The Ayurvedic Approach to Breast Health
Like all tissues and organs in the human body, the female breasts are multidimensional in function. Their most recognized function is as exocrine glands, producing breast milk for the newborn, a function common to all mammalian species. Given the multidimensional functions of the breasts, a discussion of breast health approaches could be complex. Therefore, in this article, we will limit our discussion to what women can do from the Ayurvedic perspective to reduce their chances of developing the most dangerous of breast diseases: breast cancer.
First, let’s briefly review some simple breast anatomy. Mammary glands are basically highly modified and specialized sebaceous glands which derive from embryonic ectoderm. The adult breast consists of glandular tissue, adipose tissue (fat cells), nerves, blood vessels, and lymphatics. Anatomically it overlies the pectoralis major muscle and is anchored to the pectoralis fascia by suspensory ligaments known as Cooper’s ligaments (not shown). The breast contains about 15 to 25 lobes formed by groups of “milk glands,” or lobules. Each lobule is composed of hollow milk-producing acini (also called alveoli) and feeds into a milk duct leading to the nipples. The ducts converge near the areola, the darker area around the nipple, to form ampullae or milk storage cavities. Around the areola are small glands known as Montgomery’s glands which secrete an oily substance that protects the nipples during nursing. Lymph nodes within the breast drain into the axillary lymph nodes in the armpit-the first place to which breast cancer will typically metastasize.
What Is Breast Cancer? The Western View
Cancer is fundamentally a disease of failure of regulation of tissue growth. In order for a normal cell to transform into a cancer cell, the genes which regulate cell growth and differentiation must be altered. A gene is a specific sequence of DNA at a specific location within a specific chromosome. Only 5-10% of breast cancers are inherited; the vast majority are due to sporadic, acquired mutations.
The affected genes are divided into two broad categories. Oncogenes are genes that promote cell growth and reproduction. Tumor suppressor genes are genes that inhibit cell division and survival. Malignant transformation can occur through the formation of abnormal oncogenes, the inappropriate over-expression of normal oncogenes, or by the under-expression or complete arrest of tumor suppressor genes. Typically, changes in many genes are required to transform a normal cell into a cancer cell.
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Large-scale mutations involve a deletion or gain of a portion of a chromosome. Gene amplification occurs when a cell gains many copies (often 20 or more) of a small chromosomal locus, usually containing one or more oncogenes and adjacent genetic material. Translocation occurs when two separate chromosomal regions become abnormally fused, often at a distinct location. Disruption of a single gene may also result from the integration of genomic material from a DNA virus or retrovirus and resulting in the expression of viral oncogenes in the affected cell and its descendants, but this is not the case in breast cancer.
The transformation of normal breast cells into cancer is akin to a chain reaction caused by initial errors, which compound into more severe errors, each progressively allowing the cell to escape the controls that limit normal tissue growth. This renegade-like scenario causes an undesirable survival of the fittest, where the natural forces of evolution become distorted and work against the body’s design and harmonious order. If the rate of DNA damage exceeds the capacity of the cell to repair it, the accumulation of errors can overwhelm the cell and result in early senescence, apoptosis, or cancer. Once cancer has begun to develop, it uses the body’s own design to serve its own destructive and invasive purposes.
What Is Breast Cancer? The Ayurvedic View
The female breasts are predominantly Kapha organs, having a fatty nature and producing milk, a Kapha fluid. Breast cancer is a tridoshic (involving all three doshas) disorder of breast tissue. Causes are both hereditary and acquired; the acquired causes being physical, emotional, spiritual, and environmental. Breast cancer is ultimately caused by blockage and flow irregularities at both the gross and imperceptibly subtle levels of several srotamsi (channel systems).
Dietary and other physical factors can help to cause breast cancer or to trigger the disease in one who already has the hereditary tendency. Breast cancer, like any malignant or degenerative disease, may be the result of prolonged wrong diet, wrong lifestyle, or prajnaparamita (mistake of the intellect). The wrong regimen leads first to accumulation of doshas, then in time to acute illnesses. If those illnesses are treated improperly, that is, if the excess doshas (the three-body humors) are not expelled, and ama (toxins) is not purified, then the imbalance is driven deeper, resulting in chronic complaints. If these chronic complaints, in turn, go untreated or are treated by suppressive methods without expelling doshas or cleansing ama, then the excess doshas will localize in the most toxic or most vulnerable tissue, in this case, breast tissue, to create sannipatika gulma, a malignant tumor.
