• Eczema
• Psoriasis
• Allergies
• Herpes
• White Patches / Leucoderma

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INDIGESTION

Indigestion is a clinical condition with vivid presentations like

• Pain in abdome
• Reduced appetite
• Nausea, vomiting
• Diarrohea etc

Conventionally the condition is treated with Antacids, Anti emetics, Smooth muscle relaxants etc.

Ayurveda approaches the condition as Ajeerna. It is one of the potent area of Ayurveda, wherein a genuine result can be expected.

Following are few of the causes :

• Excess water intake
• Untimely food intake
• Excess food intake
• Suppression of natural urges etc.

Primarily, as a part of treatment, aborting oneself from the causative factor leading to Ajeerna is very essential. Followed by treatment to enhance ones appetite, digestion and assimilation. If necessary, considering the severity of illness, a course of Panchakarma would be recommended. Wide range of medicaments to correct indigestion and its associated ailments are available in Ayurveda.

Gastritis

IBS (Irritable bowel syndrome)

Chron’s disease

Jaundice

Alcoholic Liver Disease

Ascites

COUGH

Cough is a positive response of the body to remove/throughout any foreign body or to any irritation in the Respiratory tract. It is also called as tussis.

Causes : –

• Flu
• Tuberculosis
• Pneumonia
• Influenza
• Cardiac aliments
• Bronchitis
• CA of Respiratory system etc.,

It could be dry or productive (with sputum) Acute or Chronic. Cough could be a symptoms indicating the underlying cause or Cough itself could be a disease. Suppression of Cough may cause irreversible damage to the body.

Complications may include :-

• Fainting
• Vomiting
• Insomnia
• Coughing defection / dribbling of urine
• Uterine prolapsed
• Hernia etc.,

Ayurvedic Approach :-

Ayurveda has also given a special importance to Cough and it is called as Kaasa. Classification is based on the predominance of Dosha (Vata, Pitta and Kapha) and hence the treatment of Cough cannot be generalized in Ayurveda. It is based on the individual and Kaasa is considered as one of the complication in most of the diseases in Ayurveda

There are various forms of medicines like Kashaya, Arishta, Asava, Churna, Ghruta, Lehya etc which will be prescribed by an Ayurvedic doctor after examination and proper diagnosis.

WHEEZING

BRONCHIAL ASTHMA

COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)

ALLERGIES

SINUSITIS

TONSILLITIS

DIABETES

Diabetes Mellitus (DM) is a metabolic disorder characterizied by hyperglycemia (increased blood sugar levels). Hyperglycemia can be an outcome of decreased insulin secreation or reduced glucose uptake my muscles, named as Type 1 and Type 2 Diabetes Mellitus respectively. DM needs to duely addressed as it shall landup into various complications related to several systems of body. In current clinical practice DM is most oftenly an accidental diagnosis but classically DM presents with

• Polyurea (excess urination)
• Polydipsia (excess thirst)
• Polyphagia (excess hunger)

Presently various treatments are available in contemporary science which acts by,

• Enhancing insulin secreations
• Reducing carbohydrate absorption from GI tract.
• Enhancing muscles uptake of glucose.
• Subcuteneous administration of insulin etc.

Ayurveda considers the condition of ‘hyperglycemia’ under various heads like Ajeerna, Kelda Vikruti, Prameha etc.

The science also enumarates the causes as below.

• Physical hypoactivity
• excess consumption of food.
• Excess consumption of milk and milk products, sugar, jaggery and other cane extracts etc.

Ayurveda approaches the condition by correcting the basic digestion and metabolism of food. Panchakarma procedures are adopted to eliminate the excess Dosha and thus help for proper metabolism of assimilated food. There are possibilities for one to over the condition of hyperglycemia and stay drug free.

• Thyroid
• Obesity

• Backache
• Spinal disorders
• Disc problems
• Rheumatoid arthritis
• Gouty arthritis

Osteoarthritis

Osteoarthritis also called as Degenerative joint disease is the most common form of chronic disease of synovial joints.

Particularly in weight bearing joints.

TYPES

Primary OA – seen in elderly generally by the end of 4^th decade.

Secondary OA – It may appear at any age and it is the result of previous wear and tear.

Common sites are Knee, Hip and Back.

Common Symptoms includes:

• Joint Stiffness

• Diminishes mobility discomfort

• Pain

In spine it may cause compression of nerve roots causing:

• Pain

• Muscle Spasm

• Neurologic abnormality

Ayurvedic approach:

As per Ayurvedic concepts, human body is made up of 3 Doshas where the 1^st and foremost important one is VATA Dosha which is the combination of Air (Vayu) and Space (Akasha) Mahabhoota.

Due to any reasons if Vata is disturbed in our body, it leads to dryness, roughness, brittleness inside. Normally impaired Vata has got an affinity towards bony tissue (Asthi) in our body and the degenerative change mainly take place there which lead to the condition OSTEO ARTHRITIS, in general which is named as SANDHI VATA.

• Sports injuries

CORONARY ARTERY DISEASE

Coronary artery disease is the most common type of heart disease which is one among the leading causes of death worldwide. It is caused by reduced blood flow to heart muscles due to build-up of plaque (Atherosclerosis) in the arteries of heart. In India, studies have shown increasing prevalence of CAD over the last 60 years, from 1% to 9%-10% in urban populations and <1% to 4%-6% in rural populations. Incidence of mortality (death) is also increasing. Important risk factors for CAD in India as reported by Case-control studies include:  dyslipidemias (high “bad” cholesterol), smoking, Diabetes, Hypertension, abdominal Obesity, psychosocial Stress, unhealthy Diet, and physical Inactivity¹. Over time, CAD can also weaken the heart muscle and lead to heart failure and arrhythmias.

Primary predisposing cause of Coronary Artery Disease is the Atherosclerosis. It refers to narrowing of arteries on the inside due to thickening and hardening because of plaque deposition. Thickening happens due to gradual deposition of fat, cholesterol or other substances in the wall of an artery. Hardening of the arterial wall is a progressive condition that may begin in childhood and progress with age. Based on severity and location, Atherosclerosis can also cause Stroke, Kidney problems, peripheral artery disease etc. “Arterial Remodelling” refers to a change in vessel size. In normal arteries, remodelling is a homeostatic response to changes in the flow and circumferential stretch to restore normal shear stress and wall tension, respectively. However, repeated injury can hamper this mechanism.

When the Heart fails to get enough blood supply for itself, it is called Ischemia. When the part of heart affected gets very less blood supply or is completely cut off, the muscle gets damaged or dies. This is called Myocardial Infarction (MI). This damage is expressed through chest pain (Angina) which is the predominant sign of CAD. Pain may range from being slight discomfort to being unbearable to an extent where the patient collapses; it may be localized resembling heartburn or radiate to shoulders, neck, jaw especially on the left.

Understanding Atherosclerosis in Ayurveda

Plaque formation begins as a compensatory mechanism after the arteries get injured repeatedly. ‘Why’ (cause) and ‘Where’ it occurs is important as it influences treatment which is the only need of the patient. ‘How’ it occurs is important for the physician to base target specific medicines.

Repeated internal injury can be correlated to involvement of Vrana in Mamsa and Sira. Sira broadly refers to entire channels carrying body fluids and therefore can be Arteries, Veins or Lymphatic vessels. Mamsa (muscle tissue) can depict the musculature of vessels. When a Mamsagata vrana gets irritated/ or inflamed, the exudates is similar to Ghee in colour and consistency. This can be compared with Fatty streaks and later chronic dyslipidemia –Atherosclerosis. When a Sira is cut / tore open; excess bleeding, leaking of plasma etc is described. This can depict the stages of endothelial injury which acts initial trigger & is caused by chronic dyslipedaemia and raised blood pressure. High BP can be caused secondarily due to Margavarana (reduced luminal space in vessels). In long standing Vrana, this mechanism is similar to pathological changes in complicated plaques such as Ulceration, thrombosis, haemorrhage etc. In cases of chronic Hypertension, the pressure itself may be responsible for repeated injuries in arterial wall (Mamsa dushti) or even rupture (Sira vrana). The atheromatous plaque is comparable to deposition of dushita kapha and rakta.

