Arbuda - Santhosh

RASAOUSHADHIS AND BHASMAS IN THE MANAGEMENT OF ARBUDA DR. SANTHOSH B DEPT. OF

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Objectives • To understand the samprapti of Arbuda • To know different treatment modalities • To know where we can use rasoushadhis 30/07/09

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Derivation  Derived from the root Arb with suffix Ena and along with ‘Nd’  Destroy particularly the Mamsa Dhatu.  Denotes the fleshy out growths 30/07/09

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Cancer • Dervied from Greek word – ‘Karkinos’meaning Crab. • Appearance of large prominent veins surrounding the growth, encircled the mass like claws of a crab.

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Definition • Large Glandular enlargement • A growth of new cells which proliferate without relation to needs of body - Tumour • Types - Benign - Malignant 30/07/09

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Mechanism of Carcinogen 30/07/09

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• Initiation A single brief exposure to a carcinogen induces changes in the tissue  The nature of the structural alterations in initiated cell is diverse  Chemicals and ultra violet radiations directly alter DNA structure 30/07/09

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• Promotion  Ability of a compound to induce an area of proliferation in initiated tissue and stimulate tumour formation  Dietary fat has been implicated as a tumour promoter in the development of colon cancer

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• Progression Usually refers to the later stage of tumour cell evolution that are irreversible  Once the tumour develops, individual traits such as hormone responsiveness, growth rate, histologic type and invasiveness, function as independent variables capable of progression

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• Metastasis  Active process consisting of 3 stages  attachment of cells to extra-cellular matrix  local degradation of extra-cellular matrix  locomotion through the locally degraded matrix

 The spread of tumour from a primary lesion to a distant site is a major cause of morbidity and mortality  Once the tumour cell has migrated to a metastatic site, additional metastatic foci may occur by repetition of these types 30/07/09

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Mechanism of Invasion & Metastasis • Metastasis, the establishment of tumour cells at distant sites in the body, is the hallmark of cancer • Tumour cells must acquire the ability to :  Invade stroma

Stimulate neoangiogenesis  Transgress stroma  Invade vessel walls  Extravasate into the extra vascular Rasoushadhis and bhasmas used 30/07/09 environment in Arbuda

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Stem Cell

Initiation event

Initiated Cell Promotion event Pre – Cancer Cell Conversion event Cancer Cell Progression event 30/07/09

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Metastatic

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Sushruta uÉÉiÉÉSrÉÉå qÉÉÇxÉqÉxÉ×Mçü cÉ SÒ¹ÉÈ l xÉlSÕwrÉ qÉåS¶É MüTüÉlÉÑÌuÉ®qÉç ll uÉרÉÉå³ÉiÉÇ ÌuÉaÉëÍjÉiÉÇ iÉÑ zÉÉåTÇü l MÑüuÉïlirÉiÉÉå aÉëÎljÉËUÌiÉ mÉëÌS¹È ll 30/07/09

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Charaka

ÌuÉmÉÉš cÉÉå®ØirÉ ÍpÉwÉMçü xÉMüÉåzÉÇ zÉx§ÉåhÉ SakuÉÉ uÉëhÉuÉΊÌMüixÉåiÉç shotha chikitsa 30/07/09

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Su. Ni. 11 / 13-15 aÉɧÉmÉëSåzÉå YuÉÍcÉSåuÉ SÉåwÉÉÈ xÉqqÉÔÎcNïûiÉÉ qÉÉÇxÉqÉÍpÉmÉëSÕwrÉ uÉרÉÇ ÎxjÉUÇ qÉlSÂeÉÇ qÉWûÉliÉqÉlÉsmÉqÉÔsÉÇ ÍcÉUuÉ×SèkrÉmÉÉMüqÉç MÑüuÉïÎliÉ qÉÉÇxÉÉåmÉcÉrÉÇ iÉÑ zÉÉåTÇü iÉSoÉÑïSÇ zÉÉx§ÉÌuÉSÉå uÉSÎliÉ 30/07/09

