Featured Case

  • Abstract

    A 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 2 months. He consulted Dr Aditya Mishra via telephone and took ayurvedic medicines for 20 days, but did not get relief. So he consulted an allopathic doctor and took conventional medicine for a few days, but the symptom did not resolve. He restarted ayurvedic treatments and was referred to a Modern Hospital for detailed investigations. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- stage 3, and was scheduled for Chemotherapy. The Ayurvedic diagnosis was Mamsa arbuda. The line of treatment adopted was Tridosa shamana specifically kapha and pitta hara. Dipana- Pacana, medhya and rasayana dravyas were also given. Along with chemotherapy, ayurvedic treatments were integrated with specific dietary recommendations and psychotherapy. This integrative approach could minimise the side effects during CT, no delay in CT and no secondary infections reported. The Scored Patient- Generated Subjective Global Assessment, revealed that the quality of life of the patient could be enhanced. The Deauville Score that was documented as 3 at baseline, became 1 at endpoint. This case report portrays the successful integrative management of DLBCL with Chemotherapy, ayurveda, diet, psychotherapy, and specific use of functional food.

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      Diffuse Large B-Cell Lymphoma- grade 3
      Mamsa arbuda

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      A 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 2 months. He consulted Dr Aditya Mishra via telephone and took ayurvedic medicines for 20 days, but did not get relief. So he consulted an allopathic doctor and took conventional medicine for a few days, but the symptom did not resolve. He restarted ayurvedic treatments and was referred to a Modern Hospital for detailed investigations. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- stage 3, and was scheduled for Chemotherapy. The Ayurvedic diagnosis was Mamsa arbuda. The line of treatment adopted was Tridosa shamana specifically kapha and pitta hara. Dipana- Pacana, medhya and rasayana dravyas were also given. Along with chemotherapy, ayurvedic treatments were integrated with specific dietary recommendations and psychotherapy. This integrative approach could minimise the side effects during CT, no delay in CT and no secondary infections reported. The Scored Patient- Generated Subjective Global Assessment, revealed that the quality of life of the patient could be enhanced. The Deauville Score that was documented as 3 at baseline, became 1 at endpoint. This case report portrays the successful integrative management of DLBCL with Chemotherapy, ayurveda, diet, psychotherapy, and specific use of functional food.

  • Timeline

  • Tabulated Summary

  • Narrative

    TITLE OF CASE

    An integrative approach to successful management of cancer- a case report 

    Dr Aditya Mishra

    ABSTRACT

    A 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 2 months. He consulted Dr Aditya Mishra via telephone and took ayurvedic medicines for 20 days, but did not get relief. So he consulted an allopathic doctor and took conventional medicine for a few days, but the symptom did not resolve. He restarted ayurvedic treatments and was referred to a Modern Hospital for detailed investigations. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- stage 3, and was scheduled for Chemotherapy. The Ayurvedic diagnosis was Mamsa arbuda. The line of treatment adopted was Tridosa shamana specifically kapha and pitta hara. Dipana- Pacana, medhya and rasayana dravyas were also given. Along with chemotherapy, ayurvedic treatments were integrated with specific dietary recommendations and psychotherapy. This integrative approach could minimise the side effects during CT, no delay in CT and no secondary infections reported. The Scored Patient- Generated Subjective Global Assessment, revealed that the quality of life of the patient could be enhanced. The Deauville Score that was documented as 3 at baseline, became 1 at endpoint. This case report portrays the successful integrative management of DLBCL with Chemotherapy, ayurveda, diet, psychotherapy, and specific use of functional food. 

    KEYWORDS

    Cancer, arbuda, lymphoma, case report, DLBCL, Integrative

    INTRODUCTION

    Diffuse large B-cell lymphoma (DLBCL) is a fast-growing blood cancer and the most common form of non-Hodgkin lymphoma. There are different forms of DLBCL that happen when several different genetic changes, or mutations, turn healthy cells into cancerous cells. 

    B-cell lymphomas frequently affect the lymphatic system. The lymphatic system is a network of tissues, vessels and organs that work together to move a colorless, watery fluid called lymph, back into your bloodstream. Lymph contains B cells (B lymphocytes). B cells make antibodies. Antibodies are proteins that target intruders such as viruses and bacteria. Normally, healthy B-cells die when they’re done fighting infection. B-cell lymphoma happens when healthy B-cells change into fast-growing cancer cells that don’t die the way that they should. The cancer cells duplicate, eventually overwhelming healthy cells. In diffuse large B-cell lymphoma, cancerous B-cells may appear in the lymph nodes, but in some cases, they can appear in virtually any organ, including your gastrointestinal tract, thyroid, skin, breast, bone or brain. Diffuse large B-cell lymphoma is aggressive, meaning it may spread very quickly.

