Ayurveda as Cancer Treatment DR.GAURANG JOSHI DR.BHAVNA JOSHI Medical Directors, Atharva Multispeciality Ayurveda Hospital, Rajkot,Gujarat, India. Cell No.+919825163953

2. Cancer Research Center

3. Panchakarma & Skin Care HospitalDR.GAURANG JOSHI DR.BHAVNA JOSHI Medical Directors, Atharva Multispeciality Ayurveda Hospital, Rajkot,Gujarat, India. Cell No.+919825163953 http://www.ayurvedindia.in http://www.atharvaayurveda.com http://www.ayurvedacancercare.com

4. असतो मा सद्गमय तमसो मा ज्योतिर्गमय मृत्योर् मा अमृतं गमय ॐ शांति: शांति: शांति: Asato maa sadgamaya Tamaso maa jyotirgamaya Mṛityor maa amṛitam gamaya Om shaantiḥ shaantiḥ shaantiḥ “From the unreal, lead us to the Real; from darkness, lead us unto Light; from death, lead us to Immortality. Om peace, peace, peace.”

5. Ayurveda Ayurveda Cancer In general and According To Ayurveda(Introduction) Cancer Incidence Causative Factors Sign and Symptoms Cancer Treatment Research

6. Ayurveda as a Cancer treatment Ayurveda Cancer In general and According To Ayurveda(Introduction) Cancer Incidence Causative Factors of cancer Sign and Symptoms Cancer Treatment Research

8. Diet,

9. Exercise,

10. Yoga,

11. Aromas,

12. Tantras,

13. Mantras,

14. Meditation

15. Consideration,

16. Longevity,

17. Rejuvenation

19. FIGHT CANCER REGARDLESS

20. Cancer 6 D’S OF CANCER: Dependency on family, spouse and physician Disfigurement and change in body appearance Disability Disruption of inter personal relationship Discomfort or pain in later stage of illness Death

21. INCIDENCE OF CANCER 3 out of 10 may get cancer in 21st cen. WHO

22. Cancer Incidence The use of alternative medical systems as an addition to conventional therapies is quite common throughout the world. The proportion of patients using alternative medicine is as follows: Germany (65%), Australia (59%), Switzerland (52%), France (52%), Mexico (50%) and USA (51%), All these figures show that the currently available modern methods are not the complete answer to CANCER.

24. Cancer Incidence

26. Destroy other tissues

27. Cells spread all over the body through the blood and lymph,

29. carcinoma,

30. lymphoma and myeloma,

31. leukemia, and

33. Type of Cancer in Ayurveda ADHYARBUDA : REGIONAL METASTASIS This is a condition when a cancer can be formed over the pre-existing one, and it is an incurable. DWI ARBUDA: DISTANT METASTASIS When two cancer are formed instantaneously or in sequence is known as Dwi-arbuda and is incurable.

34. Type of Cancer in Ayurveda SONITARBUDA: cancer of penis The pidikas, which are associated with black and red blisters and in which there is severe pain in the penis, is known as Sonitarbuda and is incurable. MAMSARBUDA: It is due to vitiation of Mamsa and occur in the penis and is incurable.

35. Type of Cancer in Ayurveda KARNARBUDA: ear cancer Susruta has mentioned seven types of ear cancer, but has not given detailed explanation. It is curable one. ASTHIARBUDA: bone cancer Bhavprakash is the first Aacharya who clearly mentioned it. cancer, which occur in bones, is curable and no details are described.

36. Type of Cancer in Ayurveda NAVARBUDA & JIRNARBUDA: ACUTE AND CHRONIC CANCER Vagbhatt is the only person who mentioned and classified the disease cancer as per the chronicity and he describes two different local applications according to the chronicity of occurence.

37. Type of Cancer in Ayurveda NASARBUDA: NASAL CAVITY & PARA NASAL SINUSES: (Head and Neck cancer) Susruta has mentined that there are seven varieties of Nasal cavity cancer but no details are available of the individual variety; clarifies that the disease occurs as an encapsulate and huge lesion in nasal cavity.

39. Mamsarbuda: Due to the vitiation Mamsa and shape of ostha becomes just like of Mamspinda and maggots are seen at the site and the Asadhya.

41. Type of Cancer in Ayurveda TALVARBUDA: HARD PALATE A swelling which occurs in the middle of the palate possesses the shape of the lotus bud, alongwith is known as Hard Palate and is incurable. GALARBUDA: BASE OF TONGUE,NASO PHARYNX, ORO PHARYNX, HYPO PHARYNX and LARYNX: Vitiated free radicals produce a swelling in the region between posterior part of tongue and in the beginning of larynx, which is non-suppressive, immobile, reddish in color, and painless and incurable.

