Case Report: The role of <i>Panchagavya</i> and <i>Panchakarma</i> treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma

Punam Sawarkar; Gaurav Sawarkar; Nandini Bhojraj

doi:10.12688/f1000research.139233.1

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Case Report

Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma

[version 1; peer review: 1 approved with reservations]

Punam Sawarkar ¹, Gaurav Sawarkar¹, Nandini Bhojraj²

PUBLISHED 20 Oct 2023

Author details Author details

¹ Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India
² Consultant, Go Anusandhana Kendra, Deolapar, Maharashtra, 441401, India

Punam Sawarkar
Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation

Gaurav Sawarkar
Roles: Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Nandini Bhojraj
Roles: Conceptualization, Project Administration, Supervision, Writing – Original Draft Preparation

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Datta Meghe Institute of Higher Education and Research collection.

Abstract

The incidence rate of infiltrative ductal carcinoma of the breast is increasing worldwide. Chemo- and radiotherapy are commonly used after the surgical intervention for radical cure. The occurrence of various side-effects of these chemo-radiation therapies creates much discomfort to the patient. Therefore, the compliance rate of the patient towards their adoption becomes poor, or the patient is highly affected by their associated side effects in unavoidable circumstances. It is imperative to study the effect of safe, alternative options such as Panchakarma and Panchagavya treatment, which are widely used in clinical practice as an adjuvant therapy in various types of carcinoma. This report presents the case of a 31-year-old female patient diagnosed with right infiltrative ductal carcinoma of the breast, and who was advised to undergo chemo-radiation therapy after surgical intervention. However, as soon as she finished the first chemo cycle, she suffered from palpitations, loss of appetite, nausea, vomiting, severe restlessness, and hot flushes. She was rushed to the Kamdhenu Panchgavya Ayurvedic Clinic of Govigyan Anusandhan Kendra. Specific Panchagvya Chikitsa, along with Mrudu Shodhana based on Ayurvedic principles, was prescribed to her (Kamdhenu Gomutra Ark, Laghusutshekhar Ras, Panchagavya Ghrita, Panchatikta Kshir Vasti, Anuvasana Vasti with Panchgavya Ghrita) throughout her total rounds of chemo- and radiotherapy. After starting the above-said Ayurvedic treatment, the patient experienced significant relief in all symptoms. Her full six sittings of chemo- and radiotherapy were smoothly completed without causing any untoward effect. The selected combination of Ayurveda medicines gave relief in all symptoms induced by chemo- and radiotherapy therapy due to their Vatanulomak, Pittghna, Dahahara, Balya and Rasayana properties. The present case study shows that the Panchakarma and Panchagavya treatment is effective to subside the side effects induced by chemo- and radiotherapy, and improve the compliance rate of the patients towards these conventional therapies.

Keywords

Breast Carcinoma, Chemotherapy, Panchagavya, Panchakarma, Radiotherapy

Corresponding author: Punam Sawarkar

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2023 Sawarkar P et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Sawarkar P, Sawarkar G and Bhojraj N. Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1383 (https://doi.org/10.12688/f1000research.139233.1) First published: 20 Oct 2023, 12:1383 (https://doi.org/10.12688/f1000research.139233.1) Latest published: 08 Apr 2024, 12:1383 (https://doi.org/10.12688/f1000research.139233.2)

Introduction

Infiltrating ductal carcinoma (IDC), also called invasive ductal carcinoma, is a carcinoma involving the milk duct. It is the most typical breast carcinoma (80 % of total incidences of breast carcinoma).¹ Its spread takes place through the lymph nodes to other body tissues.² The number of patients of this type of carcinoma of breast are increasing day by day, both globally and in India.³ Though the carcinoma of breast is considered as better compared to other cancers from a treatment and prognosis perspective, the recurrence of especially infiltrative ductal carcinoma is a common entity.⁴ Therefore, its radical cure treatment in the form of chemo- and radiotherapy is highly appreciated, preceded by surgical intervention. However, there are multiple side-effects of these chemo-radiation therapies such as body aches, nausea, vomiting, and a severe burning sensation, which is quite troublesome for the patient as these symptoms adversely affect the quality of life of the patient.⁵ As a result, many patients decline to undergo further courses and may be deprived of their total expected therapeutic outcome.⁶ In these circumstances, the pathogenesis of the primary disease may worsen or may even lead to the death of the patient due to further metastatic changes.

Moreover, modern science is limited in preventing such complications; it is difficult to target cancer stem cells (CSCs), drug resistance properties of cancer stem cells make them immune to anticancer drugs, a lack of cancer epigenetic profiling and specificity of existing epi-drugs, problems associated with cancer diagnosis make it difficult to treat, a lack of effective biomarkers for cancer diagnosis and prognosis, and there are limitations of conventional chemotherapeutic agents.⁷ Therefore, it is the need of the hour to search for some safe alternative options in Ayurveda to manage these complications effectively. Panchagavya treatment and Mrudu Shodhana, sourced from Ayurveda medicine, seem to be a ray of hope for such patients which is demonstrated through this case report.

