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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 119-126

Kshara (Alkali) in the prevention and treatment of Coronavirus Disease 2019: An ayurvedic specialized pharmacotherapy w.s.r. to the traditional diet of Northeast India


1 Department of Dravyaguna, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
2 Department of Prasuti Tantra, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

Date of Submission10-Aug-2020
Date of Decision10-Oct-2020
Date of Acceptance14-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Binay Sen
Department of Dravyaguna, Faculty of Ayurveda, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_227_20

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  Abstract 


Objective: At present, the entire world is fighting against the coronavirus disease 2019 (COVID-19) pandemic. Despite all the possible efforts, there is no proven and effective medicine or vaccine discovered till date. There are strong reasons for demanding alternative therapies that could be used in the prevention and treatment of COVID-19. Data Source and Review methods: An extensive literary and multiple database (Science Direct, PubMed, Springer, and Google Scholar) search was carried out for related published works on kshara and alkali in the domains of Ayurvedic, traditional, and modern knowledge. Kshara (alkali) made of aswagandha, tulasi, and pippali is used as a medicine and a dietetic adjuvant in respiratory diseases in Ayurveda. “Khar” is one of the popular traditional food items of Northeast India, well known for different therapeutics. Kshara (alkaline water), prepared from banana and black gram, contains a rich amount of potassium (K), chloride (Cl), calcium (Ca), magnesium (Mg), and iron (Fe), with pH of 10.22–13.00 and 10.02, respectively. Kolakhar (alkali made of banana) has been found to inhibit the growth of different pathogens in in vitro studies. Result and Discussion: Alkaline environment within the normal range of blood pH positively influences the inflammatory, immune, and antiviral mechanisms of the body, which is said to be one of the reasons to keep the body healthy and immune to disease. There is scientific evidence regarding the effectiveness of kshara in treating viral respiratory infections. In vitro studies have demonstrated the inactivation effect of alkaline medium on respiratory viruses. Conclusion: Kshara could be a potential pharmacotherapy and food adjuvant in the prevention and treatment of COVID-19.

Keywords: Alkali, Ayurveda, blood pH, coronavirus disease 2019, Khar, Kolakhar, Kshara, Northeast India, respiratory virus, Sagal Hawai


How to cite this article:
Sen B, Roy A. Kshara (Alkali) in the prevention and treatment of Coronavirus Disease 2019: An ayurvedic specialized pharmacotherapy w.s.r. to the traditional diet of Northeast India. J Ayurveda 2020;14:119-26

How to cite this URL:
Sen B, Roy A. Kshara (Alkali) in the prevention and treatment of Coronavirus Disease 2019: An ayurvedic specialized pharmacotherapy w.s.r. to the traditional diet of Northeast India. J Ayurveda [serial online] 2020 [cited 2021 Jan 17];14:119-26. Available from: http://www.journayu.in/text.asp?2020/14/4/119/304908




  Introduction Top


At present, the entire world is fighting against the coronavirus disease 2019 (COVID-19) pandemic. The novel COVID-19 is caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2).[1] It has created a major health, social, and economic impact on communities worldwide as there is no proven and effective medicine or vaccine available for it till date. Respiratory viruses are a major cause of influenza-like illness symptoms in children and adults, leading to substantial morbidity and mortality each year.[2] It is suggested that during the emergence of a newly virulent viral strain, production of a new specific vaccine requires time and might be unsuccessful. Any viral vaccine is only effective when the vaccine strains match the epidemic strains antigenically. The frequent alterations in the antigenic structures of respiratory viruses, particularly for RNA virus (as in COVID-19), pose difficulties in the production of effective vaccines. Therefore, a successfully manufactured vaccine could be less effective or ineffective when antigenic changes have developed in the target virus. Hence, vaccines have to be updated according to change in the viral strain.[3]