42. Causative Factors Modern Science Factors Ayurvedic Factors

44. IONISING RADIATION

46. ALCOHOL - LIVER , H& N

47. SMOKING – LUNG, H&N

48. INCREASED INTAKE OF SALT-CURED FISH AND MEAT - STOMACH

49. MAL NUTRITION - ALL CANCER

50. SACRIN - BLADDER

52. TEXTILE INDUSTRY - SKIN, LUNG

53. SHOE PRODUCTION - NASAL CA.

54. ARSENIC / ASBESTOS - LUNG

56. ASBESTOS / ARSENIC - SKIN, LIVER

57. VINYLE CHLORIDE - LIVER

58. MUSTURD GAS - LUNG

60. DIETHYLSTILBESTEROL - VAGINA

61. ESTROGEN - ENDO METRIUM , LIVER

63. HERPES VIRUS

64. H. BACTOR VIRUS

65. PAPILLOMA VIRUS

68. PITA : Intake of hot, Pungent, Bitter, Alkaline Salty, Source-food.

69. KAPHA: Excessive intake of heavy, sweet, cold, unctuous & non-veg. diet.

71. Bristles of poisonous insects.

72. Touching poisionous animal.

74. Causative Factors -Ayurveda Ayurveda : External irritant: Improper excision, incision, fracture, excessive pressure, grinding, assault, Gravios hurt by rope etc. on vital parts, heavy & continuous injuries, peircing compression. excessive burn. Trauma & injury by fangs, teeth, horns, nails etc.

76. V-kit

77. V-yes

80. CIRCULAR, FIXED, SLIGHTLY PAINFUL

81. BROAD BASED

82. SLOWLY GROWING & NON-SUPPORTIVE

84. Cancer Treatment Modern Science MODERN TREATMENT SURGERY RADIOTHERAPY CHEMOTHERAPY BIOLOGY TREATMENT

85. Cancer Treatment in Ayurveda Curative: In this part known as well as tried medicines which have shown encouraging results for cancer is concerned. Supportive: One can include the Ayurvedic Treatment which can be used along with the modern treatment to combat their side effects and improve the quality of life.

86. Cancer Treatment in Ayurveda Prophylactic: In this one can include the rules of swasthvritta(Hygiene), Ahara(Diet), Vihara(Life Styles) in Different Ayurvedic Text, which are specially required to prevent Cancer. Palliative: Various groups of Drugs mentioned for increasing immunity oja etc. Use of various drugs which known as anti- inflammatory properties can also recommended.

87. When diet is wrong medicine is of no use.When diet is correct medicine is of no need.

89. August 24, 2003: Adopted Ayurveda diet therapy.

90. September 24, 2004: Bone scan reveals virtually complete resolution of metastatic disease sites

92. AthrvaAyurveda, an influential leader as a Ayurveda Oncologist-India, has communicated closely with many national and international cancer institutes and endorsed importance of research.Case study at AtharvaAyurveda

94. Twelve biopsy-confirmed patients with rising PSA levels after surgery or radiation were recruited by urologists at the local cancer Centers.

95. Patients and spouses were enrolled in intensive 6-month intervention; taught and encouraged to: (1) increase intake of whole grains, vegetables, legumes, and fruit, (2) decrease meat, dairy, and refined carbs, and fermented food.(3) engage in daily practice of meditation, yogaCase study at AtharvaAyurveda

96. Treatment –Ayurveda Surgery complete resection with root and reconstruction with plastic surgery. Local applications. Hyperthermia Internal medications: Metals, Tablets, Powders etc.

97. Cancer Treatment Ayurveda Supportive treatment for rehabilitation like Yoga , Exercise, Micro biotic diet etc.

98. AyurvedaPanchakarma Treatment for Cancer(Detoxification Treatment)

99. AyurvedaPanchakarma Treatment For Cancer(Detoxification Treatment) Panchakarma means five types of therapeutic measures. These are undertaken for the purification of the body and Ayurveda considers it necessary before the start of any other therapy. The logic being that as a cloth needs to be purified or cleaned of impurities and dust before it can be permeated with a new color, similarly the body needs to be purified before it can be permeated with new colors of youthfulness, health and vigor etc. In fact, most of the time,

100. Virechana: Purgation TherapyWhen excess bile, Pitta, is secreted and accumulated in the gall bladder, liver and small intestine, it tends to result in rashes, skin inflammation, acne, chronic attacks of fever, vomiting, nausea and jaundice. Ayurvedic literature suggests in these conditions the administration of therapeutic purgation or a therapeutic laxative. Nasya: Nasal AdministrationThe nose is the doorway to the brain and it is also the doorway to consciousness. The nasal administration of medication is called Nasya. An excess of bodily humors accumulated in the sinus, throat, nose or head areas is eliminated by means of the nearest possible opening, the nose.

