Role of Ayurveda in Cancer Management A profile and focus on R&D

1. Role of Ayurveda in Cancer ManagementA profile and focus on R&D N.SRIKANTH ASSISTANT DIRECTOR CENTRAL COUNCIL FOR RESEARCH IN AYURVEDIC SCIENCES Department of AYUSH Ministry of Health & Family Welfare Government of India

2. Historical Account • The earliest and foremost recordcould be cited in AtharvaVeda (2200 BC) (‘Apachi’ ) • Apachi or Apachit which refer to multiple lymph node swelling. • Similar description has been depicted during the period of Sushruta (400 BC) in his classic SushrutaSamhita. • Apachi or multiple lymph node swelling has been cited at different places viz. the neck, axilla and groin.

3. Ayurvedic Concepts of Cancer Regulation Tissue Formation HEALTH - DISEASE Vs TISSUE PHYSIOLOGY Samahayogavahi or Homoeostasis : Tissue - Organ- System integration “Samahayogavahiyadha hi asminsareeraedatavah… ….vaishamagamanam hi ….. …… Vridhi- Hrasagamanam hi punardhatunam……….”

4. Ayurvedic Concepts of Cancer Regulation Tissue Formation CONTROL LED BY TISSUE SPECIFIC REGULATORY FACTOR AGNI (dhatwagni (tissue level) & bhutagni (organ/gene level ) Regulation /Homoeostasis of Tissue Physiology Derangement in REGULATION /AGNI FUNCTION CANCER

5. Ayurveda Understanding Malignant Disease • Superficial swellings - ARBUDA • Non-healing ulcers - ASADHYA VRANA • Malignancies of deeper structures - GULMA • Classified based on • clinical presentations • site of lesion • course • prognosis

6. Cancer pathology : Ayurveda & contemporary correlates

7. Ayurveda Understanding Malignant Disease • Can considered • as malignant Can be labeled as Clear malignancy • Possibility of • malignancy • cannot be • ruled out

8. Ayurveda Understanding Malignant Disease

9. Health Seeking attitude Role of Ayurveda in Cancer • The most prevalent users of Traditional Medicine are individuals who have • Incurable/ Refractory conditions • Non–life-threatening conditions that may be chronic viz. neurological disorders, arthritis etc. • The second largest group of users are those struggling with chronic, potentially life-threatening diseases, such as Cancer and HIV/AIDS etc

10. Health Seeking attitude Role of Ayurveda in Cancer • Both groups turn to TM/AYUSH systems for a variety of reasons, such as • to improve immune functioning • to improve overall functioning, • to increase quality of life • to cope with side effects from conventional therapies, and • to relieve symptoms related to their illness.

11. Management protocols • Systemic • SamshodhanChikitsa • Shaman Chikitsa • RasayanChikitsa • Local • Alep • Parisheka, • Abhyanga • Vimlapana • Agni Karma, • Kshara Karma • Lifestyle

12. Formulations commonly used in cancer

13. Ayurvedic Plants commonly used in cancer

14. Ayurvedic plants commonly used in cancer

15. Rasayana • Another Ayurvedic approach of treating is restoration and preservation of health • Improved tissue functions • Disease Specific effects • Symptom management • Improvement in QOL

16. Rasayana Approach

17. Possible attributes of Rasayana • PUSTIKARA NUTRITIVE • OJOVARDHAKA/ • BALAKARA IMMUNO MODULATORY/POTENT • MICRO NUTRIENT • AYUSHYA /AYUSKARA ANTIOXIDANT /ADAPTOGENIC • INDRIYA BALAPRADA SUPPORTS THE SENSORY ANDMOTOR SYSTEMS • SMRITIKARA MEMORY BOOSTER • VRISYA APHRODISIAC • VAYASTHAPANA ANTI AGEING ACTION

22. Evidence Base • In vitro Screening of Ayurvedic herbs for anti-cancer activity • Clinical studies

23. Clinical Studies • Stand Alone Ayurveda • Complementary to Conventional combinations • Clinical safety & efficacy • Improvement of quality of life • Overall survival • Event free survival • Progression free survival

