Abstract
Laryngeal cancer is the most common malignant tumor among head and neck cancers in the world. Half of laryngeal cancers involve the vocal folds. Ayurvedic science being comprehensive, may not have described contemporary diseases as we read in modern texts. However, many contemporary diseases can be evaluated well by applying Ayurvedic diagnostic and therapeutic tools such as Nidana Panchaka, Agni (digestive fire) assessment, Dosha (body humors), Dhatu (body tissues), and Mala (excretory products), Srotas (body channels).
Here a case study of a 72 year old patient with chief complaint of hoarseness of voice and having biopsy confirmed as squamous cell carcinoma of left vocal cord is treated.
The patient was treated with Ayurvedic medications like Rakta prasadaka hima, kwatha prepared from Kanchnar bark, Yashtimadhu churana and Gomutra, combination of drugs which included jaharmohra pishti, Kahrva pishti, Tapyadi lauh, Vaikrant bhasma, Swarna bhasma, Heerak bhasma given with Drakshavaleh, Tab cytocruel AT, Kanthsudharak vati.
The size of nodule in CECT neck and GRBAS score (for hoarseness of voice) declined significantly after treatment and the voice of patient was improved.
Thus a case of carcinoma of left vocal cord treated successfully only with Ayurvedic treatment without any conventional therapy and with no side effects.
Keywords: Carcinoma, Ayurveda, Vocal cord, Squamous cell
1. Introduction
According to WHO estimates, there were 20 million new instances of cancer globally in 2022, accounting for 9.7 million deaths. Cancer is one of the top causes of death worldwide [1]. As per a research by The Global Cancer Observatory, a subsidiary of the World Health Organization (WHO), India experienced an increase in cancer cases, with over 14 lakh diagnoses and over nine lakh fatalities in 2022 [2].
In India, one out of every nine persons will eventually get cancer. Laryngeal cancer is the most common malignant tumor among head and neck cancers. Vocal fold cancers involve half of laryngeal cancer. It is the 19th oncologic cause of death, constituting 1 % of cancer mortality [3]. Laryngeal squamous cell carcinoma (SCC) is strongly linked to cigarette smoking. It is thought to be responsible for over 70 % of laryngeal SCCs and up to 89 % when combined with alcohol [4].
Histologically, more than 90 % of vocal fold cancers are squamous cell carcinomas and surgery combined with radiotherapy or chemotherapy has been the most common conventional treatment method for larynx cancer. The loop hole for conventional treatment is that it may result in muscle atrophy, worsening of hoarseness of voice, trouble swallowing, erythema and dryness of laryngeal mucosa and many other side effects. So there is need of alternative treatment therapy [5].
Though there is no direct reference of laryngeal cancers in Ayurveda texts but the basics for diagnosis in management for any known/unknown disease including cancer has been given in Ayurveda. On the basis of these basic principles for diagnosis of management of unknown disease (Anukta Vyadhi), Ayurvedic treatment can be modulated. This research article is focussed on standalone Ayurvedic management of carcinoma of vocal cord.
2. Patient information
A 72 year old male patient came to Cancer Consultation and Treatment Unit, NIA (DU) Jaipur in Dec 2022 with chief complaint of difficulty in speaking/hoarseness of voice and generalized weakness in body since 3 years. Initially there was a slight change in voice progressed to improper speech. The patient was diagnosed with squamous cell carcinoma of left vocal cord and had not taken conventional therapy or any other alternative treatment for carcinoma before.
2.1. past history
Patient was known case of hypertension (HTN) since 20 years and is taking amlodipine for 20 years. Patient had cigarette addiction since 30 years with 10–20 cigarettes per day. Patient had history of TB in 1990 and took anti tubercular treatment for 1 year.
3. Clinical findings
Patient had major complaint of hoarseness of voice or difficulty in speaking. There was no problem in swallowing food. He did not had any complaints of sore throat or coughing.
On examination, no lymphadenopathy was seen in cervical or supraclavicular or submandibular lymph nodes. Per abdomen was Soft, non tender, no spleenomegaly, no hepatomegaly. Mild pallor seen in eyes (Table 1).
Table 1.
