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Copyright © Sarat Addanki 2018

AYURVEDIC APPROACH TO REDUCE SIDE AFFECTS OF CONVENTIONAL CANCER THERAPIES

BY

Sarat Kumar Addanki

A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE OF AYURVEDIC HEALTH PRACTITIONER.

CALIFORNIA COLLEGE OF AYURVEDA 2018

CALIFORNIA COLLEGE OF AYURVEDA

1117A EAST MAIN STREET

GRASS VALLEY, CA

DATE OF SUBMISSION: MARCH 13, 2018


Contents Dedication ..................................................................................................................................................... 7

Acknowledgements ....................................................................................................................................... 7

Abstract ......................................................................................................................................................... 7

Western Medicine Interpretation of Cancer ................................................................................................ 8

Side effects of Chemo and Radiation Therapies ........................................................................................... 8

Acute (occurring within few weeks after therapy) ................................................................................... 8

Side effects of Chemo therapy ............................................................................................................. 8

Side effects of radiation therapy .......................................................................................................... 8

Intermediate or late (occurring months or years after the therapy)........................................................ 9

Etiology according to western medicine ....................................................................................................... 9

Nausea and vomiting ................................................................................................................................ 9

Mucositis ................................................................................................................................................ 10

Hepatotoxicity ......................................................................................................................................... 11

Summary of Chemotherapy induced Hepatotoxicity ......................................................................... 12

Treatment according to western medicine ................................................................................................ 12

Nausea and vomiting .............................................................................................................................. 12

Mucositis ................................................................................................................................................. 13

Oral Hygiene: ...................................................................................................................................... 13

Cryotherapy: ....................................................................................................................................... 13

Allopurinol: .......................................................................................................................................... 13

Propantheline: .................................................................................................................................... 13

Pilocarpine: ......................................................................................................................................... 14

Cytokines: ............................................................................................................................................ 14

Hepatotoxicity ......................................................................................................................................... 14

Ayurvedic Interpretation of Cancer ............................................................................................................ 14

HYPOTHETICAL INFERENCE AND UNDERSTANDING THE CONCEPT OF GARA VISHA vis-à-vis

CHEMOTHERAPY RELATED SIDE EFFECTS ................................................................................................... 15

Introduction ............................................................................................................................................ 15

Definition ................................................................................................................................................ 15

Prognosis ................................................................................................................................................. 16


HYPOTHETICAL INFERENCE AND UNDERSTANDING THE CONCEPT OF DUSHI VISHA vis-à-vis

CHEMOTHERAPY RELATED SIDE EFFECTS. .................................................................................................. 16

Introduction ............................................................................................................................................ 16

Definition ................................................................................................................................................ 16

Clinical features of Dushi Visha ............................................................................................................... 16

Symptoms according to site .................................................................................................................... 17

Clinical feature produced by aggravated doshas due to Dushi Visha ..................................................... 17

Complications of Dushi Visha .................................................................................................................. 17

Prognosis ................................................................................................................................................. 18

COMPARITIVE SYMPTOMATIC ANALYSIS OF SIMILARITIES BETWEEN GARA VISHA, DUSHI VISHA AND

CHEMOTHERAPY-RADIATION RELATED SIDE EFFECTS ................................................................................ 18

Ayurvedic & Herbal Chikista........................................................................................................................ 19

Asanas ..................................................................................................................................................... 19

Mudras .................................................................................................................................................... 20

Pranayama .............................................................................................................................................. 20

Meditation .............................................................................................................................................. 20

Mantra therapy ....................................................................................................................................... 20

Nausea and vomiting .................................................................................................................................. 21

Nidana (Causes) ...................................................................................................................................... 21

Samprapti (Pathology) ............................................................................................................................ 22

Chikista (Treatment) ............................................................................................................................... 22

Herbs ................................................................................................................................................... 22

Diet ...................................................................................................................................................... 22

Pranayama .......................................................................................................................................... 23

Panchakarma ...................................................................................................................................... 23

Aromatherapy ..................................................................................................................................... 23

Mucositis ..................................................................................................................................................... 24

Nidana (Causes) ...................................................................................................................................... 24


Chikista (Treatment) ............................................................................................................................... 24

Herbs ................................................................................................................................................... 24

Diet ..................................................................................................................................................... 24

Supplements ....................................................................................................................................... 25

Panchakarma ...................................................................................................................................... 25


Acupressure ........................................................................................................................................ 25

Aromatherapy ..................................................................................................................................... 25

Hepatotoxicity ............................................................................................................................................. 25

Nidana (Causes) ...................................................................................................................................... 25


Chikista (Treatment) .............................................................................................................................. 26

Herbs ................................................................................................................................................... 26

Diet ...................................................................................................................................................... 26

Panchakarma ...................................................................................................................................... 27

Aromatherapy ..................................................................................................................................... 27

Mantra therapy ................................................................................................................................... 27

Therapeutic bath ................................................................................................................................. 27

Conclusion ................................................................................................................................................... 27

Abstract of Research Papers ....................................................................................................................... 28

Potential Chemotherapy Side Effects, What Do Oncologists Tell Parents? ............................................ 28

Background ......................................................................................................................................... 28

Procedure ............................................................................................................................................ 28

Results ................................................................................................................................................. 28

Conclusions ......................................................................................................................................... 28

Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A Systematic Review

and Meta-Analysis ................................................................................................................................... 28

AIM: ..................................................................................................................................................... 28

MATERIALS AND METHODS: ............................................................................................................... 29

RESULTS: ............................................................................................................................................. 29

CONCLUSION: ...................................................................................................................................... 29

Role of Gabapentin in Managing Mucositis Pain in Patients Undergoing Radiation Therapy to the Head

and Neck ................................................................................................................................................. 29

BACKGROUND: .................................................................................................................................... 29

OBJECTIVES: ........................................................................................................................................ 29

METHODS: ........................................................................................................................................... 29

FINDINGS: ............................................................................................................................................ 29

Chemotherapy and Radiation Induced Pulmonary Dysfunction in Hodgkin Lymphoma Patients ........ 29

Abstract ............................................................................................................................................... 29

Abstract ............................................................................................................................................... 30


References .................................................................................................................................................. 31


Plants, which as receptacles of light were born three ages before the Gods, I honor your myriad colors and

your seven hundred natures.

