{"id":3858,"date":"2022-11-10T11:28:51","date_gmt":"2022-11-10T05:58:51","guid":{"rendered":"https:\/\/ayurvedanetworkbhu.com\/?p=3858"},"modified":"2024-09-07T13:50:26","modified_gmt":"2024-09-07T08:20:26","slug":"lecture-note-concepts-of-malignancy-in-ayurveda","status":"publish","type":"post","link":"https:\/\/ayurvedanetworkbhu.com\/?p=3858","title":{"rendered":"Lecture Note: \u201cConcepts of Malignancy in Ayurveda\u201d (Part-1) by- Prof. Muralidhar Sharma"},"content":{"rendered":"

Concepts of Malignancy in Ayurveda
\n<\/strong><\/span>(Part-1)<\/h2>\n

Prof. Muralidhar Sharma<\/strong><\/p>\n

Transcript by-<\/strong>
\nDr. Mrityunjay Dwivedi,
\nJR-3, Department of Shalya Tantra,
\nFaculty of Ayurveda,
\nInstitute of Medical Sciences,
\nBanaras Hindu University, Varanasi<\/p>\n

Based on the lecture available at\u2013Concepts of malignancy in Ayurveda<\/strong><\/span><\/a><\/p>\n

In my clinical experience of dealing with malignancy from an Ayurvedic point of view, the concept of malignancy has seen a huge change now.<\/p>\n

Definition of tumor
\n<\/strong>When we were studying quite early it was something different and as it is defined now. The definition seems to be significantly different from the definition which we used to study in the beginning, as a complex statement, like a tumor is an independent growth with an atypical arrangement having no useful function and termination, but now the definition is changed. The current definition accepted by the American cancer association is-
\n\u201cA large group of diseases that can start in almost any organ or tissue of the body when abnormal cells grow uncontrollably beyond their usual boundaries to invade adjoining parts of the body and\/or spread to other organs\u201d.
\nNowadays it is considered a large group of diseases. The earlier tumor was considered a single disease. That’s one of the important issues. So, tumor now has become a syndrome, than really a single disease. Now, to make the diagnosis, the final diagnosis of any tumor or identification of any tumor or malignancy is based upon the microscopic findings, the pattern of the changes in the cells are the criteria to decide whether any tissue has become malignant or not.|
\nNow, whether Ayurveda textbooks Charaka, Sushruta, or Vagbhata would have mentioned its management is a question. I would say \u201cimpossible!\u201d because at that time there was no question of a microscope. So, defining the cellular pathology, the division of the shapes of the cells, and then defining that kind of, the pattern would have been possible in Charaka or Sushruta.
\nThat doesn’t mean that diseases of malignancy didn’t exist during the period, definitely as all the diseases were present. So, naturally, perception of the disease, and clinical course of the disease were identified at that period and they might not have been identified as a single disease entity or single pathological entity. At present, the pathological entity of a tumor is based upon a microscopic finding. \u00a0You can see the changes in the cells, the shape of the cells would be atypical, the shape of the nucleus would be atypical, and the number of divisions undergoing is more than normal. Then only, we will consider this as a tumor or malignancy. Now, this kind of perception would never have been possible in Sushruta\u2019s period. So, naturally, the perception of the disease would be something different. So, we will now try to look at the resources in the text, based upon which we can identify the disease tumor. When a patient with a tumor comes to me now, of course, we would make the diagnosis based on the current parameters, but at the same time how I would perceive the same from an Ayurvedic point of view, that’s one of the very difficult questions.
\nNow, to come to that specific point- the theory part, the tumor pathology, of course, majority of the tumors primarily the word tumor itself meaning the mass, but at present, when you say a malignancy, it need not be that the disease should be presented as a mass there could be many types of malignancy, but the mass may not be felt as in case of the leukemia.
\nSo, the primary definition of the tumor now would be based on the microscopic findings, not on the clinical findings. But if it comes to the question of clinical findings, the majority of the diseases are identified with palpable mass lesions and the palpable mass lesions with a similar character of the tumor pathology are described in Ayurvedic text as the arbuda.<\/p>\n

Palpable mass lesion
\n<\/strong>Of course, now in the colloquial language, arbuda is equated or considered as a synonym for a tumor which I don’t fully agree. One group of tumors may be identified as Arbuda but not all the tumors might be identified as arbuda. If we do not consider this part, probably we will not be able to understand the disease process from Ayurvedic point of view. So, one major group of diseases where palpable mass is the presentation of the malignancy, they may be considered Arbuda.<\/p>\n

According to Sushruta is –<\/strong><\/p>\n

\u0917\u093e\u0924\u094d\u0930\u092a\u094d\u0930\u0926\u0947\u0936\u0947 \u0915\u094d\u0935\u091a\u093f\u0926\u0947\u0935 \u0926\u094b\u0937\u093e\u0903 \u0938\u092e\u094d\u092e\u0942\u0930\u094d\u091a\u094d\u091b\u093f\u0924\u093e \u092e\u093e\u0902\u0938\u092e\u092d\u093f\u092a\u094d\u0930\u0926\u0942\u0937\u094d\u092f |<\/strong><\/span>
\n\u0935\u0943\u0924\u094d\u0924\u0902 \u0938\u094d\u0925\u093f\u0930\u0902 \u092e\u0928\u094d\u0926\u0930\u0941\u091c\u0902 \u092e\u0939\u093e\u0928\u094d\u0924\u092e\u0928\u0932\u094d\u092a\u092e\u0942\u0932\u0902 \u091a\u093f\u0930\u0935\u0943\u0926\u094d\u0927\u094d\u092f\u092a\u093e\u0915\u092e\u094d ||<\/strong><\/span>
\n\u0915\u0941\u0930\u094d\u0935\u0928\u094d\u0924\u093f \u092e\u093e\u0902\u0938\u094b\u092a\u091a\u092f\u0902 \u0924\u0941 \u0936\u094b\u092b\u0902 \u0924\u092e\u0930\u094d\u092c\u0941\u0926\u0902 \u0936\u093e\u0938\u094d\u0924\u094d\u0930\u0935\u093f\u0926\u094b \u0935\u0926\u0928\u094d\u0924\u093f |<\/strong><\/span>
\nSu. Ni. 11\/14<\/strong><\/p>\n

