|Year : 2020 | Volume
| Issue : 4 | Page : 22-27
Ayurveda prophylaxis and intervention for COVID-19 Pandemic
Kavita Chambyal1, Sanjeev Sharma1, Suman Sharma2
1 Department of Sharir Kriya, National Institute of Ayurveda, Jaipur, Rajasthan, India
2 Department of Shalya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India
|Date of Submission||02-Aug-2020|
|Date of Decision||27-Sep-2020|
|Date of Acceptance||28-Sep-2020|
|Date of Web Publication||28-Dec-2020|
Department of Sharir Kriya, National Institute of Ayurveda, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: Novel coronavirus named SARS-CoV-2 is causing a series of acute atypical respiratory symptoms. It is an Aupsargika Vyadhi and virus is transmittable between humans and has been declared as pandemic worldwide. The number of death toll continues to rise and there is no specific treatment till now. Initially, the pathology and symptoms of the disease pertain to the respiratory system and according to Ayurveda, this can be correlated with Pranavaha Srotas Vyadhi and the management should be like Shwasa roga. Objective: To provide critical evaluation of prophylaxis and interventions involved in Ayurveda for COVID-19. Data Source: Ayurveda Samhita, text, Journals, Internet etc. Review Method: Literary review. Discussion: On the basis of COVID-19 clinical features and present understanding of the pathogenesis, it mainly seems to be associated with Kapha and Vata Dosha vitiation. Nidana Parivarjana (not coming in contact with vyadhita such as maintain social distancing, use of mask, and proper hand hygiene); use of herbal, mineral, and herbo-mineral drugs; and Panchkarma procedures such as Nasya (Nasal application), Abhyanga, and Hitakara Ahara according to Desha, Kala, Ritu, etc., play important role in the prevention and management of this new disease. Conclusion: COVID-19 seems to be associated with vitiation of Kapha and Vata Dosha, and use of Ayurvedic principles and drugs can improve and regulate the immunity which helps in preventing the diseases. If disease manifestation occurs, then it can also be managed by Ayurveda interventions.
Keywords: Aupsargika Roga, COVID-19, Pranvaha Srotas, Shwasa Roga, Vyadhikshamatva
|How to cite this article:|
Chambyal K, Sharma S, Sharma S. Ayurveda prophylaxis and intervention for COVID-19 Pandemic. J Ayurveda 2020;14:22-7
| Introduction|| |
Coronavirus is a highly infectious virus and has involved almost all the countries and territories of the world. The International Committee on Taxonomy on Viruses has named the virus as SARS-CoV-2 on February 11, 2020. This virus belongs to category coronaviruses, realm Riboviria, order Nidovirales, suborder Cornidovirineae and family Coronaviridae. Coronaviridae family is further subclassified into two subfamilies; Orthocoronavirinae and Torovirinae. Subfamily Orthocoronavirinae is classified into four genera and novel coronavirus belongs to the Betacoronavirus genus of this subfamily.
After virus entry mainly in the upper respiratory tract, it enters into the epithelial cells and the whole system of the host cell is hijacked. The life cycle in the cell consists of five steps – attachment (binding to the host receptors), penetration (entering in the cell by endocytosis or membrane fusion), biosynthesis (viral proteins are synthesized using mRNA), maturation (new viral particles are made), and release (multiple viral particles are released). The antibody appearance in serum and nasal secretions is shown after the resolution of the infection. The incubation period assumed by the WHO and the European Centre for Disease Prevention and Control for COVID-19 lies between 0–14 days and 2–12 days, respectively.
According to Ayurveda, the transmission of Aupsargika Roga in non-infected person is through Prasangat (sexual intercourse) Sah-shaiya (sharing the bed), Gatra Sansparshat (direct body touch), Nishwashat (respiration), Saha Bhojanat (sharing food and utensils), contact with infected individual's clothes, Maala (common use of string of beads or ornaments), and Anulepana (reusing someone's creams or pastes). The SARS-CoV-2 is transmitted through contaminated respiratory droplets or contaminated hands to the mucosa of the nose or eyes. Briefly, it can be stated that it spreads through all those ways which have been advocated in Ayurveda.