101. The Panchakarma therapy of Ayurveda is comprised of five basic types of advanced treatment for the evacuation of vitiated Dosha (toxic materials) from the body. One can consider this as a body de-tox program. Vamana: Emesis TherapyWhen there is congestion in the lungs causing repeated attacks of bronchitis, colds, cough or asthma, the Ayurvedic treatment is therapeutic vomiting - Vamana, to eliminate the Kaphawhic is causing the excess mucus.

102. Basti: Enema TherapyVata's predominant site is the colon. AyurvedicBasti involves the introduction into the rectum of herbal concoctions of sesame oil, and certain herbal preparations in a liquid medium. Basti, is the most effective treatment of Vata disorders, although many enemas over a prescribed period of time are usually required. It relieves constipation, distention, chronic fever, cold, sexual disorders, kidney stones, heart pain, backache, sciatica and other pains in the joints. Many other Vata disorders such as arthritis, rheumatism, gout, muscle spasms and headaches may also be treated with Basti. Basti therapy is divided in two main types - AnuvasanaBasti - medicated oil enemas and NiruhaBasti - medicated enema of decoctions and medicated oils.

103. Cancer Treatment –some plants Several new plant derived natural products have proved to be of extreme interest in the treatment of cancer. Taxol, which was isolated from the bark of the pacific yew, tree in 1971, which shows anti tumor activity against a number of cancers. The process of anti cancer agents involves substantial time, effort & resources. For such achievement no magic can help but it is possible to do so by research work which requires keen observation, justified logic & deduction, great efforts & plenty of patience.

104. Cancer Treatment Herbs Ashwagandha : Bottom Line: While ashwagandha has shown an ability to hinder the growth of cancer cells in laboratory tests and enhance radiation therapy in animals, it is unknown if these effects can be replicated in humans. A popular Ayurvedic medicinal substance derived from the root and berry of the plant. Ashwagandha contains numerous biologically active components. It is thought that some of these components can influence potent hormone-like substances that cause arthritis inflammation. Extracts of the root also increase the number of red and white blood cells and platelets in the blood. Ashwagandha has been shown to relax the central nervous system in animals. Studies in laboratories have shown that extracts of ashwagandha kill some cancer cells and enhance some immune cells. It is thought that the structure of ashwagandha extracts may damage the cancer cells ability to generate the energy it needs to reproduce. Ashwagandha also reduces the level of glutathione, an antioxidant, in tumor cells which may enhance the effects of radiation therapy against those cells. Studies in animals have demonstrated possible toxicity, however comparable effects have not been observed in humans.

105. Cancer Treatment Herbs Scientific Name : Withaniasomnifera. Family: Solanaceae Ashwagandha Enhancing Cellular Immnune Response: Atharva Ayurveda Hospital & Cancer Research Centre,Rajkot, India reported another study on the effect of Withaniasomnifera on cellular immune response (CMI) in normal as well as concomitant therapy with radiation.

106. Cancer Treatment Herbs Ginger: Scientists at the University of Michigan Comprehensive Cancer Center have extensively studied the properties of ginger. Ginger is one of the most potent anti cancer herbs. It has an effect on a variety of cancers. Ginger gets its distinct flavor from a compound known as gingerol. This compound has been known to effectively combat breast, ovarian, prostate, and colorectal cancer. Ginger should be added to soups and dishes that are stir fry.

107. Cancer Treatment Herbs Garlic: Garlic has a flavor component that can effectively battle precancerous cells. The use of garlic can prevent formation of compounds that cause cancer. Care should be taken with preparations that utilize garlic. Cooking this anti cancer herb can decrease its anti-cancer properties.

108. Cancer Treatment Herbs Turmeric: Turmeric contains a compound known as curcumin. This compound has preventive effects on lung, skin, colon, stomach, prostrate, and breast cancer. One teaspoon of turmeric everyday is sufficient for the prevention of certain types of cancer development. Most Indian curries contain turmeric.