Understanding Angina and MI in Ayurveda

The pain in the cardiac region is mentioned via various terms depending on the type of pain, extent of discomfort etc in ayurveda. Hrut (heart) – Shoola (pain accompanied by difficulty in breathing), Veshtana (squeezing / forcible contraction causing pain), Vyatha (distress, fear), Toda (pricking pain), Peeda (irritation, pain), Ayama (forcible expansion causing pain), Dravata / Spandana (palpitations), Bheda (splitting/cracking like pain), Patati Iva (feeling of heart slipping from its place/ sudden thrill) ¹ etc are few examples. Therefore, chest pain may refer to any of these pains, which is an important indicator of underlying dosha & samprapti (pathophysiology). Vata is responsible for all kinds of Pain. It may be alone or in association with other Doshas, localized or radiating which gives rise to different types. Consecutively, the treatment module will alter.

The involvement of myocardium in ischemia & infarct suggests the involvement of Rasa dhatu, Rakta dhatu, Mamsa dhatu (and their repective srotas), sira & dhamani.

Angina is described as a symptom in many diseases in Ayurveda including Vataja – jwara (~a type of Fever), Kasa (~Cough), Chardi (~Vomiting), Moorcha (~Fainting/ syncope), Shwasa (~Respiratory disorders), Pandu (~Anaemia), Kshaya (~A disease causing depletion of the body), Gulma (~Diverticular disease?), Udara (except jalodara) (generalized distension or enlargement of abdomen of any aetiology), Udavarta (diseases due to reverse movement of Vata), Madatyaya (~Alcoholism), Apatantraka (~Epileptic disorder), Sharkara & Ashmari (~Renal calculi) etc. It is also seen as premonitory symptom in Atisara (~Diarrhoea). In Pittaja prameha (~Diabetes Mellitus) and Vidradhi (~Abscess), chest pain is said to be upadrava (complication). Local internal findings such as Hrudi Vidradhi (wound/abscess in the heart) can also cause angina.

Management of CAD

Based on the Bala of Roga and Rogi i.e., stage/severity of the disease and strength of the person, Mrudu (mild) or Nitya (daily) Shodhana (cleanisng) may be advised. For instant pain reduction, immediate regulation of Vata is of prime importance. To stop disease progress while maintaining the strength, oral medications such as Shoola Prashamana gana dravyas, Jeevaniya ghruta, Yavani shadava, Taleesadi churna, Bruhat vata chintami rasa, dhanvantaram gulika, dashamoolarishta, prabhakara vati; in pittanubandha vata, Drakshadi kashayam, sutashekara rasa, nagarjunabhra rasa, pravala panchamrita rasa etc; in kaphanubandha vata, hrudayarnava rasa, trivrutadi churna, dashamoola kashaya with saindhava, gandharva hareetaki tablet etc may be used. Since the disease is a Marma-ashrita vyadhi with involvement of Madhyama Roga Marga i.e., involves vital organs & systems, treatment requires time and patience. Use of Basti (medicated Enema therapy) may be done to reinstate innate strength. Rasayana therapy to reinvigorate the body must be done.

In brief, the path of disease occurrence (samprapti) can be multiple based on the causative factors such as lifestyle & risk factors associated. The ayurvedic analysis of any case presenting with Angina, with or without prior diagnosis of CAD/IHD is therefore based on thorough history taking followed by mapping the probable samprapti & then a suitable treatment plan based on Nadee & other 7 Pareekshas. Acute management will involve re-establishing the normal route & intensity of Vata while balancing the other two doshas if need be.

CARDIOMYOPATHY

Definition : A group of diseases that affect the heart muscle locally or globally. It may be either confined to the heart or may be a part of generalised systemic disorder.

Causes :

1. Diseases – (secondary Cardiomyopathy) Diabetes, Hyperthytoidism, Fabry’s disease, Muscular dystrophy etc.
2. Habits – smoking & excessive alcohol, drug abuse etc.
3. Lifestyle – irregular & improper food habits, lack of exercise etc.
4. Drug toxicity.
5. Mental – depression, anxiety etc.
6. Genetic predisposition etc.

Types :

1. Primary / Intrinsic Cardiomyopathies.

a. Genetic

• Hypertrophic Cardiomyopathy
• Arrhythmogenic right ventricular Cardiomyopathy (ARVC)
• LV non-compaction
• Ion Channelopathies
• Dilated Cardiomyopathy (DCM)
• Restrictive Cardiomyopathy (RCM)

b. Acquired

• Stress Cardiomyopathy
• Myocarditis
• Eosinophilic Myocarditis
• Ischemic Cardiomyopathy

2. Secondary / extrinsic Cardiomyopathies

General signs & symptoms :

• Fatigue
• Swelling of the lower extremities & abdomen
• Chest pain
• Shortness of breath on physical exertion
• Fainting, Dizziness
• Arrhythmia etc.

Mechanism : Changes at the cellular level (Cardiac muscle cell – structural changes & variations in responses) cause changes that are correlated with sudden cardiac death and other cardiac problems.

Investigations : Physical exam, Family history / Genetic testing, Blood tests, ECG, Echo-Cardiogram etc.

Treatment : Medications, Iatrogenic / implanted pacemakers, Defibrillators, Ventricular assist devices (VADs), Ablation or mechanical cardioversion, Heart transplant etc.

Please Note : Ayurvedic diagnosis involves the understanding of Dosha, Dhatu & Mala of an individual, through the means of different Pareeksha {Nadi pareeksha (Pulse examination) etc}. Therefore Cardivascular diseases may not always fall under Hrudroga. They may develop as consequences of underlying anomalies such as Udavarta, Dhatugata Vata, Pandu etc. Hence the treatment will be to curb the causative pathology while subsequently maintaining the cardiac health.

HYPERTENSIVE HEART DISEASE 

Definition : A group of diseases or complications of high blood pressure that affect the heart.

Causes :

Factors leading to hypertension & its exacerbation such as –

1. Habits & lifestyle – sedentary, alcohol, smoking, inadequate or no exercise etc.
2. Food – too much salt, regular consumption of fried & spicy items, improper timings etc.
3. Underlying health conditions – morbid obesity, kidney disorders etc.
4. Stress & anxiety.
5. Family history etc.

Subcategories :

1. HHD with heart failure
2. HHD without heart failure

Signs & symptoms :

HHD without heart failure, hypertension with or without enlargement left ventricle is symptomless.

1. Fatigue
2. Palpitations
3. Swelling of feet and ankles
4. Weight Gain
5. Nausea
6. Bloating and abdominal pain
7. Shortness of breath, difficulty in breathing when lying flat
8. Increased frequency of urination at night
9. Cardiomegaly
10. Silent Myocardial ischemia
11. Symptoms of CAD and accelerated atherosclerosis
12. Heart Failure With Normal Left Ventricular Ejection Fraction (diastolic heart failure)
13. Atrial fibrillation, other cardiac arrhythmias, or sudden cardiac death

Mechanism : To keep up with the increased load, ventricular hypertrophy along with vascular changes occurs. The Ejection fraction (EF) is initially normal & later reduces. Heart failure can thus occur even when the EF is preserved.

Investigations : ECG, ECHO, Coronary angiogram, exercise stress tests etc.

Treatment (for Hypertension + Cardiac issue): Medications (Diuretics, Nitrates, Statins, Aspirin etc), Surgery, implantable devices like pacemakers, defibrillators etc.

DYSRHYTHMIA

It is a group of conditions in which the heartbeat is abnormal (too fast / too slow / too early / irregular).

Tachycardia : >100 beats / minute in adults

Bradycardia : < 60 beats / minute

Types :

1. Extra beats – premature atrial contractions, premature ventricular contractionsand premature junctional contractions.
2. Supraventricular tachycardias– atrial fibrillation, atrial flutter & paroxysmal supraventricular tachycardia.
3. Ventricular arrhythmias– ventricular fibrillation & ventricular tachycardia.
4. Bradyarrhythmias.

Causes :

1. Diseases – Coronary artery disease, hypertension, diabetes, hyperthyroidism etc.
2. Habits – Excessive coffee, Alcohol & Drug abuse, Smoking etc.
3. Mental & Physical stress & anxiety etc.

Signs & Symptoms :

1. Palpitations – infrequent/ frequent/ continuous
2. Breathlessness
3. Chest pain
4. Light – Headedness / Dizziness / Fainting
5. Anxiety etc.

Mechanism :

1. Bradycardia
2. A slowed signal from the sinus node (sinus bradycardia).
3. Due to a pause in the normal activity of the sinus node (sinus arrest).

