Traditional Medicine - Some questions

Recently i addressed students from USA doing their Semester in India Programme. The raised some questions on traditional medicine. I am sure many would have the same questions. So I thought will post the reply here also.

1.What advantages do you see in the philosophies of ayurveda versus the philosophies of biomedicine? 

Ans:Traditional Medicine is based on the priniciples of living in Harmony with nature  and holistic whereas Bio-medicine approach is  more compartmentalized approach with specialist for every body system. TM believes in ' Strong body with good immunity  will take care and fight against invasive mocrobes, carcinogens etc while Bio-medicine aims at killing the invading organism.

2. Do you believe ayurvedic and western medicine institutions should be kept separate?

 No, the ideal model would be a integrative approach where Ayurvedic Physicians and Western  Medicine Physicians sit together, discuss  and provide best possible care to the patient including promotive health, cleansing therapy and rejuvenation.

3. Do you see traditional medicine as superior to other types of medical care? Why or why not?

No system can be claimed to be superior to other. They have to coexist and where ever one system is beneficial in disease prevention and care that system should be adopted. Each system could be complimentary to one another

4. Are there illnesses today that are different from previous generations?

Yes in India. Infectious disease burden and epidemics like Swine flu, Avian flu, dengue, drug resistant tuberculosis goes increasing in one hand and Non communicable diseases like obesity, hypertension, diabetes is also growing even among rural population due to sedentary lifestyle and occupational hazards for people working in Information Technology  sector is also increasing.

5. Is the "modern person" today in balance?

Certainly not. In spite of enviornment awareness, Modern person lives under continous stress and competition and live in a condition of Global warming, polluted enviornment.

6. Is traditional medicine specifically useful in Indian society, or is it useful anywhere in the modern world?

Nature and Five elements, Trinity of Life, Six tastes are common to the whole world. There may be some variation in climate, pollution level, food habits, stress level etc, That variations could be factored in TM and herbs of tropics may very from temperate zone . But clear application for western herbs is possible based on the Taste and enviornment. Even within India there is a diversity in food culture etc but principles are same.

Chronic Kidney Disease and Herbs

‘Did you take any Ayurveda or Siddha Medicine? That is the reason why you have developed this kidney disease. They contain heavy metals which damage your kidney.’ - There is a trend among some physicians of bio-medicine to blame Siddha medicine for renal disease. Some research findings published from the west go a step further and say - Indian traditional herbal medicines contain aristolochic acid which leads to renal failure.  Many scared patients ask the Ayurveda/ Siddha Physicians ‘Is that true?’

Before answering the question let me explain what is this Chronic Kidney Disease.

Chronic kidney disease means that for some time a person’s kidneys  have not been working the way they should- filtering blood  and remove waste products and extra fluid and flush them from the body as urine. If they don’t work properly, wastes build up in the blood and make the person sick. This does not occur overnight but happens in a phased manner for many years as a result of damage the kidneys. The tiny filters called nephrons are damaged, they stop working. For a while, healthy nephrons can take on the extra work. But if the damage continues, more and more nephrons shut down. After a certain point, the nephrons that are left cannot filter the blood well enough to keep the person healthy.

 The most common causes of this damage are:

·         High blood pressure.

·         High blood sugar (diabetes).

·         Urinary tract infection

·         Polycystic kidney disease

·         Birth anomaly

·         A narrowed or blocked artery that carries blood to the kidneys.

·         Long-term use of medicines that can damage the kidneys. Examples include Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.

The condition manifest as reduced urinary output, collection of fluid in the tissues- more prominent in the face and legs, nausea, vomiting, tiredness, headache, loss of appetite and weight loss and disturbed sleep.

Elevated Urea level and creatinine are the lab findings.

Now answering the question – Some Indian Medicine drugs which contain  mercury if not properly processed and if  administered more frequently even for simple conditions and in doses beyond the safe dose recommended in the classical texts of Siddha can cause this condition like any other drug of Bio- medicine. But the majority cases are due to the killer diseases of Diabetes and Hypertension.  Plants containing aristolichic acid are rarely used in any of the formulated Siddha products sold by manufacturers. The uses of these plants are negligible in Siddha and Ayurveda unlike Chinese herbal medicine. It is easier for western researchers to club the Chinese and Indian herbal products under the ‘Asian Herbal medicine’ grouping.

