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 round 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 is due to sporadic, acquired mutations.
The affected genes are divided into two broad categories. Oncogenes are genes which promote cell growth and reproduction. Tumor suppressor genes are genes which 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.
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 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 prajnaparadha (mistake of the intellect). 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 contains 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 the 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 in strokes, heart attacks, hyperventilation, tremors, etc.
Stanya vaha srota, 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.
The Ayurvedic Approach to Breast Health