As we all know ‘Is Cancer mentioned in Ayurveda or not?’ or ‘Cancer can be called Arbuda or not?’, the following debate has been going since many decades with advent of Allopathy Science. Many eminent and accomplished ayurvedic experts have and had a varying and contrasting views spiraling around the above mentioned ‘million dollar’ questions, some agreeing to the views that indeed Cancer is mentioned in Ayurveda and is mentioned as ‘Arbuda’, and some not agreeing to the same as ‘Cancer’ cannot be called ‘Arbuda’ as a small chapter has been dedicated to same for a Maharoga like Cancer which is definitely fatal if not treated at an earlier stages.
In accordance to my personal opinion and different references mentioned in Samhitas, I would like to state that we can definitely define ‘Arbuda’ as ‘Cancer’. But not all types of ‘Cancer’ can be called ‘Arbuda’. It is that specific composition of dustha doshas and medha dhatu which is mentioned in ‘Samprapti of Arbuda’, and when the same affects different dhatus (Rakhtadi) and avyav (Organs) can lead different forms of Cancers, and not all can be categorized as Arbuda as it is specifically mentioned that it affects Mansha dhatu only, as mentioned in following shloka
“गात्रप्रदेशे क्वचिदेव दोषा: सम्मूर्छिता मांसमभिप्रदुष्य। Su.Ni 11/13 It means that somewhere or anywhere (क्वचिदेव) in the body vatadi doshas collectively pollutes mansha dhatu. ”
Let me categorically enumerate why Arbuda can be categorized as few forms of Cancer: –
And as we all have observed that Cancer can affect across multiple dhatus and avyavas (For example like Blood Cancer – Raktha Dhatu, Bone Cancer – Asthi Dhatu, Liposarcoma – Medha Dhatu etc.) which does not have involvement of mansha dhatu.
1. चिरवृध्द्यपाकम्॥ Su.Ni 11/13 धीरे धीरे बढ़्ने वाला और पाक रहित।
A. चिरवृध्दि
As well all know that most cancers take years to develop and often occur in people as they get older. This long process is mainly due to the cell’s protective mechanisms to keep cancer from developing. However, as cells age, the chance of accumulating harmful mutations increases and cancer cells can start to grow. Once the cells become cancerous, it can take years of continuous dividing for the cancer cells to produce a human tumor that is large enough to cause illness or migrate to other tissues.
So in technical terms we can call cancer takes many years to grow and the same feature is exhibited (चिरवृध्दि/ धीरे धीरे बढ़्ने वाला) by Arbuda as mentioned in Ayurveda.
B. अपाकम् || Su.Ni 11/13 पाक रहित।
As we all know the shortest definition of Cancer is that ‘A wound that never heals.’ Cancer cells hijack the cellular programmes that normally get activated during wound repair and keep them activated permanently to drive and sustain malignancy, making cancer akin to a wound that never heals, says an expert at the recent Frontiers in Cancer Science 2018. There is a vast research material available over the same kindly refer the same.
As well know resolution of rogas in Ayurveda happen after dustha doshas achieves पक्व अवस्था. So Cancer by being a ‘Non – Healing Wound’ it means that the dustha doshas which is related to it never achieves पक्व अवस्था or in general sense remains in अपाक अवस्था, and the same is true about Arbuda as mentioned in Ayurveda.
2) यज्जायतेऽन्यत् खलु पुर्वजायते ज्ञेयं तदध्यर्बुदमर्बुदज्ञैः। Su.Ni 11/20 वह अर्बुद जो पहले से उपस्थित अर्बुद के उपर हो जाता हो वह असाध्य कहलाता है।
Let’s look into well-established and proven theory of ‘Intra-Tumoral Heterogeneity’.
Intratumor heterogeneity (also known as intralesion heterogeneity) refers to distinct tumour cell populations (with different molecular and phenotypical profiles) within the same tumour specimen. Also, an explanation of this is Intra-tumour heterogeneity is defined by genomic and biological variations within a tumour acquired by tumour cell evolution under diverse microenvironments. Intratumor heterogeneity may foster tumour evolution and adaptation and hinder personalized-medicine strategies that depend on results from single tumour-biopsy samples.