But the clinical sign are-
\nA palpable mas which could be having its specified border
\nSthiram- Firm Swelling
\nMandarujam- relatively painless
\nMahantam- a huge swelling
\nAnalpamoolam- its indurated base is deeper than what you see
\nChira vriddhi- which tends to take \u00a0a long time for a suppuration or progression is slow growing or maybe that time it could be fast-growing<\/p>\n

Apakam- doesn’t suppurate.
\nThe most important two characteristics are the- non-suppurative lesion and firm swelling, which is seen. That’s a very important characteristic of a neoplastic mass or tumor pathologies, which are malignant pathologies, which are presented as mass lesions. They are considered as Arbuda. One of the important characteristics of Arbuda is it doesn’t suppurate or Paka doesn\u2019t occur.<\/p>\n

The reason given by Sushruta is<\/strong><\/p>\n

\u0928 \u092a\u093e\u0915\u092e\u093e\u092f\u093e\u0928\u094d\u0924\u093f \u0915\u092b\u093e\u0927\u093f\u0915\u0924\u094d\u0935\u093e\u0928\u094d\u092e\u0947\u0926\u094b\u092c\u0939\u0941\u0924\u094d\u0935\u093e\u091a\u094d\u091a \u0935\u093f\u0936\u0947\u0937\u0924\u0938\u094d\u0924\u0941 |<\/strong><\/span>
\n\u0926\u094b\u0937\u0938\u094d\u0925\u093f\u0930\u0924\u094d\u0935\u093e\u0926\u094d\u0917\u094d\u0930\u0925\u0928\u093e\u091a\u094d\u091a \u0924\u0947\u0937\u093e\u0902 \u0938\u0930\u094d\u0935\u093e\u0930\u094d\u092c\u0941\u0926\u093e\u0928\u094d\u092f\u0947\u0935 \u0928\u093f\u0938\u0930\u094d\u0917\u0924\u0938\u094d\u0924\u0941 ||<\/strong><\/span>
\nSu Ni 11\/21<\/strong><\/p>\n

Dosha sthiratvat and dosha grathana- these are the two forms of pathogenesis.
\nNow, if we go into the basis of the vyadhi.
\nVyadhi is different, as dosha dushya sammurchana i.e., combination of dosha and dushya.|
\nIn the context of arbuda, the definition goes something beyond that sammurchana. Instead, there is a sthiratva and doshagrathana. Now, the sthiratva and doshagrathana suggest about continuity of the pathological process which doesn’t have a termination. So, the definition of a tumor is where we say that there is no termination. That’s exactly what Sushruta has considered as a dosha sthiratva and grathana. So, arbuda is one section of the malignant lesions that can be taken.<\/p>\n

So, when patient comes to me with a mass lesion which can be palpable, definitely, the diagnosis will be something around the arbuda\/ moving around arbuda. Some of the variants of the arbuda, which are mentioned in the Samhita, these are very characteristic of a malignant pathology, like in case of Shonitarbuda, the characteristic feature will be the fragile tissues. Tissues are fragile and they tend to bleed as tumor which tends to bleed on touch.<\/p>\n

\u0915\u0943\u0937\u094d\u0923\u094c\u0903 \u0938\u094d\u092b\u094b\u091f\u0948\u0903 \u0938\u0930\u0915\u094d\u0924\u0948\u0936\u094d\u091a \u092a\u093f\u0921\u0915\u093e\u092d\u093f\u0936\u094d\u091a \u092a\u0940\u0921\u093f\u0924\u092e\u094d |<\/strong><\/span>
\n\u092f\u0938\u094d\u092f \u0935\u0938\u094d\u0924\u0941 \u0930\u0941\u091c\u0936\u094d\u091a\u094b\u0917\u094d\u0930\u093e \u091c\u094d\u091e\u0947\u092f\u0902 \u0924\u091a\u094d\u091b\u094b\u0923\u093f\u0924\u093e\u0930\u094d\u092c\u0941\u0926\u092e\u094d ||<\/strong><\/span>
\n\u092e\u093e\u0902\u0938\u0926\u094b\u0937\u0947\u0923 \u091c\u093e\u0928\u0940\u092f\u093e\u0926\u0930\u094d\u092c\u0941\u0926\u0902 \u092e\u093e\u0902\u0938\u0938\u092e\u094d\u092d\u0935\u092e\u094d |<\/strong><\/span>
\nSu. Ni. 14\/13<\/strong><\/p>\n

(\u0938\u0930\u0915\u094d\u0924\u0948\u0936\u094d\u091a \u092a\u093f\u0921\u0915\u093e\u092d\u093f\u0936\u094d\u091a) that’s the typical feature or a Mansarbuda where the surface will be fimbriated or finger-like. For a Talu arbuda, where the surface also fimbriated appearance and a soft fragile appearance like padmakara i.e. surface will have an irregular surface.<\/p>\n

