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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 103-111

COVID-19: Clinical aspects and role of single herbal drugs – A review from classical texts of Ayurveda


Department of Ayurveda, Regional Ayurveda Research Institute for Metabolic Disorders, CCRAS, Ministry of AYUSH, Bengaluru, Karnataka, India

Date of Submission08-Aug-2020
Date of Decision28-Sep-2020
Date of Acceptance30-Sep-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Rinky Thakur
Regional Ayurveda Research Institute for Metabolic Disorders, #12, Uttarahalli Manavarthekaval, Uttarahalli Hobli, Bengaluru South Taluk, Kanakapura Main Road, Thalagattapura PO, Bengaluru - 560 109, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_157_20

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  Abstract 


Objectives: The present review was carried out to compile and evaluate the clinical aspects of corona virus disease 2019 (COVID-19) described in classical texts of Ayurveda. Data Sources: Information available in different classical texts of Ayurveda, compendiums, and latest Nighantu (lexicons) was compiled, analyzed and presented systematically. Review Methods: Concepts of epidemics, possible management approach, different single herbal drugs indicated in the management of symptoms related to COVID-19 as described in Ayurveda is presented systematically with the help of published scientific literature. Results and Conclusion: A comprehensive review of single herbal drugs indicated for the management of symptoms related to COVID-19 shows that, they can be categorized into symptom modifiers and general health promoters. The drugs having symptom specific indications along with reported research related to that indication such as shunthi, pippali, haridra, tulasi, saptaparna can be considered for their role in the effective management of symptoms. General health promoting agents such as Ashvagandha, Guduchi, Yashtimadhu, Haritaki, Amalaki which are having rasāyana, balya properties can improve quality of life, provides strength, or resistance against the disease. Some experimental and clinical studies are also reported to establish their efficacy which supports the classical claims. Further scientific studies to understand the exact mechanism of action of these drugs individually or in combinations is need of the time.

Keywords: Ayurveda, COVID-19, janapadodhvamsa, single drugs


How to cite this article:
Thakur R, Naik R, Avangapur S. COVID-19: Clinical aspects and role of single herbal drugs – A review from classical texts of Ayurveda. J Ayurveda 2020;14:103-11

How to cite this URL:
Thakur R, Naik R, Avangapur S. COVID-19: Clinical aspects and role of single herbal drugs – A review from classical texts of Ayurveda. J Ayurveda [serial online] 2020 [cited 2021 Jan 17];14:103-11. Available from: http://www.journayu.in/text.asp?2020/14/4/103/304897




  Introduction Top


Coronavirus disease 2019 (COVID-19) which emerged as a global pandemic refers to the novel COVID characterized by a group of acute and severe respiratory illness. COVID-19 is caused by a newly identified coronavirus SARS-COV-2 known to infect humans which is a positive-sense RNA virus and belongs to the β-coronavirus genus. The WHO identified COVID-19 a serious outbreak with rapid spread in china and declared as a Global Pandemic, on March 11, 2020, and also Public Health Emergency of International Concern.

The study of Guan et al. reports that clinical manifestations found in cases of COVID-19 are; fever (88.7%), cough (67.8%), fatigue (38.1%), sputum production (33.7%), shortness of breath (18.7%), sore throat (13.9%), headache (13.6%) and also gastrointestinal symptoms (like vomiting and diarrhea). The appearance of symptoms is estimated to be within 3–6 days after the exposure and incubation period is 3–5 days.[1] The old-aged and person with known abnormalities or underlying comorbidities (hypertension, chronic obstructive pulmonary disease, diabetes, cardiovascular disease, depression, etc.), rapidly develops acute respiratory distress syndrome (ARDS), septic shock, metabolic acidosis hard to correct and coagulation dysfunction, even lead to the death.[2] Complications of COVID-19 include ARDS, arrhythmia, shock, acute kidney injury, acute cardiac injury, liver dysfunction, and secondary infection.[3]

Till date, the golden clinical diagnosis method of COVID-19 is the detection of nucleic acid by real-time polymerase chain reaction (PCR). As per the WHO Interim Guidance, a case diagnosed with confirmed COVID-19 is defined as positive result to high throughput sequencing or real-time reverse-transcriptase the PCR (RT-PCR) assay for nasal and pharyngeal swab or other respiratory tract samplings. Currently, there is no proven drug for treating the COVID-19 and no approved drugs except for experimental studies. The standard of care is supportive measure, aimed at managing fever, dehydration, and constitutional and other clinical symptoms.

