Bottom Line: There is no documented value for any Ayurvedic therapies in treating cancer. However, recent studies demonstrate that yoga helps improve sleep pattern and also reduces symptoms of stress in cancer patients.
Ayurveda emphasizes both health maintenance (Svasthavritha) and diagnosis and treatment (Athuravritha). Patients are classified by their prominent dosha, or physical, emotional, and metabolic type, Kapha, Pitta, or Vata, each located in specific organs and associated with two of the five elements (earth, fire, water, air, and ether) and five senses. The dosha represent properties shared by the organs, body, environment and cosmos. When a patient's unique state of dosha is out of balance, illness occurs. Therapy is personalized to the individual's problems and metabolic characteristics to restore individual dosha balance through diet and lifestyle modifications, medicinals (herbs, spices, metals and/or animal products), breathing exercises, and meditation. Detoxification (panchakarma) occurs before medicines begin, including bloodletting, induced vomiting, and bowel purging. The therapeutic approach seeks to cure the disease by reversing the steps that led to it, balancing the dosha (e.g., administering cooling medicines if Pitta, the hot dosha, is predominant) (1)(2).
Many of the more frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata), gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, or antiinflammatory properties. (See monographs on these herbs for more information). Rasayana herbs (said to promote positive health) such as ashwagandha, Asparagus racemosus, Emblica officinalis, Piper longum, and Terminalia chebula show immunostimulant and adaptogenic activities in an animal study (6). Mucuna pruriens, used in preparations for Parkinson's disease, contains L-dopa (3). Ayurvedic gold preparations (e.g., Swarna Bhasma) have antioxidant and restorative effects in animal models of ischemia (7). The herbs most often used to treat diabetes, Gymnema sylvestre, Momordica charantia, fenugreek, Coccinia indica, and Pterocarpus marsupium, show hypoglycemic activity in vitro and in vivo. The herbal mixtures Maharishi Amrit Kalash-4 and -5 have antioxidant properties, inhibit LDL oxidation in vitro, inhibit platelet aggregation, and cause a reduction in aortic arch atheroma in hyperlipidemic rabbits (4). Maharasnadi Quathar, a medicinal used to treat rheumatoid arthritis, increases antioxidant enzyme activity, decreases TBARS generation, and improves symptoms in human subjects (8). Clinical trials confirmed that some Ayurvedic botanical formulations can be used to treat acute viral hepatitis (16); acne vulgaris (19); obesity (21); and rheumatoid arthritis (14)(20).
To treat acne Certain herbal preparations have been shown to be effective in reducing acne.
To treat atherosclerosis No scientific evidence supports this use.
To prevent and treat cancer No scientific evidence supports this use.
To treat cancer related symptoms Recent studies demonstrate that yoga helps improve sleep pattern in lymphoma patients and also reduces symptoms of stress in breast and prostate cancer patients.
To treat heart disease No scientific evidence supports this use.
To treat depression No scientific evidence supports this use.
To treat diabetes Several herbs used in Ayurveda have blood glucose-lowering effects, but the clinical evidence for their use is not strong.
To maintain general health No clinical trials have tested this use.
To treat hepatitis No scientific evidence supports this use.
To lower high cholesterol One clinical trial showed that certain herbal preparations could lower blood cholesterol and triglyceride levels in overweight patients, but no other clinical trials have tested this use.
To lower high blood pressure No scientific evidence supports this use.
To relieve indigestion No scientific evidence supports this use.
To treat infections No scientific evidence supports this use.
To prevent memory loss No scientific evidence supports this use.
To treat Parkinson's disease One clinical trial supports the use of one herbal preparation for improving the functional status of patients with Parkinson's disease, but no other scientific evidence supports this use.
To treat rheumatoid arthritis One clinical trial did not strongly support the use of a certain herbal preparation for treating rheumatoid arthritis. Many herbs used in Ayurveda are thought to have anti-inflammatory effects.
For weight loss One clinical trial suggested that a few herbal preparations could aid weight loss in overweight patients, but no other clinical trials have tested this use.
In this study, 59 patients with breast cancer and 10 patients with prostate cancer were enrolled in an eight-week mindfulness-based stress reduction program (MBSR) that included relaxation, meditation, yoga, and home practice. Patients were assessed before and after the intervention. Significant improvements were observed in sleep quality along with decreased symptoms of stress at the end of the eight-week program. Researchers concluded that the MBSR program helped improve the overall quality of life in cancer patients by improving sleep and reducing stress although more studies with better controls are needed.
