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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 42-48

COVID-19: Opportunity for mainstreaming Ayurveda to transform Indian health care


1 Department of Kayachikitsa, Parul Institute of Ayurved and Research, Parul University, Vadodara, Gujarat, India
2 Department of Rasashastra and Bhaishajya Kalpana, Parul Institute of Ayurved and Research, Parul University, Vadodara, Gujarat, India
3 Department of Kayachikitsa, Parul Institute of Ayurved, Parul University, Vadodara, Gujarat, India

Date of Submission07-Aug-2020
Date of Decision09-Oct-2020
Date of Acceptance10-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Nisha Munishwar
Department of Kayachikitsa, Parul Institute of Ayurved and Research, Parul University, Vadodara, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_220_20

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  Abstract 


Introduction: Every 100 years, world face dreadful pandemic proving human helpless in front of nature. Nowadays, we are struggling with COVID-19 pandemic which is caused by severe acute respiratory syndrome coronavirus 2, has spread worldwide, its first case was reported in Wuhan, China, and since then, it has spread across the world becoming one of the worst pandemics in the history of humankind. Approach to the disease is still relying on a trial basis. No accurate cure or medications have been proved effective till date. The world is trying to invent effective vaccination, but it will take one or 2 years for a successful launch of effective vaccine. Objectives: Medical sciences are giving more importance to boosting immunity and that is the heritage of Ayurveda. COVID-19 is equally affecting physical as well as mental health. So, Physical and mental health of covid-19 affected as well as non-affected persons can be very well managed with Pragmatic Ayurvedic approach. Material and Methods: An extensive literary search of different classical texts has been conducted to collect classical references along with multiple databases (PubMed and Google Scholar) available online for the related published works. Conclusion: In this panic situation, the holistic approach of Ayurveda in the form of curative and preventive medication, Rasayana Chikitsa, Yoga, and Pranayama, etc., will be helpful to manage this disease. This article is going to dig out the treasure of Ayurveda in the form of holistic approach.

Keywords: COVID-19, holistic approach, transforming Indian health-care system


How to cite this article:
Munishwar N, Bramhankar R, Deshpande S. COVID-19: Opportunity for mainstreaming Ayurveda to transform Indian health care. J Ayurveda 2020;14:42-8

How to cite this URL:
Munishwar N, Bramhankar R, Deshpande S. COVID-19: Opportunity for mainstreaming Ayurveda to transform Indian health care. J Ayurveda [serial online] 2020 [cited 2021 Jan 23];14:42-8. Available from: http://www.journayu.in/text.asp?2020/14/4/42/304906




  Introduction Top


Until today (October 8, 2020), over 35,651,607 cases and 1,045,055 deaths reported worldwide from COVID-19 pandemic suggesting its global health crisis with an actual or potential impact on citizens of all nations. If we look toward the condition of India, it became a second country following the United States of America (1st) which are worse affected by COVID-19. Modern medicine has no obvious answer for fighting COVID-19. In India, the practice of modern medicine co-exists simultaneously with indigenous systems of medicine, such as Ayurveda, Unani, and Siddha, which are widely used by particular sections of the population.[1] Therefore, the whole world is looking toward India to find out the solution to combat this pandemic. It is obvious that no one will accept easily the efficacy of Ayurveda without any evidence. Hence, its responsibility of all Vaidyas is to prove efficacy and safety of our medicines by giving therapeutic as well pharmaceutical evidences which requires a lot of efforts to dig out our hidden potential. No one is perfect or self-sufficient in this world. We have to think about the integrative approach toward COVID-19.

Coronavirus not only affects the physical health but also affects the mental health of an individual. Pathology for the same is occurring in either way as cause to effect or effect to cause, i.e., prospective or retrospective. Without the infection of COVID-19, the fear, i.e., psychological symptoms have the potential to adversely affect immune functioning. Psychosocial factors such as stress, anxiety, and depression are associated with increased susceptibility to viral upper respiratory infections.[2] Various studies suggest that a link between psychological distress and immune responses to COVID-19 infection is biologically probable and needs further attention.

The Indian government along with Ministry of Ayush has developed guidelines based on the opinion of 16 eminent Vaidyas (traditional doctors), entitled “Ayurveda's immunity boosting measures for self-care during the COVID-19 crisis”, and made it available to the common people for sake of their well-being.[3] These guidelines listed ten measures that are aimed at boosting immunity against infection, though without any specific claims being made with reference to COVID-19.

