|Section/Chapter/topic||Concepts and Contemporary Practices -Nidana Chikitsa / Vyadhi / Cancer|
|Author||Prof. Dilip Gadgil 1|
|Editors||Deole Y.S.3, Aneesh E. G.2|
1 Chief consultant physician, Niramaya ayurvedic research and consultancy, Pune, India 2Charak Samhita Research, Training and Development Centre, I.T.& R.A., Jamnagar, Gujarat, India3 Executive Editor and Professor in Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India
|Date of first publication:||January 24, 2022|
This article is based on lecture delivered by Prof. Dilip Gadgil as a part of Prof. M .S. Baghel Memorial Lecture Series on 09th March 2021.
Cancer in Ayurvedic perspective
According to the World Health Organization, cancer is a leading cause of death worldwide accounting for nearly 10 million deaths in 2020. It includes a large group of diseases that can affect any part of the body. It is also known as malignant tumours and neoplasms. The cases of cholangiocarcinoma, liver metastasis, malignant melanoma were observed in early days of author’s Ayurveda practice. The cases came mostly in advanced stage, with very less life expectancy, various symptoms associated with the disease & its treatment of chemotherapy/radiotherapy. The patients of cancer are in depressed & stressful state of mind. There are doubts about efficacy of ayurvedic treatment & diet. The available treatments are highly expensive and un-affordable. These challenging factors triggered interest in management of cancer through Ayurveda. Some references indicating cancer are found in Ayurveda classical texts. ‘Cancer’ is well researched and documented in conventional medicine. The disease condition of the patient needs to be understood individually while treating with Ayurvedic perspective.
Pollution, tobacco and alcohol:
In India, the pollution can be a major cause for cancer. The air, water and soil are polluted due to urbanization, pollution from factories, plastic wastes etc. In addition to this, addictions like tobacco chewing, smoking and alcohol also are known potent causes for cancer.
The most important cause originates from the food. The body is made from food materials, and diseases also originate from food. Hybridization, chemical fertilizers, pesticides etc. brought major change in farming. Hybridization is the main culprit. Mutated genes in seeds along with chemical fertilizers can cause cancer. This emphasizes the need for use of indigenous or local (desi) seeds and cultivation.
The effect of cooking gas, refrigerators, mixer grinders, microwaves etc. which are in daily use, is not very well studied in changing the quality of food. The use of bakery products is also increased and their effect on health is also ambiguous. The food habits are drastically changed from natural, traditional food to unnatural/junk/fast food, deep fried items, preserved food, cold drinks etc. The intake of food also changed. The food taken by watching TV also have a negative impact. One should concentrate mind and all senses while eating. These dietary factors can lead to cancer like other diseases as observed in many patients.
Improper lifestyle is one of the biggest and important cause for cancer. Ayurveda science emphasizes the importance of waking up early in morning. Timely and proper sleep, early and light to digest food at night are prerequisites to get up early morning. One should not eat if there is indigestion. All these are known facts, but rarely followed nowadays. Late night dinners, late sleeping habits are the causes for diseases including cancer.
The general signs and symptoms in cancer are as below :
- Lump or swelling in the affected body part
- Unintended weight loss or gain
- Change in color and complexion of skin, non healing wounds, changes to existing moles
- Changes in bowel or bladder habits
- Persistent cough or dyspnea
- Hoarseness of voice
- Persistent indigestion or discomfort after eating
- Persistent, unexplained muscle or joint pain
- Persistent, unexplained fevers or night sweats
- Unexplained bleeding or bruising
Types of cancer
There are four major types of cancer:
1. Carcinomas: It is most common type of cancer. It begins in the skin or epithelial tissue. These usually form solid tumors. E.g. prostate cancer, breast cancer, lung cancer, and colorectal cancer.
2. Sarcomas: Sarcoma begins in the connective tissues like fat, muscles, nerves, tendons, joints, blood vessels, lymph vessels, cartilage, or bone.
3. Leukemias: Leukemia, a cancer of the blood, shows uncontrolled growth of blood cells. The 4 main types of leukemia are acute lymphocytic leukemia, chronic lymphocytic leukemia, acute myeloid leukemia, and chronic myeloid leukemia.
4. Lymphomas: Lymphoma begins in the lymphatic system, that fights infection. There are 2 main types of lymphomas: Hodgkin lymphoma and non-Hodgkin lymphoma.
