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• Psoriasis
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INDIGESTION

Indigestion is a clinical condition with vivid presentations like :

• Pain in abdomen
• Reduced appetite
• Nausea, vomiting
• Diarrhea 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
• Improper habit of food intake – like Untimely food intake, Excess food intake etc
• Suppression of natural urges etc.
• Improper sleeping habits.

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

Gastritis indicates a clinical condition characterized by inflammation of Gastric Mucosa which is a protective layer lining the inner wall of the stomach. Mucosa protects the stomach from its own acidic secretions and corrosives or irritants in food.

Gastritis is caused by :

• Infection
• Injury
• Excess alcohol consumption.
• Excess usage of pain relieving drugs (may be NSAID) and other medications.
• Excess tea, coffee and other beverages.
• Stress.

Symptoms of Gastritis includes :

• Reduced appetite.
• Pain abdomen or abdominal discomfort.
• Chest burn.
• Sour belching
• Vomiting
• Headache etc.

Treatment approach includes uses of different class of Antacid and antiemetic. If needed other symptomatic treatment would be adopted.

In lens of Ayurveda, Gastritis is generally considered as Amlapitta, which is one of the representations of imbalanced Pitta.

Ayurveda has identified the following causes leading to Pitta imbalance :

• Excess spicy and sour food intake.
• Fasting for prolonged duration.
• Untimely food intake.
• Intake of food before the digestion previous food etc.

Treatment in Ayurveda includes:

• Correction in life style and food habits play a pivotal role.
• Different medication to pacify the imbalanced Pitta.
• Vamana (medically induced Vomiting) followed by Virechana (Medically induced Purgation) would be ideal Panchakarma to tackle chronic and severe Gastritis.

IRRITABLE BOWEL SYNDROME (I B S)

Irritable bowel syndrome is a disorder of large intestine, which mainly hampers the nature bowel movements.

Common causes of Irritable bowel syndrome are :

•  Excess stress.
•  Abnormality of nervous system of Gut.
•  Severe colon infections etc.

The condition presents with :

• Abdominal pain.
• Altered bowel habits (increased / reduced frequency)
• Change in nature of bowel (hard / watery bowels).
• Bloating of abdomen, weight loss etc.

Conventional treatment involves wide range of options which are opted based on the need.

• Change in life style to reduce stress is primary step.
• Alterations in the food habits.
• Oral medications to normalize the bowel movements.
• Smooth muscle relaxants to relieve pain abdomen.
• Antibiotics to treat infections.

Ayurveda considers Irritable Bowel Syndrome under headings like Grahani Dosha and Ajeerna.

Causes traced out are

• Improper food habits
• Excess water consumption (consumption of water without thirst)
• Excess stress
• Excess consumption of oily spicy sour foods.

Treatment includes :

• Medications for enhancing the digestion and assimilation capacity.
• Vamana (medically induced Vomiting), Virechana (medically induced Purgation) and Basti (medicated Enema) chikitsa among the Panchakarma are most beneficial.
• Dietary changes and life style modifications play a major role.

CHRON’S DISEASE

Chron’s Disease or Chron’s ileitis is an inflammatory condition of the large intestines. The cause of Chron’s is considered to be Auto immune, that is the pathological status wherein body immunity fights against the self cells.

The condition presents with :
– Pain abdomen
– Diarrhoea
– Mucus and blood mixed stools
– Excess of weight; etc

Treatment involves medications :
– To relieve pain.
– Steroids to suppress auto immunity
– Medications to subside diarrhea and regularize bowel movements

Ayurveda terms the conditions as Grahani. The cause are mainly, few of them are
– Improper food habits
– Irregular food intake
– Excess of spicy, sour food etc

Treatment involves oral medications to relieve pain, enhance appetite, thus facilitate digestion and metabolism, piccha basti, is specially formulated to be used in Grahani. Along with above, corrections in food habits and life style is far important.

Jaundice

Alcoholic Liver Disease

Ascites

COUGH

Cough is a positive response of the body to remove / throw out 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, Cancer 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 prolapse, 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. Also Kaasa is considered as one of the complication in most of the diseases in Ayurveda.

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

WHEEZING

Wheezing or Breathing difficulty or Asthama is a respiratory condition wherein there is inflammation of the respiratory passage leading to narrowing of the lumen and thus difficulty in breathing. The inflammation can be an outcome of infection by various virus or bacteria or even as an allergic response to dust or smoke etc.

The condition presents with :
– Breathing difficulty
– Cough usually with expectoration.
– Sometimes associated with fever.
Symptoms usually aggravates with cold external climate.

Treatment involves :
– Broncho dilators to ease breathing.
– Anti histamines or steroids to suppress allergic response.
– Antibiotics to combat against infection.
– Expectorants and anti tussives to facilitate expulsion of sputum and suppress cough.

Swasa is the Ayurvedic nomenclature of the condition.

Some of the important causes enlisted are
– Excess intake of cold food stuffs and exposure to cold climatic conditions
– Excess intake of water is also observed to be important cause.
– Excess intake of curds, specially at night.
– Suppression of natural urges / chronic constipated bowels too has significant impact on breathing difficulty.

Treatment needs :
– Panchakarma, specially Vamana followed by Virechana is beneficial.
– medicated smokes are beneficial to relieve acute episodes
– external therapies like applications of paste of drugs etc are also beneficial.
– Various Oral medications are available.

BRONCHIAL ASTHMA

COPD (CHRONIC OBSTRUCTIVE PULMONARY DISEASE)

ALLERGIES

SINUSITIS

TONSILLITIS

DIABETES

Diabetes Mellitus (DM) is a metabolic disorder characterized by hyperglycemia (increased blood sugar levels). Hyperglycemia can be an outcome of decreased insulin secretion or reduced glucose uptake my muscles, named as Type 1 and Type 2 Diabetes Mellitus respectively. DM needs to duely addressed as it shall land up 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 secretions
• Reducing carbohydrate absorption from GI tract.
• Enhancing muscles uptake of glucose.
• Sub-cutaneous administration of insulin etc.

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

The science also enumerates the causes as below.

• Physical hypo-activity
• excess consumption of food.
• Excess consumption of milk and milk products, sugar, jaggery and other bi-products of cane etc.

Ayurveda approaches the condition by correcting the basic digestion and metabolism of food. Panchakarma, mainly Vamana (medically induced Vomiting) and Virechana (medically induced Purgation) procedures are adopted to eliminate the excess / imbalanced Dosha and thus help for proper metabolism of assimilated food. Many a times there are possibilities to overcome the unhealthy condition of Hyperglycemia and become drug free.

THYROID

Thyroid problem or thyroid abnormality is basically of 2 types. Hypo-thyroidism and Hyper-thyroidism .

Thyroid is a gland which secretes certain hormones having wide array of functions. Primarily the thyroid hormones influence the bodily metabolism. Abnormality in thyroid reflects over abnormal metabolic activity which is expressed vividly over different systems.

Thyroid abnormalities are caused due to :

• Defect in pituitary gland.
• Poor response of thyroid cells to pituitary stimulus.
• Abnormalities with thyroid gland.
• Auto-immunity.
• Tumours of pituitary and thyroid, etc.

Thyroid abnormalities, specially Hypothyroidism is suspected observing the following clinical features :

• Reduced appetite, Excess weight gain, Lethargic feeling, Hypotension, Menstrual abnormalities, Depression etc.

Hyperthyroidism presents with :

• Increased appetite or excess craving for food, Weight loss, Excess sweating, Tremors etc.

Conventionally thyroid abnormalities are managed with oral supplementation of thyroid hormones. Other medications and surgical interventions to treat the cause is also adopted.

 Ayurveda views Thyroid abnormalities as Agni Vikruti.

 Causes like :

• Improper food habits, Excess stress, Lack of exercise etc., lead to thyroid abnormalities.