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SÉåwÉÈ mÉëSÒ¹Éå ÂÍkÉUÇ ÍxÉUÉxiÉÑ xÉqmÉÏŽ xɃ¡ûÉåcrÉ aÉiÉxiÉÑmÉÉMüqÉç xÉÉxÉëÉuÉqÉѳɽÌiÉ qÉÉÇxÉÌmÉhQÇû qÉÉÇxÉɃ¡ÓûUæUÉÍcÉiÉqÉÉzÉÑ uÉ×ήqÉç xÉëuÉirÉeÉxÉëÇ ÂÍkÉUÇ mÉëSÒ¹qÉxÉkrÉqÉåiÉSìÓÍkÉUÉiqÉMÇ ü xrÉÉiÉç

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qÉÑ̹mÉëWûÉUÉÌSÍpÉUÌSïiÉåÅ…¡åû qÉÉÇxÉÇ mÉëSÒ¹Ç mÉëMüUÉãÌiÉ zÉÉåTüqÉç AuÉåSlÉÇ ÎxlÉakÉqÉlÉlrÉuÉhÉïqÉmÉÉMüqÉzqÉÉ åmÉqÉqÉmÉëcÉÉsrÉqÉç mÉëSÒ¹qÉÉÇxÉxrÉ lÉUxrÉ oÉÉRûqÉåiÉ°uÉålqÉÉÇxÉmÉUÉrÉhÉxr É qÉÉÇxÉÉoÉÑïSÇ iuÉåiÉSxÉÉkrÉqÉÑ£Çü ......

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CLASSIFICATION OF ARBUDA

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AmÉÉMü ? • • • •

MüTüÉÍkÉMüiuÉ qÉåSÉåÅÍkÉMüiuÉ SÉåwÉÎxjÉUiuÉ aÉëjÉlÉÉŠ iÉåwÉÉÇ

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SAMPRAPTI OF ARBUDA 30/07/09

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Nija - Mamsahara Nidana sevana Agantuja - Mushtipraharad

Sanchaya Agnimandya

Dhatwagni mandya

Prasara

Prakopa Dosha prakopa

Rakta & mamsa dushti Sroto Dushti

Sthana Samshraya Khavaigunya Arbuda – Mamsarbuda - Raktarbuda Vyakti Dwirarbuda - Adhyarbuda 30/07/09

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Bheda 25

SAMPRAPTI GHATAKA : Kapha and Vata predominant

Dosha Dushya

:Mamsa, Meda and Rakta

Srotas

:Mamsa, Meda and Raktavaha

Sroto dushti

: Sanga and Sira granthi

Agni Rogamarga

: Jatharagni & Dhatwagni :Bahya

Udbhavsthana : Anywhere in the body Adhisthana : Sixth layer of the Skin - Rohini Pratyatma Linga: Mamso Pachaya Tu Shopham 30/07/09

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Lung Cancer A coronal CT scan  Showing malignant cancer of the lung. → tumor ← ★ central pleural effusion 1 & 3 lungs 2 spine 4 ribs 30/07/09

5 aorta

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AETIOLOGY • Genetics • Changes in lifestyle especially in diet and regimen • Highly polluted environment

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COMMON SITES T O P U B L I K 30/07/09

– THYROID – ORAL – PROSTATE – UTERUS – BREAST – LUNGS – GIT – KIDNEY Rasoushadhis and bhasmas used in Arbuda

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BENIGN MALIGNANT  BOUNDARIES– encapsulated or well circumscribed  SIZE–usually small

 SECONDARY CHANGES– occur less often

 PATTERN– usually resembles the

• Poorly circumscribed & irregular • Often large • More often • Often poor resemblance

tissue of origin Rasoushadhis and bhasmas used 30/07/09 in Arbuda closely

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• NUCLEOCYTOPLAS • Increased MIC RATIO–normal • FUNCTION–usually • May be retained, well maintained lost or abnormal • GROWTH RATE– • Rapid slow • Usually infiltrates • LOCAL INVASION– the adjacent often compresses tissues the surrounding tissues without invading or infiltrating them • Frequently present • METASTASIS–Rasoushadhis and bhasmas used 30/07/09 33 in Arbuda absent