• Due to blocking of the electrical impulse on its way (atria to ventricles). (AV block or heart block)

2. Tachycardia

Addition of abnormal impulses to the normal cardiac cycle causes tachycardia. Abnormal impulses can begin by one of three mechanisms: automaticity, re-entry or triggered activity. Fibrillation is a specialised form of re-entry mechanism.

1. Automaticity : The cardiac muscle cell fires off an impulse automatically without waiting for the SA (Sino-Atrial) node. It (cell/origin) is called an ectopic focus. If it fires more often than SA node, it produces a continuous abnormal rhythm.
2. Re-entry : Occurs when an electrical impulse recurrently travels in a tight circle within the heart, instead of moving from one end to the other and then stopping. These types of are different from conditions which utilize abnormal conduction pathways.

• Fibrillation : Multiple micro re-entry circuits cause the heart to beat rapidly with irregular & unsynchronised contraction of cardiac muscle cells. It can affect the atrium (atrial fibrillation) or the ventricle (ventricular fibrillation / V-fib). V-fib is life-threatening. It is considered a form of cardiac arrest.

Investigations : Blood tests, Chest X-Ray, ECG & Holter monitor, ECHO, Transesophageal atrial stimulation etc.

Treatment : Physical manoeuvres – vagal manoeuvres, Medications – anti arrhythmic drugs, anti coagulant & anti-platelet drugs like warfarin & heparins, aspirin, cardioversion, defibrillation; ICD, pacemakers, Electro or cryo – cautery etc.

INFLAMMATORY HEART DISEASE

Inflammation of the heart. Inflammation refers to body’s response in fighting infection or injury.

Types:

1. Endocarditis – inflammation of the inner lining of the heart’s chambers and valves
2. Myocarditis – inflammation of the heart muscle
3. Pericarditis – inflammation of the tissue that forms a sac around the heart

General Causes:

1. Viral / Bacterial / Fungal infections
2. Autoimmune disorders
3. Injury due to accidents or radiation therapy
4. Heart attack / heart failure or other conditions which affect heart walls & valves
5. Medications etc.

Signs & symptoms: depends on the type & severity of inflammation

1. Endocarditis –
2. Flu-like symptoms – such as fever and chills
3. A new or changed heart murmur
4. Fatigue
5. Aching joints and muscles
6. Night sweats
7. Shortness of breath
8. Chest pain when breathing
9. Swelling in feet, legs or abdomen
10. Myocarditis
11. Chest pain
12. Rapid or abnormal heart rhythms (arrhythmias)
13. Shortness of breath, at rest or during physical activity
14. Fluid retention with swelling of your legs, ankles and feet
15. Fatigue
16. Other signs and symptoms of a viral infection, such as a headache, body aches, joint pain, fever, a sore throat or diarrhea
17. Pericarditis
18. Sharp, piercing chest pain over the centre or left side of the chest, which is generally more intense when breathing in
19. Shortness of breath when reclining
20. Heart palpitations
21. Low-grade fever
22. An overall sense of weakness, fatigue or feeling sick
23. Cough
24. Abdominal or leg swelling

Mechanism: occurs when causative factors enter the bloodstream, travel to the heart and attach to abnormal heart valves or damaged heart tissue.

Investigations : ECG, Echo, Cardiac CT / MRI etc.

Treatment : Medications (pain killers, antibiotics, corticosteroids etc), surgery (repair / removal of damaged valve / Pericardiocentesis) etc.

PULMONARY HEART DISEASE

It refers to structural & functional changes in right ventricle of the heart due to disorder(s) in the respiratory system.

Cause : (starts in circulation system of lungs)

1. Acute respiratory distress syndrome(ARDS)
2. COPD
3. Primary pulmonary hypertension
4. Blood clotsin lungs
5. Interstitial lung disease
6. Cystic fibrosis
7. Sarcoidosis
8. Obstructive sleep apnea(untreated)
9. Sickle cell anemia
10. Bronchopulmonary dysplasia(in infants) etc.

Signs & symptoms :

1. Dyspnoea (breathlessness)
2. Wheezing
3. Cyanosis
4. Ascites (fluid collection in the abdomen)
5. Jaundice
6. Liver enlargement
7. Abnormal heart sound etc.

Mechanism : Due to increased pressure in the circulation system of lungs, pressure increases in the right ventricle (RV) of heart. Long-term increase in pressure leads to enlargement of RV. This consequently results in RV failure & the condition is called Cor Pulmonale.

Investigations : Chest X-Ray, ECG, Blood tests etc.

Treatment : Antibiotics, Expectorants, Diuretics,  Vasodilators, Anticoagulants, Lung transplantation etc.

Treatment : Pandu, shwasa Rx – mandura, Lakshmi vilasa, eranda hareetaki, danti hareetaki

HEART FAILURE

A condition in which cardiac output is less than the needs of the body and lungs.

Causes :

1. Diseases – In overload situations (blood or serum infusions), kidney diseases, Chronic severe anaemia, Beriberi (vitamin B₁deficiency), Hyperthyroidism, Cirrhosis, arteriovenous malformations, Chemotherapeutic agents, SLE, obesity, hypertension, diabetes, Myocardial infarction etc.
2. Habits – alcohol, drugs, sedentary lifestyle

Types :

1. HF with reduced ejection fraction, EF< 40%
2. HF with normal ejection fraction (occurs when the left ventricle contracts normally during systole, but does not relax normally during diastole, which impairs filling).

Classification

There are many different ways to categorize heart failure, including: The side of the heart involved (left HF versus right RF); whether the abnormality is due systolic dysfunction or diastolic dysfunction or both, whether the problem is primarily increased venous back pressure (pre load), or failure to supply adequate arterial perfusion (after load) etc;

Functional classification :

1. Class I : no limitation & no symptoms from ordinary activities.

1. Class II : slight, mild limitation of activity; comfortable at rest or with mild exertion.
2. Class III : marked limitation of any activity; comfortable only at rest.
3. Class IV : any physical activity brings on discomfort and symptoms occur at rest.

Mechanism : any condition which causes damage or overloading decreases the efficiency of the heart muscle. This will lead to structural or functional changes in the heart

Signs & symptoms :

1.       Left – sided failure : Causes blood to back up into the lungs.

• Respiratory symptoms : non-specific signs of respiratory distress, pulmonary oedema, cyanosis (late sign of extremely severe pulmonary oedema).
• Easily gets exhausted and exercise intolerance.
• Additional heart sounds, Heart murmurs.
• Cardiac asthma or wheezing.
• Dizziness, confusion and cool extremities at rest etc.

2.       Right – sided failure : Caused due to pulmonary heart disease

•   Peripheral oedema
•   Ascites, liver enlargement, congestive hepatopathy and jaundice
•   Nocturia
•   Coagulopathy etc

3.       Biventricular failure

1. Pleural effusion.

Investigations : Blood tests – An elevated BNP (B-type natriuretic peptide) is a specific test indicative of heart failure, Chest X-Ray, ECG, Echo, Angiography etc.

Treatments : Defibrillators, Medicines (ACE inhibitors, Beta blockers, diuretics, Vasopressin receptor antagonist etc), cardiac resynchronization therapy (CRT), Rarely cardiac transplantation.

VALVULAR HEART DISEASE

Any cardiovascular diseases process involving one or more of the four valves of the heart (the aortic and biscuspid valves on the left & the pulmonary and tricuspid valves on the right).

Causes : Maybe congenital or acquired

1. Diseases – rheumatic fever, heart attack, endocarditis, hypertension, atherosclerosis, SLE, Marfan syndrome etc.
2. Age-related degeneration
3. Radiation therapy, certain medications etc.

Types :

1. Aortic valve – Stenosis or Insufficiency (2)
2. Mitral – Stenosis or Insufficiency (2)
3. Tricuspid – Stenosis or Insufficiency (2)
4. Pulmonary – Stenosis or Insufficiency (2)
5. Heart valve dysplasia
6. Valvular endocarditis

General signs & symptoms :

1. Increasing shortness of breath
2. Palpitations (skipped beats or flip-flop feeling in the chest)
3. Edema (swelling of the ankles, feet or abdomen)
4. Weakness or dizziness
5. Quick weight gain
6. Chest discomfort etc.

Mechanism : Change in gene expressions & other factors during pregnancy lead to developmental defects (Congenital valve defects). Injury / exposure to radiation / degeneration affect the valves in Acquired defects.