 Treatment in Ayurveda is very customized, wherein based on the clinical presentation and the cause traced out, the treatment is planned.

Treatment includes :

• Corrections with food habits.
• Following a healthy life style.
• Panchakarma therapy, mainly Vamana (medically induced Vomiting) and Virechana (medically induced Purgation) and Nasya (medicated nasal drops) are known to bring changes drastically with Thyroid values.
• Oral medications which normalizes the metabolism are administered.

OBESITY

Obesity is the condition associated with excess and abnormal accumalation of Fat in body. The conditions is usually diagnosed by calculating BMI or waist – Hip ratio.

Obesity is not just an aesthetic concern but also has numerous associated abnormalities. Obesity or obese people are usually prone to suffer with Diabetes, Hypertension, Cardio-vascular disorders, Gout arthritis, metabolic disorders etc.

Treatment  is aimed to reduce the associated risk factors of obesity. Statin group of drugs are mostly used. Diet and exercise to reduce fat deposits and surgical intervention are also available.

Ayurveda names the condition Obesity as Atisthoulya. The pathognomic feature of Athisthoulya is presence of lax fat deposits in abdomen hips and chest.

Treatment approach begins with tracing the cause of obesity, accordingly different treatments are adopted :

• Vamana and Virechana among panchakarma is most esstential in management of Obesity.
• External therapies like Udwartana (Dry powder massage) is proved beneficial.
• Disciplined diet and regular exercises are pivotal in management of obesity.

 LUMBAGO (Backache)

Lumbago is a medical condition characterized by pain in low back area. Lumbago is caused by various causes like :

• Lumbar muscle strain.
• Inter vertebral disc lesions.
• Bone disorders like osteoporosis or Osteoarthritis etc.

Lumbago is triggered by :

• Sitting or standing for long duration.
• Sitting or sleeping in wrong posture.
• Excess motor bike ride.
• Lifting heavy objects etc.

Conventional treatment :

• Local application of Analgesic liniments.
• NSAIDs.
• Physiotherapy to strengthen the back muscles.
• In severe conditions surgical correction will also be done.

In Ayurveda, Lumbago is considered under Vata Vyadhi.

Causes :

• Excess of strenuous physical activity.
• Improper food habits.
• Excess consumption of food devoid of fats.
• Carrying or lifting heavy objects etc.

Treatment :

Various modalities of treatment are available in ayurveda.

• Complete rest is advised.
• Externally local application of oil in form of abhyanga.
• Internally Snehapana (with ghee or oil based medicines) or other medications  are administered.
• If very much needed, Panchakarma, mainly Vamana (medically induced Vomiting ), Virechana (medically induced Purgation) and Basti (medicated enema) Chikitsa are most beneficial.
• Kati basti is a local sudation technique beneficial in effective management of lumbago.

Ayurveda can treat lumbago effectively and need for surgical intervention can also be prevented.

SPINAL DISORDERS

Spinal Disorders is a umbrella term which includes the disorders of Spinal cord and the nerves emerging out of it. It includes paraplegia, monoplegia, neuritis, radiculopathies etc.

The causes of Spinal Disorders may be :

• External injuries over spinal cord or nerves.
• Auto immunity
• Infections of nerves like GB Syndrome.
• Disorders of vertebrae etc.

Symptoms are highly variable, like :

• Numbness or tingling sensation of limbs
• Loss of sensory percpetion.
• Weakness of limbs.
• Complete loss of motility of limbs.
• Bowel and bladder incontinence etc.

Treatment is dependent on cause. Both medical and surgical management are available. Ayurveda considers the spinal disorders under Vatavyadhi.

Among various causes, suppression of natural urges, excess of dieting, altered sleep habits etc precipitate the chances of occurence Vatavyadhi. Treatment of Vatavyadhi is one of the greatest strengths of Ayurveda.

Wide range of oral medications are available. External therapies like Abhyanya, Vestana, Dhara etc have reliable effects.

Basti Karma (Medicated Enema), one among the Panchakarma is the most beneficial and promising treatment that ayurveda offers.

DISC PROBLEMS

Disc problem or Disc lesion is the condition wherein the soft jelly disc situated between the two vertebral bones is injured or compressed. Usually disc lesions commonly occur at two areas- cervical and lumbar.

Causes of disc lesions are :
– lifting heavy weights
– excess travelling on two wheeler’s / without back support
– carrying heavy weights on head leads cervical disc lesion
– external hit injuries
– injury caused by spinal anesthesia, a pre-operative procedure in various surgeries etc.

Patients with Disc lesions typically present with :
– Pain in low back / neck.
– Pain may sometimes even radiate to legs or hands.
– Difficulty in movement of neck or back.
– Tingling sensation or numbness in limbs etc.

Treatment involves
– Simple NSAIDs to relieve pain
– Steroidal spinal injections
– Traction therapy to relieve compression
– Surgical intervention.

Ayurveda terms the condition as Kati Shoola / Grudhrasi / Vishwachi which are different presentations of Vata Vyadhi. Along with other causes enlisted, Ayurveda identifies sitting or standing in wrong postures for long duration as a main cause.

Ayurveda offers vast variety of treatment modalities in this case, as like :
– External therapies like Kati Basti (pooling oil over back), Sudation therapy etc.
– Varieties of Basti – enema therapies give excellent results.

• 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 :

1. Primary OA – seen in elderly generally by the end of 4^th decade.
2. Secondary OA – It may appear at any age and it is the result of previous wear and tear.
3. Common sites are Knee, Hip and Back.

Common Symptoms includes :

• Joint Stiffness, Diminishes mobility discomfort, Pain etc

In spine it may cause compression of nerve roots causing:

• Pain, Muscle Spasm, Neurologic abnormality etc

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:  Dyslipidemia (high “bad” cholesterol), smoking, Diabetes, Hypertension, abdominal Obesity, psycho-social 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 Remodeling” refers to a change in vessel size. In normal arteries, remodeling 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 respective 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 (strength) of Roga (disease) and Rogi (patient) i.e., stage/severity of the disease and strength of the person, Mrudu (mild) or Nitya (daily) Shodhana (cleansing) 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.

Ayurvedic perspective of Coronary Artery Disease :

Signs and symptoms explained under IHD (Coronary Artery Disease) resemble lakshanas (symptoms) of handful of diseases in Ayurveda, especially – Dhatugata Vata (deep seated vitiated Vata Dosha) and Udavarta (Vata which has lost it’s normal path). The samprapti (pathogenesis) predominantly depicts kha vaigunya (defect in the channels of the body) due to sroto dushti (defective channel) (sanga, granthi). The causative factors (hurry, worry, spicy curry lifestyle) lead to Ama formation, which refers to the undigested or improperly digested food that remains (adheres) in the body without excretion. When such deposition increases, the homeostasis is hampered. This gives rise to obstruction of channels, loss of strength and appetite, breathlessness, changes in bowel movement (slimy stools, incomplete evacuation), easy fatigue etc. Atherosclerosis resembles Ama in its tendency of coating the srotas (channels of the body). This in turn disturbs the normal movements of Vata, with greater emphasis on Vyana and Udana gati (Vyaan and Udana are the types of Vata). At the level of Dhatu (building blocks of our body or vaguely, tissues), Vata which disturbs mamsa and medas is said to cause ‘danda mushti hatamiva atyarta toda (severe pain as if beaten by a rod or fist), shrama (fatigue) and ruja (body-ache)’ (Charaka Chikitsa 28/ 32).    