STAGING IN CANCER • TNM staging T – tumour N – lymph node involvement M – metastasis 30/07/09

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TNM CLASSIFICATION T1

< OR = to 2 cm

T2

> Than 2 & = to 4 cm > Than 4 cm

T3 T4 N1 30/07/09

Adjacent structures involved Unilateral single node > than 3 to 6 cm

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N2a N2b N2c N3 M0 M1 30/07/09

bilateral single node >than 3 to 6 cm unilateral multiple nodes < or = to 6 cm Bilateral or contralateral nodes < or = node to 6cm Any (s) > than 6cm No detectable distant metastasis Distant metastasis present Rasoushadhis and bhasmas used in Arbuda

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Prognosis • Susrutha

Sadhya Vataja Pittaja Kaphaja Medoja 30/07/09

Asadhya Mamsaja Adyarbuda Dvirarbuda Raktaja Rasoushadhis and bhasmas used in Arbuda

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Treatment of Cancer • Specific

• Supportive

 Surgical Removal  Radiation Therapy  Chemotherapy

 Blood Product Transfusions  Indwelling Central Catheters  Enteral And Paraenteral Nutrition

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Liposarcoma – Medo arbuda

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rÉÉåaÉU¦ÉÉMüU aÉëÎljÉwuÉÉqÉåwÉÑ MÑüuÉÏïiÉ ÍpÉwÉYzÉÉåjÉmÉëÌiÉÌ¢ürÉÉqÉç l mÉYuÉÉlÉÉqÉç mÉÉš xÉÇzÉÉåkrÉUÉåmÉrÉåSèuÉëhÉ pÉåwÉeÉæÈ ll • rÉuɤÉÉU + ÌuÉQû…¡û oÉÏeÉ + aÉlkÉMü qÉSïlÉ ÌaÉUÌaÉOû MüÉ U£ü sÉåmÉ aÉlkÉÍzÉsÉÉÌuɵÉÉæwÉkÉÌuÉQûÉ… ¡ûlÉÉaÉpÉxqÉÍpÉÈ xÉqÉæ¶ÉÔhÉïqÉç l

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Vanagasena – Arbuda chikitsa eÉrÉå̲SìÍkÉuÉimÉÔuÉïqÉoÉÑïSÇ mÉëcNûlÉÉÌSÍpÉÈ l ¤ÉÉUÉÎalÉprÉÉÇ SWåûŠÉÌmÉ mÉëSåWæûÌuÉïÌuÉkÉæeÉïrÉåiÉç ll WûËUSìÉ sÉÉåkÉë mÉiÉ…¡û aÉ×WûkÉÔqÉ qÉlÉÈÍzÉsÉÉ l 30/07/09

qÉkÉÑ mÉëaÉÉRûÉå sÉåmÉÉåÅrÉÇ Rasoushadhis and bhasmas used in Arbuda

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Frequently Used Rasoushadhis • • • • • • • •

ApÉëMü pÉxqÉ zÉÇZÉÌuÉwÉ pÉxqÉ iÉÑijÉ pÉxqÉ WûÏUMü pÉxqÉ xÉÑuÉhÉï pÉxqÉ iÉÉqÉë pÉxqÉ UÉæSì UxÉ AoÉÑïSWûUÉå UxÉ

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Rasendra sara sangraha • UÉqÉoÉÉhÉÉÌSMüÉlÉç rÉÉåaÉuÉÉÌWûlÉÉåÅ§É mÉërÉÉåeÉrÉåiÉç l