A hundred, oh Mothers, are your natures and a thousand are your growths. May you of a hundred powers

make whole what has been hurt.

Plants, as Mothers and Goddesses, I address you. May I gain energy, light, and sustenance, your soul, you

who are a conscious being.

Where the herbs are gathered together like kings in an assembly, there the doctor is called a sage, who

destroys evil, and averts disease.

As they fell from Heaven, the plants said, "The living soul we pervade, that man will suffer no harm. The

herbs that are in the kingdom of the Moon, manifold with a hundred eyes, I take this plant as the best of

them, for the fulfillment of wishes, as peace to the heart. Plants that are queens of the Soma, spread over

all the Earth, generated by the Lord of Prayer, may your energy combine within this herb.

Rig Veda X. 97


Dedication I would like to dedicate this paper to my mother Radha Addanki, who lost her life fighting cancer. My

irreparable loss and my soul-searching lead to joining Dr program at CCA to play a role in prevention of

cancer and help cancer patients in dealing with side effects of chemotherapy and radiation.

Acknowledgements I would like to thank my guru Mrs. Jeremy Anderson in helping me to understand Ayurveda and its

application in treating and prevention of various diseases and Mrs. Vidya Venkatesh for helping me to

understand two of the critical modules in my ACS program. I would like to thank my family and friends

(Aarti, Aradhna, Lakshmi, Sreeni, Sneha, Prem, Deepa, Kritika, Venkat, Aparna, Kris, Padmaja, Jagan,

Pradnya and Pankaj) in supporting and encouraging me to learn Ayurveda. I would like to thank CEO Satya

and Sam President of Prolifics, Inc, to give me an opportunity to pursue my course at CCA while I am a

full-time employee. I would like to thank Anil Agarwal for giving my first book in Ayurveda and encouraging

me to pursue Ayurveda. I would like to thank you Dr Marc Halpern for putting together a wonderful

program supported by rich study material, administration staff (Chris, Heidi) and teaching staff. I would

like to thank you Dr. Aditi Kulkarni, in helping me in this thesis through our never-ending discussions on

cancer side effects and how Ayurveda and western herbology can help in managing them for a speedy

recovery.

Abstract When a patient is diagnosed with cancer, the journey towards wellbeing is usually an upward struggle.

The present approach for treating cancer involves either (or a combination of) surgery to remove masses

of cancer tissue and chemotherapy or radiation therapy to kill the cancer cells. While chemotherapy or

radiation deters the cancer cells, they also reduce the immunity of the patient and are accompanied by a

host of painful and lasting side effects. Ayurvedic formulations when used in parallel to chemo or

radiation, counter these side effects, strengthen immunity, and provide relief to the cancer patient. We

believe that besides being our windows to the outside world, the five senses are connected to recovery

and good health. By stimulating the sense of taste, sight, smell, hearing and touch, the deadliest of

diseases can be conquered. By creating an Ayurvedic regimen which caters to each sense so that one can

harness the power of inner healing. This thesis presents an ayurvedic and herbal approach to alleviate top

three side effects.


Western Medicine Interpretation of Cancer Cancer is caused by changes (mutations) to the DNA within cells. The DNA inside a cell is packaged into

many individual genes, each of which contains a set of instructions telling the cell what functions to

perform, as well as how to grow and divide. Errors in the instructions can cause the cell to stop its normal

function and may allow a cell to become cancerous.1

Side effects of Chemo and Radiation Therapies Cancer is a disease that has been on a rise across the world. While traditional therapies focus on a

combination of chemotherapy, radiation therapy and surgery, they also greatly diminish the body’s ability

to fight the disease because of the side effects of the treatment. Chemotherapy drugs and radiotherapy

are highly toxic and both damage adjacent healthy cells. The side effects are different for each person.

They depend on the type of cancer, location, drugs and dose and general health of the patient. These

arrays of side effects have a devastating effect on the quality of life of cancer survivors. Side effects may

be grouped into following types: 2

Acute (occurring within few weeks after therapy)

Side effects of Chemo therapy 3

• Nausea and vomiting

• Diarrhea

• Mucositis

• Low white blood cell count (this increases risk for infection)

• Alopecia

• Constipation

• Low red blood cell count

Side effects of radiation therapy

• Fatigue

• Anorexia

• Nausea

• Vomiting

• Alteration in the taste

• Sleep disturbance

• Headache

• Anemia


• Dry skin

• Constipation

Intermediate or late (occurring months or years after the therapy) • Hepatotoxicity

• Pharyngitis

• Esophagitis

• Laryngitis

• Persistent dysphagia

• Fatigue

• Infertility

• Cognitive deficits

Etiology according to western medicine

Nausea and vomiting

• Nausea and vomiting are quite common side effects of chemotherapy. The most important cause

of chemotherapy-induced nausea and vomiting is the activation of the chemoreceptor trigger

zone (CTZ) by the chemotherapy agents circulating in the blood. Vomiting is triggered from a spot

in the brain called the vomiting center. Signals from chemoreceptor trigger zone (CTZ) react to

chemicals or chemotherapy drugs in the blood and cause vomiting as side effect. Signals are

transmitted with the help of neurotransmitters that travel via blood and nerves and reach brain.

• Also, in chemotherapy, it has been noted that there are areas in the Oesophagus, Stomach, and

Intestines that are triggered due to chemo drugs leading to their irritation thereby inducing

vomiting.

• Nausea and vomiting may occur at any point during chemotherapy treatment. If it occurs in the

first 24 hours, it's considered acute, if later, it is labeled delayed.

Chemotherapy drugs that have are highly or moderately likely to cause nausea and vomiting include:4

Chemotherapy drugs Chemotherapy drugs Chemotherapy drugs

Alemtuzumab Cyclophosphamide Ifosfamide

Altretamine Cytarabine Irinotecan

Azacitidine Dacarbazine Lomustine

https://www.verywell.com/evaluate-your-vomiting-770363


Chemotherapy drugs Chemotherapy drugs Chemotherapy drugs

Bendamustine Dactinomycin Mechlorethamine

Busulfan Daunorubicin Mitotane

Carboplatin Doxorubicin Procarbazine

Carmustine Epirubicin Oxaliplatin

Cisplatin Estramustine Streptozocin

Clofarabine Etoposide Temozolomide

Crizotinib Idarubicin

Mucositis 5 • After chemo or radiation therapy cells and tissues of submucosa are damaged which leads to

demise of cells of basal epithelium

• Oral Mucositis is one of the most common adverse reactions encountered in radiation therapy for

head and neck cancers, as well as in chemotherapy, with drugs affecting DNA synthesis (S-phase-

specific agents such as fluorouracil, methotrexate, and cytarabine).

