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Thursday, April 18, 2013

Palliative care in cancer management -Siddha


This is an article presented for World Siddha Day- 2013
Dr.T.Thirunarayanan
Centre for Traditional Medicine & Research
4A, 4th Cross Street,
Mahalakshmi Nagar, Adambakkam, Chennai- 600088

Disease burden due to epidemics caused by vector borne diseases like dengue, swine flu, malaria are unabated on one hand, with no respite in communicable diseases like tuberculosis, hepatitis, HIV, the incidence of non- communicable diseases like stress, obesity, hypertension, diabetes, Ischemic heart disease and cancer pose a major challenge to the Public health managers of a developing country like India. There is a possibility of reducing the burden of the vector borne diseases by effective mosquito control, improving sanitation, making potable drinking water available to the mass. Early lifestyle modification, better diet control, exercise can reduce the burden of diabetes, obesity and hypertension. The large majority of the cancers except the tobacco caused cancers as of today is not preventable and once afflicted severely affects the quality of life or life threatening. 

The incidence of cancer is given in the Table- 1
Type in Men
Percentage
Type in Women
Percentage
Oral, including lip and Pharynx
22.9%
Cervical
17.1%
Stomach
12.6%
Stomach
14.1%
Lung
11.4%
Breast
10.2%

Source;  Dikshit R et al, Cancer mortality in India: a nationally representative survey. Lancet. 2012 May 12;379 (9828):1807-16.

Leukemia is common among children, Prostrate cancer a very common problem among men in US (25%) is not that prevalent in India. Cancer of the Urinary Bladder constitutes 5% of the cancer cases.

Cancer Drugs according to classical Siddha texts

Classical literature of the codified system of medicines of India namely Siddha and Ayurveda have detailed descriptions of cancer of the different organs of the body, their clinical manifestations, treatment procedures and drug formulations. ‘Puttru’, ‘Kazhalai’ are the terms used in Siddha, and ‘Arbuda’ ‘Gulma’ in Ayurveda for neoplasm. Many texts on Inorganic Pharmaceutics ‘Rasaoushadi’ list various drugs that could be used in neo-growth. A detailed literature search on the drugs indicated in the classical Siddha texts and are currently being manufactured by Siddha drug industry are the following.

‘Agathiyar Kuzhambu’ (Source-Agasthiyar Amutha Kalai Gnanam) A drug containing purified inorganics like mercury, red orpiment, yellow orpiment, dehydrated borax, rock salt, and herbal drugs like  aconite, croton seeds asefoetida, black mustard, ajowan, black cumin and castor oil is indicated as topical application in mammary cancer   

‘Kaantha chendooram’ (Source- Agasthiyar paripooranam 400) A drug containing purified  lode stone, sulphur, lead wort powder processed with eclipta juice, lime juice, milk, egg albumin, madder latex is indicated in Abdominal tumor

‘Poorna chandroodayam’ (Source- Theriyar Karisal 300) A drug containing Gold filling, Mercury, Sulphur processed with red cotton flower juice and banana rhizome juice is indicated in cancerous ulcers.

Mahaavallaathi (Source - Bogar Vaithyam 700 and Vallathi 600) A drug containing all herbal ingredients milk, ghee and honey- china root, emblic and belleric myrobalan, dry ginger, lesser galangal, Indian spikenard, cinnamon bark, picrorrhiza, telichery seeds, shiva’s neem, black musale, nutmeg, c;loves, cinnamon leaves, black pepper, cardamom, ajowan, long pepper, psoralea, coriander seeds, embelia, nigella, leadwort root, celestrus, withania, saffron, korochan, purified marking nut, brown sugar, is indicated in cancer.

Kowsiker kuzhambu  (Source  Kowsika muni nool)
Chebulic myrobalans, black mustard, rock salt, asafoetida, dehydrated borax, purified mercury, purified red orpiment, long pepper, purified yellow orpiment, cumin, picrorrhiza, purified aconite, purified croton seed kernel, carbonized coconut shell, palm jiggery, daemia leaf juice, coconut milk is indicated in cancer with daemia juice

Rasakanthi mezhugu (Source-Pulippani vaidhyam 500)
Purified mercury, purified sulphur, calomel, yellow orpiment, lode stone, blue vitriol, calamine, litharge, dry ginger, ajowan, turmeric, embelia, sweet flag, clove, china root, purified marking nuts, chebulic myrobalan, nigella seeds, wild cumin, beetle killer, yew leaf, raisins, long pepper, lesser galangal, costus, celastrus, fennel, cardamom, nutmeg, black pepper, cumin, psoralea, oak grass, long pepper root, rattan cane root, purified nux vomica, purified nux potatorum, astercantha seeds, sesame seed, horse gram, copra, acalypha fruticosa root, azima root, withania, corallocarpus root, lead wort root, eggs, palm jaggery is indicated for cancers and cancerous ulcers.
Some drugs like Chandamarutha chedooram, Idivallathy Mezhugu, Serankottai Nei, which are used by healers do not have a direct reference for treatment of cancer in the  texts