Another reason for indirect impact of dushta Vata ( vitiated Vata ) on Hridaya is Vegadharana, especially those which impact Apana and Udana Vata ( tpes of Vata). Vegadharana refers to controlling natural urges like thirst, hunger, defecation, urination, flatus, tears, breathing etc. This leads to a condition called Udavarta where the Doshas (led by Vata), change their physiological path of movement. The symptoms like Hrudayoparodha (blockage to normal functioning of heart), Hrudaya kampa (palpitations), Hrudi vyatha (chest pain), Hridroga (cardiac issues) etc are caused due to forceful controlling of Apana Vata (responsible for defecation, flatus, menstruation etc), Udgara (belching), Trishna (thirst) and Ashru (tears), Shrama nishwasa (breathing after exertion) respectively. (Charaka Sutra 7, Sushruta Uttara 55). 

              The stability and instability of occurrence of chest pain may be correlated to the extent of Ama, Rasa vikruti, Vyana-Udana-Prana dushti (including anyonyavarana) and involvement of Sadhaka Pitta ( a type of Pitta). When the history and development of samprapti is chronic, dhatu shaithilya (~ flaccidity of tissues) may also be considered. Sthanika kha vaigunya can also occur directly in manovikara ( Psychological problems), as seen in involvement of Hridaya in Unmada, Apasmara ( these are the types of Psycological disorders)  samprapti and lakshana.

              When it comes to chikitsa, nidana parivarjana (to avoid the causes) and adopting pathya ( healthy diet) is mandatory. Without this crucial step, no treatment can commence. The principle here is protecting Hridaya marma (~ heart) by re-establishing Vata gati ( direction of Vata Dosha) whilst ensuring ama pachana ( digestion of undigested material) and maintaining dhatu bala (integrity). In case of Bahudosha (adherent toxins / unwanted unsaturated fatty acids) – Panchakarma can be done with proper care and caution. Snehapana ( intake of ghee / oil or any form of lipids) and swedana ( sudation) offers targeted removal of adherent ama without harming the delicate circulatory structures. This ama will then be expelled. The next step would be to ensure agni deepana ( kindling of digestive fire) (especially dhatvagni) and hridya medicines and food. Rasayana (rejuvenating drugs)  may be selected based on nidana (cause)  and extent of vyadhi (disease).

              Like any other disease, IHD can be managed efficiently using Ayurveda. Prompt ashtasthana pareeksha (8 modes of examination as explained in ayurveda), customized pathya (diet) and suitable oushadha ( medicine) can help the patient in leading a better, independent life.

CARDIOMYOPATHY

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 Cardiovascular 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.

Ayurvedic perspective of Cardiomyopathy :

The site affected as a rule in Cardiomyopathy is the muscular tissue. This may be generally considered as a dhatugata vikara (problem deep rooted in the body tissues). Since in most cases the muscle becomes stiff and enlarged, it may be attributed to dushta, leenavata (vitiated Vata which has adhered / mixed with deeper tissues of the body).

Signs and symptoms of vataja hridroga (heart disease due to the vitiation of Vata Dosha), vataja shotha (swelling / edema – caused due to the vitiation of Vata), mamsagata vata (Vata lodged in muscle tissue?) and other vata prdhana (predominantly Vata Dosha) (pittanubandha (associated with Pitta Dosha), in many cases) etc can be compared to various cardiomyopathies. The presence of Pitta is necessary (along with Vata) for the focused dhatukshaya / vikruti (depletion or disturbed body tissues) at deeper levels.

The samprapti (pathogenesis) depicts mamasavaha srotodushti (problem in the channel of muscle tissue?) with underlying rasavaha srotodushti (vitiation of channel of plasma tissue?).  Involvement of dushta Vata and Pitta is essential, mostly with kapha kshaya (depletion of Kapha dosha). Initially, this causes complaints of fluctuations in BP, Fatigue, Breathlessness etc. Once Hridaya becomes sthana (site) of dushta dosha (vitiated dosha), local alterations in structure begin. Alternatively, vatadushti due to Kapha / aama (indigestion) vriddhi (increase) sanga (obstruction) to normal vata gati (direction of Vata), causing vimargagamana (abnormal direction of Vata)) can also lead to kha vaigunya (Vitiation of channel ? ) in Hridaya, and ultimately, Hridroga. The condition can exacerbate due to manovikara (disorders of mind). History of shwasa (Asthma or any kind of breathing disorders), kasa (cough), gulma (A boll kind of formation of Vata in abdominal cavity?), arsha (piles), udavarta (upward / abnormal movement of Vata); smoking, chewing tobacco etc is seen clinically in many cases of this disease.

As stated previously, different presentations of cardio-myopathy (hypertrophic, stress, dilated etc) depict various disorders in Ayurveda including Vatavyadhi (disorders of Vata), dhatugata leenadosha, Shwasa, vataja gulma etc. This condition can be effectively managed and prevented through practises such as Nitya Abhyanga (regular oil application to the body), Pranayama, seasonal shodhana (Panchakarma) etc. Medicines and treatments are mainly vatahara (which reduce Vata), pitta shamaka (which reduce Pitta) and balya  (nourishing). Recurrent snehapana (oral intake of medicated ghee / oil) followed by mriduvirechana (mild purgation therapy), Matrabasti (administration of small amount of oil / ghruta through anal route), abhyanga and avagahasweda (tub bath) etc provide definitve (Nirnayaka) results. Formulations such as brihatvata chintamani, drakshadi kashayam, Nagarjunabhra rasa etc are beneficial. Judicious use of Rasayana dravya (medications which nourish our body tissues) such as Agastyahareetaki lehya, abhraka bhasma, swarna kalpa etc can help the patient lead an independent life.  

Ayurveda perception of this disease is not comparable to a single vyadhi (disease) entity. Therefore, diagnosis and monitoring through ashta sthaana pareeksha (8 folds of examination explained in Ayurveda), especially Nadee pareeksha (pulse examination) can enable the practitioner to detect and treat (or manage) the condition at the earliest. Pathya (diet) along with suitable therapy (or medications) goes a long way in achieving normalcy in the life of the patient.

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.

Ayurveda perspective of Hypertension and Hypertensive heart disease

In the Ayurveda perspective, any disease signifies an imbalance in Doshas. In most heart diseases including Hypertension, disturbance in either one or more doshas and the manas (~ Mind) is seen. Therefore, it is psychosomatic both in cause and effect.

Any upset in the Agni (metabolic process) causes change in quantity as well as viscosity of Rasa dhatu (primary metabolic product with maximum nutrition ~ plasma), which subsequently affects Raktha dhatu (~ blood) and others. The causative factors include: eating spicy, oily, fried food; excess exposure to sun or high temperatures (eg: furnace in factories), or cold (air conditioners) etc. These may also directly affect Raktha dhatu.

At first, the body will repair itself by mechanisms which may include alarming changes like expelling the incompletely digested foods via urine (increased quantity or frequency, frothy/slimy), stools (sticky-pasty, incomplete feeling after passing), bilious (sour/bitter) vomiting etc. If the lifestyle is not corrected by now, the Dosha accumulation will increase more than the expulsion. Basic metabolic changes will result in changes in dhatu. Initially there are functional changes and if not resolved over a period of time, structural modification occurs. This leads to symptoms like shrama (fatigue), agni vikruti (reduced or fluctuating appetite), vibandha (difficulty in/ incomplete bowel movement), nidra bhramsha (disturbed sleep), irritation etc. Further, shwasa krichrata (breathlessness) on walking or climbing short distances, bhrama (dizziness), hriddrava (palpitations), moha (blackouts) etc will develop. By now, people start realising that something is wrong and go for measurements of Blood Pressure and other parameters. This explanation draws attention to the fact that BP variations do not develop overnight.  Stress is experienced both as cause and effect of variations in Rasa and Raktha dhatu.

The samprapti is usually similar to that of pandu, raktapitta, amashayagata vata, pittanubandha viloma vata, amavata etc. Viloma gati of vata is noted in most cases. In case of Pitta involvement, the nadee remains sharp even in vata (and sometimes in kapha) sthana. The nature of beats in sphygmomanometer can also be observed similarly. Lakshana of rasa and/or rakta vikriti are noted.

