By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S
Chemotherapy is a treatment used for treating cancers in which certain drugs are used which would kill and destroy the cancer cells which are dividing rapidly in order to prevent these cells from growing and making more and more cancer cells. It is a part and parcel of the overall treatment plan up which also includes surgery and radiation therapy. All these are collectively used to treat many kinds of cancer.
Read – Cancer- Ayurvedic Understanding And Hopeful Treatment Modalities

Ayurveda Concept of chemotherapy

The Vata factor and ‘vata balancing measures’ in the management of side effects of chemotherapy
The cell division and differentiation is under the control of balanced vata. When vata is aggressively aggravated the division of these cells and their differentiation takes place in an uncontrolled way. Therefore vata shall be considered as the chief principle behind the pathogenesis of cancer.

The human body is formed by the amalgamation of five elements of nature and the life element i.e. soul. Vayu is one of the five elements. Vayu means air element. Once the shukra-shonita i.e. sperm and ovum combine to form the embryo all these elements participate in differentiating and enabling development of this embryo. The role of this vayu is vibhajana i.e. cell division which is the first and foremost event which takes place once the zygote is formed. So from this level itself the division and reproduction of the cells will be under the control of vayu element. Even after the birth and throughout the entire life process from thereon vayu will carry on this function. Vayu element is represented in our body in the form of Vata dosha. The combination of vayu and akasha elements will lead to the manifestation of vata dosha in our body. When this vata is in a state of balance, the cell division and differentiation will be normal and healthy. When vata goes out of balance it may cause many health disorders which are difficult to manage. Abnormal cell division and differentiation is one such effect of imbalanced and aggravated vata. This pathological deviation of vata will lead to causation of cancer and similar such conditions. This might not happen in all people but might happen in those who are susceptible and when an environment suitable for development of cancer is found in the body following exposure to related etiological factors.

Therefore ‘vata balancing measures’ including medicines, therapies, dietetic inclusions and lifestyle changes might work on the lines of chemotherapy. When hyperactivity of vata is controlled, abnormal division and reproduction of the cells will be controlled. The same goals are achieved by chemotherapy. Side effects of chemotherapy can be brought under control and cured by balancing vata. So, addressing pathological vata and bringing it into balance might be the vital step and measure Ayurveda physicians should think about while handling the side effects of chemotherapy.
Read – Vata Dosha – Introduction, 40 Things To Know

Important vata controlling measures in this condition would include –
Vasti – herbal enemas (including skillful combination of decoction and unctuous enemas)
Balya Chikitsa – strength enhancing treatments and medicines
Brmhana Chikitsa – bulk promoting and nourishing treatments and medicines
Santarpana Chikitsa – nourishing therapies and medicines
Rasayana Chikitsa – immunomodulator medicines
Vajikarana Chikitsa – aphrodisiac medicines

It is equally important to address individual side effects expressed in blown out proportions along with vata controlling measures. In some of these side effects ‘vata balancing treatments’ like vasti might come in handy as a tertiary line of treatment rather than the primary measure. Vata balancing shall be done only after addressing the individual and worst side effects of chemotherapy.
Read – How To Balance Vata Dosha? Line Of Treatment And Reasoning

Management of individual side effects of chemotherapy

1. Nausea and Vomiting

  • Doshas involved – Tridoshas may be individually involved but kapha being the local dosha related to the stomach, kapha aggravation will be predominant. Vata or Pitta may be associated.
  • Treatment principle – when nausea or vomiting is predominant amongst the side effects of chemotherapy it shall be treated on the basis of chardi chikitsa – i.e. treatment principles of vomiting.
  • Vamana therapy – Chemotherapy, especially that administered through the oral route would have disturbed the natural environment in the stomach and would have put the doshas therein in a state of imbalance. If the patient is strong enough and especially after the stoppage of chemotherapy or during the interval phase of the therapy therapeutic emesis i.e. vamana therapy shall be administered. But this shall be administered when nausea or vomiting are absent but has a tendency to recur. So, vamana is an effective tool to treat repeated occurrences of vomiting and nausea during or after completion or during the interval of chemotherapy and as a rule should be administered to patients with good strength and endurance.
  • Virechana therapy – therapeutic purgation is also a good option in case of predominance of pitta or kapha.
    Read – 25 Easy, Effective Home Remedies for Vomiting And Nausea