Investigations : ECG, Echo, Angiogram, Exercise stress test, MRI etc.

Treatment : Medications (antibiotics, anticoagulants etc), Balloon dilatation, valve surgery/replacement etc.

CONGENITAL HEART DISEASE

It refers to heart abnormality present at birth.

Causes : Not completely understood. Possible reasons include –

1. Hereditary
2. Alcohol / smoking / drug abuse by mother during pregnancy
3. Some medications
4. Gestational diabetes
5. Infections during pregnancy etc.

Types : These can be broadly classified under – a. Heart valve defects, b. Heart wall defects & c. Defects of the blood vessels.

1. Aortic stenosis
2. Atrial septal defect (ASD)
3. Atrioventricular septal defect (AVSD)
4. Bicuspid aortic valve
5. Cardiomyopathy
6. Complete heart block (CHB)
7. Dextrocardia
8. Double inlet left ventricle (DILV)
9. Double outlet right ventricle (DORV)
10. Ebstein’s anomaly
11. Hypoplastic left heart syndrome (HLHS)
12. Hypoplastic right heart syndrome (HRHS)
13. Mitral stenosis
14. Persistent truncus arteriosus
15. Pulmonary atresia
16. Pulmonary stenosis
17. Transposition of the great vessels
18. Tricuspid atresia
19. Ventricular septal defect (VSD)
20. Wolff-Parkinson-White syndrome (WPW)
21. Coarctation of the aorta (coa)
22. Double aortic arch, aberrant subclavian artery, and other malformations of the great arteries
23. Patent ductus arteriosus (PDA)
24. Scimitar syndrome (SS)
25. Tetralogy of Fallot (tof)
26. Pentalogy of Cantrell etc.

General signs & symptoms : Signs may occur just after birth or after many years.

At birth :

1. Bluish lips, skin, fingers, and toes
2. Breathlessness / trouble breathing
3. Feeding difficulties
4. Low birth weight
5. Delayed growth etc.

Later in life :

1. Abnormal heart rhythms
2. Dizziness
3. Breathing difficulties
4. Fainting
5. Swelling
6. Fatigue etc.

Mechanism : Not clearly understood.

Investigations : ECG, Echo, chest X-ray, MRI, cardiac catheterization etc.

Treatment : Open heart surgery, procedures via catheterisation, medications, heart transplant etc.

RHEUMATIC HEART DISEASE

A condition in which the heart valves have been permanently damaged by rheumatic fever.

Cause : It is caused by a bacterium belonging to Streptococcus. Infection can lead to strep throat or in some, scarlet fever.

Signs & symptoms :

1. Fever
2. Swollen, tender, red and extremely painful joints — particularly knees & ankles
3. Nodules (lumps under the skin)
4. Red, raised, lattice-like rash, usually on the chest, back, and abdomen
5. Shortness of breath and chest discomfort
6. Uncontrolled movements of arms, legs, or facial muscles
7. Weakness
8. Shortness of breath (especially with activity or when lying down)
9. Chest pain
10. Swelling

Mechanism : It is an inflammatory disease that can affect many connective tissues, especially in the heart, joints, or brain. The heart valves get inflamed and become scarred over time. This results in narrowing or leaking of the valve making it difficult for the proper functioning of heart. This can take many years to develop and can result in heart failure.

Investigations : Blood tests – for inflammation/ infection, ECHO, Chest X-Ray, Cardiac MRI

Treatment : Antibiotics, NSAIDs, Steroids; for heart failure: ACE inhibitors, diuretics, beta blockers, and digoxin etc.

Please Note : 

Ayurvedic diagnosis involves the understanding of Dosha, Dhatu and Mala of an individual, through the means of different Pareeksha (Examination and investigations like Nadi reading etc). Therefore cardiovascular diseases may not always fall under Hrudroga. They may develop as consequences of underlying anomalies such as Udavarta (caused by improper movement of Vata resulting in reduced appetite, constipation etc), Pandu (anemia), Arsha (pile mass), chronic gastritis etc. Hence the treatment will be to curb the causative pathology while subsequently maintaining the cardiac health. 

For comparison and interpretation, refer to articles under Heart care, Prevention and Management.

KIDNEY STONES

Kidney stones or medically termed as Urolithiasis is a clinical condition where salts of calcium and phosphorous and other minerals deposit in the renal structures leading to calculus formation.

Causes :

• Inadequate fluid intake
• Excess protien or calcium or salt rich diet.
• Chronic diarrhoea
• Genetic predisposition
• Individuals with a history of urolithiasis have high chances of recurrence.

Symptoms :

• Pain abdomen and back radiating down through flancks to groin
• Painful micturation
• Burning urination
• blood mixed urine etc

Treatment :

Mainly based on size of calculus and the location various treatments are planned as like

• Flush therapy
• Lithitripsy
• Basketing etc

Ayurveda describes urolithiasis under Mootra Ashmari

• Excess indulgence in Kapha and Vata causing factors leads to formation of urolithiasis.
• Witholding the urge for mictutaion is observed to be a prime cause for urolithiasis.

Treatment involves medicines to

• Crush down the calculus and flush it away.
• Avapeedaka Sneha a special procedure towards urolithiasis is proved to be efficient.
• A course of Panchakarma would be beneficial in prevention of repeated formation of calculus.

• UTI (Urinary tract infections)
• Acute / Chronic Kidney Diseases

• Amenorrhoea

Amenorrhoea literally means absence of menstruation in a woman of reproductive age. It is a symptom not a disorder.

There are 2 types of Amenorrhoea :

• Physiological
  1. Primary
     1. Before puberty
  2. Secondary
     1. During Pregnancy
     2. During Lactation
     3. After Menopause

• Pathological
  1. Primary
     1. Congenital defect of genital tract
     2. Turner’s Syndrome
     3. High Testosterone levels
     4. Mullerian defects

                 2. Secondary (Absence of periods for 6months or more following normal menstruation)

• •  Uterine Factors
    • Tubercular Endometritis
    • Synechiae
  • Ovarian Factors
    • PCOS
    • Premature ovarian failure

• • Pituitary Factors
    • Proletinoma
    • Sheehan’s Syndrome

• • Hypothalamic Factor
    • Stress / Shock
    • Post-pill
    • Sudden change in weight either loss/gain
    • Porychotrophic & Anti hypertensive drugs
  • Systemic
    • Malnutrition
    • Hypothyroid Stali
    • Diabetes

Symptoms :

• Weight Gain / Loss
• Change in Breast size / Milky discharge
• Hair loss
• Facial hair
• Headache
• Pelvic pain

Investigations :

• Blood tests to check hormone levels
• Genetic Testing
• Pelvic USG
• CT Scan / MRI

• Painful menstruation / Dysmenorrhoea
• Oligomenorrhoea
• Excessive bleeding / Menorrhagia
• Metrorrhagia
• Polymenorrhoea
• DUB – Dysfunctional uterine bleeding
• PMS – Premenstrual syndrome
• Leucorrhoea – White discharge
• Postmenopausal bleeding
• PCOD – Polycystic Ovarian Disease
• Infertility – Primary & Secondary
• Breast disorders
• Vaginal infections
• Antenatal care (Pregnancy check ups)
• Postnatal care (After delivery care)

ORAL CANCER

Oral cancer includes caner affecting lips, tongue, floor of the mouth, palate, gingiva, alveolar mucosa, buccal mucosa, and oropharynx.

Cause and statistics :

Oral cancer in India is different compared to the western countries as most common cause us tobacco (70%) and found in 3^rd or 4^th stage associated with higher risk. Incidences are chiefly seen in males and 5 years survival rate in 1^st stage is 80% and 5^th stage is 15%.

Treatment :

The treatment options considered for these locally advanced Buccal Mucosa tumors are:

• Two types of standard treatment are used:
  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hyper fractionated radiation therapy ( divided dose radiation)
  • Hyperthermia therapy (Increasing body temperature).

Complication :

May be side effects of the disease or treatment or they may have other causes are : 

• Dry mouth
• Change in taste
• Inflammation and ulcers of the mucous membranes
• Easy bleeding in the mouth
• Tooth decay and gum disease
• Nerve damage
• Salivary gland damage partially or completely
• Fibrosis (growth of fibrous tissue) in the mucous membrane in the mouth
• Oromandibular dystonia: Characterised by forceful contractions of face, jaw, tongue leading to dehydration and malnutrition
• Fungal and viral infections.