Treatment principles primarily aim at correcting the commonly seen metabolic disturbances. This is called Nidana pratyanika chikitsa (stopping the cause). Along with this, Vyadhi pratyanika chikitsa (condition specific medicines or therapies) are prescribed. Stress management is done through counselling the patient to be strong, understanding oneself, meditation etc. This creates a positive self image, makes them aware in trying to understand themselves, develops acceptance etc. Guided meditation is advised. Behavioural changes remain a part and parcel of management. Medicines such as Drakshadi kashaya, Pravala panchamrita rasa, Sudarshana vati, Dhanvantara gulika; Herbs such as Jatamamsi, Ashwagandha, Manjishta etc are used.

Hypertensive heart disease

The involvement of heart rather than any other vital organ primarily is due to the fact that it is the point of origin of Rasavaha srotas (channels carrying Rasa) and Manas, the seat of emotions and intellect. Quantitatively increased yet qualitatively deficient Rasa and Raktha dhatu can cause variations in amount of nutrition and oxygenated blood reaching the tissues. This can cause sudden blackouts, local injury, change in impulse generation and spread – causing palpitations and later fibrillations, stroke, or even death. All these result due to disturbed Dosha which settle in the heart due to continued practise of aforesaid causes. This is termed “leena dosha” or dosha which are deeply seated in the dhatu. It depicts the chronic nature. Since hridaya is a sadyo- pranahara marma, such variations can often become detrimental. It can also cause Ojas kshaya.

The principle of treatment includes a major correction of lifestyle supplemented by medicines or therapies to establish normalcy. The aim of treatment is to always bring a balance between the body and mind using minimal yet target specific medicines for a short duration. This includes use of Panchagavya ghrita, Mahatiktaka ghrita etc for snehana during panchakarma; Hridroga chintamani rasa, Prabhakar vati, Drakshasava etc. Recurrence is avoided by following a balanced diet, prescribed water intake, proper sleep-wake cycle and staying away from addictions. Practising Achara rasayana is essential. It refers to the rejuvenation of mind by following principles such as truthfulness, non-violence, compassion, maintaining hygiene, being humble and noble etc.

In brief, simple yet fulfilling lifestyle changes coupled with medications (until necessary) will guarantee a healthy heart, mind and normal blood pressure!

ARRHYTHMIA

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.

Ayurveda perspective of Arrhythmia

Disrupted rhythm in the heart is an issue concentrated in the organ itself, or so it seems. Ayurveda looks at any change in physiology at all levels – physical and mental. Problems of (or arising in) hridaya initially develop as smaller issues (unrelated to heart itself) such as untreated chronic gastric irritation, bloating, constipation etc. Other possibility is the samprapti involving hridaya directly. The former is more commonly seen clinically than the latter.

Focusing on the latter, initially vata kopa (along with both or one of kapha, pitta) at rasa dhatu level causes commonly elicited Rasa vikriti. Based on extent of dosha imbalance, signs and symptoms such as Hriddrava (palpitations), shwasavarodha / krichra shwasa (breathlessness / laboured breathing), hricchoola (pain in the chest region), bhrama (light headedness / dizziness), glani (easy exhaustion), atanka (unexplained anxiety / agitation to small problems) begin. If this is left untreated (or only symptomatically addressed), the circulating dushta rasa dhatu carry dosha through Hridaya and other srotas causing exacerbation of existing issues in addition to others such as blackouts, coldness of extremities, sleep disturbances, intolerance, increased incidences of pain in / around chest etc. If the samprapti vighatana does not occur at this stage too, sthana samshraya of dushta dosha can occur in Hridaya. Mainly vata kopa can enhance due to sanga/avarodha which in turn leads to re-entry type mechanism. With time, this vata becomes dhatugata or leena. This causes improper gati and further causes sthanika dhatu kshaya. Fibrillation may be explained with this. Sudden expulsion of vyana coupled with prana leads to death. De-fibrillation causes vyana to forcefully move against sanga/avarodha eliciting extreme pain in already weakened hridaya. Opposed to this, vata gati can also get slowed down by either vata kshaya or avarodha, causing Bradycardia. This can occur in case dushta kapha is present. Vimarga gamana coupled with kupita vata may lead to Tachycardia, which requires coupling of pitta and vata.

Other samprapti of Anyonyavarana (vyana-prana; prana-udana; vyana-udana etc), Avarodhajanya vata kopa can also be considered to explain disrupted rhythm. Vata remains the prima factor as it controls all movements. However, for a more focused approach, pitta is considered essential. To slow down or obstruct the same, kapha remains fundamental. Role of Sadhaka pitta in generation of impulses, vyana vata in conduction and avalambaka kapha in sustenance needs further study.

The hridaya can fall victim to any vata pradhana vyadhi. Therefore, marma palana is emphasised while treating the same. In the current scenario, lifestyle disorders act as harbingers of cardiac complications. Therefore avoiding nidana such as stress, exposure to sudden scares and anxious situations (trasa); use of ushna and teekshna (spicy, sharp and penetrating tastes), rooksha (dry) food, activities which cause excess increase / decrease / vitiation of dosha such as exposure to extreme temperatures, winds and such; remains cornerstone of treatment. Practises of abhyanga regularly, seasonal shodhana, addressing minor ailments effectively (at root levels, not just symptomatic alleviation) and focusing on long term protection of hridaya using medicines such as Brihat vata chintamani rasa, Abhraka bhasma, Swarna kalpas etc will keep the heart healthy, and the person wealthy and wise.

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.

Ayurveda perspective

The general outline of inflammatory disorders of the heart seems to fall under the comprehensive perspective of jwara roga.  Jwara is not just santapa (increased temperature), klama (tiredness) and chills. It may afflict body or mind or both. It can occur with varying signs and symptoms ranging from simple ones such as increased trishna (thirst) to pralapa (delirium). Jwara is treated as an all encompassing disease in Ayurveda and therefore, the term “jwara” refers to both a disease in itself as well as any other disease entity which affects the body.

Hridi vyatha or pain in the heart / chest region is described as jwara prabhava by Acharya Charaka. In avisargi jwara or a condition when jwara has not completely set in, hridayasya avishuddi is pointed out. This generally refers to a feeling of fullness / tightness in the chest region along with unexplainable discomfort in the heart/chest. It also means a lack of clarity of thought. Another direct reference in Charaka Samhitha regarding the involvement of heart in jwara would be the occurrence of Hridroga in case of forceful / improper emesis in taruna jwara.

The signs and symptoms of myocarditis and endocarditis to an extent overlap with the lakshana of ama jwara. And those of pericarditis are found to resemble pachyamana jwara lakshana. Inflammation is never without the involvement of pitta dosha, vata dosha, rasa dhatu and rakta dhatu. Chronic or recurrent fever like symptoms (Jeerna or sannipataja jwara) causes Pitta vitiation along with Vata. In line with the involvement of dhatu, rasa-rakta-mamsa-meda and jwara of these levels (rasa dhatugata jwara, rakta dhatugata jwara etc) may be thought of. If not treated timely, the condition can worsen as dosha afflict majja dhatu and beyond.

Apart from jwara, the signs and symptoms also overlap with conditions such as pittaja gulma, pittaja grahani, sannipathaja jwara, hridi vidradhi etc. even though the inflammatory disorders are not found under a single heading (apart from Jwara rogadhikara), a broader perspective on the disease can be found across the Samhithas. Therefore the chikitsa krama will also be a comprehensive approach in Ayurveda.

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.

