This correspondence refers to the article “Cancer: an old disease, a new disease or something in between?” (1).The article was thought-provoking and eminently readable; however the authors restricted only to ancient Greek and Egyptian medical texts and evidences from fossils and mummies. By this article I want to present the evidences of diagnosis and treatment of cancer from ancient Indian medical system Ayurveda, the recorded history and practice of which dates back to second millennium BC (2).
Indian clinicians were aware of malignancies and neoplasm. They used to diagnose cancer as swelling of body surface linked to internal organs (tumors or Arbuda) or as non-healing ulcers (Asadhya vrana). The earliest records of malignancies are found in Atharva veda of approximately 2200 BC (3). One of the oldest definitive medical texts from India written in Sanskrit language, Susruta Samhita, dealt with diagnosis and cure of diseases putting focus on surgery. The Susruta Samhita contains 120 chapters divided in 5 books or divisions. Chronology committee of National Institute of Sciences of India considers Nagarjuna’s redaction of Susruta Samhita to be written in 3rd to 4th century AD (2,4)
Susruta wrote extensively about human anatomy and physiology, pathology, medical and surgical treatment and toxicology. He used to think human beings are composed of three humors- Vayu (air), Pitta (bile), Kapha (phlegm) and blood. Derangement of humors causes disease in his opinion. According to Susruta Samhita Arbuda means fleshy growths and generally non-suppurating tumors which are gradually increasing, painful and deep-seated. He also differentiated Arbuda (tumor) from Granthi (cysts). According to him Granthi is glandular swelling which when broken open gives various discharges. Susruta differentiated Arbuda (tumors) into four types – Raktaja (slightly suppurating malignant tumor), Mamsarbuda (Myoma, malignant tumor of muscle and soft-tissues) or Medaja (Lipoma), Adhyarbuda (metastatic growth) and Dvi-arbuda (a pair of hard, painless contiguous tumors) (3,4). Susruta was also aware of metastasis. He termed metastatic tumor as Adhyarbuda. Because he understood the problem of metastasis and recurrence of tumors he was of the opinion to remove tumors surgically in every possible way from every possible place. He resembled unremoved source of tumor as a small spark of fire which can bring down the whole house (3). Susruta also referred to internal tumors or glandular swellings as Gulma.
Not only diagnosis but treatment of cancers was prescribed in Susruta Samhita. Treatment consisted generally of application of medicated poultices, fomentation with boiled meat, use of emetics and purgatives etc. Para surgical approaches such as maggotification, blood-letting and cauterization by heat and alkali were suggested. Surgical removal of tumors was also prescribed followed by cleansing and bandaging with medicinal preparation containing herbs (3, 4). Susruta provided details of different surgical instruments – at least 20 types of Sastras (sharp instruments) and 101 Yantras (blunt instruments) the graphic details of which can be seen in this reference quoted (2). In fact Susruta samhita shows evidence of complex surgical procedures like rhinoplasty, otoplasty etc which many consider as a foundation for modern day plastic surgery (5, 6).
Traditional medicine in India has a long history and strong presence till date. Innumerable plant species were documented by ancient ayurvedic practitioners and different plant parts have been used for medicinal purpose in different formulations. Since the list is exhaustive few important plants e.g. Haridra (Curcuma longa Linn.), Arjuna (Terminalia arjuna Roxb.), Sallaki (Boswellia serrata Roxb.), Punarnava (Boerhavia diffusa Linn.) etc are mentioned here. In present day, many clinical trials and pre-clinical studies have shown effectivity and mechanism of anticancer activity of ayurvedic herbal medicines for which the reader may see following references (3, 7, 8, and 9). In fact the present day market for traditional medicine in India is significantly large with big and small pharmaceutical players (e.g. Dabur, Arya Vaidya Sala, Himalaya Drug Company etc). According to one estimate in the financial year 1998-1999 the production of traditional medicine in India amounted to US$ 667.5 million (10). To protect the traditional medicines from bio-piracy India is maintaining a Traditional Knowledge Digital Library (TKDL) from 2001 which recently prevented a patent to be granted to an Italian company for anticancer use of natural plant products or essential oils or components from some pistacia species (11). Government of India has promoted traditional medicine actively by setting up institutes to train doctors in traditional medicine and offering research grants to conduct research and clinical trials (10).
Hence from this article it appears that ancient Indian medical scriptures showed proof of cancer diagnosis and treatment over 3-4 millenia ago from now and Indians still practice traditional medicine for general well-being and treatment of maladies as evident from a thriving multi-million dollar industry.
1) David RA & Zimmerman MR. Cancer: an old disease, a new disease or something in between? (2010) Nature Reviews Cancer. vol 10, pp. 728-733
2) D.M. Bose, S.N.Sen, B.V.Subbarayappa (editors). (2009) A Concise History of Science in INDIA.2nd edition. Chapter 4: Medicine. Universities Press (India) Pvt Ltd, Hyderabad, India.
3) Lakshmi Chandra Mishra (editor). (2004) Scientific Basis for Ayurvedic Therapies. Chapter 16: Benign growths, cysts and malignant tumors; chapter 14 : Hepatic disorders. CRC Press, Florida, USA.
4) Priayadaranjan Ray, Hirendranath Gupta, Mira Roy. (1980) Susruta Samhita (A scientific Synopsis). Indian National Science Academy, New Delhi, India.
5) Loukas M, Lanteri A, Ferrauiola J, Tubbs RS, Maharaja G, Shoja MM, Yadav A, Rao VC. (2010) Anatomy in ancient India: a focus on the Susruta Samhita. J Anat. 217(6):646-50
6) Raju VK.( 2003) Susruta of ancient India. Indian J Ophthalmol. 51(2):119-22.
7) Aggarwal BB, Ichikawa H, Garodia P, Weerasinghe P, Sethi G, Bhatt ID, Pandey MK, Shishodia S, Nair MG.(2006) From traditional Ayurvedic medicine to modern medicine: identification of therapeutic targets for suppression of inflammation and cancer. Expert Opin Ther Targets. 10(1):87-118.
8) Balachandran P, Govindarajan R. (2005) Cancer--an ayurvedic perspective. Pharmacol Res. 51(1):19-30.
9) Patwardhan B. (2005) Ethnopharmacology and drug discovery. J Ethnopharmacol. 100(1-2):50-2.
10) http://www.tkdl.res.in/tkdl/langdefault/Common/outcome.asp?GL=Eng, last accessed 17.4.2011.Traditional Knowledge Digital Library. Collaborative Project of Council of Scientific & Industrial Research (CSIR) Department of Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homeopathy (AYUSH), India.
11) Maarten Bode (2008). Taking Traditional Knowledge to the Market. The Modern Image of the Ayurvedic and Unani Industry, 1980-2000. Orient Longman Pvt Ltd, Hyderabad, India.
Acknowledgement: I thank Mr. Pradeep Kumar Pravakar of IIT Bombay for constantly encouraging me to write this. I also thank Ms. Bhavya Jindal of IIT Bombay for fruitful discussions and help in document search. Thanks are due to IIT Bombay library from where I obtained Ayurvedic textbooks and articles which are quoted herein.