Part one of this series detailed the Western understanding of cancer, its pathophysiology, statistics, screening tests and treatment. In part two of this three part series the Ayurvedic concepts of gulma, granthi and arbuda shall be introduced.
Cancer has been understood to exist for thousands of years. While cancer may be more prevalent today in part because people live to a greater age than in the past, Cancers have always occurred. Healers since the beginning of time have tried to understand the condition and manage those who have been suffering.
Classical Ayurvedic texts have several references to cancer. Some terms used to describe the condition are general while others are much more specific. Practitioners should familiarize themselves with common terminology so that they can benefit from historical knowledge as well understand information that is published in India . The following terminology describes the most basic concepts.
Gulma is a term used to describe any palpable hard mass in the abdomen. This does not mean that gulma is cancer but rather any hard, tumor like mass in the abdominal region.
Granthi is a term for a tumor, lump or nodule that is visible from the surface. These tumors often open up on the surface of the skin as an ulcer (vrana). Granthi may be benign or malignant; however the term is most often used to describe benign tumors.
Arbuda is the most specific term for a cancerous malignancy.
Dwirabuda indicates that the malignancy has metastasized or spread from its initial site to other parts of the body.
From an Ayurvedic perspective, tumor formation is a condition of vata- kapha origin. Vata is responsible for the faulty division of cells and kapha for their growth. Hence, vata pushes kapha out of balance resulting in tumor formation. Benign tumors take on a predominantly kapha appearance.
In malignancies, pitta is also vitiated and the condition becomes sannipattika in nature. In these conditions, the agni of the affected tissue is increased making it very aggressive to its surroundings as it slowly digests the tissues of the body.
While at first, the interplay of the doshas may not be clear, over time vata imbalance predominates and the condition leads to severe wasting of the tissues of the body. Ojas in the affected tissue is always low as Cancer begins. As the condition progresses, systemic ojas becomes lower and lower.
Muscular tissue is the most common dhatu affected by cancer though any dhatu can be. Benign tumors of muscular origin are most often described as kapha entering into the mamsa dhatu and the mamsavaha srota. This is true even though it may be vata that has pushed kapha. Malignant tumors of muscular origin are most often described as pitta vitiation in the mamsa dhatu and mamsavaha vaha srota. This is true even thought there is simultaneous vitiation of vata and kapha. As the condition progresses, additional sites (dhatus and srotas) of the pathology become important.
Types: There are eight basic types of gulma. One related to each dosha, one from each combination, a tridoshic type and one type due to disorders of the artava.
Nidana: A long list of non specific causes are provided by the classical texts for the origin of gulma that include the suppression of natural urges, grief, becoming weakened by fever, vomiting or diarrhea and then eating food that vitiates vata. Other causes include drinking cold water when hungry and beginning purification without proper oleation and fomentation. These causes are quite generalized toward poor health practices and emphasize those that vitiate vata.
Purvarupa: Generalized purvarupa include all kinds of digestive disturbances such as belching, borborygmi, gas and constipation.
Comparative Rupa: (Dual dosha and tridoshic gulma combines the symptoms of the involved dosha)
Vataja gulma presents with tumors in the large intestine or pelvic region. There may be pain in the in the neck and head with fever. Patients feel cold and the spleen is often enlarged. There are usually signs of digestive discomfort such as constipation and borborygmi (intestinal churning). The mouth and skin are usually dry. Patients usually lose weight as the condition progresses. The skin, nails, eyes and feces typically become dark or gray. Texts describe the tumor as feeling as if one was being swarmed by ants. Pain is throbbing or cutting. The tumor may appear to move about and change in size and shape. Naturally, symptoms are worse on an empty stomach and during the vata times of day.
Pittaja gulma presents with tumors in the small intestine or solar plexus. Patients feel greater pitta type digestive discomforts such as hyperacidity and diarrhea. Patients run fever and the skin, nails, eyes and feces may become yellow. Pain at the site of the tumor may be described as burning. Pain is naturally worse during the pitta times of day and shortly after eating as food is digesting.
Kaphaja gulma presents with tumors in the chest or stomach. Patients present with typical symptoms of kapha vitiation such as loss of appetite and nausea. In addition, taste is significantly reduced and patients feel cold with a low fever. The skin, nails, eyes and urine take on a whitish hue. The tumor appears deep, hard, and heavy and is non mobile. Not surprisingly, the tumor does not produce much pain and grows slowly in size. Symptoms are worse during kapha times and immediately after eating.