Ayurveda is a traditional system of medicine originated in the ancient Vedic times of India. This age old system of medicine is being effectively employed over several centuries for treating various diseases. Although there is no direct reference of COVID-19 in Ayurvedic classics, it can be equated with the condition when Jvara is associated with Cough, Body ache, etc. Along with well documented preventive guidelines, the treatment modalities available for this disease can be categorized into symptom modifiers and general health promoters. In this article, clinical aspects of COVID-19 in classical texts of Ayurveda and single herbal drugs which can be used as symptom modifiers and general health promoters are compiled and presented systematically with the help of published scientific evidences.


  Materials and Methods Top


The present review aims to compile the clinical aspects of COVID-19 as described in classical texts of Ayurveda along with possible preventive and curative guidelines. Specifically, different single herbal drugs indicated in the management of symptoms related to COVID-19 in Classical texts, compendium and Nighantu (lexicons) were compiled, analyzed and the available data are presented systematically with the help of published scientific literature.


  Results and Discussion Top


Concept of Janapadodhvamsa in Ayurveda

Any epidemic or pandemic is better understood and conveyed through the concept of Janapadodhwamsa in Āyurveda. Janapadodhwamsa is defined as that incidence or outbreak in which the large number of people suffered or affected from the same, due to the vitiation of the common factors like air, water, etc.[4] The incidence of Janapadodhwamsa will manifest through any of four modes; vyādhiprabhāva (by Contagious or communicable diseases), śastraprabhāva (using bombs, missiles and other deadly weapons), bhūtaprabhāva (by infections, bio-terrorism, etc.) and abhiśāpaja prabhāva (by the curse of sages, elders, etc.). Bhelasamhitā and āritasamhitā termed the Janapadodhwamsa as Janamāra, reported the strange epidemic diseases in the form of Jvara in different animals and birds which then in turn affect the human population. In Āyurveda, Infectious, communicable diseases are termed as Āupasargikarogas, like Jvara, Kuṣṭha, Śoṣa etc., caused due to physical contact, inhaling the infected air, sexual contact, and also spreading from one person to any person.[5]

Āyurveda has two-fold of the management for Janapadodhwamsa; one is curative and the other is the preventive aspect. Curative measures include the śodhana (body cleansing therapies), bāhya and ābhyantara auśadha prayoga (External internal medications) and Rasāyana (rejuvenator). Śodhana (detoxification) refers to the body cleansing therapies like vamana (emesis), virecana (purgation), basti (enema), etc., done prior to intake of internal medicines. Internal medications should be prepared out of drugs collected before the incidence of Janapadodhwamsa for better treatment approach. Rasāyana's are the rejuvenative medications used to improve the body immunity having the proven properties of anti-oxidant, anti-inflammatory, immunomodulatory, anxiolytic, anti-depressant, etc.

Preventive measures that are followed prior to and after the incidence plays an important role in prevention and mitigation of Janapadodhwamsa which includes treatment modalities such as primarily migrating from affected place and avoiding the affected air or water; Chanting the mantra's (hymns); Worshiping god, adapting the Sadvṛtta (Social conduct), Brahmacharyā (Celibacy) etc. Dhupana (fumigation) of drugs like lākṣa, haridrā, ativiṣa, abhayā, abdha, hareṇuka, elā, kuṣṭha, etc., is indicated for the purification of air.

