|Year : 2020 | Volume
| Issue : 4 | Page : 49-53
Management approach to Covid-19 associated upper respiratory tract infection in Ayurveda: A review study
Gulab Chand Pamnani, Prabhakar Vardhan, Rajendra Kumar Soni
Department of Shalakya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India
|Date of Submission||07-Aug-2020|
|Date of Decision||12-Oct-2020|
|Date of Acceptance||19-Oct-2020|
|Date of Web Publication||28-Dec-2020|
Gulab Chand Pamnani
National Institute of Ayurveda, Jaipur, Rajasthan
Source of Support: None, Conflict of Interest: None
Introduction: The outbreak of COVID-19, a global pandemic is extraordinarily contagious, and its fast spread has affected more than 180 countries and has made the containment difficult. It is imperative to have proficient therapeutics to manage the current and upcoming situation. Unfortunately, no acceptable treatment protocol has been developed yet. On the other hand, a number of clinical entities have been described in detail with their treatment in Ayurvedic classics which closely resemble various presentations of COVID 19 infections. Material and Methods: A meticulous search of classic Ayurvedic texts, available contemporary literature pertaining to COVID 19 as well as clinical wisdom of stalwarts of Ayurveda was analysed to draw safe and effective treatment protocols as per presentation of the disease. Results and Discussion: Treatment protocols for COVID 19 with special reference to upper respiratory tract infections as detailed in Ayurveda have been developed and leads from these protocols can be utilized for the better management of COVID 19 related ailments and post COVID 19 complications.
Keywords: Ayurveda, AYUSH, Chikitsa, COVID-19
|How to cite this article:|
Pamnani GC, Vardhan P, Soni RK. Management approach to Covid-19 associated upper respiratory tract infection in Ayurveda: A review study. J Ayurveda 2020;14:49-53
|How to cite this URL:|
Pamnani GC, Vardhan P, Soni RK. Management approach to Covid-19 associated upper respiratory tract infection in Ayurveda: A review study. J Ayurveda [serial online] 2020 [cited 2021 Jan 19];14:49-53. Available from: http://www.journayu.in/text.asp?2020/14/4/49/304909
| Introduction|| |
COVID-19, better contemplated as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is a pandemic that has gripped almost the whole of the globe with its rapid infective spread. The infamous virus has continuously been evolving, making its containment difficult. However, several kinds of research have been going on to obtain information and develop treatment protocols. However, no firm evidence has been obtained; it is assumed that coronavirus originated as a result of zoonotic transmission. However, it is not clear that how did the virus travel to human populations, the virus is highly contagious with humans as the primary host, and human-to-animal transmission has also been reported in some countries. Previously, we have witnessed that the viruses from the coronavirus family have caused acute respiratory syndromes such as severe acute respiratory syndrome and Middle East respiratory syndrome, which have case fatality rates of 9.6% and 34.3%, respectively, which is far more than the case fatality rate of COVID-19, which ranges from 1.38% to 3.4%. However, the number of fatalities has been higher in the case of COVID-19. Higher fatalities in COVID-19 cases could be due to the high R0 (reproductive number) of this disease; various independent studies have shown that the average R0 for COVID-19 is 3.28, and this score exceeds the World Health Organization's estimate of 1.4–2.5. COVID-19 has spread over 180 nations, with India among the countries with the highest number of cases which can also be contributed to its high population density as seen in studies and believed by epidemiologists and medical professionals, that is, this disease possesses too high contagiousness and has a rapid spread with symptoms ranging from mild cold and cough to severe pneumonia. At the same time, some infected persons can remain asymptomatic. Measures such as quarantine, social distancing, and using masks are the application of the Ayurvediya siddhanta of nidana parivarjana. When we consider the spread of infection, it is notable that the concept of ”Aupsargika Roga” has already been expounded and established by Ayurveda much earlier before the existence of modern medical sciences. The prasarana hetu such as satra-sansparsha and nishwasa matches accurately with modes of transmission of the virus. In the current scenario, it becomes imperative to explore and appreciate this concept for obtaining targeted treatment strategies to handle the situational needs of the COVID-19 disease.