Ayurveda in preventing oral cancer :

 Procedures and herbs indicated in daily regimes in Ayurveda like Danta Dhavana (Dental hygiene and gum strengthening), Kavala, Gandusha, Dhoomapana and Nasya are highly beneficial in preventing oral cancer. 

Ayurveda in treating as well as subsiding oral cancer complications :

• Kavala is highly effective in reducing inflammation, facilitate healing of mucous ulcer, controls gum bleeding, stimulate salivary glands, reduces dryness of mouth thus enhance taste perception.
• Gandush is highly recommended in stimulating salivary glands, increase oral circulation facilitate healing and regeneration, reduces fibrosis and dystonia of face, jaw and tongue, beneficial in improving quality of speech, chewing and swallowing food.
• Karnapoorna reduce temper mandibular joint dry and stiffness.
• Nasya helps to upkeep moisture of facial sinuses, strengthen maxilla bones which includes upper jaw and hard palate, reduce chances of getting infection and improve nerve conduction.

Reference : 

• https://www.cancer.gov 

OESOPHAGEAL CANCER

Oesophagus is a muscular tube connects Throat and Stomach, through with the food and water reaches stomach after swallowing. Men are more prone to oesophageal cancer mostly between the are group of 55-85 years.

According to ICMR (Indian Council of Medical Research)

•      8th common cancer in the world
•      Very high incidence has been reported in North-East region of India
•      Survival ranges from 5 to 30% in five years
•      The lower oesophageal cancers the most common site of malihnancy.

Most common caused for oesophageal Cancer :

• Smoking
• Alcohol
• Habit of drinking hot or too cold liquid
• Acid reflex (heart burn)
• Obesity
• Oral leukoplakia
• Achalasia
• Baret’s oesophagus

First signs normally is difficulty in swallowing food or liquid which make the person to eat less leading to weight loss. Chest pain or burning/pressure.

 Treatments :

•    Surgery
•    Radiation Therapy
•    Chemo Therapy
•    Laser Therapy
•    Electrocoagulation
•    Targeted Therapy

Ayurveda in preventing oesophageal cancer :

There are effective treatment and diet regimens to treat repeated irritation caused in oesophagus. Being obese will be a platform for multiple systemic diseases which need to be regulated only through proper lifestyle, Ayurveda is the pioneer in techniques of healthy lifestyle.

Ayurveda in treating oesophageal cancer :

•    Pachakarama : If patient is suitable. This helps to remove Bahu Dosha (Toxin) and try to restore physiology which further helps for better and quicker therapeutic results.
•    Very early stage of oesophageal cancer is responds well to Ayurveda treatment.
•    Ayurveda External treatments and internal medications are helpful to reduce the complication as well as to improve the endurance in persons who are undergoing Chemo or radiation therapy.

Recurrence : Avoiding or treating triggering factors with lifestyle changes, Ayurveda medications as per the requirement.

Palliative care with the combinations of medicines as well as various food preparations explained in Ayurveda are highly recommended in situations like patient has difficulty in swallowing.

STOMACH CANCER

Stomach is a part of digestive system, it is J-shaped hollow organ present in the upper abdomen between Oesophagus and Small Intestine. Stomach is not merely a transitory storage of food before digestion but also secretes acid and enzymes that helps to digest food. The stomach muscles contract periodically, churning food to enhance digestion.

Most Stomach Cancers are a type called Adenocarcinoma (Cancer started in the glandular tissue that lines the inside of the stomach).

Cause and Statistics : It is the 4th leading cancer in the world and the 2nd most common cause of death due to malignancy. According to a study conducted in Karnataka, Gastric Cancer ranks amongst the 5th most common cancers. The 5-year survival rate, 0 – 1st stage 68%, 2 – 3rd stage 31% and 4th stage 5%.

Risk Factors :

• Age : > 50 years.
• Gender : Men and Women at 2:1 ratio.
• Incidence rates are the highest in the north-eastern Indian region.
• Food and Habits :
  • Eating a diet high in salt : High intake of pickle, smoked, salty or preserved foods and a low intake of fruits and vegetables.
  • Tobacco use and drinking a lot of alcohol.
• Obesity : Excess body weight increases a man’s risk of developing Stomach Cancer. It is not clear whether obesity increases a woman’s risk of Stomach Cancer.
• Predisposing conditions :
  • People who have had Stomach surgery.
  • Mainly Bacteria – Helicobacter pylori (H. pylori) causing stomach inflammation and ulcers.
  • Pernicious Anemia.
  • Achlorhydria (lack of hydrochloric acid in the gastric juices).

Treatment : Often a combination of treatment is used for Stomach Cancer includes Surgery, Radiation therapy, Chemotherapy, Targeted therapy or Immuno-therapy.

Ayurveda in preventing Stomach / Gastric Cancer :

Considering the risk factors a healthy stomach can prevent it from being victim of cancer. Healthy ways and means of eating considering individual body type, age, season, nature of food, time of day and night are key factors behind healthy stomach. A primary consultation with an Ayurveda doctor is necessary for to get proper guidance regarding all these factor influencing the state of stomach.

Ayurveda in treating as well as subsiding Stomach / Gastric complications :

Most of the time it is difficult to cure Stomach Cancer because it is often not found until it is at an advanced stage.

• Avoids recurrence : As 60 – 70% recurrence in post-surgery cases within 2 years or maximum of 5 years, this risk period can be altered / avoided with Panchakarma procedures.
• Supportive care / Palliative Care : 
  • Post-surgery; Amount of stomach removed will affect how much you need to change the way you eat ie. storage will be issue, vitamin deficiencies as stomach is not fully functional. Ayurveda techniques are highly beneficial guiding the food which is suitable to that individual type and need.
  • Medication for supporting body either during or post conventional therapies.
  • Metastatic stomach cancer only Palliative treatments including medication, nutritional changes, relaxation techniques, emotional and spiritual support and other therapies

References :

https://www.cancer.net

 https://Cancer.org

  Consensus document for management of gastric cancer by ICMR

SUBCUTANEOUS PANNICULITIS – LIKE T – CELL LYMPHOMA (SPTCL)

A very rare form of skin lymphoma that is localized primarily to the subcutaneous adipose tissue/ subcutaneous tissue without palpable involvement of the lymph nodes. Category of peripheral T-cell lymphoma in the World Health Organization classification.

• Characterized by infiltration of the subcutaneous tissue by neoplastic cytotoxic T cells mimicking panniculitis.

• Diagnosis
  • SPTCL is a challenge, especially during its early phases when symptoms mimic other, more common conditions, such as benign panniculitis, eczema, dermatitis, psoriasis and cellulitis.
  • Clinical and systemic features are nonspecific and can include fever, chills, and weight loss. Further complicating diagnosis is the high number of false negatives provided by biopsy.

• Age group : The average age of presentation is mid to late thirty with a female predominance (male: female=0.5).

• Treatment : No standardized therapy for SPTL currently exists.

• Local radiotherapy for indolent local disease has been found successful.
• For indolent disease with a more generalized distribution, immunosuppressive agents as well as low dose chemotherapy may be used.
• For aggressive presentations, combination chemotherapy, anthracycline-based regimens, fludarabine-based regimens, and rarely high-dose chemotherapy followed by hematopoietic stem cell transplant (SCT) with moderate success.

• Ayurveda in Preventing and Treating :
  • Among Panchakarma, Vamana will be highly beneficialindetoxing Rasa (plasma / body fluids), improve micro circulation, helps in avoiding fluid accumulation and stasis, improve immunity, reduce fat accumulations / cholesterol and maintain specific gravity of body fluids.
  • Udwarthana : Dry or medicated power massage helps to reduce accumulation of fluid beneath skin by improving lymphatic circulation and improve skin tonicity.
  • Lepa : If the skin is sensitive for udwarthana, lepa helps in inducing similar benefits, can be sued till sensitivity come down then switch on to
  • Kashayadhara : Rhythmical method of pouring warm medicated water on the body improves cutaneous circulation and acts like flush therapy to displace accumulation in and beneath skin.
  • Internal medication according to condition specific need to be selected to target Rasa, Raktha, Kapha

References;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242123/

https://www.longdom.org/open-access/subcutaneous-panniculitislike-tcell-lymphoma-review-of-therapies-2165-8048-1000198.pdf

PROSTATE CANCER

Prostate is a small walnut size and shaped glad in men that produces seminal fluid for nourishing and sperm transport. Cancer of Prostate is the most common type of cancer in elderly men. Prostate cancer tends to grow slowly compared with most other cancers. Cell changes may begin 10, 20, or even 30 years before a tumour gets big enough to cause symptoms. Eventually, cancer cells may spread (metastasize) throughout the body. By the time symptoms appear, the cancer might be advanced.