    Causes:Diffuse large B-cell lymphoma happens when B-cells mutate. These are acquired genetic mutations, meaning you develop them during your lifetime instead of being born with them. Medical researchers aren’t sure what triggers these mutations, but having a family history of DLBCL could be a risk factor. A risk factor is an activity or condition that increases your risk of developing a disease.

    Symptoms:The symptoms most people notice are swollen lymph nodes in their neck, armpits or groin. They may notice a lump or mass that doesn’t go away and seems to be getting larger. Other symptoms sometimes include: 

    Unexplained fever: A fever that stays above 103 degrees Fahrenheit (39.5 degrees Celsius) that lasts longer than two days or that comes back may be a sign of a serious issue.

    Heavy night sweats: This is sweating that’s so intense it drenches your sheets.

    Unexplained weight loss: This is losing body weight without trying. Losing 10% of your total body weight over six months is a sign of unexplained weight loss.

    Diagnosis: Several different blood tests and an imaging test to diagnose this condition. They also do genetic testing to understand whether specific mutations, or changes, are part of how a given case of diffuse large B-cell lymphoma occurred. Some commonly used diagnostic tests are as follows: 

    Treatment: There are 4 stages of DLBCL, and the treatment will be planned taking into consideration the stage that the patient is in.  The standard treatment is R-CHOP. It combines the monoclonal antibody drug rituximab with three chemotherapy drugs and a drug that helps kill lymphoma cells. This treatment is safe and effective but doesn’t always work or keep DLBCL from coming back. (Studies show relapses or recurring disease affect an estimated 10% to 35% of people who receive R-CHOP.) If that happens, healthcare providers may recommend the following treatments: Second-line therapy and autologous stem cell transplant, Chimeric antigen receptor (CAR) T-cell therapy and Targeted therapy

    Prognosis: Like many kinds of cancer, healthcare providers have more success treating early-stage DLBCL than advanced or later-stage cancer that’s spread. In general, people who are cancer-free two years after their diagnosis can expect to live as long as most people in their age group. However, diffuse large B-cell lymphoma can relapse. And there are different forms of DLBCL that are more difficult to treat.

    PATIENT INFORMATION

    In this case report, a 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 3 months. He tried Ayurvedic medicines but there was no relief. He consulted an allopathic doctor and took conventional medicine, which also did not resolve his complaints. Again he restarted ayurvedic medicines and was referred to a modern hospital. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- Stage 3.

    No relevant family/genetic/surgical history

    Psychosocial history- Stressed

    CLINICAL FINDINGS

    On examination 

    July 2018- No examinations were done as it was a telephonic consultation                                                                                       

    August 2018- Physical examination done. On palpation of left axillary region- tenderness, hard mass, movable. It was a lemon sized mass. No discoloration or redness observed. 

    TIMELINE

    Image 1. Timeline of events added below

    dlbcl-_dr_aditya_mishra.jpg

    DIAGNOSTIC ASSESSMENT

    Modern Diagnostic parameter; Based on the clinical examination and FNAC- PET Scan, the biomedical diagnosis was made as Diffuse Large B Cell Lymphoma- Stage 3.

    Image 2. Before treatment dated 7.9.2018

    before_treatment.png

    Image 3. Diagnosis proof document dated 26.10.2018

    fdg_pet_scan_dated_26_10_2018.png

    Image 4. Histopathology report dated 5.12.2018

    histopathology_dated_5_12_2018.png

    Ayurvedic Assessment was done based on the presenting complaints and clinical evaluation. The treating physician confirmed the Ayurvedic diagnosis as Mamasarbuda. 

    Differential Diagnosis-   

    Infectious mononucleosis, Hodgkin lymphoma, T-cell lymphomas.
    Based on previous treatment records and investigation reports, the condition was previously diagnosed as DLBCL- grade 3 and reconfirmed by the treating physician. 