The definite diagnosis of cancer is done only after invasive tissue biopsy. No noninvasive diagnostic test is sufficient to define a disease process as cancer. Staging of cancer is dome by a specific system called TNM (tumor， node， metastasis) system codified by the International Union Against Cancer and the American Joint Committee on Cancer. This classification is an anatomically based system that categorizes the tumor on the basis of the size of the primary tumor lesion (Tl -4， where a higher number indicates a tumor of larger size)， the presence of nodal involvement (usually NO and Nl for the absence and presence， respectively， of involved nodes， although some tumors have more elaborate systems of nodal grading) and the presence of metastatic disease (MO and Ml for the absence and presence， respectively of metastases). 
Approach towards treatment of cancer through Ayurveda
When a patient suffering from cancer comes for Ayurveda therapies, there are two approaches towards it:
1. Ayurveda therapies with conventional medicine, can be named as ‘integrated approach’
2. Only Ayurvedic therapy without any conventional medicine
Advantages and disadvantages
There are certain advantages and disadvantages for both these approaches.
- In this approach, the diagnosis of cancer as per conventional medicine is accepted with its prognosis. Knowledge of experiences from Oncologists can be obtained to understand stages and prognosis.
- The concepts from conventional medicine are correlated with Ayurvedic concepts. For e.g. multiplication of cells is associated with functions of reproductive fluid (shukra dhatu) and essence of all body tissues (ojas). Regeneration capacity is attributed to shukra. The main function of shukra is the regeneration of all body tissues or multiplication of cells. [A. Hr. Sutra Sthana 11/4] This is very well established in the treatment of wounds. [A. Hr. Sutra Sthana 29/33] This same principle can be applied while understanding pathology of cancerous growth.
- In leukemia, when white blood cells count goes very high, it is considered as the growth of immature cells. This can be understood in terms of decreased metabolism at the level of body tissues (dhatuagnimandya). [A. Hr. Sutra Sthana 11/34]
- Based on the progress of disease, Ayurvedic prognosis can be judged and treatment is planned. In a cancer patient, liver and spleen was involved. The liver was palpable for 8 fingers and spleen 4 fingers and was stony hard. Milk diet and copper (tamra) and diamond (hiraka) basma was prescribed. The patient responded well. After 1 month the spleen was not palpable and liver was palpable for 4 fingers. In the etiology of pleehodara, Charak opines that morbidity of rasa and rakta in turn cause enlargement of spleen.[Cha.Sa.Chikitsa Sthana 13/36-37] The portion of body tissue (dhatu ansha) of muscle tissue (mamsa), fat (meda) and bones (asthi) may get diverted to blood (rakta) and results in disease in the process of transformation (dhatu agnivyapara). The treatment is changed to milk and ghee processed with Tinospora cordifolia (guduchi) to correct the same.
Thus the integrated approach includes knowledge sharing of allopathic and ayurvedic system of medicine.
Disadvantages of integrated approach
- If the base of modern medicine changes drastically, the Ayurvedic concept based on those concepts will have no value.
- More over this approach ultimately leads to cessation of Ayurvedic way of thoughts. If we are carried away by the modern medicine diagnostic methods, then that is a very big loss to Ayurveda. As Ayurvedic practitioners, diagnosis of condition in Ayurvedic way is moral responsibility.
- The disease is evaluated based on nidanapanchak perspective. This is little bit tough task.
- Cancer can be considered as single or multiple entity as per Ayurvedic texts.
- Consideration of cancer as local or systemic or systemic with local manifestations is tricky in diagnosis and assessment.
For example, in a case of malignant melanoma, the first mole is removed and found that it is malignant. The doctors went on removing the malignant moles. After removal of fifth mole, there was a spread all over the body. There were more than 300 moles and grown to the size of coconut and was oozing, having foul smell and severe pain. In many breast cancer patients, it is observed that after magnetic resonance imaging (MRI), the disease spreads faster. So such conditions cannot be limited to a local disease. This is both systemic and local. So the surgery or radiation might not be always the best possible solution for this. Ayurvedic approach to treat origin of disease (utpattisthana) with site of manifestation (vyaktisthana) is advantageous in such cases.
Disadvantages of only Ayurvedic approach
- Ayurvedic doctors are comparatively less experienced to treat cancer patients than an oncologist. This lack of experience may lead to improper judgment regarding prognosis.
- The Ayurvedic perspectives and views are difficult to explain to the modern world. It might not be possible to find out a single anti-cancer drug.