Cancer in Äyurveda is not seen as a discrete disease but a milestone on the continuum of doshic aggravation, ama (toxic waste) accumulation, and srotodushti (channel blockage). A pernicious energy gains access to the individual through the diet, the emotions, the environment, or even the karmic-influenced internal momentum of one’s life. Although modern medicine has disproven any appreciable connection between fibrocystic breasts or fibroadenoma to breast cancer, Ayurveda considers both of these benign conditions to be stages in the breast cancer samprapti. Cancer is a deepening pattern of internal disconnection from the body-mind’s greater intelligence which eventually begins to exhibit its own warped purpose, momentum, and direction.
Importance of Srotamsi (Channels of Circulation) in Breast Cancer
The entire fifth chapter of the Vimanasthana Section of the Charaka Samhita is devoted to the detailed description of the srotamsi and their importance in health and disease. The body and mind contain a large number of srotas or channels through which the basic tissue elements, doshas, and malas circulate. These channels are called srotas (plural srotamsi). Srotas, meaning channels or pores, are present throughout the visible body as well as at the “invisible” or subtle level of the cells, molecules, atoms, and subatomic strata. It is through these channels that nutrients and other substances are transported in and out of our physiology. It is also through these channels that information and intelligence spontaneously flow. When the flow of appropriate nutrients and energies through these channels is unimpeded, there is health; when there is excess, deficiency, or blockage in these channels, disease can take root.
The channels are, to a certain extent, similar to the different physiological systems of Western medicine (e.g., arteries, veins, nerves, digestive tract, etc.) but also contain subtler energies comparable to the meridian system of Chinese medicine.
The movements of energy in all srotamsi are directly influenced by stimuli that arise in mind, which are conveyed by the Vata energy. Hence mental disturbances, both conscious and unconscious, can cause disorders in any of the channels.
Excessive or deficient mental activity can cause excess or deficient flow in the channels of the body. Emotional outbursts or lack of mental control have effects that are analogous to surges in the channels of the physical body and can produce such conditions as strokes, heart attacks, hyperventilation, tremors, etc.
Stanya vaha sorta, which consists of the milk-producing apocrine cells of the lobules, the related pituitary hormones (i.e. prolactin), the ducts, ampullae, and nipple, is the main srota involved in breast cancer.
Artava vaha srotas, which consists of the uterus, ovaries, fallopian tubes, their hormones (i.e. estrogen, progesterone), secretions and connective tissues and related pituitary hormones (i.e. FSH, LH) all belong to artava vaha srotas–the channels carrying out female reproductive functions. The breasts are also included in this system.
Each lunar cycle between menarche and menopause, the proliferation of epithelial cells lining the breast’s lobular acini (increasing from one to two layers) occurs during the luteal phase. The breast epithelium, unlike the endometrium of the uterus, cannot be shed at the end of the cycle; regression at the end of the cycle is by apoptosis (self-programmed cell death). The apoptotic residue (ama) is plentiful within the lumens toward the late luteal phase of the cycle. Efficient removal of this material is essential for the breast tissue to remain healthy and vital.
Due to uncorrected exposure for a sufficient period of time to nidanas–internal and external causes of doshic vitiation–(a few common examples described below), the doshas can become aggravated and begin a sequence of pathological steps culminating in the creation of a disease state. The term “samprapti” (from the root “Ap” to cause, arrive, reach or obtain; “sam” conjunction, union, intensity, completeness) refers to this sequence of doshic-related pathology triggered by one or more nidanas (causes). Let us consider a brief explanation of this sequence.
First, one or more doshas begins to accumulate somewhere in the body and soon becomes vitiated (aggravated). Next, the aggravated dosha spills over and begins to spread. In the case of breast cancer, it may enter the stanya vaha srota or another associated srota. When it reaches a vulnerable or somewhat weakened area or organ of the body, it will stagnate there and begin to mix with and disturb the structure and function of the local tissues including sometimes cellular DNA. The tissues of the body, when spoken of in their healthy state are of course called the dhatus; however when we speak of these same tissues with regard to their mixing with vitiated doshas, we always refer to the tissues as dushyas.
This dosha-dusyas sammurcchana is the actual disease process (sammurcchana means “interaction”). The interaction of the doshas and dushyas, together with the specific effect from the site or organ involved (adhisthana) leads to the development first of specific prodromal features, and then of the main symptoms, of a disease. Involvement of primarily Kapha might result in a fibrocystic breast condition; predominantly Kapha-Vata vitiation might lead eventually to fibroadenoma; Pitta-Vata can be associated with mastitis and other inflammatory states; Tridoshic vitiation can ultimately produce cancer. Left untreated the disease will evolve its unique set of complications and can reach a stage where it is no longer curable by any means.