Risk factor :

• There is no exact cause
• The most common riskfactor is age above 50 years of age
• Person with family history have 2 to 3 times higher risk
• Risk is slightly higher in men from families with history of breast cancer
• Person eating high-fat diet may be at risk

Symptoms can be similar to the symptoms of BPH (Benign prostatic hyperplasia) :

• Trouble passing urine
• Frequent urge to pass urine, especially at night
• Weak or interrupted urine stream
• Pain or burning when passing urine
• Blood in the urine or semen
• Painful ejaculation
• Nagging pain in the back, hips, or pelvis

5-year relative survival rates :

• Localized : There is no sign that the cancer has spread outside the prostate is nearly 100%
• Regional : The cancer has spread outside the prostate to nearby structures or lymph nodes is neatly 100%
• Distant : The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones is 31%
• Overall 5-year survival rate for prostate cancer in Indiais 64%

Tests for diagnosis :

• Digital rectal examination to feel the texture of prostate gland
• Prostate-specific antigen (PSA) test
• Trans-rectal ultrasound (TRUS)
• Prostate biopsy
• PET CT scan

Treatment : Depending on stage of prostate cancer following methods are adopted ;

• Observation or active surveillance
• Surgery
• Radiation therapy
• Cryotherapy
• Hormone therapy
• Chemotherapy
• Immunotherapy
• Treating prostate cancer spread to bones

Ayurveda in preventing :

• Food and life style
• Doing Panchakarma like Virechan or Basti once in year or two depend on individual after the age of 40 years
• Urinating in
• Pelvic floor exercise

Ayurveda in treating :

• Surgery advised wherever required
• Aiming to strengthen bone tissues to prevent metastasis progression to reduce pain and reduce cancer progression.
• Aim to reduce PSA so that the intensity of active prostate cancer can be reduced
• Shrinking tumour and relieve the symptoms of prostate enlargement helps in reducing Trouble passing urine, Frequent urge to pass urine, Weak or interrupted urine stream

Pain or burning when passing urine, Blood in the urine or semen, Painful ejaculation, Nagging pain in the back, hips, or pelvis

Medications can be used during other conventional therapies like chemo, radio, immune etc.

References:

1. https://www.cancer.gov/publications/patient-education/understanding-prostate-changes (assessed on 18^th March 2020)
2. https://www.cancer.org/cancer/prostate-cancer/treating.html(assessed on 18^th March 2020)

BREAST CANCER

Breast Cancer now become the most common female cancer in urban India, varies from as low as 5 per 1 lakh female population per year in rural areas to 30 per 1 lakh female population per year in urban areas. With the exception of 5-10% Breast Cancers where the main risk factor is genetic predisposition, in the remaining 90% of sporadic Breast Cancers.

Risk Factors :

1. Being Female
2. Increasing age
3. Family history & Genetic factor
4. Early menarche
5. Late menopause
6. Poor diet, Obesity, Alcohol consumption
7. Lack of physical activity
8. History of hormone therapy
9. Late first pregnancy (<30years) and never been pregnant (nulliparous)

Symptoms :

1. Change in size
2. Lump in breast
3. Nipple discharge
4. Change in skin colour
5. Nipple retraction
6. Peaud’ Orange
7. Ulcerative mass
8. Swelling in armpit
9. Dimpling

5 years survival rate:

For Indian women with operable Breast Cancer who received standard multimodal treatment in the control arm of a recently published large randomized clinical trial from Tata Memorial Hospital (TMH), the 5 years disease free survival (DFS) rate of 70% and overall survival rate of 78% was reported.

Male Breast Cancer :

1. Male Breast Cancer (MBC) is an uncommon malignancy.
2. MBC comprised of 1.03% of total Breast Cancer cases.
3. Median age of presentation was 60 years ranging from 42 years to 70 years.
4. Most of the patients presented to us in advanced stage.

Modalities for early detection :

1. Self and clinical Breast examination.
2. Mammograpy, Ultrasonography, CT or MRI.
3. Confirmative test by Biopsy.

General types of Breast Cancer :

1. In Situ Breast Cancers that have not spread or on-invasive or pre-invasive Breast Cancer.
2. Invasive or Infiltrating Cancers have spread (Invaded) into the surrounding Breast tissue.

Conventional Treatment :

1. Surgery
2. Radiation / Chemo / Both Therapy
3. Hormone Therapy
4. Targeted Therapy

Preventions :

1. Food and life style which can avoid early menarche and obesity.
2. Breast feeding for an year.
3. Most physically active women had a 12 – 21% lower risk of Breast Cancer than those who were least physically active.
4. Periodically doing self-Breast massage with oil (Coconut / Sesame Oil).
5. Avoiding tight bra.

Ayurveda Treatment :

1. Ayurveda drugs significantly reduce side effects in Breast Cancer patients during Chemo or Radiation Therapy and helps in faster recovery.
2. If the person and stage are suitable for surgery that will be best to avoid further spread.
3. Suitable Panchakarma is advised before and after surgery.
4. Herbs having specific action on Rasa and Stanyavaha Srotas are the key too.
5. In metastatic conditions, the line of treatment formulated according to metastatic sights.

BLADDER CANCER

Bladder is a hollow muscular (flexible) sac situated in lower abdomen dose the function of temporary reservoir of urine received through ureters filtered by kidneys. Most commonly cancer is found in urothelial cells (bladder lining) tend to go out control in their growth leading to tumor, which can be benign or cancerous. Since urothelial cells are also present in renal pelvis and ureters, cancer of these parts is also considered a type of bladder cancer and it generally called as upper tract bladder cancer.

Risk factor :

• Tobacco smokers are 4 to 7 times more susceptible in both genders.
• Chemical exposures in Aroma, Rubber, Leather, Textile, Paint, Printing industries and Truck drivers (diesel fumes exposure) and drinking water contaminated with arsenic.
• Age > 65.
• More common in men than in women but women are more likely die for bladder caner.
• Iatrogenic cause :
  • Cyclophosphamide used in chemotherapy
  • Pioglitazine used for diabetes more than 1 years
• Previous history :
  • Repeated urinary infections, untreated bladder stones
  • Bladder cancer once
  • Family history in siblings
• Schistosomiasis; Inherited condition lynch sylndrome

Screening is essential in for early detection in,

• People who had cancer before
• People with birth defects in bladder
• People who has more exposure to chemicals

Signs and symptoms :

Though the early symptoms mimic UTI, Renal calculi and diabetic but commonly the haematuria or microscopic haematuria will be diagnostic

• Blood in urine
• Pain or burning sensation while urination
• Frequent urination or unable to pass even feeling urge
• Low back pain in one side of body
• Pelvic pain

Diagnostic tools :

• Urine test : Random urine sample for routine and micro (cytology test) to see the presence of tumor cells.
• Urine test of tumor markers :
  • UroVysin : to see chromosome changes which normally found in baladder cancer cells
  • To see the presence of bladder tumor- association antigen (BTA)
  • ImmunoCYt; to look for mucin and carcinoembryonic angtigent (CEA)
  • NMP33 Bladder check

• Cystoscopy :
  • It is the key diagnostic, eases to see inside bladder for any abnormality of growths etc. and to decide to go for biopsy or surgery
  • Biopsy if required for check signs of cancer
  • It can be therapeutic to remove the entire tumour during biopsy procedure if appropriate
• Imaging techniques : Any of the suitable
  • USG; if cystoscopy not possible or for routine check
  • For diagnosis CT or MRI with or without contrast
  • PET CT is frequently used to confirm metastasis

Survival rate : About 77 % in 5 year depending on stage

• Localized : There is no sign that the cancer has spread outside of the bladder.
• Regional : The cancer has spread from the bladder to nearby structures or lymph nodes.
• Distant : The cancer has spread to distant parts of the body such as the lungs, liver or bones.

