The Gerson Institute of Ayurvedic Medicine

Scott Gerson, M.D., Ph.D. (Ayurveda) Medical Director, Jupiter Medical Center Dept. of Integrative Medicine Division of Education and Research

Jupiter Medical Center at The Calcagnini Center for Mindfulness
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The Āyurvedic Approach to Breast Health

Like all tissues and organs in the human body, the female breasts are multidimensional in function. Their most recognized function is as exocrine glands, producing breast milk for the newborn, a function common to all mammalian species. The role of the fatty deposits surrounding the glandular tissues of the human female breasts is less obvious. They serve no physiological purpose. However, clearly as a female secondary sexual characteristic, breasts contribute an intimate part of a woman’s attractiveness and hence of her self esteem and body image. Thirdly, breasts also play a significant role in a women’s own sexual arousal. Finally, a fascinating, yet less recognized, role is the psychological role breasts play for the infant. If given a choice between (a) a wire mesh through which a nipple protrudes from which they have previously nursed for several weeks or (b) a soft pad from which they have not, chimpanzees and other primate infants run to the soft pad when confronted with a stressful situation. “Softness” appears to be a primary psychological need for the comfort, security, confidence, and normal development of primate infants. This may explain why infants love to nuzzle in their mothers breasts and cuddle soft, furry stuffed bears (Harlow, American Psychologist, 13, 573-685 1958).

The human female breasts respond both to an array of endogenous hormones and to exogenous hormones and environmental pollutants; furthermore their structure and function fluctuate both with the monthly menstrual cycle and the life cycle.

Given the multidimensional functions of the breasts, a discussion of breast health approaches could be complex. Therefore, in this article we will limit our discussion to what women can do from the Āyurvedic perspective to reduce their chances of developing the most dangerous of breast diseases: breast cancer.

Figure 1. The human female breast

 

 

First let’s briefly review some simple breast anatomy (Fig. 1). Mammary glands are basically highly modified and specialized sebaceous glands which derive from embryonic ectoderm (Fig 2). The adult breast consists of glandular tissue, adipose tissue (fat cells), nerves, blood vessels and lymphatics. Anatomically it overlies the pectoralis major muscle and is anchored to the pectoralis fascia by suspensory ligaments known as Cooper’s ligaments (not shown). The breast contains about 15 to 25 lobes formed by groups of “milk glands”, or lobules. Each lobule is composed of hollow milk producing acini (also called alveoli), and feeds into a milk duct leading to the nipples. The ducts converge near the areola, the darker area round the nipple, to form ampullae or milk storage cavities.  Around the areola are small glands known as Montgomery's glands (not shown) which secrete an oily substance that protects the nipples during nursing. Lymph nodes within the breast drain into the axillary lymph nodes in the armpit—the first place to which breast cancer will typically metastasize.

 

Fig. 2. Similarity between sebaceous gland of skin and mammary gland--a specialized sebaceous gland (compare with Figure 1)

What Is Breast Cancer? The Western View

 

Cancer is fundamentally a disease of failure of regulation of tissue growth. In order for a normal cell to transform into a cancer cell, the genes which regulate cell growth and differentiation must be altered. A gene is a specific sequence of DNA at a specific location within a specific chromosome. Only 5-10% of breast cancers are inherited; the vast majority is due to sporadic, acquired mutations.

The affected genes are divided into two broad categories. Oncogenes are genes which promote cell growth and reproduction. Tumor suppressor genes are genes which inhibit cell division and survival. Malignant transformation can occur through the formation of abnormal oncogenes, the inappropriate over-expression of normal oncogenes, or by the under-expression or complete arrest of tumor suppressor genes. Typically, changes in many genes are required to transform a normal cell into a cancer cell.

Genetic changes can occur at different levels and by different mechanisms. The gain or loss of an entire chromosome can occur through errors in mitosis. More common are mutations, which are changes in the nucleotide sequence (A, T, G, C) of genomic DNA.

GENE                                  

Figure 3. Mutations which cause cancer occur as changes in the sequence or structure of nucleotides A, T, G or C.

Large-scale mutations involve a deletion or gain of a portion of a chromosome. Gene amplification occurs when a cell gains many copies (often 20 or more) of a small chromosomal locus, usually containing one or more oncogenes and adjacent genetic material. Translocation occurs when two separate chromosomal regions become abnormally fused, often at a distinct location. A well- known example of this is the Philadelphia chromosome, or translocation of chromosomes 9 and 22, which occurs in chronic myelogenous leukemia.

Small-scale mutations include point mutations, deletions, and insertions, which may occur in the promoter region of a gene and affect its expression, or may occur in the gene's primary coding sequence and alter the function or stability of its protein product. Disruption of a single gene may also result from integration of genomic material from a DNA virus or retrovirus, and resulting in the expression of viral oncogenes in the affected cell and its descendants, but this is not the case in breast cancer.

Living cells divide and reproduce at tissue-specific intervals which involved the copying of DNA. The replication of the enormous amount of data contained within the DNA of living cells will inevitably result in some errors (mutations). Cells all have a built in sophisticated error correction and prevention mechanism, which defends the cell against cancer. If significant error occurs and is uncorrected, the damaged cell can "self destruct" through programmed cell death, termed apoptosis. If the error control processes fail however, then the mutations will survive and be passed along to daughter cells.

Some environments make mutations more likely to arise and propagate. Such environments can include the presence of disruptive substances called carcinogens, repeated physical injury, heat, ionizing radiation, or hypoxia.

Certain errors which cause cancer are self-amplifying and compounding, for example:

  • A mutation in the error-correcting machinery of a cell might cause that cell and its progeny to accumulate other errors more rapidly.
  • A further mutation in an oncogene might cause the cell to reproduce more rapidly and more frequently than its normal counterparts.
  • A further mutation may cause loss of a tumor suppressor gene, disrupting the normal apoptosis (cell-death) signaling pathway and resulting in the cell becoming immortal.
  • A further mutation in signaling machinery of the cell might send error-causing signals to nearby cells.

