Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast: A Case Study

Reenu A Sahani; Harshad K Jain

doi:http://dx.doi.org/10.21760/jaims.8.8.41

E-ISSN:2456-3110

Case Report

Stangranthi

Journal of Ayurveda and Integrated Medical Sciences

2023 Volume 8 Number 8 August

Publisher

www.maharshicharaka.in

Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast: A Case Study

Sahani R^1*, K Jain H²

DOI: http://dx.doi.org/10.21760/jaims.8.8.41

^1* Reenu A Sahani, 3rd Year Post Graduate Scholar, Department of Rachana Sharir, Government Ayurved College, Nagpur, Maharashtra, India.

² Harshad K Jain, Ayurvedic Medical Practitioner, MD RS BK, Mumbai, Maharashtra, India.

According to Ayurveda, Breast CA can be correlated to Granthi explained by many Acharya’s which is developing due to abnormal vitiation of Dosha and Dushya. According to Acharya Charaka, Granthi can be equated with all types of small-sized glandular or nodular swelling in any part of the body due to benign tumours or cysts. There is no direct reference for Stana Granthi but Maansaja Granthi occurs in Stana is having a close resemblance with fibroadenoma of the breast. So, in the present study, a patient with fibroadenoma was successfully treated by Ayurvedic management from Cap Boheco Peace, Raspachak Yoga, Kanchanar Guggul and Abhyanga with Chandanabala Lakshadi Taila which got the significant result.

Keywords: Abhyanga, Boheco peace, Fibroadenoma, Granthi, Oestrogen, Raspachak

Corresponding Author	How to Cite this Article	To Browse
Reenu A Sahani, 3rd Year Post Graduate Scholar, Department of Rachana Sharir, Government Ayurved College, Nagpur, Maharashtra, India. Email:	Sahani R, K Jain H, Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast: A Case Study. J Ayu Int Med Sci. 2023;8(8):258-264. Available From https://jaims.in/jaims/article/view/2713

Manuscript Received	Review Round 1	Review Round 2	Review Round 3	Accepted
2023-06-12	2023-06-28	2023-07-03	2023-07-12	2023-07-25
Conflict of Interest	Funding	Ethical Approval	Plagiarism X-checker	Note
Nil	Nil	Yes	17%

© 2023by Sahani R, K Jain Hand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

J Ayu Int Med Sci 2023;8(8)258

Back To Article Download PDF Introduction Materials and
Methods Observation and
Results Discussion Conclusion Reference

Sahani R et al: Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast

Introduction

Globally, Breast cancer (BC) is the most prevalent cancer that affects women. With an anticipated 2.3 million new cases, or 11.7% of all cancer cases, it will now surpass lung cancer as the most common type of cancer worldwide in 2020. In India, there were an estimated 118000 incident cases in 2016 (95% confidence interval: 107000–130000), 98.1% of whom were female, and 526000 prevalent cases (474000–574000).^[1] According to recent trends, Indian women experience the disease more frequently and at a younger age than Western women. In Ayurveda, Breast cancer can be co-related with Agnimandya of Rasa Dhatu due to which there is malformation of Rasaposhak Dhatu and there is abnormal growth of cells in breast tissue. It is a new growth formed of both fibrous and glandular tissues. This tumour is said to develop as the result of increased sensitivity of a focal area of the breast to oestrogen. This tumour most commonly presented as a painless, slowly growing, solitary lump in the breast. In modern medicine after a systemic review of available conservative management like hormonal therapy, keeping in mind the side effect of hormonal treatment, surgeries like lumpectomy and mastectomy becomes the ideal option which also has its own physical and psychological impact on women’s life. A balanced and rational approach to the management of fibroadenoma of the breast needs to address the crucial questions about its association with breast cancer, which is ideally done by imaging techniques like mammography where fibroadenoma appears as a distinct area from other breast tissue, with smooth round edges and breast ultrasound where it is typically seen as well-circumscribed, round to ovoid or macro lobulated mass or if necessary, a minimally invasive biopsy may be performed via a core needle biopsy i.e., FNAC. Fibroadenoma is one of the most common benign tumours of the breast in women under 30 years of age. In the adolescent population, the overall incidence of fibroadenoma is 2.2%. They account for 68% of all breast masses and 44%-94% of biopsied breast lesions. Blacks have a greater propensity than whites to develop fibroadenoma and at a younger age.