There are things one can do to slow or stop the damage to your kidneys. Taking medicines and making some lifestyle changes can help you manage your disease and feel better.

The Siddha herbal formulations used in treating diabetes invariably contain herbs that protect the liver and Kidney and prevent accumulation of waste to be removed by kidney. Low sodium salt, proper intake of pulses and choice of vegetables and fruits can help. It must be ensured none of the following is taken in excess – Sodium, Pottasium and Calcium. Indhuppu is  better than the sodium salt.

Phyllanthus amarus, Orthosiphon stamineus and Musa paradisiaca are the top three herbs that can improve the renal function and prevent elevation of Serum creatinine and Blood urea. 

The first one is to be taken as a cold processed extract, the second as a decoction- Herbal tea and third as a food supplement. It is futile if the primary cause is not properly addressed. These herbs can still be used even when the patient is on dialysis so that the frequency could be drastically reduced.

The best way is to go for regular health check up and follow a systemic life to prevent the Non communicable Diseases of Diabetes and Hypertension and if already affected follow a healthy lifestyle and regimen and ensure they do not go beyond control. 

Food allergies

I recommend different food ingredients to be used by patients suffering from various ailments as many of the food ingredients contain phytochemicals which can effectively help overcome the disease. This is also in line with the thinking ‘Food is your medicine’.  

One of the recipes I suggest is the soup of the leaves of Moringa and moringa leaves made into ‘keerai’ along with mung dal and coconut grating. This is very helpful in correcting Iron deficiency anemia and also osteoarthrosis.  Moringa leaves are highly nutritious and are rich in fiber, vitamins and trace elements, Manganese, Magnesium, Lysine, Riboflavin, Calcium, Thiamin, Potassium, Iron, Protein and Niacin.  Moringa also contains all 8 essential amino acids and is rich in flavonoids, including Quercetin, Kaempferol, Beta-Sitosterol and Zeatin. Other interesting aspect why I promote it is because of the reason that it can also thrive in tough climates and poor soil and can be readily grown even outside your compound wall.

But yesterday when I was recording the medical history including dietary habits, known allergy etc, of a patient on first visit to our centre (65 year old lady) she said twenty years ago she developed urticarial rashes all over the body after consuming moringai keerai. I doubled checked on her is that rashes because she came into contact with the leaf-eating caterpillars that are normally seen during monsoon. She distinctly remembered that there was no caterpillers in the trees and the leaves were not plucked by her and there was no exposure. After long gap she tried again she again developed the allergic reaction.

I discussed it Vd.S.Suman Ali, the medicinal plant expert and President of CTMR, prompt came the answer that the allergy may be due to presence of sulfur compounds though in traces. The patient confirmed she is allergic to sulfur. So what we think is insipid and safe could cause an allergy to someone. I write this to inform ‘One man’s elixir could be other man’s poison’.

CTMR – Annual Report- 2012-13

CTMR – Annual Report- 2012-13

Centre for Traditional Medicine & Research (CTMR), is a ‘Voluntary organization’ operational since 2000. The key objectives of CTMR are Mainstreaming Traditional medicine in the area of public health, Creation of awareness, Capacity building by way of training, Developing cost effective treatment protocols based traditional medicine  and promotion of research in traditional medicine including cultivation and conservation of Medicinal plants. The NGO works closely with different Government departments, other institutions and organizations for the above cause.