These are all the typical characteristics of neoplastic mass lesions, as we Study now and they are mentioned in Sushruta Samhita. So, palpable neoplastic conditions benign or malignant are considered without any doubt about them and they are over the surface of the body- gatra pradesha. That gatra pradesha is over the surface of the body but along with that, there are certain conditions where the mass may not be over the surface of the body but mass may be palpated within the abdomen and that abdominal masses like gulma also may be considered as some variety of the neoplastic condition. So, there is a difference between the gulma and the arbuda. \u00a0The gulma is located in the abdomen and it is tend to be movable-<\/p>\n

Visceral mass lesion\u00a0 -Gulma<\/strong><\/p>\n

\u0939\u0943\u0926\u094d\u092c\u0938\u094d\u0924\u094d\u092f\u094b\u0930\u0928\u094d\u0924\u0930\u0947 \u0917\u094d\u0930\u0928\u094d\u0925\u093f\u0903 \u0938\u091e\u094d\u091a\u093e\u0930\u0940 \u092f\u0926\u093f \u0935\u093e\u093d\u091a\u0932\u0903 |<\/strong><\/span>
\n\u091a\u092f\u093e\u092a\u091a\u092f\u0935\u093e\u0928\u094d \u0935\u0943\u0924\u094d\u0924\u0903 \u0938 \u0917\u0941\u0932\u094d\u092e \u0907\u0924\u093f \u0915\u0940\u0930\u094d\u0924\u093f\u0924\u0903 ||<\/strong><\/span>
\nSu. U. 42\/4<\/strong><\/p>\n

Some variety of the gulma could be presented as the malignant lesions where the patient would have the systemic symptoms as such. Another presentation of the tumor pathologies or malignant pathologies (I would say the malignant pathologies) would be an obstruction to the passages- like oesophageal malignancies which produce obstruction to the swallowing. or maybe the pathologies of the prostate or so on where the urethra may be obstructed, common bile duct may be obstructed and so on. So, you identify a neoplastic condition based upon the evidences either the clinical or investigational evidences of obstruction to the passage of the contents, Such obstructive diseases also are mentioned in Sushruta in different contexts among them, one is Balasa.<\/p>\n

obstructive diseases
\n<\/strong>Balasa is a situation where the annagati (the movement of the food) would be affected and you would have a circular swelling around the area.<\/p>\n

\u092c\u0932\u093e\u0938 \u090f\u0935\u093e\u092f\u0924\u092e\u0941\u0928\u094d\u0928\u0924\u0902 \u091a \u0936\u094b\u092b\u0902 \u0915\u0930\u094b\u0924\u094d\u092f\u0928\u094d\u0928\u0917\u0924\u093f\u0902 \u0928\u093f\u0935\u093e\u0930\u094d\u092f |<\/strong><\/span>
\n\u0924\u0902 \u0938\u0930\u094d\u0935\u0925\u0948\u0935\u093e\u092a\u094d\u0930\u0924\u093f\u0935\u093e\u0930\u0935\u0940\u0930\u094d\u092f\u0902 \u0935\u093f\u0935\u0930\u094d\u091c\u0928\u0940\u092f\u0902 \u0935\u0932\u092f\u0902 \u0935\u0926\u0928\u094d\u0924\u093f ||<\/strong><\/span>
\nSu. U. 16\/53<\/strong><\/p>\n

So, when the swallowing difficulty is presented and along with that there is a circular<\/p>\n

swelling, a circular lesion. Valaya or like appearance so balasa and valaya- these are the two variables conditions. Balasa is where the surface would be elevated raised a fungating mass lesion in the oesophagus and an annular lesion or a circular lesion is a Valay So, variance of the esophageal obstructions were described in Sushruta.<\/p>\n

Mudrasthila or \u00a0Mutragranthi
\n<\/strong>Similarly, the obstructive pathologies in the urinary tract like mudrasthila or the mutragranthi.
\nMutrasthila is where a palpable hard mass is felt per rectal<\/p>\n

\u0936\u0915\u0943\u0928\u094d\u092e\u093e\u0930\u094d\u0917\u0938\u094d\u092f \u092c\u0938\u094d\u0924\u0947\u0936\u094d\u091a \u0935\u093e\u092f\u0941\u0930\u0928\u094d\u0924\u0930\u092e\u093e\u0936\u094d\u0930\u093f\u0924\u0903 |<\/strong><\/span>
\n\u0905\u0937\u094d\u0920\u0940\u0932\u093e\u0935\u0926\u094d\u0927\u0928\u0902 \u0917\u094d\u0930\u0928\u094d\u0925\u093f\u0902 \u0915\u0930\u094b\u0924\u094d\u092f\u091a\u0932\u092e\u0941\u0928\u094d\u0928\u0924\u092e\u094d |||<\/strong><\/span>
\n\u0935\u093f\u0923\u094d\u092e\u0942\u0924\u094d\u0930\u093e\u0928\u093f\u0932\u0938\u0919\u094d\u0917\u0936\u094d\u091a \u0924\u0924\u094d\u0930\u093e\u0927\u094d\u092e\u093e\u0928\u0902 \u091a \u091c\u093e\u092f\u0924\u0947 |<\/strong><\/span>
\n\u0935\u0947\u0926\u0928\u093e \u091a \u092a\u0930\u093e \u092c\u0938\u094d\u0924\u094c \u0935\u093e\u0924\u093e\u0937\u094d\u0920\u0940\u0932\u0947\u0924\u093f \u0924\u093e\u0902 \u0935\u093f\u0926\u0941\u0903 |<\/strong><\/span>
\nSu U 58\/7,8<\/strong><\/p>\n