Ayurvedic correlation of COVID-19

Although there is no direct reference related to COVID-19 in Ayurveda, it can be equated with the condition when Jvara (fever) is associated with cough, body ache, etc. In Ayurvedic literature, one can find such references where fever is associated with Kāsa (cough), pratiśyāya (rhinitis), angamarda (body ache), etc. The symptoms of Vatakaphaja jvara are similar to the symptoms of COVID-19 to some extent. Characteristic features of vatakaphaja jvara as per Carakasamhitā are śitaka (cold), kāsa (cough), gaurava (heaviness of the body), tandrā (drowsiness), pratiśyāya (running nose), and śirogṛaha (headache), with moderately high rise of fever.[6] Symptoms mentioned for Vatakaphaja jvara in Aṣṭāngahṛdaya of Vagbhatta may be correlated with acute fever due to upper respiratory tract infection and other associated symptoms such as śvāsa (dysponea), kāsa (cough), pīnāsa (chronic rhinitis), śirasūla (headache), and parvabheda (joint pain).[7]

Further, under the heading of Ādidaivika bala pravṛtta vyādhi (diseases arising due to such causes that cannot be controlled by human intelligence), terms such as samsargaja and upasargaja are mentioned which indicate that there are certain diseases which can be transmitted directly from infected persons to healthy persons such as contagious diseases or certain diseases can be transmitted by respiration/air borne.

As per Ayurvedic principles there is no such a disease without the involvement of doṣa. Even if the disease is not enlisted in classical texts (anuktavyādhi), the associated doṣa should be analyzed based on the presentation of symptoms (linga) in a given patient and the treatment should be planned properly.

Possible āyurvedic management approach of COVID-19

Preventive aspect

Āyurveda considers the avoidance of the causative factors (nidānaparivarjana) as an important aspect of management which is effective in preventing the disease origin and its progression. Avoiding Prasanga (close interaction with a person), gātrasamsparśa (Physical contact with the diseased individual), Sahabhojana (sharing the food), Sahaśayyā (sleeping together), Sahaāsana (sitting together), Vastramālyānulepana (reuse of used cloths, cosmetics, etc.) maintaining the distance to prevent transmission through inhalation or droplet infection are some of the measures mentioned in classical texts for the prevention of spreading the infection. Disinfecting the environment (includes quarantine and living rooms) with Dhūpana (Fumigation) by using different Dhūpanadravya's like Aparijāta dhūpa, Rakṣoghna dhūpa, Nimba, Haridrā, Viḍanga, Guggulu, etc., is also indicated.

Curative aspect

In general, selection of treatment in conditions like COVID-19 should be based on its symptoms related to the involvement of doṣa. In the case of samsṛṣta (combination of two dosha's) and sannipātaja (combination of two or all the three doṣa's), type of Jwara, the tara, tama or sama (lesser, greater, or equal) status of the vitiated doṣa's should be ascertained and the treatment planned according to the line of treatment and drugs prescribed for that doṣa. As the initial symptoms related to the disease mainly related to vitiation of Vāta and Kapha doṣas, the drugs which are having vāta and Kaphahara properties should be selected. Since the Vāta and Kapha are having opposite properties and usage of drugs with opposite properties to one doṣa leads to vitiation of another doṣa, selection of drugs carefully is most important. In such cases, drugs with uṣṇa vīrya (hot potency) properties can show the instant effect.

Specifically, the treatment modalities of COVID-19 can be categorized into symptom modifiers and general health promoters. The drugs/formulations having symptom specific indications along with reported research related to that indication can be selected for the administration. Drugs that improve quality of life, provides strength or resistance against the disease can be considered under general health promoters. The drugs having rasāyana, balya, etc., properties and reported for their immunomodulatory, antioxidant etc., properties can be categorized under this.