Treatment of Cancer Related Symptoms: Thirty-nine patients with lymphoma who had either finished treatment or were being treated within the past one year were assigned to a Tibetan yoga (TY) group or a control group. Patients in the TY group participated in 7 weekly yoga sessions while those in the control group were offered enrollment after the 3-month assessment period. Each session consisted of the Tibetan practices, Tsa lung and Trul khor that incorporated minfulness techniques, controlled breathing, visualization, and postures. Follow-up was done at 1 week, 1 month and 3 months after the last session. There was significant improvement in the quality of sleep that included longer duration of sleep, and less use of sleep medications in the TY group. Researchers concluded that the yoga program was effective in improving the quality of life by improving sleep-related outcomes in cancer patients.
Treatment of morphine-induced constipation in cancer patients: In this study, 50 patients with advanced cancer were given either 2.5 ml of Misrakasneham (a liquid purgative containing 21 herbs, castor oil, and ghee) mixed with warm milk or 120 mg senna laxative tablet (Sofsena) for 14 days before morphine therapy. Doses were increased if the earlier dose was not effective after 2 days. Each day, satisfactory bowel movements were measured. There was no significant improvement with misrakasneham compared to senna tablets. Researchers suggest that although there was no significant difference between the two treatments, the low cost, the small volume of drug needed for effective laxative action, and fewer side effects make misrakasneham an alternative choice to treat morphine-induced constipation in patients with advanced cancer.
Although heavy metals such as lead, gold, and silver are traditionally used in ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications.
In the last few decades, commercialized meditation regimens have emerged to the concern of many. They often associate meditation with supernatural abilities. Such claims are not based on scientific evidence and should not be confused with meditation practice in Ayurveda.
From the Sanskrit words "ayur" (life) and "veda" (knowledge), Ayurveda originated in India over 3000 years ago. Treatment is patient-tailored and consists of oral formulations containing herbal, mineral, spice, and animal components, mental balance through yoga or meditation, purgatives, and dietary and lifestyle changes. It is available in at least 10 clinics in North America, but there is no licensure for practicing Ayurveda in the United States. Ayurvedic medicinals, which can contain from a few to hundreds of components, are commonly used to treat chronic diseases such as diabetes, rheumatoid arthritis, Parkinson's disease, acne, obesity, and cancer. Many of the more frequently used herbs have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, hypoglycemic, or antiinflammatory properties. Clinical trials show benefit of various formulations in treating acne, rheumatoid arthritis, diabetes, hepatitis, obesity, and constipation. The effects of meditation in reducing anxiety, lowering blood pressure, and enhancing general well-being have also been confirmed. The World Bank is funding research in India to evaluate ayurvedic medicines for anemia, edema during pregnancy, and postpartum complications. Little is known about the drug interactions between Ayurvedic and modern drugs. Numerous cases of lead poisoning from Ayurvedic preparations have been reported. There is no documented value for Ayurvedic therapies in treating cancer. However, certain modalities can be used to relieve cancer related symptoms and to improve quality of life. Recent studies demonstrate that yoga helps improve sleep pattern in lymphoma patients (22)and also reduces symptoms of stress in breast and prostate cancer patients (23).
Ayurveda emphasizes both health maintenance (Svasthavritha) and diagnosis and treatment (Athuravritha). Patients are classified by their prominent dosha, or physical, emotional, and metabolic type, Kapha, Pitta, or Vata, each located in specific organs and associated with two of the five elements (earth, fire, water, air, and ether) and five senses. The dosha represent properties shared by the organs, body, environment and cosmos. When a patient's unique state of dosha is out of balance, illness occurs. Therapy is personalized to the individual's problems and metabolic characteristics to restore individual dosha balance through diet and lifestyle modifications, medicinals (herbs, spices, metals and/or animal products), breathing exercises, and meditation. Detoxification (panchakarma) occurs before medicines begin, including bloodletting, induced vomiting, and bowel purging. The therapeutic approach seeks to cure the disease by reversing the steps that led to it, balancing the dosha (e.g., administering cooling medicines if Pitta, the hot dosha, is predominant) (1)(2).