Ayurvedic perspective of Pulmonary Heart disease

With the heart being situated in between the lungs, problems in the lungs will have an impact on the heart. Here, hridaya is affected due to shwasa (respiratory diseases including Asthma), kasa (acute / chronic / recurrent cough), hikka (acute/recurrent hiccups), gulma (comparable with various metabolic disorders like GERD, bloating etc.,) etc. Also, uras (chest / thorax) is the sthana of prakrita bala. This bala is essential for the smooth functioning of hridaya. Prana, udana and vyana vata along with avalambaka kapha and sadhaka pitta are directly involved in this region. Depending on the chronicity, the dosha involved may have become dhatugata. Clinically, this is seen in people with repeated allergies and asthma (unmanaged / poorly managed / suppressed) or those with history of indiscriminate use of OTC anti-allergens. The line of treatment depending on the extent of dosha and history often requires Panchakarma (especially Vamana) and then medications.

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.

Ayurveda perspective of Heart failure

The inadequacy of heart in pumping enough blood to all parts of body is termed heart failure. In general, heart fails due to any condition which causes damage or overloading and in turn, decreases the efficiency of the heart muscle. It may also be due to less input to the heart itself in the first place, or due to peripheral resistance (diseases of artery). This functional failure may be attributed directly to adverse effects of Vata vikruti, especially that of Vyana (which is the one which circulates all over). The other 4 also vata share equal responsibility in bringing about a disturbance in filling /output. For example, in case of samana vikruti (commonly seen in case of gastritis – bloating, flatulence, belching etc), palpitations are often experienced. If this is not treated, it may affect udana vata, and may end up in hridaya-related complications.

The symptoms seen such as shrama (fatigue), agni mandya / vaishamya (altered appetite), weight gain, kasa (cough), hriddrava (palpitations), udara (fluid accumulation in abdomen, similar to Ascites), shwasawarodha (breathlessness/laboured breathing),  pada shotha (pedal edema) etc are seen in diseases like Pandu, udara, shotha, udavarta, shwasa, hridroga etc. Chronic or recurrent cough, respiratory infections leads to Vata moving in different directions rather than the path of action. This increases pressure on heart and surrounding structures, which may lead to cardiomegaly due to constant overworking (vata vriddhi). This in turn leads to dhatu shaithilya, causing structural damage. Similar is the pathogenesis of Udavarta, where Apana may be the culprit due to improper lifestyle habits. In Pandu roga, involvement of heart can be understood based on the vikruta Rasa dhatu (vitiated / improperly formed /unformed rasa) involved.

Other causes include arsha, bhagandara, asrgdhara, abhighata etc conditions where dhatu kshaya (predominantly rasa and rakta) is apparent. This may be seen in light of hampered input of blood to heart. The initial samprapti points at rasa dhatu reduction (quantity and / or quality). Symptoms are often seen to begin with those of rasa vikriti such as klama (fatigue without exertion) and shabdha asahishnuta (irritation / anxiety to moderate sounds or noises). Many cases may also present with kapha pradhana samprapti where kleda management required utmost care and attention. Due to involvement of vata (especially samana), pittanubandha nadee is also elicited.

The treatment protocol follows the order of identifying and stopping the causative factors, treating potential underlying conditions such as pandu, arsha, shwasa etc; while establishing a healthy regimen for marma paripalana. Generally, deepana and pachana are preferred to bring about rasa dhatu samyata. Next, condition specific approaches (including panchakarma) are listed. Medicines such as Mukkadi vati, Amrutottara kashaya, Shiva gulika, Punarnava Mandura, Amavatari rasa, Lakshmi vilasa rasa, Ashta churna etc are used. Lifestyle correction remains the foundational element. Remember, if you fail to take care of yourself, your heart will fail you!

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.

Ayurvedic perspective of Valvular Heart disease

Structural variations in the heart include changes in the valves. When these valves are afflicted, the condition is called Valvular heart disease. Valve involvement points to acute or chronic Dosha vitiation, especially in the avayava (hridaya) itself. This focused dosha dushti can occur directly due to local nidana such as manasika karana, ativak pravrutti etc or generalised nidana such as Pandu, Arsha, Gulma etc. However, the major culprits remain Udana and prana vata with or without pittanubandha. Dhatugata vata lakshana are seen in the conditions of valvular diseases. Usually history of respiratory illnesses (acute / chronic / recurrent) is seen in Aortic valve diseases in clinical practise. In mitral and tricuspid valve diseases, disorders affecting metabolism and digestion (or the result of the same) like udavarta, arsha, gulma etc., (irregular movement of Vata) are elicited. The line of treatment will remain vata shamana along with hridya upachara.

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.

Ayurvedic perspective of Congenital Heart disease

All major treatises on Ayurveda mention about various congenital disorders including those of heart. The major cause is listed to be due to faults during pre-natal care of pregnant women (douhruda-apachara) or dushta shukra / shonita (defective sperm /ovum) (Beejadosha) itself. It also extends to causes just after birth such as not conducting jaata karma, especially sadyojaata vidhi such as swarna prashana during primary care of infant etc. To avoid these, the parents are encouraged to undergo Panchakarma before trying for conception and to follow Garbhini charya (the rules and regulations to be followed during pregnancy). Swarna prashana upto 16 years of age will also be beneficial.

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.

Ayurveda perspective

Like any other inflammatory disease, rheumatic fever, falls under the category of jwara rogadhikara in Ayurveda. As described under the Ayurveda perspective of inflammatory diseases of heart, jwara roga has a all encompassing outreach. Acharyas have specifically described lakshana such as pandu, dinata (uneasiness), glaani (fatigue), shwayathu (edema), kushta with patches (skin lesions), kandu (itching) etc in Punaravartita jwara. These are also described in Rheumatic fever. Jeerna jwara and Sannipataja jwara lakshana can also be recounted here.

Therefore, rheumatic fever also falls under the purview of jwara roga, with extensions found in diseases which involve affliction of pitta and vata dosha at the levels of rasa, rakta and mamsa dhatu. If and when jwara is untreated / inadequately managed or if the person indulges in food/ activities which are apathya, the doshas tend to increase + affect the deeper dhatus. This also ensures that this dosha vaishamya becomes chronic, resulting in manifestation of diseases of hridaya. The residual effect is explained as jwara udarka. It is therefore necessary not only to treat simple fever but to educate about pathya, apathya and period of recovery.

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 protein or calcium or salt rich diet.
• Chronic diarrhea
• Genetic predisposition
• Individuals with a history of urolithiasis have high chances of recurrence.

Symptoms :

• Pain abdomen and back radiating down through flanks to groin
• Painful micturition
• Burning urination
• blood mixed urine etc.,

Conventional treatment :

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

• Flush therapy
• Lithotripsy
• Basketing etc

Ayurveda describes urolithiasis under Mootra Ashmari

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

Treatment involves medicines to

• Oral medication which can crush down the calculus and flush it away.
• Avapeedaka Sneha a special variety of SNEHAPAANA towards urolithiasis is proved to be efficient.
• A course of Panchakarma would be beneficial where there are complications of these ASHMARI or in prevention of repeated formation of calculus.

URINARY TRACT INFECTIONS (UTI)

Urinary Tract Infection (UTI) is the general term used to indicate presence of infection anywhere in the Urethra or bladder or ureters.

UTI is comparatively common in females than in males owing to short length of urethra.

Individuals suffering with Diabetes are also prone to UTI.

Presence of urolithiasis (stone in urinary tract) precipitates UTI.

Presence of strictures or other structural abnormalities in urinary tract give scope for UTI.

UTI presents with :

• Burning sensation while urination.
• Painful urination.
• Frequent urge for urination.
• Change in urine color.
• Pain abdomen or back.
• Fever usually associated with chills.

Conventional treatment includes use of Antibiotics to suppress infection.

Smooth muscle relaxants and NSAIDs to relieve pain and fever.