• Mucositis may limit the patient's ability to tolerate chemotherapy or radiation therapy, and

nutritional status is compromised.

• It may drastically affect cancer treatment as well as the patient's quality of life.

• The exact pathophysiology of development is not known, but it is thought to be divided into direct

and indirect mucositis.

• Direct Mucositis: The epithelial cells of the oral mucosa undergo rapid turnover, usually every 7

to 14 days, which makes these cells susceptible to the effects of cytotoxic therapy. Both

chemotherapy and radiation therapy can interfere with the maturity and cellular growth of

epithelial cells, causing changes to normal turnover and cell death.

• Indirect Mucositis: Oral mucositis can also be caused by the indirect invasion of Gram-negative

bacteria and fungal species. Patients are at increased risk for oral infections when they are

neutropenic, and this usually happens when indirect stomatotoxicity appears. The onset of

mucositis secondary to myelosuppression varies, but typically develops anywhere from 10 to 21

days after chemotherapy administration.

• Risk factors such as age, nutritional status, type of malignancy, and oral care during treatment will

play important roles in the development of mucositis.

• National Cancer Institute has devised a common toxicity criterion for grading of stomatitis. This

scale is graded from 1 to 4.

• Painless ulcers, erythema, or mild soreness is graded as 1.


• When the patient has painful erythema, edema, and ulcer but can eat, it is graded as 2.

• When there is inability to eat, it is graded as 3.

• A patient requiring parenteral or enteral support is graded as 4.

Hepatotoxicity • Most hepatotoxic drug reactions are idiosyncratic and classified mechanistically either as

immunologic (hypersensitivity) or metabolic

• These reactions typically are neither dose dependent nor predictable

• Hepatoprotective agents assume particular importance to preserve liver function

• Chemotherapeutic agents can produce liver toxicity through different pathways, resulting in

different categories of liver injuries

• The US National Cancer institute (NCI) and World health organization categorizes specific

adverse event criteria for those undergoing chemotherapy. These include

o Grade 0- No adverse event

o Grade 1- Mild

o Grade 2 – Moderate

o Grade 3 – Severe

o Grade 4 – Life-threatening

o Grade 5- Death

• Potential interactions between the liver and chemotherapy fall into two categories:

o Direct chemotherapy-induced hepatotoxicity and Potentiation of pre-existing liver

disease, especially viral hepatitis.

o Altered hepatic drug metabolism due to underlying liver disease can result in higher or

more persistent drug levels, thereby causing increased systemic toxicity (particularly

myelosuppression) or worsening of liver function because of chemotherapy-induced

hepatotoxicity.

• Veno-occlusive disease of the liver can be observed in the setting of high-dose chemotherapy or

radiotherapy to the liver. Pathologically, it is characterized by nonthrombotic obliteration of small

intrahepatic veins by loose connective tissue. Clinical features include acute upper abdominal

pain, hepatomegaly, ascites, weight gain, and jaundice.


Summary of Chemotherapy induced Hepatotoxicity

Chemotherapy agent Associated Hepatotoxicity

Proposed Mechanism of Hepatotoxicity

Impact of Hepatotoxicity

5-Flurouracil Capecitabine

Steatosis Impaired B-oxidation and accumulation of fatty acids

30-47 %

Irinotecan Steato Hepatitis Mitochondrial impairment leading to Impaired B-oxidation

12-25%

Oxaliplatin Sinusoidal obstruction syndrome

Generation of Reactive oxygen species and glutathione depletion

19-78 %

Treatment according to western medicine 6

Nausea and vomiting

• Treatment is generally separated into two types: prophylactic (preventative) treatment, given

before the dose of chemotherapy agents, and rescue treatment, given to treat breakthrough

Nausea and Vomiting.

• Most patients undergoing chemotherapy receive anti-nausea (anti-emetic) medications to

prevent nausea and vomiting. These drugs may be given alone or in combination, either in pill

form or administered intravenously.

• 5-HT3 (Setron) receptor antagonists are very effective antiemetics and constitute a great advance

in the management of Chemotherapy Induced Nausea and Vomiting. These drugs block one or

more of the nerve signals that cause nausea and vomiting. They are considered most beneficial if

given within /during the first 24 hours after chemotherapy.4

• NK1 (Neurokinin 1) antagonists are a recently developed class of very efficacious drugs for

controlling Chemotherapy Induced Nausea and Vomiting. These drugs are often used alongside

https://en.wikipedia.org/wiki/5-HT3_antagonist

https://en.wikipedia.org/wiki/Antiemetic

https://en.wikipedia.org/wiki/NK1_receptor_antagonist


5HT3 inhibitors and corticosteroids to form a very potent combination of antiemetics that verge

on achieving a nearly complete patient response.

• Other category drugs include Neuroleptic agents.

Medications used to treat nausea and vomiting include: 7

Medications Medications

Alprazolam Lorazepam

Aprepitant Methylprednisolone

Dexamethasone Metoclopramide

Diphenhydramine Midazolam

Dolasetron Nabilone

Dronabinol Olanzapine

Droperidol Ondansetron

Fosaprepitant Palonosetron

Granisetron Prochlorperazine

Haloperidol Promethazine

Mucositis

Currently, there is no intervention in modern medicine that is completely successful at preventing oral

mucositis. Despite the availability of many therapeutic agents that claim to prevent or reduce severity,

oral mucositis often takes a therapeutically refractory turn, necessitating the use of topical and systemic

analgesics. 8

Oral Hygiene: Patients are encouraged to seek professional dental care throughout cancer therapy, as necessary.

Cryotherapy: It has been hypothesized that cooling of oral mucosa using ice chips will reduce the blood flow to the

oral mucosa, thus reducing the availability of chemotherapeutic agents to the oral mucosa.

Allopurinol: Oxypurinol reduced 5FU-induced mucositis for patients receiving the allopurinol mouthwash.

Propantheline: This is an anticholinergic agent that is known to produce dry mouth and xerostomia.