Objectives

Various theories are known regarding the mortality of COVID 19, much less is known about its pathobiology. An attempt is made to understand probable cause and its suitable management through Ayurveda through the following objectives.

  1. Holistic approach of Ayurveda in the management of COVID 19
  2. Correlation of COVID 19 with concept of Nidana panchaka (Ayurvedic disease approach)
  3. To develop stage-wise approach through Ayurveda in COVID 19
  4. Integrated approach to combat COVID 19 for benefit of humanity.



  Materials and Methods Top


An extensive literary search of different classical texts along with commentaries has been conducted to collect classical references related to COVID 19. Multiple databases (Science Direct, PubMed, and Google Scholar) were also searched online for the related published works. An attempt has been made to explain the correlation between COVID 19 with Jwara and Shwasa through a holistic approach of Ayurveda.

Samprapti (pathology) as per Ayurveda

If we look into the correlation between the concept of COVID-19 and Ayurveda, it shows similarity with Sannipataja jwara or Agantuja jwara.[4] The samprapti can be summarized as follows: the inhaled virus SARS-CoV-2 (agantuja nidana) likely binds to epithelial cells in the nasal cavity and starts replicating. Doshas aggravated by their causative factors reach amashaya and deranged the function of Agni. Then, vitiated dosha mixes with rasa carrying ama and moves in upward direction obstructing the respiratory channels, urdhwajatrugata pradesha and then settles down at a khavaigunya region of pranavaha, udakavaha, and annavaha strotasa.[5] The seat of affliction of this disease is primarily Uras (chest region) with symptoms such as anosmia, anorexia, high-grade fever, body ache, headache, and dry cough. If oja is displaced due to dhatupakavastha, the patient may suffer from severe respiratory distress with other symptoms and sometimes leading to death. COVID comes under the disease of Abhyantara roga marga as jwara (fever), shwasa (respiratory distress) and kasa (cough), the three major symptoms belong to this roga marga. Abhyantara roga marga is one among three roga margas (pathways of disease), as described by Acharya Vagbhata.[6]

Sushruta while explaining Samsargajanya vyadhi (communicable diseases),[7] explained the causative factors for infective diseases are sexual relation (Prasangat), physical contact (Gatra samsparshat), droplets infection (Nishwasa), eating, sharing beds, seating in mob with infected person (Sahabhojana), etc. It mainly affects the respiratory system with the symptoms of high-grade fever with other associated symptoms. In COVID-19, a causative factor is SARS-Cov-2, which is spreading through the same causes as mentioned by Sushruta. One more special concept given in Ayurveda is about Janapadodhwamsa,[8] which is an elaborate description of causation, and management of epidemic and that is very much relevant to the present condition of pandemic.

Pathophysiology as per the modern science

SARS-CoV-2 is predominantly transmitted through the respiratory droplet, contact, and potential in fecal–oral.[9] Viral replication primarily is presumed to occur in the mucosal epithelium of the upper respiratory tract (nasal cavity and pharynx), with further multiplication in lower respiratory tract and gastrointestinal mucosa,[10] landing into mild viremia. Due to one's resistance power, infections are controlled at this point and remain asymptomatic. Some patients have also exhibited nonrespiratory symptoms due to concerned pathologic changes such as acute liver and heart injury, kidney failure, and diarrhea,[11],[12],[13] implying multiple organ involvement. ACE2 is broadly expressed in the nasal mucosa, bronchus, lung, heart, esophagus, kidney, stomach, bladder, and ileum, and these human organs are all vulnerable to SARS-CoV-2.[14] Recently, researchers, implying fertility concerns in young patients,[15] have also proposed potential pathogenicity of the SARS-CoV-2 to testicular tissues.

Curative and preventive approach

An approach toward the management of COVID 19 is Yukti vyapashraya (planning of physician about medicine and Pathya ahara) as per stages.[16]

Stage 0: As preventive

One can follow the above-mentioned regimen to boost immunity and prevent the entry of causative factor [Table 1].
Table 1: Ayurvedic approach as a preventive and curative aspect as per stages of COVID-19

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Stage 1: Asymptomatic state

The scope of Ayurvedic management is more to enhance the immunity (Vyadhikshamatva) that will not cause the progression of disease and to prevent the replication of virus at surfaces and mucosa of the respiratory nasal pathway. If a patient's RT-PCR test is positive without any symptoms then, it is well managed by following Achara Rasayana, Shadrasatmaka Ahara, Yogasana, Pranayama, Nidra, Brahmacharya Palana along with Aushadhi Yoga.[17] [Table 1].