    Prognosis- Diffuse large B cell lymphoma (DLBCL) is the most common form of non-hodgkin lymphoma, accounting for approximately 25% to 30% of all cases. This disease typically presents as a rapidly growing mass or the enlargement of lymph nodes in either nodal or extranodal locations. Although it is an aggressive condition, DLBCL generally responds well to chemotherapy. In this case, Ayurvedic treatment along with dietary regimens and psychotherapy could provide supportive care in cancer treatment thereby enhancing the overall quality of life.

    THERAPEUTIC INTERVENTION

    Refer the tab ‘Treatment’ in the Portal. 

    FOLLOW-UP AND OUTCOMES

    The patient had 8 follow ups in total. Each follow up, the symptoms were assessed and tests were done to analyse the outcome. 

    Subjective parameters: Images were taken of the mass during the entire course of treatment so as to assess the outcome. 

    Image 5. After Biopsy dated 1.12.2018

    after_biopsy_dated_1_12_2018.jpg

    Image 6. After Biopsy dated 20.3.2019

    after_biopsy_dated_20_3_2019.jpg

    Image 7. After Biopsy dated 28.4.2019

    after_biopsy_dated_28_4_2019.jpg

    Image 8. After the 6th Chemotherapy

    after_6_chemotherpy.jpg

    Clinician-based assessment; The repeat PET CT Scan done at regular intervals to assess the size of the mass.

    Image 9. PET CT scan dated 2.5.2019

    fdg_pet_scan_2_5_2019.png

    Image 10. PET CT scan dated 6.9.2019

    fdg_pet_scan_6_9_2019.png

    Image 11. PET CT scan dated 5.3.2020

    fdg_pet_scan_5_3_2020.png

    Image 12. PET CT scan dated 4.10.2021

    fdg_pet_scan_4_10_2021.png

    There was a significant reduction in the size of the mass as evident from the PET CT Scan reports. 

    Table 1. The size of the mass and the Deauville score assessed throughout the treatment

    DATE

    SIZE OF THE MASS

    DEAUVILLE SCORE

    26.10.2018

    5.4 x 3.9 cm

     

    2.5.2019

    2.3 x 1.5cm

    3

    6.9.2019

    2.2 x 1.5

    3

    5.3.2020

    1.8 x 1.0 cm

    1

    4.10.2021

    1.1 x 0.7 cm

    1

    Patient-assessed; The OG- SGA score was done at endpoint indicating the enhancement in the the quality of life of the patient, minimise the side effects during CT , no delay in CT and no secondary infections reported.

    Image 14. The Patient generated subjective global assessment at endpoint

    pg_sga_assessment_at_endpoint.png

    Image 15. Bone marrow biopsy done dated 7.1.2019

    histopathology_dated_7_1_2019.png

    Intervention adherence and tolerability – The patient adhered to the prescribed treatments and tolerated the treatments well. 

    Method of assessment- Subjective and objective parameters were the main assessment tools. 

    Adverse and unanticipated events; None reported

    DISCUSSION: 

    Early-stage DLBCL can be treated successfully than advanced or later-stage cancer that’s spread. In general, people who are cancer-free two years after their diagnosis can expect to live as long as most people in their age group. In this patient the stage was identified as 3, indicating that it had crossed the mild intensity stage. The ayurvedic diagnosis was Mamsa arbuda and the treatment targeted at Tridosa shamana specifically kapha and pitta hara. Dipana- Pacana, medhya and rasayana dravyas were also incorporated. Specific diet chart was given to combat the side effects of chemotherapy. Psychotherapy, chemotherapy, diet and ayurvedic treatments, helped managed this condition successfully. 

    PATIENT’S PERSPECTIVE

    Not available. 

    LEARNING POINTS/TAKE HOME MESSAGES 

    This case highlights the efficacy of integrative approach in a patient who was suffering from DLBCL 3. With an integrative approach he achieved a better quality of life with a stable mental status. 

    INFORMED CONSENT

    Written consent obtained from patient for publishing of the case report in the Portal 

    ACKNOWLEDGEMENTS

    None

    CONFLICT OF INTEREST

    None declared.

    FUNDING

    None

    REFERENCE

    1. https://my.clevelandclinic.org/health/diseases/24405-diffuse-large-b-cell-lymphoma

     

     

  • Immersive Learning

    • Modern Diagnosis

      MODERN DIAGNOSIS: Diffuse large B-cell lymphoma (DLBCL) Stage 3

      ABOUT THE DISEASE:

      Diffuse large B-cell lymphoma (DLBCL) is a fast-growing blood cancer and the most common form of non-Hodgkin lymphoma. There are different forms of DLBCL that happen when several different genetic changes, or mutations, turn healthy cells into cancerous cells. 