Case report

Patient information

The 31-year-old married female patient, housewife, with a diagnosis of right infiltrative ductal carcinoma of the breast, who had a mastectomy three weeks before her first chemotherapy session, approached Go-Anusandhana Chikitsasalaya, Nagpur, in February 2014. According to her history, she was experiencing issues such as palpitations, loss of appetite, nausea, and vomiting. These symptoms began after the first chemo session, and after the third session she additionally experienced hot flushes, constipation, burning micturition, and sensations of burning in the anal region. Thus, she was unable to consume any type of food. A detailed history of the patient is presented in Table 1. Upon examination at her first visit to the outpatient department, the general condition of the patient was fair, no icterus/swelling was found, mild pallor, palpable axillary lymphadenopathy, and blood pressure was 90/70 mm of Hg. Prakriti of patient was Vatapradhan Pittaj Prakriti. Ashatavidha Parikshana results are mentioned in Table 2.

Table 1. Patient past-present-drug and family history.

Past medical history	Jaundice before six years No other major medical/surgical illness
Personal history	Diet: vegetarian Sleep: disturbed Occupation: housewife Menstrual history: Menarche at the age of 13 years Regular (30 days cycle) for four days, painless with moderate bleeding Obstetric history: G1P1A0 (normal delivery but a mentally disabled male child)
Drug History	Chemotherapy
Family history	Father: no specific history Mother: K/C/O HTN Siblings: normal Paternal uncle: K/C/O carcinoma of stomach

Table 2. Ashatavidha Parikshana.

S.N.	Head	Observation	S.N.	Head	Observation
1	Nadi (pulse)	64/min (Vata-Pittaja)	5	Shabda (speech)	Spashta (clear)
2	Mala (stool)	Constipated (after third chemo)	6	Sparsha (touch)	Ushna
3	Mutra (urine)	Burning micturition	7	Druka (vision)	Good
4	Jivha (tongue)	Sama	8	Akruti (posture)	Madhyam

She was given Ayurvedic medication as adjuvant therapy for infiltrative ductal cancer and to address these side effects of chemotherapy. The patient self-reported that the intensity of the above symptoms was controlled with the prescribed medicines: Kamdhenu Gomutra Ark (distilled cow urine) 10 ml twice a day with the dilution of 100 ml water on an empty stomach; Laghusutashekhar Rasa (comprising of Swarna gairika – purified red ochre, iron oxide; Shunthi – ginger rhizome, Zingiber officinalis; Nagavalli – betel leaf juice extract, piper betel) 125 mg tablets twice a day with clarified butter and candy sugar; Panchagavya Ghrita 10 ml twice a day with each meal when hungry; Panchatikta Kshir Vasti 50 ml before the day of chemotherapy and alternating three enemas sittings after three days of chemotherapy; Matra Vasti with Panchagavya Ghrita 60 ml once a week after food for six months.

However, eight weeks after completing her third chemo round, she visited the out-patient department again suffering from additional symptoms such as severe hot flushes (all over the body), constipation, burning micturition and burning sensation in the anal region, and her quality of life was also severely affected. Therefore, specific Panchakarma (Mrudu Shodhana) of 60 ml Matra Basti with Panchagavya Ghrut was prescribed, which was continued throughout her chemo- and radiotherapy. After adding this, encouraging results were found in all signs and symptoms, and all sittings of chemo-radiotherapy were completed smoothly without any undue effect.

Timeline and diagnostic assessment

The patient first reported to the outpatient department with a pre-existing diagnosis of breast infiltrative ductal carcinoma. The oncologist did not determine the patient’s prognosis due to the unknown metastases in the body. Pathological investigations of the patient carried out for the diagnosis are described in Table 3.

Table 3. Method of diagnosis and investigation.

S.N.	Method of diagnosis/investigations	Timeline	Impression/remark
1	Self-recognition	16/02/2014	The feeling of a lump in the right breast
2	Chest PA view	17/02/2014	NAD
3	USG (abdomen & pelvis)	17/02/2014	Bulky uterus with small cystic lesions in left ovary
4	Skeletal scintigraphy	18/02/2014	Scan negative for skeletal metastasis
5	Bilateral mammography	17/02/2014	Irregular speculated high-density 3.5*2.5 cm lump in the upper right breast ACR-BI-RADS Category
6	Biopsy (histopathology)	21/02/2014	+ ve for malignancy Muscle bundles with a small focus of tumor showing infiltrating duct carcinoma
7	FNAC (Rt axillary lymph node)	21/02/2014	Scattered polymorphs in hemorrhagic background
8	Surgical intervention	27/02/2014	Mastectomy
9	First chemo	20/03/2014	Side-effects started

After the initial chemo treatments, the patient reported to the outpatient department with palpitation, lack of appetite, nausea, and vomiting. Kamdhenu Gomutra Ark, Laghusutshekhar, and Panchagavya Ghrit were prescribed for primary treatment. After 4 weeks between chemo rounds, the patient felt better. After 8 weeks, the third chemo session, the patient reported additional symptoms such hot flushes, constipation, burning micturition, and anal burning. Panchatikta Kshir Vasti was administered before chemo, three enemas three days after chemo, and Matra Vasti with Panchagavya Ghrita once a week after eating. After six months, the patient claimed improvement from palpitation, loss of appetite, nausea, vomiting, hot flushes, constipation, burning micturition, and anal burning.