1.  Public Health Initiatives:

1.1    Primary Health Care :

Almost 80% of the population in the semi-urban areas and 60% of the rural population depend on private health care providers- both qualified as well as unqualified in spite of improvement in Public health delivery infrastructure. Marginalized communities like fishermen, dalits and tribal, who are daily wage earners still find it difficult to utilize the Govt. services due to reasons like loss of wage on the days of hospital visits, distance to the nearest health facility and the timing of the outpatient clinics. There is very limited awareness about disease prevention and treatment through AYUSH systems. CTMR felt it necessary to provide the AYUSH services at the doorstep of such marginalized communities, create awareness about healthy lifestyle, food as envisaged in Traditional Medical systems and reduce health expense burden of these communities. CTMR runs two Primary Health Care Centres (Chinnandikuppam in Kanchipuram district and Kanavaaipudur in Salem District) and a Mobile clinic (Velankaadu in Kanchipuram district). About 10,000 people are benefitted by these intervention, where medical services and medicines are provided free of cost to the beneficiaries. A uniform treatment protocol is developed and followed. The drug list for the centers is based on the ‘Essential drug list’ of Dept. of AYUSH which essentially contains safe plant medicines and they are procured from GMP approved units.  40% of the residents of these adopted villages now solely dependent on AYUSH services, while 40% utilize these services for primary health needs and avail services of other medical facilities for Lab investigations and medical emergencies. 20% have reservations in using traditional medicines. Medical Records are maintained for all registered users. Tamil Nadu Industrial Investment Corporation and AMR Charitable trusts provide partial support for these activities.

1.2    Public Awareness on Healthy Living:

Health Education is of primary importance particularly in prevention and management of Non Communicable Diseases – Lifestyle Disorders. CTMR use a three pronged strategy for health education. Since young student population is attracted to unhealthy processed food due to strong enticing advertisement both in print and visual media, CTMR conducts regular interactive programme in both govt. and private schools and colleges and also conducts health exhibitions including medicinal plants, minor millets, health food and healthy lifestyle. These sessions also cover the ill effects of lack of physical activities, smoking and consumption of alcohol. CTMR volunteers along with Ekam foundation organized awareness programme for health workers and anganwadi workers on ‘Managing common ailments with locally available medicinal plants’ in almost 10 districts of Tamil Nadu during the ‘Joy of Giving Week’. CTMR also conducts interactive sessions for public on diseases like diabetes, hypertension, obesity and cancer along with various residents associations and Community Based Organizations. The Third approach is by a serial of Talk shows on health in Doordarshan – Pothigai sponsored by Ministry of Health and Family welfare. (About 50 shows during the current year) and write-ups in both English and Tamil dailies and magazine including one published from Srilanka.

2.      Documenting Traditional Knowledge.

2.1    Local Health Traditions

Traditional Health Practitioners still put to use the knowledge acquired from their 

forefathers and treat patients with locally available plant resources. This knowledge also helps conservation of the medicinal plant resources. As the continuation of the project of ‘Documentation and Validation of Local Health traditions’ supported by Dept. of AYUSH, further interactions were held with the healers individually and as groups and the peer validation of the practices were carried out in six districts of Tamil Nadu namely, Vellore, Thiruvanamalai, Salem, Dharmapuri, Krishnagiri and Namakkal Preliminary interactions have also been initiated with healers of Villupuram, Kanchipuram and Thiruvallur districts. The use of plants and practices mentioned by the healers were further validated with classical Siddha texts and recent research publications. This compilation is ready for finalization.

2.2    Digitalization of Siddha Palm Manuscripts

During the previous year 160 bundles consisting of 257 works of Siddha Palm Manuscripts collected from individual healers were digitalized with Grant-in- Aid from Dept. of AYUSH and the digital copy along with the catalogue was submitted to Dept. of AYUSH and Siddha Central Research Institute.  The work of collection of Palm manuscripts and digitalization was further continued and currently 367 works are digitalized. This will be a continuous process and requires financial support.

3.  Capacity building

3.1    Training

One day training was conducted for the traditional healers of Salem and Dharmapuri district at Kolathur in Mettur Taluk (August 2012). Management and treatment of common ailments, differential diagnosis in Jaundice, Mother and child health care were covered. 80 healers from this district took part. This was followed by field visit for identification of Medicinal plants.

The Objective of conserving the palm manuscripts is to enable passing on the traditional knowledge to the next generation. Very few people have the expertise to decipher the writings in Palm manuscripts particularly the ones in poetic form. CTMR has conducted training to Siddha physicians, students of plant sciences and Tamil literature to read and interpret the palm manuscripts. Training in groups was conducted at Madras Christian College (Feb 2013) and for individuals at CTMR.