Vyadhikshamatva (immunity) plays an important role in the prevention of various diseases such as Aupsargika Roga (communicable diseases), Janapadodhwansa Roga (epidemic diseases), and Krimija Roga (infectious diseases), and this can be achieved by Yuktikrita Ahara, Vihara, etc. This review is an attempt to describe about various principles, preventive aspects, and interventions of Ayurveda in context to COVID-19. Pathogenesis: COVID-19 is new disease entity, and on the basis of Ayurvedic principles, any disease can be understood using Yukti Pramana. If we analyze COVID-19 on the basis of available contemporary understanding of the disease and its symptomatology, it seems involving Pranavaha srotasa and Rasavaha srotasa up to some extent. Shwasa Roga is related to the vitiation of Kapha and Vata Dosha and vitiated Vayu with Kapha block Prana, Anna, and Udakvaha Srotas. Vitiated Dosha starts moving in the Pranvaha Srotas, and Shwasa Roga develops. They start displacing the Agni from Agnashaya Sthana together with Rasa Dhatu. Agni with its Ushnata starts blocking the Srotas and spreads in the whole body with Vriddha Dosha and generates heat which is known as Jvara. Prana with Samana Vayu and other Dosha produce sound like Sambhinna-kansya tulya ghosha from the mouth and is known as Kasa. Vata, Pitta, Kapha, and Rakta separately and together get collected in Murddha (head) and give origin to Pratishyaya.
Nidana: Mithyahara vihara leads to Jathragnimandya which resultantly produces Rasadhatwagnimandya. Imbalance of Agni produces Aama which causes blockade of Srotasa (Khavaigunya) leading to malformation of subsequent Dhatus and vitiation of Doshas. Vitiated Doshas displace (Sthanasamshraya) from their own sites and cause Dosha dushya sammurchana leading to disease development and if disease remains untreated can lead to complications (Bhedavastha).
Symptoms of COVID-19 are mostly similar to SARS-CoV. The common symptoms such as fever, cough, ARDS, headache, hemoptysis, diarrhea, dyspnea, and lymphopenia are found. Most of these symptoms are related with Pranavaha Sroto Dushti. Tachycardia, Atibaddha Atikupita, Alpa, Shoola, and with some sounds in breathing of person are the evidence of Pranavaha Sroto Dushti. Asymptomatic patients have no symptoms, but the test for COVID-19 has found positive results. The clinical presentation on the basis of severity have been shown in [Table 1].
Early diagnosis of COVID-19 is essential for isolation of confirmed cases to prevent further transmission and for early management. In the preanalytical stage, a nasopharyngeal or oropharyngeal swab from the right anatomical site is suggestive of the diagnosis of infection. In the analytical stage, the detection of viral RNA is done by nucleic acid amplification tests such as real-time reverse transcriptase-polymerase chain reactions. In the post analytical stage, the diagnosis is made based on molecular and serological findings. Viral sequencing provides information about the confirmation of virus and monitors the mutations of the viral genome.
| Ayurveda Principles of Vyadhikshamatva, Rasayana, and Management|| |
The varied response to diseases or pathogens in different individuals is called Vyadhikshamatva in Ayurveda which otherwise is called as immunity. All individuals do not have the same proportion of excellence of Vyadhikshamatva (immunity). According to Acharya Chakrapani, Vyadhikshamatva is Vyadhyautpadakpratibandhaka (which inhibits disease borne environment). Ahitakara Ahara, Vihara, Dosha vitiation, and different body composition's cause mild, severe, acute, and chronic diseases. At the end of Adana Kala (summer season) and beginning of Visarga Kala (rainy season), Daurbalya occurs that means immune status (bala) of the body remains weak generally. During the mid of Visarg Kala (winter season) and Adan Kala (spring season), the immune status remains at average level (Madhyam Bala) and at the end of Visarga Kala (Hemanta) and starting of Adana Kala (Shishira), the body power of a person remains at maximum level. This time or season-dependent immunity is called Kalaja Bala. Yuktikrita Bala (acquired immunity) helps Durbala Sharira individuals to promote their strength and health by appropriate Ahara, Vyayama, Vajikarana, and Rasayana Sevana (consumption). Rasayana is a unique concept of Ayurveda and can modulate, regulate, and enhance body strength and immunity and also increases the Smarana (memory), Medha (intellect) power, Arogya (wellness), Uttam Bala (super body power), etc., e.g., Chyavanprasha, Brahma Rasayana, and Amalaki Rasayana.
Sharira (body) and Mana (psyche) are the Ashraya of Roga (seats of diseases), and after due course of time, Sharirika Roga (physical diseases) can cause Mansika Roga (psychological diseases) and vice versa.