Therapeutic intervention

In this therapeutic intervention, palliative treatment and purification were given: prescribed medicines: Kamdhenu Gomutra Ark (distilled cow urine) 10 ml twice a day with the dilution of 100 ml water on an empty stomach; Laghusutashekhar Rasa 3 125 mg tablets twice a day with clarified butter and candy sugar; Panchagavya Ghrita (Ghrit prepared from cow milk, curd, clarified butter, urine, and dung) 10 ml twice a day with each meal when hungry; Panchatikta Kshir Vasti (enema of cow milk treated with Azadirachta indica (stem bark), Tinospora cordifolia (stem), Adhatoda vasica (root), Solanum xanthocarpum (root) and Trichosanthes dioica (aerial parts)) 50 ml before the day of chemotherapy and alternating three enemas after three days of chemotherapy; Matra Vasti with Panchagavya Ghrita (medicated clarified butter enema with Panchagavya) 60 ml once a week after food for six months.

Palliative treatment increases the quality of life of patients and their families who are dealing with the hardships of a life-threatening disease, and the purification method helps to detoxify the body for better improvement in quality of life. Details of the types of therapeutic intervention and administration of therapeutic intervention applied in this case are depicted in Table 4.

Table 4. Details of therapeutic intervention applied.

S.N.	Medicine	Dose	Frequency	Time of administration	After drink	Duration
1	Kamdhenu Gomutra Ark (Distilled cow urine)	10 ml	Twice a day	With empty stomach	With the dilution of 100ml water	For six months
2	Laghusutashekhar Rasa	3tabs	Twice a day	10 a.m. - 2.p.m.	Goghrita+ candy sugar
3	Panchagavya Ghrita (Ghrit prepared from cow milk, curd, clarified butter, urine, and dung)	10ml	Twice a day	At the time of hunger	with each meal
4	Panchatikta Kshir Vasti [Enema of Cow milk treated with Azadirachta indica (stem bark), Tinospora cordifolia (stem), Adhatoda vasica (root), Solanum xanthocarpum (root) and Trichosanthes dioica (aerial parts)]	50 ml (Godugdha 25ml +Pancha tikta Ghrita 25 ml)	-	Before the day of chemo & alternate three enemas after three days of chemo	-	Six months
5	Matra Vasti with Panchagavya Ghrita [Medicated clarified butter enema with Panchagavya]	60 ml	-	Once a week after the food	-	Six months

Follow-up and therapeutic outcome

After prescribing the above treatment plan compromising of Mrudu Shodhana (Ksheervasti +Anuvasana Vasti) with Panchagavya Chikitsa for 6 months, the patient felt significant relief in all side effects of the chemo- and radiotherapy and the conventional therapies were completed smoothly and successfully. Moreover, to date, there is no recurrence of the disease or any complication in the form of metastasis. The symptoms like palpitations, lack of appetite, nausea, vomiting, hot flushes, constipation, burning micturition, and burning sensation in the anal region reduced remarkably. Therapeutic outcomes observed in this patient are mentioned in Table 5.

Table 5. Therapeutic outcome.

S.N.	Clinical findings	Before Treatment	After one month	After two months	After three months	After four months
1	Palpitation	4	2	1	0	0
2	Loss of appetite	3	1	1	1	0
3	Nausea	4	1	1	1	0
4	Vomiting	4	0	0	0	0
5	Hot flushes (All over body)	-	-	-	4	1
6	Constipation	-	-	-	4	0
7	Burning micturition	-	-	-	4	0
8	Burning sensation in anal region	-	-	-	3	0

Discussion

Kamdhenu Gomutra Arka (distilled cow urine) is one of the most effective medicines among Panchagavya formulations.⁸ Due to its highly concentrated nature as a result of the specific method of preparation and original properties of Gomutra, it is highly Kaphaghna and Agnidipaka in nature, which increases the patient’s appetite.⁹ According to the modern perspective, potassium in Gomutra Arka is responsible for its effect on appetite.⁹ Ruksha Guna decreases the excess Drava Guna of Pitta which results in relief of nausea. The sodium in Gomutra Arka relieves the hyperacidity. Mainly, Gomutra corrects the Kledak Kapha Dushti, which is the leading cause of Chhardi, i.e., vomiting. Due to its Kaphaghna properties, it is useful in Kapha-predominant conditions in Granthi and Arbuda. It is highly effective in various carcinomatous conditions due to the anti-cancer properties of Gomutra.¹⁰ Gomutra is diuretic in nature; it eliminates the excess Kleda (toxic materials induced by chemotherapeutic agents) and also decreases the burning sensation during urination.¹¹ It also decreases hematological toxicities induced by chemo and radiation therapies.¹²^,¹³