Symptom modifiers

The symptoms alleviating agents are categorized under symptom modifiers. Easily available drugs which are having laghu (light), ushna (hot), dipana (digestion and metabolism enhancer), pachana (enhancing digestion) properties and mentioned for their indications in disease conditions like different types of jvara (Fever), kasa (Cough), svasa (Dyspnoea), pratishyaya (rhinitis), etc., can be included under this group [Table 1].
Table 1: Single drugs useful in symptomatic treatment as mentioned in classical texts

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Zingiber officinale (L.) Roscoe

In an experimental study, fresh ginger dose dependently inhibited HRSV-induced plaque formation in both HEp-2 and A549 cell lines. The study concluded that, fresh ginger of high concentration could stimulate mucosal cells to secrete interferon (IFN)-β that possibly contributed to counteracting viral infection.[8] Intravenous (i.v.) administration of (6)-gingerol (at 1.75–3.5 mg/kg) or (6)-shogaol (at 1.75–3.5 mg/kg) and oral administration of them (at 70–140 mg/kg) produced antipyretic effect. In addition, (6)-Shogaol also showed an intense antitussive effect in comparison with dihydrocodeine phosphate.[9] Ginger and its isolated active components, (6)-gingerol, (8)-gingerol, and (6)-shogaol, relax ASM, and (8)-gingerol attenuates airway hyper responsiveness, in part by altering (Ca2+) regulation. These purified compounds alone or in combination with accepted therapeutics may provide a therapeutic option, including β2-agonists, in airway diseases.[10] In a clinical trial to evaluate the effect of ginger on inflammatory factors in the respiratory profile of patients with ARDS, ginger supplementation was found to significantly lower inflammatory cytokines; interleukin-1 (IL-1), IL-6, and tumor necrosis factor-α (TNF-α). Improvements in oxygenation were also observed with ginger supplementation. The data show the use of ginger in enteral diets and formulations for patients with ARDS, improvising the gas exchange, declining the time period of ICU stays and mechanical ventilation.[11],[12] In addition, the ginger ameliorated allergic asthma by reducing allergic airway inflammation and suppressed Th2-mediated immune responses in mice with ovalbumin-induced allergic asthma.[13] The times of coughing was decreased due to the water-extracted polysaccharides of ginger which was induced through citric acid in guinea pigs.[14] The rat tracheal contraction was inhibited due to ginger oil and its bioactive compounds, including citral and eucalyptol, induced by carbachol in rats.[15] The results depicts that ginger and its bioactive constituents, including 6-gingerol, 8-gingerol, 6-shogaol, citral, and eucalyptol, are good against respiratory disorders, at least mediating them through the induction of relaxation in airway smooth muscle and the attenuation of airway resistance and inflammation.[16]

Piper longum L.

The passive cutaneous anaphylaxis was reduced due to fruit effectively in rats and protects guinea pigs against antigen-induced bronchospasm; in an in vitro study the 30% protection of mast cells was observed. Studies conducted on children revealed that long-term use of fruits decreased severity of bronchial asthma attacks. Therate and amplitude of respiration was decreased in piperine which showed the nonspecific blockade of acetylcholine, histamine 5-hydroxy-tryptamine induced spasm on isolated guinea pig and rabbit intestine.[17],[18] Decoction and alcoholic extract of Amalakyadi Gana (Pippali is one of the ingredient) has moderate antipyretic activity in rats, which may be due to inhibition of the synthesis and/or release of local PGE2.[19]

Curcuma longa L.

It is reported that, curcumin inhibits the infectivity of enveloped viruses. Curcumin inhibited plaque formation in all analyzed enveloped viruses, including the influenza virus. The study provided the insights on the molecular antiviral mechanisms of curcumin and its potential use as an antiviral agent for enveloped viruses.[20] Many in vivo and in vitro studies have shown that curcumin is active against different viruses, fungi and bacteria, including highly pathogenic and multi-drug-resistant strains.[21] Using a well-established model of reovirus 1/L-induced acute viral pneumonia, which displays many of the characteristics of the human ALI/ARDS, a study evaluated the anti-inflammatory and anti-fibrotic effects of curcumin. The administration of curcumin significantly modulated inflammation and fibrosis, as revealed by histological and biochemical analysis. The expression of IL-6, IL-10, IFNγ, and MCP-1, key chemokines/cytokines implicated in the development of ALI/ARDS, from both the inflammatory infiltrate and whole lung tissue were modulated by curcumin potentially through a reduction in the phosphorylated form of NF-κB p65.[22] Extract of C. longa also proved as a potential antiviral against DENV with low cytotoxicity and effective inhibition.[23]

Ocimum sanctum L.