3.2    Workshops

One day interactive session was held for the tribal medicinal plant collectors and growers from Dindigul and Thiruvanamalai districts affiliated to Centre for Indian Knowledge Systems along with Tamil Nadu Siddha Ayurveda Unani Drug manufacturers Association in Apl 2012. The Sustainable collection practices, Good Post harvest handling practices were explained to them.

One day workshop on medicinal plants was conducted in association with Healers association of Kolli hills for the traditional healers at Kolli hills in Namakkal district in May 2012. Healers from Namakkal, Thirupur, Sivaganga and Ramanathapuram districts took part

One day workshop was conducted in May 2012 on the ‘Beauty of Siddha Formulations’ in which a large number of practicing Siddha doctors, Post graduate Scholars and Traditional healers participated. The synergy of the ingredients in the formulation to enhance efficacy, safety profile and the ability to enhance the bio-availability was dealt in great details.

One day workshop on identification, propagation and utilization of medicinal plants was conducted for the students of Community College of Agriculture at Sukkankolai farm of the CIKS. 50 students took part in the workshop.

4.  International Training and interactions.

4.1    International Conference;

Dr.T.Thirunarayanan was invited to present a keynote address on Siddha Medicine in the Second international conference of Tibetan Medicine held in Dharmshala in the august presence of H.H.Dalai Lama. There was also a Joint meeting on ‘Impact in Traditional pharmaceutics on UN ban on the use of Mercury’

4.2    Training on Siddha for foreigners

A three days training was conducted in association with Siddha Applied Science Institute at Penang, Malaysia on the ‘Management of lifestyle disorders and common ailments with plant drugs based on the principles of Siddha Medicine in Sept 2012.Forty  participants from Russia, USA, Canada, France, U.K and Switzerland took active part and the trainees continue the learning online.

4.3    A two days interactive session on the ‘Commonalities between Siddha and Tibetan Medicine’ was organized by CTMR along with Mee-See- Khan at Chennai in March 2013. Eighteen Tibetan doctors and 14 Siddha Physicians took part in the interaction. This helped the participants appreciate the common features of the two traditional medical systems and paved way for joint research in the future.

5.  Medicinal Plants

5.1    Institutional Gardens  and Home herbal garden

During the current Year, School herbal garden has been established in five city schools.  Herbal garden has also been initiated in Institute of Child Health Egmore and 100 households were trained in establishment of home herbal garden.

Continuous technical support is rendered to Green kovai- a unit of AIM For Sewa. Technical inputs provided for farmers group affiliated to CIKS and Murugappa Chetty Research Centre.

A survey of the Medicinal Plant Flora of National Institute of Siddha was carried out by Vd.S.Usman Ali along with volunteers of Siddha Maruthuva Mandram, Kalpakkam in Nov 2012 and report presented to the Director.

6.  Research

6.1 A study was carried out on the ‘Role of traditional food with minor millets on Obesity, Hypertension and Non Insulin Dependent Diabetes Mellitus’ by Dr.T.Thirunarayanan

6.2 A study on the propagation and survival of select medicinal plants by stem cuttings is initiated for three important medicinal plants.

6.3 Three Research Scholars were guided on the ethno botanical studies and Urban garden studies with reference to medicinal plants by Vd.S.Usman Ali.

6.4 Authentic samples of medicinal plant materials were provided to numerous research scholars for carrying out pharmacognostical, phytochemical and toxicological studies. Results are published in their research reports.

6.5 Two students were provided support for studies on Siddha Palm Manuscripts as part of their Ph.D programme by Vidwan N.Srinivasan.

7.  Publications

Two books, ‘Introduction to Siddha Medicine’ in English and ‘Training manual for traditional healers’ were published during the current year. A small booklet on ‘Home Herbal Garden’ was published in association with ‘reStore garden’ a NGO. Manuscripts for two other books are in the pre-press stage. Three research papers of CTMR staff were published in peer reviewed international journals

8.  Advocacy

CTMR has been continuously interacting with Government Departments on the various regulations which have an impact on improving the quality standards of medical services through Traditional Medicine. The organization has enabled the revision of ‘Poisonous drug list, Essential Drug List and the Siddha Dossier of the Dept. of AYUSH. CTMR office bearers  have also participated in stake holders meeting organized by different Govt. Depart on Safe guarding Intellectual Property of Traditional knowledge and promotion of Traditional health food and minor millets. CTMR has also been instrumental in pushing for opening of Urban Siddha Health Centers by Local Govt. Chennai corporation in fact in its current year budget has announced opening of 25 AYUSH centers in Chennai. CTMR has also been advising ISM drug manufacturers on continuous quality improvement.