      B-cell lymphomas frequently affect the lymphatic system. The lymphatic system is a network of tissues, vessels and organs that work together to move a colorless, watery fluid called lymph, back into your bloodstream. Lymph contains B cells (B lymphocytes). B cells make antibodies. Antibodies are proteins that target intruders such as viruses and bacteria. Normally, healthy B-cells die when they’re done fighting infection. B-cell lymphoma happens when healthy B-cells change into fast-growing cancer cells that don’t die the way that they should. The cancer cells duplicate, eventually overwhelming healthy cells. In diffuse large B-cell lymphoma, cancerous B-cells may appear in the lymph nodes, but in some cases, they can appear in virtually any organ, including your gastrointestinal tract, thyroid, skin, breast, bone or brain. Diffuse large B-cell lymphoma is aggressive, meaning it may spread very quickly.

      Causes:Diffuse large B-cell lymphoma happens when B-cells mutate. These are acquired genetic mutations, meaning you develop them during your lifetime instead of being born with them. Medical researchers aren’t sure what triggers these mutations, but having a family history of DLBCL could be a risk factor. A risk factor is an activity or condition that increases your risk of developing a disease. Other risk factors may include: 

      Certain viruses, including Epstein-Barr virus, human immunodeficiency virus (HIV), hepatitis B and hepatitis C. 

      Immunosuppressant drugs taken after organ transplants. 

      Autoimmune disorders. Immunodeficiency.

      Increased body mass index in young adults. 

      Agricultural pesticides. 

      Ionizing radiation.

      Symptoms:The symptoms most people notice are swollen lymph nodes in their neck, armpits or groin. They may notice a lump or mass that doesn’t go away and seems to be getting larger. Other symptoms sometimes include: 

      Unexplained fever: A fever that stays above 103 degrees Fahrenheit (39.5 degrees Celsius) that lasts longer than two days or that comes back may be a sign of a serious issue.

      Heavy night sweats: This is sweating that’s so intense it drenches your sheets.

      Unexplained weight loss: This is losing body weight without trying. Losing 10% of your total body weight over six months is a sign of unexplained weight loss.

      This patient had Stage 3, which implies there’s lymphoma in lymph node areas on both sides of (above and below) your diaphragm.

      Diagnosis: Several different blood tests and an imaging test to diagnose this condition. They also do genetic testing to understand whether specific mutations, or changes, are part of how a given case of diffuse large B-cell lymphoma occurred. Some commonly used diagnostic tests are as follows: 

      In this case report, a 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 3 months. He tried Ayurvedic medicines but there was no relief. He consulted an allopathic doctor and took conventional medicine, which also did not resolve his complaints. Again he restarted ayurvedic medicines and was referred to a modern hospital. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- Stage 3. The Ayurvedic diagnosis was made as Mamsa arbuda.

      Image 1. Before treatment dated 7.9.2018

      before_treatment.png

      Image 2. Diagnosis proof document dated 26.10.2018

      fdg_pet_scan_dated_26_10_2018.png

      Image 3. Histopathology report dated 5.12.2018

      histopathology_dated_5_12_2018.png

      Treatment: There are 4 stages of DLBCL, and the treatment will be planned taking into consideration the stage that the patient is in.  The standard treatment is R-CHOP. It combines the monoclonal antibody drug rituximab with three chemotherapy drugs and a drug that helps kill lymphoma cells. This treatment is safe and effective but doesn’t always work or keep DLBCL from coming back. (Studies show relapses or recurring disease affect an estimated 10% to 35% of people who receive R-CHOP.) If that happens, healthcare providers may recommend the following treatments: 

      Second-line therapy and autologous stem cell transplant: Second-line therapy is intensive treatment with combined cancer drugs.

      Chimeric antigen receptor (CAR) T-cell therapy: This treatment may be helpful for people with diffuse large B-cell lymphoma that comes back after treatment.

      Targeted therapy: This treatment targets the genetic changes or mutations that cause diffuse large B-cell lymphoma.