Cancer patients die primarily due to disease recurrence after transient treatment responses. The emergence of therapy-resistant escape variants is fuelled by intra-tumour heterogeneity, underpinned by interference and Darwinian evolution among continuously developing sub-clones in the mutating tumour. Novel cancer cell variants build upon the pre-existing genetic landscape and tumour heterogeneity is often ascribed largely to genetic variability.
Tumour heterogeneity is associated with poor prognosis and outcome. It is thought that Intratumor heterogeneity is one of the leading determinants of therapeutic resistance and treatment failure and one of the main reasons for poor overall survival in cancer patients with metastatic disease
3) न पाकमायान्ति कफ़ाधिकत्वान्मेदोबहुत्वाच्च विशेषस्तुतिरस्ति। Su.Ni 13/21 सभी प्रकार के अर्बुद स्वभावतः पाक रहित होते हैं, क्योंकि इनमें विशेषकर कफ और मेद/adipose tissue की अधिकता होती है।
Let’s look into fact what’s the role of मेद/adipose tissue in Cancer progression and proliferation, which is clarify our Question Is Cancer mentioned in Ayurveda or not ?
Environment surrounding tumours are now recognized to play an important role in tumour development and progression. Among the cells found in the tumour environment, adipocytes from adipose tissue establish a vicious cycle with cancer cells to promote cancer survival, proliferation, metastasis and treatment resistance. This cycle is particularly of interest in the context of obesity, which has been found as a cancer risk factor. Cancers cells can reprogram adipocyte physiology leading to an “activated” phenotype characterized by delipidation and secretion of inflammatory adipokines. The adipocyte secretions then influence tumour growth and metastasis which has been mainly attributed to interleukin 6 (IL-6) or leptin but also to the release of fatty acids which are able to change cancer cell metabolism and signalling pathways.
Obesity is associated with an increased risk of developing multiple types of cancer. It is estimated that up to 20% of all cancers are caused by obesity. In the past 30 years, there have been hundreds of epidemiologic studies that have examined the relationship between obesity and cancer risk. In 2016, the International Agency for Research on Cancer (IARC) concluded that obesity was associated with an increased risk of 13 types of cancer, including breast (post-menopausal), colorectal, endometrial, oesophageal (adenocarcinoma), gall bladder, gastric cardia, kidney (renal cell), liver, meningioma, multiple myeloma, ovary, pancreas, and thyroid. Evidence also suggests that weight gain during adulthood is associated with an elevated risk of developing post-menopausal breast, colorectal, endometrial, kidney, and high-risk or fatal prostate cancers when compared with adults whose weight remains stable.
The about mentioned explanation confirms my belief that adipocytes supports cancer survival, proliferation, metastasis and treatment resistance, the same is mentioned in Ayurveda in relation to Meda Dhatu with Arbuda.
And the above mentioned statement hold true that obese people ( state of excess मेद dhatu) are more predisposed to cancer.
It also explains the above mentioned statement why Cancer is called a wound that doesn’t heals because its कफ और मेद/adipose tissue that lets the dustha doshas which is related to it never achieves पक्व अवस्था or in general sense remains in अपाक अवस्था because of its स्थिरत्व guna and these all above statement describe our questions answer ” Is Cancer mentioned in Ayurveda or not ? “
4) स शेषदोषाणि हि योअर्बुदानि करोति तस्याशु पुनर्भवन्ति॥ तस्मादशेषाणि समुध्दरेत्तु हन्यु सशेषाणि यथा हि वन्हि:। सु.चि 18/42 यदि चिकित्सक द्वारा सम्पुर्ण अर्बुद न निकाला गया हो तो ऐसे अर्बुद पुन: हो जाते हैं। अत: सम्पुर्ण अर्बुद को निकाल देना चाहिए। शेष रह गये अर्बुद रोगी को अग्नि कि तरह नष्ट कर देते हैं।
Let’s look into well-established and proven theory of ‘Intra-Tumoral Heterogeneity’.Lets look into the fact that why clear margins/negative margin or no cancer cells at the outer edge of excised tissue is important following excision of cancer mass in long term survival or prognosis of cancer patients by an example of different cancer cases
Positive Surgical Margin (PSM).