In between the rectal and the urinary tract the mass is felt which is stone like so that’s obviously the prostatic pathologies.<\/p>\n

Again, it’s not the question of benign or malignant it could be a presentation of a mass lesion or similarly in case of mutragranthi which is again a palpable mass but the difference is the there would be a painful condition in mutragranthi, like aybe either the prostatics or some of the tumors of the prostate too can be painful. so that’s evidently identified.<\/p>\n

\u0905\u092d\u094d\u092f\u0928\u094d\u0924\u0930\u0947 \u092c\u0938\u094d\u0924\u093f\u092e\u0941\u0916\u0947 \u0935\u0943\u0924\u094d\u0924\u094b\u093d\u0932\u094d\u092a\u0903 \u0938\u094d\u0925\u093f\u0930 \u090f\u0935 \u091a <\/strong><\/span>
\n\u0935\u0947\u0926\u0928\u093e\u0935\u093e\u0928\u0924\u093f \u0938\u0926\u093e \u092e\u0942\u0924\u094d\u0930\u092e\u093e\u0930\u094d\u0917\u0928\u093f\u0930\u094b\u0927\u0928\u0903 ||<\/strong><\/span>
\n\u091c\u093e\u092f\u0924\u0947 \u0938\u0939\u0938\u093e \u092f\u0938\u094d\u092f \u0917\u094d\u0930\u0928\u094d\u0925\u093f\u0930\u0936\u094d\u092e\u0930\u093f\u0932\u0915\u094d\u0937\u0923\u0903 |<\/strong><\/span>
\n\u0938 \u092e\u0942\u0924\u094d\u0930\u0917\u094d\u0930\u0928\u094d\u0925\u093f\u0930\u093f\u0924\u094d\u092f\u0947\u0935\u092e\u0941\u091a\u094d\u092f\u0924\u0947 \u0935\u0947\u0926\u0928\u093e\u0926\u093f\u092d\u093f\u0903 |||<\/strong><\/span>
\nSu Ut 58\/18,19<\/strong><\/p>\n

Ulcerative lesions<\/strong><\/p>\n

\u0905\u0924\u093f\u0938\u0902\u0935\u0943\u0924\u094b \u0905\u0924\u093f\u0935\u093f\u0935\u0943\u0924\u094b \u0905\u0924\u093f\u0936\u0940\u0924\u094b\u093d\u0924\u094d\u092f\u0941\u0937\u094d\u0923\u094b \u0915\u0943\u0937\u094d\u0923 \u0930\u0915\u094d\u0924 \u092a\u0940\u0924 \u0936\u0941\u0915\u094d\u0932\u093e\u0926\u0940\u0928\u093e\u0902 \u0935\u0930\u094d\u0923\u093e\u0928\u093e\u092e\u0928\u094d\u092f\u0924\u092e\u0903 \u092d\u0948\u0930\u0935\u0903 \u092a\u0942\u0924\u093f\u092a\u0942\u092f\u092e\u093e\u0902\u0938\u0938\u093f\u0930\u093e\u0938\u094d\u0928\u093e\u092f\u0941 \u092a\u094d\u0930\u092d\u0943\u0924\u093f\u092d\u093f\u0903 \u092a\u0942\u0930\u094d\u0923\u0903 \u092a\u0942\u0924\u093f\u092a\u0942\u092f\u093e\u0938\u094d\u0930\u093e\u0935\u0940 \u0909\u0924\u094d\u0938\u0919\u094d\u0917\u0940 \u0905\u092e\u0928\u094b\u091c\u094d\u091e\u0926\u0930\u094d\u0936\u0928\u0917\u0928\u094d\u0927\u0903 \u0905\u0924\u094d\u092f\u0930\u094d\u0925\u0902 \u0935\u0947\u0926\u0928\u093e\u0935\u093e\u0928\u094d \u0926\u093e\u0939\u092a\u093e\u0915\u0930\u093e\u0917\u0915\u0923\u094d\u0921\u0942\u0936\u094b\u092b\u092a\u093f\u0921\u0915\u094b\u092a\u0926\u094d\u0930\u0941\u0924\u0903 \u0905\u0924\u094d\u092f\u0930\u094d\u0925\u0902 \u0926\u0941\u0937\u094d\u091f\u0936\u094b\u0923\u093f\u0924\u093e\u0938\u094d\u0930\u093e\u0935\u0940 \u0926\u0940\u0930\u094d\u0918\u0915\u093e\u0932\u093e\u0928\u0941\u092c\u0928\u094d\u0927\u0940 \u091a\u0947\u0924\u093f \u0926\u0941\u0937\u094d\u091f \u0935\u094d\u0930\u0923\u0932\u093f\u0919\u094d\u0917\u093e\u0928\u093f \u0964<\/span> Su .Su22\/7<\/strong><\/p>\n

There are a presentation of the human pathologies in the form of ulcers. Ulcerative lesions are another representation of the management pathologies. It could be either over the surface of the body or it could be anywhere in the area like in the stomach or so on. Sushruta has described the varieties of the Dusta Vrana, which could be suggestive of the malignant changes, malignant pathologies like<\/p>\n

A wound which has become quite wide and the surface is wide and it continues to widen further<\/p>\n

bhairav- itself looks unappealing and it produces some fearful feeling. Looks changed.<\/p>\n