Patient centric appropriate approach
Considering both approaches, a patient centric approach for the benefit of his health needs to be developed. Appropriate approach is to take advantages of experiences of modern medicines to know signs and symptoms, causative factors and prognosis of disease, and consider them on Ayurvedic grounds. Modern physics has provided variety of techniques like X-ray, CT scan etc. to overcome the hurdles of limitation of human sense organs. The interpretation of results of these techniques must be done in Ayurvedic terminologies.
For Ayurvedic treatments, Ayurvedic diagnosis is a must. Diagnosing in conventional methods and going for Ayurvedic treatments is not the correct way. For Ayurvedic treatment we should know about the dosha, dhatu, agni, bala etc. of the patient. The current treatment protocol is focus only on cancer. Other important factors involved in pathogenesis like the cause, the season etc. are not considered in treatment. In hot season, chemotherapy and radiation might not be suitable. This causes more harm to patient than benefit leading to deterioration of health at the cost of treatment of disease. Generally in advanced stage of cancer, the patient will be in depressed state of mind. Depression itself is aggravator of all diseases. [Cha.Sa. Sutra Sthana 25/40] Therefore, boosting positive thinking is essential for the patient.
Challenging social aspects of Ayurvedic treatment of cancer
The patients generally are in doubt about the efficacy of Ayurvedic treatment especially regarding the diet. The patient won’t hesitate to undergo radiation as it is a conventional treatment, but when complete milk diet is advised, they raise questions about their survival. The society believes that only conventional medicine is scientific and all other traditional treatments including Ayurveda is not scientific. Even after cure through Ayurvedic treatment, they believe that it was his destiny and not the scientific nature of Ayurveda treatment. This social stigma needs to be considered to improve acceptance of Ayurveda as to provide better health and quality of life in cancer patients. When a cancer patient comes for Ayurvedic treatment the following points need to be considered. Usually they are in advanced stage and generally incurable. The life span is very less. Along with the symptoms of the disease, the symptoms due to chemo or radiotherapy also should be considered. The economical condition may also be poor. Ayurveda treatments, if started in initial stage, might prove better efficacy with affordable healthcare.
Objectives of Ayurvedic treatment of cancer
- Pain relief
- Improve the quality of life
- Extend the life span as much as possible
- Try to cure
- Try to prevent the recurrence
Disease free interval with a good quality of life should be the goal of treatment. The goals can be achieved by following methods.
Cause oriented treatment (hetu-pratyanika chikitsa):
Tobacco, stress, psychological shock, improper food habits, surgery, FNAC, biopsy, heredity etc. are common causes. Avoidance or removal of causative factors is the foremost treatment of a disease. [Su.Sa. Uttar tantra 1/25] For that, in Ayurvedic perspective, the causes of cancer shall be elucidated. If cause is known, etiopathogenesis (samprapti) also can be judged and treatment can be decided.
Avoiding the causes and reversing their effect
Emphasizing on the use of desi cow (A2) milk with natural/organic food only is a primary and important requirement. Only natural and organically grown farming was in practice for thousands of years, till last 4-5 decades. Returning to natural food is most important to regain health. Intake of milk and ghee is considered as most important rejuvenator (rasayana). So only desi cow milk and ghee should be used for this purpose. [Cha.Sa.Sutra Sthana 25/40] If the food is proper, then the tissues formed from this food won’t have any abnormalities.
Detoxification with panchakarma in tobacco addicted patients is advised. Pouring medicated liquid over forehead (shirodhara), counseling, yoga and massage are advised for patients having stress and psychological shock. Life style correction including food habits for improper food habits is important.
spiritual therapies (adidaivika treatment) for those who are having bad destiny. I had a recent case of cancer for a 3 ½ year old child. Alpha fetoprotein was 57000 units. How a child at this age get cancer? Here we have to think about the past life (purvajanma) of patient and should treat accordingly.
General guidelines for the treatment of cancer
Drugs which purifies the reproductive fluids (shukra shodhanagana drugs) [Cha.Sa.Sutra Sthana 4/12] are used for the treatment of cancer, since vitiation of reproductive fluid (shukra dushti) happens as a result of intake of hybridized foods. The hybrid grains can cause vitiation of reproductive fluid shukra.
