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Case Report
Revised

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

[version 2; peer review: 1 approved, 2 approved with reservations]
Punam Sawarkar
https://orcid.org/0000-0001-7980-7832
1, Gaurav Sawarkar
https://orcid.org/0000-0002-5605-795X
1, Nandini Bhojraj2
Punam Sawarkar
https://orcid.org/0000-0001-7980-7832
1, Gaurav Sawarkar
https://orcid.org/0000-0002-5605-795X
1, Nandini Bhojraj2
PUBLISHED 08 Apr 2024
Author details Author details
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 treatment, 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 treatments are effective in subside the side effects induced by chemo- and radiotherapy and improving 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:  © 2024 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 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 12:1383 (https://doi.org/10.12688/f1000research.139233.2) 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)

Revised Amendments from Version 1

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.

See the authors' detailed response to the review by Amit Nakanekar and Payal Rathod

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 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 historyJaundice before six years
No other major medical/surgical illness
Personal historyDiet: 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 HistoryChemotherapy
Family historyFather: no specific history
Mother: K/C/O HTN
Siblings: normal
Paternal uncle: K/C/O carcinoma of stomach

Table 2. Ashatavidha Parikshana.

S.N.HeadObservationS.N.HeadObservation
1Nadi (pulse)64/min (Vata-Pittaja)5Shabda (speech)Spashta (clear)
2Mala (stool)Constipated (after third chemo)6Sparsha (touch)Ushna
3Mutra (urine)Burning micturition7Druka (vision)Good
4Jivha (tongue)Sama8Akruti (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 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/investigationsTimelineImpression/remark
1Self-recognition16/02/2014The feeling of a lump in the right breast
2Chest PA view17/02/2014NAD
3USG (abdomen & pelvis)17/02/2014Bulky uterus with small cystic lesions in left ovary
4Skeletal scintigraphy18/02/2014Scan negative for skeletal metastasis
5Bilateral mammography17/02/2014Irregular speculated high-density 3.5*2.5 cm lump in the upper right breast ACR-BI-RADS Category
6Biopsy (histopathology)21/02/2014+ ve for malignancy Muscle bundles with a small focus of tumor showing infiltrating duct carcinoma
7FNAC (Rt axillary lymph node)21/02/2014Scattered polymorphs in hemorrhagic background
8Surgical intervention27/02/2014Mastectomy
9First chemo20/03/2014Side-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 as 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.MedicineDoseFrequencyTime of administrationAfter drinkDuration
1Kamdhenu Gomutra Ark (Distilled cow urine)10 mlTwice a dayWith empty stomachWith the dilution of 100ml waterFor six months
2Laghusutashekhar Rasa3tabsTwice a day10 a.m. - 2.p.m.Goghrita+ candy sugar
3Panchagavya Ghrita (Ghrit prepared from cow milk, curd, clarified butter, urine, and dung)10 mlTwice a dayAt the time of hungerwith each meal
4Panchatikta 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 25 ml +Pancha tikta Ghrita 25 ml)-Before the day of chemo & alternate three enemas after three days of chemo-Six months
5Matra 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. 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.

Table 5. Therapeutic outcome.

S.N.Clinical findingsBefore TreatmentAfter one monthAfter two monthsAfter three monthsAfter four monthsAfter five monthsAfter six months
1Palpitation4210000
2Loss of appetite3111000
3Nausea4111000
4Vomiting4000000
5Hot flushes (All over body)---4100
6Constipation---4000
7Burning micturition---4000
8Burning sensation in anal region---3000

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 effective in decreasing Kapha properties and increasing digestive fire, which increases the patient’s appetite.9 According to the modern perspective, potassium in Gomutra Arka is responsible for its effect on appetite9 dried nature decreases the excess liquid qualities of Pitta which results in relief of nausea. The sodium in Gomutra Arka relieves hyperacidity. Mainly, Gomutra corrects the Kledak Kapha vitiation, which is the leading cause of Chhardi, i.e., vomiting. Due to its Kapha-decreasing properties, it is useful in Kapha-predominant conditions in Granthi and Arbuda (Cyst & tumour). 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 pacification effect due to its cooling properties, which subsides the symptoms of Pitta vitiation such as hot flushes, burning micturition and burning sensation in anal region. It absorbs the excess liquid properties of vitiated Pitta, which occurs due to heating properties 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 sweet, oily properties.16 As it contains–cow ghee, which increases digestive fire, it results in increased appetite.17