      Prognosis: Like many kinds of cancer, healthcare providers have more success treating early-stage DLBCL than advanced or later-stage cancer that’s spread. In general, people who are cancer-free two years after their diagnosis can expect to live as long as most people in their age group. However, diffuse large B-cell lymphoma can relapse. And there are different forms of DLBCL that are more difficult to treat. 

      Reference

      1. https://my.clevelandclinic.org/health/diseases/24405-diffuse-large-b-cell-lymphoma

    • Ayurveda Diagnosis

      AYURVEDA DIAGNOSIS: Mamsa Arbuda

      ABOUT THE DISEASE:

      The biomedical diagnosis of Diffuse Large B cell Lymphoma,  in this case report has been correlated to Arbuda by the treating physician. The biomedical diagnosis specifies the stage as Grade 3. The treating physician has specified the arbuda as mamsa. 

      According to Acharya Sushruta, the father of surgery, the aggravated Dosas are accumulated in a particular localised area of the body. There, they cause excess aberration in muscular tissues (mamsa pradushana) and hence in the area, circular- stable-mild painful-larger-broad based-non suppurative growths are caused which are gradually maturing in nature. Such muscular growths will have broader (wider) base and often the base (site of origin) is not visible too. Such abnormal, prominent growths are termed as Arbuda. 
      गात्रदेशे क्विचदेव दोषा: सम्मूर्च्छिता मांसं अिभप्रदूष्य ।
      वृत्तं स्थिरं मन्दरूजं महान्तं अनल्पमूलं चिरवृधिं अपाकं॥
      कुर्वन्ति मांसोच्छ्रायं अत्यगाधं तदर्बुदं शस्त्रविदो वदिन्त ॥ (Su.Ni. ) 

      Types Based upon the dominance of dosha factor and tissues involved, they are classified as- 

      1. Vataja arbuda
      2. Pittaja arbuda
      3. Kaphaja arbuda 

      4. Raktarbuda
      5. Mamsarabuda 

      6. Medo arbuda 

      The symptoms will vary depending upon the type of arbuda. 

      In this case report, a 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 3 months. He tried Ayurvedic medicines but there was no relief. He consulted an allopathic doctor and took conventional medicine, which also did not resolve his complaints. Again he restarted ayurvedic medicines and was referred to a modern hospital. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- Stage 3. The Ayurvedic diagnosis was made as Mamsa arbuda.

      Lakshana of Mamsarbuda: Constant trauma or damage in any muscular part of the body leads to vitiation of localised area. Further, these tissues undergo instant transformation and quick multiplication of abnormal cells result into a tumour. This is usually painless, unctuous, vivid coloured, non suppurative, palpated like stone and stable in nature. This is caused usually in non vegetarians and such a condition (mamsarbuda) is incurable. 

      Prognosis: Even among the curable forms of arbuda, the following are to be rejected – that which has heavy discharges (exudation): that occurring on or around the vital organs; that occurring on or around the channels including nasal passage etc (and hence imparting pressure on them and obstructing their functioning); that which is immobile
      Treatment and rationale of treatment as specified by the treating physician:  Acharya Charaka denotes that the metastasis should be treated as like the cysts or abscesses, as they have similar site of origin, aetiology, characteristic features, dosha and dushya (tissues). The efforts should be carried to achieve the paka of the arbuda and then cauterise it. 

      Table 1. The medicines prescribed and the rationale behind using them

      Medicines/ Procedures

      Rationale

      Arogyavardhini vati

      Indicated in Yakrit vikara

      Kanchanara guggulu

      Helps to balance kapha and reduces medha dhatu.

      Sutasekara rasa

      Pittashamanam

      Gandhaka Rasayana

      Broad-spectrum antibiotic activity

      Mahalaxmi Vilas rasa

      Tridoshamaka

      Kutaja ghan vati

      In Diarrhoea

      Sanka vati

      Deepana and pachana

      Chitrakadi vati

      Kapha shamana

      Triphala rasayanam

      Tridosha shamaka

      Chyavanaprasha + Swarna bhasma

      Rasayana, Improve low appetite

      Amalaki Rasayana

      Kesheya

      Brahma Rasayana

      Medhya

      Kamadudha rasa

      Pittashamanam

      Sataverex granules

      Pittashamanam

      Cruelcap

      Lekhana

      Suvarnavasantha Malathi

      Kapha samanam

      Triphala churnam

      Tridoshaghna

      Sitopaladi Churnam + Sphatik bhasma + Abharak bhasm + Praval Pisti

      Madiphala rasayana

      Cough , cold

       

      Indicated in mandagni

      Table 2. Specific diet was advocated to manage the symptoms caused due to chemotherapy. 

