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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 14  |  Issue : 4  |  Page : 64-67

COVID-19: An ayurvedic appraisal


Department of Roga Nidana Avum Vikriti Vigyana, Institute for PG Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Submission06-Aug-2020
Date of Decision05-Oct-2020
Date of Acceptance07-Oct-2020
Date of Web Publication28-Dec-2020

Correspondence Address:
Darshna H Pandya
515, Department of Roga Nidana Avum Vikriti Vigyana, Institute for PG Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_200_20

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  Abstract 


Introduction: The novel coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness, transmitted by breathing of or contact with infected droplets and the clinical features characterized by a variable degree of severity of symptoms, ranging from a mild upper respiratory tract illness to severe interstitial pneumonia and acute respiratory distress syndrome. As of mid of August 2020, this has been spread to 218 countries with more than two billion confirmed cases, including near about 7.5 lakh deaths. Objectives: The aim was to understand the disease COVID-19 in Ayurvedic phraseology. Material and Data Source: To fulfill the aim, Ayurvedic classical literature starts from Brihatrayee to Siddhanta Nidana (by Gananath Sen) has been referred and published literature available on COVID-19 was searched out from PubMed search. Results: No one to one match of the disease found in Ayurveda, but on the basis of scattered references regarding Jwara and Janapadodhvamsa, an attempt has been made to understand COVID-19 in Ayurvedic phrasing. Conclusion: The disease COVID-19 may be categorized as Vayu-Kapha predominant Sannipataja Agantuja type of Jwara.

Keywords: Agantuja jwara, COVID-19, Janapadodhwamsa, Jwara, Sannipataja


How to cite this article:
Pandya DH. COVID-19: An ayurvedic appraisal. J Ayurveda 2020;14:64-7

How to cite this URL:
Pandya DH. COVID-19: An ayurvedic appraisal. J Ayurveda [serial online] 2020 [cited 2021 Jan 22];14:64-7. Available from: http://www.journayu.in/text.asp?2020/14/4/64/304903




  Introduction Top


The novel coronavirus disease (COVID-19) has been identified as the cause of an outbreak of respiratory illness in Wuhan, Hubei Province, China, beginning in December 2019. As of August 13, 2020, this epidemic has spread to 218 countries with more than two billion confirmed cases, including near about 7.5 lakh deaths.[1] The WHO has declared it a Public Health Emergency of International Concern. It is an ongoing outbreak of lower respiratory tract disease initially identified as novel coronavirus pneumonia and renamed as COVID-19 by the World Health Organization. Out of seven detected species of coronavirus, three species, i.e., SARS-CoV, Middle East respiratory syndrome coronavirus, and SARS-CoV-2 (recent one) cause severe disease, whereas the rest of four, i.e., HKU1, NL63, OC43, and 229E are associated with mild symptoms like rhinitis.[2] The infection is transmitted by the breathing of or contact with infected droplets and the clinical features characterized by a variable degree of severity of symptoms, ranging from a mild upper respiratory tract illness to severe interstitial pneumonia and acute respiratory distress syndrome.[3],[4],[5] Adverse outcomes of COVID-19 are associated with comorbidities, including hypertension, cardiovascular disease, and lung disease.[6]

The virus transmits and migrates down the respiratory tract along the leading airways, and a more robust innate immune response is triggered.

The spike of coronavirus comprises two functional subunits S1 and S2 that are responsible for binding to the host cell receptor and the fusion of the viral at cellular membranes, respectively. Fusion of fractional subunits of Virus with human cell membrane leads to irreversible changes in ACE2 enzyme and now the enzyme find as functional receptors for SARS CoV-2. This ACE2 has been identified as a functional receptor for SARS-CoV-2[7] which is highly expressed on lung epithelial cells, heart, kidney, and bladder.[8]


  Clinical Manifestation Top


According to the US CDC, symptoms present at the onset of COVID-19 are highly variable. However, in the stage of full-blown disease, 83%–99% of patients develop fever, 59%–82% have dry cough, 44%–77% have fatigue, 40%–84% have anorexia, 31%–40% of patients have shortness of breath, 28%–33% of patients have sputum production, and 11%–35% of the patients have myalgia.[9] Out of that fever, sore throat and dry cough are considered as cardinal symptoms of the disease. CDC further added chill, headache, and tastelessness. Studies shows that Diarrhoea and hemoptysis like atypical symptoms are also found in COVID-19 patients.[10],[11] However, these are seen only in <10% of the cases. Same way skin eruptions are also found in more or less the same number of cases.[12] These descriptions are similar to the findings of the study done by the World Health Organization-China Joint Mission on COVID-2019 on 55,924 confirmed cases of COVID-19.[13] The prognosis of this disease remains poor in the individuals who are over 60 years of age, having comorbidity conditions such as hypertension, diabetes, cardiovascular disease, chronic respiratory disease, and cancer.[14]

The US CDC classifies COVID-19 into the following categories based on the severity of the presentation.