The transformation of normal breast cells into cancer is akin to a chain reaction caused by initial errors, which compound into more severe errors, each progressively allowing the cell to escape the controls that limit normal tissue growth. This renegade-like scenario causes an undesirable survival of the fittest, where the natural forces of evolution become distorted and work against the body's design and harmonious order. If the rate of DNA damage exceeds the capacity of the cell to repair it, the accumulation of errors can overwhelm the cell and result in early senescence, apoptosis, or cancer. Once cancer has begun to develop, it uses the body’s own design to serve its own destructive and invasive purposes.

Induced mutations on the molecular level effects that then lead to transitions, transversions, or deletions can be caused by:

    • Base analogs (e.g. Bromodeoxyuridine) These are inserted substitute nucleotides. can only mutate the DNA when the analog is incorporated in replicating the DNA.
    • Alkylating agents (e.g. N-ethyl-N-nitrosourea) These agents can mutate both replicating and non-replicating DNA.
    • Hydroxylamine NH2OH
    • Agents that form DNA adducts (e.g. ochratoxin A metabolites)[25]
    • DNA intercalating agents (e.g. ethidium bromide)
    • DNA crosslinkers
    • Oxidative damage
    • Nitrous acid converts amine groups on A and C to diazo groups, altering their hydrogen bonding patterns which leads to incorrect base pairing during replication.
    • Over-exposure to endogenous hormones, e.g. estrogens, growth hormone

What Is Breast Cancer? The Āyurvedic View

The female breasts are predominantly Kapha organs, having a fatty nature and producing milk, a Kapha fluid. Breast cancer is a tridoshic (involving all three doshas) disorder of breast tissue. Causes are both hereditary and acquired; the acquired causes being physical, emotional, spiritual, and environmental. Breast cancer is ultimately caused by blockage and flow irregularities at both the gross and imperceptibly subtle levels of several srotamsi (channel systems).

Dietary and other physical factors can help to cause breast cancer, or to trigger the disease in one who already has the hereditary tendency. Breast cancer, like any malignant or degenerative disease, may be the result of prolonged wrong diet, wrong lifestyle, or prajnaparadha (mistake of the intellect). Wrong regimen leads first to accumulation of doshas, then in time to acute illnesses. If those illnesses are treated improperly, that is, if the excess doshas (the three body humors) are not expelled and ama (toxins) is not purified, then the imbalance is driven deeper, resulting in chronic complaints. If these chronic complaints in turn go untreated or are treated by suppressive methods without expelling doshas or cleansing ama, then the excess doshas will localize in the most toxic or most vulnerable tissue, in this case breast tissue, to create sannipatika gulma, a malignant tumor.

Cancer in Āyurveda is not seen as a discrete disease, but a milestone on the continuum of doshic aggravation, ama (toxic waste) accumulation, and srotodushti (channel blockage).  A pernicious energy gains access to the individual through the diet, the emotions, the environment, or even the karmic-influenced internal momentum of one’s life. Although modern medicine has disproven any appreciable connection between fibrocystic breasts or fibroadenoma to breast cancer, Āyurveda considers both of these benign conditions to be stages in the breast cancer samprapti. Cancer is a deepening pattern of internal disconnection from the bodymind’s greater intelligence which eventually begins to exhibit its own warped purpose, momentum, and direction.

Importance of Srotamsi (Channels of Circulation) in Breast Cancer

 

The entire fifth chapter of the Vimānasthāna Section of the Charaka Samhita is devoted to the detailed description of the srotamsi and their importance in health and disease. The body and mind contains a large number of srotas or channels through which the basic tissue elements, doshas, and malas circulate. These channels are called srotas (plural srotamsi). Srotas, meaning channels or pores, are present throughout the visible body as well as at the “invisible” or subtle level of the cells, molecules, atoms, and subatomic strata. It is through these channels that nutrients and other substances are transported in and out of our physiologies. It is also through these channels that information and intelligence spontaneously flow. When the flow of appropriate nutrients and energies through these channels is unimpeded, there is health; when there is excess, deficiency, or blockage in these channels disease can take root.

The term “srotodushti” means a pathological state of a srota and can be of four types:

· Sanga (Congested)

· Granthi (Dilated)

· Atipravritti (Extravasating)

· Vimārgagamanam (Retrograde Movement)

The channels are, to a certain extent, similar to the different physiological systems of Western medicine (e.g. arteries, veins, nerves, digestive tract, etc.) but also contain subtler energies comparable to the meridian system of Chinese medicine.

The movements of energy in all srotamsi are directly influenced by stimuli that arise in the mind, which are conveyed by the Vata energy. Hence mental disturbances, both conscious and unconscious, can cause disorders in any of the channels. Emotional blockages can cause energy stagnation that result in blockages in the flow of the srotamsi. Thus clearing out suppressed emotions in the mind is essential for the proper circulation of energy in the body.

Excessive or deficient mental activity can cause excess or deficient flow in the channels of the body. Emotional outbursts or lack of mental control have effects that are analogous to surges in the channels of the physical body and can produce such conditions as in strokes, heart attacks, hyperventilation, tremors, etc. Alternatively, excessive flow in the mind may actually cause deficient flow in the body and vice versa. Worry, fear, or anger which are excessive mental activities, are common major root causes of physical disease. Any excessive mental activity is capable of producing excess flow through one or more srotamsi and will tend to deplete or distort the function and structure of the respective regions. Hence the importance of yoga asana, pranayama, and meditation which aim at cultivating a calm and unfettered mind.

Stanya vaha srota, which consists of the milk-producing apocrine cells of the lobules, the related pituitary hormones (i.e. prolactin), the ducts, ampullae, and nipple, is the main srota involved in breast cancer.

Artava vaha srotas, which consists of the uterus, ovaries, fallopian tubes, their hormones (i.e. estrogen, progesterone), secretions and connective tissues and related pituitary hormones (i.e. FSH, LH) all belong to artava vaha srotas--the channels carrying out female reproductive functions. The breasts are also included in this system.

These two srotamsi are very closely related. Consider that when the breast milk is flowing, menstruation does not occur. Hence the main action of these two channels is largely mutually exclusive. Both can be seen as two aspects of one system and both products, menstrual fluid and breast milk, are secondary tissues (upadhatus) of the plasma (rasa).