Sepia Officinalis (samudraphena) and Myrica Nagi (katphala) is generally used for cancer treatment. When there is vata and blood (rakta) involvement, the drug of choice is Asteracantha Longifolia (ikshuraka). If there is predominance of pitta, Andropogon Muricatus (ushira) is used. Bergenia Ligulata (pashanabeda) is used when hard lumps are present. The drug is selected based on the dosha and dushya involvement. The dushyas involved can be judged based on the vitiation of channels of transportation and transformation (srotodushti) causes, symptoms and the organ involved. For e.g.in lung cancer, involvement of blood (rakta) can be considered since lungs (phuphusa) is originated from blood (rakta). For particular dushyas involved, its specific dhatupachaka medicines should be used. The treatment for chorinic fever (vishama jwara) can be adopted here. The 5 decoctions mentioned for the treatment of five types of vishama jwara can also be used as specific treatments for doshas, if it resides in particular dhatus. If rasadushti happens, rasa pachaka medicines can be used. This concept can be applied while treating kushtha, prameha etc.
I used to give heeraka bhasma along with specific dhatupachaka drug.
Principles of treatment
- Nourishment/depletion therapies (santarpana/apatarpana)
- Purification/pacification therapies (shodhana/shamana)
- Disease specific treatments (vyadhipratynika)
- Dosha specific treatments (dosha pratyanika)
- Cause specific treatments (hetupratyanika)
- Relieving side-effects of chemo and radiation
- Rejuvenation therapies(rasayana)
Nourishing therapies (santarpana treatment)
Indications: Weight loss, emaciation, weakness, stress, depression and anxiety.
Treatment: Counseling, only milk diet, medicines like Vasantakusumakara rasa, Asparagus racemosus (shatavari), Pueraria tuberosa (vidari), Withania somnifera (ashwagandha) etc. can be used. Thin gruel (peya)/vegetable soup (yusha)/thick gruel (vilepi) etc. may also be used as santarpana.
Depletion therapies (apatarpana treatment)
Basically cancer is apatarpanajanya disease. So the treatment is light to digest nourishing food (laghusantarpana). However in some cases initially depletion (apatarpana) may be beneficial.
Improving digestion (pachana), fomentation (swedana), application of medicated paste (lepa), leech application (jalaukavacharana) etc. can be done as per the conditions. Particularly when there is skeletal metastasis, fomentation with bolus of leaves of herbs (patrapotalli sweda) can be done in condition associated with ama ( samaavastha). Keeping heated oil over lowback (Katibasti) with kottamchukkadi/sahacharadi oil is followed by patrapotalli sweda. Fomentation (seka) can also be done with oil (taila), fermented rice water (kanji) etc. Leech application (jalukavacharana) will help particularly in oral cancers. Where there is a tendency of bleeding the pain gets relieved after bleeding. In a malignant melanoma case, treatment started with leech application and fumigation showed good results.
Vyadhi pratynika (disease specific)
- Diamond powder (Hiraka basma) is used in every patient. It is very safe without any side effects. Dosage is 0.04mg/day.
- Dushya specific dhatupachaka medicines can be given.
- Semecarpus anacardium (Bhallataka) can be used with caution because some patients may get allergic reactions.
- Pippali rasayana can be used. It can be given in escalating dose either from 10 pipers to 100 or from 6 to 60 or 3 to 30. In lung cancer and liver cancer, when there is low digestive power (agnimandya) and in cold season, it is ideal to use.
- Narasinha rasayana is used particularly in lung cancer.
- Copper (tamra) and tin (vanga) is better for vitiated reproductive fluid (shukradushti).
- Bringing vata dosha to its normalcy (Vatanulomana) by pacifying (shamana) or purificatory (shodhana) procedures is most important for dosha pratyanika treatments. In a case of esophagus and stomach cancer, puncture of esophagus and metastasis to right humerus was present. The patient was in agony. Per abdominal examination revealed the presence of fecal matter. The case was admitted and therapeutic enema (basti) was given. When the fecal matter came out, gradually the pain subsided. Within a week, the patient was absolutely pain free. It was a clear case of obstruction induced vitiation of vata dosha (margavaranaganyavataprakopa). We can at least relive the pain, which is most important.
- Pitta pacifiying (shamana) or purification (shodhana) in pitta predominant conditions is advised.
- Kapha pacifiying (shamana) or purification (shodhana) in kapha predominant condition is advised.