Ayurvedic Prevention and Treatment Approach
The essence of the Ayurvedic approach is beautifully summed up in one of its well-known statements, “Avert the danger from illness before it arrives”. This terse directive emphasizes the importance of correcting imbalances while still in their earliest stages and hence very remediable. Ayurveda accomplishes this goal through health programs uniquely tailored to the idiosyncratic characteristics of each individual. It celebrates our individual uniqueness while recognizing our universal Oneness. It is through our uniquely developed human consciousness, which among other capacities, affords us the enormous power of choice, that we can influence our health. The positive and negative health effects of those choices have been understood by Ayurvedic sages for thousands of years.
It must be stated at the outset of this section that, based on current level of available Ayurvedic knowledge, Ayurveda has no place as a primary treatment for any form of breast cancer. Ayurvedic treatment for breast cancer are useful as complementary therapy in order reduce side effects and sometimes bring about a more comprehensive response to conventional treatment. Ayurvedic medicines main strength is as a strategy to prevent the initial disease or its recurrence and to prolong survival.
That being said, current research is advancing towards a rational use of Ayurveda as a primary intervention. Specifically, the methanolic leaf extract of Ashwagandha leaf (Withania somnifera) was demonstrated to restore normal p53 function in tumor cells bearing mutated copies. p53 is a tumor suppressor protein which causes either the complete destruction of cells which have irreparably damaged and abnormal DNA or to temporarily arrest cell replication so that the DNA repair mechanisms can repair the damage. Once repaired p53 then allows the cell to duplicate. How p53 chooses cell destruction or arrest is unknown; it is commonly called the “guardian angel” of the cell.
It should be noted that today all breast cancer patients should be under the regular care and supervision of a medical oncologist.
Practical Choices That Matter
The Ayurvedic approach to breast health centers on diet, detoxification, lifestyle and exercise, mental health, environment and herbal preparations. Additionally, both ancient and current Ayurvedic physicians also emphasize early detection. Self-examination of breasts, regular breast examinations by health care professionals and mammograms if clinically warranted are the methods.
One of Ayurveda’s great recognitions is that the body and mind naturally proceed in the direction of balance and, in fact, are designed to achieve and maintain balance and vibrant health. The systems and organs that make possible this remarkable state of physical and mental well-being, and the intelligence which directs them all, exist in all of us from birth. Cancerous changes show that, despite this inherent healthy tendency, there is an imbalance of the tri-dosha with toxins. Food is the foundation of the tissue formation process and health itself. Here are some of the more important Ayurvedic recommendations.
i. First and foremost, choose foods according to either your constitutional type or your primary doshic imbalance, if known. This will help match your diet to your agni (digestive fire). Your physician may alternatively instruct you to eat according to the seasons if you are already in a balanced state of health. Eat organic foods whenever possible.
ii. Construct a diet which reduces ama formation. A predominantly vegetarian diet of foods that are light, warm, and cooked will do this. Freshly prepared dals and soups, organic vegetables prepared with fresh spices, whole grains such as basmati rice, barley, and amaranth, and freshly made flat-breads are ideal.
iii. Include organic cooked prunes, figs, apples, pears, pineapple, papaya, and cooked leafy greens, Brussels sprouts, broccoli, cauliflower, and cabbage (cruciferous vegetables) in your diet. These foods provide fiber, antioxidants, and detoxifying effects.There is also a burgeoning body of evidence that curcumin, a component of turmeric, has breast cancer protective effects.
iv. Avoid foods that create body ama, including leftovers; packaged, canned, and frozen foods; foods grown with chemicals, GMO’s, pesticides and chemical fertilizers.
v. Restrict the intake of alcoholic beverages of all kinds.
vi. Visceral (abdominal) adiposity contributes to the risk for estrogen receptor-negative breast cancer in premenopausal women.
As discussed above, ama-along with agni and the srotamsi–has tremendous importance in the manifestation of breast cancer. Ama is principally the result of the initial ahara rasa (nutrient juices) not being completely digested in the amashaya (small intestines) due to abnormal jatharagni. Ama then enters the srotamsi where it causes srotodushti (pathology of the srota) leading to srotorodha (obstruction). This results in an abnormal or arrested flow of doshas, nutrients and wastes.
The doshas thus retained can extravasate out of the srota and penetrate the surrounding dhatus (now called dushyas). The site where this interaction occurs (dosha-dushya sammurcchana) is the site where disease is initiated. If the impairment to the srotas can be prevented or reversed, disease will be averted.
