|Year : 2020 | Volume
| Issue : 4 | Page : 171-176
Garbhini Paricharya in COVID-19 pandemic: A leading role of Ayurveda
Pankhuri Hitesh1, Sunita Suman2
1 PG Scholar, Department of Prasuti Tantra, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
2 Associate Professor, Department of Prasuti Tantra, Faculty of Ayurveda, IMS, BHU, Varanasi, Uttar Pradesh, India
|Date of Submission||02-Aug-2020|
|Date of Decision||08-Oct-2020|
|Date of Acceptance||15-Oct-2020|
|Date of Web Publication||28-Dec-2020|
Hitesh Gupta Kirana Merchant, Holi Road, Milak, Rampur, Uttar Pradesh - 244 701
Source of Support: None, Conflict of Interest: None
Introduction: The coronavirus disease 2019 (COVID-19) is a highly transmittable and pathogenic viral infection caused by severe acute respiratory syndrome corona virus 2 (SARS COV-2) and Garbha-kala is one of the most crucial and responsible stage in woman's life. COVID-19 can produce devastating effect on maternal wellbeing. Garbhini Jwara can be interrelated to some extent with features of COVID-19 in pregnancy. Objective: As, there is still some time for the approval and distribution of anti-viral vaccine against it. Thus, imperative critical care is a pre-requisite to manage COVID-19 during pregnancy. Due to shortfall of data on COVID-19 in traditional system of knowledge, present trial utilizes treatment modalities mentioned in ayurvedic classics to conquer novel COVID-19 symptomatically. Data Source: The proposed review article draws the data from different ayurvedic texts, research papers and drudging efforts are made to gather the knowlegde of Garbhini Paricharya from contemporary science to fulfill the lacunas and thoroughly excel in it. Review Method: The symptoms of COVID-19 can be analogized with the features of Sannipata Jwara during pregnancy. It epitomizes as Janapada-dhamsa vikara and can be categorized into Bhutabhisanga Agantuga Vikara (External cause of microbes). Result and Conclusion: Ayurveda exhilarate intensive approach to cope-up with this unprecedented pandemic of COVID-19 during pregnancy. Decoction prepared from the ayurvedic drugs like Tulsi patra, Shirish twak, Guduchi kanda, Yastimadhu mool and Nimba patra acts as Daha-prashaman, Jantughna, Swashara, Kasahara, Krimighna, Jwarahara and Rasayana. It possess Anti-viral, Anti-bacterial, Anti-inflammatory, Anti-oxidant, Immuno-modulatory properties due to various chemical constituents.
Keywords: COVID-19, Garbhini Jwara, Janapada dhamsa vikara, Sannipata Jwara
|How to cite this article:|
Hitesh P, Suman S. Garbhini Paricharya in COVID-19 pandemic: A leading role of Ayurveda. J Ayurveda 2020;14:171-6
| Introduction|| |
Coronavirus disease is a highly contagious viral infection outbreak in Wuhan, China, in December 2019, but today, the unprecedented altitudes of COVID-19 have apprehended the entire humanity motionless.
Garbha-kala is one of the most crucial and responsible stage in woman's life where mother has to safeguard two precious lives simultaneously. There is no difference in physical disorders of a pregnant woman from any other individual. but treatment modalities differ as the fetal pole is delicate to withstand general treatment principles. Acharya Charaka opined that the diseases of pregnant women should be treated with the use of soft, sweet, cold, pleasing, and gentle drugs, dietetics, and regimens.
In this COVID-19 pandemic, Garbhini should be treated like a pot filled with oil as the slightest oscillation of such pot causes spilling of oil; similarly, modest mismanagement can evince life-threatening fetomaternal complications such as acute respiratory distress syndrome (ARDS), abortion, preterm birth, and stillbirth.