In Ayurvedic understanding of newly emerging diseases, COVID-19 can be considered an exogenous disease caused by bhoota (SARS-CoV-2), and on due course vitiates tridosha, particularly kapha and vata, with involvement of pranavaha, rasavaha, and raktavaha srotas, leading to pulmonary involvement in particular and other systems in general. In this context, the term “bhoota” may be interpreted as organisms.[4]

Until now, there is no proven and effective medicine or vaccine available for it. Health professionals, scientists, and researchers have been trying to repurpose some effective medicines for COVID-19-like illness for symptomatic relief, and the search for vaccine is under different phases of clinical trials. The Ministry of AYUSH has issued guidelines and advisories on preventive and prophylactic measures through immunity boosting and population-based studies to collect evidences of AYUSH interventions including potential medicinal plants such as pippali (Piper longum Linn.), ashwagandha (Withania somnifera [Linn.] Dunal), yashthimadhu (Glycyrrhiza glabra Linn.), tulasi (Ocimum sanctum Linn.), and guduchi (Tinospora cordifolia Willd Miers ex Hook. F. and Thoms) on COVID-19.[5],[6] In Ayurveda, dravya (substances) have been used either as medicine or diet (food and drinks).[7] Kshara (alkali) is a unique example of pharmacotherapeutic measure and dietetic substance. It is one among the 18 useful parts of plants,[8] a unique preparation[9] and described under Aharayogi varga.[10] It has been praised as supreme to the entire sharp and subsidiary instruments in surgical field.[11] In diseases of respiratory system (shwasa; dyspnea and kasa; cough), Charaka has mentioned kshara in the preparation of both medicine and diet. It is used along with paste of maricha (Piper nigrum Linn)[12] and as an ingredient of different preparation and formulations.[13],[14] Two types of kshara namely yavakshara (alkali of Hordeum vulgare Linn.) and svarjikshara (alkali of Capparis decidua Edgew.)[15] are referred in respiratory diseases. It is also used as an ingredient of medicated smoke.[16] Some medicinal plants such as aswagandha,[17] leaf of eranda (Ricinus communis Linn.), tulasi,[18] and pippali[19] are specially mentioned for the preparation of kshara in the context of respiratory diseases. In diet also, kshara is added with different yusha (soup) preparations.[19],[20] Chakrapani, the commentator of Charaka Samhita, opines that Apamarga (Achyranthes aspera Linn.) kshara should be used in respiratory symptoms.[21] Sushruta advocates a group of alkaline drugs, of which bibhitaka (Terminalia bellirica Roxb.), apamarga, vasaka (Adhatoda vasica Nees), kadali (Musa balbisiana Colla), and chitraka (Plumbago zeylanica Linn.)[9] may be considered for kshara therapy on the basis of their properties and actions related to the respiratory system. The recent researches have also suggested the potential use of ashwagandha and pippali in COVID-19 as recommended by a joint initiative of the Ministry of AYUSH, in collaboration with the CSIR and ICMR to conduct clinical trials on four Ayurvedic herbs namely ashwagandha, guduchi, pippali, and yashtimadhu as a preventive or an add-on standard care to COVID-19.[22]

The Northeast (NE) India, officially known as North-Eastern Region, comprises eight states namely Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Nagaland, Tripura, and Sikkim. It lies between 22°N and 29°5'N latitude and 88°E and 97°30'E longitude. NE India displays the character of tropical climate to a large extent, especially in the valleys. Except the plains of Brahmaputra and Barak rivers, which together account for about 25% of the total area of the NE, the rest of the region is mountainous and forest. It is the rainiest region in the country and receives much higher rain than the average of 1000 mm for the whole country. The temperature ranges between 16°C and 33°C in the valleys and sub-zero to 20°C in the mountainous region. The Brahmaputra valley experiences a high level of humidity all the year round.[23],[24]

Through literature search, no studies were found concerning the preventive or therapeutic effects of kshara (alkali) as pharmacotherapy or as a dietary adjuvant (alkaline diets and drinks) against COVID-19. Because there is no effective medication or vaccine for the current pandemic, it is imperative to search for some rationale alternative therapies from the ancient heritage of knowledge and tradition. The aim of this review is to investigate the alternative therapies for COVID-19 with special emphasis on kshara with scientific background.