Gomutra plays a crucial role in immune modulation by enhancing the activity of macrophages, lymphocytes (both T and B cells), humoral cellular immunity, and cytokines (interleukin 1 and 2), and works as an adjuvant therapy with the conventional modalities.¹⁴ It also protects the cell from getting damaged by free radicals, which can cause tumor cell growth or recurrence.¹⁴

Laghusutashekhar Rasa is the combination of herbs and minerals that consists of Gairik responsible for the Pitta Shamana effect due to its Shita Virya, which subsides the symptoms of Pitta Prakopaka such as Sarvang Daha (hot flushes), Mootra Daha and Guda Daha. It absorbs the excess Drava Guna of vitiated Pitta, which occurs due to Ushna Guna of the chemotherapeutic agent. Therefore, it decreases the sensation of nausea and reduces the frequency of vomiting¹⁵ and is highly recommended for acid peptic disease and lack of appetite. It also pacifies Vata due to its Madhura Rasa, Snigdha, and Madhur Vipaka.¹⁶ As it contains Go–Ghrita, which is Agnidipaka in nature, it results in increased appetite.¹⁷

Panchagavya Ghrita (Ghrit prepared from cow milk, curd, clarified butter, urine, and dung) is the medicated Ghrita that pacifies the Pitta and Kapha.¹⁸ In this case, it was used in the forms of Shamana Snehapana and Matra Vasti. Shamana Snehapana, with Panchagavya Ghrita, acts as a carrier that can facilitate the drug or its pharmacological properties to get into the cells, enhancing the effects of Shamana drugs.¹⁹ It processes free radicals as a result of the anti-oxidant effects due to vitamins A, C, and E, and fatty acids present in it. It is especially recommended for liver disorders.²⁰ It acts as the best immuno-modulator through its anti-oxidant properties.²⁰ It also has anti-cancer properties and helps to remove the hematogenous toxins induced by chemotherapeutic agents.²¹^–²² The neuroprotective action of Panchagvaya Ghrita is demonstrated by Sawarkar G et al. (2018), resulting in the relief in hot flushes.²³

Matra Vasti with Panchgavya Ghrita (enema of cow milk treated with Azadirachta indica (stem bark), Tinospora cordifolia (stem), Adhatoda vasica (root), Solanum xanthocarpum (root) and Trichosanthes dioica (aerial parts)) acts as a mild type of purification and can be adopted to induce harmony between the vitiated Dosha and Dhatu, which can normalize the Vata without causing any deterioration in the status of the person.²⁴ While Shodhan Vasti is contraindicated in cancer treatment due to the complexity of the disease, Shaman Vasti can be used with cancer patients as it is a mild type of Vasti. Moreover, side effects induced by chemo- and radiotherapy mainly affect the Rasavaha, Annavaha and Pursihvaha Strotas by causing vitiation of Vata and Pitta primarily. Therefore, Panchagavya Ghrita, which mainly is Pitta Shamaka, also brings the Vatanulomama (especially ApanVayu) due to Snigdha Guna of Ghrita. As a result, it corrects the Saman Vayu and Pachak Pitta. It reverts the normalcy of Annavaha Strotas by improving appetite.²⁵

Panchtikta Kshir Vasti (medicated clarified butter enema with Panchagavya) is recommended for Pitta predominant and degenerative conditions due to its Pitta Shamaka, Kledahara, Balya, and Rasayan properties.²⁶ In clinical practice, it has significant results in Amlapittta Daha, Astha-Majjagata Dushti Vikara, and Dhatukshayajanaya Vata Vyadhi.²⁷ The Kaphaghna and Sukshma properties of Panchtikta (Guduchi, Patol, Kantakari, Nimba and Vasa) reduces the inflammation in gastric mucosa induced by chemotherapeutic agents due to their anti-inflammatory and anti-oxidant properties.²⁸ At the same time, clarified butter and cow milk, in this enema preparation, induce a soothing effect due to their Pitta Shamaka nature.¹⁷

Strengths and limitations

The combination of all Ayurveda medicines and Panchagavya therapies induces the Anulomana of Apana Vayu, which stimulates the Samana Vayu and corrects the vitiation of Kledka Kapha and Pachaka Pitta.²⁴ Therefore, symptoms related to Amlapitta and Sarvanaga Daha (Pitta Prakopa) were completely subsided. Due to Kledahara and Agnidipaka properties, it removes the Rasa Dushti, resulting in the relief of heart palpitations. As a result, symptoms induced by chemo- and radiotherapy therapy will ease due to the correct combination of Panchakarma and Panchagavya formulations with their Vatanulomak, Pittghna, Dahahara, Balya, and Rasayana (immuno-modulators, anti-oxidant, bio-enhancing) properties. Because this is only a single case study, the patient should be treated according to suitable medical guidelines and under the supervision of specialists in the respective domains in the future.

