Clinical effect of Ayurveda medicine in recurrent post-operative ovary carcinoma: a case report

Background

Abnormal growth of cell called as cancer or malignancy.Although it may be seen in any age, more commonly seen in patients more than 50 years of age.where epithelial ovarian cancer has been commonly seen[1].Approximately 70% of ovarian cancers have been diagnosed at progressive stage where only 30% of women suffering from this cancer, expect to survive up to 5 years.

Ovarian malignancy constitutes about 15–20 percent of genital malignancy.In India the incidence of ovarian carcinoma (age adjustable to range from 1.7 to 15.2 from 2012 to 2014) in various population-based registers of cancer.Approximately 59,276 have been estimated as new ovarian cancer causes by the end of 2020 and twenty percent of neoplasms are malignant.It is the fourth most common cause of cancer death in women exceeded only by breast, colon and lung malignancies.Again, the recurrent ovarian cancer is a fatal disease with few survivors.Despite the fact that most patients have uniform surgery and chemotherapy, the status of recurring disease varies.The location of recurrence and the periods between recurrences are likewise widely dispersed.After recurrence,approximately 70% of advanced stage ovarian cancer patients relapse,and even in stage I or II patients, the relapse rate is 20%–25%.Because the survival curve following recurrence never plateaus, the goal of treatment for recurrent ovarian cancer is to control the disease and its symptoms, limit treatment-related damage, and preserve or improve quality of life [2].There seems to be no doubt that Ayurveda,with its holistic approach, is the finest way to limit the adverse treatment outcomes while also enhancing the patient’s quality of life.

Case report

A 37 years old married woman a post-operative case of Carcinoma(CA) ovary approached the cancer consultation and Treatment Unit National Institute of Ayurveda Jaipur (OPD No.15403032020) on 20.07.2020 with chief complaints of excessive bleeding per vagina associated with chief complaints of excessive bleeding per vagina associated with excessive clots, severe dysmenorrhea, dyspareunia for 6 months, bilateral lower abdominal pain, vulval itching, vaginal discharge, increased frequency of micturition with burning, Burning sensation in chest, loss of appetite, and flatulence for 2 months.

皮帶輸送機(jī)構(gòu)帶動穴盤從機(jī)架下穿過，機(jī)架上安裝有左、右支撐板，主軸通過軸承安裝在支撐板上，主軸與支撐輪相連，支撐輪與滾筒相連，滑板在滾筒與支撐輪形成的滑板滑道內(nèi)上下運(yùn)動?；鍍蓚?cè)連接有滾子，滾子可在焊接于支撐板上的凸輪槽內(nèi)滾動。支撐板上坐有料箱，料箱上通過螺栓連接固定有導(dǎo)料板。調(diào)速電機(jī)由接近開關(guān)控制，通過鏈傳動帶動主軸旋轉(zhuǎn)。

在處理“雙反”問題時(shí)，應(yīng)該重視問題預(yù)防與事后補(bǔ)償相結(jié)合的方法。通過計(jì)算方法上的調(diào)整來消除“雙反”問題固然是一種方法。但是正如美國法院所說，通過細(xì)微的調(diào)整來抵消雙重征稅的問題存在很大的困難。并且，這種救濟(jì)方式屬于被動的救濟(jì)，即存在貿(mào)易損失已經(jīng)發(fā)生后再通過手段進(jìn)行彌補(bǔ)。但是，既然問題已經(jīng)明確，更好的方式則是通過預(yù)防來防止問題的產(chǎn)生。如果調(diào)查機(jī)構(gòu)在調(diào)查中能夠具體問題具體分析，嚴(yán)格仔細(xì)審查中國的市場以及相關(guān)企業(yè)和商品的情況，那么就可以避免采取不必要的救濟(jì)措施，而“雙反”問題從根源上也不會發(fā)生。

Raktaprasadak hima is the proprietary medicine from Pharmacy of National Institute of Ayurveda, Ministry of AYUSH (Ayurveda, Siddha,Homeopathy, Yoga and naturopathy), Government of India, Jaipur,Rajasthan, containing 5 drugs namely Ushir, Kakmachi, Bhumiamali,Satavari, Manjistha.Most of the drug in the Rakta Prasadhak him have Madhur (sweet), Tikta (bitter) Rasa having Laghu (light), Snigdh(onctous) Guna, Shita (cold) Virya which helps in pacification of aggravated Pitta Dosha, drugs such as kakmachi and sariva are tridoshshamak where kakmachi have rejuvenating effect along with shothhara properties and sariva has vishghana property.Ushir and bhumamlaki helps to pacify kaphpitta dosha and act as vranropan it also has manjistha as another important drug which help in purification of blood with the major vishaghna property.

Physical and systemic examination revealed nothing noteworthy except per abdomen on deep palpation; there was tenderness on Right Iliac Fossa, Hypogastrium and Left Iliac Region.Prior to the pelvic examination informed consent was obtained.