109. Cancer Treatment Herbs Giloy (Tinospora Cordifolia): The active principles from T. cordifolia enhance host immune system by increasing immunoglobulin and blood leukocyte levels and by the stimulation of stem cell proliferation. It has the ability to reduce solid tumour volume by 58.8%, which is comparable to cyclophosphamide, a known chemotherapeutic agent [40–42]. These immuno stimulating properties can be used in the prevention of tumour mediated immuno suppression and hence could be a drug choice for various Cancers.

110. Cancer Treatment Herbs Bhallataka (Semecarpus Anacardium): Anti-Cancer Activity: In traditional medicine, the nut is highly valued for the treatment of tumours and malignant growth. Studies have been also done in proving the anticancer and hepatoprotective activity of Semecarpus anacardiumnut milkextract against aflatoxin B1 (AFB1)- induced hepatocarcinoma in rats and establishing its protective role on deranged cell membrane in AFB1 induced hepatocarcinoma. The biochemical basis of anticarcinogenic potency of Semecarpus anacardiumnut was studied using hepatocellular carcinoma as cancer model in rats

111. Reference References: 1) Premalatha B., “Semecarpus anacardium Linn. Nuts--a boon in alternative medicine” Indian J Exp Biol.,38(12):1177-82(Dec2000). 2) B. Premalatha, P. Sachdanandam, “Effect of Semecarpus anacardium nut extract against aflatoxin B1-induced hepatocellular carcinoma”, Fitoterapia, Vol 70, Issue 5, 1, 484-492(Oct 1999). 3) B. Premalatha, P. Sachdanandam, “Semecarpus anacardium L. nut extract administration induces the in vivo antioxidant defense system in aflatoxin B1 mediated hepatocellular carcinoma ”, Journal of Ethno pharmacology, Vol 66, Issue 2, 131-139(Aug 1999). 4) P. Mathivadhani, P. Shanthi, P. Sachdanandam “Effect of Semecarpus anacardiumnut extract on ECM & protease in mammary carcinoma rats”., Vascular Pharmacology, (2007). 5) B. Premalatha, P. Sachdanandam, “Stabilization of lysosomal membrane and cell membrane glycoprotein profile by Semecarpus anacardiumlinn. nut milk extract in experimental hepatocellular carcinoma”, Phototherapy Research.;14(5):352-5(Aug 2000). 6) B. Premalatha, P. Sachdanandam ,“Modulating effect of Semecarpus anacardiumlinn. nut extract on Glucose Metabolizing Enzymes in Aflatoxin B1-induced experimental Hepatocellular Carcinoma”, Pharmacological Research, Vol 36, Issue 3, 187-192 (Sep 1997). 7) K. Veena, P. Shanthi, P. Sachdanandam “The biochemical alterations following administration of Kalpaamruthaa and Semecarpus anacardium in mammary carcinoma”, Chemico-Biological Interactions, Vol161, Issue 1, 15, 69-78(May 2006) 8) B. Premalatha, P. Sachdanandam “Semecarpus anacardium L. nut extract administration induces the in vivo antioxidant defense system in aflatoxin B1 mediated hepatocellular carcinoma”, J Ethnopharmacol.;66(2):131-9(Aug 1999). 9) B. Premalatha, P. Sachdanandam “Effect of Semecarpus anacardium nut milk extract on rat serum alpha-fetoprotein level in aflatoxin B1-mediated hepatocellular carcinoma ”, Fitoterapia, Volume 70, Issue 3, 1, 279-283 (June 1999). 10) H.F. Smith *a, H.J. Woerdenbag a, R.H. Singh b, G.J. Meulenbeld c, R.P. Labadie d, J.H. Zwaving, “Ayurvedic herbal drugs with possible cytostatic activity”, J Ethno Pharmacology. 47, 75-84(1995)

112. Cancer Treatment Herbs AyurvedaImmuno-modulators: Aswagandha(witheniaSomnifera) Satavari(AsparagousRacemosus) Guduchi(Tinosporacordifolia)

113. Some Anticancer Herbs. Sadabahar-: Soya Beans(Glycine Max) Tulsi: Occimum sanctum Punarnava(Boerhaviadiffussa) Gomutra: cow’s urine Aloe vera: Vasha: Adhatodavasika Raudra rasa, Guggula, NityanandaRas etc….