Conclusion

The present case study shows that the Ayurvedic intervention based on Panchagavya and Panchakarma is effective in subsiding the side-effects induced by the chemo- and radiotherapy through their threefold effects of Shamana, Bruhana and Mrudu Shodhana. It is also helpful to increase the compliance rate of the patients towards conventional therapies like chemo-radiotherapy. Further multi-centric clinical trials with large sample sizes are encouraged to establish the significant and comprehensive role of Panchagavya Chikitsa with Panchakarma in Ayurveda. It will become a milestone for Ayurveda in oncology for its acceptance at a global level.

Patient perspective

The patient is satisfied with the treatment protocol and desired outcomes.

Ethical statement

Written informed consent was received from the patient for publishing this case study and the patient consented to the disclosure of her clinical details. The ethical clearance for the publication of this case study was taken from the local ethical committee at Mahatma Gandhi Ayurveda College, Hospital and Research Centre, Salod (H), Wardha with IRB No. MGAC/IEC/April/2023/102. All procedures and treatments advised and performed in this study were conducted by ethical standards mentioned in the 1964 Declaration of Helsinki, as revised in 2013.

Glossary

• Agnidipaka: increasing appetite
• Amlapittta Daha: hyper acidity
• Annavaha Strotas: gastro-intestinal channels
• Anulomana- correct direction
• Anuvasana Vasti with Panchgavya Ghrita: medicated clarified butter enema with Panchagavya
• Apan Vayu: air entity below umbilicus
• Ashatavidha Parikshana: eight-fold examination
• Astha-Majjagata Dushti Vikara: disease that occurred due to vitiation of toxins at bone and bone marrow
• Balya: nutritive
• Bruhana: nutritive treatment
• Chhardi: vomiting
• Chikitsa: treatment
• Dahahara: dispelling one’s burning sensation
• Dhatu: body tissue
• Dhatukshayajanaya Vata Vyadhi: diseases of air entity due to its depletion
• Dosha: bio humour
• Drava Guna of Pitta:liquid nature of fire/hot entity in body
• Go–Ghrita: cow clarified butter
• Gomutra: cow urine
• Granthi and Arbuda: cyst
• Guda Daha: burning sensation at the anus
• Guduch: Tinospora cordifolia
• Kamdhenu Gomutra Ark: distilled cow urine
• Kantakari: Solanum xanthocarpum
• Kapha: phlegm
• Kaphaghna: anti-phlegm
• Kledahara: hydrous conetent absorber
• Kledak Kapha Dushti: vitiation of phlegm
• Laghusutshekhar Ras: herbs-minerals Ayurveda drug combination
• Matra Vasti: oil retention enema
• Mootra Daha: burning micturition
• Mrudu Shodhana: mild detoxification
• Nimba: Azadirachta indica
• Niruha Vasti: decoction enema
• Pachak Pitta: fire/hot entity in abdomen
• Panchagavya: a combination of cow milk, curd, clarified butter, urine, and dung
• Panchagavya Ghrita: Ghrit prepared from cow milk, curd, clarified butter, urine, and dung
• Panchakarma: putative therapy
• Panchatikta Kshir Vasti: enema of cow milk treated with Azadirachta indica (stem bark), Tinospora cordifolia (stem), Adhatoda vasica (root), Solanum xanthocarpum (root), and Trichosanthes dioica (aerial parts)
• Patol: Trichosanthes dioica
• Pitta Dosha: fire entity or humor in the body
• Pitta Prakopaka: Pitta dosha flare-up
• Pitta Shamaka: pacification of Pitta dosha
• Pittghna: anti-bilious
• Pursihvaha Strotas: eliminitory channels
• Ras Dushti: vitiation of circulatory tissues in the body
• Rasavaha Strotas: the channels of the body which convey the first tissue formed from the nutritive juices
• Rasayana: immuno-modulators, anti-oxidant, bio-enhancing
• Ruksha Guna: dry property
• Saman Vayu: air entity at the abdomen
• Sarvanaga Daha:burning sensation in all over body
• Sarvang Daha: hot flushes
• Shamana: pacification treatment
• Shamana Snehapana: palliative oleation
• Shodhana: purification
• Snigdha Guna: unctuous property
• Strotas:circulatory channels
• Sukshma: micro
• Tikshana Shodhana:extreme putative therapy
• Ushna Guna: thermal properties
• Vamana: therpeutic emesis
• Vasa: Adhatoda vasica
• Vatanulomak: the drugs responsible for the change in direction of Vata Dosha i.e. Vata means to blow or to move like the wind. Containing the elements like air and space,
• Vatanulomama: correct the direction of Vata Dosha
• Vatapradhan Pittaj Prakriti: patient having predominantly air entity followed by fire entity
• Virechana:therpeutic purgation