Diuretics and other medications to address other causes precipitating UTI.

Ayurveda terms it as Mootraghata  and provides a wide array of medicines which can be adopted based on presenting condition.

Virechana (medically induced Purgation) is one of the ideal Panchakarma beneficial in the condition.

Food and drinks (medicated water) which help to normalize the urine formation and concentration are indicated.

In chronic cases of UTI ‘Avapeedaka Sneha’ a unique treatment modality is helpful.

ACUTE / CHRONIC KIDNEY DISEASES (CKD)

Chronic kidney diseases (CKD) are the condition wherein the kidneys fail to filter the blood, as a result of which sometimes the essentials like proteins are excreated while the excess of salts and water which needs to be excreated are retained.

Causes :

• Secondary to chronic diabetes or hypertension
• Chronic infections
• Autoimmunity.
• Adverse reaction to drugs or toxins etc.

Symptoms:

•  Frothy urine.
•  Edema of legs and face.
• Nausea, vomiting, loss of appetite.

Micro albuminuria, Serum Creatinine, Blood Urea are recommended for confirmation of diagnosis.

Treatment –

•  If underlying cause be diabetes or hypertension, then these primary disorders are to be addressed first.
•  Nephrotoxic drugs are to be stopped.
• Water electrolyte and proteins are to be maintained.
• Regular / periodic dialysis.

Ayurveda diagnosis differs based on the clinical features / parthenogenesis of the disease. Prameha, Shotha, Pandu are few of the heads under which Chronic Kidney Diseases can be included.

Causes – Ayurveda identifies certain of foods / lifestyle to cause CKD :

•  Excess and regular intake of red meats.
•  Excess usage of curds specially at night.
• Not attending the natural urges in time.
• Inadequate physical exercises etc.

Treatments :
Initially steps to prevent the excess formation of metabolic waste are to be adopted. This is possible by changing the food and life style of individual. Efforts to excrete the various metabolic waste accumalated, through Panchakarma. Vamana and Virechana are of prime importance. Rejuvenate and restore the kidney functioning by various medicines.

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

Painful menstruation, medically termed as Dysmennohrea, refers to the pain a woman experiences during or around the time of her menstruation. The pain that normally occurs around 2 days prior to menstruation and persists for few hours to a day after the onset of menstruation is termed as Spasmotic or Primary Dysmennohrea.

Painful menstruation can be a symptom of other abnormalities related to female reproductive system, as like :

• Ovarian cysts.
• Uterine fibroids.
• Excess flow.
• Some uterine infections.
• Structural anamoly of uterus, etc.

Treatment usually includes a pain relieving drug (NSAID) or smooth muscle relaxants. At time harmonal pills or Antibiotics may also be used to treat the underlying cause.

Ayurveda states that the causative factors which enhance Vata Dosha and causes Rasa Dusthi would be the prime factor towards painful menstruation. Young girls who have habit of withholding the natural urges are more prone to painful menstruation.

Improper dietary habits, excess of oily spicy foods, improper sleep patterns also contribute towards painful menstruation. The disease is considered as a Yoni Vyapat and treatment is planned mostly on the grounds of Udavartini Yoni Vyapat.

Ayurveda Treatment starts with dietary and lifestyle modifications. “Rajaswala Charya” – regimns to be followed by a menstruating woman will be advised.

Medications facilitating normal movement of Vata dosha is utilized. Uttara Basti, a special treatment modality will  be adopted in severe conditions.

OLIGOMENORRHOEA

Oligomenorrhoea is the condition wherein there is scanty menstruation and sometimes associated with delayed cycles.

Causes :

• Uterine infections
• Harmonal abnormalities
• Structural anomalies of uterus.
• Sometimes after the child birth, know as Post partum Oligomennohrea, near to menopause or drug induced.

Treatment involves attempts to correct the cause of Oligomennohrea. Harmonal therapies play pivotal role in the management.

Ayurveda consider the condition as Artava vikruti. The female body is identified to be dominant with Agni Guna. Hence imbalance in Agni Guna or Pitta is the prime Pathological event resulting in Oligomennohrea.

Treatment needs the details of ones routine activities to identify the causes. Sometimes mere change in ones diet and routines too aids to relieve the condition. Virechana is the trust worthy Panchakarma procedure to address Oligomenorrhea.

Many oral medications have proven results against Oligomennohrea.

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.

LIVER CANCER

Liver is the largest internal organ, major chemical factory of our body situated in Right-upper part of abdomen. Prime function of it is filtering, breaking down and stores many of nutrients from the blood received from the digestive system prior to circulate in body as well as responsible for neutralizing or eliminating chemicals and drug metabolism etc. Bile secretion from liver is essential for digestion and absorption of fat and fat soluble vitamins in the small intestine.

Cancer pertaining to liver can either be a primary cancer which begins from it or secondary to any other cancer where liver has metastatic lesions.

Risk Factors :

• Gender :
  • Male : Hepatocellular is common.
  • Female : Fibro lamellar sub type of HCC is common.
• Chronic viral hepatitis is most common risk factor.
• Cirrhosis of liver : Most common cause seen where liver cells are damages and replaced with scar tissue.
  • Non-alcoholic fatty liver : Commonly seen in obese.
  • Primary billary cirrhosis : Autoimmune disease that affect liver.
  • Inherted metabolic disease : Like people with hereditary hemochromatosis absorb too much iron from their blood.
  • Alcohol : Heavy indulge
• Tobacco consumption specially smoking history or current smoker.
• Type 2 diabetes with other risk factors like alcohol, chronic viral hepatitis, overweight and obese.
• Anabolic steroids used for long period.

Signs and symptoms : Some are commonly seen but might be not specific.

• Sudden weight loss
• Enlarged liver or spleen (felt as fullness under the ribs)
• Pain near Right shoulder blade.
• Swelling or fluid in abdomen
• Itching
• Yellowing of skin and eyes (Jaundice)
• In case of liver tumour
  • High blood calcium
  • Breast enlargement / Gynecomastia or shrinkage of testicles
  • High RBC count
  • High Cholesterol levels.

Test for Liver Cancer:

• Imaging test like USG, CT, MRI, Angiography Bone scan are helpful.
• Biopsy : Biopsy helps to re confirmation, though imaging test can confirm the diagnosis.
• Lab test : Changes in liver functions tests like AFP, Viral hepatitis, blood clotting, Kidney function test, Complete blood count.

5-year survival rate :

• Early stage will be ~33%
• If spread to surrounding tissues and lymph nodes will be ~11%
• If spread to distant part of body will be ~2%

Liver cancer types are,

1. Malignant type :
   • Primary :
     • Hepatocellular carcinoma (HCC) : Most common type on adults.
     • Intrahepatic cholangiocarcinoma (Bile duct cancer) : About 10 to 20% primary liver cancer.
     • Angiosarcoma and hemangiosarcoma : Rare cancers of begin in liver blood vessels.
     • Hepatoblastoma : Exceedingly rare that develop in children < 4years.
   • Secondary (Metastatic) : This type is more common than the primary and it might be metastatic from Pancreas, Colon, Stomach, Breast and Lung.
2. Benign type : Some time grow large enough but do not spread.
   • Hemangioma : Most common that starts in blood vessels withoutsymptoms.Some might bleed.
   • Hepatic adenoma : Tumor starts from hepatocytes (liver cells), might be without symptoms or might cause pain or lump in abdomen or blood loss. Eventually it can turn to liver cancer. Seen in women taking birth control pills and men using anabolic steroids.
   • Focal nodular hyperplasia (FNH) : Tumor like growth made up of several cell types like hepatocytes, bile duct, connective tissue cells. Hard to differentiate form liver cancer.