114. Role of Diet to Prevent Cancer Among the Many Anticancer Compound present in fruits and vegetables ,Phytochemicals are the most importantas it block carcinogen action ,block the promotion and progression of cancer cells. One can protect them selves by increase intake of fruits and veg . Anticancer Molecules present in food keep them from progressing to an advanced stage of lithality

115. Cancer Treatment Herbs Azadirachtaindica(Neem) has been used in buccal carcinogenesis, skin carcinogenesis, prostate cancer, mammary carcinogenesis, gastric carcinogenesis, Ehrlich carcinoma and B16 melanoma. Dietary neem flowers caused a marked increase in glutathione S-transferase (GST) activity in the liver, while resulting in a significant reduction in the activities of some hepatic P450-dependent monooxygenases. These results strongly indicate that neem flowers may have chemopreventive potential.

116. Cancer Treatment Herbs Cancer prevention (gastrointestinal and breast cancers) with green tea Green tea is made from the dried leaves of Camellia sinensis, a perennial evergreen shrub. Green tea has a long history of use, dating back to China approximately 5000 years ago. Green tea, black tea, and oolong tea are all derived from the same plant. Laboratory and animal studies report that components of tea, such as polyphenols, have antioxidant/free radical scavenging properties and may possess various effects against tumor cells (such as angiogenesis inhibition or induction of apoptosis). Limited human study reports lower estrogen levels in women drinking green tea, proposed as possibly beneficial in estrogen-receptor positive breast cancers. However, other animal and laboratory research suggests that components of green tea may actually be carcinogenic, although effects in humans are not clear. Green tea also protect from prostate cancer.

117. Cancer Treatment Short” History of Botanical Therapeutics 1971 NIH/NCI discovers paclitaxel (Taxol®) from Taxusbrevifolia 1972 Chinese scientists discover artemisinin from Artemisia annua 1994 Dietary Supplement Health and Education Act (DSHEA) 2000 US FDA publishes Botanical Drug Guidance (draft) 2002 Pharmaceutical companies dramatically downsize their phytochemical-based drug discovery 2004 US FDA finalizes the Botanical Drug Guidance 2006 US FDA approves the first botanical NDA

118. Cancer Treatment Why Botanical Mixtures Are Viable Candidates of New Drugs? Tens of thousands of botanicals used as “herbal medicines” Anecdotal claims are legitimate subjects of investigations Non-controlled human experience needs to be verified About 25% of prescription drugs derived from natural products, and many from plants Almost all are highly purified to almost a single molecule Many drugs used in combinations Use botanical mixtures as a different therapeutic paradigm (in addition to the single agent-single receptor approach) The addition of active botanical mixtures increases the pool of drug candidates Search additive/synergistic effects of multiple botanicals (or multiple fractions)

119. Research Two Different Approaches of Developing Drugs from Plants One species” – “One compound” – “One drug” (i.e., highly purified) Mixtures were looked at, but eventually abandoned A purified active compound may become a drug Semi-synthetic derivatives may also become drugs “One/multiple species” – “Multiple compounds” – “One botanical drug” Example: Punarnavadikwaths(BoerhaviaDiffusa Decoction)

120. Research Assuring Therapeutic Consistency of Marketing Batches of Botanical Drugs One or more of the following approaches may be needed Adequate Chemistry Manufacturing and Control Starts from the raw materials Standardized extraction/purification processes with comprehensive product (intermediates) testing Qualitative/quantitative analysis of multiple-markers, fingerprinting, mass balance, etc. Clinically relevant Bioassay Could be very helpful to justify variations of chemical compositions Study the dose-response relationship Use therapeutic windows to evaluate the relevance/importance of chemical variations “Multiple-batch” phase 3 clinical trials

121. ART OF MEDICINE IS TO BRING COMFORTS AND IT IS AN ART OF LOVING AND KINDNESS

122. RESEARCH IN AYURVEDA ONCOLOGY Pharmacological Analysis of BHASMA- Metals i.e. Ayurvedic chemotherapy.

123. RESEARCH IN AYURVEDA ONCOLOGY Role of Glutathione to Manage the side effect of Radiotherapy in Head & Neck Cancer

124. RESEARCH IN AYURVEDA ONCOLOGY Pain Management in Terminal Stage of Cancer with herbs like bhallatak,ahifen,sunthietc…

125. RESEARCH IN AYURVEDA ONCOLOGY NK Cell & Macrophage activity by Immunomodulator like; withenia somnifera, asparagus racemosus, tinospora cordifolia……

126. RESEARCH IN AYURVEDA ONCOLOGY Role of Medicated Enema for preventing or Reducing the severity of CT/RT induced bleeding P/R, Piles, Skin Reactions in any Pelvic Tumor