Aetiology^[2]: Breast cancer is caused by a complex interplay of multiple factors including age, genetics, environment, and reproductive history

and probably yet unknown factors. The risk of breast cancer increases with older age and is most common in post-menopausal women. Genetics and heritable factors play an important role in the development of breast cancer. A first-degree family history of breast cancer significantly increases breast cancer risk. Potentially modifiable factors including obesity, alcohol consumption, smoking, physical inactivity, and replacement hormonal therapy have all been associated with increased breast cancer risk. Women’s reproductive history also affects risk with nulliparity associated with increased rates compared to multiparity.

Pathophysiology^[3]: This lesion invariably has a relation to oestrogen sensitivity, and it occurs predominantly in the 2^nd and 3^rd decades of life.

These lesions are encapsulated and tend to be spherical but on occasions, they may be multinodular or somewhat irregular, these typically stop growing when they reach 2 to 3cm in diameter.
On section, these lesions are composed of uniform, greyish white, fleshy, homogeneous mass with fibrous whorls which tend to bulge from the capsule.
There may be some minute yellow to pink softer areas. These are classified into two varieties based on their origins-
Peri canalicular variety (hard fibroadenoma)
Intracanalicular variety (soft fibroadenoma)

Oestrogen and progesterone

Oestrogen predominance over progesterone is considered a causative factor for this.
Presence of High Levels of serum oestrogen. Shortened luteal phase.
Progesterone level decreased to 1/3rd of the normal and women with progesterone deficiency carry a five-fold risk of premenopausal breast cancer.
Patients with premenstrual tension syndrome more likely to develop fibrocystic disease of the breast.

Clinical Features^[4]

a. The peri canalicular type usually occurs in younger girls between 15 and 30 years of age. Intracanalicular affects older groups from 30 to 50 years of age.

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Sahani R et al: Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast

b. This tumour most commonly presented as a painless, slowly growing, solitary lump in the breast is often seen in the lower part of the breast and mostly in the upper and outer quadrant of the breast.

c. Multiple fibroadenomas may be present in about 10% of cases.

d. Pain is usually conspicuous by its absence, though it may occasionally be complained of.

e. Though hard variety is known for its slow growth and never attains big size, yet intracanalicular fibroadenoma tends to be larger due to rapid growth.

f. Discharge through the nipple is almost unknown.

Local examination

Inspection- does not reveal anything particular and the nipple remains always normal, but in some cases, swelling may be visible.
Palpation- is important. Fibroadenoma is characteristically mobile. Freely mobile solitary lump usually firm inconsistency with a round smooth margin within the breast is nothing but a fibroadenoma.
The lump is neither fixed to the overlying skin, nor fascia covering pectoralis major. It is not also fixed within the breast and is so freely movable, that is often called a “Breast mouse”.
The axillary lymph nodes are not usually enlarged.

Diagnosis

Up to the age of 25 years, clinical diagnosis is enough.
Mammography has no place in its routine diagnosis. With increasing age mammography and fine needle aspiration cytology (FNAC) should be performed to exclude malignancy.
Ultrasonography is quite helpful in the differential diagnosis of a palpable breast lump.
BI-RADS (breast imaging- reporting and data system) is a risk assessment and quality assurance tool developed by the American college of radiology. It applies to mammography, ultrasound and MRI.^[5]

According to Ayurveda, Due to abnormal vitiation of Dosha and Dushya may cause excessive abnormal

growth of cells which may develop in any part of the body, these types of growths are multiple in numbers, because of their different locations in the body and clinical features, they are named and classified into different types. These all types of growth are called “Granthi” and “Arbuda.” Acharya Charaka explained these types in the chapter of “Shotha”.^[6] There are many types of Granthi, but the Granthi present in the Stana is “Maansaja Granthi”.^[7] Charaka described it as “Maansaja Granthi” which is a big and painless structure, correlated with fibroadenoma. According to the classical text of Ayurveda, it is mentioned to treat

Maansaja Granthi similar to Kaphaja Granthi. Ayurveda being a holistic approach towards the line of treatment gives complete satisfactory results without any complications, hence, to find a long-lasting solution with not many adverse effects is the need of the hour. Considering the above facts, this ailment has been selected to pursue its perfect cure through Ayurveda.

Materials and Methods

Case Report

The present case study is about the Ayurvedic management of fibroadenoma i.e., Stana Granthi.

A 35-year-old female patient came to OPD with chief complaints of a freely movable lump at upper lateral quadrant of left breast associated with pain in the past 2 years.

Associated complaints - nausea and vomiting, loss of appetite.