Treatment depending on the stage :

1. Surgery :
   • Partial hepatectomy where part of liver removed, suggested in person with single tumor not grown into blood vessels, good liver function and no other systemic complication.
   • Liver transplant
2. Ablation : Suggested in tumors≤ than 3 cm and various methods like Radiofrequency, MicrowavsCryo and Ethanol are used as per the need.
3. Embolization : Used to block or reduce the blood flow to tumor by injecting substance in to particular artery of liver in patients
   • Where the tumors that cannot be operated
   • Tumor larger than 5 cm across

Methods used are Trans-arterial embolization (TAE), Trans arterial chemoembolization (TACE), Drug-eluting bead chemo embolization (DEB-TACE) and  Radioembolization (RE)

1.  Radiation
2. Chemotherapy / Targeted drug therapy
3. Immunotherapy

https://www.cancer.org

https://www.cancer.net

GALLBLADDER CANCER

The gallbladder is a small, pear – shaped hollow organ of 7 to 10cm long and 3 cm broad at its widest part and 30 to 50ml capacity. It sits just beneath the Right lobe of liver behind right lower ribs. Gall bladder is a reservoir of bile before it is released into duodenum.

Gallbladder uncommon and when discovered at its earliest stages the chance for a cure is very good. But most gallbladder cancers are discovered at a late stage, because it often causes no specific signs or symptoms. Also, the relatively hidden nature of the gallbladder makes it easier for gallbladder cancer to grow without being detected. When the prognosis is often very poor.

Risk factor :

• Being Female
• Increases as the age
• Obesity
• Person with history of gallstone, polyps, inflammation and infection
• Genetic predisposition
• Heavy metals
• Oral contraceptive
• Extensive calcium encrustation of Gall bladder

Signs and symptoms may include :

• Abdominal pain, particularly in the upper right portion of the abdomen
• Abdominal bloating
• Losing weight without trying
• Yellowing of the skin and whites of the eyes (Jaundice)
• Lump in abdomen
• Fever

Diagnosing

• Physical examination, Liver function test, Blood chemistry (Ca 19-9), CT or USG or MRI, ERCP, Laparoscopy and biospy

Statistics :

• If the cancer is diagnosed and treated before it has spread outside the gallbladder, the 5-year survival rate is 65%.
• If the cancer has spread to surrounding tissues or organs and / or the regional lymph nodes, the 5-year survival rate is 28%.
• If the cancer has spread to a distant part of the body, the 5-year survival rate is 2%.

Treatment depending on stage : Surgery, Radiation Therapy, Chemotherapy, Targeted Therapy Drugs, Immunotherapy and Palliative are chosen

Our approach :

• Prevention :
  • Lifestyle modification
  • Treating gall bladder diseases at their initial stage so that they wont turn to cancer i.e., 95% of GBC are with gallstone are probable cause
• Treatment :
  • 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 tridosha predominately Pitta dosha resides in liver and that is the one which regulates transformation hence therapies focused on Pitta and enhancing liver functions.
  • Treatments are also aimed to support or manage adverse reaction other therapies like chemo / radiaton etc

LIPOSARCOMA

A rare type of soft tissue called sarcoma, malignant tumor of fatty tissue (fat cells) which can grow anywhere in the body. Common places are abdomen, thigh and behind knee.  They are also called lipomatous tumors which often appears like lipomas. It is more in men than in women and makes 18% of the soft tissue sarcomas. Soft tissue sarcomas account for less than 1 percent of all cancers globally.

Symptoms:

• Often no symptoms
• Visible lump under skin which is not painful at beginning
• A new lump anywhere in body grows persistently
• Painful swelling or numbness in the area around the lump
• Pain in abdomen or cramping
• Weakness in of the affected limp

Risk:

• Genetic
• Expose to radiation, chemicals (Vinyl chloride – a toxic chemical used in making plastic)
• Damaged lymph system
• Age group 50-65 years

Diagnosis:

• Biopsy
• Radiological investigations

Types:

• Well- differentiated: The most commonly diagnosed liposarcoma, with cells that grow slowly and closely resemble with typical fat cells. No incidences of metastasize is seen.
• Dedifferentiated: Usually begins with slow growing cancer cells in the abdomen, but can occur in the extremities or chest area.
• Myxoid: Often develops in arms and legs. Has tendency to spread to unusual locations like skin, muscle or bones.
• Round cell: Often develops in the thigh and can involve changes in the chromosomes in cells
• Pleomprphic: Rarest type and most likely to re-occur even after treatment

5-year relative survival rates:

• Well differentiated liposarcoma has 100% survival rate
• Myxoid type – 88%
• Round cell and dedifferentiated type – 50%

Treatment:

• Surgery
• Radiation
• Chemotherapy

Ayurveda treatment concept:

• Surgery is advised wherever required.
• 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 Panchakarma, Vamana and Virechana are induced periodically to regulate Kapha and Pitta dosha respectively
• As liposarcoma is dominated in connective tissue, fat and muscle main focus will be to Kapha dosha regulation

References

https://my.clevelandclinic.org

https://www.mayoclinic.org

https://www.hopkinsmedicine.org

https://en.wikipedia.org

https://www.emedicinehealth.com

• https://www.cancer.net

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.

Anxiety

Anxiety is a feel of worry or apprehensiveness about certain situation or the outcome of the situation. Everyone feels anxious at some point of their life. The feeling of anxiety can be high during stressful moments like exams, starting a new job, making life- changing decision, or loss of a loved one. Anxiety is mostly triggered by external situations and a person’s reaction to the situation. It is normal for everyone to feel anxious. But, for some people, anxiety is constant, which keeps them from enjoying their daily life and even having a normal relationship with people around.

Did you know that there is an anxiety treatment in Ayurveda? But, before we go there, let’s see the cause and symptoms of anxiety.

Common anxiety signs and symptoms include:

• Feeling nervous, restless, or tense
• Having a sense of impending danger, panic or doom
• Having an increased heart rate
• Breathing rapidly (hyperventilation)
• Sweating trembling
• Feeling weak or tired
• Trouble concentrating or thinking about anything other than the present worry
• Having trouble sleeping
• Experiencing gastrointestinal (GI) problems
• Having difficulty controlling the worry
• Having the urge to avoid things that trigger anxiety

Common anxiety disorders

• Separation anxiety disorder
• Social anxiety disorder
• Selective phobias
• Panic disorder
• Agoraphobia
• Anxiety induced by medication
• Obsessive compulsive disorder
• Hoarding disorder
• Post-traumatic stress disorder
• Acute stress disorder

Ayurveda perspective

From Ayurveda’s perspective, anxiety is a dosha imbalance where excess vata has accumulated in the nervous system.

Vata is the mobile element in Ayurveda. It has the same qualities of the Fall season; dry, light, rough, mobile.

Anxiety is an expression of excess vata in Mano vaha srota, the channel of mind.

To put it plainly, it means you have a windy mind.

When it comes to bringing back to balance a dosha that is in excess, we follow the Ayurvedic principle of “like increases like, and the opposite balances.”

Anxiety treatment in Ayurveda first involves identifying the type of anxiety disorder and its cause.anxiety treatment in Ayurveda, no matter what type it is, involves ensuring the patient gets better sleep, strict diet and proper regimen. These basic practices go a long way in reducing panic attack.

Herbs such as ashwagandha, brahmi, mandukaparni, yastimadhu, jatamamsi, amla, vacha etc have been found effective in reducing the symptoms of anxiety and relaxing the body and mind.

Autism

Autism spectrum is a developmental disorder caused due to differences in the brain, which can be caused due to genetic conditions. It affects how a person perceives and socializes with others and causes problems in social interaction and communication. This starts manifesting in childhood that causes problems to work, school and home.

Symptoms of Autism spectrum

• The person is unable to communicate
• Delayed speech
• Loses previous ability to say words
• Speaks in abnormal tone
• Unable to express emotions
• Can’t start a conversation
• Self-harming activities
• Sensitive to light and touch
• Fixates on an object etc.

