Case - 2
Efficacy of Panchakarma
and Ayurvedic Herbo-mineral Preparations in the Management of Malignant
Astrocytoma – a Case Study
Authors:
Dr. Sawant Prashant M.D. (Ayu), Dr. Jagtap Reshma M.D. (Ayu.), Dr. Kadam
Sandhya M.D. (Ayu), Ayurlife Positive Health Centre and Research Institute,
Chembur, Mumbai - 71
Note: This Case Study was
selected for presentation at Second International Conference of the Society for
Integrative Oncology held November 10-12, 2005 in San Diego, California.
The Case Study is also published in the November 06 issue of 'Light On
Ayurveda Journal' publised in the U.S.A
Introduction:
Brain tumors account for 85% to 90% of all
primary central nervous system (CNS) tumors.
In general, the incidence of primary brain tumors is higher in whites than in
blacks, and mortality is higher in males than in females. Anaplastic
astrocytoma and glioblastoma account for approximately 38% of primary brain
tumors
Within the brain are nerve cells
and also cells that support and protect the nerve cells (glial cells). A tumor
of these cells is known as a glioma. Astrocytoma is a type of glioma which
develops from astrocytes.
Tumors of Grade III and Grade IV astrocytomas
are frequently referred to as malignant astrocytomas. For patients with brain
tumors, 2 primary goals of surgery include (1) establishing a histologic
diagnosis and (2) reducing intracranial pressure by removing as much tumor as is
safely possible to preserve neurological function. Total elimination of primary
intraparenchymal tumors by surgery alone is extremely rare. Radiation therapy
and chemotherapy options vary according to histology and anatomic site of the
brain tumor In Grade III astrocytoma, with conventional treatment, the
patient's survival outcome is very poor.
The use of ayurvedic
panchakarma treatment, namely, ‘basti’ (administration of medicines as an enema)
and herbo-mineral internal medicine has shown promising result.
We are presenting a case study of a patient with
Grade III Astrocytoma, who responded to the above mentioned treatment.
Case Report:
A female age 30 years, a known
case of malignant astrocytoma Grade III, approached for ayurvedic treatment on
19th June 2004. Her tumor had been surgically removed on 13th
April 2004. She was then advised Radiation Therapy followed by Chemo Therapy.
However due to severe debility and post-operative complications, she had to
discontinue Radio Therapy after three sittings. She was subsequently advised
against Chemo Therapy too
On her first visit to the
centre she was looking very anxious and exhausted. She was complaining of
dyspnoea on exertion and extreme fatigue. She had no complaints of headache,
giddiness, diplopia or tinnitus. On examination she was afebrile, pulse 92 /
minute, B.P 130 / 80 mm of Hg. No abnormality was detected on respiratory and
cardiovascular examination. She weighed 39 Kg., markedly underweight for her
height of 5’1”. There were no signs of neurological deficit.
History of Present
Illness:
In early March 2004, the
patient developed giddiness, nausea, headache and occasional diplopia in left
eye. On examination left lateral rectus muscle palsy was observed. There was no
evidence of pappilloedema. Respiratory, cardiovascular examinations were
unremarkable.
She was advised CBC, ESR, RBS,
serum creatinine. All the investigations were normal, except a moderate rise (32
mm / hr.) in the ESR. She was advised to take tab. Cinnarizine 25 mg. t.d.s. and
tab. Prochlorperazine 2.5 mg in the morning and 5 mg at bed time. However, there
was no relief in the symptoms after five days.
She was then advised MRI of
the brain (3rd April, 2004), which revealed a large well defined
lobulated non-enhancing, mixed intensity lesion in the left temporo parietal
region (7.9 cm x 5.6 cm). It was causing marked mass effect on the left
ventricle, 3rd ventricle, the mid brain, and left basal ganglia with
midline shift, subfalcine and early transtentorial herniation to the right,
suggestive of neoplasm.
MRI of
the brain (3rd April, 2004)
Patient was immediately
referred to a tertiary care hospital, where the tumor was surgically removed on
13th April 2004. In the histopathological study the dissected
confirmed oligoastrocytoma grade III of left temporoparietal region.
Radiation Therapy (RT) and
Chemotherapy were planned. She was given RT on 22nd, 23rd
and 24th of April 2004 and was discharged on 24th April
2004.
However, she developed bleed
under the scalp and was readmitted immediately on 25th April 2004.
Subsequently, she developed high-grade fever in range 104 *F – 105 *F. which was
not settling down even after antipyretics and higher anti-biotics.
CT scan on 25th
April, 2004, showed left fronto-parieto-temporal mixed density lesion, which was
partly the result of residual neoplasm with bleed within it. Left
fronto-parieto-temporal, extracerebral collection and subfalcine herniation to
the right was also noted.
CT scan on 25th April,
2004
The clot was evacuated on 27th
April 2004. Debridement and skin grafting was done on the scalp was done on 15th
May 2005. Eventually fever settled and the patient was discharged on 9th
June 2004.
In view of complications and
severe debility, the RT was suspended. Thereafter, it was decided not give RT or
Chemotherapy. She was prescribed Oxytol, Librium, Restyl, B-complex and Folvite.
As there was no active
conventional treatment planned, the patient, knowing the prognosis of the
disease, approached for ayurvedic treatment.
The
Ayurvedic Treatment:
Thirty
‘Rajayapan Basti’ (a multi-ingredient generic formulation administered as an
enema) were administered consecutively from 22nd June 2004 to 24th
July 2004.