Each lunar cycle between menarche and menopause, the proliferation of epithelial cells lining the breast’s lobular acini (increasing from one to two layers) occurs during the luteal phase. The breast epithelium, unlike the endometrium of the uterus, cannot be shed at the end of the cycle; regression at the end of the cycle is by apoptosis (self-programmed cell death). The apoptotic residue (ama) is plentiful within the lumens toward the late luteal phase of the cycle. Efficient removal of this material is essential for the breast tissue to remain healthy and vital. To some extent, stanya and artava vaha srotas act as one system. Their tissue components are both subject to fibrotic and cystic cellular changes and are similarly affected by estrogen and other hormones, dietary habits, and emotions. Thus regardless if a cancerous breast, uterus, or ovary is removed, if the doshic derangement remains unchecked, these doshas, if conditions are right, tend to migrate to the remaining stanya or artava vaha srota sites. Within stanya vaha srotas, the three doshas normally exist in harmony. Vata governs the functions of timing, communication and coordination with other psycho-biological cycles and states.· Pitta governs the circulatory functions, cellular metabolism, and their functional interface with the liver.. Kapha governs the mucosal properties of thickness, viscosity and cellular adherence affecting the glandular secretions (i.e. milk). It regulates cell-to-cell junctions and orders intercellular communication.

The Charaka Samhita clearly states in several places that there is no more important cause in the manifestation of disease than aggravated Vata dosha (i.e. CS Si I, 38-40). One particularly unique quality of Vata is its capacity to activate or move Pitta and Kapha to express their qualities while simultaneously also exhibiting its own Vata aspects. This functional capacity of Vata is known as the yogavāhi effect of Vata. For instance, the clinical finding of a lump in a breast could arise from the effect of increased Vata dosha on Kapha dhatu, which had been in its normal state. The Vata yogavahi effect could provoke the expression of various Kapha gunas (e.g. sāndra (solid), guru (heavy), manda (slow), sthira (immobile) while at the same time causing a degree of dehydration or roughness (Vata qualities) in the srotasmi and local area.

 

While on the subject of the Srotamsi it is appropriate to briefly discuss the relevance of the recent insights of quantum biology. Quantum theory in general reminds us is that the real world is much stranger than we imagine. Of the many strange but true features it has brought to light here are two that have relevance to our revised thinking about the genetics of breast cancer.

The quantum principle of superposition shows us that before we observe—and therefore do not yet know— what the state of any object is (for example, light as either a wave or a particle), it is actually in all possible states simultaneously (coherence), as long as we don't consciously observe to check. It is the observation or measurement itself that causes the object to be limited to a single possibility (decoherence). The way we look also matters. We can choose to run an experiment which proves the particle nature of light or we can choose to do an experiment which just as powerfully proves its wave nature.

Entanglement is another strange feature of quantum mechanics. Any two particles — photons of light or atoms, for example —can be temporarily linked to become effectively two parts of the same entity. You can then separate them as far as you like—even have them in different galaxies— and a change in one is instantaneously (faster than light ) reflected in the other.

One of the fundamental truths of Āyurvedic philosophy is proclaimed in the classical idea of loka-purusa samya. This seminal concept teaches that the universe (loka) and the individual human being (purusa) are under the same laws and in fact exist on a continuum which reaches from the realm of the universal to that of the smallest form of creation. The individual living being, whether it be a man or an ant, is a miniature replica of the universe. Āyurvedic healers realized the fundamental truth that the entire universe, animate and inanimate, is one interconnected life interpenetrated by the ultimate reality which they named Brahman.

This ancient insight resonates well with the modern finding of quantum entanglement. How is it possible for a human being to achieve a state of cosmic consciousness? If everything is initially derived from one source—Brahman—entanglement could be the mechanism to explain it. By establishing a purer connection with Brahman through one’s sadana it is then possible to restore our true nature and reestablish in our DNA the perfection residing there.

The microcosm (subatomic realm) and macrocosm (universal realm) are in a never-ending interaction with each other. The constantly changing conditions both in Nature and in the individual create a dynamic harmony between the two--a state which we recognize as health. When there is more deviation that can be tolerated between the individual and Nature (the universe) that harmony is lost and a disease state can arise. The principle of superposition gives at least the possibility for a system (i.e. nucleotide mutation) to return to a state of coherence (all possible states) once again and reconstruct the material outcome in a new healthy pattern. The actual mechanism by which this occurs is explained by quantum mechanical concepts. Initially there is a spontaneous and random rearrangement of the valence (reactive) electrons; this subsequently creates the breaking and making of new chemical bonds and the creation of new molecules with different structures. The causal origin of such new molecules could never be traced backward due to the considerable probabilistic quantum mechanical scatter and the vast number of possible molecular conformations.

 

The universe and the individual being interact through the eternally shifting interplay of consciousness which exists in both realms. The srotamsi form a bridge between loka and purusha for gross and subtle events. Although beyond our scope here, some fascinating and still controversial work has been done on the role of cytoskeletal microtubules in quantum biology (Penrose-Hameroff theory). Microtubules are hollow cylindrical protein structures which organize many functions in cells including cell division and synaptic activity. They can change conformational states and are being explored as possible quantum computers within living cells. They represent one of the smallest imaginable forms of a srota.

Samprapti (Pathogenesis)

Due to uncorrected exposure for a sufficient period of time to nidanas--internal and external causes of doshic vitiation--(a few common examples described below), the doshas can become aggravated and begin a sequence of pathological steps culminating in the creation of a disease state. The term "samprapti" (from the root “āp” to cause, arrive, reach or obtain; “sam” conjunction, union, intensity, completeness) refers to this sequence of doshic-related pathology triggered by one or more nidanas (causes). Let us consider a brief explanation of this sequence.

First, one or more doshas begins to accumulate somewhere in the body and soon becomes vitiated (aggravated). Next, the aggravated dosha spills over and begins to spread. In the case of breast cancer, it may enter the stanya vaha srota or another associated srota. When it reaches a vulnerable or somewhat weakened area or organ of the body, it will stagnate there and begin to mix with and disturb the structure and function of the local tissues including sometimes cellular DNA. The tissues of the body, when spoken of in their healthy state are of course called the dhatus; however when we speak of these same tissues with regard to their mixing with vitiated doshas, we always refer to the tissues as dushyas.