Clinical findings of the patient.
| Clinical findings before and after treatment | |||
|---|---|---|---|
| S.no. | Clinical Finding | Before Treatment | After Treatment |
| 1. | Hoarseness of voice | + + + (voice could not be heard) | + (decreased and voice could be heard) |
| 2. | Generalized weakness | + (present) | - (Absent) |
| 3. | Mild pallor in eyes | + (present) | - (Absent) |
| Grading for hoarseness of voice- GRBAS Scale | |||
| S.No. | Component | Before treatment | After treatment |
| 1 | Degree of hoarseness of voice | 3 | 2 |
| 2 | Roughness | 3 | 2 |
| 3 | Breathiness | 2 | 1 |
| 4 | Asthenia | 3 | 1 |
| 5 | Strain | 3 | 1 |
| TOTAL SCORE | 14 | 7 | |
| Radiological Changes in CECT NECK | |||
| S. No. | Parameter | Before treatment (dated- 20 Dec,2022) | After treatment (dated- 21 Aug, 2023) |
| 1 | Size of left vocal cord nodule | 8.4mm(AP) × 9mm(CC) × 6mm(TR) | 5mm(AP) × 6mm(CC) × 4mm(TR) |
mm-millimetres, AP- Anteroposterior, CC- Craniocaudal, TR- Transverse.
4. Timeline
The timeline of the events is given in the Fig. 1.
Fig. 1.
5. Diagnostic assessment
The assessment was done both clinically and radiologically. Hoarseness of voice was assessed subjectively using GRBAS SCALE proposed by the Japanese Society for Logopedics and Phoniatrics [6].
The GRBAS scale measures overall dysphonia grade, roughness, breathiness, asthenia, and strain to evaluate vocal quality in a variety of contexts. Radiological assessment was done on basis of CECT neck (Table 1).
5.1. CECT scan of NECK before treatment dated 20-12-2022
Heterogeneously enhancing mass measuring approx. 8.4(AP) × 9mm(CC) × 6mm(TR) lesion involving left vocal cord region.
5.2. Histopathological investigation
Biopsy of growth fragments on left vocal cord showed well differentiated squamous cell carcinoma.
5.3. Ayurvedic diagnostic principles
According to the principles of diagnosis mentioned in Ayurveda, vitiation (Vikriti) is of Pitta Pradhana Tridoshajanya Dosha (Pitta predominant Tridosha), Rasa (primary circulating nutrient fluid) and Mamsa (muscle) dhatu as a Dushya (a bodily structure which can be vitiated by aggravated dosha), Srotas (body channels) involved were Raktavaha Srotas, Mamsvaha srotas and Pranavaha srotas (Table 2).
Table 2.
Ashtavidha pariksha (Eight fold examination method) findings.
| Parishiya bhav (Parameters) | Parinam(Result) |
| Nadi (pulse) | Vatapittaja |
| Mutra (urine) | Samanya (normal) |
| Mala (stool) | Samanya (normal) |
| Drika (eyes and vision) | Samanya (normal) |
| Shabda (voice and speech) | Aspashta (not clear) |
| Sparsha (tactile sense/touch) | Sheeta |
| Aakriti (general body build) | Krisha (thin) |
| Jihva (tongue) | Nirama (clear) |
6. Therapeutic interventions
The patient was treated only with Ayurvedic drugs and therapies. Internal shamana chikitsa included Ayurvedic formulations like Rakta prasadaka hima, Kwatha(decoction) prepared from kanchnar chaal (bark of Bauhinia variegata), Yashtimadhu (Glycyrrhiza glabra) churana (powder) and Gomutra (cow's urine), combination of drugs which included Jaharmohra pishti, Kahrva pishti, Tapyadi lauh, Vaikrant Bhasma, Swarna Bhasma, Heerak bhasma given with Drakshavaleh. Lavanbhaskar churan and Sarjikshar was given with buttermilk (chaach) with food. Yashtimadhu churan kwatha (decoction made by boiling yashtimadhu powder) was given for gargling (kavala) twice a day. Tab cytocruel AT which is proprietary medicine, was given with milk twice a day. Kanthsudharak vati was given for chewing. Patient was advised to do Nadi Shodhana pranayam. This entire duration of treatment was given for 8 months to patient (Table 3).
Table 3.