Useful herbs –
Ginger – zingiber officinale (efficacy is proved through studies and researches)
Matulunga – Citrus medica
Trijata – combination of cinnamon, cardamom and Cinnamomum tamala
Coriander – coriandrum sativum
Laja – parched grains
Bilwa – Aegle marmelos
Jambu – Syzygium cumini
Mango – mangifera indica
Raisins – Vitis vinifera
Licorice – Glycyrrhiza glabra
Amla – Emblica officinalis
Hrivera – Pavonia odorata
Sandalwood – Santalum album
Ushira – Vetiveria zizanioides

Useful formulations –
Trijata churna
Trikatu churna
Bilwadi Leham
Madiphala Rasayanam
Eladi Vati
Drakshadi Kashayam

2. Loss of hairs

Chemotherapy may cause hair loss or thinning of hairs.
Doshas involved – vitiation of vata and pitta in the hair roots cause hair fall. This aggravation of vata and pitta might occur due to the effect of chemotherapy.
Treatment principle –
Therapeutic purgation
to expel the morbid pitta and balance vata
Nasya – medicinal errhines to support the hair roots and to prevent further hair loss shall be considered.
Useful herbs and medicines – The hairs will grow once the causal doshas are addressed following the above said therapies. Later herbs, diet and formulations which support the hair roots and helps to rejuvenate and grow in a healthy way are prescribed.
Murdni taila – oil therapies done over the head
Hair oils like Bhringaraja Taila or Bhringamalaka Taila are prescribed to be applied to the hair roots.
Read – How To Make Bhringraj Oil For Hair Growth [Video]
Supportive medicines
which are prescribed are usually Rasayanas i.e. immune modulators like Narasimha Rasayana, Chyavanaprash, Amalaki Rasayana and Brahma Rasayana etc. Oral consumption of medicated ghee like Guggulutiktakam Ghrtam in small doses are helpful. Herbs which are helpful in this condition include –

Amalaki – Emblica officinalis
Bhringaraja – Eclipta alba
Brahmi – Bacopa monneiri
Methika – Fenugreek
Kumari – Aloe vera etc

3. Brittle Nails

Chemotherapy may cause many nail deformities including brittle and thin nails, pain in nail beds, color changes, formation of marks and ridges and falling of nails.
Nails are said to be the waste materials of bone tissue according to Ayurveda. Though they are wastes we do not get rid of them totally and they are part of our fingers and toes and are also of cosmetic importance. Nail deformities can be related to bone deformities. Nail deformities which occur as side effects of chemotherapy probably indicate that the chemotherapy has affected the bones and bone metabolism according to Ayurveda.
Doshas involved – Vata predominant doshas are involved in this condition. Pitta may also be involved along with vata.
Treatment principle – Virechana and Vasti are ideal treatments for this condition. Vasti with Tikta Ghrtas like Guggulutiktaka Ghrta are used for unctuous enema. Treatments prescribed for ‘asthivaha sroto dushti’ i.e. contamination of bone carrying channels should also be followed.
Local treatments for the nails are also useful. Example – showering of the brittle nails with herbal decoction prepared with Panchatikta group of herbs or Nalpamaradi herbs. Brittle nails shall also be treated on the lines of treating kushta.

Useful herbs and formulations
Guggulu – Commiphora mukul
Neem – Azadirachta indica
Patola – Trichosanthes dioica – pointed gourd
Aragwadha – Cassia fistula
Khadira – Acacia catechu
Turmeric – Curcuma longa
Daruharidra – Berberis aristata etc

Panchatikta Ghrta Guggulu
Triphala Guggulu
Tiktakam Kashayam / Tiktakam Ghrtam
Mahatiktakam Kashayam / Mahatiktakam Ghrtam
Guggulutiktaka Kashayam / Guggulutiktakam Ghrtam
Aragwadhadi Kashayam
Gandhaka Rasayanam
Madhusnuhi Rasayanam etc