We know that till now, there is no treatment available for the prevention of COVID-19. Ayurveda talks about the breaking down or halting the pathogenesis of disease and is named as Samprapti vighatana. As said above, this disease mimics the Shwasa Roga, and Chikitsa of Pranavaha Srotodushti related diseases is like Shwasa Roga.
| Proposed Prophylaxis|| |
- Nidan Parivarjana (preventive measures): The measures which have been advocated to prevent Aupsargika Roga (communicable diseases) in Ayurveda should strictly be followed to prevent the threat of COVID-19. In the present scenario, the use of masks or face covers, obeying appropriate hand hygiene, physical distancing, avoid sharing the food and other articles, and use of personal protection kits (personal protective equipment) while handling the SARS-CoV-2 positive patients are very much essential to prevent the spread of this
- Vyayama: Vyayama (physical exercises) is an essential component of health and uses of doing regular Laghu Vyayama are Sharira Samyaka Pushti, Diptagni, Ushna-Sheeta Shishnuta, and Arogya
- Padaprakshalana and Snana: Padaprakshalana (foot hygiene) and Snana (bath) as advocated in Ayurveda are the best hygienic measures to keep the body clean and minimize viral load
- Dhoopana Karma: Many drugs such as Nimba, Tulsi, and Nirgundi are used in Dhoopana Karma and can be used for fumigation to reduce environmental pathogen load. Dhoopana Karma is also indicated in Jvara with Gugglu, Nimba, etc., with ghee
- Achara Rasayana should be followed. e.g., always eat ghee and milk, keep calm, do not consume alcohol (Madya), etc.
| Local Prophylaxis|| |
Ushna Jala (warm water)
Warm water is locally soothing, healer, maintains health of local mucosa, and also increases the Agni (digestive fire). Improved Agni minimizes the production of Aama (the product of impaired digestion or metabolism). The production of Aama is believed to be the cause of many infectious diseases. During febrile diseases, the use of plain or medicated water or hot decoctions is very much customary and integral part of Ayurvedic management. Nidana and Kala for Pachana of Dosha and Soshana of Kapha take place in the body due to the use of Ushna Jala.
Nasya (nasal application) is used to treat many diseases particularly pertaining to the supraclavicular region (Urdhavajatrugata Vikara). For the nasal route, medicated oils or ghee (clarified butter) are mainly used and these maintain the health and immunity of local mucosa keep it lubricated. This may protect the respiratory tract from various pathogens as these can be trapped and destroyed by healthy mucosa. All Urdhvajatrugata Vikara do not occur and Indriya Nirmalata occurs using Nasya. The location of Kapha Dosha is predominantly in Urah, Shira, Griva, Parva, Amashaya, Meda, and mostly in Vaksha. In Pakva, Pratishyaya-Nasya should be given.
Kavala and Gandusha
Warm liquids or oils or decoctions are used as mouth rinse (Kavala) or gargles (Gandusha) and relieve the sign and symptoms of Vyadhi (diseases) and Vaishadya (feeling of cleanliness). These measures cleanse the mouth, pharynx, and larynx. The mucosal epithelium is made healthy.
Steam inhalation and Dhoompana
Steam inhalation by adding Ajmoda, Putiha (mint), and Yavani or their Dhoompana (medicated smoke inhalation) is beneficial in Kasa, Shwasa Roga and can be used for upper respiratory symptoms of COVID-19.
Neti (with water, Snigdha Sutra, etc.,) removes foreign bodies and enhances the drainage of sinuses by preventing stasis of mucus. This helps to prevent from conditions such as sinusitis, cold, cough, rhinitis, and insensitivity to smell.