Many of the more frequently used herbs, such as ashwagandha (Withania somnifera), guggul (Commiphora mukul), Boswellia (Boswellia serrata),gotu kola (Centella asiatica), curcumin (Curcuma longa), ginger (Zingiber officinale), aloe (Aloe barbadensis), and garlic (Allium sativum), have been studied extensively in vitro and in vivo and show antioxidant, antitumor, antimicrobial, immunomodulatory, or antiinflammatory properties. (See monographs on these herbs for more information). Rasayana herbs (said to promote positive health) such as ashwagandha, Asparagus racemosus, Emblica officinalis, Piper longum, and Terminalia chebula show immunostimulant and adaptogenic activities in an animal study (6). Mucuna pruriens, used in preparations for Parkinson's disease, contains L-dopa (3). Ayurvedic gold preparations (e.g., Swarna Bhasma) have antioxidant and restorative effects in animal models of ischemia (7). The herbs most often used to treat diabetes, Gymnema sylvestre, Momordica charantia, fenugreek (Trigonella foenum-graecum ) Coccinia indica, and Pterocarpus marsupium, show hypoglycemic activity in vitro and in vivo. The herbal mixtures Maharishi Amrit Kalash-4 and -5 have antioxidant properties, inhibit LDL oxidation in vitro, inhibit platelet aggregation, and cause a reduction in aortic arch atheroma in hyperlipidemic rabbits (4). Maharasnadi Quathar, a medicinal used to treat rheumatoid arthritis, increases antioxidant enzyme activity, decreases TBARS generation, and improves symptoms in human subjects (8). Clinical trials confirmed that some Ayurvedic botanical formulations can be used to treat acute viral hepatitis (16); acne vulgaris (19); obesity (21); and rheumatoid arthritis (14)(20).
Although heavy metals such as lead, gold, and silver are traditionally used in ayurvedic formulations, the use of lead for its assumed benefit has been a cause of concern. The US Centers for Disease Control and Prevention reported 12 cases of lead poisoning associated with the use of Ayurvedic medications (24).
In the last few decades, commercialized meditation regimens have emerged to the concern of many. They often associate meditation with supernatural abilities. Such claims are not based on scientific evidence and should not be confused with meditation practice in Ayurveda.
Reported (General): Headache, gastrointestinal complaints. Several herbs in Ayurvedic preparations can cause photosensitivity, while some contain arsenic or mercury that can produce skin lesions. Common (Mineral tonics): Ayurvedic preparations can contain varying amounts of lead and have caused severe gastrointestinal symptoms and anemia due to lead poisoning. Common (Adhatoda vasica): This herb, often used for respiratory tract ailments, is reported to have oxytocic and abortifacient effects. (5)(7)(8)(9)(10)(13)(15)
Phenytoin: The Ayurvedic syrup shankhapushpi causes decreased blood concentrations of phenytoin (10). Guggul induces CYP3A4 activity and may interact with medications that are metabolized by the CYP3A proteins (26).
Almost all clinical trials reported in the literature are conducted in India. Only a few are published in English. No research dealing with cancer was uncovered.
Ayurvedic interventions for diabetes mellitus: a systematic review. Evid Rep Technol Assess 2001;41. A systematic review of all published studies of ayurvedic treatments for diabetes mellitus available in English. Seven randomized controlled trials and 10 controlled clinical trials were identified; all evaluated single herbs or herbal formulations. The best quality RCT and smaller trials showed benefit of Coccinia indica; a single trial of holy basil found beneficial effects on fasting blood glucose; fenugreek showed overall cholesterol-lowering effects and, to a lesser extent, improved blood glucose control; Gymnema sylvestre showed improved glucose control in a number of trials; D-400 and Ayush-82, two herbal formulations containing Gymnema sylvestre, showed positive results. No serious adverse events were reported. Most trials had insufficient numbers for statistical power and had design flaws.