Stage 2: Upper airway and conducting airway response

In this stage 80% of the infected patients, the disease will be mild and mostly restricted to the upper and conducting airways.[17] To maintain normal physiology of affected parts, rasaoushadhies and smoke particles of herbal fumigation with the quicker action of drug showed significant relaxation in histamine-induced tracheal chain contraction[18] [Table 1].

Stage 3: Hypoxia, ground-glass infiltrates, and progression to adult respiratory distress syndrome

In this stage, highly potent, quick acting, small dosage formulations such as hemagarbha pottali, suchikabharana rasa, arsenic compound, and Agada (herbal antidotes) can administer through convenient route, which can combat severe adult respiratory distress syndrome with significant recovery.[17] [Table 1].

Post COVID-19 management

The following treatment modalities considered as possible treatment protocol [Table 1].

Apunarbhava Chikitsa

The treatment is considered as best, which restore the function of Dosha-dhatu-mala without relapse of disease.[19] Depending on the condition of Dhatu avastha and Dosha avastha, shamana in the form of brimhana chikitsa such as ghrita, avaleha, and swarna-vasanta kalpa can be adopted to restore the function of Tridosha.

Satvavajaya Chikitsa (ayurvedic psychotherapy)

It is a nonpharmacological approach aimed to maintain mental health. Memory herbs increase the level of neurotransmitters, particularly acetylcholine, and improve blood flow to the brain, thereby increasing its oxygen and nutrient supply, which will aid brain function and memory. Regular practice of yogasana and pranayama with achara rasayana is useful for mental stability.[16]

Achara Rasayana (behavioral therapy)

It should be followed in a proper way to get adequate relief as a preventive measure.[20] Along with that some preventive means such as home quarantine, social distancing, mask wearing, sanitizing, avoiding sexual desire, medicated oil instillation, medicinal herbs fumigation, Oil puling, and medicated smoking should be followed in the present context. Keeping the epidemiology of COVID in mind, it is evident that all the groups have a direct or indirect relation with the acts of prajnaparadha.[21] Subjects failing to follow the standard guidelines of COVID are prone for acts of prajnaparadha, thus helping the disease to spread more rapidly in the community. Sadvritta, Achara Rasayana, Bramhacharya Palana,[22] and Yoga must be helpful to create awareness so that the spread of this dreaded disease can be controlled to a great extent.

Herbs

Many natural products and herbal ingredients are observed to possess robust antiviral activity and their discoveries can further help develop derivatives and therapeutic leads (e.g., glycyrrhetinic acid derivatives as novel anti-HBV agents, acetoxime derivative from the Mediterranean molluscs Hexaplex trunculus as an inhibitor against HSV-1, and caffeic acid derivatives as a new type of influenza NA antagonist).[23]

Aushadhi yoga (herbal formulations)

Due to the complex composition of multiple phytoconstituents from medicinal plants, the mixture of this combination could modulate multiple proteins and would help to boost the immune system, which can be explained via network pharmacology and gene-set enrichment analysis. Intake of the multiple compounds in the form of herbal tea as suggested by AYUSH could be more beneficial rather than a single molecule for boosting the immune system as a prophylactic against COVID-19 and could be helpful in subjects with comorbid conditions such as diabetes and hypertension in which 4-hydroxychloroquine treatment cannot be proceed.[24]

Rasoushadhies (herbomineral/metallic drugs)