Raktaja Gulmais a tumor arising from the blood in the artavavaha srota and occurs only in woman. This is the term used to describe of ovarian cysts and uterine fibroids. The condition is described as being like a false pregnancy where a mass forms instead of an embryo. KRL Gupta in his commentary on the Madhava Nidanam tells of an embarrassed physician who told a woman and her family she would die of the Gulma. He stated that it would increase in size, it would produce great pain and that nothing could be done for her. The woman was isolated from friends and family and left to die where upon she delivered a healthy female child. Because of the difficulty of diagnosing Rakta gulma and pregnancy, ancient texts recommend waiting until the 10 th month to treat the condition. The distinguishing feature is whether or not there is movement of the fetus. Naturally, in our modern age a distinction can be made quite early. This condition often presents with excessive menstrual bleeding leading to fatigue with anemia.
Samprapti: The primary cause of gulma is stated to be vitiation of vata but this can mix with doshas in other locations. Vitiated doshas failing to be eliminated remain in their home site or may mix with the other doshas in the digestive tract. The path of elimination of the doshas is obstructed in both an upward and downward manner preventing elimination. Excess dosha then becomes palpable as a lump
Prognosis : Single dosha involvement is the easiest to treat, dual dosha is more difficult and sannipattika type is stated to be incurable through Ayurveda. According to the Madhava Nidanam, the prognosis is terminal if the tumor fills the abdomen, has the shape of a tortoise shell, there is loss of appetite, debility, nausea, cough, vomit, discharge of mucous from the mouth and nose and loss of taste or smell. Systemic swelling is also a poor sign.
Regardless of the type of gulma, patients benefit from a diet that is warm, light and oily. This diet reflects the predominance of vata in the pathology. Over the region of the tumor, oleation and fomentation are recommended to pacify vata. Blood letting at the site of the tumor is also classically recommended. Agni should be properly managed. In most cases, agni will be low and hence a dipana is suggested to be taken in takra if possible. A simple formula recommended by Chakradatta is Yavani Takra prepared by mixing Yavani (Henbane: Hyoscymus Niger ; nervine sedative, antispasmodic and pain reducer) with a pinch of salt into takra.
Vata Gulma benefits from anuvasana basti if the tumor is below the umbilicus. A vata type tumor above the umbilicus requires oral oleation. Chakradatta suggests mixing 1 part ginger with 4 parts sesame oil and 2 parts jaggery taken in hot milk. Other medicines recommended by Chakradatta include castor oil or garlic taken in warm milk. Purifying bastis may also be performed in accordance with the principles governing such therapy.
Pitta Gulma benefits from the intake of bitter medicated ghee as the preferred method of oleation. This should be followed by fomentation and then purgation. Milk basti prepared with bitter herbs help to reduce the size of the tumors. Blood letting should also be considered.
Kapha Gulma benefits from fasting and the practice of vamana. While internal oleation is not necessary, a paste of sesame, castor, linseed or mustard oil should be applied to the site of the tumor and this should be followed by fomentation. Herbs taken should have a strong pungent and / or bitter quality. Virechana should be performed using castor oil. Niruha basti should be performed using dashmool.
Dual and tridoshic gulma benefits from the combined treatment of the doshas involved. Special herbs mentioned in classical texts to be used to help break up the tumor include calamus, long pepper, chitrak and hing. As these herbs are all warming they are best for gulma that is vata ? kapha in nature.
Rakta Gulma is best treated with oleation and fomentation followed by purgation. In order to break up the tumors, herbs with an alkali quality (strong caustic bases) are recommended. Common herbs that are important in the management of rakta gulma include ashoka and manjistha. It is important to note that it is expected to be seen that the proper treatment of rakta gulma will lead to a temporary increase in bleeding. Care should be used to make sure that the patients does not become too weak from the treatment.
Types: Granthi is categorized to be of 9 kinds by Vagbhat. There is one caused by each dosha, and six categorized by the tissue that is vitiated. These tissues are: rakta, mamsa, medas, asthi, sira (vein) and vrana (ulcer). Other authors have added additional types such as nadi dhatuja, lasika granthi, lasika vahini and tilaja
Samprapti: Kapha plays the predominant role as it enters the affected dhatus. The most common dhatus affected are medas, mamsa and rakta. The result is slow growing cancer of a benign nature.
Vataja granthi presents with a visible tumor that is black or dark in color and is non fixed. It is able to move from place to place if pushed. Its size may fluctuate. It tends to be soft and if pricked, exudes a clear, thin fluid.
Pittaja granthi present with burning over the tumor. The tumor or the region surrounding it will be yellow or red in color. The tumor suppurates quickly and easily and exudes a warm blood when pricked.