| Modes of Transmission|| |
There are two modes of transmission of the infection:
- Direct mode – Respiratory droplet nuclei and aerosols, body fluids such as saliva, mother to fetus
- Indirect mode – Surfaces and fomites which have come in contact with an infected person, objects used by/on the infected individual.
| Who is at Risk?|| |
- Health-care professionals and other frontline workers who remain exposed to the infection are at high risk
- People who have come in contact with a COVID-19-positive individual
- People with comorbidities such as hypertension, diabetes, hyperlipidemia, cardiovascular diseases, renal diseases, chronic obstructive pulmonary disease, and other lung diseases, cancer, dengue
- Patients who are undergoing chemotherapy, taking steroids for a long time, and transplant recipients
- Smokers and drug abusers
- Malnourished individuals and people in their sixth decade of life
- Anatomical abnormalities of upper airways
- People who do not follow the prevention and safety guidelines issued for COVID-19.
| Sign and Symptoms|| |
- Cough cold, fever, chills, runny nose, nasal obstruction, sore throat, headache, upper respiratory tract infection (URTI)
- Difficulty in breathing and chest pain are most common symptoms often associated with critical cases
- Severe respiratory distress, pneumonia, and multiple organ failure
- Anosmia and loss of sensation of taste are two symptoms which are found to be associated with individuals who later on tested to be positive for the infection, most of such patients are either asymptomatic or have mild symptoms. Presence of these symptoms could prove helpful in the early screening of the patients and initiate isolation
- Acquired secondary infections.
| Classification|| |
There has been no official classification created for COVID-19 yet. However, an effort has been made by Chinese researchers to categorize the disease on the grounds of the severity of clinical manifestations.
- Mild to moderate – No pneumonia and/or mild pneumonia
- Severe – Increased respiration frequency, increase in lung infiltrates, respiratory distress, and decreased blood oxygen saturation
- Critical – Severe pneumonia, multiple organ failure, and respiratory failure.
Most of the patients show no symptoms or show symptoms ranging from mild to moderate and do not require hospitalization and recover simultaneously.
Other criteria that can be taken into consideration for classification are sepsis or septic shock, along with the severity of respiratory insufficiency and multiple organ failure when the clinical manifestations tend to worsen all of a sudden.
| Diagnostics|| |
- Rapid antigen detection test
- Reverse transcription-polymerase chain reaction
- X-ray chest, computed tomography chest
| Treatment|| |
Multiple studies and trials are being conducted by the AYUSH systems which have provided abundant evidence; also Ayurvedic Chikitsa has been officially incorporated in the treatment protocols for COVID-19.
The first and foremost measures to be taken must be preventive, which are stated below:
- Maintaining social distancing – Unnecessary gatherings and crowds should be avoided
- Reporting the incidence – If an individual has symptoms, then he/she should immediately consult a physician and follow the guidelines provided, a self-isolation is considered ideal in such situations
- Hygiene – Washing hands frequently with soap and alcohol-based sanitizers (ideally alcohol content should be 70%) is a good practice, and using soaps to clean hands is considered to be better as compared to sanitizers.
- Touching the face should not be done
- Physical touch should be avoided; spitting in public is strongly discouraged
- Gloves should be used whenever possible
- Respiratory hygiene must be followed strictly, and face masks and face shields should be used
- Proper sanitizing of most commonly touched surfaces and objects must be done.
- Gargles with Koshna Saindhava Lavana and Triphala, Madhudaka should be done
- Pratimarsha Nasya should be administered
- Immunity-boosting herbal formulations such as Chyawanprasha, Amlaki, Guduchi, and golden milk should be consumed as suggested by the AYUSH Ministry
- A healthy nutritious diet should be taken, along with regular exercise and proper sleep.
Treatment protocols have been specifically designed for various levels of the progression and severity of the disease.
- Uncomplicated illness: Lakshnika Chikitsa is advised in this phase.