It could be Amanojna darshana i.e looks very wacky and suggestive of a possibility of the tumor.<\/p>\n

utsangi i.e. surface could be raised multiple tracts or induration.<\/p>\n

deerghakalanubandhi i.e. which tends to persist towards chronicity.<\/p>\n

These also could be the evidences of arbuda. These also could be the evidences of the malignant changes in any ulcer that’s exactly the same. Now, whenever we have a very chronic non-healing ulcer Marzolin\u2019s ulcer \u00a0or maybe the carcinomas basal cell carcinoma, the clinical suspicion would be based upon these features only.<\/p>\n

Of course, the confirmation now it has to follow histopathological background. Without histopathological background it may not be possible to make the diagnosis whereas the clinical signs of both the ulcerative lesions are described by Sushruta.\u00a0 or the other way, in a typical ulcer which is having an indurated surface and these edges are raised that too is considered as one of the conditions where either the ulcer surface has to be curated or excised and that’s what Sushruta has mentioned the characteristic feature of an ulcer where the surface could be hard there are the ends to disrupt repeatedly or it may have a raised fleshy surface. That is considered also as crenation which requires either a lakshana that’s a curating or excision<\/p>\n

Though, Sushruta has not considered this as arbuda, I would consider a malignant ulcer as<\/p>\n

one of such vranas which require either the excision (chhedana) or lekhana depending upon conditions.<\/p>\n

That’s the point. So, when we look at from Ayurvedic point of view we have to consider the clinical presentation than the real pathology, as such. Now systemic symptoms of malignancy also are described in Sushruta in certain specific disease conditions like Raktarbuda. \u00a0In the raktarbuda characteristic clinical symptoms like raktarbuda. In raktarbuda,<\/p>\n

\u0926\u094b\u0937\u0903 \u092a\u094d\u0930\u0926\u0941\u0937\u094d\u091f\u094b \u0930\u0941\u0927\u093f\u0930\u0902 \u0938\u093f\u0930\u093e\u0938\u094d\u0924\u0941 \u0938\u092e\u094d\u092a\u0940\u0921\u094d\u092f \u0938\u0919\u094d\u0915\u094b\u091a\u094d\u092f \u0917\u0924\u0938\u094d\u0924\u094d\u0935\u092a\u093e\u0915\u092e\u094d |||<\/strong><\/span>
\n\u0938\u093e\u0938\u094d\u0930\u093e\u0935\u092e\u0941\u0928\u094d\u0928\u0939\u094d\u092f\u0924\u093f \u092e\u093e\u0902\u0938\u092a\u093f\u0923\u094d\u0921\u0902 \u092e\u093e\u0902\u0938\u093e\u0919\u094d\u0915\u0941\u0930\u0948\u0930\u093e\u091a\u093f\u0924\u092e\u093e\u0936\u0941\u0935\u0943\u0926\u094d\u0927\u093f\u092e\u094d |<\/strong><\/span>
\n\u0938\u094d\u0930\u0935\u0924\u094d\u092f\u091c\u0938\u094d\u0930\u0902 \u0930\u0941\u0927\u093f\u0930\u0902 \u092a\u094d\u0930\u0926\u0941\u0937\u094d\u091f\u092e\u0938\u093e\u0927\u094d\u092f\u092e\u0947\u0924\u0926\u094d\u0930\u0941\u0927\u093f\u0930\u093e\u0924\u094d\u092e\u0915\u0902 \u0938\u094d\u092f\u093e\u0924\u094d ||<\/strong><\/span>
\n\u0930\u0915\u094d\u0924\u0915\u094d\u0937\u092f\u094b\u092a\u0926\u094d\u0930\u0935\u092a\u0940\u0921\u093f\u0924\u0924\u094d\u0935\u093e\u0924\u094d \u092a\u093e\u0923\u094d\u0921\u0941\u0930\u094d\u092d\u0935\u0947\u0924\u094d \u0938\u094b\u093d\u0930\u094d\u092c\u0941\u0926\u092a\u0940\u0921\u093f\u0924\u0938\u094d\u0924\u0941 |<\/strong><\/span>
\n\u0938\u0942 \u0928\u093f 11\/15,16,17<\/strong><\/p>\n

Because of the lesion present over the area the patient would have Raktakshaya lakshana. i.e. anaemic features would be presented or there would also be persistent bleeding. These are the exact clinical description of a surface tumor pathology, the fragility producing the lesion as such. So, that is about the conditions which we can now identify based upon the clinical features as the malignant lesions with the evident local sites or localized malignancy conditions, but there are certain malignancy conditions which are systemic now like leukemias and Sushruta has definitely not have considered them as arbuda but this features of those leukemia like conditions can be seen in the description of the pandu, particularly among the asadhya lakshana of the pandu and in the asadhya lakshana of the pandu, the conditions which can present with the\u00a0 appearance of the very chronic condition- khareebhootah which becomes chronic and becomes resistant to the other features as such and which also can present with the systemic symptoms like digdhangah, chhardi, murccha, trisharditah these are the considered as asadhya pandu so a patient of leukemia with these clinical presentation I would consider them as a one variety of the one or other variety of the pandu, either asadhya \u00a0or sadhya depending upon the same situation.<\/p>\n

\u00a0Dhatugata Jwara
\n<\/strong>Some of the leukemic features also could be seen as dhatugata jwara, in the gambhira jwara dhatugata jwara. The features mentioned are the same.<\/p>\n