History of present illness

The patient was normal 2 years back. Then she suddenly developed with freely mobile lump associated with tenderness and slight swelling in the left breast.

History of family

Father has DM. Rest nothing significant.

Personal history

Name - XYZ	Bala - Madhyama
Age - 35 years	Sleep - Sound
Sex - Female	Addiction - None
Marital status - Married	Bowel habit - Regular
Occupation - Housewife	Appetite - Loss of appetite

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Sahani R et al: Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast

Menstrual history

Age of Menarche	14 years
L.M.P.	26/10/2022
Duration of flow	4 to 6 days
Length of the cycle	28-30days
Regularity of cycle	Regular
Amount of flow	2 to 3 pads/day

Ashtavidha Pariksha

Nadi - 76/min	Shabda - Normal
Mala - Regular	Sparsha - Normal
Mutra - Regular	Drik - Normal
Jivha - Niram (not coated)	Akriti - Madhyama

Weight - 68 Kg

BP - 110/70 mmHg

Systemic examination

CVS: S1 S2 heard, No added sounds

Respiratory system: lungs clear

Digestive system: No abnormality detected.

Breast examination

Inspection - Swelling present in the left breast

Nipple - normal

Skin - normal, localised mild redness was present at the site of pain.

Palpation - Tenderness - present

Lump - single lump in superomedial quadrant of left breast at 9 o’clock position.

Treatment plan: The patient was treated on OPD basis.

1. Cap BOHECO PEACE 0-0-1 after dinner

2. Rasapachak Yoga 2-0-2 before meals

3. Tab Kanchanara Guggulu 2-0-2 after food

4. Abhyanga with Chandanabala Lakshadi Taila – 2 times per day.

Follow up after every 2 weeks. Above mentioned medicines were continued for 2 months.

Pathya

Ahara - Protein-rich diet (Split Green gram, Soya bean), Sesame, Black gram, Horse gram, Intake of egg, Plenty of fluids, Seasonal fruits and vegetables.

Vihara - Walking, Physical exercise, Meditation.

Apathya

Ahara - Oily fried food, Spicy food, Non-vegetarian, Potato and Brinjal, Junk foods.

Vihara - Day sleep, Night vigilance (awake).

Diagnostic criteria - Patient with classical signs and symptoms of fibroadenoma with mammography reports.

Investigation - Breast examination and mammography.

Breast examinations

Before treatment	After treatment
Inspection:	Inspection:
left lumps - present in left breast	left lumps - reduced within 2 weeks
Nipple - normal	Nipple - normal
Skin - normal, localised redness was present at the site of pain.	Skin - normal, localised redness reduced completely.
Palpation:	Palpation:
Tenderness - present	Tenderness - relieved
Lump - multiple lumps in Lump upper lateral quadrant of left breast, freely mobile with irregular border.	Lump - less palpable, freely mobile with smooth round border.
Nipple discharge - absent	Nipple discharge - absent
No changes during the menstrual cycle.	No changes during the menstrual cycle.

Mammography results

Before treatment	After treatment
Done on 02/11/2022§ A large highly dense lobulated solid mass measuring 2.5cm, 2.2cm, 1.7cm, in size with micro lobulated margins noted in superomedial quadrant of left breast.§ A small oval hypoechoic predominantly cystic lesion measuring 1.2cm, 0.5cm in size is seen in superomedial quadrant of left breast at 9 o’clock position.§ Assessment: BI-RADS Category - 4-C	Done on 28/02/2022§ Lesions in the left breast measuring 1.6cm, 1.4cm, 1.0cm, at 9-10’o clock position and,§ 1.6cm, 1.1cm, 0.8cm, at 11 o’clock position with circumscribed margin.§ Assessment: BI-RADS Category - 4

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Sahani R et al: Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast

Observation and Results

Remarkable reduction in the size of the lumps was observed and symptoms like pain, swelling and redness reduced within 2 weeks of treatment and mammography also revealed significant results following two months of treatment. The above-said management was found to be more effective and satisfactory without many complications.

Discussion

The health of a nation mainly depends on the health of a woman, because the healthy and happy woman lays the first step of a prosperous nation. Apart from undergoing natural processes of menstruation, pregnancy etc., Stana Granthi (fibroadenoma of the breast) is a common condition seen in a woman. Though it seems to be common, it affects the whole role of women in the day- to-day activities. It is computed that about 30% of women are suffering from benign tumours of the breast at any age. So, it is necessary to pay immediate attention to this most troublesome disease.