In Ayurveda breast cancer primarily involves the channels of the female breasts and of the reproductive system and are called the Stanya Vaha Srotas and Artava Vaha Srotas, respectively. They include all the reproductive tissue, breasts, hormones and all secretions including breast milk. Keeping these channels clear of ama and all toxins is essential. The Mano Vaha Srotas, channels of the mind, are also involved. Proper diet, lifestyle, exercise, emotional health and select Ayurvedic herbs all help however a regular comprehensive detoxification procedure is also advised. It forms the foundation of preventive health in the Ayurvedic view and is often an important part of the treatment protocol for diseases which have already occurred.
Vulnerable Breasts on a Chemical Planet
Besides the assault from endogenous toxins (ama), exogenous toxins also have a grave effect on breast health. As a consequence of decades of uncontrolled environmental pollution with persistent organic pollutants (POP’s), the contamination of human milk has become widespread. Polychlorinated biphenyls (PCBs), DDT and its metabolites, dioxins, dibenzofurans, phthalates, polybrominated diphenyl ethers (PBDEs), and heavy metals are among the toxic chemicals most often found in breast milk. Whether she is pregnant or not, these and many other chemical pose a tremendous risk to the female breast. This is because POP’s are fat-soluble “lipophilic” (i.e. affinity for fat) chemicals which undergo bio-accumulation and concentration over time in the breast fatty tissue. The positive news is that POP’s can be significantly removed from their sites of accumulation through regular periods of panchakarma detoxification therapies.
Ayurveda states in the Ashtanga Hridayam Sutrasthanam IV/25-26:
“Exhaustive effort should be made to radically expel the malas (doshas and metabolic wastes) at the right times. Uncorrected accumulation will verily result in aggravation and cut short life itself.” “Doshas which are subdued by langhana and pachana therapies can inevitably become re-aggravated, but those which are radically expelled by samshodhana (purification) therapies will not become deranged again.” (italics added)
Lifestyle and Exercise: Balancing the Doshas
Scientific evidence suggests about 30% of all 572,000 cancer deaths (39,500 due to breast cancer) expected in 2011 will be related to being obese or overweight, inadequate physical inactivity or errors in nutrition and thus are preventable.
It is clear that only about 30-40% of all breast cancer cases can be traced to identifiable genes or a familial tendency. Of those, 5 to 10 percent of women have inherited defective breast cancer genes, the most common being BRCA1 or BRCA2. The remainder have forms of breast cancers in their families that involve several genes.
That leaves 60-70% caused by unknown factors. Some are environmental–toxins we breathe, drink, touch or are exposed to in some way. The biggest risk factors are simply being a woman (<1 percent breast cancers occur in men) and getting older (risk increases after age 50). We can’t change that, but we can change our lifestyles. The best recommendations are these six:
-Avoid hormone replacement therapy -Improve your diet -Exercise regularly -Follow good detection strategies -Maintain good body weight -Consume less or no alcohol
The state of one’s mental health is a direct reflection of how we think, feel and act as we face different life experiences. Our mental health determines how we handle emotional stress, relate to others and make choices. It is the emotional and spiritual resilience (atati shakti) which enables us to achieve happiness and to survive pain, sorrow and disappointment. Normal mental health instinctively creates an underlying belief in one’s self-worth, and in the dignity and worth of other human beings and all life forms. Psycho-social-spiritual stress can play a role in breast health. To refresh the mind Ayurveda suggests the classical mental balancing and rejuvenation techniques described in Patanjali’s system of Raja Yoga. Because there are eight aspects in the Raja Yoga path to enlightenment, it is also known as Ashtanga Yoga (eight-limbed). Patanjali’s Yoga Sutras begins with the statement yoga cittavritti nirodhah (I/2), “Yoga is for the restraint of the activities of the mind”. They proceed to describe the ways in which mind can create false ideas and understandings, and details the eight steps that can taken to escape from the unreal.
Meditation techniques have been shown in numerous research studies to positively influence the physiology. The regular practice of yoga postures (asanas), breath control techniques (pranayama), and dhyana (meditation) is the most effective way to relieve anxiety, depression and emotional stress, according to Ayurvedic tradition. Although the mechanism by which meditation helps re-establish mental health is not clear, we do know that these techniques provide periods of profound sensory and cognitive rest. The regular dissociation of the senses from their sense objects and the withdrawal of the attention within appears to release deep-rooted stresses that have lodged in the structure, chemistry and energetic matrix of the mind-body.