\u0930\u0915\u094d\u0924\u094b\u0937\u094d\u0923\u093e\u0903 \u092a\u093f\u0921\u0915\u093e\u0938\u094d\u0924\u0943\u0937\u094d\u0923\u093e \u0938\u0930\u0915\u094d\u0924\u0902 \u0937\u094d\u0920\u0940\u0935\u0928\u0902 \u092e\u0941\u0939\u0941\u0903|<\/strong><\/span>
\n\u0926\u093e\u0939\u0930\u093e\u0917\u092d\u094d\u0930\u092e\u092e\u0926\u092a\u094d\u0930\u0932\u093e\u092a\u093e \u0930\u0915\u094d\u0924\u0938\u0902\u0938\u094d\u0925\u093f\u0924\u0947||\u096d\u096d||<\/strong><\/span>
\n\u0905\u0928\u094d\u0924\u0930\u094d\u0926\u093e\u0939\u0903 \u0938\u0924\u0943\u0923\u094d\u092e\u094b\u0939\u0903 \u0938\u0917\u094d\u0932\u093e\u0928\u093f\u0903 \u0938\u0943\u0937\u094d\u091f\u0935\u093f\u091f\u094d\u0915\u0924\u093e|<\/strong><\/span>
\n\u0926\u094c\u0930\u094d\u0917\u0928\u094d\u0927\u094d\u092f\u0902 \u0917\u093e\u0924\u094d\u0930\u0935\u093f\u0915\u094d\u0937\u0947\u092a\u094b \u091c\u094d\u0935\u0930\u0947 \u092e\u093e\u0902\u0938\u0938\u094d\u0925\u093f\u0924\u0947 \u092d\u0935\u0947\u0924\u094d||\u096d\u096e||<\/strong><\/span>
\n\u0938\u094d\u0935\u0947\u0926\u0938\u094d\u0924\u0940\u0935\u094d\u0930\u093e \u092a\u093f\u092a\u093e\u0938\u093e \u091a \u092a\u094d\u0930\u0932\u093e\u092a\u094b \u0935\u092e\u094d\u092f\u092d\u0940\u0915\u094d\u0937\u094d\u0923\u0936\u0903|<\/strong><\/span>
\n\u0938\u094d\u0935\u0917\u0928\u094d\u0927\u0938\u094d\u092f\u093e\u0938\u0939\u0924\u094d\u0935\u0902 \u091a \u092e\u0947\u0926\u0903\u0938\u094d\u0925\u0947 \u0917\u094d\u0932\u093e\u0928\u094d\u092f\u0930\u094b\u091a\u0915\u094c||\u096d\u096f||<\/strong><\/span>
\n\u0935\u093f\u0930\u0947\u0915\u0935\u092e\u0928\u0947 \u091a\u094b\u092d\u0947 \u0938\u093e\u0938\u094d\u0925\u093f\u092d\u0947\u0926\u0902 \u092a\u094d\u0930\u0915\u0942\u091c\u0928\u092e\u094d|<\/strong><\/span>
\n\u0935\u093f\u0915\u094d\u0937\u0947\u092a\u0923\u0902 \u091a \u0917\u093e\u0924\u094d\u0930\u093e\u0923\u093e\u0902 \u0936\u094d\u0935\u093e\u0938\u0936\u094d\u091a\u093e\u0938\u094d\u0925\u093f\u0917\u0924\u0947 \u091c\u094d\u0935\u0930\u0947||\u096e\u0966||<\/strong><\/span>
\n\u0939\u093f\u0915\u094d\u0915\u093e \u0936\u094d\u0935\u093e\u0938\u0938\u094d\u0924\u0925\u093e \u0915\u093e\u0938\u0938\u094d\u0924\u092e\u0938\u0936\u094d\u091a\u093e\u0924\u093f\u0926\u0930\u094d\u0936\u0928\u092e\u094d|<\/strong><\/span>
\n\u092e\u0930\u094d\u092e\u091a\u094d\u091b\u0947\u0926\u094b \u092c\u0939\u093f\u0903 \u0936\u0948\u0924\u094d\u092f\u0902 \u0926\u093e\u0939\u094b\u093d\u0928\u094d\u0924\u0936\u094d\u091a\u0948\u0935 \u092e\u091c\u094d\u091c\u0917\u0947||\u096e\u0967||<\/strong><\/span>
\n\u0936\u0941\u0915\u094d\u0930\u0938\u094d\u0925\u093e\u0928\u0917\u0924\u0903 \u0936\u0941\u0915\u094d\u0930\u092e\u094b\u0915\u094d\u0937\u0902 \u0915\u0943\u0924\u094d\u0935\u093e \u0935\u093f\u0928\u093e\u0936\u094d\u092f \u091a|<\/strong><\/span>
\nCh. Chi 3\/ 77 -81<\/strong><\/p>\n

Like, the patient would have a persistent fever, sweating and loss of weight<\/p>\n

Antardaha- the temperature (core Temperature) of the body may be raised whereas the surface body feature may not be very much raised and there could be multiple systemic symptoms including the marmaccheda i.e. consciousness also could be impaired. These are all the typical features of the dhatugata jwara. So some of the leukemic conditions based upon the clinical presentation, I would be making the diagnosis of a dhatugata jwara<\/p>\n

Depending upon the presentation either it could be uttana dhatugata jwara and gambheera dhatugata jwara.Majority of the leukemias have the diagnosis of Gambheera dhatugata jwara<\/p>\n