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pÉÉUiÉ pÉæwÉerÉ U¦ÉÉMüU • rÉÉåaÉuÉÉÌWû mÉërÉÉåaÉ :  AaÉlkÉZÉmÉïU mÉmÉïÌOû  AÎalÉMÑüqÉU UxÉ (31)  AqÉU xÉÑlSU UxÉ  AµÉMÇücÉÑMüÐ UxÉ  A͵ÉlÉÏ MÑüqÉU UxÉ  AÉUÉåarÉ xÉÉaÉU UxÉ  ESrÉ pÉÉxMüU UxÉ  EqÉÉzÉqpÉÑ UxÉ  MüÉliÉsÉÉåWû UxÉ 30/07/09

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Main Drugs • mÉÉUS • aÉlkÉMü • uÉixÉlÉÉpÉ

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Roudra Rasa • References :

 Rasendra sara sangrah  Rasa chandamshu  Rasa raja sundara  Bhruhannighantu ratnakara  Rasa kamadhenu 30/07/09

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zÉÑ® xÉÔiÉÇ xÉqÉÇ aÉlkÉÇ qɱïÇ rÉÉqÉcÉiÉѹrÉÇ l lÉÉaÉuÉssÉÏUxÉærÉÑï£Çü qÉåbÉlÉÉS mÉÑlÉlÉïuÉæÈ ll aÉÉåqÉÔ§ÉÌmÉmmÉsÉÏrÉÑ£Çü qɱïÇ ÂSèkuÉÉ mÉÑOåûssÉbÉÑ l ÍsɽÉiÉç ¤ÉÉæSìæÈ UxÉÉå UÉæSìÉå

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AoÉÑïSWûUÉå UxÉ iÉhQÒûsÉÏrÉMüuÉwÉÉïpÉÔlÉÉaÉMülrÉÉ oÉsÉÉUxÉå l aÉÉåqÉÔ§ÉÇ cÉ UxÉÈ ÌmÉ¹È mÉÑOûmÉYuÉÉåÅoÉÑïSÉÌSÎeÉiÉç ll ( U. U. xÉ. 24/136 ) 30/07/09

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ApÉëMü pÉxqÉ • Puta – 1 – 1000 ( AÍkÉMüxrÉÉÍkÉMÇü TüsÉqÉç ) • aÉÉæUÏiÉåeÉÈ mÉUqÉqÉqÉ×iÉÇ uÉÉiÉÌmɨɤÉrÉblÉÇ mÉëblÉÉoÉÉåÍkÉ mÉëzÉÍqÉiÉÂeÉÇ uÉ×wrÉqÉÉrÉÑwrÉqÉaêrÉqÉç • oÉsrÉÇ ÎxlÉakÉÇ ÂÍcÉSqÉMüTÇü

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• xÉuÉïurÉÉÍkÉWûUÇ Ì§ÉSÉåwÉzÉqÉlÉÇ uÉ»åû¶É xÉlSÏmÉlÉÇ.... ....xÉ±È mÉëÉhÉÌuÉuÉkÉïlÉÇ .....( U. mÉë. xÉÑ. ) • qÉ×irÉÉåpÉÏïÌiÉ WûUÌiÉ xÉiÉiÉÇ xÉåurÉqÉÉlÉÇ qÉ×iÉÉpÉëMüqÉç ( AÉ. mÉë) • xÉuÉïUÉåaÉWûUÇ urÉÉåqÉ eÉÉrÉiÉå rÉÉåaÉuÉÉWûMüqÉç ( U. ÍcÉÇ) 30/07/09

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zÉÇZÉÌuÉwÉ pÉxqÉ • MüTüuÉÉiÉÉqÉrÉWûUÉå , oÉsrÉ , uÉ×wrÉ , UxÉÉrÉlÉ -( UxÉÉqÉ×iÉ )

• UxÉoÉlkÉMüU , ÎxlÉakÉ , SÉåwÉblÉÉå , UxÉuÉÏrÉïM×üiÉç ( U. U. xÉ. 3/ 126) 30/07/09

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iÉÑijÉ pÉxqÉ • sÉåZÉlÉ, pÉåSlÉ, UxÉÉrÉlÉ, oÉsrÉ, cɤÉÑwrÉ, qÉåWûqÉåSÉåWûUÇ mÉUÇ • xÉÇMüÉãcÉlÉMüUÇ lÉÉQûÏlÉÉÇ oÉsÉM×üiÉç mÉUqÉç ( U. iÉ. 21/129 )