4. Skin changes

Following chemotherapy, the skin would become dry and sore and also photosensitive.
Doshas involved – Dryness and photosensitivity following chemotherapy indicate aggravation of vata, pitta or both.
Treatment principle – This side effect should be treated on the lines of vataja or pittaja or vata-pittaja kushta. From the dosha perspective, virechana i.e. therapeutic purgation will be an ideal choice to balance the aggravated pitta and vata. Kaya dhara / pizhichil with vata / pitta alleviating oils / processed milk (ksheera dhara) protect and heal the skin from effects of sunlight. Anyways it is ideal to avoid getting exposed to the sunlight if skin changes are found as side effects of chemotherapy.

Useful Herbs and formulations –
Khadira – Acacia catechu
Aragwadha – Cassia fistula
Neem – Azadirachta indica
Turmeric – Curcuma longa
Daruharidra – Berberis aristata
Patola – Trichosanthes dioica etc

Formulations –
Shatadhauta ghrta (application)
Yashtimadhu Taila (application)
Nalpamaradi Taila (application)
Tiktaka Ghrta
Draksha Ghrta etc

5. Fatigue

Doshas involved – predominantly vata
Treatment principle – Vata alleviating measures including medicines, foods and activities, rest, being in a zone of pleasure and far from stress, nutritious and balanced foods are handy.

Useful Herbs
Bala – Sida cordifolia
Ashwagandha – Withania somnifera
Draksha – Vitis vinifera
Kapikachchu – Mucuna pruriens
Shatavari – Asparagus racemosus

Useful formulations
Ashwagandha Lehya
Drakshadi Leham
Dashamula Kashayam

6. Hearing impairment

Toxins of the chemotherapy affect the nervous system and may cause tinnitus and hearing loss.
Doshas involved – predominantly vata
Treatment principle – Vata mitigating medicines, comforts, therapies, diet and activities shall be prescribed. Murdni Taila – oil therapies done on the head and Nasya – errhines will help in recovery from these conditions. Karna Purana – filling the ears with oils processed with vata alleviating herbs is also an ideal choice. In extreme conditions and recurrences, vasti – herbal enemas may be included.

Useful herbs
Castor – ricinus communis
Bala – Sida cordifolia
Ashwagandha – Withania somnifera
Bilva – Aegle marmelos

Useful formulations
Triphala Guggulu
Bilwadi Taila
Ksheerabala Taila 101
Anu Taila
Shadbindu Taila
Read – Tinnitus Causes, Ayurvedic Treatment, Herbs, Lifestyle Tips

7. Bleeding problems

Platelet count would be reduced following chemotherapy. This will hamper clotting of blood. This might cause excessive bleeding.
Doshas involved – predominantly pitta will be involved, vata might be involved or associated in this condition
Treatment principle – This condition shall be treated on the lines of raktapitta chikitsa – treatment of bleeding disorders as explained in Ayurveda. If the blood is contaminated and signs and symptoms similar to raktapitta are found pratimargaharana chikitsa i.e. expulsion of doshas in opposite routes shall be administered i.e. therapeutic emesis shall be given if bleeding occurs from lower passages (anus, urethra, vagina) and therapeutic purgation shall be administered if bleeding occurs from upper passages (eyes, mouth, nose, ears). If pure blood is being expelled then raktaprasadana chikitsa i.e. treatments and medicines to promote blood formation and maintenance shall be considered.
Read – Bleeding Disorders: Ayurveda Treatment, Diet, Home Remedies

Useful herbs
Vasa – Adhathoda vasica
Sariva – Hemidesmus indicus
Manjishta – Rubia cordifolia
Trivrt – Operculina turpethum

Useful formulations
Parpati formulations
Vasarishta / Vasavaleha
Mahamanjishtadi Kashayam