       

      Diet & its form

      Quantity

      Time

      Indication

      Orange

      2

      11am- 3pm

      Vomiting, Dysplasia

      Pappaya/ Apple

      2

      10am- 5pm

      Constipation

      Banana

      2

      8am

      Diarrhoea

      Munnaka

      5

      At bed time

      Immunity, Mucositis

      Lemon

      1

      Juice form

      Nausea, Dry mouth

      Ginger

      Small quantity

      Juice/ Curry

      Vomiting, Nausea

      Palak

      Small quantity

      Juice/ Curry

      Constipation

      Potato

      Small quantity

      Juice/ Curry

      Diarrhoea

      Lashuna

      Small quantity

      Juice/ Curry

      Cough

      Beetroot

      Small quantity

      Juice/ Curry

      Immunity

      Honey

      Small quantity

      Added in juices

      Mucositis

      Tomato

      Small quantity

      Juice/ Curry

      Dysplasia

      Beetroot+ Lemon+ Tomato+ Palak+ Carrot+ Amla+ Giloy+ Pudina+ Wheat grass+ Turmeric Juice

      2 glass

      7 am- 4:30 pm

      Immunity

      Table 3. Psychotherapy for the patient

      Type of regimen

      Duration reccommended

      Yajna

      on special occasion/ festival

      Mantra Chanting

      10 min at bed time

      Bhaktiyoga

      30 min

      Meditation

      30 min

      Yogasana- Sukshma yayama, Padmasana, vajrasana

      10 min

      Mudras- Jnana mudra, Dhyana mudra

      15 min

      Pranayamas- Anuloma Viloma, bhastrika, kapalabhati, bramari

      30 min (Morning- Evening)

      Counselling

      As required

      Reference: 

      1. Madhavana Nidana. Chapter 38. Galaganda gandamala apaci grantyarbuda nidanam

    • Treatment

      Name of Medicine Dosage Form Dosage Mode of Administrtation From - To (Date) Medicine Reference
      Arogyavardhini vati Vati 2-0-2 Oral, with warm water before food 2018-07-08 - 2018-07-23 Rasendrasarasangraha. Jwararogadhikara 13- 105
      Kanchanara guggulu Tablet 2-0-2 Oral, with warm water before food 2018-07-08 - 2018-07-23 Sharangadhara Samhita Madhyamakhanda 7.94
      Sutasekara rasa Tablet 1-0-1 Oral, with warm water after food 2018-08-05 - 2018-08-09 Yogaratnakara. Amlapitta cikitsa 705
      Gandhaka Rasayana Tablet 1-0-1 Oral, with warm water after food 2018-08-10 - 2018-10-20 Rasatarangini.8. 81-86
      Mahalaxmi Vilas rasa Tablet 1-0-1 Oral, with warm water after food 2018-08-10 - 2018-10-20 Rasendrasarasangraha Kapharoga cikitsa.17-29
      Kutaja ghan vati Tablet 2-0-2 Oral, with warm water after food 2019-02-11 - 2019-02-13 Sidhayogasangraha -Atisara pravahika grahani rogadhikara
      Shanka vati Tablet 1-0-1 Oral, with warm water after food 2019-01-15 - 2019-02-13 Bhaishajya Ratnavali Agnimandhya rogadhikara 182-183
      Chitrakadi vati Tablet 1-0-1 Oral, with warm water after food 2019-02-15 - 2019-02-25 CS. Ci. 15.96-97
      Triphala rasayanam Lehya 1 tsp Oral, at bedtime 2019-02-15 - 2019-02-25 CS. Ci 1.3.41-47
      Chyavanaprasha + Swarna bhasma Samyoga 1 tsp + 500 mg of bhasma Oral, at bedtime 2021-10-12 - 2021-11-10 Chyavanaprasha- CS. Ci 1.1.73: ?Swarna bhasma- Rasaratna samucchaya 5.15
      Amalaki Rasayana Lehya 1/2 tsp Oral, at bedtime 2021-11-21 - 2021-12-21 CS. Ci- 1.1.75
      Brahma Rasayana Lehya 1/2 tsp Oral, at bedtime 2022-01-01 - 2022-02-14 AH. Utt. 39.15-23
      Kamadudha rasa Tablet 1-0-1 Oral, at bedtime 2019-05-02 - 2019-07-05 Ayurveda sarasangraha - Rasa Rasayana prakarana
      Sataverex granules Granules 1 tsp Oral, at 10.30 am and 10 pm 2019-04-01 - 2019-08-24 Patent and Proprietary Medicine
      Cruelcap Capsule 1 Oral, with warm water after food 2018-08-10 - 2018-10-30 Patent and Proprietary Medicine
      Suvarnavasantha Malathi Tablet 1 Oral, with warm water after food 2018-08-10 - 2018-10-30 Bhaishajyaratnavali - Jvara cikitsa
      Triphala curnam Curna 1 Teaspoon Oral, with warm water at bedtime 2018-08-10 - 2018-10-30 Bhavaprakasa Haritakyadi varga
      Sitopaladi Churnam + Sphatik bhasma + Abhraka bhasma + Praval Pisti Samyoga {50 gm+ 50 gm+ 5 gm+ 10 gm } mixed- 1/2 tsp Oral, with warm water before food 2018-08-10 - 2018-10-30 Sitopaladi Churnam- Sa. Sam Madhyama Khanda 6.134-137: ?Sphatik bhasma- Ayurveda Prakasha 257 - 258: ?Abhraka bhasma- Rasa Tarangini 10.39-42: ?Pravala Pisti- Ayurveda Sara Sangraha, Shodhana marana prakarana p:119, AFI Vol. 1.
      Madiphala rasayana Lehya 1 tsp Oral, after food twice daily 2018-08-10 - 2019-09-05 Sahasrayogam - Rasayana prakarana
      Dasamula Kwatha Kashayam Required Quantity Bahya Swedana, once daily 2018-08-10 - 2018-10-30 Bhaishajya Ratnavali Kasarogadhikara 13- 15