This dosha-dusyas sammurcchana is the actual disease process (sammurcchana means "interaction"). The interaction of the doshas and dushyas, together with the specific effect from the site or organ involved (adhisthana) leads to the development first of specific prodromal features, and then of the main symptomatology, of a disease. Involvement of primarily Kapha might result in a fibrocystic breast condition; predominantly Kapha-Vata vitiation might lead eventually to fibroadenoma; Pitta-Vata can be associated with mastitis and other inflammatory states; Tridoshic vitiation can ultimately produce cancer. Left untreated the disease will evolve its unique set of complications and can reach a stage where it is no longer curable by any means.

There is another important aspect of samprapti not usually described in popular texts known as vikalpa samprapti, which determines which gunas (properties) of each dosha have entered into the disease and in what measure or degree. Breast cancer is a disease which is tridoshic in nature. However, each of the three doshas has multiple qualities (gunas). Vata includes mobile, dry, cold, rough, subtle, light, and subtle; Pitta includes hot or warm, liquid, light, yellow in color, sharp, and somewhat viscous; Kapha includes heavy, solid, cold, slow, immobile, compact, viscous, white, and smooth. However, not all of the properties of a dosha will physically manifest into every disease. Vikalpa samprapti (root kalp: form, act, determine; vi : division, distinction) is the knowledge of which doshic properties have manifested in a disease and in what measure.

Also one’s diet over the course of the lifetime can play a decisive role in the samprapti of any disease including breast cancer. The conversion of ingested food to body constituents by digestion takes place at three levels (jatharagni, bhutagnis, dhatvagni), rendering it into progressively more subtle and absorbable states. With each level of digestion, food becomes progressively purified from the unusable waste products (kitta). The actions of the various thirteen agnis which bring about this transformation are collectively known as ahara parinamakara bhavas and each has a specific and essential role in the digestive process. A defect of any of these, individually or collectively, can lead to the initiation of intrinsic disease process. Defects in the digestive procession leads to ama, and not healthy dhatu, formation. This ama is a highly toxic, gross, dense, slimy, cold and heavy substance. Although it originates as food and rasa, it is not nourishing in nature but rather injurious and destructive. Depending on which stage of digestion it manifests, it has access to all the structures and srotamsi of that specific dhatu. Ama causes suppression and derangement of Vata (coordinated movements), Pitta (metabolic order) and Kapha (stable cohesive structure) activities.

Survey of Common Nidanas (Modern Stress Factors) (check off those items which apply to you on a constant or frequent basis.)

  • Sit or stand in a slumped, hunched over or non-erect position.
  • Sit on metal chairs for long periods of time.
  • Stand on bare concrete floors for long periods of time.
  • Underwear, outerwear, nightwear clothes are made of mainly synthetic fabrics.
  • Hats, wigs or hairpieces are made of mainly synthetic fabrics.
  • Bedding sheets or blankets are made of mainly synthetic fabrics.
  • Use an electric blanket for warmth in bed during the colder months.
  • Wear eyeglasses/sunglasses with metallic frames.
  • Wear tinted eyeglasses; wear sunglasses nearly all the time when outdoors.
  • Wear high heeled shoes.
  • Wear bras with under wires or which are constricting
  • Wear wrist watches with radium coated dials.
  • Wear battery‑powered wrist watches
  • Wear partial metal dentures which cross the midline of the body.
  • Have mercury amalgam fillings in your teeth.
  • Use perfumes, deodorants, shampoos, conditioners, dyes, permanent solutions, soaps, mouthwashes, toothpastes made of synthetic chemicals.
  • Use a microwave oven.
  • Use aluminum cookware, utensils. p highway more than two hours per day.
  • Work or live indoors where the rooms are saturated with tobacco smoke.
  • Work or travel in areas saturated with auto exhaust fumes.
  • Cook at a gas or electric stove.
  • Work in front of a video console monitor for long periods of time.
  • Work or sit under fluorescent lighting for long periods of time.
  • Watch television for long periods of time, i.e., over an hour at a time.
  • Use headphone to listen to music of any kind.
  • Live in buildings with exposures to lead, formaldehyde, asbestos
  • Live a completely sedentary life and have a completely sedentary job
  • Sleep <7 or >9 hours daily
  • Drink >2 alcoholic beverages per day
  • Drink <4 12 oz. glasses of water daily
  • Eating after 7:00 pm or while watching television
  • Having sex or exposure to cold during menses
  • Suppressing flatulence, defecation, or urination (retrograde apana Vata)
  • Unresolved sadness surrounding issues of conception, maternity or abortion
  • Unresolved physical/psychological trauma related to intimacy or sexual abuse
  • Unresolved attachments, melancholy, depression, anxiety, resentments or fears

Āyurvedic Prevention and Treatment Approach

The essence of the Āyurvedic approach is beautifully summed up in one of its well-known statements, अपाय अपमृत्यु अनागति (Apāya apamtu anāgati): “Avert the danger from illness before it arrives”. This terse directive emphasizes the importance of correcting imbalances while still in their earliest stages and hence very remediable. Āyurveda accomplishes this goal through health programs uniquely tailored to the idiosyncratic characteristics of each individual. It celebrates our individual uniqueness while recognizing our universal Oneness. It is through our uniquely developed human consciousness, which among other capacities, affords us the enormous power of choice, that we can influence our health. The positive and negative health effects of those choices have been understood by Āyurvedic sages for thousands of years.

It must be stated at the outset of this section that, based on current level of available Āyurvedic knowledge, Āyurveda has no place as a primary treatment for any form of breast cancer. Āyurvedic treatment for breast cancer are useful as complementary therapy in order reduce side effects and sometimes bring about a more comprehensive response to conventional treatment. Āyurvedic medicines main strength is as a strategy to prevent the initial disease or its recurrence and to prolong survival.