8. Anemia

Chemotherapy would affect the blood cells and RBC levels would fall down drastically. This will lead to anemia which results in palpitations, shortness of breath and other symptoms of anemia.
Doshas involved – Pitta is the main dosha involved here though anemia is also caused by predominant vitiation of other doshas also. Increased pitta and the resultant increase in excessive heat will destroy the blood cells and cause anemia. This process is likely triggered by chemotherapy which has an aggressive impact on pitta.
Treatment principle – This condition is treated on the lines of pandu roga chikitsa i.e. treatment of anemia as explained in Ayurveda. Therapeutic purgation to combat morbid pitta will be ideal to take control of the situation but the strength of the patient shall be assessed first. If the patient is debilitated due to chemotherapy and has anemia, medicines which bring about rakta prasadana i.e. enhancement of quality and quantity of blood and those beneficial for the channels carrying blood shall be administered along with diet which is suitable for blood improvement as explained in the context of pandu roga treatment. Following this, medicines to improve strength shall be administered. Once the patient gains strength if the anemia is intact and the blood picture has not improved appreciably, therapeutic purgation shall be considered. Following purgation the medicines and diet as recommended to improve blood picture shall be implemented.

Useful herbs
Punarnava – Boerhavia diffusa
Draksha – Vitis vinifera
Mandura – waste of iron
Pippali – Piper longum
Haritaki – Terminalia chebula
Dhatri – Emblica officinalis
Turmeric – Curcuma longa
Danti – Baliospermum montanum
Pomegranate – Punica granatum
Katuki – Picrorhiza kurrooa

Useful formulations
Punarnava Mandura
Mandura Vataka
Trivrt Leham
Tryushana Churna
Yogaraja Guggulu
Navayasa Loha
Mandura Bhasma
Loha Bhasma
Gomutra Haritaki

9. Mucositis

Inflammation of mucous membrane occurs as a side effect of chemotherapy and may affect the mucous membrane of any part of the digestive system.
Doshas involved – pitta is aggravated
Treatment principle – anti-pitta treatments so as to balance it, mainly therapeutic purgation (if the strength and tolerance of the patient is good) and pitta balancing diet shall be administered to combat mucositis.

Useful herbs
Licorice – Glycyrrhiza glabra
Raisins– Vitis vinifera
Amalaki – Emblica officinalis
Shatavari – Asparagus racemosus
Shankha – conch
Kaparda – shell oyster

Useful formulations
Drakshadi churna / ghrta
Yashtimadhu churna
Sukumara Kashayam / ghrtam
Shatavari Ghrtam / gudam
Trivrt Leham
Triphala Churna
Shanka Bhasma / Vati
Kaparda Bhasma

10. Loss of Appetite and weight loss

Doshas involved – predominantly vata and pitta
Treatment principle – these conditions shall be treated on the lines of ajirna (indigestion), agnimandhya (loss of appetite) and arochaka (tastelessness). Treatment principles of karshya (emaciation, weight loss) and measures to balance vata and pitta will come in handy. Brmhana (bulk promoting) and balya (strengthening) medicines will be helpful.

Useful herbs
Pippali – Piper longum
Ginger – Zingiber officinale
Chitraka – Plumbago zeylanica
Coriandrum – Coriandrum sativum
Musta – Cyperus rotundus
Rock salt
Cumin seeds
Krshna Jiraka – Carum carvii
Hingu – asafetida
Ashwagandha – Withania somnifera

Useful formulations
Hingwashtaka Churna
Bhaskara Lavana
Chitrakadi Vati
Panchakola Churna
Trikatu Churna
Ajamodadi Churna / Vati

11. Loss of interest in sex / loss of libido / reduced fertility

Chemotherapy may cause loss of interest in sex and also reduce a person’s fertility.
Doshas involved – Vitiation of vata and pitta in particular will lead to the contamination of shukravaha / artavavaha srotas i.e. channels which produce and transport sperms or ovum, and eventually damage the sperms and ovum. They may also contaminate the testes and ovary. The doshas will also afflict the higher centers located in the brain which control sexual functions and hormones which regulate normal sexual behavior / performance of individuals. It is in fact balanced vata which is responsible for interest in sex, menstruation, ovulation and ejaculation. Increased pitta may cause inflammation of organs of reproductive system.
Treatment principle – Increased vata and pitta should be expelled by administration of medicated enemas and therapeutic purgation. Herbs and formulations which promote formation and maintenance of sperms and ovum and are also therapeutic on the related channels of formation and transportation shall be prescribed. Rasayanas and Vajikaranas are ideal prescriptions. Since increase in vata will also lead to impairment of mental functions and also cause systemic stress which might impact sexual performance and fertility, external therapies like herbal oil massage and oil therapies done on the head – murdni taila and nasya will help.