Chemotherapeutic agent etoposide is known to be excreted in the saliva. It was hypothesized that

propantheline may reduce dose-limiting toxicity in patients receiving etoposide.


Pilocarpine:

It is a cholinergic agonist that has demonstrated efficacy in relieving symptoms of radiation-

induced mucositis. It preserves salivary gland function when used for patients receiving

radiotherapy.

Cytokines: Topical administration of granulocyte colony-stimulating factor (G-CSF) and granulocyte-macrophage

colony-stimulating factor (GM-CSF) shows promising effects on the oral mucosa.

Hepatotoxicity

• There is no treatment for liver damage once it occurs.

• The primary approach is to discontinue any medications that are processed through the liver.

• Medications that help reduce the symptoms of liver damage may be given. For example- Diuretics

to reduce fluid accumulation.

• Bevacizumab may have a protective effect against oxaliplatin-induced sinusoidal injury.

Bevacizumab lowered the incidence of sinusoidal dilatation in patients receiving oxaliplatin.

Ayurvedic Interpretation of Cancer Dr. David Frawley in his Ayurvedic Healing book defines cancer as the following:

In Ayurveda cancer is a disease that often involves all three doshas, though it typically starts with a

predominance of one. The digestive fire and other Agnis are low, allowing a build-up of toxic substances.

The cancer represents a negative life-energy, something like a parasite, which has become established in

the body. Negative life-energy usually comes from an excess of Apana, the downward moving air. Hence,

Apana disorders such as distention, constipation and diarrhea may be the basis of this condition. Cancer

cells, lacking oxygen (prana), represent a growth in the body outside the rule of prana. Cancer has many

causes including our toxic environment, devitalized foods, sedentary life-style, and lack of spiritual purpose

or effort in life. Its basis often is suppressed emotion or emotional stagnation, which causes accumulation

of toxic material, and excess doshas. In older Western medicine, it was a disease of melancholy or black

bile, which also translates as suppressed emotions. Hence, physical remedial measures are usually not

enough to restore health. In the Vedic system cancer is viewed as a psychic disorder, a disruption in the

aura allowing the entrance of a negative astral force. Emotional cleansing, mantra and meditation are

important to counter this. 9


HYPOTHETICAL INFERENCE AND UNDERSTANDING THE CONCEPT OF

GARA VISHA vis-à-vis CHEMOTHERAPY RELATED SIDE EFFECTS

Introduction Gara visha is well explained in all classics and traditional books of Ayurveda. According to this science,

Gara visha is considered as one of the forms of Kritima visha (Artificially prepared poisons) which gets

formed by the combination of two or more than two poisonous or nonpoisonous substances or drugs and

ultimately affects the whole body by vitiating all dhatus in it. It can go to such extent that it diminishes all

dhatus drastically, which in turn can prove fatal to the person. (Reference Charaka .chikitsa sthana 23/14).

10

Definition As described by Acharya Vagbhata, a combination of incompatible drugs, ashes and poisonous substances

of mild potency is known as Gara visha. Thus ‘Gara’ is a toxic combination of various substances that exert

lethal effect after interval of sometime and as such doesn’t kill the patient immediately. (Reference:

Ashthanga Hrudaya Uttara Sthana 35/49-50). Because of the low potency of the poison, it usually won’t

cause sudden death. Because of the enveloping (Avarana) action by humor Kapha, these low potency

poisons are retained in the body for a long period of time.

Clinical features of Gara Visha

Clinical features Clinical features Clinical features

Person becomes pale(Anemic)

Flatulence Tuberculosis

Emaciation Edema in hands and feet Abdominal lumps

Poor digestion Distension in abdomen Wasting/Loss of strength

Palpitations in heart Malabsorption syndrome Fever

As per Acharya Yogaratnakara, Gara Visha consumption shows its impact on body after 15 days or one

month of duration leading to manifestations of the below symptoms:


Lethargy Flatulence Loss of strength

Heaviness in body Edema in hands and feet Hemorrhage

Cough Distension in abdomen Edema and yellow discoloration of eyes



Dyspnea Malabsorption syndrome

Prognosis According to Acharya Vagbhatta, the Patient afflicted by Gara Visha dies very soon if not given immediate

treatment.

HYPOTHETICAL INFERENCE AND UNDERSTANDING THE CONCEPT OF

DUSHI VISHA vis-à-vis CHEMOTHERAPY RELATED SIDE EFFECTS. Introduction Dushi Visha is one of the unique concepts elucidated in Ayurveda. The term Dushi Visha is a combination

of two different words, ‘Dushi’ and ‘Visha’. ‘Dushi’ means denatured, attenuated, latent, vitiated. Visha

means poison. Thus, Dushi Visha means denatured poison or attenuated poison. Attenuated or denatured

poisons function as latent toxin in the body. 11

Definition Acharya Sushruta and Acharya Vagbhata described Dushi Visha as any kind of poison originating from

inanimate or animate sources or any artificial poison (Kritrima Visha) retained in the body after partial

expulsion or which has provisionally undergone detoxification, by the anti-poisonous drugs, the wind or

the sun is termed latent poison (Dushi Visha).

Because of the low potency of the poison, it usually won’t cause sudden death. Because of the enveloping

(Avarana) action by humor Kapha, these low potency poisons are retained in the body for a long period

of time.

Clinical features of Dushi Visha • Loose stools

• Altered complexion

• Foul smell from mouth

• Impaired olfactory and gustatory senses

• Unquenchable thirst.

• Slurring and broken speech

• Vomiting

• Sorrow/Depression


• Sudden bouts of unconsciousness

• Symptoms of ascites (Dushyodara)

• The above symptoms are followed by sense of intoxication after consuming food, indigestion,

anorexia, appearance of red patches all over the body, edema of the face and extremities,

urticaria, fainting, ascites, vomiting, diarrhea, discoloration, epileptic attacks, intermittent fever

and increased thirst.

Symptoms according to site When Dushi Visha is retained in Stomach (Amashaya) it produces the diseases due to derangement of

humors Kapha and Vata i.e. unconsciousness, vomiting, diarrhea, tympanites, burning sensation, tremors,

altered sensorium etc.

When located in Intestines (Pakwashaya), it produces diseases of deranged Vata and Pitta humors such

as burning sensation all over the body, fainting, diarrhea, tympanites and anemia Symptoms according to

predominance of humor.