Past history: She was diagnosed with CA Right Ovary, and underwent Right Salpingo–Oophorectomy and Left Ovarian Cystectomy on 13.07.2019 along with 6 cycles of chemotherapy.Approximately 6 months after the surgery she was again diagnosed with Recurrent Left Ovarian Mass Adenocarcinoma in histopathology done on 05.02.2020 for which again she underwent total abdominal hysterectomy + Left Salpingo-Oophorectomy + Omentectomy on 03.07.2020.No relevant family history.Thereafter she approached cancer consultation and Treatment Unit National Institute of Ayurveda Jaipur.

2017年4月21日，我們在烏蘭巴義爾的帶領(lǐng)下參觀完令人震撼的斯大林格勒保衛(wèi)戰(zhàn)全景博物館和神往以久的祖國母親紀(jì)念碑群后，驅(qū)車過伏爾加河來到30公里外的阿赫圖巴河左岸，來到了前文所述伏爾加市基里亞科夫基(Киляковки)區(qū)。這里就是我們一直在尋找的當(dāng)年圖理琛曾造訪過的阿玉奇汗牙帳所在地——馬奴托海。

External genitalia were found to be normal on a local examination.During the per vaginal examination- tenderness and white discharge was found locally.

Investigations

隨著國有企業(yè)改革的深入推進(jìn)，基層黨支部的政治地位和作用發(fā)揮缺乏準(zhǔn)確定位。在參與重大決策、領(lǐng)導(dǎo)思想政治工作等方面底氣不足，黨支部的地位和作用“邊緣化”。黨務(wù)工作人員不足，黨務(wù)干部“兼職化”“業(yè)余化”，影響了基層黨組織的政治核心作用發(fā)揮。

觀察組在常規(guī)護(hù)理的基礎(chǔ)上，增加5A模式進(jìn)行干預(yù)，時(shí)間同對照組。包括（1）詢問：詢問患者的基本情況、解答患者的疑慮和擔(dān)憂；（2）評估：查閱患者病例資料，了解患者的基本病情、手術(shù)情況、術(shù)后用藥情況，并作好記錄，并由專職護(hù)士負(fù)責(zé)術(shù)后的追蹤和隨訪；（3）建議：由責(zé)任護(hù)士向患者講解術(shù)后管理的重要性及需要注意的問題，建議患者家屬參與到患者的病情管理中；（4）幫助：對患者的自我管理進(jìn)行指導(dǎo)，如藥物不良反應(yīng)、飲食、日?；顒拥囊?guī)范等，提醒患者按時(shí)復(fù)查相關(guān)指標(biāo)；（5）安排隨訪：追蹤患者的個(gè)人行為管理情況，隨訪期間，主動通過電話、微信等多種渠道了解患者信息，定期于醫(yī)生處隨診。

Therapeutic intervention

Apana Vayu is situated in Shroni (pelvis), Vasti (bladder), Meddhra(penis) and Uru according to Ayurveda.It is responsible for the excretion of Sukra (semen in males), Artava (menstrual blood in females), Mutra (urine) and Garbha (foetus) outside the body.Whenever Apana Vayu gets vitiated, its normal functions get hindered[3].In this case, complains of Aadhmana (flatulence), Udara gaurava(heaviness in abdomen especially in Adhahudara), Vibandha(constipation) which reflects the symptoms of vitiated Apana Vayu.However, in due course of time, these symptoms get aggravated and causes Samana Vayu Dushti, because Samana Vayu is situated just above the Apana Vayu.Samana Vayu receives food from Aamashaya(stomach) and it helps in digestion and separation of Aahar Rasa from Mala and mutra.Here, due to Samana Vayu Dushti Udarshula(abdomen pain), Adhmana (flatulence), Chardi (vomiting) and Udara gaurava (heaviness in abdomen) symptoms were seen.Generally, the site of Pachak Pitta is Kshudranta (second part of small intestine),where it helps in digestion of Aahara (food) and separation of Rasa(Sara) from Mutra (urine) and Mala (Kitta- feaces).In this case due to vitiation of Pachaka Pitta, Udaradaha, Chardi was noted in patient.

Result and observation

Patient was examined every 15 days follow up for 1 year, though symptoms subsided within 2 months of the treatment and watch for CA-125, the prognostic tumor marker for Ovarian Cancer.But same medicine continued for rest of the months as a precautionary measure.Before and after treatment observations are showed in table 2 and is illustrated in figure 1.

This combination of medicines was continuously given for 8 months to the patient.Then she repeated Contrast Enhanced CT Scan Whole abdomen on 13/03/2021, which revealed no evidence of any free fluid in peritoneal or pelvic cavity, no obvious residual/recurrent lesion in pelvis in either adnexa, No evidence of pelvic lymphadenopathy.She was repeatedly advised the CA-125 tumor marker investigation.The changes of tumor marker CA-125 after treatment started till 1 year later are given in table 3 and illustrated in figure 2.

Discussion

In India, ovarian cancer is the leading cause of death and despite of conventional therapies including Surgery, Chemotherapy &Radiotherapy, recurrence of Ovarian Cancer is common.The treatment principles can be effectively formulated in such a way to avoid recurrence of Ovarian Cancer by controlling the CA-125 which prognostic laboratory test for Ovarian cancer.In Ayurveda though the direct reference of ovarian cancer has been found directly, but clinical manifestation of ovarian cancer is likely to similar with Raktaj Gulma.