Pathogenesis of Granthi is propounded as when morbid Tridoshas, vitiate Rakta, Maansa and Meda that are admixed with Kapha produce rounded protuberant, knotty or glandular hard swelling called Granthi. Etiopathogenesis, clinical features and treatment of Granthis, are identical to the Granthis of any other body part. In Ayurvedic literature, many type of Granthi

have been mentioned depending on the pathological factor and body tissue involved. Granthi present in Stana can be compared with Maansaja Granthi due to similar pathology and clinical features. So as in Samprapti of Granthi, Vata and Kapha dominating Tridosha are involved, Vata-Kaphahara medications are required. Dushiyas are Rakta, Maansa and Meda hence medications that possess Raktashodhak, Lekhana, Bhedana, Deepana and Pachana properties should be selected. With this hypothesis, in this study Cap Boheco Peace for pain management as Vijaya is Uttam Shulhara, Raspachak yoga because there is Dushti of Ras Dhatu, Kanchanara Guggulu and Chandanabala Lakshadi Taila to reduce the size of Granthi has been selected.

Ingredients of Cap Boheco Peace^[8]

Drug name	Latin Name	Rasa	Guna	Virya	Vipaka	Karma
Vijaya[9]	Cannabis sativa Linn.	Tikta	Laghu, Tiksna	Ushna	Katu	Grahi, Dipana, Pachan, Medhya, Rasayana. Kaphahara, Pittala
Haridra[10]	Curcuma longa Linn.	Tikta, Katu	RukshaLaghu	Ushna	Katu	Kaph-Pitta Shamak, Sothahara, Kandughna, Vranahara, Visaghna, Krimighna, Ruchikar, Sheetapittahara.

Ingredients of Raspachak Yoga^[11]

Drug name	Latin Name	Rasa	Guna	Virya	Vipaka	Karma
Kutaj	Holarrhena antidysentria	Tikta, Katu, Kashaya	Laghu, Ruksha	Sheeta	Katu	Deepana, Pachan, Jwarghna
Patol	Trichosanthes dioica	Tikta	Laghu, Snigdha	Ushna	Madhura	Kapha-Pittahara
Kutki	Picrorhiza kurroa	Tikta	Laghu Ruksha	Sheeta	Katu	Jwarghna, Kapha-Pittahara

Ingredients of Kanchanara Guggulu^[12]

Drug name	Latin Name	Rasa	Guna		Virya	Vipaka	Karma
Kanchanara	Bauhinia purpurea linn.	Kashaya	Ruksha, Laghu		Sheeta	Katu	Kapha-Pittahara, Dipana
Shunti	Zingiber officinale	Katu	Guru, Ruksha, Tikshna		Ushna	Madhura	Vata-Kaphahara, Dipana, Bhedana
Maricha	Piper nigrum	Katu	Laghu, Tikhna		Ushna	Katu	Kapha-Vatahara, Pramathi, Dipana
Pippali	Piper longum Linn.	Katu		Laghu, Snigdha	Ushna	Madhura	Vata-Shleshmahara, Dipana
Haritaki	Terminalia chebula	Kashaya Pradhana Pancarasa		Laghu Ruksha	Ushna	Madhura	Tridoshahara, Anulomana, Lekhana
Vibhitaki	Terminalia bellerica	Kashaya		Ruksha, Laghu	Ushna	Madhura	Kapha-Pittahara, Bhedana
Amalaki	Emblica officinalis	Amla Pradhana Pancharasa			Sheeta	Madhura	Tridoshahara, Vrishya, Vayasthapana
Varuna	Crataeva religiosa	TiktaKashaya		Laghu Ruksha	Ushna	Katu	Kapha-Vatahara,Dipana, Krimighna
Twak	Cinnamomum zeylanica	Katu, Tikta, Madhura		Laghu, Ruksha, Tikshna	Ushna	Katu	Vata-Pittahara, Varnya, Grahi
Ela	Elettaria cardamomum	Katu, Madhura		Laghu, Ruksha	Sheeta	Katu	Kapha-Vatahara, Dipana
Patra	Cinnamomum verum	Katu, Tikta, Madhura		Laghu, Ruksha,Tikshna	Ushna	Katu	Kapha-Vatahara, Pitta-Vardhaka
Guggulu	Commiphora mukul	Tikta, Katu		Laghu, Ruksha, Visada, Sara	Ushna	Katu	Tridoshahara, Lekhana

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Sahani R et al: Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast

Ingredients of Chandanabala Lakshadi Taila^[13]