Therapeutic interventions.
| S·NO. | INTERNAL MEDICATION | DOSE | ANUPANA |
|---|---|---|---|
| 1 | Rakta prasadak himaa | 50 ml twice a day empty stomach | Water |
| 2 | Kwatha prepared from kanchnara chaala(5 gm) and yashtimadhu churana(5 gm) and Gomutra(50ml) | 50 ml twice a day before food | Water |
| 3 | Combination of-Jaharmohra pishti | 125mg | Twice a day with Drakshavleha |
| Kahrva pishti | 125mg | ||
| Tapyadi lauh | 125mg | ||
| Vaikrant bhasma | 25mg | ||
| Swarna bhasma | 15mg | ||
| Hirak bhasma | 5mg | ||
| 4 | Drakshaveleh | 5 gm twice a day | With milk |
| 5 | Tab cytocruel AT | 1 tab twice a day | With milk |
| 6 |
Lavanbhaskar churan + Sajjikshar |
3 gm 1 gm |
Buttermilk |
| 8 | Kanthsudharak vati | 1 tab four times a day | For chewing |
| For local treatment(gargles) | |||
| Yashtimadhu churan kwaath | 50ml | For kaval(gargling) | |
| Nadishodhan pranayam |
The patient was advised to soak 5 g of Raktaprasadaka hima powder in one cup (50 ml) of water for at least 8–10 h during the night. After soaking, the mixture was filtered through a clean cloth. The patient was instructed to consume the filtrate empty stomach.
7. Follow up and outcome
After 7 months of entire treatment the size of ulcerative growth in vocal cord was decreased from 8.4mm(AP) × 9mm(CC) × 6mm(TR) to 5mm(AP) × 6mm(CC) × 4mm(TR). (Table 1).
Patient was clinically improved in gradeness of hoarseness of voice measured by GRABS scale from 14 to 7 (Table 1). There were no adverse effects found in entire duration of treatment.
8. Discussion
Conventional therapy can help slow the growth of tumors, but also lowers the patient's quality of life. A significant portion of people cannot afford to purchase modern medications. Current cancer treatments are not only costly but also have a poor success rate and a lot of severe side effects. Since cancer is primarily a disease of old age, finding less toxic therapies is a major priority.
Approach of Ayurveda being a holistic science, is person-centered. Instead of using targeted treatments to remove the tumors, Ayurvedic drugs and treatment plans try to correct metabolic imbalances and restore normal tissue functions, or “Sama Dhatu Parampara” As with most traditional medical systems, Ayurvedic medicine is comprehensive; immunotherapy (Rasayanaprayoga), which revitalizes the body's defenses, is a major part of cancer treatment [7].
Ayurveda says it is not always necessary to know the exact nomenclature or name a disease and it is not always possible [8]. Ayurvedic classics may not have addressed contemporary diseases that have developed over time, but these can be understood very well by applying Ayurvedic diagnostic and therapeutic tools such as Nidana Panchaka, Agni (digestive fire) assessment, Dosha (body humors), Dhatu (body tissues), and Mala (excretory products), Srotas (body channels) [9]. According to Ayurveda imbalance in the biological fire (Agni), known as an Agnimandya, is the core reason behind all diseases [10]. An autotoxin called Ama is formed when the biological fire, or Mandagni, is not operating at its optimum level results in poor food digestion (Mandagni).
This autotoxin affects bodily tissues, affecting their properties and causing a variety of disease processes when combined with the bioentities (dosha) [11].Squamous cell carcinoma has ulcerative growth which can be co-related to Vrana in Ayurveda. Vrana manifest because of Vikriti of pitta dosha and its growth is due to kapha.
Therefore this Vyadhi (disease) is having Pitta-kapha Pradhan Tridosha dominance, Rakta (blood) and Mamsa (muscle) as Dushya, raktavaha and Mamsvaha srotas(channels of body), internal medications given to patient were mainly Pitta Shamaka (pacify pitta dosha) and Rakta Prasadaka (cleanses the blood). Among internal medications Rakta Prasadak Hima was given. Hima Kalpana is one the of the Panchavidha kashaya Kalpana with Pitta pacifying properties [12]. Rakta prasadaka hima contained Dravya viz. Sariva (Hemidesmus indicus), Manjishtha (Rubia cordifolia), Kakamachi (Solanum nigrum Linn.), Usheer (Vetiveria zizanioides), Bhumyamalaki (Phyllanthus niruri) all in equal ratio and all these ingredients are supposed to calm down Pitta [13]. Kwatha containing kanchnar tvaka churan, yashtimadhu churana and cows urine (gomutra). Kanchnar (Bauhinia variegata) has a great potential in reducing cancerous growth which has been established in various scientific experiments.