Clinical feature produced by aggravated doshas due to Dushi Visha

Complications of Dushi Visha Complications like pyrexia, burning sensation, hiccough, distension of abdomen, impotence, edema,

diarrhea, fainting, cardiac disorders, abdominal enlargement, insanity, tremors might occur.

VATA PITTA KAPHA

Chest pain (Hrtpeeda) Sensory loss (Sanjnanasha)

Vomiting (Chardi)

Belching (Urdhwanila) Warm expiration (Ushnanishwasa)

Anorexia (Arochaka)

Stiffness (Sthambha) Chest burn (Hrtdaha) Heart burn (Hrillasa)

Lassitude (Gatrasada) Pungent taste in the mouth (Katukasyata)

Salivation (Praseka)

Binding pain (Udveshtana)

Oedema (Sopha) Heaviness of the body (Gourava)

Joint pain (Parvaruk) Coldness (Shaitya)

Pain in the bones (Asthiruk)

Sweet taste (Mukhamadhurya)


Prognosis Dushi Visha in the prudent and in early cases of poisoning is curable, cases of one year’s standing become

relievable, while even this type of poisoning in an enfeebled and imprudent patient, who is taking

unwholesome food should be considered to be incurable.

COMPARITIVE SYMPTOMATIC ANALYSIS OF SIMILARITIES BETWEEN

GARA VISHA, DUSHI VISHA AND CHEMOTHERAPY-RADIATION RELATED

SIDE EFFECTS

GARA VISHA SYMPTOMS

DUSHI VISHA SYMPTOMS

CHEMOTHERAPY SIDE EFFECTS

RADIATION SIDE EFFECTS

Diarrhea Diarrhea Diarrhea

- - Nausea Nausea

Vomiting Vomiting Vomiting

- - Constipation Constipation

- Alopecia Alopecia Alopecia

- - Mucositis Mouth and gum sores

Anemia - Anemia Anemia

Poor and Impaired digestion

- Digestive disturbances Digestive disturbances

- Altered complexion - -

Emaciation - - -

Loss of strength - Weakness Weakness

- Impaired olfactory and gustatory senses

Alteration in taste Alteration in taste

- Foul smell form mouth

- -

Palpitations - Tachycardia -

Flatulence -

- Unquenchable thirst - -

- Slurred speech - -

Distension in Abdomen

- Bloated abdomen

Malabsorption syndrome

- Digestive disturbances -

- Depression

Depression

- Sudden bouts of unconsciousness

Loss of consciousness due to seizures

-

Abdominal lump - - -

Ascites - -

- Indigestion Digestive disturbances

Fever Intermittent fever Fever/flu-like -syndrome -


GARA VISHA SYMPTOMS

DUSHI VISHA SYMPTOMS

CHEMOTHERAPY SIDE EFFECTS

RADIATION SIDE EFFECTS

- Anorexia Anorexia Anorexia

Heaviness in body - - -

- Red patches all over body

Mild to severe rashes Mild to severe rashes

Cough - Dry cough /Wheezing Cough and fullness in chest

Edema in hands and feet

Edema of face and extremities

Edema of feet, ankles, hands and face

Lymphedema

- Urticaria Redness/Itching /Rash on skin

Itching /Skin rash

Dyspnea - Dyspnea due to Anemia or Lung complications

Dyspnea

Hemorrhage - Bleeding due to low platelet count

-

Yellow discoloration of eyes(Jaundice) indication of Liver malfunction

- Liver damage/ Hepatotoxicity

-

Fainting - -

- - Dry skin / Skin irritation Dry skin / Blistering/ Peeling

- - - Headache

- - Sleep disturbance Sleep disturbance

Also, When the major side effects of chemo-radiotherapy are analyzed by an ayurvedic viewpoint, it

appears that there are many manifestations of aggravated Pitta Dosha. Pitta pacifying herbs may be used

clinically as an important adjuvant to Chemotherapy and Radiation to improve the quality of life in cancer

patients.

Ayurvedic & Herbal Chikista Yoga, Pranayama, Meditation and Mantra therapy helps in management of cancer and improves overall

immune system response and accelerate healing. These four yogic therapies are common across various

types of cancers and side effects.

Asanas Yoga blends seamlessly with conventional medications and interventions to help manage cancer. It can

aid the effect of conventional treatments by reducing after effects and bolstering the innate fighting force

of the body. 12

• It helps to manager the emotional trauma during the therapy.

• It improves healing by maximizing blood flow to the affected areas


• Brings metabolic balance

Mudras In Sanskrit, the term mudra means a gesture or a form. Yoga mudra is a specific posture which stimulates

the chakras, activates the pranic pathways and awakens latent kundalini energy. It also awakens

Vijnanamaya and Anandamaya koshas. Shambhavi mudra, nasikagra drishti, khichari mudra, shanmukhi

mudra, prana mudra, vipareeta karani mudra, vajroli /sahajoli mudra and Ashwini mudra. 13

Pranayama Pranayama is derived from the Sanskrit root words ‘prana’ and ‘ayama’. Prana is the pranic or subtle force

pervading both the cosmos and the human system. Ayama means extension or expansion. Soo Pranayama

is expansion of pranic energy in the whole body to carry out all activities optimally. Yogic breathing, nadi

shodana, bhramari, ujjayi and cooling pranayamas like sheetali and sheetakari. The alternate nostril

breathing technique helps in balance the nostril activity, which balances the sympathetic and

parasympathetic flows in the body. Bhramari pranayama, reduces anger, stress, improves blood

circulation in the brain, removes toxins from the cerebro-spinal fluid, boosts the immune system and

hastens healing. It harmonizes the mind and attunes the body systems with the mind. Ujjayi pranayama

activates pranas and enhances the function of the nervous and immune systems. It has profound effect

on the healing and repairing capacity of the body. Sheetali and Sheetakari pranayama reduce excessive

heat tin the body and bring cooling effect. 14

Meditation Regular meditation can reduce stress and clear the mind, which is helpful for nausea and vomiting

brought on by tension and anxiety.

Mantra therapy Sound has been utilized in various cultures for thousands of years as a tool for healing. Whether through

the use of mantras as with the Hindis, the Icaros (medicine melodies) of various Indigenous peoples from

Central and South America, or Pythagoras' use of interval and frequency, these various techniques all have

the same intention: to move us from a place of imbalance to a place of balance.