- Even in acute cases, different therapeutic enemas like anuvasana/asthapana/yapan/uttarabasti can be used. In bladder cancer, enema through uretheral route (uttarabasti) is used particularly.
Indication: Treatments can be given based on the symptoms of disease, symptoms due to chemotherapy and radiation, depression and fear.
Treatment: Symptoms like pain, constipation, loose motion etc. should be treated. For adverse effects of chemotherapy such as nausea, vomiting etc. kamadugha, Cynodon dactylon (durva) etc. can be used. For adverse effects of radiation like burning sensation, ghee, Aloe vera (kumari) and Cynodon dactylon (durva) can be used. Aloe vera (kumari) is a better choice since it is cold in potency, rejuvanating rasayana, good for liver and lungs and is easily available. To combat, fear and depression food/medicines which increases the essence of all body tissues (ojo vardhaka) can be given. E.g. milk
As rejuvanator (rasayana) only milk diet can be advised. The patient can take upto 2 liters/day. If the patient continues to take milk, the immunity increases and regression of disease happens gradually. By taking the Ayurvedic medicines, there may not be notable changes in markers and size of tumors. But there will be stagnation of disease progression for a period and later tumor also may get cured. We have some cases in which the tumor gets cured completely. Diamond powder (Hiraka bhasma), bhallataka rasayana, vardhamanapippali rasayana and chyavanaprasha also can be given.
For treating cancer, we need a holistic approach that includes Ayurveda, Yoga, counseling, massage, and lifestyle and diet management. Before advising surgery, the status of shukra and ojas shall be considered. If the patient is above 70 years of age, it’s better to avoid biopsy or FNAC. If some markers are available to diagnose that is fine. FNAC and biopsy may disturb the whole equilibrium of tissues. Even if, it is confirmed that aggressive management with chemotherapy and radiation is not possible at this age. There is no meaning to diagnose and leave the case. For them, it is better to start Ayurvedic treatments that can improve quality of life.
A case of CA bladder with muscle invasion, advised for bladder removal was treated with oral medication and uttarabasti. Avapeedaka snehapana was also done considering suppression of urine as one of the causative factor for disease. Further spread of disease was arrested and could retain the bladder also. Since last 21 years, the person is completely disease free.
A 57 year old renal cell carcinoma patient, treated with only milk diet for 9 months. For three years, the general condition was satisfactory. Kidney started functioning but he developed hydronephrosis due to ureteral obstruction. This was misunderstood by patient as aggravation of disease, which leaded to depression. The patient suffered from brain metastasis and hemiplegia, making the condition worse and the patient died. However, the patient survived for three years due to Ayurveda treatments.
Another patient had the symptoms of hyperacidity and stomach ulcer. Underwent surgery for that and was revealed as CA stomach. Subtotal gastrectomy was done. The chance of survival was only for 2 months. Then the patient came to me and I kept him on milk diet. He used to consume 2 liters of milk a day. There was weight gain and restoration of normal activities. After six months, the patient started vomiting without pain. So he is referred back to surgeon for resecting the adhesions. The patient further survived for one more year.
A patient aged 50 years, was unconscious, primary focus unknown and secondaries in liver and lung. His bilirubin level was 32 mg/dl and was in intensive care unit (ICU). Supplementary oxygen and intravenous fluids were given. Life expectancy was only few hours. Relatives of the patient requested me to see the patient and on their compulsion the patient was shifted to a smaller hospital. Instead of ICU, patient was admitted in a special room. Along with oral medication, scum of gruel prepared with fried paddy (lajamanda) and green gram soup (mudgayusha) was started. Even though the intake was less, it was possible to stop saline and oxygen supply. After that cassia fistula (aragwadha) and a combination of Terminalia chebula (haritaki), Terminalia bellirica (vibitaki) and Phyllanthus emblica (amlaki) (triphala) was used for mild purgation (mridu stramsana). After passing 5 to 6 loose bowels, the patient became semi-conscious and could recognize some relatives. Bilirubin came down to 20 mg/dl. But still hallucinations were present. He died after 6 days. During these 6 days, the quality of life of that patient improved and could provide economical treatment.
Importance of concept of health
- Health can neither be sold nor purchased.
- It has to be achieved, maintained and enhanced, through proper means, by an individual.
- Investing in health has multi-faceted benefits, in the form of strength, vigor and vitality, protecting us from diseases and moreover making the life meaningful through achievement of four objectives of life (purushartha).
