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.

皮带输送机构带动穴盘从机架下穿过，机架上安装有左、右支撑板，主轴通过轴承安装在支撑板上，主轴与支撑轮相连，支撑轮与滚筒相连，滑板在滚筒与支撑轮形成的滑板滑道内上下运动。滑板两侧连接有滚子，滚子可在焊接于支撑板上的凸轮槽内滚动。支撑板上坐有料箱，料箱上通过螺栓连接固定有导料板。调速电机由接近开关控制，通过链传动带动主轴旋转。

在处理“双反”问题时，应该重视问题预防与事后补偿相结合的方法。通过计算方法上的调整来消除“双反”问题固然是一种方法。但是正如美国法院所说，通过细微的调整来抵消双重征税的问题存在很大的困难。并且，这种救济方式属于被动的救济，即存在贸易损失已经发生后再通过手段进行弥补。但是，既然问题已经明确，更好的方式则是通过预防来防止问题的产生。如果调查机构在调查中能够具体问题具体分析，严格仔细审查中国的市场以及相关企业和商品的情况，那么就可以避免采取不必要的救济措施，而“双反”问题从根源上也不会发生。

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，我们在乌兰巴义尔的带领下参观完令人震撼的斯大林格勒保卫战全景博物馆和神往以久的祖国母亲纪念碑群后，驱车过伏尔加河来到30公里外的阿赫图巴河左岸，来到了前文所述伏尔加市基里亚科夫基(Киляковки)区。这里就是我们一直在寻找的当年图理琛曾造访过的阿玉奇汗牙帐所在地——马奴托海。

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

Investigations

随着国有企业改革的深入推进，基层党支部的政治地位和作用发挥缺乏准确定位。在参与重大决策、领导思想政治工作等方面底气不足，党支部的地位和作用“边缘化”。党务工作人员不足，党务干部“兼职化”“业余化”，影响了基层党组织的政治核心作用发挥。

观察组在常规护理的基础上，增加5A模式进行干预，时间同对照组。包括（1）询问：询问患者的基本情况、解答患者的疑虑和担忧；（2）评估：查阅患者病例资料，了解患者的基本病情、手术情况、术后用药情况，并作好记录，并由专职护士负责术后的追踪和随访；（3）建议：由责任护士向患者讲解术后管理的重要性及需要注意的问题，建议患者家属参与到患者的病情管理中；（4）帮助：对患者的自我管理进行指导，如药物不良反应、饮食、日常活动的规范等，提醒患者按时复查相关指标；（5）安排随访：追踪患者的个人行为管理情况，随访期间，主动通过电话、微信等多种渠道了解患者信息，定期于医生处随诊。

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].

在进行信息导入数据库时，需要以友好界面为基准进行相关信息导入。同时，在录入的过程中要确保信息的准确度。只有确保信息的准确度，才能发挥数据库的优势，提升数据管理方面的效率。同时，工作人员也可以根据实际工作需求，对数据进行修改操作。

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，我们来看一下这波团战的经过。”王小景一边看着大屏幕上的资料，一边开启了解说模式，“清军的主‘肉盾’‘定远号’用主炮射击首先开团，副‘肉盾’‘镇远号’跟着施放技能，然后所有队员冲了上去！日军利用速度优势，派出四舰突击，切了清军的后排，直接灭了后排的‘超勇号’和‘扬威号’，对清军形成了两面夹击！为保护后排，清军‘致远号’拼尽全力，冲击日军的突击队，最终英勇献身！‘经远号’继续冲击日军的突击队！但在这时，两名后排队员‘友济元号’和‘广甲号’直接选择了回城！”

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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