Aims and objective
- To study the COVID-19 in the light of Ayurveda with special reference to Sam-sannipataja jwara
- To prevent the development of COVID-19 disease in Garbhini
- To treat the signs and symptoms of COVID-19 disease in Garbhini
- To explore ayurvedic drugs and their effectiveness in COVID-19 pandemic.
| Incidence|| |
The world community is lamented with an unparalleled pandemic of novel coronavirus disease (COVID-19). The disease has spread globally, with more than 16.1 million confirmed cases and 645 thousand deaths as of June 17, 2020. Despite worldwide efforts to terminate it, COVID-19 cases are increasing exponentially beseeching clinically proven prophylaxis and therapeutic strategy.
| Etiopathogenesis|| |
The coronavirus disease 2019 (COVID-19) is a highly transmittable and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It attacks primarily the human respiratory system, i.e., throat and lungs. Genomic analysis revealed that SARS-CoV-2 is phylogenetically related to SARS-like bat viruses; therefore, bats could be the possible primary reservoirs. The intermediate source of origin and transfer to humans is not known, however, the rapid human-to-human transfer has been confirmed widely. When an infected person talks, coughs, or sneezes, droplets carrying the virus may land in the mouth or nose and target the throat, nose, and lungs cells. The glycoprotein crown-like spikes on its outer surface are responsible for the attachment and entry of the virus to host cells where it takes over its internal machinery. It does not need to enter the host cell's nucleus as it can also directly access ribosomes which use genetic information from virus to make viral proteins.
| Signs and Symptoms|| |
The symptoms of COVID-19 infection appear after an incubation period of approximately 1–12.5 days. The most common symptoms at the onset of COVID-19 illness are fever, cough, and fatigue, while other symptoms include sputum production, headache, hemoptysis, diarrhea, dyspnea, and signs such as lymphopenia, pneumonia, RNAemia, ARDS, acute cardiac injury, and incidence of ground-glass opacities that led to death.
| COVID-19 in Ayurveda|| |
Ayurveda revealed that it is not always possible to name a disease in a definite term. Hence, this disease has to be analyzed according to the Nidana Panchaka theory of Ayurveda based on the concepts of Dosha, Dushya, Srotas, Samprapti, and its management.
Since the Vedic period, Ayurveda practitioners have an insight into the existence of microorganisms inducing infectious diseases. The word Krimi was referred to as an infectious agent in Vedas. Ancient Indian classics described nearly 100 types of infectious agents. In Mahabharata, Vedavyasa narrated the unavoidable existence of Krimi. It is also mentioned in classics that Mahamari (communicable diseases) can spread from one person to another through air, water, animal, flies, and physical contact.
Ayurveda, the oldest medical system, described fever (Jvara) as a major disease in its Charaka Samhita. The symptoms of the COVID-19 may be correlated with the features of Sannipata Jwara described in ayurvedic classics. However, in critical cases of COVID-19, it best matches with symptoms described for Sama Sannipata Jwara. It comes under Janapada dhamsa vikara and can be grouped in Bhutabhisanga Agantuga Vikara (external cause of microbes).
| COVID-19 in Garbha-kala (Pregnancy)|| |
Harita has enlisted sosha (emaciation), hrllasa (nausea), chardi (vomiting), shopha (edema), jwara (fever), aruchi (anorexia), atisara (diarrhea), and vaivarnyata (discoloration), eight disorders which afflict the pregnant woman. Realizing the importance of the subject, Kashyapa has given two full chapters on this and has emphasized that proper management of disorders during pregnancy is helpful for the protection and development of both mother and fetus.
In today's unexpected and atypical circumstances of the COVD-19 pandemic, although any direct similitude is complicated, it can be correlated to Garbhini Jwara. The present work will be helpful for drug development and serve the purpose of ayurvedic formulation development in the prevention and treatment of COVD-19.
| Garbhini Jwara|| |
Kashyapa revealed that fever to a pregnant woman is the most troublesome disease as the fetus also suffers due to the transfer of heat of fever from the mother to the fetus.
Nidana – Though several etiological factors of Garbhini Jwara are enlisted in Kashyapa Samhita but the smell of grass and flowers (pollen) have a considerate resemblance as external causative factors as seen in novel COVID-19. It is predominantly a Bhutabhisanga Agantuga Vikara.
Purvaroopa – Although there is no subject mentioned in ayurvedic classics regarding Nidana Panchaka, the current scenario depicts the severely infectious state and signs and symptoms of COVID-19. Daha, Kantha-shosha, sirovedana, nindra, tandra, arti, and alasya are visible purvaroopa.
Rupa – Jwara, Kasa, Shvash, Atisaar, and Vedana.
Upshaya – Garbhastrava and Garbhapata.
| Samprapti Ghataka|| |
Dushya: Rasa and Rakta
Srotodusti: Atipravritti and Sanga.
| Management|| |
Current management of COVID-19 is a supportive and respiratory failure from ARDS is the leading cause of mortality. Traditional remedies may alleviate the symptoms of COVID-19.
| Garbhini Paricharya during Jwara|| |
Principles of treatment before fourth month of pregnancy
- She should be advised to fast for a day, followed by use of drinkables free from fat and salt.