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22. Sawarka G, Sawarkar P: Management of Obsessive-Compulsive Disorder (OSD) Through Ayurveda. J. Indian Syst. Med. 2018 Jul 1; 6(3): 157.
23. Sawarkar G, Sawarkar P: Case Study of Avascular Necrosis of Femoral Head. J. Indian Syst. Med. 2016 Jan 1; 4(1): 46.
24. Bhojraj N, Sawarkar G: The effect of Panchagavya formulations in the case of CA Rectum. Int. J. Ayurvedic Med. 2020; 11(3): 572–574. Publisher Full Text
25. Kadambari PB, Dharmarajan P, Prathibha CK, et al.: A Critical Review on the Concept of Avapeedaka Snehapana, a Special Mode of Lipid Administration. J. Evid.-Based Integr. Med. 2018; 23: 23. PubMed Abstract | Publisher Full Text | Free Full Text
26. Landge A, Sawarkar G, Sawarkar P: The role of Ayurveda in the management of Asthimajjagata Vata (Spondylosis): A Case Report. Drugs and Cell Therapies in Hematology. 2021; 10(1): 3324–3333.
27. Sawarkar P, Deshmukh M, Sawarkar G, et al.: A Comparative Efficacy Study of the Panchtikta Ghrita Matra Vasti and Panchtikta Ghrita Marsha Nasya in Cervical Spondylosis. Int. J. Ayurvedic Med. 2020; 11(2): 218–227. Publisher Full Text
28. Harinarayanan CM, Kumar D, Geetha SP, et al.: The phytochemical composition and therapeutic efficacy of an Ayurvedic drug combination Panchatikta: A review. Med. Plants - Int. J. Phytomed. Relat. Ind. 2022; 14(3): 355–373. Publisher Full Text

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Author details Author details

Punam Sawarkar
Roles: Data Curation, Formal Analysis, Writing – Original Draft Preparation

Gaurav Sawarkar
Roles: Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Nandini Bhojraj
Roles: Conceptualization, Project Administration, Supervision, Writing – Original Draft Preparation

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (2)

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Published: 08 Apr 2024, 12:1383

https://doi.org/10.12688/f1000research.139233.2

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https://doi.org/10.12688/f1000research.139233.1

© 2023 Sawarkar P et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Sawarkar P, Sawarkar G and Bhojraj N. Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma [version 1; peer review: 1 approved with reservations]. F1000Research 2023, 12:1383 (https://doi.org/10.12688/f1000research.139233.1)

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Reviewer Report 19 Dec 2023

Amit Nakanekar, Government Ayurved College, Maharashtra, India

Payal Rathod, Kayachikitsa, Government Ayurved College Nagpur, Nagpur, Maharashtra, India

Approved with Reservations

https://doi.org/10.5256/f1000research.152493.r220496

This Case report nicely describes the importance of Pangavya and Panchkarma treatment in infiltrative ductal carcinoma. I congratulate the authors for successfully treating this challenging case. The authors have nicely explained the case in detail.
I suggest authors avoid the use of complicated Ayurvedic terminologies to increase the visibility and citation value of the article. Authors need to emphasise the concepts rather than medicines in the discussion section. Authors can compare their current study with previously published articles. Please mention the quality of life scales used for this case report. Provide all the reports as a supplementary material

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Partly
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Ayurveda, Herbal Medicine,

We confirm that we have read this submission and believe that we have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however we have significant reservations, as outlined above.

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Author Response 19 Jun 2024

Punam Sawarkar, $usrAffiliation

19 Jun 2024

Author Response

Concepts are more emphasized in the discussion section based on reviewer comments and comparisons to prior published papers. A scale for quality of life is employed. WHOQOL-SRPB: scoring and coding ... Continue reading Concepts are more emphasized in the discussion section based on reviewer comments and comparisons to prior published papers. A scale for quality of life is employed. WHOQOL-SRPB: scoring and coding for the WHOQOL SRPB field-test instrument: Users Manual, 2012 version, WHO Reference Number: WHO/MSD/MER/Rev.2012.05.
All the supporting reports are submitted as a supplementary material
Concepts are more emphasized in the discussion section based on reviewer comments and comparisons to prior published papers. A scale for quality of life is employed. WHOQOL-SRPB: scoring and coding for the WHOQOL SRPB field-test instrument: Users Manual, 2012 version, WHO Reference Number: WHO/MSD/MER/Rev.2012.05.
All the supporting reports are submitted as a supplementary material
Competing Interests: Nil Close
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Author Response 19 Jun 2024