She was advised Investigation CA-125- which was 5.9UmL on 17.08.20.

The Ayurvedic Medicine along with pathya ahar (diet) were started after examination in detail are given in table 1.

Classical text has mentioned the definition of health i.e., the functions of Dosha, Dhatu, Agni and mala should be in normal state[4].

在進(jìn)行信息導(dǎo)入數(shù)據(jù)庫時(shí)，需要以友好界面為基準(zhǔn)進(jìn)行相關(guān)信息導(dǎo)入。同時(shí)，在錄入的過程中要確保信息的準(zhǔn)確度。只有確保信息的準(zhǔn)確度，才能發(fā)揮數(shù)據(jù)庫的優(yōu)勢，提升數(shù)據(jù)管理方面的效率。同時(shí)，工作人員也可以根據(jù)實(shí)際工作需求，對數(shù)據(jù)進(jìn)行修改操作。

Because of the vitiation of Doshas, Dhatus, Patient was complaining of burning Sensation in Epigastric Region, with abdominal Belching,Watery brash.After examination, her Dosha, Dhatu and Mala Dushti were found.As per the symptoms, the treatment of Apana Vayu,Samana Vayu and Pachaka Pitta must be done to normalize their functions.For that, different kinds of Vata-Pitta Shamak medicines were given, that helped to pacify of aggravated Dosha.At present patient is under observation.No complications were noted during follow up and no worsening of previous symptoms noted.

Menstrual History: She attainted menarche at age of 13 years and had regular cycles thereafter with 28 days interval and 4 days of bleeding cycle.Dysmenorrhea and clots were ++.

“最后，我們來看一下這波團(tuán)戰(zhàn)的經(jīng)過?！蓖跣【耙贿吙粗笃聊簧系馁Y料，一邊開啟了解說模式，“清軍的主‘肉盾’‘定遠(yuǎn)號’用主炮射擊首先開團(tuán)，副‘肉盾’‘鎮(zhèn)遠(yuǎn)號’跟著施放技能，然后所有隊(duì)員沖了上去！日軍利用速度優(yōu)勢，派出四艦突擊，切了清軍的后排，直接滅了后排的‘超勇號’和‘揚(yáng)威號’，對清軍形成了兩面夾擊！為保護(hù)后排，清軍‘致遠(yuǎn)號’拼盡全力，沖擊日軍的突擊隊(duì)，最終英勇獻(xiàn)身！‘經(jīng)遠(yuǎn)號’繼續(xù)沖擊日軍的突擊隊(duì)！但在這時(shí)，兩名后排隊(duì)員‘友濟(jì)元號’和‘廣甲號’直接選擇了回城！”

Lavana Bhaskara Churna having the property of Vatanulomana with Sarjika kshara which decreases Udara daha by neutralizing increased Pachaka Pitta.

Shatavaari Gudum Avaleha in this formulation, the main ingredient is Shatavari, having Vatapitta Shamak property, Rashayan, Balya karma.Because of these properties of Shatavari, it nourishes all the diminished Dhatus and also acts on Garbhashaya by improving ovarian function and enhance ovulation, provides strength to the uterus, inhibits abnormal discharge from any part of the body or any vaginal discharge [5].

Combination of Jawahara mohara pisti, kaharva pishti, Swarna makshika and Mukta pishti was given, as it has Sheeta guna and pittahara property which relives Udaradaha.

Haridra (Turmeric) has Kapha Vata Shamak properties, that is responsible for anti-inflammatory activity (Shothghna).Active principle that mainly shows anticancer properties in Haridra are Curcumin, Turmerone and polysaccharides.So, these active principles inhibit TNF-α-induced AKT activation through where metastasis growth takes place and thus suppresses the tumor angiogenesis [6].

Because of presence of Ushna Virya and Katu Veepeka in Haridra, it strengthens Pachak pitta.

Gomutra (cow urine) has Katu, Tikta Rasa with Kapha-Vatashamak[7].It has the potency to increase the efficacy of ayurvedic cancerous drugs and helps in absorption of these medicines by treating Apana Vayu.It also shows property of antimicrobial and antifungal action.

Some studies showed that, cow urine promotes lymphocytes to survive by inhibiting their degradation and also repairing the normal damaged DNA.Similarly, chemoprotective potential of Gomutra has been observed through a study in mice, that showed the incidence of tumor (papilloma), tumor yield and its burden was found statistically less in mice that was treated with cow urine than untreated group [8].

Conclusion

The signs & symptoms of patient of ovarian cancer has been subsided within 2 months and there were no obvious abnormal changes found in Contrast Enhanced CT Scan abdomen and CA.125 < 0.0

U/L.Thus,Ayurvedic Treatment will be effective in controlling of regrowth of ovarian cancer and avoidance of recurrence.Although much more research is needed to confirm the findings.

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