Useful herbs
Ashwagandha – Withania somnifera
Shatavari – Asparagus racemosus
Kapikachchu – Mucuna pruriens
Vidari – Pueraria tuberosa
Guduchi – Tinospora cordifolia

Useful formulations
Ashwagandha Rasayana / Lehya
Shatavari Gulam
Vanari Kalpa
Vidaryadi Churna
Brahmi Rasayana

12. Problems related to bowel

Diarrhea or constipation are the usual gut related side effects of chemotherapy.
Doshas involved – Pitta or Vata are usually involved
Treatment principle – T reated on the lines of atisara if there is diarrhoea and koshtabaddhata, anaha, udavarta or atopa if there is constipation. Vata and pitta balancing foods and medicines shall be given and the hydration shall be taken care of. In severe constipation unctuous purgation or oil / ghee (medicated) enema shall be administered. Light foods as mentioned in samsarjana krama i.e. post-emesis / post-purgation dietetic regimen shall be administered after diarrhoea has stopped. This will help in gut recovery and also will provide strength and nutrition to the patient.
Read – 37 Ayurveda Home Remedies For Diarrhea And Dysentery

Useful herbs
Kutaja – Holarrhena antidysenterica
Musta – Cyperus rotundus
Bilwa – Aegle marmelos
Castor – Ricinus communis
Ginger – Zingiber officinale
Cumin seeds

Useful formulations
Kutaja Ghana Vati
Bilwadi Leham
Gandharvahastadi Kashayam
Gandharvahastadi Tailam

13. Problems related to mental health and cognition

Following chemotherapy reasoning and organising skills and multitasking will be affected. One may also suffer from mood swings and depression.
Doshas involved – All three doshas are put into a state of imbalance. The dosha predominance shall be judged depending on the symptoms manifested in relation to disturbance of mental health and cognition. Many times signs and symptoms of vata and pitta increase will be seen.
Treatment principle – These mental and cognitive disturbances shall be treated on the lines of treating unmada, apasmara and afflictions of manovaha srotas. Medhya Rasayanas i.e. rejuvenation medicines for the mind and treatment principles mentioned for mind disorders shall be followed as supportive interventions. They include counseling and methods to enhance intellect, courage and self help techniques and channelizing the thoughts. Panchakarma measures including therapeutic purgation, enema or errhines shall be administered to expel the morbid doshas as and when needed depending on the predominance of doshas, strength of the patient and disease. External therapies, mainly murdni taila procedures i.e. oil therapies conducted on the head should be included.

Useful herbs
Brahmi – Bacopa monnieri
Jatamansi – Nardostachys jatamansi
Shatavari – Asparagus racemosus
Ashwagandha – Withania somnifera
Tagara – Valeriana wallichii
Shankapushpi – Convolvulus pluricaulis
Guduchi – Tinospora cordifolia
Bala – Sida cordifolia
Kushmanda – Benincasa hispida
Draksha – Vitis vinifera

Useful formulations
Brahmi Ghrta
Brahmi Vati
Shatavari Ghrta / Gulam
Ashwagandha Leham
Kushmanda Rasayanam
Draksharishtam / Drakshavaleham
Brahma Rasayana
Shilajatu etc

14. Infections

WBCs are the line of defense in the body. Chemotherapy damages these cells and exposes the body for many infections.
Doshas involved – all three doshas are involved
Treatment principle – Depending on the predominant dosha involved – therapeutic emesis, purgation or herbal enemas are administered. There will be serious tissue damage in these conditions and would make the person susceptible to infections and also would lower the immunity. Therefore apart from dosha balancing treatments, Rasayanas should also be administered to strengthen the tissues, improve the defense mechanism and immunity of the body. Daily regimens and seasonal regimens should be followed as explained in Ayurveda texts.
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