Punam Sawarkar, $usrAffiliation

19 Jun 2024

Author Response

Concepts are more emphasized in the discussion section based on reviewer comments and comparisons to prior published papers. A scale for quality of life is employed. WHOQOL-SRPB: scoring and coding ... Continue reading Concepts are more emphasized in the discussion section based on reviewer comments and comparisons to prior published papers. A scale for quality of life is employed. WHOQOL-SRPB: scoring and coding for the WHOQOL SRPB field-test instrument: Users Manual, 2012 version, WHO Reference Number: WHO/MSD/MER/Rev.2012.05.
All the supporting reports are submitted as a supplementary material
Concepts are more emphasized in the discussion section based on reviewer comments and comparisons to prior published papers. A scale for quality of life is employed. WHOQOL-SRPB: scoring and coding for the WHOQOL SRPB field-test instrument: Users Manual, 2012 version, WHO Reference Number: WHO/MSD/MER/Rev.2012.05.
All the supporting reports are submitted as a supplementary material
Competing Interests: Nil Close
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	1	2	3
Version 2 (revision) 08 Apr 24		read	read
Version 1 20 Oct 23	read

Amit Nakanekar, Government Ayurved College, Maharashtra, India

Payal Rathod, Government Ayurved College Nagpur, Nagpur, India
Aishwarya Ashish Joglekar, All India Institute of Ayurveda, New Delhi, India

Sumedh Joshi, All India Institute of Ayurveda, New Delhi, India
B Thamarai Selvi, Sri Ramakrishna College of Arts and Science for Women, Coimbatore, India

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Reviewer Report

3 Views

07 Nov 2024 | for Version 2

B Thamarai Selvi, Sri Ramakrishna College of Arts and Science for Women, Coimbatore, Tamil Nadu, India

3 Views Cite this report Responses(0)

Approved

The Panchagavya and Panchakarma therapies outlined here offer a valuable complementary approach in the holistic management of cancer treatment side effects.

These therapies help mitigate common symptoms like nausea, vomiting, appetite loss, and fatigue associated with chemotherapy and radiotherapy, while also enhancing the immune system and promoting detoxification.

he reported positive outcomes in the case study suggest that these Ayurvedic therapies can help improve patient quality of life and treatment compliance during cancer therapy. However, further research with larger sample sizes is essential to validate these findings on a wider scale.

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Strengths and Limitations: Strengths: Multi-Pronged Action: The combination of various therapies works on multiple aspects of the body, including immunity, digestion, and detoxification. Holistic Approach: Ayurvedic treatments like Panchagavya therapies can serve as complementary treatments that support the body during conventional cancer therapies. Immune Boosting: By enhancing immunity and detoxifying the body, Panchagavya therapies may help improve the patient's overall resilience to treatment and recovery. Limitations: Lack of Large-Scale Evidence: This case study is limited to a single patient, and while the results are promising, larger and more comprehensive studies are necessary to establish the efficacy of these treatments in a broader population. Medical Supervision Required: These therapies should be used under the supervision of trained Ayurvedic practitioners, especially in conjunction with conventional cancer treatments, to avoid any potential adverse effects. Herbal Medicines and ecofriendly dying

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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6 Views

11 Oct 2024 | for Version 2

Aishwarya Ashish Joglekar, Samhita Siddhant, All India Institute of Ayurveda, New Delhi, India

Sumedh Joshi, Dravyaguna, All India Institute of Ayurveda, New Delhi, India

6 Views Cite this report Responses(0)

Approved With Reservations

The authors have successfully provided insights in the treatment of ductal carcinoma of breast. The scientific treatment is done with classical medications and simple therapeutic protocol.

Few aspects mentioned below can be incorporated for further understanding of the subject
1) Incidence and Prevalence of ductal carcinoma in India and/or globally can be expressed in numbers
2) Terms like modern science or modern perspective can be avoided and replaced with terms like western biomedicine and conventional medicine
3) Introduction can be give brief information regarding the Panchagavya treatment
4) English equivalent for all the sanskrit terms including basti etc should be provided
5) Pacifier Ghee intake ?? Clarify the statement
6) The name of GMP company from which the study drugs were used can be mentioned. Authentication certificate can be provided
7) Term Panchagavya Belief - Not clear
8) Recent research work done in this field can be mentioned (where in the use of same of drugs for the treatment of ductal carcinoma , ayurvedic treatment of ductal carcinoma can be mentioned)

Is the background of the case’s history and progression described in sufficient detail?

Partly
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Partly
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Yes
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Ayurveda , Ayurveda Basic principles , endocrinology

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Reviewer Report

12 Views

19 Dec 2023 | for Version 1

Amit Nakanekar, Government Ayurved College, Maharashtra, India

Payal Rathod, Kayachikitsa, Government Ayurved College Nagpur, Nagpur, Maharashtra, India

12 Views Cite this report Responses(1)

Approved With Reservations

Is the background of the case’s history and progression described in sufficient detail?

Yes
Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes?

Yes
Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment?