That being said, current research is advancing towards a rational use of Āyurveda as a primary intervention. Specifically, the methanolic leaf extract of Ashwagandha leaf (Withania somnifera) was demonstrated to restore normal p53 function in tumor cells bearing mutated copies. p53 is a tumor suppressor protein which causes either the complete destruction of cells which have irreparably damaged and abnormal DNA or to temporarily arrest cell replication so that the DNA repair mechanisms can repair the damage. Once repaired p53 then allows the cell to duplicate. How p53 chooses cell destruction or arrest is unknown; it is commonly called the “guardian angel” of the cell.

It should be noted that today all breast cancer patients should be under the regular care and supervision of a medical oncologist.

Practical Choices That Matter

The Āyurvedic approach to breast health centers on diet, detoxification, lifestyle and exercise, mental health, environment and herbal preparations. Additionally, both ancient and current Āyurvedic physicians also emphasize early detection. Self examination of breasts, regular breast examinations by health care professionals and mammograms if clinically warranted are the methods.

Diet

One of Āyurveda’s great recognitions is that the body and mind naturally proceed in the direction of balance and, in fact, are designed to achieve and maintain balance and vibrant health. The systems and organs that make possible this remarkable state of physical and mental well-being, and the intelligence which directs them all, exist in all of us from birth. Cancerous changes show that, despite this inherent healthy tendency, there is an imbalance of the tri-dosha with toxins. Food is the foundation of the tissue formation process and health itself. Food (gross food), thoughts and impressions (subtle foods) enter the general circulation to form the deeper organs and structures. Thus the foods we choose to consume represent the principal means of tissue renewal. Fresh, clean, doshically suitable foods will aid the physiology in restoring healthy tissues while leaving no residue of undigested, putrified toxic substances or ‘ama’. Here are some of the more important Āyurvedic recommendations. 

i. Firsf     Choose foods according to either your constitutional type or your primary doshic imbalance, if known. This will help match your diet to your agni (digestive fire). Your physician may alternatively instruct you to eat according to the seasons if you are already in a balanced state of health. Eat organic foods whenever possible. For more information on diets and foods for pacifying each of the three doshas, visit the diet section of this website.

ii. Construct a diet which reduces ama formation. A predominantly vegetarian diet of foods that are light, warm, and cooked will do this. Freshly prepared dals and soups, organic vegetables prepared with fresh spices, whole grains such as basmati rice, barley, and amaranth, and freshly made flat-breads are ideal.

iii. Include organic cooked prunes, figs, apples, pears, pineapple, papaya, and cooked leafy greens, Brussels sprouts, broccoli, cauliflower, brussel sprouts and cabbage (cruciferous vegetables) in your diet. These foods provide fiber, antioxidants, and detoxifying effects. Also important are spinach, kale, chard, romaine, mustard greens (dark green leafy vegetables), garlic, grapes, green tea, tomatoes, walnuts and flax seeds. There is also a burgeoning body of evidence that curcumin, a component of turmeric, has breast cancer protective effects.

iv            Avoid foods that create body ama, including leftovers; packaged, canned, and frozen foods; foods grown with chemicals, pesticides and            chemical fertilizers. Also beware of foods which have been tainted with chemical additives and preservatives.

v. Restrict the intake of alcoholic beverages of all kinds[1].

vi   Visceral (abdominal) adiposity contributes to the risk for estrogen receptor-negative breast cancer in premenopausal women. The increased risk appears to involve insulin and not estrogen. Therefore although there is no specific diet for reducing visceral fat, a diet consisting of 20 grams or more of dietary fiber has been shown to help along with proper sleep and daily exercise.

As discussed above, ama—along with agni and the srotamsi--has tremendous importance in the manifestation of breast cancer. Ama is principally the result of the initial ahara rasa (nutrient juices) not being completely digested in the amashaya (small intestines) due to abnormal jatharagni. Ama then enters the srotamsi where it causes srotodushti (pathology of the srota) leading to srotorodha (obstruction). This results in an abnormal or arrested flow of doshas, nutrients and wastes. The doshas thus retained can extravasate out of the srota and penetrate the surrounding dhatus (now called dushyas). The site where this interaction occurs (dosha-dushya sammurcchana) is the site where disease is initiated. If the impairment to the srotas can be prevented or reversed, disease will be averted.

In Āyurveda breast cancer primarily involves the channels of the female breasts and of the reproductive system and are called the Stanya Vaha Srotas and Artava Vaha Srotas, respectively. They include all the reproductive tissue, breasts, hormones and all secretions including breast milk. Keeping these channels clear of ama and all toxins is essential. The Mano Vaha Srotas, channels of the mind, are also involved. Proper diet, lifestyle, exercise, emotional health and select Āyurvedic herbs all help however a regular comprehensive detoxification procedure is also advised. It forms the foundation of preventive health in the Āyurvedic view and is often an important part of the treatment protocol for diseases which have already occurred.

Vulnerable Breasts on a Chemical Planet

Besides the assault from endogenous toxins (ama), exogenous toxins also have a grave effect on breast health. As a consequence of decades of uncontrolled environmental pollution with persistent organic pollutants (POP’s), the contamination of human milk has become widespread. Polychlorinated biphenyls (PCBs), DDT and its metabolites, dioxins, dibenzofurans, phthalates, polybrominated diphenyl ethers (PBDEs), and heavy metals are among the toxic chemicals most often found in breast milk. Whether she is pregnant or not, these and many other chemical pose a tremendous risk to the female breast. This is because POP’s are fat-soluble "lipophilic" (i.e. affinity for fat) chemicals which undergo bioaccumulation and concentration over time in the breast fatty tissue. The positive news is that POP’s can be significantly removed from their sites of accumulation through regular periods of panchakarma detoxification therapies.

Āyurveda states in the Aṣṭañga Hṛdayam Sutrasthanam IV/25-26:

"Exhaustive effort should be made to radically expel the malas (doṣas and metabolic wastes) at the right times. Uncorrected accumulation will verily result in aggravation and cut short life itself.”