Simultaneously, eight ‘shodhana nasya’ (nasal
instillation of medicine) with ‘panchendriya gunavardhana taila’, was
administered consecutively from 22nd June 2004. It was followed by
‘shamana nasya’ every day.
Herbo-mineral formulation, containing generic
ayurvedic medicines, namely, Vajra bhasma, Suvarna bhasma, Bruhat Vata
Chintamani Rasa, Abhrak bhasma (1000 puti), Shankha bhasma, Bramhivati,
Shankhapushpi churna, in a prescribed dose was given orally.
Results:
- CT Scan (23rd
August 2004): On comparison with scan dated 25th
April 2004, there has been a complete regression of left extra cerebral and
subglial collection. There was regression in ill-defined hyperdensity seen
within the left temporoparietal hypodense lesion.
CT Scan (23rd August 2004)
- CT Scan (12th
Feb 2005): On comparison with scan dated 23rd
August 2004, there had been no significant changes, there was no evidence of
enhancing residual lesion.
CT
Scan (12th Feb 2005)
Follow up on 4th
June 2005
The patient was asymptomatic.
Afebrile, pulse rate 88/ min., B.P: 120/70 mm of Hg. No abnormality detected on
respiratory, cardiovascular and CNS examination.
Investigations including C.B.C,
Urine Analysis, Renal Profile and Liver Profile were within normal limits.
Follow up C.T Scan, 31st
October 2005
Post operative status. Left
temporo-perital hopdense lesion, most likely representing post-operative gliosis.
No evidence of enhancing residual lesion.
Follow
up C.T Scan, 27th May 2006
No
evidence of enhancing residual lesion was identified. On comparison with CT Scan
of 31st October 2005, no change was noted.
As
on date: (2nd Nov 2006)
Patient is stable and asymptomatic. She is continuing with the
nasya (shamana) and oral medicines. She is also advised a course of eight
‘Rajayapana basti’, repeated every four months.
Discussion:
According
to ayurved, regeneration of cells is carried out by the ‘shukra dhatu’ and is
controlled by the ‘vata dosha’. The uncontrolled cell division is a result of
imbalance of ‘vata dosha’, which results into neoplasm. Therefore, the aim of
the treatment is to restore the proper balance of vata dosha and fortify the
shukra dhatu by giving rasayan medicines specific for shukra dhatu.
‘Basti’11 (therapeutic enema) is the
ideal treatment for ‘vata' related disorders. ‘Rajayapana basti’ is a type of
‘basti’ in which a specific formulation as described in treaties of ayurved, is
administered per rectum. This particular type of basti is selected because it is
recommended for fortification of shukra dhatu. It immediately restores strength
and prolongs life.
‘Nasya’ is useful in the diseases of head and neck.
It clears the channels of nutrition of the organs in the region. Nasal route is
the only route by which the medicines can directly reach the brain vault,
through the porous cribiform plate of the roof of the nose.
The herbomineral formulation used internally, is a
combination of generic formulations described in ayurvedic treaties. Each of
these formulations has a specific role in the management of neoplasm and
prevention of its relapse. The main propertoes of the key ingredients is as
under:
|
Medicine |
Main Properties |
|
Vajra bhasma4
|
Yogawahi (reaches in to the smallest part),
Rasayana |
|
Suvarna bhasma5 |
Vayasthapana (enhances quality of life), useful
in diseases of nervous system, improves blood circulation in the brain,
increases ‘oja’. |
|
Bruhat Vata Chintamani Rasa6 |
Fast acting, vata dosha balancing |
|
Abhrak bhasma7 |
Promotes strength, intellect promoting, useful
in diseases of nervous system |
|
Shankha bhasma8 |
Useful in reducing ‘arbuda’ (mass / tumor) |
|
Bramhivati9 |
Brain tonic, nervine tonic |
|
Shankhapushpi churna10 |
Nervous system specific Rasayana |
The Hypothesis:
|
 |
|
The cell division is controlled by vata dosha.
The exact information about this cell division and multiplication is coded
in the shukra dhatu (sarvadehik).
|
|
 |
|
The uncontrolled / abnormal multiplication of
cells may result from
1.
Vitiation of vata dosha caused by
the etiological factors.
2.
Faulty encoding of shukra dhatu
which may be by birth or acquired |
|
 |
|
The aim of treatment:
1.
Restore balance of vata dosha by
vata balancing herbo-mineral medicines, basti and nasya
2.
Lekhana – scrapping of tumor mass
with internal medicines
3.
Rasayana – Tissue specific
medicines which may be responsible for normal information encoding at
‘shukra dhatu’ level. |
Conclusion:
The treatment protocol based
on ayurvedic hypothesis used to treat this particular case has yielded positive
outcome. However, the usefulness of this therapy for malignant astrocytoma has
not been established and the hypothesis needs to be extensively evaluated.
References:
- Charak
Samhita / Siddhishtana / XII / 16.)
- Ashtanga Hrudaya / Sutra /
20 /1
- Rasatantra sara
- Rasatarangini / 23 / 25-26
- Rasatarangini / 15 / 69-80
- Bhaishajyaratnavali /
Vatavyadhi Chikitsa / 91-94
- Rasatarangini / 10 / 72-73
- Rasatarangini / 12/
20-21,29
- Rasatantra sara
- Charak
Samhita / Chikitsa / 1.3 / 31
- Ashtanga Hrudaya /
Sutrasthana / 19 / 1