127. WHERE THERE IS A WILL,THERE IS A WAY…

128. Research TITLE : BRING NATURE BACK IN MODERN HEALTH CARE IN CANCER. SCHOLAR : Dr. BHAVNA JOSHI M.D.- AYURVEDA IN ONCOLOGY Dr. GAURANG JOSHI

129. Research Plants are sophisticated organisms consisting of thousands of organic compounds. Several new plant derived natural products have proved to be of extreme interest in the treatment of cancer. In radiotherapy x-ray particles are aimed at the tumor to cause damage in the cells of the tumor. However, because of the location of the tumor, it is impossible to avoid some damage to the normal cells that are in the path of radiation beam. Present prospective study compared radiotherapy plus herbal therapy

130. Research AIMS AND OBJECT: In radiotherapy x-ray particles are aimed at the tumor to cause damage in the cells of the tumor. However, because of the location of the tumor, it is impossible to avoid some damage to the normal cells that are in the path of radiation beam. Thus to increase the locorigional control and disease free survival, to combact the side effect of the radiotherapy and most important aims to provide and agent to increase the radiation effect by this concomitant radio-herbal protocol.

131. Research MATERIAL AND METHOD: Aswagandha (WITHENIA SOMNIFERA) Root extract in dose of 5 GM per day with milk before external radiation dose 150-200 Gy/25-30 Fr. (5Fr. /week) in 50 patients of oral and cervical carcinoma.

132. Research Inclusion criteria: It was mainly based on the signs & symptoms of Arbuda described in Ayurvedic classics as well as in modern texts after confirming the investigation reports like biopsy, FNAC etc. Head & Neck cancer of 3rd and 4th stage and cervical cancer of III-B and above were selected. The selected patients were divided into 2 Groups: GROUP A : Radiotherapy plus placebo. GROUP B : Radiation plus Aswagandha.

133. Research Plan of study was divided in two arms: - 1. PATIENT ENROLLMENT FORM: Patient enrolment form must be completed for each eligible patient. This form must be completed before the study drug is given to the patient. This form will contain information regarding the patient’s eligibility before a patient can be randomized

134. Research 2. Investigation: - [a] Routine investigation : For the purpose of assessing the overall condition of the patient, routine investigation of blood, urine, stool & biochemical investigation whenever necessary. [b] Special investigation : All the patients included in present study will biopsy proved. Relevant radiological and clinical examinations will carried out for any other kind of pathology.

135. Research DRUG SCHEDULE: DRUG NAME : Aswagandha root FORM : Powder. DOSE : 5 Gm. With milk / 30 minuets before external radiation.

136. Research PHARMECOKINETICS: The main property of Aswagandha is a natural Anti-oxidant, which helps to increase the molecular effect of radiation. Thus this drug acted both directly on cancer cells and by making them more sensitive to Radiotherapy. Aswagandha helps to decrease the amount of Glutathione in tumor cells after which radiation therapy become more effective.

137. Research DIETARY SCHEDULE: On the basis of an exploratory study a detailed case control investigated was initiated at the TMH-Tata Memorial Hospital to explore the role of diet in Head & Neck cancer.

138. Research DIETARY SCHEDULE: Among the several food items considered, some showed protective effect, One was with respect to vegetable consumption. It was observed that those who did not eat vegetables daily were at a significantly higher risk. So, every patient will advised to take vegetables & fruits. Intake of buttermilk & milk also showed protective effect with a 3-fold risk in those who did not intake it daily versus those who did. So, patients will advise to take it daily. Laboratory observations suggest that vitamin-A; Beta-carotene, Vitamin-C & fiber have protective effect in Head & Neck cancer. So, carrots & other vegetable where vitamin-A and increase fiber are present are advised specially to the patients. Every kind of addiction were restricted & specially advised for maintain good oral hygiene.

139. Research PROGRESS: - Once the treatment was start, the patients were weekly examined for vital sign, symptoms and for overall condition. Weekly progress was recorded up to total radiation and final assessment for the efficacy of the drug was carried out.

140. Research DISCUSSION ON THE OVERALL EFFECT OF THE DRUG ON BOTH GROUP: GROUP A: Out of 33 patients 12 patients (36.36%) developed mild reaction, 13 patients (39.39%) developed moderate reaction. 8 patient (24.24%) developed severe reaction.