“Doṣas which are subdued by laῆghana and pācana therapies can inevitably become re-aggravated, but those which are radically expelled by samśodhana (purification) therapies will not become deranged again.” (italics added)

Once a patient has undergone the proper preparation, they should undergo further radical cleansing therapies through panchakarma. The true purpose of panchakarma is to help restore the energetic flow of consciousness to all tissues. Physical structural and functional order and health then ensues. The treatments involve specialized physical hands-on therapies (abhyanga; mardana), herbalized fomentation or alternative sweat therapy (swedana), herbal paste application (lepana), mentally-relaxing shirodhara therapy, therapeutic vomiting, oil and decoction enemata (basti) and other specialty therapies. Panchakarma includes preparatory and follow-up periods individually tailored to each person. Herbal preparations are commonly administrated during the post-panchakarma period to augment continued purification and assure normalization of metabolic functions such as agni, appetite, elimination and sleep. See our website’s section on “Panchakarma” for more detailed information.

Lifestyle and Exercise: Balancing the Doshas

Scientific evidence suggests about 30% of all 572,000 cancer deaths (39,500 due to breast cancer) expected in 2011 will be related to being obese or overweight, inadequate physical inactivity or errors in nutrition and thus are preventable.

It is clear that only about 30-40% of all breast cancer cases[2] can be traced to identifiable genes or a familial tendency. Of those, 5 to 10 percent of women have inherited defective breast cancer genes, the most common being BRCA1 or BRCA2. The remainder have forms of breast cancers in their families that involve several genes.

That leaves 60-70% caused by unknown factors. Some are environmental--toxins we breathe, drink, touch or are exposed to in some way. The biggest risk factors are simply being a woman (<1 percent breast cancers occur in men) and getting older (risk increases after age 50). We can't change that, but we can change our lifestyles. The best recommendations are these six:

1-Avoid hormone replacement therapy 2 -Improve your diet  3-Exercise regularly 4-Follow good detection strategies 5-Maintain good body weight 6-Consume less or no alcohol.

Within Stanya and Artava Vaha Srotas, Vata governs the functions of timing, communication and coordination of the various processes and cycles. Pitta governs the functions of cellular metabolism and the important interface between Stanya and Artava Vaha Srotas, including the lunar cycle of menstruation and later on menopause. Kapha governs the mucosal and adhesive properties. Keeping the doshas in balance and the srotamsi free of ama (impurities) - is emphasized in Āyurveda.

Guided by skilled assessment, textual knowledge and insight, an experienced vaidya can make recommendations to maintain or restore health. It is essential to not create a new imbalance while providing intelligent and natural purification and nutrition to re-balance all areas of the body and mind. The core of the program is this: support the natural ability of the body to purify and strengthen itself.

Mental Health

The state of one’s mental health is a direct reflection of how we think, feel and act as we face different life experiences. Our mental health determines how we handle emotional stress, relate to others and make choices. It is the emotional and spiritual resilience (atati shakti) which enables us to achieve happiness and to survive pain, sorrow and disappointment. Normal mental health instinctively creates an underlying belief in one’s self-worth, and in the dignity and worth of other human beings and all life forms.

Psycho-social-spiritual stress can play a role in breast health. In particular, human interpersonal relationships are complex energetic interactions suffused with memory and unresolved, often unconscious, emotions. Intense or prolonged periods of stress (e.g. loss of a child, an abusive relationship) result in suppressed fear, anger, resentment or other morbid feelings which can become encoded in the connective tissues.[3],[4] These emotional toxins may combine with genetic, environmental, social and nutritional factors to increase blockage, stagnation and eventual doshic and srota disruption.

To refresh the mind Āyurveda suggests the classical mental balancing and rejuvenation techniques described in Patanjali’s system of Raja Yoga. Because there are eight aspects in the Raja Yoga path to enlightenment, it is also known as Aṣṭānga Yoga (eight-limbed). Patañjali's Yoga Sutras begins with the statement yogaś citta vṛtti nirodhaḥ (I/2), "Yoga is for the restraint of the activities of the mind". They proceed to describe the ways in which mind can create false ideas and understandings, and details the eight steps that can taken to escape from the unreal. This process, it is said, will lead to a spontaneous state of a quiet, unattached and blissfully content mind. Although a complete discussion of Aṣṭānga Yoga is beyond our scope here, I will say that the Path ultimately culminates in the regular practice of meditation which leads to Samadhi (enlightenment). This is relevant to our discussion of breast cancer prevention.

Meditation techniques have been shown in numerous research studies to positively influence the physiology. The regular practice of yoga postures (asanas), breath control techniques (pranayama), and dhyana (meditation) is the most effective way to relieve anxiety, depression and emotional stress, according to Āyurvedic tradition. Although the mechanism by which meditation helps re-establish mental health is not clear, we do know that these techniques provide periods of profound sensory and cognitive rest. The regular dissociation of the senses from their sense objects and the withdrawal of the attention within appears to release deep-rooted stresses that have lodged in the structure, chemistry and energetic matrix of the mind-body.

Ayugenetics – Environment and Gene Expression

Scientists are also looking beyond the confines of the physical body to the environment a person chooses to live in. Autopsy and biopsy studies reveal that 30 percent of women have microscopic cells that are problematic but which never develop into breast cancer. What determines that these cells will not become cancerous? It's analogous to well-behaved pre-teen brought up well in a nice neighborhood then moving into a bad neighborhood and being exposed to stressful antisocial behavior of his new friends. If even the smallest latent tendency to misbehave is present, it will now likely manifest.

The list of environmental factors that can influence the development of cancer is diverse particularly when we use the term environment in its broadest scope. Carcinogenic agents are present in our diets, air, homes, workplaces, water, soil, sunlight; cancers are promoted by excess exercise, some medical procedures, certain bacteria and viruses, as well as thought patterns and negative emotions.

One approach to breast cancer in Āyurveda is to clean up our patients’ neighborhood; in the body through proper exercise, diet, and daily and seasonal routines to improve metabolism and immunity; in the mind through promoting a yogic lifestyle of appropriate behaviors, observances, asana practice, concentrative and sensory development, and ultimately meditation practice. Āyurveda has known for centuries what science is discovering today--that by improving the physical and psychical environment you may change gene expression.

