cancer include unhealthy diet, behavioral habits, and environmental factors that can be prevented. Cancer is not described in Ayurveda, but in Brihatatrayi, there is a description of Granthi and Arbuda, which can be correlated with cancer due to the similarity in nature and clinical course. In Ayurveda, there are three major causes of any ailment: Kala Parinam, Pragyaparadha, and AsatmendriyarthaSamyoga. All of this can be prevented by adopting a healthy lifestyle. Hence there is a need to focus on a healthy lifestyle to manage and prevent cancer. Concept of Primordial prevention: The holistic approaches of Swasthavritta like Healthy dietary and behavioral habits, Dincharya, Ritucharya, not restraining nonsuppressible urges and holding suppressible desires, Good conduct, Yoga, Pranayama, Meditation, and Shatkarma purifying procedures, all come under primordial prevention. This is the prevention of the risk factors by optimizing lifestyles associated with cancer by following the holistic principles of Ayurveda. Various research studies also proved that these principles of Ayurveda are helpful in the prevention and recovery of cancer patients. On the basis of the conclusion from the literature and available research on cancer, it can be said that adopting the holistic principles of Ayurveda is beneficial in preventing the risk of various types of cancers. 

Agadtantra is a specialized Ayurveda branch that deals with toxicity management. This specialized branch has given the novel concept of Dooshivisha. It is a transformable state of Visha (poison) which any type of poison can attain if it is not eliminated from the body completely. Today every individual is frequently exposed to many toxic substances, mostly carcinogenic. Polycyclic hydrocarbons, nitrosamine, pyrogenic compounds and many others are now known to be potent mutagens and carcinogens. These carcinogens enter the body through air, water, radiation, drugs, cosmetics and reflect deposit in the body as a Dooshivisha and slowly vitiate all the Dosha & saptadhatu (seven Dhatu). After studying the etiological factor of cancer in the context of Ayurveda and modern medicine, it is seen that most of the etiological factors and pathology of cancer come under these headings. Radiotherapy and chemotherapy are the only lines of treatment for cancer, but they produce harmful toxic effects along with their beneficial effects. Management of cancer is made easy by adopting a therapeutic approach of Dooshivisha. Various Agadkalpas are useful to reduce or vanish latent toxicity. The integrated system of modern medicine with Dooshivisha management means the application of Agada will be helpful for prevention, minimizing the side effects of conventional therapies, and improving the quality of life of cancer patients.