    • Outcome Measures

      In this case report, a 43-year-old male patient complained of a painless hard mass in the left axillary region that was slowly progressing since the past 3 months. He tried Ayurvedic medicines but there was no relief. He consulted an allopathic doctor and took conventional medicine, which also did not resolve his complaints. Again he restarted ayurvedic medicines and was referred to a modern hospital. FNAC, PET Scan and Biopsy done confirmed the biomedical diagnosis as Diffuse Large B cell Lymphoma- Stage 3. The Ayurvedic diagnosis was made as Mamsa arbuda.

      Assessment: Objective parameters were assessed to analyse the outcome of the treatment.

      Table 1. FDG- PET Scan reports and Deauville Score during and after treatment tabulated 

      DATE

      SIZE OF THE MASS

      DEAUVILLE SCORE

      26.10.2018

      5.4 x 3.9 cm

       

      2.5.2019

      2.3 x 1.5cm

      3

      6.9.2019

      2.2 x 1.5

      3

      5.3.2020

      1.8 x 1.0 cm

      1

      4.10.2021

      1.1 x 0.7 cm

      1

      The size of the lymph nodes were continuously reducing and the reduction of the Deauville score indicated the intensity of the disease was coming down.

      Image 1. PET CT scan dated 2.5.2019

      fdg_pet_scan_2_5_2019.png

      Image 2. PET CT scan dated 6.9.2019

      fdg_pet_scan_6_9_2019.png

      Image 3. PET CT scan dated 5.3.2020

      fdg_pet_scan_5_3_2020.png

      Image 4. PET CT scan dated 4.10.2021

      fdg_pet_scan_4_10_2021.png

      The appearance of the mass was documented with photographs to assess the outcome.

      Image 5. After Biopsy dated 1.12.2018

      after_biopsy_dated_1_12_2018.jpg

      Image 6. After Biopsy dated 20.3.2019

      after_biopsy_dated_20_3_2019.jpg

      Image 7. After Biopsy dated 28.4.2019

      after_biopsy_dated_28_4_2019.jpg

      Image 8. After the 6th Chemotherapy

      after_6_chemotherpy.jpg

      Image 9 Bone marrow biopsy done dated 7.1.2019

      histopathology_dated_7_1_2019.png

      Image 10. The Patient generated subjective global assessment at endpoint 

      pg_sga_assessment_at_endpoint.png

      This integrative approach, could  enhance the quality of life of the patient, minimise the side effects during CT , no delay in CT and no secondary infections reported.

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