Dhatu anukramana \u2013 Neoplasm<\/strong><\/p>\n

\u0915\u094d\u0930\u092e\u0947\u0923 \u0909\u092a\u091a\u092f\u0902 \u092a\u094d\u0930\u093e\u092a\u094d\u092f \u0927\u093e\u0924\u0942\u0928\u0928\u0941\u0917\u0924\u0903 \u0936\u0928\u0948\u0903\u0964
\n<\/strong>\u0928 \u0936\u0915\u094d\u092f \u0909\u0928\u094d\u092e\u0942\u0932\u092f\u093f\u0924\u0941\u0902 \u0935\u0943\u0926\u094d\u0927\u094b \u0935\u0943\u0915\u094d\u0937 \u0907\u0935 \u0906\u092e\u092f\u0903 \u0965<\/strong><\/span>
\n\u0938 \u0938\u094d\u0925\u093f\u0930\u0924\u094d\u0935\u093e\u0924\u094d \u092e\u0939\u0924\u094d\u0935\u093e\u091a\u094d\u091a \u0927\u093e\u0924\u094d\u0935\u0928\u0941\u0915\u094d\u0930\u092e\u0923\u0947\u0928<\/u> \u091a \u0964
\n\u0928\u093f\u0939\u0928\u094d\u0924\u094d\u092f\u094c\u0937\u0927\u0935\u0940\u0930\u094d\u092f\u093e\u0923\u093f \u092e\u0928\u094d\u0924\u094d\u0930\u093e\u0928\u094d \u0926\u0941\u0937\u094d\u091f\u0917\u094d\u0930\u0939\u094b \u092f\u0925\u093e \u0965
\nSu Su 23\/15,16<\/span><\/span><\/strong><\/p>\n

\u0905\u0924 \u090a\u0930\u094d\u0927\u094d\u0935\u0902 \u090f\u0924\u0947\u0937\u093e\u0902 \u0905\u0935\u0926\u0940\u0930\u094d\u0923\u093e\u0928\u093e\u0902 \u091a \u0935\u094d\u0930\u0923\u092d\u093e\u0935\u092e\u093e\u092a\u0928\u094d\u0928\u093e\u0928\u093e\u0902 \u0937\u0937\u094d\u0920\u0903 \u0915\u094d\u0930\u093f\u092f\u093e\u0915\u093e\u0932\u0903 \u0964<\/strong><\/span>
\nSu ,Su 21\/35<\/strong><\/p>\n

\u00a0<\/strong>Now, the pathogenesis where the disease doesn’t end up and it tends to produce a sequence of the pathologies in the same manner, their description is dhatu anutkramana, which is mentioned by Acharya Charaka. Dhatu anutkramana is a very specific word like once a pathology has occur usually in the normal course either that pathology would be having a paka it would be having a situation of further progression and then there will be paka or \u00a0maybe the suppuration and then the disease may be terminated or it may result in a stigma a vranavastu can occur, but there would be certain pathology which can result into dhatu anutkramana. Dhatu anutkramana is a disease process which has occur in one tissue.<\/p>\n

It can produce further progression of the dhatus which are of the same nature. The next generation of the dhatu also would have the same pathology. That’s dhatu anutkramana and dhatu anutkramana is also considered one of the causes, where a disease becomes incurable \u00a0and this is exactly the malignant pathology. So, a malignant pathology \u00a0described by Ayurvedic point of view is used by the word dhatu anutkramana, where a clinical evidence of a pathological dhatu or tissue formation in the next generation is identified by clinical means. Whereas now we make the diagnosis based upon the histopathological evidence. We need a microscope. Without the microscope you may not make the diagnosis whereas Sushruta or Charaka had made the diagnosis based upon the clinical parameters. So, naturally there would be some gap some gap of identification of the lesion, some gap of the nomenclature of the lesion, some gap in predicting the prognosis and so on. But the point is the pathological process related to the malignancy were well described in the context of either dhatu anutkramana \u00a0or the dosha sthiratva or dosha grathana- these are the three variants of the pathogenesis produced in case of the tumor pathology.<\/p>\n

Now how these are relevant, I will come to that later. When we discuss some more issues related to the malignant pathology as such or another evidence where the disease process may not have a termination, is also in mentioned by Sushruta in case of the shashtha kriyakala the bheda kriyakala where the vrana.<\/p>\n

\u0905\u0924 \u090a\u0930\u094d\u0927\u094d\u0935\u092e\u0947\u0924\u0947\u0937\u093e\u092e\u0935\u0926\u0940\u0930\u094d\u0923\u093e\u0928\u093e\u0902 \u0935\u094d\u0930\u0923\u092d\u093e\u0935\u092e\u093e\u092a\u0928\u094d\u0928\u093e\u0928\u093e\u0902 \u0937\u0937\u094d\u0920\u0903 \u0915\u094d\u0930\u093f\u092f\u093e\u0915\u093e\u0932\u0903<\/strong><\/span>
\nSu Su 21\/35<\/strong><\/p>\n

A disease may be reach a process where it become avadeerna and it tend to disrupt or spread to other areas and it will have a vrana bhava. Vrana bhava is adehadharanat- A lesion which will be remaining in the body as long as the person will live or it may end up with the patient. That’s the vrana bhava and such a situation may occur and that too is an evidence of the malignant pathology.<\/p>\n

Metastasis<\/strong><\/p>\n

\u092f\u091c\u094d\u091c\u093e\u092f\u0924\u0947\u093d\u0928\u094d\u092f\u0924\u094d \u0916\u0932\u0941 \u092a\u0942\u0930\u094d\u0935\u091c\u093e\u0924\u0947 \u091c\u094d\u091e\u0947\u092f\u0902 \u0924\u0926\u0927\u094d\u092f\u0930\u094d\u092c\u0941\u0926\u092e\u0930\u094d\u092c\u0941\u0926\u091c\u094d\u091e\u0948\u0903 |<\/strong><\/span>
\n\u092f\u0926\u094d\u0926\u094d\u0935\u0928\u094d\u0926\u094d\u0935\u091c\u093e\u0924\u0902 \u092f\u0941\u0917\u092a\u0924\u094d \u0915\u094d\u0930\u092e\u093e\u0926\u094d\u0935\u093e \u0926\u094d\u0935\u093f\u0930\u0930\u094d\u092c\u0941\u0926\u0902 \u0924\u091a\u094d\u091a \u092d\u0935\u0947\u0926\u0938\u093e\u0927\u094d\u092f\u092e\u094d ||<\/strong><\/span>
\nSu Ni 11\/20<\/p>\n