9.    Resource Management

All units (Office and two Health Centres) are operating from ‘Rent free accommodation’ provided by donors. The fund for procurement of medicine, medical records and dispensing material are provided by AMR trust and TIIC. Local Health Tradition documentation is partially supported by Dept. of AYUSH.  Excepting three junior staff all others render service voluntarily. Most activities are carried out with support from Partner NGOs and deficit of Rs 5, 00,000 is met by office bearers.

Acknowledgement

CTMR is thankful to the following Govt. Department and other organizations for their continuous support

·         Dept. of AYUSH, Govt. of India. New Delhi

·         Tamil Nadu Industrial Investment Corporation, Chennai particularly its Chairman. Mr Md.Nasimuddin ,I.A.S. Mr. A.Mohan , Deputy Gen. Manager & Mrs.S.Sashikala.

·         Mr.P.Arulmudi Chairman, AMR Charitable Trust, Chennai

·         Dr.R.Vijayakumar I.A.S Addl. Chief Secretary –Planning Govt. of Tamil Nadu, Smt.Sheela Rani Chunkath. I.A.S Addl Chief Secretary, Govt. of Tamil Nadu Mr.V.Prabakaran-I.F.S, Chief Conservator of Forest. Tamil Nadu for constant support and guidance for various projects.

·         Dr.K.Manikavasagam- Director, National Institute of Siddha

·         Siddha Applied Science Institute. Malaysia and its founder SriPranaji.

·         Principal, Head of the Dept. of Plant Biology and Biotechnology Madras Christian College, Chennai and Prof.D.Narasimhan 

·         Mr.R.T.Vijayaraghavan Charted Accountant

·         Siddha Physicians– Dr.R.Sudha, Dr.V.Tamilalagan, Dr.T.R.Siddique Ali,

Dr. G.Padmavathy and Dr. R.B.Ramamoorthy.

CTMR Personnel

Name	Area
Vd.S.Usman Ali	President. Research  &  Local Health Tradition
Vidwan. N.Srinivasan	Manuscriptology
Dr.T.Thirunarayanan	Public Health &  Training
Dr.R.Padmapriya	Health awareness & Publication
Dr.S.Rajkumar *	Digitalization of Palm Manuscript
Dr. S.Sangeetha	Public Health Initiative
Dr.Thirumagal	Primary Health Care
Mrs.V.Sundaravalli	Medicinal Plants –Garden initiative
Mr.Adikesavan	Photodocumentation & Palm Manuscript Conservation

Dr.S.Rajkumar *  resigned during the course of the year.

Be part of our mission.

Contact us:

Secretary,

Centre for Traditional Medicine & Research,

 4A,4^th Cross Street, Mahalakshmi Nagar.

 Adambakkam,

Chennai- 600088.

Ph: 044-22533399

E-Mail: ttn64@sify.com/siddhactmr@gmail.com

Palliative care in cancer management -Siddha

This is an article presented for World Siddha Day- 2013

Dr.T.Thirunarayanan

Centre for Traditional Medicine & Research

4A, 4^th Cross Street,

Mahalakshmi Nagar, Adambakkam, Chennai- 600088

E-mail: ttn64@sify.com

Disease burden due to epidemics caused by vector borne diseases like dengue, swine flu, malaria are unabated on one hand, with no respite in communicable diseases like tuberculosis, hepatitis, HIV, the incidence of non- communicable diseases like stress, obesity, hypertension, diabetes, Ischemic heart disease and cancer pose a major challenge to the Public health managers of a developing country like India. There is a possibility of reducing the burden of the vector borne diseases by effective mosquito control, improving sanitation, making potable drinking water available to the mass. Early lifestyle modification, better diet control, exercise can reduce the burden of diabetes, obesity and hypertension. The large majority of the cancers except the tobacco caused cancers as of today is not preventable and once afflicted severely affects the quality of life or life threatening. 