The essential oil Eugenol of Tulsi leaves shows anti-viral activity.[24] The extracted components of this plant like linalool, apigenin, and ursolic acid show broad spectrum antiviral activity.[25],[26],[27] Ocimum sanctum in the dose of 100 mg/kg and 300 mg/kg significantly reduced yeast induced pyrexia. The mechanism of action could be by inhibition of releasing of inflammatory mediators and prostaglandins.[28] It has been reported to be a strong antioxidant against oxidative stress, genotoxicity, and imbalanced xenobiotic metabolizing enzymes induced by 7,12-dimethylbenz [a] anthracene in rats.[29] In a study, it is also predicted that hydroxy group on 4th position of phenyl ring is responsible for bronchial smooth muscle relaxation. The presence of methoxy and propylene group on the phenyl ring may confer a maximum β-activity and selectivity. The presence of ursolic acid in the volatile oil may be responsible for anti-inflammatory activity, which may be due to inhibition of COX.[30]

Allium sativum L.

A study was carried out to evaluate the effect of Allium sativum (Garlic) extract on infectious bronchitis virus (IBV) in specific pathogen-free embryonic egg (IBV is a corona virus). The results showed that IBV's different strains and garlic extract as a primary mixture had inhibitory effects on non-acute strain than acute one and using garlic extract as a treatment 8 h after exposure to different strains of IBV had a significant inhibitory effect which was similar on both field and vaccine strain.[31] It is reported that, the S-ethyl cysteine or S-methyl cysteine can protect bronchial cells and respiratory epithelia.[32] Garlic shows beneficial effects on immune cells especially through regulation of proliferation and cytokine gene expression and was able to maintain the immune system homeostasis. The mechanisms observed are through modulation of cytokine profiles and direct instruction and stimulation of immune cells. It is suggested that the garlic beneficial effects are attributed, in particular, to sulfur-containing compounds, some polyphenols, and flavonoids.[33]

Swertia chirata Buch.-Ham. ex Wall.

In an experimental study, the aqueous extract of Swertia chirata Buch Ham. was evaluated for its antipyretic potential on Brewer's yeast induced pyrexia in albino rats and Typhoid-Paratyphoid A, B vaccine induced Hyperexia in rabbits. In both models, the extract, at dose of 200 mg/kgbody wt. and 400 mg/kg body weight, produced significant reduction in elevated body temperature in a dose dependent manner.[34]

Swertia chirata (L.) R. Br

Cystine knot α-amylase inhibitors named alstotides discovered from the Alstonia scholaris plant family display antiviral activity. Antiviral and cell-permeable effect of Alstotides to inhibit the primarily phase of infectious bronchitis virus and Dengue infection, in addition to their ability to inhibit α-amylase.[35] Benzene and methanol extracts of the inflorescence showed significant anti-pyretic activity in yeast induced pyrexia in rats.[36] The alkaloids fraction inhibited mice's frequency of cough induced by ammonia, increased mice's latent period of cough induced by sulfur dioxide, and increased guinea pigs' latent period of cough and inhibited frequency of cough. The alkaloids fraction increased delitescence of convulsion, and tumbles of guinea pigs in anti-asthmatic test, and enhanced tracheal phenol red output in expectorant evaluation. The main alkaloid, picrinine exhibited anti-asthmatic and anti-tussive activities in vivo.[37]

Cyperus rotundus L.