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WûÏUMü pÉxqÉ • AÉrÉÑwrÉmÉëSqÉç SÉåwɧÉrÉmÉëzÉqÉlÉÇ xÉMüsÉÉqÉrÉblÉqÉç xÉÔiÉålSìoÉlkÉ qÉ×irÉÑleÉrÉÇ AqÉ×iÉÉåmÉqÉqÉåuÉ uÉeÉëÇ ( U. U. xÉ. 4/32 ) • xÉÑqÉ×iÉÇ WûÏUMÇü....wÉQíûxÉÉÎluÉiÉqÉç rÉÉåaÉuÉÉÌWû.... xÉuÉÉåïi¢×ü¹Ç UxÉÉrÉlÉqÉç ....qÉåWûqÉåSÉåÌuÉlÉÉzÉlÉqÉç...

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xÉÑuÉhÉï pÉxqÉ • • • •

UxÉ - qÉkÉÑU MüwÉÉrÉ ÌiÉ£ü uÉÏrÉï - zÉÏiÉ ÌuÉmÉÉMü - qÉkÉÑU aÉÑhÉ - xÉëÇxÉlÉ , aÉÑ , sÉåZÉlÉ , rÉÉåaÉuÉÉÌWû , UxÉÉrÉlÉ , ̧ÉSÉåwÉlÉÉzÉlÉÇ , AÉrÉÑwrÉqÉç , oÉsrÉÇ

• Dose : ¼ to ½ ratti 30/07/09

( AÉ. Mü. 2/48

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iÉÉqÉë pÉxqÉ • • • •

UxÉ - ÌiÉ£ü MüwÉÉrÉ uÉÏrÉï - EwhÉ ÌuÉmÉÉMü - qÉkÉÑU aÉÑhÉ - sÉåZÉlÉ, ÌmÉ¨É MüTüÉmÉWÇû • UÉåaÉblÉiÉÉ - SÒlÉÉïqÉ, ¤ÉrÉ, mÉÉhQÒû, MÑü¸, 30/07/09

(U. U. xÉ.

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Maggotification • Paste of Nishpava, Pinyaka, Kulatha, Mamsa, Takra etc. are applied over arbuda to attract flies. So that worms & parasites may be produced and will consume the tissues of Arbuda. ( Su. Chi. 18 / 37-39 ) • Remnant unconsumed Arbuda should be done Lekhana & Agnikarma.  30/07/09

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Effect of rasayana :• It effects the genesis of proper rasadi dhatus • It acts as an immuno-modulator • It acts at the physical and mental 30/07/09

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Some important Rasayana prayogas  Bhallataka rasayana  Chitraka rasayana  Silajatu rasayana  Lashuna rasayana  Pippali rasayana  Hareetaki rasayana  Guggulu rasayana 30/07/09

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Drugs having anti cancerous action  Aswagandha 

Ananthamool a

 Amalaki  Triphala  Guduchi  Bhallataka  Haridra

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Vinca rosea  Lashuna  Silajatu  Guggulu  Kumari  Chitraka  Yavani Rasoushadhis and bhasmas used in Arbuda

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Discussion • Can we manage Arbuda without surgery, only on Rasoushadhis ?

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Conclusion • Understanding the samprapti of Arbuda is prime requirement for planning the treatment • Granthi – Arbuda are Chedya Vyadhi. So Surgery is the best line of treatment • Chemotherapy and Radiation therapy cause lot of side effects. So Rasayana therapy should be adjoined

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References • • • • • • • • •

A. P. I. Text book of Medicine Sushruta Samhita Charaka Samhita Rasa Ratna Samuchaya Rasa Tarangini Yogaratnakara Bruhannighantu Ratnakara Rasendra Sara Sangraha Dr. Pradeep Shinde sir’s collection of PPT • Jamnagar dissertation • Internet 30/07/09

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