Partly
Is the case presented with sufficient detail to be useful for other practitioners?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Ayurveda, Herbal Medicine,

Respond to this report

Responses (1)

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[9] 9. Goyal R, Kaur M, Chandola HM: A clinical study on the role of Agnimanthadi compound in the management of Sthaulya (obesity). Ayu. 2011 Apr; 32(2): 241–249. PubMed Abstract | Publisher Full Text | Free Full Text

[10] 10. Mahajan SP, Chavan SA, Shinde SA, et al.: Miraculous Benefits of Cow Urine: A Review. JDDT. 15 Aug. 2020 [cited 2023 Jul 20]; 10(4-s): 275–281. Publisher Full Text Reference Source

[11] 11. Randhawa GK: Cow urine distillate as bioenhancer. J. Ayurveda Integr. Med. 2010 Oct; 1(4): 240–241. PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Dr. Kalwar AK : Kamdhenu Urine (Fresh) Therapy in Cancer Patients: A Holistic Approach, Souvenir of Go Anusandhana Kendra. Rajasthan: Kamdhenu Urine Centre; 2018.

[13] 13. Dr. Varmudy SS : A clinical study on Gomutra for Stage IV Oro Pharyngeal Carcinoma Undergoes Complete Regression, Approach, Souvenir of Go Anusandhana Kendra. Rajasthan: Kamdhenu Urine Centre; 2018.

[14] 14. Hoh JM, Dhanashree B: Antifungal effect of cow’s urine distillate on Candida species. J. Ayurveda Integr. Med. 2017; 8(4): 233–237. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Patil SS, Khilare MC: Ayurvedic management of amlapitta with special reference to hyperacidity: A case study. World Journal of Advanced Research and Reviews. 2022; 16(2): 1022–1027. Publisher Full Text

[16] 16. Archana K, Vaghela DB: Management of Migraine with Ayurvedic Intervention-A Case Report. European J. Med. Plants. 2020 Sep 3; 60–64. Publisher Full Text

[17] 17. Sawarkar PG, Prasad KS: Concept of Sadyasnehana-A review. J. Indian Syst. Med. 2017 Oct 1; 5(4): 292.

[18] 18. Sharma Prof. Priyavat, Charaka Samhita of Agnivesha, treatise refined and annotated by Charaka and redacted by Dridhbala, English translation, Volume II, Chikitsasthana, Verse 16,8 ^th edition, Varanasi, India: Chaukhamba Orientalia.2007; 237.

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[20] 20. Achliya GS, Kotagale NR, Wadodkar SG, et al.: Hepatoprotective activity of panchagavya ghrita against carbontetrachloride induced hepatotoxicity in rats. Indian J. Pharm. 2003 Sep 1; 35(5): 308–311.

[21] 21. Joshi R, Reeta KH, Sharma SK, et al.: Pharmacodynamic and pharmacokinetic interaction of Panchagavya Ghrita with phenytoin and carbamazepine in maximal electroshock induced seizures in rats. Ayu. 2015 Apr; 36(2): 196–202. PubMed Abstract | Publisher Full Text

[22] 22. Sawarka G, Sawarkar P: Management of Obsessive-Compulsive Disorder (OSD) Through Ayurveda. J. Indian Syst. Med. 2018 Jul 1; 6(3): 157.

[23] 23. Sawarkar G, Sawarkar P: Case Study of Avascular Necrosis of Femoral Head. J. Indian Syst. Med. 2016 Jan 1; 4(1): 46.

[24] 24. Bhojraj N, Sawarkar G: The effect of Panchagavya formulations in the case of CA Rectum. Int. J. Ayurvedic Med. 2020; 11(3): 572–574. Publisher Full Text

[25] 25. Kadambari PB, Dharmarajan P, Prathibha CK, et al.: A Critical Review on the Concept of Avapeedaka Snehapana, a Special Mode of Lipid Administration. J. Evid.-Based Integr. Med. 2018; 23: 23. PubMed Abstract | Publisher Full Text | Free Full Text

[26] 26. Landge A, Sawarkar G, Sawarkar P: The role of Ayurveda in the management of Asthimajjagata Vata (Spondylosis): A Case Report. Drugs and Cell Therapies in Hematology. 2021; 10(1): 3324–3333.

[27] 27. Sawarkar P, Deshmukh M, Sawarkar G, et al.: A Comparative Efficacy Study of the Panchtikta Ghrita Matra Vasti and Panchtikta Ghrita Marsha Nasya in Cervical Spondylosis. Int. J. Ayurvedic Med. 2020; 11(2): 218–227. Publisher Full Text

[28] 28. Harinarayanan CM, Kumar D, Geetha SP, et al.: The phytochemical composition and therapeutic efficacy of an Ayurvedic drug combination Panchatikta: A review. Med. Plants - Int. J. Phytomed. Relat. Ind. 2022; 14(3): 355–373. Publisher Full Text

Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma

Abstract

Keywords

Introduction

Case report

Patient information

Table 1. Patient past-present-drug and family history.

Table 2. Ashatavidha Parikshana.

Timeline and diagnostic assessment

Table 3. Method of diagnosis and investigation.

Therapeutic intervention

Table 4. Details of therapeutic intervention applied.

Follow-up and therapeutic outcome

Table 5. Therapeutic outcome.

Discussion

Strengths and limitations

Conclusion

Patient perspective

Ethical statement

Glossary

References

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