Kaphaja granthi presents as a painless, hard tumor whose color is pale. The area around the tumor is cool and itches. The tumor suppurates slowly and if pricked, exudes thick, white, cloudy pus.
Raktaja granthi presents with symptoms similar to pitta and a loss of tactile sensation. This is believed to be causes by an infestation of parasitic worms.
Mamsaja granthi presents essentially as a myoma or benign tumor of the muscle. Closely related are myxomas which are tumors of the connective tissues called snayuaja granthi in Ayurveda. These are large, hard tumors which are moist or oily and tend to be very vascular. They ulcerate and bleed easily and often become malignant. These tumors are associated with meat consumption.
Medaja granthi presents similar to a lipoma or fatty tumor. These often occur on the back, neck, shoulders and wrists. They are caused by either the intake of too much fat or faulty fat metabolism. With kapha at the root of these tumors, they present as being soft. Vata contributes to the condition causing the tumors to also have a movable nature. When they ulcerate, they exude a coppery, black or white fatty fluid. There may be itching with this type of tumor as well but no pain.
Asthi granthi presents similar to an osteoma and also as bone spurs. They often occur secondary to fractures and boney stress. These tumors appear as hard growths within the bone.
Sira granthi are vascular tumors such as angiomas. While they may be benign, many become malignant. They are stated to follow the sudden exposure to cold water on the feet. Sira granthi are painless and they do not pulsate.
Vrana granthi refers to tumors which form of the dried blood surrounding a wound or ulcer. Vrana means ulcer.
Nadi dhatuja granthi refers to benign tumors of nerve origin such as neuromas and neurofibromas (schwann cell tumors). These present as masses within nerve tissue.
Lasika granthi refers to lymphadenomas. This is a general term for any tumor of the lymph glands. These may become malignant.
Lasika vahani refers to lymphangiomas. These are masses of anomalous lymph vessels that are present at birth.
Tilaja granthi refers to skin cancer. Though categorized as a type of granthi it should be listed as a type of arbuda as these are malignant cancers.
Ayurvedic prognosis depends on factors such as the relationship of the condition to the patient?s constitution, age and the season the condition occurs within. Those arising from the three doshas, rakta and medas are curable and consider easier to treat. Those that are large, hard and located on marmas along with those occurring in or on the throat and abdomen are said to be incurable.
According to Vagbhatta benign tumors that have not suppurated are treated in a manner similar to swelling. In addition, purification therapies should be applied following proper oleation. When purification is complete, a penetrating paste can be applied to the tumor.
One simple suggested paste is that of turmeric, manjishta and mung dal. The area is then fomentated and squeezed gently as the tumor ripens. This procedure is repeated over and over. The goal is to draw the tumor out. This treatment is true for tumors of all three doshas but most especially those of vata nature. Due to the application of heat and paste, the tumor should ripen and allow itself to be squeezed. If this does not occur the tumor should be removed by surgical means. It was well known that if the entire tumor was not removed it would surely grow back again. In the case of pitta granthi, it is recommended to apply leeches to the tumor and heat is avoided or minimized. The open wound should be washed with cool infusions of herbs and allowed to heal.
Types: There are six kinds of malignancies. They are vataja, pittaja, kaphaja, raktaja, mamsaja and medaja. Sarcomas are considered a type of mamsaja arbuda.
The classical management of Arbuda (malignancy) is considered to be similar to the management of granthi (benign tumors) in so much as the treatment noted under granthi is applied first. In addition, poultices are prepared with specific herbs, spices and oils and applied to the tumor. Herbs are chosen which pacify the affected dosha. This is then followed by localized steam therapy such as nadi swedana. Specific formulations for each poultice are provide in Chakradatta and other classical texts.
According to Sushruta, vataja arbuda chikitsa responds to a simple poultice prepared with boiled fatty meat and spices. Pitta arbuda chikitsa requires milder fomentation and purgation in addition to the other therapies while kapha arbuda chikitsa requires both vamana and virechana be performed.
Medaja Arbuda (Fatty malignancy) is first fomentated and then the surgically opened. According to Sushruta, the wound is then thoroughly cleansed, sutured and plastered with healing herbs.
Ancient knowledge provides important clues for the modern practitioner who desires to provide his / her patient with the best possible care. In this modern age cancer remains a primary threat to society and Western medicine offers little in the way of conventional treatment for many types of cancer. Thus, we must look for answers in the timeless sciences steeped in the knowledge, lore and wisdom of Nature herself. There lie treasures to be re-discovered that may one day bring an end to suffering.
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