- Use of pungent dietics and drinkables, sudorifics and exercise should be avoided.
- She should take only rice gruel to subside aggravated doshas, next she should take cereals with soups.
Principles of treatment after fourth month of pregnancy
- She is advised to take drugs after giving due consideration to the duration of pregnancy, amount of vitiation of doshas.
- One should use moderate treatment after understanding the type of fever i.e. vataja, pittaja or kaphaja jwara and also severity of disease.
- Use of oleation, sudation, emesis, purgation, enemas before seventh month, nasya, venesection, dhupana etc are contraindicated as it can make their disease incurable or even cause death.,
Accounting these venturesome effects catalyzed by different treatment modalities mentioned in [Table 1], Garbhini is left with restricted medications in this novel COVID-19 pandemic.
|Table 1: Use of Strenuous Regimens in Acute fever and their hazardous effects on fetus|
Click here to view
General treatment of fever during pregnancy in COVID-19 pandemic
- Decoction of madhuka, candana, sariva, usira, madhuyasti and padmaka mixed with honey and sugar is beneficial.
- Decoction of candana, sariva, lodhra and mrdvika mixed with sugar should be prescribed.
- Water medicated with payasya, sariva, pathya, nagara should be given for drinking.
- Hriberadi decoction prescribed for diarrhea is also beneficial.,
Decoction of ayurvedic drugs like Tulsi, Guduchi, Shirish, Neem and Yastimadhu can prove to be an elixir for pregnant woman in COVID-19 pandemic and will aid to prevent and treat COVID-19 symptomatically as these drugs possess Anti-viral, Anti-bacterial, Anti-oxidant, Anti-inflammatory, Anti-allergic and Immune-modulatory effects.
[Table 2] depicts the ayurvedic properties of drugs and its effect on respiratory system & basal body temperature.
|Table 2: Ayurvedic properties of drugs and its effect on respiratory system and basal body temperature|
Click here to view
[Table 3] shows the chemical constituents and biological activities of ayurvedic drugs effective for pregnant women in COVID-19 pandemic.
|Table 3: Chemical constituents and biological activities of drugs effective for pregnant women in coronavirus disease 2019 pandemic|
Click here to view
Method of preparation of decoction
Fresh raw drugs (1 part each) are taken and washed off properly, and then all dirt and contamination are removed. Decoction can be prepared from Tulsi patra, Shirish twak, Guduchi kanda, Madhuka mool, and Nimba patra by adding four times water and reducing it to one-fourth and is allowed to cool down. The pregnant woman is advised to drink a 20-ml decoction twice a day.
Principles for management of pregnant women with confirmed/suspected COVID-19
- Patients with respiratory symptoms should adhere to respiratory hygiene, cough etiquette, and hand hygiene
- Ensure rapid triage of pregnant patients with respiratory symptoms
- Patients with respiratory symptoms should wear a facemask and wait in a separate, well-ventilated waiting area at least 6 feet from other people
- Confirmed and suspected cases of COVID-19 should be isolated as soon as possible in an airborne infection isolation room (AIIR). If an AIIR is not available, consider transfer to a hospital with an AIIR
- Implement Centers for Disease Control and Prevention (CDC) infection prevention and control procedures for health care providers including standard, contact, and airborne precautions
- Eye protection and properly fitted N95 respirators should be used. Provide additional staff training in correct use of personal protective equipment including correct donning, doffing, and disposal of personal protective equipment
- Contact hospital infection personnel. In coordination with local/state health department, collect and send relevant specimens for diagnostic SARS-CoV-2 testing
- Limit visitor and health-care personnel access to patient rooms with a confirmed or suspected case
- Pregnancy should be considered a potentially increased risk condition and monitored closely including fetal heart rate and contraction monitoring
- Consider early oxygen therapy (target O2 saturations 95% and/or pO2 70 mmHg). Consider early mechanical ventilation with evidence of advancing respiratory failure
- Noninvasive ventilation techniques may have a small increased risk of aspiration in pregnancy
- Use intravenous fluids conservatively unless cardiovascular instability is present
- Screen for other viral respiratory infections and bacterial infections (because of risk of coinfections)
- Consider empiric antimicrobial therapy (because of risk for superimposed bacterial infections)
- Consider empiric treatment for influenza, pending diagnostic testing
- Do not routinely use corticosteroids. The use of steroids to promote fetal maturity with anticipated preterm delivery can be considered on an individual basis
- If septic shock is suspected, institute prompt, targeted management
- Delivery and pregnancy termination decisions should be based on gestational age, maternal condition, and fetal stability, and maternal wishes
- Consult with specialists in obstetrics, maternal-fetal medicine, neonatology, intensive care, anesthesia, and nursing
- Communicate with patients and families regarding diagnosis, clinical status, and management wishes
- AIIR; CDC; COVID-19, coronavirus disease 2019; SARS-CoV-2
- All guidance should be considered subject to revision as additional data on pregnant women with COVID-19 become available. Rasmussen. 2019 novel coronavirus and pregnancy (Am J Obs Gyne 2020).