  Materials and Methods Top


An extensive literary search of Brihat-trayee (Charaka Samhita, Sushruta Samhita, and Ashtanga Samgraha/Ashtanga Hridaya) along with commentaries has been conducted to collect classical references on different aspects on kshara. Multiple databases (Science Direct, PubMed, Springer, and Google Scholar) were also reviewed for related published works on alkali and kolakhar. Traditional knowledge on kshara (khar) was collected only restricted to Assam and Manipur, NE India. Relevant information on COVID-19 was also collected and considered for preparing this review article. The data were obtained from systematic review, animal experimental (in vitro), physico-chemical, elemental analysis, and bioassay studies.

Ayurvedic aspects of kshara

The substance that disintegrates the vitiated debris of skin, muscle etc or causes doshas to move and produces injury to skin, muscle etc due to ksharana property (corrosive nature) is known as kshara.[25],[26],[27] According to the Ayurvedic Formulary of India, Kshara are alkaline substances obtained from the ash of drugs.[28] Kshara (alkali) is obtained from different single or combination drugs (plants, animal, and mineral origin), of all taste but with the predominance of pungent and salt.[9],[26] It possesses katu (pungent), ushna (hot), tikshna (sharp), laghu (light), ruksha (rough), and fire-like properties and does the functions of deepana (stomachic), pachana (digestion), darana (tearing), vilayana (dissolving), shodhana (cleaning) and ropana (healing), and lekhana (scraping) and alleviates all the three doshas. It cures krimi (worms), ama (undigested food metabolites), and kapha and medas (obesity), the complications of poisoning.[10],[29],[30]

Sushruta has mentioned two types of kshara according to use, that is, pratisaraniya (external use) and paniya kshara (internal use).[31] Pratisaraniya kshara is indicated to be used in skin disorders, bhagandar (fistula), and ear diseases and paniya kshara in gastrointestinal, urinary, respiratory (ashwagandha and yava), anorectal, and abdominal disorders (gulma, udararoga).[32],[33],[34]

Three types were explained according to the methods of preparations, that is, mridu (mild penetrating action), madhyama (moderate penetrating action), and tiksna (sharp/deep penetrating action) kshara. In mild kshara, conch-shell etc are not added, when added, it is called moderate type and in sharp variety, powder of ushna and tikshna drugs like chitraka (Plumbago zeylinica), danti (Bliospermum montanum) and vacha (Acorus calamus) are added.[9]

Traditional aspect of kshara (khar)

Kshara, an alkaline food adjuvant, known as “Khar” in NE India, is one of the popular traditional food items used by many ethnic people. The kolakhar (the name derived from the local term of Banana, “kol” or “kola” and kshara, as khar) is made from banana stem, rhizome, and peel. Among the available varieties of banana in the NE region, khar made from M. balbisiana Colla (a wild variety of heavily seeded banana tree [Figure 1], locally known as “athiya kol” or “bhim kol”) [Figure 2] has the best quality. The pseudostem of a mature healthy tree of M. balbisiana was cut into pieces and sun dried for 10 days. After complete drying, the pieces were burned into ashes [Figure 3] and sieved. 50 g of this ash was suspended in 100-mL sterile deionized water and filtered through a muslin cloth. This filtrate (50% aqueous extract) is referred to as kolakhar (ksharodaka in Ayurveda) [Figure 4], and it can be stored at room temperature for a year.[35] It can be made from banana rhizome and peel of the ripe fruits in the same way. Apart from using as a food additive in cooking, kolakhar is used to treat various ailments such as digestive disorders and to prevent bacterial attacks on freshly cut injury, as soaps and detergent for washing clothes, and for shampooing hair, in villages. It is also used by farmers to kill leaches and prevent their attack while working in leech-infected fields. It also cures and prevents certain cattle diseases.[36] Similarly, in Manipuri culture, khar is made from the ashes of a legume which is called “Sagal Hawai” (black gram) [Figure 5] in Manipuri language. Plants having ripe pods of black gram (Phaseolus mungo Linn.) are uprooted and dried up for a couple of days in sunlight. The dried-up plants as well as cover of the pods are put in fire for “ut” (ash form) [Figure 6] preparations. To prepare alkaline form, a handful of ashes of Sagal Hawai after mixing with water is filtered by a cotton cloth. The filtration process will continue for few days. The liquid of ashes is collected from the upper portion of the filtrate [Figure 7], which is used as alkali in preparing curry, as ointment, and hair cleanser. Some residues are deposited in the lower portion which is of no use.[37]
Figure 1: Banana tree (Musa balbisiana Colla)