141. Research DISCUSSION ON THE OVERALL EFFECT OF THE DRUG ON BOTH GROUP: It has been observed that CR complete response in 18 patients (54.54%) PR partial response in 11 patients (33.33) Stable disease in 1 patient (3.03%) Progressive disease in 3 patient (9.09%)

142. Research DISCUSSION ON THE OVERALL EFFECT OF THE DRUG ON BOTH GROUP: GROUP B: Out of 33 patients 14 patients (42.42%) developed mild reaction, 17 patients (51.51%) developed moderate reaction. Only 2 patient (6.06%) developed severe reaction.

143. Research DISCUSSION ON THE OVERALL EFFECT OF THE DRUG ON BOTH GROUP: It has been observed that CR complete response in 21 patients (63.63%) PR partial response in 10 patients (30.30) Stable disease in 1 patient (3.03%) Progressive disease in 1 patient (3.03%)

144. Research Conclusion: It has been observed that Radiotherapy reaction appeared late during the course. There was sence of well being in patients. Grade iii and iv reactions were less. The study is encouressing since Aswagandha reduces the discomfort and pain during radiotherapy period. Patient tolerates radiotherapy in better manner. Discontinuation during Radiotherapy due to radiation reaction was less. This Ayurvedic combined modality of the treatment has improved local control in many clinical situations & its most profound impact has definitely been on improving the quality of life of cancer patients who taking radiotherapy. It is hoped that a better understanding of the clinical use of anti-oxidant drug i.e. Aswagandha will provide a sound scientific basis for the improved care of patients with cancer.

146. Devita – 4th edition.

147. Dravyagunavigyanm- priyavatsharma

148. Dravyagunavigyanm- AcharayYadavjiTrikamji.

149. Harrison LB, Zelefsky MJ, Pfister DG, et al: detailed quality of life assessment in patients treated with primary radiotherapyforsquamous cell carcinoma of head & neck. Head & neck 19:169-175,1997.

150. Koch WM, BRENNAN ja, Zahurak M, et al: p 53 mutation and locoregional treatment failure in hean & neck cancer. J Natl cancer inst 88:1580,1996.

151. Lindberg RD,Fletcher GH: The role of irradiation in the management of head & neck cancer : Analysis of results and causes of failure. Tumori 64: 313-325, 1978.

152. Periz a book of Radiation Oncology – Vol. 2000-2001 by Periz.

153. Wista journal .1999-00 et el prof. DeviPrasad KMC Manipal.

154. Research CAN WE IMPROVE THE QUALITY OF LIFE IN ADVANCED CANCER? PHARMACOLOGICAL TERATMENT OF CANCER PAIN Scholar: Dr.GAURANG J. JOSHI B.A.M.S. DR. BHAVNA G. JOSHI M. D. Guide: DR. S.P. SRIVASTAV MEDICAL DIRECTOR AND CHIEF RADIATION ONCOLOGIST, SURAT CANCER HOSPITAL. DR. KAMLESH M. KUMAWAT M.D., RADIATION ONCOLOGIST RAJKOT CANCER HOSPITAL.

155. Research INTRODUCTION Of the million people who get cancer every year in India, the vast majority is incurable at the time of diagnosis. Almost 70% of cases we see in our clinics today are in stage iii or IV of the disease. This means that palliation starts from day one. In addition social, financial, emotional and spiritual factors compound their problems. Pain from cancer is a major health care problem. 30% of patients with cancer has pain at the time of diagnosis, and majority of the patients has pain when disease is advanced. Pain relief in patients with cancer remains inadequate because it is not given priority and because there is a lack of education about the inappropriate attitudes towards the nature of pain and the appropriateness of pain control drugs. No patient with cancer needs to live or die with unrelieved pain. In the final stage of life, pain not controlled by therapies aimed at both comfort and function can be relieved by intentional therapies like Ayurveda.

157. 5 or higher on scale: substantial pain.

158. 5 to 6: moderate pain.

159. 7 to 10: severe pain.Patients receiving no analgesic therapy who have mild to moderate pain should be treated with nonopioid analgesic Ayurvedic drugs. Nonopioid analgesic drug, step 1 includes Ativish, Bhangro, Kupilu, Guggula, Dashmool, Bhallataka, SuvarnBhshma,Raudra Rasa and so many compound protocols etc.. If a patient has mild-to-moderate pain despite taking a nonopioid analgesic, the dose of the nonopioid analgesic should be maximized and a step 2 Ayurvedicopioid or Ahifen(PapaverSomniferum) Protocols should be added. Patients who had moderate-to-severe pain despite therapy with step 2 opioids require an increase in the dose of the opioid or, if that is not feasible, a change to a step 3 opioid i.e. Ahifen. This method can effectively relieve pain in 80 to 90 % of the patients.

