Tumours are characterised by aberrant cell development and the ability to infiltrate or spread to various regions of the body [1]. Benign tumours do not spread to other parts of the body and remain confined to the local region. Although typically considered non threatening, benign tumours can pose significant medical challenges due to their potential to grow and compress adjacent structures, resulting in pain and complications. Common examples of benign tumours encountered in clinical practice include fibroids in the uterus and lipomas in the skin [2]. While they do not metastasise or invade surrounding tissues, their growth can lead to compression of vital structures. For instance, a large benign lung tumour may compress the trachea, leading to respiratory distress and necessitating urgent surgical intervention. Colon polyps are closely monitored due to their propensity to develop into malignant tumours, necessitating timely intervention to mitigate the risk of progression to malignancy [3].
Malignant tumours, commonly referred to as cancerous growths, exhibit unrestrained cellular proliferation and have the capacity to invade adjacent tissues and metastasise to distant sites via the bloodstream or lymphatic system [4]. Metastasis, the hallmark of malignancy, can occur in various organs, with frequent occurrences observed in the liver, lungs, brain, and bone. Early detection of malignant tumours is paramount, as timely intervention offers the best chance for successful treatment outcomes. Surgical resection, often accompanied by adjuvant therapies such as chemotherapy or radiotherapy, remains the primary treatment modality for localised malignancies. However, in cases where metastatic spread has occurred, systemic therapies such as chemotherapy or immunotherapy are indicated to target disseminated cancer cells and control disease progression [5].
Materials and Methods
The investigation involved searching the online databases PubMed and Google Scholar using the terms “Arbuda,” “Malignancy,” and “Tumour”. Thirteen articles were included and comprehensively reviewed. Studies lacking abstracts or presented in languages other than English were excluded, ensuring that only relevant and accessible scholarly works were included. The review encompassed a thorough examination of original articles, case reports, and review articles, specifically focusing on discussions related to the causes and management of Arbuda. Data collection was achieved through a review of classical Ayurvedic texts.
Discussion
Causes of Arbuda (Cancer)
According to Ayurveda, the principle of Karmaphala Siddhanta, which dictates that one reaps the fruits of their actions, is evident in the aetiology of Arbuda [9]. Additionally, factors such as ageing, smoking, sun exposure, radiation, chemical exposure, a family history of tumours, alcohol consumption, poor dietary habits, physical inactivity, and obesity are commonly associated with tumour development. Environmental factors also play a significant role, including pollution, excessive sun exposure, radiation, pesticide exposure, chemical carcinogens, arsenic, and other environmental toxins [10].
Pathogenesis (Samanya Samprapti) of Arbuda
Ayurvedic scholars such as Sushruta, Vagbhata, and others have all described very similar concepts regarding the general pathogenesis of Arbuda. Their works contribute to the understanding of tumour development according to Ayurvedic principles. Arbuda is described in Ayurveda as a round, hard, large, deep-rooted, slowly growing, non suppurating swelling composed of a fleshy mass. It is formed when aggravated doshas vitiate the tissues, leading to damage to the inner layer of the dermis (Rohit kala), and the development of aberrant blood vessel branches [11]. The primary cause of Arbuda is uncontrolled cell and tissue proliferation, resulting in the spread of abnormal growth via the Rasavahasrotas (channels carrying nutrient fluids). These abnormal growths can lodge in various organs and systems, giving rise to a diverse array of symptoms. The aggravation of all doshas, particularly affecting blood and muscle tissues (Rakta and Mamsa), results in the derangement of metabolic fire (Agni) and the formation of metabolic toxins (Ama). Ama, in turn, obstructs the channels, leading to the formation of swelling characterised by its round shape, deep embedding, tendency to protrude, and rapid expansion, ultimately culminating in the development of Arbuda [12]. Based on the dosha, dhatu, sadhyasadhyatava (prognosis), and lakshana (signs and symptoms), Arbuda is classified in Ayurvedic texts as shown in [Table/Fig-1] [13].