| Internal Medication|| |
- Single herb drugs: The Ministry of AYUSH, Government of India, has also recommended many such single herbs which can be used as prophylaxis, add on treatment for COVID-19 disease depending upon the severity of diseases. Few such drugs are being described here and their Rasa, Guna, Virya, Vipaka are detailed in [Table 2]:
- Guduchi: Aqueous extract of Tinospora cordifolia has the phagocytic ability of macrophage in vitro at 5 g/ml and treatment with aqueous and ethanolic extracts at 10 mg/kg body weight for 14 days significantly increased the production of antibodies. This herb is used as Jvarahara, Krimihara, Balya, Shwasa, and Kasa Nashaka
- Nimba: Nimba bark extract significantly blocked HSV-1 entry into cells at concentrations ranging from 50 to 100 g/mL. Extract of leaves has virucidal activity
- Ashwag a ndha: Polyherbal drug (Immu-25) containing Withania somnifera has shown antiviral properties in an in vivo experiment in a previous study. Ashwagandha Kshara with honey and ghee should be used in severe Kasa and Shwasa Roga
- Haridra: The decoction of rhizome is used for gargle, and piece of rhizome is slightly burnt and given for chewing in cough and sore throat. The fumes of Haridradi Dhumvarti have given in asthma and congestion
- Adraka: Fresh ginger is effective against HRSV (human respiratory syncytial virus) which induced plaque formation on airway epithelium by blocking viral attachment and internalization in an earlier study
- Tulsi: Ocimum sanctum can be used as an antiviral agent in viral infection. Tulsi is Kasa, Shwasa, and Parshava Shoola Vinashaka.
- Mineral and herbo-mineral formulations can play important role in Pranavaha Sroto Dushti such as Panchaamrita Parpati, Tribhuvanakirti Rasa, and Arogyavardhini Vati
- Proposed interventions: Gross recommendation can be projected to have a glimpse of the prophylaxis and management of this disease. These recommendations are as follows.
|Table 2: Different herbs with their Rasa-Guna-Virya-Vipaka-Dosha effect|
Click here to view
Prophylaxis and asymptomatic patients
Regular use of AYUSH Kwatha as recommended by the Ministry of AYUSH, Government of India, steam inhalation, oil pulling therapy, Ushna Jala/Shadanga paniya, Chyavanprasha 10 g, and Nasya with oil or ghee in asymptomatic patients.
Patients with mild symptoms
One of the following lines of treatment can be used:
- Godanti Bhasma-250 mg, Sitopaladi Churna-3 g, Madhuyasti Churna-1 g, Amalaki Churna B.D. with Chyavanprasha-10 g each twice-a-day
- Gojihwadi kwatha-10 g and Samshamani Vati-250 mg B.D. twice a day.
Patients with moderate symptoms
Based on the Prakruti etc., of the patient, a clinician can design the treatment from the formulations such as Anand bhairava Rasa-125 mg, Arogyavardhini Vati-250 mg, Tribhuvana Kirti Rasa-125 mg, Sitopaladi Churna-3 g, Madhuyasti Churna-1 g, Shringarabhra Bhasma-125 mg Gojihwadi kwatha or Tulsiadi Kwatha-10 g, Samshamani Vati-250 mg, Ashwagandha Churna-5 g B.D. (twice a day each). Milk with Adraka or Haridra Paka should be recommended.
Patients with severe symptoms
These patients require intensive care in which the facility of the intensive care unit with recommended ventilators, flow nasal cannula oxygenation, or non-invasive mechanical ventilation should be available, and management of septic shock requires urgent attention.
| Discussion|| |
The novel coronavirus is highly contagious, i.e., spreading from one person to another through droplets or by direct contact. Hence, personal hygiene, social distancing, proper use of mask, and other measures should also be taken. According to Ayurveda, all diseases develop due to the in-equilibrium state of Dosha which provides a congenial environment for external factors to affect the human body. By adopting appropriate Dinacharya, Ritucharya, and the use of prophylactic measures mentioned in Ayurveda, one can improve Vyadhikshamatva and can prevent many diseases possibly including COVID-19 disease. Vyadhikshamatva can be increased by balanced Ahara, Vyayama, Vajikarana, and Rasayana Sevana in proper time, Ritu, Desha, etc. Various herbal, mineral, herbo-mineral drugs, and Panchkarma procedures like Nasya are supposed to have better effects in the prevention and management of COVID-19. All these interventions have mostly Kapha, Kaphavata, and Tridosha Shamaka property, Ushna Virya, Tikta, Kashaya Rasa, Katu Vipaka, and Laghu, Ruksha Guna.
| Conclusion|| |
SARS-CoV-19 is an infectious disease and has posed a global threat to the humanity. However, by adopting preventive measures of Aupsargika Roga and Vyadhikshamatva boosting methods or drugs, this disease can be prevented or its impact on individuals can be minimized up to much extent. Disease manifestation can be managed successfully by understanding the Ayurvedic principles of treatment and can be used as stand-alone therapy depending on the condition of the patient.
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Conflicts of interest
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[Table 1], [Table 2]