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Figure 2: Athiya Kol/Bhim Kol

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Figure 3: Kolakhar (ashes of banana)

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Figure 4: Kolakhar (Ksharodaka)

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Figure 5: Black gram/Sagal Hawai

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Figure 6: “Ut”/ashes of black gram (whole plant)

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Figure 7: Ksharodaka (black gram)

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Modern insight of alkali

Inorganic compositions

Very limited studies have been done so far in this field. X-ray florescence spectrometer analysis suggested that the ksharodaka (alkaline water) of banana obtained from Assam contains K (17.70), Na (0.87), Ca (0.057), Mg (0), Fe (0.184), and Cl (59.10) in wt.%. In masha (Phaseolus mungo Linn., known as mati kalay in Assam) ksharodaka, the following is obtained: K (27.77), Na (0), Ca (0.09), Mg (3.05), Fe (0.0317), and Cl (15.76) in wt.%. The pH (measured by “Systronics pH System 361” at 25°C) was recorded as 10.22 and 10.02 respectively.[38] Another study reported that K+ content (1740), Na+ content (16.5), chloride (24,850 ppm), total alkalinity (45,500 ppm), and a significant amount of vanadium (0.4) and zinc (0.027) in ppm with pH 13.0 of Kolakhar were obtained from Assam. Kolakhar was found to inhibit the growth of the pathogens Pseudomonas aeruginosa to be more sensitive toward kolakhar followed by others: Klebsiella pneumonia, Salmonella typhi, Proteus vulgaris, Corynebacterium diphtheria, Escherichia coli, Salmonella paratyphi A, S. paratyphi B, and Shigella checked by agar cup method (bioassay study).[35]

Blood pH – health, immunity, and disease

The human blood pH value is useful in understanding the disease of the human body. The human blood pH value is a general parameter linking together the complexity of relations between organ pairs, the organ itself, the capabilities for intervention reaction, and self-protection of the body and mind as a whole, related to the environment, food, health and personal history, air, water, earth, climate, season, etc. Prof. Mario Pianesi identified an important indicator for human health: the value of blood pH, which, under normal conditions, ranges from 7.35 to 7.45 with the median 7.4. Outside this range (acid and alkaline), disease appears. Almost always, when there is disease, the condition of the blood pH value is an acidic condition.[39] Most studies to date focus on the effect of acidic rather than alkaline pH. A review of different studies revealed that the extracellular pH has a direct influence on a broad range of immunological functions. It is observed that acidic pH results in diminished random migration and chemotaxis of neutrophils, plus a reduction in phagocytosis and bactericidal capacity of polymorphonuclear leukocytes. Acidic pH predominates at inflammatory loci and other sites of immune activity. There is also experimental evidence of an inhibition of lymphocyte activity when the surrounding pH of tumors is reduced. Extracellular acidic pH may be triggered by a multiplicity of humoral or pathological factors originating in inflammatory lesions remote from the site of immune activity. There is a strong inter-relationship between extracellular and intracellular pH on immune function. The Na+/H+ exchanger plays a role in the regulation of pH. The available data strongly suggest that the Na+/H+ exchanger is an essential component in generating a rapid intracellular alkalinization prior to the differential activation of certain immune activities.[40] The Na+/H+ exchanger mechanism involves in extradition of one hydrogen ion (H+) from the cytosol in exchange for the entry of one Na+. The primary physiological role of this exchanger is to maintain intracellular pH homeostasis by extruding metabolically generated H+ ions.[41],[42] Different clinical findings revealed that impairment of immune function consequent to organic acidosis and ketoacidosis is accompanied by immunodeficiency including a decrease in white cell numbers and γ-globulins, diminution of the inflammatory response, delayed phagocytosis, impaired chemotaxis, and inhibition of antibody production.[40]