\u00a0<\/strong>In addition to this the description of a secondary produced also are described in the context of arbuda. When arbuda produces another lesion of the same nature which is exactly the definition of metastasis is described as a presentation of a similar disease entity elsewhere in the body. \u00a0Sushruta has mentioned two varieties of that metastasis, one is adhyarbuda and dwirarbuda. Adhyarbuda is when a mass produce is generated over the mass and hence the surface becomes irregular, as you see over this image where a lesion- breast cancer where there is a mass and then because of the differential growth.<\/p>\n

you will have some more lesions which look like a mass over the other area or a mass which is produced elsewhere maybe in the axilla as you see. That’s the dwirarbuda so metastatic presentations are described as one of the possible variants of the Arbuda.<\/p>\n

So that basic pathology is identity and when it comes to the question of management too in such apaki rogas the only possible choice of the cure is a Chhedana.<\/p>\n

Need of total excision:<\/strong><\/p>\n

\u0905\u092a\u093e\u0915\u0947\u0937\u0941 \u0924\u0941 \u0930\u094b\u0917\u0947\u0937\u0941 \u00a0\u0915\u0920\u093f\u0928\u0947\u0937\u0941 \u0938\u094d\u0925\u093f\u0930\u0947\u0937\u0941 \u091a ||<\/strong><\/span>
\n\u0938\u094d\u0928\u093e\u092f\u0941\u0915\u094b\u0925\u093e\u0926\u093f\u0937\u0941 \u0924\u0925\u093e \u091a\u094d\u091b\u0947\u0926\u0928\u0902 \u092a\u094d\u0930\u093e\u092a\u094d\u0924\u092e\u0941\u091a\u094d\u092f\u0924\u0947 |<\/strong><\/span>
\nSu Chi\u00a0 1\/33,34<\/strong><\/p>\n

it’s a consideration of irreversible pathology and hence the indication for chhedana or the excision the complete surgical removal is the only possible cure and Sushruta has given you all that complete description about the importance of the surgical excision, like a disease which is presented as a firm and non-suppurative lesion, maybe that’s what we have considered as a may be a palpable tumor pathology, surgical excision has to be done. Chhedana is indicated and when you do chhedana in case of arbuda you have to ensure that the disease is completely removed. Even if a part of the lesion is left over then that could be recurrence.<\/p>\n

\u0938\u0936\u0947\u0937\u0926\u094b\u0937\u093e\u0923\u093f \u0939\u093f \u092f\u094b\u093d\u0930\u094d\u092c\u0942\u0926\u093e\u0928\u093f \u0915\u0930\u094b\u0924\u093f \u0924\u0938\u094d\u092f\u093e\u0936\u0941 \u092a\u0941\u0928\u0930\u094d\u092d\u0935\u0928\u094d\u0924\u093f ||<\/strong><\/span>
\n\u0924\u0938\u094d\u092e\u093e\u0926\u0936\u0947\u0937\u093e\u0923\u093f \u0938\u092e\u0941\u0926\u094d\u0927\u0930\u0947\u0924\u094d\u0924\u0941 \u0939\u0928\u094d\u092f\u0941\u0903 \u0938\u0936\u0947\u0937\u093e\u0923\u093f \u092f\u0925\u093e \u0939\u093f \u0935\u0939\u094d\u0928\u093f\u0903 ||<\/strong><\/span>
\nSu Chi 18\/42,43<\/strong><\/p>\n

A possible recurrence of the disease was also identified by Sushruta and hence when you remove, you have to be very careful.
\nYou have to remove the lesion completely as such. If complete removal of the lesion is not possible by the surgical process, you may make use of alternative methods debulking therapy also could be possible as a surgical treatment by Sushruta and debulking may be facilitated by natural entities- the krimi- maggot formation.<\/p>\n

\u0905\u0932\u094d\u092a\u093e\u0935\u0936\u093f\u0937\u094d\u091f\u0947 \u0915\u0943\u092e\u093f\u092d\u0915\u094d\u0937\u093f\u0924\u0947 \u00a0\u091a<\/strong><\/span>
\n\u0932\u093f\u0916\u0947\u0924\u094d\u0924\u0924\u094b\u093d\u0917\u094d\u0928\u093f\u0902 \u0935\u093f\u0926\u0927\u0940\u0924 \u092a\u0936\u094d\u091a\u093e\u0924\u094d |.<\/strong><\/span>
\nSu Chi 18\/38<\/strong><\/p>\n

If it is not possible to remove the tumor completely, then it may be partially excised and whatever residual lesion is left over, it could be managed with the krimi- the natural evidence. These are the methods which are suggested by Sushruta. \u00a0So the point is almost the clinical course of the malignant disease and a basic clinical approach for malignancy is described by Sushruta, which seems to be almost the same as we follow now. The only difference now is that you have some more details as such. Unfortunately, when it comes to the question of the history of malignant lesions and neoplastic lesions, the current textbooks do not mention anything about Sushruta as such.<\/p>\n