161. Prescribe the appropriate dose of the drug.

162. Administer the drug by the appropriate route.

163. Schedule the appropriate dosing interval.

164. Prevent, anticipate, and manage the side effect of the drug.

166. Research THE APPROPRIATE ANALGESIC DOSAGE: The appropriate dose is one that relieves a patient’s pain throughout its doing interval without causing unmanageable side effects. The initial dose should be based on the patient’s level of pain and the efficacy of prior analgesic therapy. One can use opioid in Grams per day as severity of pain. Although pain can be relieved in many patients with opioid like Afiphen protocols

167. Research ROUTE OF ADMINISTRATION OF ANALGESIC DRUGS: Most patients with cancer who have chronic pain should receive oral analgesic therapy, because it is simpler, easier to use and less expensive than parental therapy. If a patient can not swallow tablets or liquids, Ahifen protocols can be administered sublingually. The usefulness of prolonged sublingual administration is limited by the low dosage of available formulations and the need to repeat the dose every four hours. The same drugs may be administered rectally.

168. Research APPROPRIATE INTERVALS OF ANALGESIC DOSING: Analgesic drugs should be scheduled at intervals that prevent the recurrence of pain and minimize the number of daily doses. The appropriate dosing interval is determined by the opioid used and its route of administration. If pain returns sooner, the dose should be increased until the pain continues to be relieved without toxicity during the four-hour dosing interval.

169. Research SIDE EFFECTS OF ANALGESIC DRUGS: Pain prevention must be accompanied by the prevention of side effects. Almost all patients receiving around the clock opioid/Ahifen therapy need regular laxative therapy. Constipation is a frequent and distressing complication in-patients with advanced cancer. Opioids-Ahifen products cause constipation by binding to specific opioid receptors in the enteric and central nervous systems. Management of opioid induced constipation by AerandbhrustaHaritaki(TermineliaChebula), Triphalakwatha(TermineliaBellirica), Echhabhedi Rasa or medicated enema as per patient requirement and severity of constipation.Opioid associated nauseais often caused by constipation but may require treatment.

170. Research NON DRUG METHODS TO RELIEVE THE PAIN: Systematic rubbing of the affected part i.e. Massage through application of heat, cold or local applications of pain relieving Pastes or Ointments. Specific rehabilitation in terms of appropriates levels of mobilization, maintenance of muscle tone and function with Yoga and Meditation to relieve the pain. To relieve pain without medicine by relaxation, imagery, distraction, skin stimulation, and hyperthermia.

171. Research NON DRUG METHODS TO RELIEVE THE PAIN: Skin stimulation is the use of pressure, friction, temperature change, or chemical substances to excite the nerve endings in the skin. Scientists believe that the same nerve pathways transmit the sensations of pain, heat, cold, and pressure to the brain. When the skin is stimulated so that pressure, warmth, or cold is felt, pain sensation is lessened or blocked. Skin stimulation also alters the flow of blood to the affected area. Sometimes skin stimulation will get rid of the pain, or the pain will be less during the stimulation and for hours after it is finished.

172. Research NON DRUG METHODS TO RELIEVE THE PAIN: For pain relief, massage is most effective when using slow, steady, circular motions. You can massage over or near the area of pain with just your bare hand or with any substance that feels good such as pain relieving ointments or oil, warm oil or any herbal analgesic oil/oint protocols.

173. Research There is a limit for cure, for that is divine and we are not Gods, but there is no limit for care and that is truly human, which we are. These paper reviews the pharmacological treatment of cancer pain in a guideline format in facilitate the acceptance of Ayurvedic formulation into clinical practice. It will also provide a model for better care of the patients who suffering from cancer.

174. Research REFERENCES: PATT RB, ed: cancer pain. Philadilphia: J.B. LIPPINCOTT, COL 1994; 21: 740-747 SCHUG SA, ZECH D, DORR U: cancer pain management according to WHO analgesic guidelines. 1990;5:27-32. LEVY MH: constipation in cancer patients. Cancer bull 1001; 43:412-22 Ch. Opiod therapy in nonmelignant pain. PORTENOEY RK: 1990;5: SUPPL: S46-S62.

176. Thank You DR.GAURANG JOSHI DR.BHAVNA JOSHI Medical Directors, Atharva Multispeciality Ayurveda Hospital, Rajkot,Gujarat, India. Cell No.+919825163953 http://www.ayurvedindia.in http://www.atharvaayurveda.com http://www.ayurvedacancercare.com