The incidence of cancer is given in the Table- 1

Type in Men	Percentage	Type in Women	Percentage
Oral, including lip and Pharynx	22.9%	Cervical	17.1%
Stomach	12.6%	Stomach	14.1%
Lung	11.4%	Breast	10.2%

Source;  Dikshit R et al, Cancer mortality in India: a nationally representative survey. Lancet. 2012 May 12;379 (9828):1807-16.

Leukemia is common among children, Prostrate cancer a very common problem among men in US (25%) is not that prevalent in India. Cancer of the Urinary Bladder constitutes 5% of the cancer cases.

Cancer Drugs according to classical Siddha texts

Classical literature of the codified system of medicines of India namely Siddha and Ayurveda have detailed descriptions of cancer of the different organs of the body, their clinical manifestations, treatment procedures and drug formulations. ‘Puttru’, ‘Kazhalai’ are the terms used in Siddha, and ‘Arbuda’ ‘Gulma’ in Ayurveda for neoplasm. Many texts on Inorganic Pharmaceutics ‘Rasaoushadi’ list various drugs that could be used in neo-growth. A detailed literature search on the drugs indicated in the classical Siddha texts and are currently being manufactured by Siddha drug industry are the following.

‘Agathiyar Kuzhambu’ (Source-Agasthiyar Amutha Kalai Gnanam) A drug containing purified inorganics like mercury, red orpiment, yellow orpiment, dehydrated borax, rock salt, and herbal drugs like  aconite, croton seeds asefoetida, black mustard, ajowan, black cumin and castor oil is indicated as topical application in mammary cancer   

‘Kaantha chendooram’ (Source- Agasthiyar paripooranam 400) A drug containing purified  lode stone, sulphur, lead wort powder processed with eclipta juice, lime juice, milk, egg albumin, madder latex is indicated in Abdominal tumor

‘Poorna chandroodayam’ (Source- Theriyar Karisal 300) A drug containing Gold filling, Mercury, Sulphur processed with red cotton flower juice and banana rhizome juice is indicated in cancerous ulcers.

Mahaavallaathi (Source - Bogar Vaithyam 700 and Vallathi 600) A drug containing all herbal ingredients milk, ghee and honey- china root, emblic and belleric myrobalan, dry ginger, lesser galangal, Indian spikenard, cinnamon bark, picrorrhiza, telichery seeds, shiva’s neem, black musale, nutmeg, c;loves, cinnamon leaves, black pepper, cardamom, ajowan, long pepper, psoralea, coriander seeds, embelia, nigella, leadwort root, celestrus, withania, saffron, korochan, purified marking nut, brown sugar, is indicated in cancer.

Kowsiker kuzhambu  (Source  Kowsika muni nool)

Chebulic myrobalans, black mustard, rock salt, asafoetida, dehydrated borax, purified mercury, purified red orpiment, long pepper, purified yellow orpiment, cumin, picrorrhiza, purified aconite, purified croton seed kernel, carbonized coconut shell, palm jiggery, daemia leaf juice, coconut milk is indicated in cancer with daemia juice

Rasakanthi mezhugu (Source-Pulippani vaidhyam 500)

Purified mercury, purified sulphur, calomel, yellow orpiment, lode stone, blue vitriol, calamine, litharge, dry ginger, ajowan, turmeric, embelia, sweet flag, clove, china root, purified marking nuts, chebulic myrobalan, nigella seeds, wild cumin, beetle killer, yew leaf, raisins, long pepper, lesser galangal, costus, celastrus, fennel, cardamom, nutmeg, black pepper, cumin, psoralea, oak grass, long pepper root, rattan cane root, purified nux vomica, purified nux potatorum, astercantha seeds, sesame seed, horse gram, copra, acalypha fruticosa root, azima root, withania, corallocarpus root, lead wort root, eggs, palm jaggery is indicated for cancers and cancerous ulcers.