The pharmaceutical companies, hospital management groups, and insurance companies control the whole world of so called health industry today! Unhealthy society is the bread and butter of these three. Insurance companies taking advantage of fear psychosis are compelling people to go for health insurance.
Real reason behind illness
- For last 4-5 decades, we have gone away from natural farming.
- Hybridized seeds and animals have started giving rise to unnatural mutations leading to diseases like Cancer.
- Farming is further worsened by poisonous pesticides and fertilizers.
Need for holistic efforts for cancer:
The number of cancer patients are increasing worldwide. Cancer leads to untimely painful miserable death. In most of the cases, the diagnosis is made only in advanced stages. There are limitations to treat this condition. The side effects of existing treatments are too hazardous for health. The psychological factors like fear, depression, stress etc. aggravates the disease.
Needs to be addressed:
- Prevention of secondary onset of the disease and primary onset in next generation or cancer prone people.
- Provide safe and cost effective treatment.
- Better quality of life should be assured in advanced stages.
- Holistic approach with positive changes in lifestyle as a whole.
- Change in mindset of the patients and society.
- Early detection of disease or proneness to disease for better prognosis.
- Creating awareness for healthy lifestyle with changes in dietary habits, work schedules, psychological factors, etc.
- Creating awareness also for organic farming, eco friendly environment, etc.
- Correction of lifestyle in all patients of cancer being treated by any medical system.
- Improving mental strength and management of stress, depression with proper counselling and yoga therapy for all cancer patients being treated by any medical system.
- Full-fledged Ayurvedic treatment in advanced cases where conventional treatments have limitations.
- Adjuvant Ayurvedic therapy for better prognosis and better quality of life in other cases being treated by conventional therapy.
- Panchakarma and rasayana treatment for prevention of secondary onset in disease free state and also for prevention of primary onset in their next generation or disease prone people.
Prerequisites for holistic healthcare unit of cancer
- Development of full-fledge Ayurvedic treatment unit with Panchakarma facility.
- Formation of support groups for mutual benefits
- Orientation and training of Ayurvedic physicians.
- Development of Ayurvedic medicine store.
- Development of desi cow farm for various cow products.
- Development of medicinal plants garden.
- Development of Ayurvedic Research Wing.
- Set up of Ayurvedic unit with Panchakarma and drug store.
- Commencement of Ayurvedic OPD.
- Separate Ayurvedic IPD care and /or combined IPD care.
- Ayurvedic Research Wing.
- Better quality of life and prolongation to certain extent.
- Reduction in the side effects of chemotherapy and radiation and their timely completion.
- Change in attitude of the society.
- Spread of message of advantages of collaborative approach across the globe.
Q. (Dr Samata Lokhande) Please share the experience and prognosis of osteosarcoma
A. It is very difficult to treat. The pain factor is very severe. This happens in children at the age of 12 to 18 and the survival rate is also very low. But I have been able to at least give symptomatic relief to some extend and prolong the life with better quality of life. It is very difficult to handle. The condition is very miserable.
Q. (Dr Manisha Sharma) If desi cow milk is not available then can we prescribe other milk?
A. We have to go for Desi cow milk only. Jersey cow milk is the culprit, it cause cancer. So it cannot be used. Buffalo milk or goat milk are the other options. If these are not available, go for organic foods. That is the only solution.
Q. What is the option for milk in cancer patients in case of lactose intolerance?
A. Generally it is not found. There can be some problems like flatulence, loose motions, hiccups in some cancer patients with milk diet. This can be treated easily with pippali rasayana or by adding shunti or haridra with milk.
Q. (Dr Arpitha Konana) Are gold preparations or suvarna bhasma is useful in treatment of cancer?
A. That can be used. I emphasized on hiraka bhasma. There can be other gold preparations like suvarnasutasekara rasa, suvarnamalinivasant rasa etc. if needed. We generally tried to go for siddha kshira, suvarnaguduchikshira. 1 cup of milk, 1 cup of water, 1 golden bangle or ring and guduchi, boil it, reduce to 1 cup. Have that milk as anupana with whatever medicines we are giving. I was using mahakalyanaka grita. But rakta dushya is very commonly seen in most of the cancer patients. So we now prepare raktakalyanakaghrita which raktapachaka and kalyanakaghrita combination. We prepare it by ourself. Every week I require 5 to 10 kgs of ghrita. This is to be given as anupana followed by suvarnaguduchiksheera. That helps better.
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