In 1918 and 1919, while fighting the “flu,” it was brought to the attention of the US Public Health Service that rarely anyone who had been thoroughly alkalinized with bicarbonate of soda contracted the disease, and those who did contract it, if alkalinized early, would invariably have mild attacks.[43] The coronavirus was found to be quite stable at pH 6.0 and 37°C (half-life, approximately 24 h) but was rapidly and irreversibly inactivated by brief treatment at pH 8.0 and 37°C (half-life, approximately 30 min).[44] A study reported that chloroquine and hydroxychloroquine, anti-malarial drugs, work by increasing alkalinization in parts of the cell where the virus is present, thereby inhibiting the replication of the SARS coronavirus and hence possibility of such mechanism to be ruled out in SARS Cov-2.[45],[46],[47]

Alkali diet and drinks

Diet and drinks play a role in blood pH adjustment. The normal range of arterial blood pH is 7.35–7.45. Alkaline-forming diet or drinks could induce low-grade metabolic alkalosis which causes only a small increase in blood pH within the normal range. Within the normal range means that the system equilibrates nearer the higher end (7.45) rather than the lower end (7.35) of normal. In a slightly alkaline environment, viruses might be weakened or do not multiply efficiently. Immune function may work better in alkaline medium as well. Alkalization can be achieved through increasing alkaline dietary sources, alkaline water, or alkaline drinks (alkaline diet sources: predominantly fruits and vegetables) and reducing acidic dietary sources (acidic diet sources: meat, fish, eggs, dairy products, grains and grain products, soft drinks, etc.). Blood pH could also be affected naturally (nondietary) that stress and anxiety produce acidic pH, while meditation yields alkaline pH.[3]


  Discussion Top


Kshara is used in Ayurveda as a medicine and a dietetic adjuvant in Ayurveda. It has a wide range of pharmacotherapeutic importance on medicinal and para-surgical interventions. In the treatment of shvasa (dyspnea) and kasa (cough), kshara alone or two types of kshara (yava-kshara and svarjika-kshara) are being used. Some medicinal plants such as aswagandha pippali, tulasi, and yava are specially mentioned for the preparation of kshara in the context of respiratory diseases. Yava (as kshara) and masha are also found in dietetic prescription in respiratory disorders. The mridu type of kshara represents the range of alkalinity toward the upper range of pH. Therefore, mild-to-moderate kshara is best for application to avoid the side effect of tikshna kshara. The Ministry of AYUSH has also issued guidelines and advisories on preventive and prophylactic measures through immunity boosting and population-based studies on some potential medicinal plants such as pippali, ashwagandha, and tulasi on COVID-19 which are well referred as the sources of drugs for kshara preparation in respiratory illness.

Conventionally, it (Khar) is also used as a medicine and an alkaline dietetic adjuvant in NE India. Kolakhar (made of banana ashes) and Sagal Hawai (made of black gram ashes) are the two unique examples of traditional kshara, which are a rich source of potassium salts and other alkaline micronutrients. Kola-khar is used widely in Assamese cuisine in the case of artificial poisoning, abdominal lump, anorexia, common cold, etc. It is also locally used on wounds, cuts, and piles. It is also used as soap and detergent for washing clothes and shampooing hair in villages. Similarly, another traditional alkaline food adjuvant used in Manipuri culture, is called “Sagal Hawai” in Manipuri language. It is also a khar preparation made from the ashes of a legume “black gram” (Phaseolus mungo). Alkaline processed from the ashes of “Sagal Hawai” is poured into some dal (pulses) or curry (vegetables) and used to prepare alkaline food which is a traditional dish of Manipur and some tribes of NE India.