| Discussion|| |
The dimensions of pandemic require an urgent call of all knowledge systems available globally as there are no clinically approved antiviral drugs or vaccines available to be used against COVID-19. Ayurveda has enough potential and possibilities to employ antenatal care regarding both the prevention and treatment of COVID-19.
Tulsi patra, Shirish twak, Guduchi kanda, Yastimadhu mool and Nimba patra act as Daha-prashaman, Jantughna, Shvashhara, Kasahara, Krimihgna and Jwarahara.
Tulsi (Ocimum sanctum) is kapha-vata shamaka due to katu, tikta rasa, laghu, ruksha guna, ushna virya, and katu vipaka. It has shvashhara, kasahara, krimihgna, jantuhagna, vata-kapha, and jwarahara properties. Modern studies showed that tulsi possess antioxidant, antibacterial, antiviral, antifungal properties and act as an expectorant in bronchitis, anti inflammatory, and immunomodulator.
Shirish (Albizia lebbeck) is tridosha-samaka due to its kashaya, tikta, madhura rasa, laghu, ruksha, tikshna guna, esad ushnavirya, and katu vipaka. It is described as vishahgna, vedanasthapana, kasa-shvash-pratishayahara, and shothahara. Modern studies showed that it has antimicrobial, anti-inflammatory, antiviral, antiallergic, and immunostimulant and used in pulmonary hypertension treatment.
Guduchi (Tinospora cordifolia) is tridosha-shamaka due to its tikta, kashaya rasa, guru and snigdha guna, usna virya, and madhura vipaka. It is described as Daha-prashaman, jwarahara, rasayana, and kasahara. Modern studies showed that it has antiviral (HIV), anti-inflammatory, immunomodulatory, vasorelaxant, and antihypertensive properties.
Yastimadhu (Glycyrrhiza glabra) is vata-pitta shamaka due to its madhura rasa, guru and snidha guna, sheeta virya, and madhura vipaka. It is described as kanthya, daha-shamaka, shothahara, vedana-sthapana, jantuhagna, and kasa-shvash-swarabhedahara. Modern studies showed that it has anti-inflammatory, antifungal, antiallergic properties and has been used as a demulcent in sore throat.
Nimba (Azadirachta indica) is tridosha-shamaka due to its tikta, kashaya rasa, laghu, ruksha, tikshana guna, esad virya, and katu vipaka. It is described as Jantughna, Daha-prashamana, Vedana-sthapana, and kasa-shvash-vinashani. Modern studies showed that it has anti-inflammatory, antibacterial, antiviral, antipyretic, and antifungal properties.
| Conclusion|| |
- The disease COVID-19 can be considered as the clinical congruence of Sam-sannipataja jwara
- It comes under Janapada dhamsa vikara and can be grouped in Bhutabhisanga Agantuga Vikara (external cause of microbes)
- Garbhini should be treated circumspectly during this COVID-19 pandemic to prevent a deleterious hazard
- Garbhini paricharya should be pursued meticulously as mentioned in ayurvedic classics
- COVID-19 in pregnancy should be treated with due consideration regarding Garbhini Jwara
- Tulsi, Shirish, Guduchi, Yastimadhu and Neem kwath is effective in preventing and controlling the signs and symtoms of novel COVID-19 as all these drugs which are mentioned in ayurvedic texts acts as Daha-prashaman, Jantughna, Shvashhara, Kasahara, Krimihgna, Jwarahara.
- No adverse effect or complications should be produced with the use of this treatment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]