Nagashayana N, et al. Association of L-DOPA with recovery following Ayurveda medication in Parkinson's disease. J Neurolog Sci 2000;176:124-7. A prospective study of an Ayurveda medicinal containing cow's milk, Mucuna pruriens, Hyoscyamus reticulatus, Withania somnifera, and Sida cordifolia with or without panchakarma (cleansing therapy) in 18 patients with Parkinson's disease. 13 patients underwent 28 days of cleansing, consisting of oleation, purgation, enemas, etc., prior to 56 days of the medicinal and 5 patients received the medicinal alone for 84 days. A significantly greater proportion of patients receiving medicinal plus panchakarma experienced improvements in activities of daily living, motor function, and symptoms, which the authors attribute to cleansing of the intestine to allow increased absorption. Patient demographic data and detailed protocol were not provided.
Lalla JK, et al. Clinical trials of ayurvedic formulations in the treatment of acne vulgaris. J Ethnopharmacol 2001;78:99-102. A short communication on a double-blind, randomized, placebo-controlled trial of a mixture of seven herbs (Aloe barbadensis, Azardirachta indica, Curcuma longa, Hemidesmus indicus, Terminalia chebula, Terminalia arjuna, and Withania somnifera) taken orally and applied topically in a cream or aqueous solution in 46 patients. After four weeks, the group receiving active oral and active cream (n=21) experienced the largest improvement in acne, while the group receiving active oral and active aqueous gel (n=20) had less of an improvement, and the small placebo groups and receiving active oral only (n=4) and placebo (n=1) experienced slight improvement and no improvement, respectively.
Ramesh PR, et al. Managing morphine-induced constipation: a controlled comparison of an ayurvedic formulation and senna. J Pain Symptom Manage 1998;16:240-4. A small, open, controlled trial evaluating prophylactic Misrakasneham, a liquid purgative containing 21 herbs, castor oil, ghee, and milk versus senna laxative tablet (Sofsena) in patients receiving oral morphine for advanced cancer. Patients received 2.5 ml of Misrakasneham mixed with warm milk (n=20) or 120 mg senna tablet (n=16) before initiation of morphine therapy; doses were escalated if prior dose was ineffective after 2 days. Daily 'satisfactory' bowel movements were measured. Difference in efficacy between treatment arms was not significant: 85% of the Misrakasneham group and 69% of the senna group had satisfactory bowel movements.
Chopra A, et al. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol 2000;27:1365-71. A randomized, double-blind trial evaluating RA-1, a standardized formulation of Withania somnifera (ashwagandha), Boswellia serrata (gugulla), Zingiberis officinale (ginger) and Circuma longa (circumin), in patients with active rheumatoid arthritis. Patients received 444 mg RA-1 extract in split doses (n=89) or placebo (n=93) for 16 weeks and were required to discontinue NSAID therapy 3-5 days prior to entry, but stable prednisolone use not exceeding 7.5 mg was permitted. A significantly greater proportion of patients in the RA-1 group showed >50% reduction in joint swelling. Both the RA-1 group and placebo showed significant improvement from baseline in functional criteria, including joint count pain, joint count swelling, pain VAS, Stanford Health Assessment Questionnaire, and patient and physician global assessment; RA-1 showed numerically, but not statistically, greater improvement than placebo. Adverse events, consisting of headache and nausea, were similar between groups. Subjects were enrolled from free community arthritic camps, which may have led to selection bias towards women and lower socioeconomic classes.
Paranjpe P, Patki P, Patwardhan B. Ayurvedic treatment of obesity: a randomized double-blind, placebo-controlled clinical trial. J Ethnopharmacol 1990;29:1-11. A randomized, double-blind trial of four Ayurvedic medicinals versus placebo in seventy otherwise healthy patients at least 20% in excess of ideal body weight. Patients were randomized to receive 250 mg TID Triphala guggul and 250 mg TID Gokshuradi guggul (group I), 250 mg TID Triphala guggul and 100 mg TID Sinhanad guggul (group II), 250 mg TID Triphala guggul and 250 mg TID Chandraprabhavati (group III), or 250 mg TID placebo (group IV). Dietary intake was not controlled. Body weight, skinfold thickness, body measurements, and serum cholesterol and triglycerides were significantly lower after three months in groups I, II, and III compared to placebo. Results did not differ significantly between active groups. Treatment did not result in changes in blood pressure, pulse rate, or body temperature. Diarrhea and nausea were reported side effects. The four medicinals contain a variety of Ayurvedic herbs, but have in common guggul (Commiphora mukul), hirda (Terminalia chebula), beheda (Terminalia belerica), and amalaki (Emblica officinalis).