Ayurvedic herbal medicine regimens are not conceived using the model of a specific drug to neutralize or suppress a specific symptom or disease (allopathic model). In fact, successful treatment depends on rational and logical actions of a mixture of plant substances coupled with the incomprehensible healing intelligence of Nature. The intention of herbal treatment, like all forms of Ayurvedic therapies, is to up-regulate the innate healing capacity of the human being. Herbal treatment may be categorized according to the following scheme which forms a sequence for the prevention of any disease including breast cancer and also for the treatment of many diseases.
1. Separation of Dosha and Dushya (Sammurcchana Bhanga)
2. Autodigestion of Ama (Ama pacana)
3. Clearing of the Srotasmi (Shroto Vishodhana)
4. Optimization of Agni (Dipanagni)
5. Strengthening of Immunity (Vyadhi Kshamatva)
Separation of Dosha and Dushya (Sammurcchana Bhanga)
The initial action which must be taken in the treatment of disease is the separation of the vitiated dosha from the dushya. Since many on the subsequent steps in treating disease are strong measures aimed at the doshas, if separation of the healthy tissue is not achieved first, these treatments can and will harm the tissues and the associated srotas and vital organs. The degraded dosha and the affected tissue or organ becomes joined together like the milk fats and ghee are joined together in milk. And just as we heat the milk in order to separate the ghee from the milk fats, the herbal substances which accomplish the separation of dosha from dushya (a process called sammurchana bhanga) have the following gunas: hot (ushna), sharp (tikshna), penetrating (sukshma), rapid onset (vyavam), purifying (punanam), destructive (nashita), and separating (viyujate).
The following herbal and herbomineral medicines have the action of separating dosha and dushya. This list is by no means complete. Please note that many of these medicines can be toxic and cause
adverse reactions. They should therefore only be given for short courses and only under expert supervision.
Trailokya Rasa Chintamani
Datura metal Boswellia serrata
Aconitum ferox Tamra Bhasma
Strychnos nux vomica Heerak Bhasma
Semicarpus anacardium Holarrhena antidysenterica
Abhrak Bhasma Embelia ribes
Autodigestion of Ama (Ama pacana)
The operative principle behind the reversal and removal of ama is to temporarily stop providing nutrition to those parts of the body which we wish to purge of ama. In clinical application, this is achieved most readily, not with herbal medicines, but rather through fasting. Fasting is advocated as a bona fide approach for the removal of ama when found to be present or to prevent its formation. Like any other therapy, it is prescribed and supervised by an experienced physician.
During the fasting period, no new nutritive substances are available to the digestive system. Therefore the jathara agni and various dhatvagnis are utilized for the digestion of the accumulated ama. The fasting period can be as short as one or two days, or may extend for up to two weeks under medical supervision. There are several herbs and formulations which have been found to be effective in supporting and augmenting ama pacana:
Zingiber officinalis, Terminalia chebula, Tinospora cordifolia, Terminalia bellerica, Berberis aristata, Coriandrum sativum, Piper longum, Alpinia galangal.
Clearing of the Srotasmi (Shroto Vishodhana)
Whereas ama pacana is effective in transforming and liquefying the waste materials in the tissues,
the process known as shroto vishodhana draws these substances out of the tissues and into the appropriate channels of elimination (i.e. Stanya Vaha Srota). In addition, this process initiates movement in the proper direction in the srotasmi for the expulsion of the wastes. This stage requires that no matter what the primary doshic imbalance may be (Vata, Pitta, or Kapha), the Vata dosha needs to be in a balanced state. Thus is because Vata dosha is what creates movement of the wastes. A balanced Vata dosha moves the wastes in the proper and natural direction.
Medicines which act on the rasa, rakta, mamsa, meda, and sukra dhatus and their corresponding srotas are used in promoting breast health. These medicines will promote the elimination of doshas from the tissues without harming the tissues and include:
Holharrhina antidysentrica, Cissampelos pareira, Tricosanthe dioica, Cyperus rotundus, Picrorrhiza kurroa, Azadirachta indica, Hemidesmus indicus, Triphala, Piper nigrum, Acorus calamus, Curcuma longa, Aegle marmelos.
In addition to these herbal medicines, anuvasana bastis (oil-based enemata) or often administered during this phase to promote the proper flow of Vata dosha in the srotas. Also there are specialized techniques of breast massage which are performed with specific oils (i.e. Narayana, Vishagarbha, Chandanbala Laxadi) and can be taught to patient to perform at home.