Classification (Bheda) of Arbuda according to Ayurveda [13].
| S. No. | Classification of Arbuda |
|---|
| 1 | According to dosha | a) Vatajab) Pittajac) Kaphajad) Tridosaja |
| 2 | According to dhatu | a) Medajaarbuda (fatty tissue)b) Mamsajaarbuda (muscular tissue)c) Rakatarbuda (blood) |
| 3 | According to prognosis | a) Sadhya (curable)b) Asadhya (non curable) |
| 4 | According to sign and symptoms | a) Vrittam (round)b) Sthiram (immovable)c) Mandrujam (slightly painful)d) Unalpa-moolam (deep seated)e) Chiravruddhi (slowly increasing)f) Apakam (non suppurating) |
Acharya Sushruta also described Adhyarbuda (two tumour groups growing simultaneously), Dwirarbuda (tumours growing one after another) and Adhyaarbuda (tumours growing one after another), which can be correlated with the malignant stage of cancer or cancer metastasis [14].
Clinical Features (Lakshana) of Arbuda
The clinical features described by Sushruta include a spherical shape (Vrittam), stability (Sthiram), low pain (Mandrujam), large size (Mahantama), multiple roots (Analpa-moolam), slow but consistent progression (Chiravruddhi), and failure to reach the maturity stage (Apakam) [15].
Ayurvedic Approach in the Management of Arbuda
Cancer is one of the leading causes of morbidity and mortality worldwide. Effective drugs and treatment therapies are available for this disease but side-effects are very common [16]. According to Ayurveda, Arbuda develops due to mithyaaharavihar (unhealthy diet and lifestyle) as per Ayurveda. Most cancer patients use Ayurvedic drugs with the hope of boosting their immune system, relieving pain, and controlling side-effects related to the disease or its treatment. Chedana (excision), Agnikarma (thermal cauterisation), Ksharakarma (caustic therapy), and Rasayana (rejuvenation therapy) are suggested modalities for Arbuda [17]. Although treatment modalities in Ayurveda may vary according to the types of Arbuda, as shown in [Table/Fig-2] [18].
Treatment modalities for Arbuda management according to types [18].
| S. No. | Types of arbuda | Treatment |
|---|
| 1 | Vataj arbuda | 1. Poultices of Karkaruka (Cucumis melo), Ervaruka (Cucumis sativus), Narikela (Cocos nucifera), Priyala (Buchanania latifolia), and Panchangula (Ricinus communis)2. Poultices of Vesavara (meat preparation with herbs)3. Nadi swedana (Fomentation)4. Rakstamokshana (Blood letting) with Shrunga (horn).5. Virechna (Purgation) with Trivrit sneha |
| 2 | Pittaj arbuda | 1. Gentle sudation2. Virechana3. Warm poultices4. Paste application of Anjana (Corrylium), Sarjras (Oleo gum resin), Somaraji (Centratherumantihel menthica), Pattanga (Caesalpinia sappan), Aaragvadha (Cassia fistula), Priyangu (Callicarpa macrophylla), Rodhra (Symplocosracemosa), Yashtika (Glycyrrhiza glabra), and Shyama (Ocimum tenuiflorum) mixed with honey5. Medicated ghee of Syama (Operculina turpethum), Girihva (Symplocos racemosa), Amjanaki, Draksha (Vitis vinifera), and Saptalika (Euphorbia lutescens), Klitaka (Glycyrrhiza glabra) |
| 3 | Kaphaj arbuda | 1. Shodhana (Purification treatment)2. Raktamokshana3. Poultice of bird excrement, Kakadani (Cardiospermum halicacabum) root, and cow urine4. Ksharkarma, Agnikarma and Chedana5. Asphota (Aganosma caryophyllata), Jati (Jasminum grandiflorum), and Karvi (Strobilanthe scallosa) decoction for wound dressing6. Bharngi (Clerodendrum serratum), Vidanga (Embelia ribes), Patha (Cissampelos pareira), and Triphala (Emblica officinalis, Terminalia bellerica, and Terminalia chebula) oil for wound healing |
| 4 | Medoj arbuda | 1. Swedana2. Chedana and Sivana (Suturing)3. Karanja (Millettia pinnata) oil with honey for wound dressing4. Haridra (Curcuma longa), Rodhra, Manassila (realgar), and Ela (Elettaria cardamomum) for wound dressing |
Modern Medicine Approach in the Management of Tumour
Surgical excision or conservative treatment may be sufficient for benign tumours, with further attention typically not necessary. Treatment options, such as cryotherapy, curettage, or electrodesiccation, vary depending on the type and location of the common benign skin tumours [18]. Oncology, the branch of modern medicine that deals with malignant tumours, employs surgical excision, palliative care, chemotherapy, radiation therapy, and hormone therapy in the management of malignant tumours [19]. Often, multiple treatment modalities are used to manage and prevent the recurrence of malignant disease [20].