These are mainly prepared from metals, herbomineral drugs, which play a vital role in asymptomatic as well as symptomatic condition of COVID-19 and require in minimal dosage, easy for administration, act as a Rasayana with high potency, and their properties make them more popular, superior over the other medicines.[25] The herbometallic formulations containing gold Bhasma plays a key role in overall efficacy, Research works had been proved that the herbo-metallic formulations containing gold bhasma helps to regulate antigen-specific immune response as nanoparticles of gold possess immunomodulatory, free radical scavenging, antistress, analgesic and antioxidant properties.[26] Mercurial preparation with arsenic along with medicinal herbs makes it less toxic and converts its inorganic nature to organic nature, so it acts as a carrier of herbs in very less dosage.[27] Tamra bhasma increases the defensive mucopolysaccharides including sialomucin and fucose and decreases DNA in gastric juice suggesting decrease in cell shedding and increase in life span of mucosal cells, with no change in mucosal DNA and incorporation of [3H]-thymidine uptake in mucosal tissues, indicating an absence of activity on cell proliferation30. This can be helpful to break sampapti of COVID-19.[28] Shilajit has shown free radical scavenging and antioxidant effect against SO3-, OH radical, and paramagnetic nitric oxide depending on its concentration. Higher concentrations of processed shilajit provided greater free radical protection.[29] Evaluation of anti-histaminic activity of Arsenic compound (malla sindoora) in guinea pigs showed maximum protection at 30 minutes (both plain & vehicle groups). This might be due to the high solubility of arsenic accounting to its quick action, and as rasaoushadhies are said to be aashukari accounting to the quicker action of drug, showed significant relaxation in histamine induced tracheal chain contraction.[18] These dosage forms are useful in respiratory diseases to maintain normal function of Vata, thereby maintaining function of Oja to sustain liveness in human body.

Rasayana (rejuvenation therapy)

Rasayana drugs are capable of impelling the biological systems in a multidimensional manner and it is equally worthwhile to examine them for other effects such as anti-stress adaptogenic and antiviral activities. The Rasayana category contains a plethora as a constituents with similar, synergistic or antagonistic properties.[30] Tinospora cordifolia improves the phagocyte function without affecting cell-mediated and humoral immune systems and also causes inhibition of C3 convertase of the classical complement pathway, hence acts as immunomodulatory.[31] Ayurveda has a treasure of Rasayana drugs, which are mentioned in [Table 1], which are equally effective as immune booster.

Dhoopana (herbal medicated fumigation)

Drugs of herbal, herbomineral, and animal origin containing volatile and antimicrobial constituents are used as single or in combination for Dhoopana purpose. Dhoopanavarthi (fumigation sticks) can be made out of these drugs for easy administration. As microbes or pathogens are microscopic in structures and these are narrated under terms of Bhuta, Graha, Jantu, or Krimi. Dhoopana is the ideal regime to kill such pathogens and to prevent spreading of infectious diseases, especially COVID-19-19 originated from them through contaminated air. The main action and properties of Dhoopana Dravya are antimicrobial, antifungal, and antiviral. Fumigation with the help of these drugs destroys worms and germs in the environment.[32] The hemagglutinin protein of the virus appeared to be a major target of most of these oil vapors, and this may provide therapeutic benefits for people suffering from influenza or other respiratory viral infections. Air sterilization without human health damage using essential oils could be a good way to prevent COVID-19. However, the minimum essential oil concentration needed for SARS-CoV-2 inhibition should be investigated.[33]

Nasya (medicated oil instillation in nose)

Administration of medicated oil, most commonly Anu taila, cleanses the nasal route, strengthens the mucus membrane, strengthens the respiratory tract, and maintains blood flow in the upper part of the neck. Pratimarsha nasya, which is used for nasal instillation on daily basis, helps to prevent all types of respiratory diseases such as breathlessness, sneezing, nasal congestion, runny nose, sore throat, etc., which are common complaints in COVID-19.[34]

Gandusha and kavala (oil pulling)

It involves retention of medicated oil or decoction in the mouth cavity for several minutes. Besides providing comprehensive oral and dental health, Gandusha cleanses the ear, nasal, and throat passages, prevents dryness in the throat, and promotes overall sinus health by preventing infections.[35]

Anjana (eyeliner)

It is Ayurvedic herbal collyrium, which is applied on the inner part of the eyelids. To maintain respiratory health, the immunity of eyes is also crucial. The nasolacrimal ducts act as one of the entry points of viruses that attack the respiratory system. Anjana keeps the eyes lubricated and protects it from environmental chemicals and pathogens.[36]

Ahara (diet)

Charaka has explained shadrasatmaka ahara as balkaranam.[37] To improve immunity, subjects with respiratory diseases are advised to include ginger, turmeric, pepper, cinnamon, or mint in their diet. Consuming Amla (Indian Gooseberry), which contains Vitamin C, helps to boosts immunity. Honey mixed with tulsi juice or ginger juice is beneficial for respiratory tissues. It helps to prevent the formation of phlegm, which seems to be the basic pathology for respiratory diseases.[38]

Yogasana and pranayama (breathing exercise and meditation)