Treatment depending on the stage :

• Surgery, though there are known risk and side effects but inevitable :

• Transurethral resection of bladder tumor : to take out cancer cell and surrounding tissues till the muscle layer of the bladder wall of bladder wall
• Cysteomy :
  • Partial cysteomy : If cancer is invaded the muscle layer of bladder but localised
  • Radical cystectomy : If cancer is not localised, removal of complete bladder and nearby lymph nodes needed. In male patients along with complete bladder prostate and seminal vesicles are also removed. Similarly in women ovaries, fallopian tube, uterus, cervix and small part of vagina are also removed.

• Intravesical therapy where medicines are put in to the bladder to stay for 2 hours so that drug interaction will be more targeted and localised, more over drug effects on other parts of body will be less. They are of 2 type immunotherapy and chemotherapy
• Chemotherapy : Might be intavesial chemotherapy or systemic (will pills or injections either IV or IM)

• Radiation therapy :
• • Helpful in early stage as therapeutic
  • To avoid relapse where surgery where bladder is removed partially
  • To prevent further spread in advanced/ metastatic conditions

Ayurveda view in preventions :

1. Since Basti (bladder) is Sadhya praanhara marma (vital part/ organ if injured lead to death) and Snayu marma ( Ligament and fibres tissue ) injury or disease related to bladder will not be easy to treat hence prevention is best.
2. Vulnerable group can start adopting food and life style as per their body type will reduce more chances of being the victim.
3. If required periodical intervention of Panchakarma specially Virechana, Basti and Uttrabasti.
4. Drink only required quantity of liquid according to the nature of job individual does and with respect to season.
5. Avoid with holding urge of urination, forcing and interfering urine flow during urination.
6. Keep regular bowel movements.
7. Avoid nap.

Ayurveda treatment :

1. Ayurveda drugs significantly reduce side effects in bladder cancer patients during chemo or radiation therapy and helps in faster recovery.
2. If the person and stage are suitable for surgery that will be best to avoid further spread.
3. Suitable Panchakaram is advised before and after surgery to help early recovery avoid further complication.
4. Herbs having specific action on Apana vata, Mutravaha srotas and Marma ghata treatments will be beneficial.
5. In metastatic conditions, the line of treatment formulated according to metastatic sights.

Reference

https://www.cancer.org

https://seer.cancer.gov/statfacts/html/urinb.html

BONE CANCER

Bone cancer are mostly secondary or metastatic cancer of breast, prostate, lung etc., similarly multiple myeloma is most common cancer that start from bone marrow but cause tumour in bone. Bone cancers are primary only that starts from bone itself is called Sarcomas. Sarcomas starts in bone, muscle, fibrous tissues, blood vessels, fat tissue and some other tissues.

Cancer and Sarcoma:

1. Carcinomas are cancers that develop in epithelial cells, which cover the internal organs and outer surfaces of your body.
2. Sarcomas are cancers that develop in mesenchymal cells, which make up both your bones and soft tissues, such as muscles, tendons, and blood vessels.

Primary Bone sarcoma constitute as the 3^rd most common cause of mortality in adolescents and most commonly affects the long bones. 5years over all survival rate is 65-70% in adolescent’s age group, if metastasis to other parts will reduce survival rate.  Benign tumours of bone are not life threating as they often cured with surgery.

Types of primary bone cancers are:

• Osteosarcoma: Osteogenic sarcoma is most common type which stats from bone cells. Effects age group between 10-30 years and 10% in 60 to 70 years. It is more common in males and most commonly seen in long bones.
• Chondrosacroma: It is 2^nd most common and it starts in cartilage cells (some time from trachea, larynx, scapula, ribs and skull). Rare in < 20 years age and risk group is 20-75 years. Most common in females. It can start in cartilage tissue but commonly seen in hip, leg and arm bones. Benign tumour are common in cartilage origin.
• Ewing Tumor: 3^rd common and 2^nd most common in children, teens and young adults. Most common site it pelvis, chest wall and long bones.
• Malignant fibrous histiocytoma: Most often starts in soft tissue like ligament, tendon, fat and muscle and rare in bones. Commonly seen in elderly and middle age in legs or arms. Most of time it is localized but some time metastatic in nature to lungs.
•  Fibrosarcoma: More likely occur in soft tissue effecting middle age and elderly, Long bones and jaw are most often affected.
• Giant cell bone tumor: It is of both benign and malignant types, Benign affects knee or arms of young and middle aged adults. They recur in the same place after operation.
• Chordoma: Usually occur in base of skull and spine.

Risk factors:

• Unknown
• Very less number are linked to hereditary factors
• Exposure to larger doses of radiation

Signs and Symptoms:

• Swelling and tenderness near affected area
• Bone pain
• Week bone and pathological fracture
• Weight loss

Diagnosis:

• Biopsy either by core needle or open
• Radiological investigations simple x- ray to PET CT
• Bone scan

Treatment:

• Surgery if localized
• Chemotherapy
• Radiation therapy
• Targeted therapy
• Immunotherapy

Ayurveda approach:

• As disease involving or originates in deeper Dhatu (tissues) like Meda( ~adipose), Asthi (~Bone) , Majja (~Bone marrow) and Surka ( ~reproductive fluids) are maintenance as difficult to treat.
• If patient Bala (Strength) is good then we can go for Panchakaram, Vanama or virechan or both depending on need.
• Basti ( ~medicated enema).
  • Will be choice of therapy as it is applicable from birth to elderly.
  • Vata and Asthi (~bone) are indirectly proportional i.e., if Vata increase will reduce the Asthi.
  • It is the best treatment to treat Vata and use of tikata rasa ksheerabasti directly nourishing the bone and found effective most of done degenerative diseases.
• Herbal and herb mineral combination to strengthen Majjadhatu ( ~bone marrow) so that bone change are should not influence Majja if happen so the bone cancer or denegation will get accelerated.
• Most of bone cancer are supportive and palliative treatments but treatment stated in very initial stages will be highly beneficial.

References:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991135/
2. https://www.cancer.org
3. https://www.cancer.net

MULTIPLE MYELOMA

It is a type of blood cancer of unknown cause. Plasma cells, part of white blood cells which has an important role in our immune system and are present in bone marrow. When they starts multiply uncontrollably leads to myeloma. Plasma cells let too much protein (immunoglobulin) into bone and blood results in bone destruction and damage immune system, kidneys as well as reduce blood cells count.

Signs and Symptoms might be :

• Reduces Blood count : Anaemia, low platelets count (thrombocytopenia) and reduces WBC count (leukopenia).
• Bleeding : Low platelets count (thrombocytopenia).
• Frequent infection : Reduces WBC count( (leukopenia).
• Reduced Bone density : Myeloma cells make a substance that accelerate dissolving the bone without new bone cells replacement, making the bones weak and easy to break.
• Raised blood calcium level : Accelerated bone cells destruction can also raise calcium levels in the blood.
• Antibodies produced by myeloma cells will impair kidney function and leading to kidney failure.

Risk factor : Obesity, radiation exposure, family history, certain chemicals used in rubber manufacturing, wood working or fire fighting or in herbicides.

Preventions : As there is no clear or strong risk factor hence currently no known ways to prevent it. Although the mutations that cause myeloma are acquired and not inherited, family history is a known risk factor for multiple myeloma.

Overall survival rate :  54%

Conventional Treatment :

• Chemotherapy
• Radiation therapy
• Corticosteroids
• Bone marrow (Stem-cell) transplant
• Blood transfusion
• Bone care

Ayurveda treatment for multiple myeloma : 

• Looking at pathology, signs, symptoms and it’s secondary complication at its later stage, involves majorly 4 Dhatu (tissues) of rasa (~ Plasma), Raktha (~ Blood), Asthi (~ Bone) and Majja (~ Bone marrow)
• Ayurveda medications : Herbo and herbo-mineral combinations are prescribed as per the patient requirement to :
  • Enhance blood quality
  • Prevent reduction in bone density to avoid pathological fracture
  • Regulate or to rectify bone marrow and liver functions
  • Prevent kidneys diseases
  • To increase immunity and avoid bleeding

• Panchakarma :
  • Among Pancha karam Basti is the line of treatments indicated in Asthi and Majja disease helps in
• Restore normal function of Asthi and Majja Dhatu
  • Best in avoiding secondary complications like bone destruction and kidney problems
• Virechana and Vamana if required before the Basti

PHYLLODES / PHYLLOIDES TUMOUR OF BREAST

 The word Phyllodes is from Greek term which means “leaf like” appearance of growth. This is uncommon but mostly seen in adult women (> 40- 50 Yrs.).It is grows in connective tissues of breast called stroma (tissues, ligaments, milk duct, blood vessels and lymph vessels).