In the case of Jwara and Angamarda Pradhanta, Yogas such as Mahasudarshana Ghana Vati, Sanjivani Vati, and Pathyadi Kashayama must be administered.
When Shwasa Kasa Pradhana Lakshana manifest, Trikatu Siddha Jala, Vyaghri Haritaki Leha, Shadanga Paniya, and Shwasa Kuthara Rasa should be administered.
If the patient complains of myalgia, then Rasanasaptaka Kwatha should be administered.
- Mild pneumonia: In the case of dyspnea, Dhanwantra Ghrita, Somasava, Dashmularishta, and Sameerpannaga Rasa should be administered
- Pneumonia comprising Lakshana of Shwasapradhana Kasa should be treated with Sanjeevani Vati, Agastya Haritaki, Vasakasava, and Chandramrita Rasa
- Acute respiratory distress syndrome should be treated with Shwaskuthara Rasa, Mallasindoora and Saidhavadi Taila should be massaged on the chest, and then Nadi Swedana should be done
- Vulnerable sections and people with co-morbidities must be treated according to the issued guidelines and based on the circumstantial needs
- A posttreatment restorative health-care regimen has been designed specifically for managing adverse effects which the patient has faced during infection. Formulations which should be administered in the initial stage are Indukanta Kashayam and Amritarishta, and Rasayana such as Vasanta Kalpa, Drakshadi Leha can be used. Specific compounds have been advised for targeted organ healing and protection such as Ashtachurna for improving digestion, Kalamegha Churna for hepatoprotective action, and Chandraprabha Vati and Rasayana Churna for the kidneys.
It is imperative to monitor and decided the dose, duration, Anupana, and Snehpana for each person monitored by a physician as per the issued guidelines.
| Proposed Treatment Protocols for the Management of COVID-19-Associated Upper Respiratory Infections|| |
Treatment modalities for URTIs according to the area involved are as under:
- In the initial stage (congestion of nasal mucosa and throat)
- Langhana 3–5 days
- Pepper + ginger juice with honey
- Ushna Jala Sevana
- Milk processed with ginger and turmeric
- Runny nose, throat discomfort, and congestion
- Gojihwadi Kwath 20–40 mL 2 times a day on an empty stomach.
- Sitopaladi Churna 3 g, Shuddha Tankana Bhasma 250 mg, Yashtimadhu Churna 1 g, Godanti Bhasma 250 mg, and Giloy Satwa 500 mg with honey two times a day
- Nardiya Laxmivilas Rasa 250 mg with lukewarm water two times a day after breakfast
- Samsahamni Vati 2 tablets two times a day with lukewarm water
- Gargles with Tankana Bhasma
- Instillation of normal saline (saltwater) processed with turmeric
- Add Haridrakhanda 3–5 g with water two times a day if sneezing present.
- If tonsils are congested and enlarged
- Gojihwadi Kwath 20–40 mL 2 times a day on an empty stomach
- Sitopaladi Churna 3 g, Shuddha Tankana Bhasma 250 mg, Yashtimadhu Churna 1 g, Kaparda Bhasma 250 mg, Sanjeevani Vati 250 mg, and Giloy Satva 500 mg with honey two times a day
- Kanchnar Guggulu 2 tablets + Nardiya Laxmivilas Rasa 250 mg with lukewarm water two times a day after breakfast
- Powder of Guduchi, Gokshura, and Amalakieach 1 g with honey on an empty stomach
- Samsahamni Vati 2 tablets two times a day with lukewarm water
- Gargles with Tankana Bhasma
- Instillation of normal saline (saltwater) processed with turmeric in nostrils
- Golden milk at bedtime.
- If the middle ear is involved (otitis media)
- Gojihwadi Kwath 20–40 mL 2 times a day empty stomach
- Sitopaladi Churna 3 g, Shuddha Tankana Bhasma 250 mg, Yashtimadhu Churna 1 g, Shataputi Abhraka Bhasma 250 mg, Vishana Bhasma 250 mg, and Giloy Satwa 500 mg with honey two times a day
- Kaishor Guggulu 2 tablets + Nardiya Laxmivilas Rasa 250 mg with lukewarm water two times a day after breakfast
- Samsahamni Vati 2 tablets two times a day with lukewarm water
- Powder of Guduchi, Gokshura and Amalaki each 1 g with honey on an empty stomach.
