It was a beautiful summer afternoon brushing through the pages of sapiens by Noah Harari with the whistle of the train in the background. I was on my way for the monthly consultation to Kottakkal. I could barely concentrate on the book amongst the chaos of the railway coach. The phone rang and a worried voice stood out among the chaos. “Hello doctor, this is Madhavi from Andhra Pradesh”. She called in for her husband who was diagnosed with a brain tumour. Mohan was an IT professional, working 8 hour shifts of screen time, a normal fun guy with an interest in online gaming. One evening, back from office, he felt slight weakness in the fingers of his left hand along with loss of sensation. They consulted with a neurologist and on a detailed scanning a tumour was found in his brain. This happened one and a half years back. It was decided to surgically remove the lesion and do radiation. On surgical biopsy the lesion was diagnosed as low-grade astrocytoma [a type of cancer that can form in the brain or spinal cord]. After 6 months of surgery, life was again back to normal, that is what they thought until the weakness of the left hand appeared again. Another scan was done which showed slight increase in residual lesion after surgery and a few neurological symptoms. 

Mohan was the sole financial source for Madhavi and their children. “Sir, please help us! We do not know what to do again. I don’t want to lose my husband or see him debilitated. Please educate us about the situation, our options and tell me all about astrocytoma- brain tumour.”

A tumour is a mass of tissue that is formed by an accumulation of abnormal cells. Brain tumours are broadly classified as benign and malignant tumours. Benign tumours are those which do not invade adjacent tissue or spread to other parts (e.g. meningioma). Malignant tumours (cancerous) spread and invade adjacent tissues (e.g. astrocytoma). Meningiomas are predominantly benign tumours affecting the meninges (elastic covering of the brain, they may go untested for life without any symptoms. Larger masses may cause symptoms due to mass effect and are successfully managed by surgical removal. Rarely the meningiomas can become malignant called anaplastic meningiomas (grade III) and cause mortality. Meningiomas and astrocytoma are the most common tumours of the brain. Astrocytoma originates in star shaped cells in the brain called astrocytes. It is the most common glioma (cancer affecting glial - the non neuronal cells). They are broadly classified as low grade and high grade astrocytomas based on the mitotic activity and spread. World health organization uses a four-tier grading system for the mitotic activity. Grade I and II have low mitotic activity and can be controlled by surgery and radiation. Grade III is anaplastic astrocytoma that causes rapid growth and neurological symptoms. It causes fatality at 18 months without treatments. Then there is the prince of all cancers, the black mamba among tumours, grade IV astrocytoma famously known as GBM (glioblastoma multiforme). It truly embodies the black mamba, quick acting and potent with imminent death. The worst part among astrocytomas is 70% of tumours are diagnosed as GBM, low grade astrocytomas are rare, hence the death rate is staggeringly high. A GBM patient survives 17 weeks without treatment, with surgery and radiation can survive for about 30 weeks. All astrocytomas are deadly, can reoccur and spread anytime, leading to complications due to secondary clinical sequelae by increased intracranial pressure. This happens due to increased mass effect, blood volume and increased cerebrospinal fluid accumulation. 

Ayurveda's Take

This condition is detailed in Ayurveda as mastiṣka vṛddhi (increased brain mass) and śīrṣāmbu rogaṃ (hydrocephalus). mastiṣka vṛddhi is classified into two types. The first one where the brain mass is increased along with expansion of cranium (skull) usually in children and young adults creating lesser complications. The second type where the brain mass is increased without expansion of the skull results in severe neurological complications and death. The major complications include severe headache especially in the morning accompanied with vomiting, reduced immunity, unconsciousness, fatigue, paraplegia, neurological tremors as described in text book called Bhaiṣajya Ratnāvalī. Seizures, problems with vision, behavioral changes along with difficulty in speech and sensation are common. These symptoms mimic common migraine, cluster headache etc. and can go unnoticed unless severe neurological symptoms are evident. 

Management in Ayurveda

Mastiṣka vṛddhi is a dangerous complication and has to be treated with care. Primary option like any other tumour is surgery in Ayurveda. If not resolved by surgery or the health of the patient does not allow surgery, other treatment options are included. The treatment is aimed at reducing mass effect and fluid build up by giving medicines which facilitate induced purgation (virecana) and diuretic properties especially if hydrocephalus is noted. The treatment should be aimed at pacifying Kapha Rakta Doṣa and strictly done with rejuvenating (rasāyana) properties. The treatment mentioned in epilepsy should be done in mastiṣka vṛddhi due to chance of seizures. Ayurveda clearly indicates the use of anti-epileptic drugs as medicines and rasāyana. 

Ayurveda Formulations for this condition

Pañcagavya Ghṛtaṃ with honey, Rasasindūraṃ in multiple doses with virgin coconut oil and śatāvarī juice with honey are few classical examples mentioned in Ayurveda. But as these are very strong medicines and the dosage and timing are to be set only after a thorough evaluation by the Ayurveda Physician. In advertant use may aggravate the condition. 

Along with these, treatment regimens like nasal instillations (nasya), Medicated oil retention on head (śirovasti, talaṃ) etc. are of prime importance to pacify complications. 

Dietary Advises

Medicine alone cannot reduce or treat these deadly diseases. An appropriate diet along with habitual change is necessary to help the body recover and prevent relapse. Mohan was placed on a gluten free (no wheat, atta, maida), vegan (only plant products) diet. The prescribed diet in Ayurveda for Masthishka Roga include:

• Rice varieties like śāli, ṣāṣṭika
• Snake gourd 
• Drum sticks
• Grapes
• Spinach
• Amla
• Pomegranate
• Coconut
• Aloe vera
• Sesame oil
• Matured ghee (purāṇa ghṛtaṃ)

To be avoided:

• Alcohol
• Smoking
• Incompatible food combinations (viruddhāhāraṃ)
• Excessive eating
• Sleep disturbances
• Brain injuries
• Obesity

Obesity is a major factor in brain tumours and other cancers. Since brain can feed only on glucose and cholesterol, the quality of cholesterol fed to brain play a huge part in the cellular structure and function. In an obese patient or someone with defective fat metabolism, the quality of brain food is altered along with fat deposits in the blood vessels (duṣṭa medas). This can potentially bring about changes and mutation in cellular structure. When Ayurveda talks about Mastiṣka rogaṃ, it clearly states the use of medicated ghee and alcohol-based medications. Only these can pass the blood-brain-barrier and deliver desired results in mastiṣka vṛddhi. Bhaiṣajya Ratnāvalī states..

 “madyaṃ snāyunāṃ puṣṭikṛt paraṃ”

(alcohol based medicines are good for the strengthening of the nervous tissues)

Medicines like ariṣṭaṃ and āsavaṃ which contain natural fermented alcohol can be used in treatment along with medicated ghee and nutritious food. 

Mohan was advised with wholesome and agreeable diet and activities, anti-epileptic drugs along with rasāyana were administered. After the first two months of treatment, weakness of left hand was bettered dramatically, sensation was back. He could take and hold his mobile phone which he was not able to do before. Headaches, sleep disturbances and other neurological symptoms were relieved completely. The lesion on scan after 4 months showed no growth pattern. The aim of treatment in an extremely difficult to manage condition (asādhya rogaṃ) like astrocytoma is to prepare the body and mind so that the medicine can bring about the best possible outcome. This quality demarcates a adept physician (mahāvaidya) from an ordinary physician.  He is the bridge between suffering and healing. Healing my friends is the closest thing to creation. When you can heal people, you enter the realm of creating life. After all, Ayurveda literally is the knowledge of life.