Panchagavya Ghrita (Ghee prepared from cow milk, curd, clarified butter, urine, and dung) is the medicated ghee that pacifies the Pitta and Kapha.18 In this case, it was used in the pacification of toxins and Matra Vasti (medicated enema). Pacifier ghee intake, 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 pacifier medicine.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 (medicated enema) 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 (putative enema) is contraindicated in cancer treatment due to the complexity of the disease, Shaman Vasti (pacificatory enema) can be used with cancer patients as it is a mild type of enema. Moreover, side effects induced by chemo- and radiotherapy mainly affect the Rasavaha (channel of nutrition), Annavaha (food carrying channels), and Pursihvaha Strotas (body waste product channel) by primarily causing vitiation of Vata and Pitta. Therefore, Panchagavya Ghrita, which is mainly a Pitta pacifier, also brings the Vatanulomama (downward Vata movement) due to the oily quality of Ghrita. As a result, it corrects the Saman Vayu (digestive air) and Pachak Pitta (digestive fire). 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 pacification properties, Kledahara (factor responsible for minimizing moisture), Balya (creating power), and Rasayan (rejuvenation) properties.26 In clinical practice, it has significant results in Amlapittta Daha (hyperacidity), bone or bone marrow-based diseases.27 The Kaphaghna (Kapha pacifing) and Sukshma (micro functioning) properties of Panchtikta (Guduchi, Patol, Kantakari, Nimba, and Vasa) reduce the inflammation in gastric mucosa induced by chemotherapeutic agents due to their anti-inflammatory and antioxidant 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 (air movement in downward direction) of Apana Vayu, which stimulates the Samana Vayu (digestive air) and corrects the vitiation of Kledka Kapha (moisture minimizing) and Pachaka Pitta (digestive fire).24 Therefore, symptoms related to Amlapitta (acidity) and Sarvanaga Daha (burning sensation in body) completely subsided. Due to Kledahara (moisture minimizing) and Agnidipaka (increasing appetite) properties, it removes the vitiation of circulatory tissues in the body, 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 (downward direction of air), Pittghna (anti-bilious), Dahahara (minimizing burning sensation), Balya (powerful/nutritive), 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.

Panchagavya therapy believe it can help modify the immune system, which is critical in combating cancer cells. The components of Panchagavya are thought to increase immunity and support general wellness. Panchagavya therapy is also supposed to help in detoxification of the body. Detoxifying the body may help the body’s natural systems for clearing toxins, which may be useful in cancer prevention and treatment. Panchagavya’s components, particularly milk, ghee, and curd, include critical nutrients that may promote general health and well-being throughout cancer therapy.29 Some research indicates that Panchagavya components have anti-inflammatory capabilities. Chronic inflammation is connected to cancer development, and lowering inflammation may aid in cancer preventive methods.30 Panchagavya contains a lot of antioxidants, including ghee. Antioxidants aid in neutralizing free radicals in the body, which can contribute to cell damage and even cancer formation.21

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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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 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 12:1383 (https://doi.org/10.12688/f1000research.139233.2)
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ApprovedThe 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 approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 07 Nov 2024
B Thamarai Selvi, Sri Ramakrishna College of Arts and Science for Women, Coimbatore, Tamil Nadu, India 
Approved
VIEWS 3
https://doi.org/10.5256/f1000research.164456.r330371
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 ... Continue reading
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Selvi BT. Reviewer Report For: Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 12:1383 (https://doi.org/10.5256/f1000research.164456.r330371)
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https://f1000research.com/articles/12-1383/v2#referee-response-330371
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Reviewer Report 11 Oct 2024
Aishwarya Ashish Joglekar, Samhita Siddhant, All India Institute of Ayurveda, New Delhi, India 
Sumedh Joshi, Dravyaguna, All India Institute of Ayurveda, New Delhi, India 
Approved with Reservations
VIEWS 6
https://doi.org/10.5256/f1000research.164456.r330370
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 ... Continue reading
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Joglekar AA and Joshi S. Reviewer Report For: Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 12:1383 (https://doi.org/10.5256/f1000research.164456.r330370)
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https://f1000research.com/articles/12-1383/v2#referee-response-330370
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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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
VIEWS 12
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 ... Continue reading
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Nakanekar A and Rathod P. Reviewer Report For: Case Report: The role of Panchagavya and Panchakarma treatment in the management of radiotherapy and chemotherapy side effects in infiltrative ductal carcinoma [version 2; peer review: 1 approved, 2 approved with reservations]. F1000Research 2024, 12:1383 (https://doi.org/10.5256/f1000research.152493.r220496)
The direct URL for this report is:
https://f1000research.com/articles/12-1383/v1#referee-response-220496
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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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
    Report a concern
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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
    Report a concern

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Open Peer Review

Reviewer Status

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

Reviewer Reports

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 08 Apr 24 		read read
Version 1
20 Oct 23 		read
  1. Amit Nakanekar, Government Ayurved College, Maharashtra, India
    Payal Rathod, Government Ayurved College Nagpur, Nagpur, India
  2. Aishwarya Ashish Joglekar, All India Institute of Ayurveda, New Delhi, India
    Sumedh Joshi, All India Institute of Ayurveda, New Delhi, India
  3. B Thamarai Selvi, Sri Ramakrishna College of Arts and Science for Women, Coimbatore, India

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    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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