- Jatyadi Taila Pichu in Ear canal for 30–60 minutes 2 times a day
- Instillation of normal saline (saltwater) processed with turmeric in nostrils.
| Home Remedies for Upper Respiratory Tract Infections Associated with COVID-19|| |
- Steam inhalation
- Drinking warm beverages such as hot tea, warm water, hot chocolate, and warm milk
- Using a vaporizer to increase humidity in the room
- Avoid cold, dry air if possible
- Apply warm salt water (inhale) in the nostril to relieve nasal congestion
- Repeated application of a warm pack (a warm well towel or washcloth) to the face
- Saltwater gurgles and lozenges may reduce throat irritation and dryness
- Cough can be curbed by limiting exposure to irritants, such as cold weather, dust, and pollution
- Sleeping in a semi-upright or prone position may be helpful to reduce cough
- Intake of honey may reduce cough in children with an upper respiratory infection
- Adequate hydration with water, juices, and non-caffeinated drinks can thin nasal secretions and replace the fluid losses
- Intake of herbal tea prepared using Tulsi leaves, Shunthi, Dalchini, Giloya, Maricha, Munakka, and lemon.
| Discussion|| |
COVID-19 is an extremely contagious disease which might prove to be fatal. In addition, patients who recover are left with organ damages, specifically lungs and other adverse side effects. It has not only just affected physical health, but it has also caused a state of panic and tension, causing behavioral changes and anxiety problems. Therefore, both the administration of herbal formulations along with workouts and counseling is advised.
People with comorbidities are most at risk; hence, special attention should be given to them.
Simple techniques such as proper hand washing, covering face while coughing or sneezing, self-quarantine, and rest may reduce the spread of respiratory tract infections. Increased intake of oral fluids is also beneficial to keep up with the fluid loss from a runny nose, fevers, and poor appetite.
Golden milk, food items containing Vitamin C and E, zinc and calcium, proper and healthy diet, daily instillation of oil in nostrils, oil pooling, and Pranayama are also beneficial in COVID-2-associated URTIs.
| Conclusion|| |
COVID-19 is a highly infective global pandemic that produces symptoms ranging from mild to severe and associated with systemic and neurological complications as suggested by studies. Symptoms such as loss of sensation of smell and taste might be helpful in the screening of asymptomatic individuals. Ayurvedic medicines have been found to effective both in providing immunity and treating the virus backed up by the evidence from the studies; these formulations are readily available and cost-efficient with the foremost benefit of being safe. Therefore, these formulations can easily be distributed and can be utilized by almost all the sections of society and form an essential tool for fighting against COVID-19.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Liu Y, Gayle AA, Wilder-Smith A, Rocklöv J. The reproductive number of COVID-19 is higher compared to SARS coronavirus. J Travel Med 2020;27:taaa021. doi: 10.1093/jtm/taaa021. PMID: 32052846; PMCID: PMC7074654.
Zhou F, Yu T, Du R, Fan G, Liu F, Liu Z, et al
. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.
Spinato G, Fabbris C, Polesel J, et al
. Alterations in Smell or Taste in Mildly Symptomatic Outpatients with SARS-CoV-2 Infection. JAMA 2020;323:2089-90. doi:10.1001/jama.2020.6771.
Wu Z, McGoogan JM. Characteristics of and important lessons from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42.
Cascella M, Rajnik M, Cuomo A, Chand PG, Prabhakar V, Kumar SR, et al
. Features, Evaluation, and Treatment of Coronavirus (COVID-19). In: Statpearls. Treasure Island (FL): Statpearls Publishing; 2020. [Last updated on 2020 Aug 10].
Ministry of AYUSH Guidelines for Ayurveda Practitioners for COVID-19. [Last accessed on 2020 Sep 27].