The whole world is familiar with the importance of Yoga for maintaining physical as well mental health. Poor mental health conditions including stress, depression, insomnia, and lack of concentration are known to increase the risk of acute respiratory infections.[39] Rapidly rising numbers of COVID-19 cases and deaths probably raise stress and anxiety, while loneliness, financial burdens, and depressive feelings are likely due to lockdown and mandatory social distancing measures.[40] Consideration of the mind or mental health is another specialty of Ayurveda and Yoga. Several measures for mental health are described, including pranayama and yoga. Pranayama is well recognized to improve lung function. Meditation is helpful to reduce inflammatory markers and influence markers of virus-specific immune response.[41] Yoga with pranayama could be a simple, useful, costless home-based practice for the prevention and post-recovery management of COVID-19.[42]


  Discussion Top


COVID-19 and its aftermath have come with many inevitable eventualities. Modern medicine fails to provide any evidence-based treatment for COVID-19, yet clinical interventions are being done worldwide. A similar strategy is required to be implemented by the Ayurveda system of medicine. Recent data suggested that all patients suffering from COVID-19 not require hospitalization or intensive management. These patients can be categorized as asymptomatic, mild symptomatic, and symptomatic requiring hospitalization without intensive care unit (ICU) and hospitalization requiring intensive care. If we look at the potential of Ayurveda medicines, first three category patients can be very well managed. For patients requiring ICU management, the integrative approach should be acquired. In diseases of Pranavaha srotasa, there is the active involvement of Kapha along with Vata and Pitta. So for, scrapping of Kapha and Karshana chikitsa is needed, followed by Brimhana chikitsa to overcome the erosion caused due to disease. Another way through which Ayurveda can be helpful to prevent this pandemic is by boosting immunity, use of medicated mask, use of herbal disinfectant, and maintaining mental health by yoga and pranayama.

Charaka explained the management of Janapadodhwansa Vayadhi as intake of Rasayana, administration of the drugs that are collected before the occurrence of pestilence, Sadvritta palana, Achara Rasayana, and Dharma palana. Ayurveda has a huge potential in preventive as an immunity booster and curative as epidemic management to prevent disease and arrest its progress to maintain health in this pandemic. Strength building of mind and body to cope with various stressors, including infection, is a cornerstone of Ayurveda practice. Similar to innate and acquired immunity, the concept of immunity (Bala or strength) in Ayurveda is classified as natural (Sahaja), chronobiologic (Kalaja), and acquired (Yuktikrita). The holistic approach of Ayurveda toward promoting health (Swasthavritta) includes personalized intrusions based on host and environmental factors. The interventions include therapeutic cleansing procedures known as Panchakarma and certain immunomodulators (known as Rasayana). Local and systemic interventions to boost the immune system have been encouraged to manage respiratory illnesses.[43] Acharya Chakrapanidatta has explained the concept of immunity as “Vyadhikshamatwa” and interpreted the term Vyadhiksamatwa as Vyadhi bala Virodhitwa, i.e., antagonistic to the strength and virulence of the disease and Vyadhyutpada Pratibandhakatwa, i.e., the capacity to inhibit and bind the causes and factors of the disease.[44]

Dietary regimen, herbal and herbo-mineral medicines along with fumigation for quarantine, and asymptomatic and symptomatic COVID-19 patient's ward against COVID-19 could be used to prevent or cure COVID-19 in following sutras as:

(1) Use of food and herbs as diet or supplement to prevent infection and strengthen immunity; (2) use of masks coated with an antiviral agent such as tulasi and guduchi; (3) use of an air disinfectant (essential oil) to stop aerosol transmission, for example, Karpuradi oil; and (4) use as a surface sanitizing agent to provide a disinfected environment.[45]

Very well mentioned in our classics about lack of “Rajashraya” is one of the important causes for deterioration of Ayurveda. Hence, in today's situation, support of Raja, i.e., government, is needed to flourish our nation or humanity with a treasure of Ayurveda. The world's oldest living health-care system originated in India; therefore, it is carefully watched by the world community for how it handles the crisis, using its own resources.


  Conclusion Top


The pandemic by COVID-19 is a burning issue affecting people worldwide. There is an urgent need to develop effective therapies to combat the worst situation. Ayurveda has enough potential and possibilities to be applied for prevention as well as treatment of COVID-19. Without wasting time on discussing pros and cons related to the traditional Indian system of medicine, a nationwide trial should be conducted. Increasing cases of COVID-19 is not a good sign for human or health care, but it is giving a platform to prove the safety and efficacy of Ayurveda to create credible evidences and researchers have to work on it vigorously.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
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