Systematic randomised trials have shown that combination chemotherapy with cisplatin, etoposide, and bleomycin (PEB) is the standard treatment for testicular cancer. However, long-term complications include secondary leukaemia, therapy-related solid tumours, nephrotoxicity, neurotoxicity, pulmonary toxicity, vascular toxicity, and infertility. Patients receiving cisplatin-based chemotherapy have an increased risk of second non germ cell malignancies, especially when combined with radiation therapy. Approximately 25% of patients experience azoospermia 2-5 years post-treatment. Vascular toxicities include Raynaud’s phenomenon, acute myocardial infarction, and cerebrovascular events, with bleomycin and cisplatin being significant contributors. Peripheral neuropathy is the most common neurotoxicity, linked to high doses of cisplatin, the use of vinblastine, and Raynaud’s phenomenon. Cisplatin also causes significant nephrotoxicity. Anthracycline-induced cardiotoxicity remains a concern, with the incidence of heart failure increasing dose-dependently [21,22].
Radiotherapy, used alone or in combination with chemotherapy, also presents significant long-term complications. These include secondary malignancies, cardiovascular diseases, pulmonary fibrosis, and endocrine dysfunction. The risk of secondary cancers increases with higher doses and larger treatment fields. Cardiovascular complications can result from radiation-induced damage to the heart and blood vessels, leading to conditions such as coronary artery disease and heart failure. Pulmonary fibrosis is a common outcome of thoracic radiation, causing chronic respiratory issues. Endocrine dysfunctions, particularly thyroid and gonadal dysfunctions, are prevalent due to radiation exposure to endocrine glands [23].
In contrast, Ayurveda offers a holistic approach to tumour management that emphasises not only the eradication of the tumour but also the restoration of the body’s overall balance and health. Ayurvedic treatments, which include herbal formulations, dietary modifications, lifestyle changes, and specific therapeutic procedures like Panchakarma, aim to address the root cause of the disease by balancing the doshas and eliminating toxins (Ama) from the body. This approach is believed to result in fewer side-effects and improved overall wellbeing [24].
Ayurvedic therapies such as Rasayana (rejuvenation therapy), Chedana (excision), Agnikarma (thermal cauterisation), and Ksharakarma (caustic therapy) are used according to the individual’s constitution and the specific type of Arbuda, potentially offering more personalised and effective treatment options [25]. Additionally, Ayurveda’s emphasis on prevention and holistic health can complement modern treatments, reducing side-effects and enhancing recovery.
Studies have shown that integrating Ayurvedic principles with conventional cancer treatments can lead to better patient outcomes, improved quality of life, and reduced treatment-related toxicity [26,27]. This integrative approach could provide a more balanced and comprehensive strategy for managing both benign and malignant tumours, addressing the limitations of modern medicine while leveraging the strengths of traditional Ayurvedic wisdom.
Exposure to ionising radiation disrupts the balance of tridoshas, leading to radiation sickness and mortality. Ayurvedic Rasayana drugs like Amritaprasham, AshwagandhaRasayana, BrahmaRasayana, Chyavanaprasha, NarasimhaRasayana, and Triphala are reported to have radioprotective effects. These formulations scavenge free radicals, increase antioxidant enzymes, and inhibit lipid peroxidation. For instance, studies have shown that BrahmaRasayana scavenges Fe2+-ascorbate-induced lipid peroxidation, while Triphala increases glutathione levels and antioxidant enzymes, protecting against oxidative stress. Triphala has also demonstrated a reduction in radiation-induced DNA strand breaks in leukocytes and splenocytes of mice exposed to 7.5 Gy of whole-body irradiation, highlighting Ayurveda’s potential in mitigating radiation-induced damage [28].
Conclusion(s)
Malignant tumours continue to pose a significant health challenge globally, with modern medicine making considerable strides in elucidating their molecular underpinnings and developing effective treatments. Despite these advances, complete eradication and management of malignant tumours remain elusive, often complicated by severe side-effects. Ayurveda, with its holistic approach, offers a comprehensive understanding of life, health, and disease, including the conceptualisation and management of Arbuda. The integration of Ayurvedic principles with modern medical practices has the potential to enhance patient care by offering complementary strategies that may improve quality of life and treatment outcomes. Future research and clinical trials exploring this integrative approach could lead to more effective, holistic, and patient-centered cancer care.