Sound helps to facilitate shifts in our brainwave state by using entrainment. Entrainment synchronizes our

fluctuating brainwaves by providing a stable frequency which the brainwave can attune to. By using

rhythm and frequency, we can entrain our brainwaves and it then becomes possible to down-shift our

normal beta state (normal waking consciousness) to alpha (relaxed consciousness), and even reach theta

(meditative state) and delta (sleep; where internal healing can occur).

http://www.mindbodygreen.com/0-8898/sound-healing-changed-my-life-why-it-can-change-yours.html

http://www.mindbodygreen.com/0-14913/what-to-expect-during-an-ayahuasca-ceremony.html

http://www.mindbodygreen.com/0-14913/what-to-expect-during-an-ayahuasca-ceremony.html

http://www.phy.mtu.edu/~suits/pythagorean.html


Using sound as therapy can provide results for a variety of issues including:

• Anxiety, Depression, Sleep disorders

• Stress management, PSTD

During this thesis Ayurvedic and Herbal therapies are identified to reduce the below critical side effects:

Nausea and vomiting Nidana (Causes)

• Ayurveda recognizes this condition as Chardi. All types of Chardi originate from Amashaya.

(Vitiated Doshas lodged in stomach).

• Nausea and vomiting induced by chemo-radiotherapy can be correlated with Pittaja chhardi (pitta

dosha dominant).


Samprapti (Pathology)

Udana vayu gets vitiated due to above mentioned Nidana and brings all contents of stomach upwards

and finally everything is expelled from mouth. There is severe distress during this forceful expulsion.

Chikista (Treatment)

Herbs

CLASSICAL AYURVEDA MEDICINES WESTERN HERBOLOGY

Haritaki churna with honey Peppermint extract

Cold water processed with tender leaves of mango (mangifera indica) and Jamun (Syzygium Cumini)

American ginseng extract

Guduchyadi Kashaya Cayenne extract

Parpataka kashayam Ginger water

Chandanadi avalehya Hawthorne berry, Red Raspberry

Diet

• Green gram soup with rock salt

• Laja manda: Boil the mixture of Puffed rice, cardamom, clove, sugar and water. Allow it to cool

and give the same to patient.

• Ginger water

• 64 glasses of pure water starting two days before chemotherapy 15

• Buttermilk

• Food with sweet, sour and bitter tastes are advisable.

• Avoid withholding urges of thirst, hunger, improper food, psychological emotions like anger and

fear.

• Avoid white rice and replace with Basmati brown rice 16

Stage Evidence Dosha Sub-Dosha

Dhatu Srota Category Examples

RMD Vomiting Vata Udana Rasa Annavaha Laxatives, Demulcents

Triphala Aloe Vera

RMD Burning mucosa

Pitta Pachaka Rasa Annavaha Demulcents Aloe Vera

RMD Nausea Kapha Kledaka Rasa Annavaha Dipanas Ginger, black pepper, long pepper


• Quinoa and cinnamon 17

• Carrot soup with fennel 18

• Papaya salad 19

• Carrot, Ginger and Arame salad 20

• Non-dairy mango yogurt 21

• Coconut ice cream 22

Pranayama Pranayama appears to give relief from Nausea. Physiologically, deep breathing works to reduce nausea

because of the closeness of the vomiting center to the respiratory center in the brain. When the

respiratory center in the brain is focused on taking controlled deep breaths, the vomiting center might be

less able to process thoughts about nausea.

Panchakarma For treating all types of Vomiting, first Langhana (Controlled fasting or Consuming light or easily digestible

foods should be done except for Vataja Chardi). When Kapha and Pitta are aggravated, Vamana and

Virechana are treatment of choice. They can be initiated based on strength of patient and disease.

Aromatherapy Aromatherapy may be used individually or combined with any of touch therapies. It can help for

anticipatory, acute and delayed Nausea and Vomiting. Aromatherapy works to calm a fragile, irritated, or

nervous stomach with essential oils from plants and herbs. The oils can be given on the tongue, massaged

into the skin, or applied with a compress.

Internal: Peppermint, a digestive aid, is considered one of the most effective essential oils for curbing

nausea. Essential oil of Greenland Moss, Lemon, Rosemary Verbenone, Juniper ingested at the rate of 2

drops each twice a day, beginning the day of chemotherapy for 3 to 4 days. 23

Diffusion/Direct inhalation: Bergamot, Ginger, Grapefruit, Lemon, Orange, Peppermint.

Massage: Massage with the following essential oil combination is recommended.

SNo Essential oils

1 Lavendula vera

2 Cinnamosma Fragrans

3 Helichrysum italicum

4 Peppermint


Mucositis Nidana (Causes) As per Charaka Samhita, the symptoms of mucositis resemble the sign and symptoms of Mukha Paka,

which is basically due to increased pitta dosha in the body by Chemotherapy drugs and Radiation.

Samprapti (Pathology) Amongst various Mukharogas, Mukhapaka is Pittaja Nanatmaja and Rakta Pradoshaja Vikara,

characterized by VedanayuktaVrana in the Mukhaguha (Oral cavity). The lakshanas of Mukhapaka can be

co-related with apthous ulcer (recurrent ulcerative stomatitis) explained in modern medical science.

Chikista (Treatment) Correcting and strengthening digestion, balancing the Tridoshas especially Pitta, improving nutrition

status and advice of food and life style changes are the mainstay of treatment protocol according to

Ayurveda.

Herbs


Yashthimadhu churna with honey 1–3 tablespoons of aloe vera juice used as a mouthwash,

Kalaka Churna Slippery elm Capsules

Peetaka churna Red raspberry leaves capsules

Khadiradi Vati Echinacea

Diet 24

• Avoid spicy, dry, deep fried and heavy foods that are difficult to digest

• Prepare herbal tea (seep 1 to 2 tsp of herb for 5 to 10 mts in 8 ounces of water) made from

German chamomile, Holy basil or Myrrh

• Include garlic in the meals, which will reduce risk of infection

• Honey from tea tree plant (Camellia sinensis) helps to prevent radiation-induced mucositis,

swish and swallow ¾ ounce of honey 15 minutes prior to radiation therapy, then 15 mts and 6

hours after radiation

• Chew on holy basil leaves throughout the day

• Have congee soup

• Avoid acidic foods such as oranges, grapefruit, tomato, lemons



RMD Burning mucosa

Pitta Ranjaka Rasa & Rakta

Rasavaha, Raktavaha & Mahavaha

Demulcents & Alteratives

Red raspberry Echinacea


• Consume non-acid fruits or vegetable juice, such as celery, carrots, kale, berries, watermelon

and cantaloupe

Supplements

• Take Glutamine 2 gms/m2 2 times a day

Panchakarma The treatment modalities under Panchakarma include Virechana(Mrudu) and external therapies called

Kavala(Gargling) and Gandusha(Mouth fills) with medicated decoctions / oils . Shiro Dhara with medicated

buttermilk (Takra) / Milk (Ksheera) is also beneficial.