Treatment seeking pattern
Centre for Traditional Medicine & Research receives cancer patients at different stages. Difficulty in swallowing, abnormal bleeding, loss of appetite, weight loss, low grade fever, fatigue, altered bowel habits and pain are some of the features with which patients present themselves. Most of the patients come to us with diagnosis from cancer hospitals.

Detailed interactions with the patients reveal increasing number of patients seek remedy from practitioners of Traditional medicines for the following reasons.
  • 1.      Most cases are diagnosed very late after metastasis has occurred and the general health of the patient does not permit complete surgical removal as the disease has spread to multiple locations. In spite of removal in rest of the cases where the lesion is localized the possibility of microscopic metastasis cannot be ruled out.
  • 2.      The serious side effect of chemotherapy like severe vomiting, diarrhea makes the patient does not continue the treatment for its suggested full course.
  • 3.      The possibility of chemotherapy and radiotherapy destroying the normal cells apart from the cancer cells due their cytotoxic effects.
  • 4.      Target chemotherapy and monoclonal antibodies therapies are not widely available.
  • 5.      The absence of specific cancer treatment hospitals even in many district head quarters is yet another hurdle.
  • 6.      Without health insurance, the cost of treatment is prohibitive for most people and they are ill affordable to a vast majority.

Above all there is a trust that the traditional medicine, particularly Siddha can cure cancer is very strong among people.
The following are the different categories of patients who seek treatment at CTMR.

  • ·   Patients in advanced stage where all other options of chemotherapy, surgery and radiotherapy are not possible,
  • ·         Patients not willing to undergo the orthodox method but wants to be treated with Siddha medicine
  • ·         Patients who want supportive therapy- supplementation alongside conventional treatment and
  • ·       the last set of patients who have undergone treatment including surgery but want to prevent reoccurrence or with late secondaries.

Pallative Care

The basis of treatment at CTMR is palliative care. Since vast majority come at advanced stages the realistic option is palliative care aimed at improving the quality of life of the patient and their immediate family by providing pain relief, psychological support and administration of specific plant based drugs for which enough evidence are available in classical texts and also evaluated by scientific methods both in-vitro and in-vivo.

The first step in the care is proper counseling to the patient and the attendants on the nature of the condition, the likely prognosis and need for following the suggestions on dietary recommendations, lifestyle modification, abstaining from causative substances like tobacco, alcohol and adation of Kayakalpa methods including breathing exercise, meditation etc.

The dietary recommendation is generally rich in fruits and vegetable salads- baked vegetables rather than deep fried once. Significant reduction in intake of meat products, avoidance of oily, fat rich deep fried spicy pungent diet is also suggested. Depending upon the patient’s ability to sallow porridge, fruit juices, soups are suggested.

Then the administration of drugs. The preferred drug of choice in most types of cancer is Mahavallathy Among the different drugs listed in Siddha this drug is free from inorganic and contains powerful anti-oxidants like Amla, long pepper etc, appetite enhancers like black pepper, clove, cinnamon bark etc. cytotoxics like leadwort and marking nut.

As supportive therapy all patients are provided with a blend of turmeric and Indian gooseberry which are known to quench the free radicals. Withania somnifera, apart from being a drug which sensitize cytotoxic drugs is an anabolic and adaptogen helps the patient in overcoming stress and ensure sleep. Dry ginger or Inji legiyam greatly helps in preventing nausea and vomiting in co-adminstered in patients undergoing chemotherapy. The blend of Indian gooseberry and turmeric is also a hypoglycemic drug and reduces supply of glucose to cancer cells and slows down cell multiplication.

In pancreatic carcinoma and secondaries in liver, Phyllanthus amarus extract is also administered. In conditions of spread to lungs manifested with coughing, Thalisathy churanam is included. In anemia associated with blood loss ‘ Karsalai Karpam’ is also prescribed.

Conclusion

Our observations assure us all these patients including the ones with esophageal, pancreatic cancer, ovarian cancer patient have lived over two years without much of clinical symptom and compromising on the quality of life. It is worth considering the Pallative care approach of Siddha in improving the quality of life of cancer patients.