24. Intervention • Panchakarma (Snehan Karma with Triphala Ghrita as poorvakarma) • 6 months intervention with Ayurvedic drugs containing: • Bhallatak • Rohitak • Madhyasthi • Tamra Bhasma

25. METHODOLOGY • Stand alone and add-on/adjuvant therapy to radio/chemo therapies • N=400 • Study period =10 years • Follow-up = 5years • Different types of Cancer • Different sites and stages

26. treatment groups(n=400)

27. Subjects and trial interventions

28. Systemic involvement

29. Histopathology

30. Bio –constitution and Cancer Subjects

31. Report on Follow-ups Years

32. RESULTSOUTCOMES • Weight • Hb% • Glutamate Decarboxylase (GAD) Activity • Cytotoxic effects • Immune function • Survival and lifespan

33. Body weight changes • When compared with other groups in those patients who received therapy of Ayurvedic drugs alone or in combination/adjuvant to radio therapy, chemotherapy or radiotherapy+ chemotherapy • Inhabited loss in body weight • Significant gain in weight

34. Body weight changes

35. Inhibited fall in Hemoglobin% • Increase in Hb% • The hemoglobin percentage has increased from 9.0 gm% to 11.0 gm% in combined therapy of radiation and Ayurvedic drug. • Whereas it has improved from 9.6 gm% to 12.2 gm% in combined therapy of chemotherapy and Ayurvedic drug. • Those patients treated with the combined therapy of radiation, chemotherapy and Ayurvedic drug reveal increase in hemoglobin percentage from 10.3gm% to 11.2 gm% after six months of treatment. • Similarly patients subjected to only Ayurvedic drug therapy at stage I and II also showed increase in hemoglobin percentage from 9.6 gm% to 12.7 gm%.

36. Hb

37. Glutamate Decarboxylase (GAD) Activity • Significant decrease in GABA and increase in glutamate in the blood was observed in all cancer subjects • The synthetic enzyme of GABA and degrading enzyme of glutamate i.e. glutamate decarboxylase (GAD) revealed significantly low activities.

38. Glutamate Decarboxylase (GAD) ActivityChemotherapy

39. Glutamate Decarboxylase (GAD) Activity Chemotherapy+Radiotherapy

40. Glutamate Decarboxylase (GAD) ActivityChemotherapy + Ayurvedic drug

41. Glutamate Decarboxylase (GAD) ActivityCHEMO+RADIO+AYURVEDIC DRUG

42. SURVIVAL IN DIFFERENT GROUPS • Increase in survival % with addition of Ayurveda therapy to conventional treatments ranging from …65-76%

43. SURVIVAL IN DIFFERENT GROUPS

44. Summary • Ayurveda stand alone and as add-on/ adjuvant therapy to radio/chemo therapies have shown … • Significant increase in Hb% • Prevent fall in Hb% • Loss in body weight inhabited • Significant gain in weight • Increase in GAD levels • Increase in survival period • Improved immune status (IgA Levels) ………… when compared to radio/chemo therapies alone

45. Biological activity and Ayurveda leads Leads on Anticancer Activity • Screening of Ayurvedic herbs for anti-cancer activity • Standardized Plant Extracts • Basis from Classical Literature • In vitro studies on cell lines • Potential leads • Scope for further Validation

46. Leads on Anti Cancer activity* *Report on Screening of single Herbal drug extracts for potential anti-cancer activity; 2009, Central Council for Research Ayurveda & Siddha, New Delhi.

47. Current Drug Trials

48. A Way Forward Evidence base of Ayurveda can offer for global health • These modalities • Stand alone • As add on therapies are proven to have an edge over conventional medical approach in dealing with Chronic and refractory disease conditions sharing huge Global burden • The integration of AYUSH Systems with bio-medicine should be a symbiosis without losing their own core fundamentals and this approach could possibly provide a solution for the benefit of cancer subjects

49. Thank you