The alcoholic extract of Cyperus rotundus showed highly significant antipyretic activity against pyrexia produced in albino rats by the subcutaneous injection of suspension of dried Brewer's yeast. In addition, the specific fraction gained from the petroleum ether extract showed significant anti-pyretic effect similar to acetyl salicylic acid.[38] In a clinical study, Clevira, (Ayurvedic formulation containing C. rotundus as an ingredient) as add on drug in patients with viral fever with or without thrombocytopenia showed a rapid recovery without any adverse effects.[39]

Nyctanthes arbor-tristis L.

In an open-labeled observational study clinical activity of Nyctanthes arbor-tristis was evaluated by monitoring pyrexia, parasitemia, and morbidity score (MS) in twenty patients of malaria. The administration of a paste of 5 fresh leaves, thrice a day for a week showed disease-modifying activity. In TNF-α within a day, the inflammatory cytokines showed a reduction.[40] The extract exhibited antipyretic effect against brewer's yeast-induced pyrexias in rats.[41] In an experimental study to evaluate the bronchodilator effect of ethanolic extract of the N. arbortristis is leaves, the extract inhibited the histamine-induced maximum contractile responses of tracheal smooth muscle. Ethanolic extract also showed dose-dependent relaxation of tracheal smooth muscle.[42] Ethanolic leaf extract is also found effective in prevention of experimentally induced asthma in rats.[43] The alcoholic extract of N. arbortristis leaves shows protect against histamine aerosol-induced asphyxia in guinea pigs. The arbortristoside A and arbortristoside C present in N. arbortristis have been reported to be antiallergic.[44]

Picrorhiza kurroa Royle ex Benth.

The plant extract is reported for its protective effects on humoral immunity. The administration of extract remarkably ameliorated both humoral and cellular antibody response.[45] Methanolic extracts Picrorhiza kurrooa rhizome at 260 mg/kg as well as 520 mg/kg exhibited highly significant antipyretic activity in yeast-induced pyrexia.[46] Using different chemical and pharmacological methods, a study identified the phenol glycoside androsin as active compound preventing allergen and platelet-activating factor induced bronchial obstruction in guinea pigs in vivo.[47]

General health promoters

This category includes the drugs having the balya, rasāyana, etc., properties that improve the immunity, Quality of life and also facilitates the early recovery. Drugs like Gudūci, Yashtimadhu, Haritaki, and Aśvagandha showed the immunomodulatory potential and help in rejuvenation of body homeostasis. Therefore, they can be used as adjuvant or mainstream treatment for COVID-19, when the disease is manifested with its symptom because of their potential in inhibiting the replication of SARS-CoV–2 [Table 2].[48]
Table 2: Single drugs useful as general health promoters as mentioned in classical texts

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Tinospora cordifolia (Willd.) Miers

Tinospora cordifolia benefits the immune system in variety of ways. The alcoholic and aqueous extract of this plant have been reported for their immunomodulatory activities.[49] Seven immunomodulatory active compounds belonging to different classes have been isolated and characterized indicating that the immunomodulatory activity may be attributed to the synergistic effect of group of compounds.[50] T. cordifolia extracts treatment cause significant reduction in eosinophil count and improved hemoglobin in HIV patients.[49] Active compounds 11-hydroxymustakone, N-methyl-2-pyrrolidone, N-formylannonain, cordifolioside A, magnoflorine, tinocordiside, and syringin[50] have been reported to have potential immunomodulatory and cytotoxic effects.[51] They have been reported to function by boosting the phagocytic activity of macrophages, production of reactive oxygen species in human neutrophil cells, enhancement in nitric oxide (NO) production by stimulation of splenocytes and macrophages indicative of anti-tumor effects.[52],[53] In a study to evaluate the role of T. cordifolia in status of Vyadhikshamatwa (immunity) in children, statistically significant increase in total leukocyte count, lymphocyte percentage and absolute lymphocyte count and lymphocyte percentage was observed as compared to placebo. In addition, the rate of infections in the trial group was significantly lesser during the study period.[54]

Glycyrrhiza glabra L.