Risk factor : Though there is no specific riskfacator specified butinjury or increased levels of estrogen hormone are noted in several cases

Signs and symptoms :

• Breast lump with tendency to grow quickly with-in a week to month
• It is often difficult to distinguish benign from malignant phyllodes tumors from other benign entities such as fibroadenomas.
• Fibroadenomas grow up to 2-3 cm then stop growing whereas phyllodes tumors fast-growing and can increase in size in just few weeks (Sometime grow up to 40 cm)
• Less than 1% are of malignant;
  • all forms of phyllodes tumor are regarded as having malignant potential
  • that has an aggressive growth pattern, often leading to a markedly large palpable mass with resultant skin thickening and tenseness of the breast
  • Malignant phyllodes tumours behave like sarcomas an develop blood-borne metastases
  • the commonest sites for distant metastases are the lung, bone, and abdominal viscera
• Open sore is seen if the tumor breaks through skin though it might be malignant

Diagnostic tools :  Hard to diagnose as they look very similar to fibroadenomas

• USG of breast
• Mammogram
• MRI
• Biopsy; Core needle but some time excisionalwill be confirmative

 Survival rate : Various research shown 5 years survival rate in benign 91% and malignantis 82%

Treatment:

• Conventional : Surgical resection remains the gold standard of treatment, whereas radiation therapy and chemotherapy have a more undefined role. Most studies recommend a more than 1- to 2-cm excision margin based on the evidence that local recurrence occurs more frequently in patients with narrow surgical margins less than 1-2 cm
• Ayurveda treatment :
  • Since the nature of the phyllodes tumor is fast growing and tendency to beso surgery will be mandatory
  • Once the post-surgical would get heeled and suitable for Panchakaram is advised for detoxification before stating internal medications to nullify the nature of rapid growth (Regression)
  • Herbs having specific action on Rasa and stanyavaha srotas are the key
  • In metastatic conditions, the line of treatment formulated according to metastatic sights

References :

1. https://pubmed.ncbi.nlm.nih.gov/22816226/#:~:text=They%20arise%20from%20intralobular%20fibrous,are%20to%2040%20cm%20big.
2. https://en.wikipedia.org/wiki/Phyllodes_tumor#:~:text=Phyllodes%20tumors%20(from%20Greek%3A%20phullon,1%25%20of%20all%20breast%20neoplasms.
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5823393/

Colorectal Cancer

Colorectal cancers or bowel cancers are often conversed together because of their common features but termed either colon or rectal cancer depending on site of origin. Structurally colon is a hallow muscular tube about  1.5  meters long having 4 parts i.e., Ascending colon which starts form the end of small intestine, transverse colon, descending colon  and sigmoid colon which is ’S’ shaped continues as rectum and connects anus.

Though Polyps (growth on inner lining of colon or rectum) are commonly seen during initial stage or alarming sings but not always, which depends on size and type of polyp confirmed by biopsy.

Types; may be benign or malignant. Commonly seen colorectal cancer are adenocarcinomas. Though less common tumours which can start from colon or rectum are Carcinoid, Gastrointestinal stromal tumours (GISTs), Lymphoma and Sarcoma.

Risk factors :

• Obese or over weight
• Less physical activity
• Non-veg
  • More of meat (Beef, pork, lamb or liver)or processed food (hot dog etc.)
  • Eating, meat cooked at very high temperature (deep fry, grilling) creates chemical that might raise cancer risk.
• Low serum Vitamin D levels.
• Smoking &
• Elderly (above 50yrs).
• Person with history of IBS, colorectal polyps, ulcerative colitis.

Symptoms :

• Bowel habits changes.
• Diarrhoea or constipation.
• A feeling that the bowel does not empty properly after a bowel movement.
• Blood in stools that makes stools look black.
• Bright red blood coming from the rectum.
• Pain and bloating in the abdomen.
• Feeling of fullness in the abdomen, even after not eating for a while.
• Fatigue or tiredness.
• Unexplained weight loss, vomiting .
• Unexplained iron deficiency in men, or in women after menopause.

If any of few symptoms persist for 4 weeks or more will be suspect of colorectal cancer

Statistics :

• 8% of every new cancer detected patients.
• More common in male than females.
• 5 years survival rate is 64%.

Prevention :

* Screening once a year is the best way in

– In case of family history.

– Above the age of 45 years with anorectal symptoms .

– Fecal occult blood test (FOBT)/ fecal immunochemical test (FIT).

– Colonoscopy – once in 10 years OR Sigmoidoscopy OR Virtual colonoscopy ( atypie of CT3-D        image ) – once in 5 year.

• Maintain weight and physically active
• Avoid smoking and alcohol
• Limit red meat and processed meat
• Timely treating bowel diseases

Treatment :

Depends on several factors like location, size, cancer stage, whether recurrent if so overall state of health of individual patient.

1. Surgery; Ranging from cryosurgery to colectomy etc
2. Chemo therapy
3. Radiation therapy

Recovery

1. If metastasis to other parts of the body if left untreated
2. The chances of a complete cure depend enormously on how early the cancer is diagnosed and treated.
3. A patient’s recovery depends on the following factors:

• The stage when diagnosis was made
• Whether the cancer created a hole in intestine

Our approach:

• Surgery will be initial line of treatment if appropriate to patient.
• As per the cancer stage and endurance of patient either supportive, detoxing therapies are adopted to provide better quality life support to extend the span of life.
• Among tridoshapredominately Vatadosha resides in colon and that is the one which regulates the movement of Pitt and Kapha so the treatments are:
  • Aimed for regulating vatadosha for regression of tumour.
  • To reduce further growth or advance stage tridosha needs attentions.
• Treatments are also aimed to support or manage adverse reaction other therapies like chemo/ radiation etc.

HAEMORRHOIDS( PILES)

These are the swollen (Inflammed) veins at Anal region.

Common causes :

• Chronic constipation
• Hereditary
• Improper circulation during pregnancy
• Portal hypertension (Increased blood pressure in portal veins)
• Tumours of rectum
• Cardiac failure

Symptoms :

• Pain
• Bleeding
• Discomfort
• Itching
• Swelling

Types –

External piles : Which can be felt with hands.

Internal piles : Which is not visible externally.

Ayurvedic perspective :

Ayurveda terms piles as ARSHAS which is caused due to improper Food habits and Lifestyle.

Signs & symptoms are explained extensively.

Unique treatments like Kshara sutra, Kshara karma and Agni karma are explained in Ayurveda.

These are the Simple procedures with minimum cost and least post-op complications. But one can expect the best result.

FISTULA IN ANO

Fistula is a narrow tunnel / blind tract with its internal opening in the anal canal and external opening in the skin around the anus.

It may be a complication of anal abscess.

Symptoms :

• Pain
• Itching
• Swelling
• Tenderness
• Pus, serous fluid/ feaces discharge – bloody/purulent
• Fever

Complications :

• Delayed wound healing.
• Multiple tract formation etc

Ayurvedic Approach :

In Ayurveda, especially in Sushruta samhita, this condition has been explained as BHAGANDARA. As we have seen, there is an excellent treatment procedure called KSHARA SUTRA, in which a specially prepared medicated thread is passed through the track.

Here there is no need to cut open the track, the healing process will be very fast also the recurrence chance is very minimal.

In total the benefits of this Ayurveda treatment can be listed as:

• Minor surgery
• Minimum painful
• Least post op complication
• Low cost
• Faster healing
• Minimum chance of recurrence.

FISSURE IN ANO

In Ayurveda it is considered as PARIKARTIKA which means pain as if being cut by a scissor.

Main cause is chronic constipation which inturn due to improper diet (having more spicy, over eating, some of the non vegetarian food etc) and lifestyle (sitting for a longer period, more travelling etc).

Treatment :

•           Oral
•           Pichu (applying cotton swab dipped in medicated oil/ghee).
•           Avagaha Sweda (Sitz/tub bath).
•           Agni karma (type of burning, locally with a special metal instrument prepared with Panchaloha).
•           Kshara karma (where medicated ash/alkali from specific plants is applied in a methodical way).
•           Food and Lifestyle modification.