The ash of banana and black gram was found to be rich in potassium (K+), sodium (Na+), calcium, iron, chloride, and many alkaline minerals. These bio-antacids have been found to inhibit the growth of microorganisms, help in wound healing, and cleansing the body channels. The bioactivity of kshara may be attributed to its high alkalinity (pH 10.22–13.00 and 10.02 respectively) which is mainly due to its alkali elements such as potassium, sodium, calcium, carbonate, and chloride.

It is evident from different studies that many diseases and their consequences are due to lack of dietary alkaline minerals. The enzymatic, healing, repairing and immunological functions of body are performed better way in an alkaline environment. Different experimental studies have revealed that there is a strong interrelationship between extracellular and intracellular pH on immune function. Acidic pH leads to inhibition of chemotaxis of neutrophils and reduction in phagocytosis and bactericidal capacity of polymorphonuclear leukocytes. Extracellular acidic pH may be triggered by a multiplicity of humoral or pathological factors originating in inflammatory lesions. Clinical data are also suggesting impairment of immune function consequent to organic acidosis and ketoacidosis. These all provide an indirect inference that alkaline environment is desirable for body immunity and healthy metabolic activities. Therefore, human body's internal environment remains in alkaline ranges of 7.35–7.45. The best range may be considered closure to the upper limit. Alkaline diets or drinks might have antiviral properties as in vitro studies have demonstrated the inactivation effect of alkaline medium on respiratory viruses.

Modern dietetic consumption enhances the body acidic stress. The acidic pH leads to several adverse effects on cell metabolism, causes autoimmune disorders and micronutrient deficiency, and increases free radical generation. For the prevention of these conditions, alkaline diet and drinks is a good choice. The traditional food items of NE India chiefly include plant derivatives, which possess alkaline minerals, medicinal values, and micronutrients.

NE India is a mountainous, forest covered with moderate temperatures and relatively high humidity and it is the rainiest region in the country. It may be considered as “Anupadesha” (marshy state) on the basis of geographical, weather, and climatic conditions. There is a prevalence of diseases due to vata and kapha vitiation.[48] Kshara, due to its properties of ushna (hot), tikshna (sharp), deepana (stomachic), lekhana (scraping), etc., cures certain morbidities of vitiated vata and kapha dosha. COVID-19 can be considered a kapha-vata-predominant tridoshaja vyadhi with the involvement of pranavaha srotas, in particular kshara may be an alternative measure for it. As on August 14, 2020, data on COVID-19 show that in Assam (71,795/169) and Manipur (4112/13), the total cases and death recorded, respectively, were lower in comparison to the total figure (1,461,190/48,040) of India.[49] Use of kshara as a food adjuvant in this region may be one of the factors of low morbidity and mortality, which needs further investigation.

There are sufficient evidence and rationality behind considering kshara as a unique therapy under the headings of ksharatantra[50] and anushastra,[51] respectively, by the school of medicine and surgery. The internal and external use of kshara have been directly influencing the pH of the internal and external (e.g., wound, cut) environment.

These findings of Ayurvedic, traditional, and modern aspects of kshara are emerging into a new dimension of research, particularly for immune boosting and antiviral properties. By virtue of its properties and actions and the hypothesis supported by modern researches, kshara could be a good alternative in the prevention of and new drug discovery in treating COVID-19.


  Conclusion Top


Many alternative therapies have scientific evidence of activity against respiratory viruses. This study reviewed several aspects of kshara, which support its potential use in pharmacotherapy and as a food adjuvant in the prevention and treatment of COVID-19. Further studies are recommended to investigate the possible role of kshara as medicine and diets or drinks for the prevention and treatment of respiratory viral infections especially in the cases of COVID-19.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
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