According to Bhavaprakasha, Yasthimadhu is Pittashamaka drug (pacifying Pitta). It has Madhura (sweet) rasa, Sheeta virya (cold potency), Madhura vipaka [14]. The antitumour activity of the ethanol extract of Bauhinia variegata (EBV) has been evaluated against Dalton's ascitic lymphoma (DAL) in Swiss albino mice [15]. The urine of native breed cows contains chemotherapeutic properties. Numerous case studies, success stories, and patient feedback have demonstrated the anti-cancer potential of cow urine therapy in the treatment of cancer. Cow urine increases immunocompetence, improves overall health, inhibits the production of free radicals and acts as an anti-aging agent; it lowers lymphocyte apoptosis and promotes lymphocyte survival; and it effectively repairs damaged DNA, making it useful for cancer treatment [16].
Lavanbhaskar Churana [17], an ayurvedic classical formulation was administered to the patient to stimulate his appetite because, according to Ayurveda, weak disgestive fire (Mandagni) is the cause of most ailments. Sajji Kshara, a 2:1 mixture of sodium carbonate and sodium bicarbonate (NaHCO3), has demonstrated promising results in the treatment of cancer by neutralizing the acidic microenvironment of tumors and preventing tumor invasion and dissemination [18].
Drakshavaleha is an Ayurvedic classical preparation which has Pitta Shamak, Balya and Rasayana action which might overcome the weakness complaint of patient [19]. Yashtimadhu kaval (gargling with decoction made with powder of Glycyrrhiza glabra) promotes healing process due to its anti-ulcer, anti-inflammatory and skin regeneration activity [20]. Patient has been given Tapyadi lauha [21] which might improve generalized weakness of patient as it an iron preparation of ayurveda and also aids in digestion, Kahrva Pishti, Jaharmohra Pishti to pacify Pitta dosha as the vyadhi is mainly Pittapradhan tridosha. Pishtis are generally used in Pittaja disorders, or where cooling effect is desired. The herbo-mineral formulation CYTOCRUEL which is a propretiary medicine contains drugs from different herbs viz., Cinnamomumspp., Boerhavia spp., Capsicum spp., Moringa spp., Curcuma Spp; Glycyrrhiza spp., Tecomella Spp. and Syzygium spp. Metals including copper, mercury, and sulphur are also present. Two distinct cancer cell lines, MDA-MB-231 (breast cancer) and A549 (lung cancer), were used for the concentration-dependent cell viability (MTT) experiment of CYTOCRUEL. The MTT assay results for CYTOCRUEL demonstrate a dose-dependent decrease in the percentage of viable cells in both cell lines after 48 hours of treatment when compared to the normal control, suggesting that it may be used to treat cancer. Kanthsudharak vati [22] has been excellent remedy for hoarseness of voice as it contains principal ingredient mulethi (glycyrhizza glabra) extract which heals the respiratory tract. Heerak bhasma and Swarna bhasma has anti-cancer, antimetastatic and antimutagenic properties [23]. Heerak bhasma is a potent alternative treatment of cancer [24]. Not only does it increase the immune power and vitality of the patient but also reduce the size of the tumor and prevent further metastasis.
The autonomic nervous system benefits from Nadishodhana Pranayama, which lowers sympathetic activity and increases parasympathetic outflow. Based on a randomized controlled experiment with cancer patients, Pranayama can lead to significant improvements in antioxidant levels, stress, anxiety, sleep quality, and overall quality of life for cancer patients [25].
Patient consent
Written permission for publication of this case study had been obtained from the patient.
Patient Perspective
The perspective was recorded in September 2023. The patient was satisfied with his overall improvement without any adverse effects.
Author contributions
All the authors contributed in conceptualization, methodology, drafting and reviewing the study.
Declaration of generative AI in scientific writing
The authors did not use generative AI and AI-assisted technologies in the writing process.
Funding sources
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of interests
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Acknowledgment
The authors thank Prof. Sanjeev Sharma, Vice-Chancellor, National Institute of Ayurveda (DU) Jaipur, for his moral and administrative support.
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