Acupressure

• Primary acupressure points HT 8, Lu 10, SP 2, ST 44

• Secondary acupressure point DU 14, HT 5, Kid 2, LI 2, LI 4, LU 6

Aromatherapy

• Prepare Mouth wash with combination wheat germ oil (90% to 10% ratio) with one of (Bay

laurel, Carrot seed, Tea tree, Niaouli and Roman Chamomile) essential oils and gargle 2 to 3

times a day

• Applied locally on ulcers or gargling with calendula tincture are effective for preventing or

soothing ulcers

• Mouth wash with wheat germ oil (90% to 10% ratio) and either German chamomile or Myrrh, 2

to 3 times a day

Hepatotoxicity Nidana (Causes) Tridoshas especially Pitta gets highly vitiated due to toxicity induced by Chemotherapy drugs. Ranjaka

Pitta, Pachaka pitta along with Samana vayu vitiation leads to Yakrit (Liver malfunctioning and causation

of Liver related distressing symptoms.

Samprapti (Pathology) Ayurveda identifies abnormalities related to liver by the term Yakrittodara. It is associated with symptoms

of fatigue, anorexia, constipation, nausea, vomiting, excessive thirst, emaciation, mild fever, loss of taste,


abdominal distension, indigestion, prominent veins on the abdomen fainting, dyspnoea and cough.

Inflammation of liver is known as Yakrit shotha.

Chikista (Treatment) 25 Ayurvedic treatment is beneficial for cleansing liver, removing obstruction, detoxifying liver cells and

improving liver function.

Herbs


Panchakola ghrita Golden seal

Rohitaka ghrita Dandelion root

Punarnavashtaka kwath Milk thistle seed

Kumaryasava Oregon Grape and Barberry root

Kutki Scutellaria barbata – 9 gm per day

Dr. Christopher’s Liver Transition formula (take this first after chemo and radiation therapies)

Dr Christopher’s Liver and Gall bladder formula (take this after completing Liver Transition formula, and also ensure that ESR and CRP levels in the blood are in normal range)

Diet

• Avoid foods that are too cold, heavy, deep fried foods, red meat and milk products

• Avoid Alcohol, high-fat foods, and raw or partially-cooked shellfish should be completely

avoided

• Avoid raw or partially-cooked shellfish because they can contain a bacterium called Vibrio

vulnificus that can cause a serious infection due to the damaged immune system

• Turmeric helps boost liver detoxification by assisting enzymes that actively flush out toxins

• Liver cleansing like artichoke, asparagus, kale, and Brussels sprouts should be included in diet

• Broccoli and cauliflower are good sources of glucosinolates, which supports enzyme production

in the liver



RMD Heat and nodular formation in the liver, fibrosis in the liver, red palms, increased vascularity

Pitta Ranjaka Raktavaha Cholegogues Liver tonics

Milk thistle, kutki,

bhumyamalaki Gaduchi, Aloe vera, Milk thistle

RMD Weight loss Vata Samana Medas Medovaha Fat tonics Bala, Ashwaganda


• Incorporate leafy greens such as bitter gourd, arugula, dandelion greens, spinach, mustard

greens, and chicory in diet. This will increase creation and flow of bile that helps remove waste

from the organs and blood. They also aid in liver cleansing

Panchakarma Oleation (Snehana), Swedana (Sudation), Purgation(Virechana) and Niruha vasti (Decoction enemas) are

indicated as per state of the disease and strength of the patient.

Aromatherapy Ledum groenlandicum (Greenland Moss) + Citrus limon (Lemon) + Rosamarinus officinalis verbenone

(Rosemary verbenone) 3 drops internally each. Take for 10 days 3 times a day.

Mantra therapy Mantra chikitsa as an alternative healing technique under sound therapy can greatly assist cancer patients

in the healing process of Liver. Sound in the form of Mantras can change our immune function.

According to various scientific studies, after either chanting or listening to certain forms of music,

Interleukin-1 level, (an index of immune system) goes up between 12 and a half and 15 percent.

After about 20 minutes of listening to meditative type music, immunoglobin levels in blood happen

to increase significantly. There’s no part of our body not effected. Even our heart rate and blood

pressure are lowered with certain forms of music. So, it effects not only our soul and our spirit, but

it affects us on literally a cellular and sub-cellular level.

• Chant – Om Pam Namah Daksina Parsve 26

Therapeutic bath Dissolve 2 pounds of baking soda in a tub of water as hot as can be tolerated. Stay in the bath until the

water has cooled, at least 45 minutes. Do not shower for at least eight hours following the bath. Mix ½

teaspoon of baking soda in a glass of warm water and sip this during the bath.

Conclusion According to WHO (World Health Organization), 7.9 million deaths in 2007 were caused by cancer, this

number is projected to increase to 12 million by 2030. At this alarming rate of increase due to life style,

diet, stress, pollution and other causes, an integrated approach to include Ayurvedic life style and herbal

supplements supported by Vedic Counselling and five sense therapy will significantly help us to prevent

cancer and also support cancer patients to get a relief from the side effects of conventional therapies

thereby improving chances of a speedy recovery and reducing chances of relapse.


Abstract of Research Papers

Potential Chemotherapy Side Effects, What Do Oncologists Tell Parents?

Background In order to determine the number of short-term side effects and late effects discussed during an informed

consent conference (ICC) after the diagnosis of acute leukemia, we observed the occurrence(s) and the

ratio between short-term side effects versus late effects during an ICC.

Procedure ICC(s) of childhood leukemia trials were audio-taped at six different study sites. The side effects

mentioned during each of these ICC(s) were coded and analyzed.