Drug name	Latin Name	Rasa	Guna	Virya	Vipaka	Karma
Devadaru	Cedrus deodara	Tikta, Katu, Kashaya	Laghu, Ruksha	Ushna	Katu	Krimighna, Shothaghna, Kaphahara
Ashwagandha	Withnia somnifera	Katu, Tikta, Kashaya	Laghu, Snigdha	Ushna	Katu	Vata-Kapha Hara, Shothahara, Balya
Haridra	Curcuma longa	Katu	Laghu, Tikhna	Ushna	Katu	Kapha Pittahara, Shotha Hara
Daruharidra	Berberis aristaka	Katu	Laghu, RukshaTikshna	Sheeta	Katu	Shulaghna, Krimighna, Vatakaphahara
Bala	Sida cardifolia	Madhur	Laghu, Snigdaha	Sheeta	Katu	Vata-Pitta Hara, Balya, Brimhana
Rakta Chandana	Santlum album	Tikta, Madhur	Laghu, Ruksha	Sheeta	Katu	Varnya, Dahaprashamana, Kandughna
Ushira	Vetiveria zizanoides	Tikta, Madhura	RukshaLaghu	Sheeta	Katu	Kaphapittahara, Pachana

Conclusion

Science is advancing as the treatment modalities have also been changed. So, the treatment having maximum benefits with fewer side effects is well anticipated by Ayurveda management. As per the case study, it has once again proved that the time-tested age-old Ayurvedic treatment in fibroadenoma of the breast is very effective which was confirmed by the mammography reports before and after the treatment. Clinical features and reports of mammography suggested a remarkable reduction in symptoms and size of the lump that almost disappeared. Further detailed clinical research studies are needed to conclude.

Reference

1. Michelle Lee And Hooman T Soltanian, Breast Fibroadenoma In Adolescents: Current Perspectives. 2015; 6:159-163.

2. https://www.ncbi.nlm.nih.gov/books/NBK583818/

3. S. Das. A Concise Textbook of Surgery, The Breast, Benign Neoplasms. 8th Edition. Kolkata: Dr S. Das; 2014. P. 601.

4. S. Das. A Concise Textbook of Surgery, The Breast, Benign Neoplasms. 8th Edition. Kolkata: Dr S Das; 2014. P. 602.

5. Daniel J Bell, Yuranga Weerakkody Et Al. Breast Imaging-Reporting and Data System (BI-RADS). 2013

6. Charaka A, Samhita C. In: Chaturvedi GN, Shastri PK, Editors. Vidyotini Hindi Commentary. Sutra Sthana-12/1. 2005 Ed. Varanasi: Chaukambha Bharati Academy; Reprint 2005, P.353

7. Charaka A, Samhita C. In: Chaturvedi GN, Shastri PK, Editors. Vidyotini Hindi Commentary. Sutra Sthana-12/98. 2005 Ed. Varanasi: Chaukambha Bharati Academy; Reprint 2005.

8. https://www.myupchar.com/medicine/boheco-peace-capsule-for-mild-chronic-and-neuropathic-pain-p37175253/-v292185

9. https://www.researchgate.net/publication/282317397_Vijaya_Cannabis_sativa_Linn_and_its_therapeutic_importance_in_Ayurveda_a_review#:~:text=Vijaya%2C%20also%20commonly%20known%20as,of%20the%20family%20Cannabinaceae.

10. https://www.wjpmr.com/download/article/17112016/1477981257.pdf

11. https://www.wjpmr.com/download/article/17112016/1477981257.pdf

12. Kaviraj Shri Ambikadatta Shastri Ayurvedacharya, Bhaisajya Ratnavali, Bhisagratna Shri Bhramhashankar Mishra Editors. Vidhyotini Hindi Commentary. Galagandadi Roga Chikitsa Prakarana 44/64-69. Varanasi: Chaukanbha Oriental; 2018

13. Late Kaviraj Harswarup Sharma, Bhaisajya Sara Sangraha. Chandanabala Lakshadi Taila Chapter 16, Taila Prakarana, Urjha Pharmacy, Gujurat. Third Edition 2000.

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Case Report

Stangranthi

Journal of Ayurveda and Integrated Medical Sciences

Ayurvedic management of Stangranthi w.s.r. to Fibroadenoma of Breast: A Case Study

Sahani R1*, K Jain H2

Introduction

Materials and Methods

Observation and Results

Discussion

Conclusion

Reference

Sahani R^1*, K Jain H²