Some drugs like Chandamarutha chedooram, Idivallathy Mezhugu, Serankottai Nei, which are used by healers do not have a direct reference for treatment of cancer in the  texts

Treatment seeking pattern

Centre for Traditional Medicine & Research receives cancer patients at different stages. Difficulty in swallowing, abnormal bleeding, loss of appetite, weight loss, low grade fever, fatigue, altered bowel habits and pain are some of the features with which patients present themselves. Most of the patients come to us with diagnosis from cancer hospitals.

Detailed interactions with the patients reveal increasing number of patients seek remedy from practitioners of Traditional medicines for the following reasons.

• 1.      Most cases are diagnosed very late after metastasis has occurred and the general health of the patient does not permit complete surgical removal as the disease has spread to multiple locations. In spite of removal in rest of the cases where the lesion is localized the possibility of microscopic metastasis cannot be ruled out.
• 2.      The serious side effect of chemotherapy like severe vomiting, diarrhea makes the patient does not continue the treatment for its suggested full course.
• 3.      The possibility of chemotherapy and radiotherapy destroying the normal cells apart from the cancer cells due their cytotoxic effects.
• 4.      Target chemotherapy and monoclonal antibodies therapies are not widely available.
• 5.      The absence of specific cancer treatment hospitals even in many district head quarters is yet another hurdle.
• 6.      Without health insurance, the cost of treatment is prohibitive for most people and they are ill affordable to a vast majority.

Above all there is a trust that the traditional medicine, particularly Siddha can cure cancer is very strong among people.

The following are the different categories of patients who seek treatment at CTMR.

• ·   Patients in advanced stage where all other options of chemotherapy, surgery and radiotherapy are not possible,
• ·         Patients not willing to undergo the orthodox method but wants to be treated with Siddha medicine
• ·         Patients who want supportive therapy- supplementation alongside conventional treatment and
• ·       the last set of patients who have undergone treatment including surgery but want to prevent reoccurrence or with late secondaries.

Pallative Care

The basis of treatment at CTMR is palliative care. Since vast majority come at advanced stages the realistic option is palliative care aimed at improving the quality of life of the patient and their immediate family by providing pain relief, psychological support and administration of specific plant based drugs for which enough evidence are available in classical texts and also evaluated by scientific methods both in-vitro and in-vivo.

The first step in the care is proper counseling to the patient and the attendants on the nature of the condition, the likely prognosis and need for following the suggestions on dietary recommendations, lifestyle modification, abstaining from causative substances like tobacco, alcohol and adation of Kayakalpa methods including breathing exercise, meditation etc.

The dietary recommendation is generally rich in fruits and vegetable salads- baked vegetables rather than deep fried once. Significant reduction in intake of meat products, avoidance of oily, fat rich deep fried spicy pungent diet is also suggested. Depending upon the patient’s ability to sallow porridge, fruit juices, soups are suggested.

Then the administration of drugs. The preferred drug of choice in most types of cancer is Mahavallathy Among the different drugs listed in Siddha this drug is free from inorganic and contains powerful anti-oxidants like Amla, long pepper etc, appetite enhancers like black pepper, clove, cinnamon bark etc. cytotoxics like leadwort and marking nut.

As supportive therapy all patients are provided with a blend of turmeric and Indian gooseberry which are known to quench the free radicals. Withania somnifera, apart from being a drug which sensitize cytotoxic drugs is an anabolic and adaptogen helps the patient in overcoming stress and ensure sleep. Dry ginger or Inji legiyam greatly helps in preventing nausea and vomiting in co-adminstered in patients undergoing chemotherapy. The blend of Indian gooseberry and turmeric is also a hypoglycemic drug and reduces supply of glucose to cancer cells and slows down cell multiplication.

In pancreatic carcinoma and secondaries in liver, Phyllanthus amarus extract is also administered. In conditions of spread to lungs manifested with coughing, Thalisathy churanam is included. In anemia associated with blood loss ‘ Karsalai Karpam’ is also prescribed.

Conclusion

Our observations assure us all these patients including the ones with esophageal, pancreatic cancer, ovarian cancer patient have lived over two years without much of clinical symptom and compromising on the quality of life. It is worth considering the Pallative care approach of Siddha in improving the quality of life of cancer patients.