Glycyrrhizin does not allow the virus cell binding and has a prominent antiviral activity. The antiviral activities of ribavirin, 6-azauridine, pyraziofurin, mycophenolic acid, and glycyrrhizin against two clinical isolates of SARS (severe acute respiratory syndrome) virus FFM-1 and FFM-2 were evaluated. It was observed that glycyrrhizin the most effective in controlling viral replication and could be used as a prophylactic measure. Glycyrrhizin has been used to treat patients suffering from HIV-1 and chronic hepatitis C virus.[55],[56],[57] N-acetylmuramoyl peptide is glycyrrhizin analogue having potential in vitro immune-stimulating properties,[58] also animal studies have revealed its efficacy against the influenza virus that is mediated by stopping the virus replication. Glycyrrhizin acid inhibits virus growth and inactivates virus particles as a potential source of immunomodulator.[59] Immunomodulatory properties of the roots of Glycyrrhiza glabra was evaluated in NMRI-mice challenged with sheep red blood cells (SRBCs). Oral administration of hydroalcoholic extract in the dose of 0.75 g/kg for 2 weeks showed a significant increase in the level of anti-SRBC antibody. The level of the respiratory burst of phagocyte cells of splenocytes significantly decreased in the treatment groups, while the level of lymphocyte proliferation significantly increased in the treatment group as compared to the control group.[60]

Withania somnifera (L.) Dunal

The administration of an extract from the powdered root of the plant was found to stimulate immunological activity in BALB/c mice. Treatment with five doses of root extract (20 mg/dose/animal; i.p.) was found to enhance the total WBC count on the 10th day. Withania extract also inhibited delayed type hypersentivity reaction in mice (Mantoux test).[61] Some of the previous studies also conclude that Ashwagandha enhances NO synthatase activity of the macrophages, which in turn increases the microbial killing power of these immune cells thereby enhancing the cell mediated immune response.[62] Extracts showed a protective effect in cyclophosphamide-induced myelosuppression in animals, revealing a significant increase in white blood cell counts and platelet counts. Cyclophosphamide-induced immunosuppression was counteracted by treatment, revealing significant increase in hemagglutinating antibody responses and hemolytic antibody responses towards sheep red blood cells.[63] Oral administrations, ashwagandha churna also showed a significant increase in neutrophil adhesion and delayed-type hypersensitivity (DTH) response. The drug potentiated the cellular immunity by facilitating the footpad thickness response to SRBCs in sensitized rats.[64]

Terminalia chebula Retz.

Terminalia chebula has retroviral reverse transcriptase inhibitory activity.[65] It saves epithelial cells against influenza A virus, supporting the traditional use for aiding in recovery from acute respiratory infections.[66] It also showed inhibitory activity on the effects of immunodeficiency virus1-transcriptase.[67] Terminalia chebula has demonstrated therapeutic activity against herpes simplex virus both in vitro and in vivo tests.[68] The drug is also found effective in inhibiting the replication of human cytomegalovirus in vitro and in an AIDS model with immunosuppressed mice showing that it may be beneficial for the CMV diseases and immunocompromised patients.[69] In an experimental study, the aqueous fruit extract produced an increase in humoral antibody titer and DTH in mice indicating its immunostimulant properties.[70] Alcohol extract of dried ripe fruits increased the concentration of antioxidant enzymes, GSH, T and B cells, the proliferation of which play important roles in immunity. The drug also increased the concentration of melatonin in pineal gland as well as the levels of cytokines, such as IL-2, IL-10 and TNF-α, which play important roles in immunity.[71]


  Conclusion Top


COVID-19 is affecting a large number of people and becoming challenge particularly in medically and technologically advanced countries. A detailed review of literature from Classical texts of Ayurveda reveals that the concept of outbreak of such diseases is well documented along with preventive and curative measures. There is a need to exploit the wealth of knowledge available in Classical texts to cure this disease and control the epidemic. Different single drugs indicated for symptoms related to COVID-19 can be used as prophylactic as well as curative measure after systematic scientific documentation. Further clinical studies on these single drugs need to be planned to produce evidence for safety and efficacy and wider acceptance.

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Conflicts of interest

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