The edge or border of the tissue removed in cancer surgery. The margin is described as negative or clean when the pathologist finds no cancer cells at the edge of the tissue, suggesting that all of the cancer has been removed. The margin is described as positive or involved when the pathologist finds cancer cells at the edge of the tissue, suggesting that all of the cancer has not been removed.
Positive surgical margins after excision of the cancer increase the risk of disease recurrence, primarily in patients with adverse pathological features, and dampens the patient’s prognosis and long term survival.
So a complete excision of the cancer both at the macroscopic and microscopic level which is evident by clear margin or negative margin of the excised mass is necessary for reducing the chaces of recurrence, and improving the prognosis and long term survival of the patient. And the same is mentioned regarding arbuda in our Shastras.
All the above points confirm my belief that ‘Arbuda’ as mentioned in Ayurveda Shastras can be definetly compared with ‘Cancer’. But why does all form of ‘Cancer’ can’t definetly be defined as ‘Arbuda’ the same answer is mentioned in our ayurvedic texts only.’
Lets take an example of ‘Blood Cancer’ which in popular trends is synonusmosly is called ‘Rakta-Arbuda’ by Ayurveda Vaidya’s now a days. But can really ‘Blood Cancer’ can be called as ‘Rakta Arbuda’ the answer lies below –
रक्तार्बुद
दोष: प्रदुष्टो रुधिरं सिरास्तु सम्पीड्य सन्कोच्य गतस्वपाकम् ॥ सास्रावमुन्नह्यति मांसपिण्डं मांसाड्ंकुरैरचितमाशुवृद्धिम्। स्रवत्यजस्रं रुधिरं प्रदुष्टमसधिरात्मकं स्यात॥ रक्तक्षयोपद्रपीडितत्वात् पाण्डुर्भवेत सोऽर्बुदपीडितस्तु। सु.नि 11/15-16 ’.
प्रदुष्ट दोष रक्त और सिरा को पीडित तथा संकुचित कर पाक को प्राप्त नहीं होते हैं जिससे स्रावयुक्त मांसपिण्ड को ’उन्नह्यति’ अर्थात उभार युक्त कर देते हैं।
इससे दूषित रुधिर निरन्तर स्रवित होता रहता है। यह रक्तार्बुद असाध्य है। रक्तार्बुद से पीडित व्यक्ति रुधिर के निकल जाने से उपद्रव – पीडित होकर पाण्डु वर्ण का हो जाता है॥
In short Raktha-arbuda mostly closely represent an ulcerating raised wound consisting of granulating tissues with continuous bloody discharge and the same is called Asadhya Vyadhi.
Interestingly Fungating Cancer represent more of a kind mentioned as ‘Rakhta-arbuda’ in Sushrut Samhita.
Now let’s define ‘Fungating Cancer’ –
A Fungating cancer wounds are sometimes called malignant ulcers or ulcerating tumours. It develops when cancer that is growing under the skin breaks through the skin and creates a wound. They can develop in the part of the body where the cancer started or in part of the body that the cancer has spread to. A fungating wound is most likely to happen if you have breast cancer, head and neck cancer and melanoma. This kind of lesion may occur in many types of cancer, including breast cancer, melanoma, and squamous cell carcinoma, and especially in advanced and fatal disease. The symptoms of fungating cancer are bleeding, pain, foul smelling discharge etc.
There is a gross similarity between Raktha-arbuda and fungating cancer as both define a stage of end stage disease and are asadhya/untreatable.
So, I would be cautious not to use Blood Cancer synonusmosly with रक्तार्बुद.
Let’s answer to our final question – Why a small chapter has been dedicated for Arbuda which we are corelating with Maharoga like Cancer which is definitely fatal if not treated at an earlier stages?
The answer lies in the statistics of incidence of the disease. As statistics suggests incidence of Cancer have exponentially risen post – industrialization due to unhealthy lifestyle and eating habits evident by consuming more of a processed food. Post – Industrialization, ‘Acquired Cancers’ cases which was in low incidence pre-industrialization era have outnumbered the cases of ‘Hereditary Cancers’ which was more prominent in pre-industrialization era (Charak and Sushrut Kaal) eventually leading to overall increase in cancer incidences across generations and decades.
So as our acharayas have already said the disease which is of low incidence is described in संक्षिप्त or small chapters, and has further we can expand the chapters based on our vivek buddhi.