Results One hundred and forty cases were reviewed, from which we coded a total of 3173 acute side effects and

242 late effects. The mean total side effects mentioned during each ICC was 24 (range 5-47). The number

of late effects coded were significantly less than acute side effects. We also found that the duration of

ICC(s) was positively correlated with the number of side effects mentioned. In addition, the frequency of

total side effects mentioned was independent of patient or parent demographic factors.

Conclusions Our results show that acute side effects are often mentioned but the discussion of late effects is much

less frequent in the initial ICC(s). Careful consideration regarding the ratio of acute and late effects that

are communicated to parents in the context of the informed consent conference may facilitate parental

understanding of clinically relevant side effects.

Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A

Systematic Review and Meta-Analysis

AIM: To evaluate the efficacy of topical corticosteroids in managing acute radiation dermatitis (RD) in female

breast cancer patients.


MATERIALS AND METHODS: MEDLINE, EMBASE, CINAHL, CENTRAL, ScienceDirect, Google Scholar and Clinicaltrials.gov were searched up to and including March 2017 to identify Randomised Controlled Trials (RCTs) assessing topical corticosteroids for the management and prevention of acute RD.

RESULTS: Ten RCTs (919 participants) were identified. Meta-analysis, including results for 845 participants, demonstrated significant benefits of topical corticosteroids in preventing the incidence of wet desquamation (OR: 0.29; 95%CI: 0.19-0.45; p<0.0001) and reducing the mean RD score (SMD: -0.47, 95%CI: -0.61 - -0.33, p<0.00001).

CONCLUSION: Topical corticosteroids impacted on the incidence of wet desquamation and the average RD score observed in female breast cancer patients. The use of topical corticosteroids can reduce pruritus in participants and improve quality of life.

Role of Gabapentin in Managing Mucositis Pain in Patients Undergoing

Radiation Therapy to the Head and Neck

BACKGROUND: Oral mucositis (OM) is a painful and debilitating side effect that affects 80%-100% of patients undergoing radiation therapy for head and neck cancer. This dose-limiting side effect may potentially lead to pain, dehydration, malnutrition, infection, and treatment breaks. Treatment breaks can lead to decreased disease control and suboptimal patient outcomes. No primary prevention exists for OM, and management is focused on pain control. Compelling evidence exists that OM pain has somatic and neuropathic components.

OBJECTIVES: This article reviews the existing literature on the use of gabapentin (Neurontin®) as a co-analgesic in treating the neuropathic pain in OM.

METHODS: A literature search was performed using CINAHL® and PubMed with the search terms gabapentin and oral mucositis. The selected articles were briefly screened for relevance, and three were included in this review.

FINDINGS: No systematic reviews exist on the role of gabapentin for neuropathic pain in radiation-induced OM. Two retrospective studies concluded that gabapentin reduced escalation of opioid doses and unplanned treatment breaks. One retrospective study demonstrated favorable swallowing outcomes. Pain and OM are nursing-sensitive outcomes that can be significantly affected by evidence-based nursing interventions.

Chemotherapy and Radiation Induced Pulmonary Dysfunction in Hodgkin Lymphoma

Patients 27

Abstract Although the deterioration in pulmonary functions is a well-known important problem due to the treatment of the Hodgkin's lymphoma patients, the immediate and long term effects of the therapy and


its distinctive components were not shown clearly yet. We planned to investigate effects of multiple agent chemotherapy and/or radiotherapy to pulmonary functions immediately and thereafter and the possible effects of the managing this situation. 34 patients were included the study. The patients were evaluated for peak expiratory flow (PEF), forced expiratory volume in 1 s (FEV1), forced expiratory vital capacity (FVC), mean total lung capacity (TLC) values, FEV1/FVC ratio, diffusing capacity for carbon monoxide (DLco), diffusing capacity for carbon monoxide corrected for hemoglobin concentration (DLCO) before and at 1, 6 and 12 months after the initiation of the treatment. Demographic characteristics; disease stages; chemotherapy protocols; whether radiotherapy is received; if yes, the region and the dose received were recorded. The tests were finally analysed in two separated groups; group A treated with only chemotherapy and group B; treated with combination therapy, chemotherapy and radiotherapy. In group A, FVC and FEV1 is similar before and after treatment. FEV1/FVC ratio was increased (P = 0.0001) in this group despite increasing in mean TLC values (P = 0.001). No meaningful changes were observed in PEF and DLCO values in group A. In group B, FVC, FEV1 and PEF were decreased after treatment (for FVC P = 0.028, for FEV1 P = 0.04). Despite a decrease in first month of the treatment in FEV1/FVC ratio and DLco these two parameters were recovered at the end of the first year in group B patients. TLC values were increased after treatment in group B as in group A (P = 0.035). We believe that, if these patients are managed well in 1 year; necessary precautions are provided; and patients are well-informed, then there wouldn't be too much risk and mortality rate for long-term side effects of ABVD and mediastinal RT.

The timing of the appearance of oral mucositis induced by concurrent

chemoradiotherapy with S-1 for head and neck cancer, PMID: 25596050, 28

Abstract Oral mucositis is a frequent adverse event in patients receiving concurrent chemoradiotherapy for head and neck cancer. Although the management of oral mucositis is essential to improve treatment completion rates, no detailed studies on the time of oral mucositis appearance have been reported. We conducted a retrospective study on the timing of the appearance of oral mucositis induced by concurrent chemoradiotherapy with S-1 for head and neck cancer. A total of 11 patients with head and neck cancer who received concurrent chemoradiotherapy with S-1 were examined. All patients developed oral mucositis within 13.8 ± 5.6 days after the initiation of radiotherapy (20.4 ± 8.1 Gy). In addition, the effects of pain-associated symptoms caused by oral mucositis on the patients' nutritional status, including reduction in caloric intake (24.4% ± 31.1%), weight loss (5.2% ± 5.2%), and duration of a regular diet (24.5 ± 17.1 days), were observed and lasted until the completion of radiation therapy. The delineation of the timing of oral mucositis appearance has become a key motivator for the patients to perform oral care proactively to limit severity and serves as a necessary index for monitoring oral health and managing pain and nutrition.


References

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(Department of Hematology, Medical Faculty, Istanbul Kemerburgaz University, Istanbul, Turkey ; Department of

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ayurvedic approach to reduce side affects of … · side effects of chemo and radiation therapies...

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