The study of changes in gene expression or cellular phenotype caused by factors other than changes in the underlying DNA sequence is known as epigenetics. The epigenome, which proteins and other molecules attached to the genome in different and modifiable ways, are like software programs instructing the hardware. They tell your genes to when and how to switch on or off, to express like a beautiful sunny day or as a hurricane. They are important examples of environmental effects on our health. What this means is that your physical inherited genetic code is not your complete fate but rather is influenced by conscious choices you make. If this sounds reminiscent of modern quantum mechanical insights, you are not imagining it and it is being pondered by physicists and biologists alike.

Herbal Medicines

Āyurvedic herbal medicine regimens are not conceived using the model of a specific drug to neutralize or suppress a specific symptom or disease (allopathic model). In fact, successful treatment depends on rational and logical actions of a mixture of plant substances coupled with the incomprehensible healing intelligence of Nature. The intention of herbal treatment, like all forms of Āyurvedic therapies, is to up-regulate the innate healing capacity of the human being. Herbal treatment may be categorized according to the following scheme which forms a sequence for the prevention of any disease including breast cancer and also for the treatment of many diseases.

1. Separation of Dosha and Dushya (Sammurcchana Bhanga)

2. Autodigestion of Ama (Ama pacana)

3. Clearing of the Srotasmi (Shroto Vishodhana)

4. Optimization of Agni (Dipanagni)

5. Strengthening of Immunity (Vyadhi Kshamatva)

Separation of Dosha and Dushya (Sammurcchana Bhanga)

The initial action which must be taken in the treatment of disease is the separation of the vitiated dosha from the dushya. Since many on the subsequent steps in treating disease are strong measures aimed at the doshas, if separation of the healthy tissue is not achieved first, these treatments can and will harm the tissues and the associated srotas and vital organs. The degraded dosha and the affected tissue or organ becomes joined together like the milk fats and ghee are joined together in milk. And just as we heat the milk in order to separate the ghee from the milk fats, the herbal substances which accomplish the separation of dosha from dushya (a process called sammurchana bhanga) have the following gunas: hot (ushna), sharp (tikshna), penetrating (sukshma), rapid onset (vyavam), purifying (punanam), destructive (nashita), and separating (viyujate).

The following herbal and herbomineral medicines have the action of separating dosha and dushya. This list is by no means complete. Please note that many of these medicines can be toxic and cause adverse reactions. They should therefore only be given for short courses and only under expert supervision.

 

 

Terminalia arjuna Trailokya Rasa Chintamani

Datura metal Boswellia serrata

Aconitum ferox                                  Tamra Bhasma

Strychnos nux vomica                          Heerak Bhasma

Semicarpus anacardium Embelia ribes

Holarrhena antidysenterica Abhrak Bhasma


Autodigestion of Ama (Ama pacana)

The operative principle behind the reversal and removal of ama is to temporarily stop providing nutrition to those parts of the body which we wish to purge of ama. In clinical application, this is achieved most readily, not with herbal medicines, but rather through fasting. Fasting is advocated as a bona fide approach for the removal of ama when found to be present or to prevent its formation. Like any other therapy, it is prescribed and supervised by an experienced physician.

During the fasting period, no new nutritive substances are available to the digestive system. Therefore the jathara agni and various dhatvagnis are utilized for the digestion of the accumulated ama. The fasting period can be as short as one or two days, or may extend for up to two weeks under medical supervision. There are several herbs and formulations which have been found to be effective in supporting and augmenting ama pacana:

Zingiber officinalis, Terminalia chebula, Tinospora cordifolia, Terminalia bellerica, Berberis aristata, Coriandrum sativum, Piper longum, Alpinia galangal

Clearing of the Srotasmi (Shroto Vishodhana)

 

Whereas ama pacana is effective in transforming and liquefying the waste materials in the tissues,

the process known as shroto vishodhana draws these substances out of the tissues and into the appropriate channels of elimination (i.e. Stanya Vaha Srota). In addition, this process initiates movement in the proper direction in the srotasmi for the expulsion of the wastes. This stage requires that no matter what the primary doshic imbalance may be (Vata, Pitta, or Kapha), the Vata dosha needs to be in a balanced state. Thus is because Vata dosha is what creates movement of the wastes. A balanced Vata dosha moves the wastes in the proper and natural direction.

Medicines which act on the rasa, rakta, mamsa, meda, and sukra dhatus and their corresponding srotas are used in promoting breast health. These medicines will promote the elimination of doshas from the tissues without harming the tissues and include:

Holharrhina antidysentrica, Cissampelos pareira, Tricosanthe dioica, Cyperus rotundus, Picrorrhiza kurroa Azadirachta indica, Hemidesmus indicus, Triphala,Piper nigrum, Aegle marmelos, Curcuma longa

In addition to these herbal medicines, anuvasana bastis (oil-based enemata) or often administered during this phase to promote the proper flow of Vata dosha in the srotas. Also there are specialized techniques of breast massage which are performed with specific oils (i.e. Narayana, Vishagarbha, Chandanbala Laxadi) and can be taught to patient to perform at home.

Optimization of Agni (Dipanagni)

There is not a single biological process occurring within our bodies and mind which does not depend on agni. Our intelligence, awareness, energy, appearance, perception, immunity, and life itself is kindled by its power. There are thirteen forms of agni as we have outlined earlier. The most important is jathara agni--which presides over and creates all the others. Any disturbance in jathara agni will result in incomplete and improper digestion and the formation of ama. Some of the herbal medicines which help to stimulate and balance the jatharagni and, indirectly, all the agnis of the body are as follows:

Gingiber officinalis

Piper longum

Piper nigrum

Cayenne pepper

Plumbago zeylanica

Strengthening of Immunity (Vyadhi Kshamatva)

The capacity to resist disease depends prominently on a substance known as ojas. Ojas is formed from the best and purest parts of each of the seven bodily dhatus; it is said to be the quintessence of human tissue metabolism. Like bees make honey by gathering the essence of several species of flowers, ojas is formed from the saptadhatus. There are certain plant-medicines which increase ojas and are therefore called jīvanīya gana aushadhi, medicines which sustain Life. Some of these include:

Withania somnifera, Curculigo orchiodes, Asparagus racemosus, Phaseolus trilobus, Hemidesmus indicus, Ocimum sanctum, Tinospora cordifolia, Eclipta alba, Emblica officinalis, Shilajitu, Glycerrhiza glabra, Terminalia chebula

In addition, medicines like Triphala Guggulu, Kanchnaar Guggulu, Arogyavardhini, Maha-manjishthadi kwath, Guduchi (Tinospora cordifolia), Gokshur (Tribulus terrestris) as well as the two most renowned Āyurvedic compound preparations Triphala and Chywanprash are used on a long term basis to prevent recurrence.