Understanding Autism with Ayurveda

According to Ayurveda, autism spectrum disorder is a behavioral abnormality that is manifested due to defects in neuropsychological platform and derangement of metabolism and digestive system. ‘Unmada’ is the term that can be related to autism in Ayurveda. The impairments in this condition include – Manasa, Buddhi, Samjna janana, Bhakthi, Sheela, Chesta and achara. It can be summarized as, a person’s jnanotpathy (the acquisition of knowledge that happens only when Manas is in sync with Atma, Indriya and Indriyartha) is disturbed.

Thus, in order to treat autism spectrum in Ayurveda, it is important to note a persons’ physical, mental and emotional state. This is done by various therapies like Daiva Vyapasraya, Yukti Vyapasraya and Satvajaya Vyapasraya. It is also accompanied by panchakarma procedures that help in cleaning toxins from the channels and restoring the connection between body, mind and soul. This line of treatment helps in reversal from symptoms of autism and encourages a person’s social behaviour.

Types :

• Austic disorder: This is referred to as “classic” autism. When most people suffer major language deficits, social and communication difficulties, as well as odd habits and interests. Many people who have autism also have intellectual disabilities.
• Asperger syndrome: Austic symptoms are frequently milder in those with Asperger syndrome. They may exhibit social difficulties as well as unique actions and interests. They do not, however, often have linguistic or intellectual disabilities.
• Pervasive development disorder: This is sometimes known as PDD-NOS or “atypical autism”. Atypical autism refers to those who satisfy some but not all of the criteria for autistic disorder or Asperger syndrome. These folks often have fewer and milder syndrome than people who have autism. The symptoms may just create social and communication difficulties.

Ayurveda Perspective of Autism

The beauty of Ayurveda lies in its strong view of Jivita (life) as sustaining combination of sareera (physical body), satva (mind) and atma(spirit).

Ayurveda has viewed ASD as a behavioral abnormality with its roots embedded in the defective neuropsychological platform and derangement in digestive and metabolic system.

Autism, typical or atypical and other disorders with autistic features fall under the category of Unmada, in which one or more of the mental faculties go wrong. The very definition of unmada incorporates various forms of inappropriate actions exhibited by the individual as a result of distortion of normal mind, intellect, conscious knowledge, memory, desire, manner and behaviour.

In the definition of unmada, we find some of the impaired faculties which are seen in Autism spectrum Disorders. These includes impairment of

• Manas – mind – total or partial loss of sensory perception
• Buddhi – intellect – partially affected – could be abnormal as seen in savant abilities.
• Samjna Jnana – conscious presence – seen as being lost in their own world, barring one or more sensory stimuli
• Bhakti – desire – innate willing to communicate with others
• Seela – manners – inappropriate emotional outbursts and adhering to specific rigid routines
• Cheshta – activities – motor stereotypes which are inappropriate and compulsive
• Achara – learnt skills – impaired socialization skills, inability to follow commands, losing of good habits etc.

The acquisition of knowledge (jnotpathy), one among the important functions of Manas is distributed in Unmada. Jnanotpathy happens only when Manas is in tune with Atma (soul), Indriya (sense organ), Indriyartha (objects).

The concept of genetic defects (Beeja dusthti), antenatal psychological stress, non-congenial dietetics (Virudha ahara) disturbing the metabolism (gut brain axis), defective parental psychological back ground (parental genetic makeup) and faulty child rearing system (refrigerated parentage, neglected childhood, monitor addiction) have the key role in the etiopathology of Unmada and ASD.

Ayurveda believes that in addition to the food and activities of the pregnant mother, her mental status plays an important role for the development of health and disease – both physical and mental in the child.

Ayurveda Management of Autism

There are three classical therapeutic streams advocated by Ayurveda which used in the management of Autism Spectrum Disorders (Unmada). They are

• Daiva Vyapasraya (Confidence building treatment) – rites and rituals to ward off the unseen evil forces (environmental agents including microorganisms) and in turn protecting the body and mind.
• Yukthi Vyapasraya (Rational Medical Management) – rational prescription of drugs, therapies, food and activities to keep the equilibrium of the body intact.
• Satvavajaya (Mind or self-control techniques) – cognitive, behavioural and spiritual knowledge and training methods to develop and maintain the mental faculties.

The rational Ayurveda treatment is carried out in four parts. Thay are

• Dosha pacifying therapy (Samsamana)
• Bio-cleansing therapy (Samshodhana or Panchakarma)
• Avoidance of causative factors (Nidana Parivarjana)
• Favourable diet and regimens (Pathya Aharavihara)

Obsessive Compulsive Disorder

OCD is a mental health condition where an individual has obsessive musings and compulsive conduct. OCD is a strain disorder portrayed by absurd musings and expects that lead you to do dreary behaviours. With obsessive – compulsive disorder, you may understand that your obsessions are not reasonable and you may try to ignore them or stop them. But that only increases your distress and anxiety. Ultimately, you feel driven to perform compulsive acts in an effort to ease your stressful feelings. Obsessive- compulsive disorder is described as an anxiety that you feel you have to do. OCD can be unpleasant and frightening. OCD is an anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviours you feel compelled to perform.

Causes of OCD

OCD is caused by a combination of organic, hereditary and ecological factors. Changes in the level and equalize of chemicals in the cerebrum are connected with restlessness and identified disorders. OCD runs in families (i.e., it has a hereditary segment) and once in a while, OCD can improve after certain youth bacterial contaminations (streptococcal) or after mind or head damages or traumas. Individuals with OCD have abnormalities, as expanded blood flow and action, in a few parts of the brain. The areas of the cerebrum influenced manage solid feelings and the reaction to them.

Symptoms of OCD

Obsessive compulsive disorder (OCD) influences individuals distinctively, however ordinarily cause a specific example of thought and conduct. This pattern has following main steps:

• Obsession: where your mind is moved by a consistent obsessive trepidation or concern, for example the dread your house will be burgled.
• Anxiety: the obsession incites a feeling of compelling strain and trouble.
• Impulse: You then receive an example of compulsive conduct to decrease your strain and misery, for example checking all the windows and entryways are bolted no less than three times before you go out.
• Temporary relief: The compulsive conduct carries interim alleviation from uneasiness, however the fixation and strain soon return, causing the pattern or cycle to begin again.
• Fear being contaminated by germs or dirt or contaminating others.
• Doubts that you’ve locked the door or turned off the stove.
• Intense stress when objects aren’t orderly or facing the right way

Ayurvedic treatment for Obsessive Compulsive Disorder

Ayurvedic medication may be given as extra treatment keeping in mind the end goal to enhance or expedite a quicker remedial reaction. Home grown solutions which might be utilized for this intension are Bramhi, Mandukparni, Shankapushpi. As per Ayurvedic patho-physiology, obsessions are redundant, compulsive acts are accepted to be because of an aggravated or expanded “Vata” dosha. Restorative measures to treat “Vata” have advantageous impacts in treating OCD. These measures incorporate a massage of the whole body utilizing cured herbal oils. Special Panchakarma techniques like ‘Shiro-Basti’ and ‘Virechan-Nasya’.

Ayurveda Oleated sudation Therapies – This is again divided into following therapies

• Swedana – Hot steam help with Nirgundi and Tulsi takes off.
• Naysa – Vacha with Ashwagandha oil.
• Shirodhara – Warm oil help to the third eye, carefully ixed Sesame oil.
• Ashwagandha oil – Ashwagandha Tulsi and some essential oils.
• Snehana – Body massage with warm sesame oil mixed with herbs.
• Basti – Enemas utilizing Dashamula tea combined with oil.
• Meditation – Yoga, Pranayam, Breathing techniques are very beneficial.