Medicines like Medhohar-Guggulu, Chandraprabha-Vati, and Trivang-Bhasma are also used according to the presentation of symptoms.

To prevent or reduce side effects from chemotherapy and radiation therapy, Ashwagandha, Shatavari, Kamadudha, Shankhbhasma vati, Laghu sutshekhar vati and Shunthi (Zinziber officinale) can be used.

Patwardhan and Gautum[5] summarize the results of preclinical studies on the cyto­protective potential of W. somnifera and its constituents. They include reports on the inhibition of breast and colon cancer cell lines compared to doxorubicin after the administration of witha­ferin A and an increase in the response to radio-resistant tumors when radiotherapy is combined with withaferin A treatment, among others studies.

Triphala is an Āyurvedic herbal rasayana formula consisting of equal parts of three myrobalan fruits: Amalaki (Emblica officinalis), Bibhitaki (Terminalia bellirica), and Haritaki (Terminalia chebula). Rasayana preparations are adaptogens and can be taken for life without fear of side effects. Triphala was recently found to dose-dependently induce apoptosis in human breast cell cancer lines (MCF-7) and mouse thymic lymphoma (barcl-95). Treatment did not affect neither normal human breast epithelial and peripheral blood mononuclear cells nor mouse liver and spleen cells. Direct oral feeding of triphala to mice (40 mg/kg for 13 days) resulted in significantly (P < 0.05) reduced tumor growth and more than three times higher levels of apoptosis in excised tumor tissue. According to the researchers, increases in intracellular reactive oxygen species appeared to be involved with induced cytotoxicity, supporting the hypothesis that the antioxidant effect of triphala fruits is at least partly responsible for this anticancer activity (Sandhya et al.)[6].

Triphala extract ad­ministered to mice for five days (10 mg/kg/day intraperitoneally) before γ-irradiation delayed the onset of mortality and reduced the symptoms of radiation sickness compared to non-drug distilled water controls. The extract also protected against gastrointesti­nal tract epithelium cell death. In the same study, triphala was found to exhibit dose-dependent free radical scav­enging and antioxidant activities that, according to the authors, may have contributed to its radioprotective action (Jagetia et al.)[7].

Chywanprash

Oxygen radicals are continuously generated within our cells. This is a result of normal breathing which creates something called hydroxyl radicals. These molecules damage your DNA, producing the mutations that initiate and sustain health issues later on. Studies suggest that a diet that is rich in antioxidants may help to support breast health. This has led to the current nutritional recommendation that we all should consume at least five portions of fruits or vegetables each day.

Chyawanprash is significantly more powerful than other single antioxidant; it is up to 1,000 times more effective per dose than comparable amounts of Vitamin C and Vitamin E in scavenging free radicals and preventing damage to the body. It provides full-spectrum, super-antioxidant power. Traditional literature states that Chywanprash improves cardiovascular and neurological functioning, reduces toxicity of the dhatus, improves immunity, balances emotions, and improves mental clarity.

Finally, here is a modified anti-cancer formula used in India but not in the United States due to FDA restrictions on the use of heavy metal-containing preparations. It is included here only for historical perspective. The original formula was introduced by Vagabhata in the 13th century, in the 24th chapter of his book Rasayana Samucchaya. “Purified mercury is processed with tanduliyam juice (Amaranthus polyganus), Punarnava root (Boerhavia diffusa), Nagbala (a variety of Sida cordifolia), aloe vera, Bala (Sida cordifolia), and cow urine. This processed mercury is further potentiated with Tinospora cordifolia (Guduchi) and Semicarpus anacordium (Bhallataka). This powerful mercury is further be fortified with addition of Kanchanara Guggul. The preparation should be used along with Panch Gavya Ghrita and Maker-Sanjivani.”

Conclusion

All matter is energy vibrating at different rates. The fundamental state of the universe contains all possible forms of undifferentiated matter (i.e. energy) vibrating in coherent harmony. Human beings, because we are a part of the natural universe, also have a fundamental vibration that harmonizes with the rest of the creation. Illness, including cancer, is a manifestation of disharmony which arises in the individual’s core vibration due to stress, environmental changes, emotional distress, physical injury, dietary indiscretion, or an infinite number of physical, mental, or spiritual factors. Healing is therefore initiated by restoring the normal vibratory state to the individual as a whole and to the vulnerable or diseased body part. The Āyurvedic therapies mentioned in this paper are not the only methods available from this comprehensive science, but will help us begin to understand how our mothers, wives, sisters and daughters can keep their bodies free from toxins and impurities and their immunity high even in modern times and thus avert the scourge of breast cancer.



[1] JAMA. 2011;306[17]:1884-1890. JAMA. 2011; 306[17]:1920-1921. Study shows that even modest consumption in any form (3-6 glasses/week) gives a 15% added risk of developing breast cancer

[2] Approximately 230,480 new cases of invasive breast cancer will be diagnosed in women in 2011.

[3] Connective tissue under emotional stress (in Russian), Aviakosm Ekolog Med. 2000;34(3):27-33. 4 Garcia-Campayo J,, et.al., Joint hypermobility and anxiety, Curr Psychiatry Rep. 2011 Feb;13(1):18-25.

[5] Journal of Ethnopharmacology 2006, vol. 107, 107-115

[6] Cancer Letters, vol. 238, Issue 2, 18 July 2006, 304-313

[7] Phytomedicine,Volume 9, Issue 2, 2002, Pages 99-108