  • Mild to moderate (mild symptoms up to mild pneumonia): 81% of the patients
  • Severe (difficulty in breathing, hypoxia, or >50% lung involvement on imaging): 14% of the patients
  • Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%



  Classical Understanding of the Disease COVID-19 Top


To have Ayurvedic appraisal of the disease COVID-19, the author gone through major classical texts such as Charak Samhita, Sushrut Samhita, along with its chief commentary like Chakrapani, Dalhana, literature of the middle era like Madhav Nidana, Bhav Prakash, and further Siddhant Nidana by Kaviraj Gananath Sen. To enrich the information, published article on PubMed was searched with the word “COVID-19 Ayurveda.” A total of 20 articles were found. To search articles related to current epidemiology, the word COVID-19 was used in the PubMed search engine and more than 7000 articles were found for the same.


  Observation Top


While going through Ayurved classical text, it is found that Acharya Gananath Sen has described Shwasanak Jwara (pneumonia) in detail which met with the presentation of COVID-19 one to one. Though Kaviraj Gananath Sen has narrated Shwasanaka Jwara very clearly, but as the text is of Early years of 20th century; hence may be written under influence of Modern medicine and hence may not be considered as pure Ayurveda classical text. Hence its description was not considered while explaining classical explanation. Hence, it has not been considered here. In BhavaPrakash Uttarakhand Jwaradhikara Snnipataja Jwara like Karkataka, Vispharaka Sannipataja Jwara having little similarity with COVID-19, but no one to one correlation can be made with any single Jwara. Hence, it became necessary to search out the root from Brihatrayee. On the basis of available references in classics appraisal of COVID-19 in Ayurvedic perspective is explained in forthcoming paragraphs.

As per the pattern of spread the condition must be understand on the basis of Janapadodhvamsa.[15] Moreover, hence, the factors like any kind of faulty act (Adharama/Pragyaparadha) (here eating animals that too affected with virus) make the person diseased. The disease may get spread by vitiated Vayu one of the key factors to make the condition epidemic. As Vayu gets vitiated and becomes toxic in the cold atmosphere and junction of two seasons,[16] these toxins spread by aerosol/droplets (Vayu) through entering in the nasal pathway of the person and manifest cough (Kasa), breathing difficulty (Shwasa), rhinitis (Pratishyaya), headache (Shiroruja), and fever (Jwara) like features.[17] Here, further anosmia (Gandhagyan), dizziness (Bhrama), should also be considered as symptoms.[18] As it exhibits irrespective of Dosha and Prakriti of the person, it should be considered as infectious (Aupasargika) type of disease and hence different way for the spread of infection like, frequent exposure with suffer, to stay and/or share food, bed, clothes, etc., are the prime causative reasons to spread the disease, hence avoid direct or indirect contact and stay away from the area is the primary solution to be free from the same.[19]


  Clinical Aspect Top


As fever is the primary and most frequently seen symptom of COVID-19, it should be understood under the umbrella of disease Jwara. Shushruta has listed Jwara under the infectious disease list and out of eight broad categories of fever, Agantuja Jwara is caused by external agents. Abhiṣaṅgaja Jvara is one of the subcategories of Agantuja Jwara which includes a subtype of fever called Bhutabhiṣaṅgajvara.[20] Cakrapaṇidatta clarifies that Bhuta means Viṣakṛmi (virulent microorganisms). When a person gets infected with such krimi, may develop Bhutabhishangaj Jwara and all Bhutabhisangaja diseases are Sannipataja in nature.[21],[22]

As the disease is exogenous in origin, only uneasiness (Vyatha)[23] along with symptoms of invaded organ/system can be there as primary manifestation[24] and that remains for 3 to 7 days[25] after that involved Dosha symptoms start to manifest. This time period should be considered as the incubation period of the virus. Although it is an exogenous type of disease, the line of management also differs from the endogenous type of fever.[26] Majority of symptoms of Sannipataja Jwara[27] were found in COVID-19.


  Presentation Variation Top


One more important thing to be discussed here is about the stages of severity found in different patients of the disease. As mentioned earlier, more than 88% of COVID-19 patients show mild to moderate kind of disease, about 20% need hospitalization and only 5% of the cases need critical care. This happens due to the presence or absence of Vikara Vighata Bhava in that particular person. This is the factor of the body that allows developing mild, moderate, or severe intensity of the disease.[28] Though the sentence means that balanced status of Dosha, Dhatu and Mala will have good inner strength (as per definition of Swastha) and hence mild presentation of disease or asymptomatic may be there even after infection. Just opposite to that weaker quality of Dhatu and imbalanced status of Dosha can lead to life-threatening condition and likewise. Hence, the response of the host toward the exposure decides the intensity. This can be explained in terms of Pratyaneeka Bala (resistance toward disease) that has been given due importance in each stage of diseases.[29]


  Dosha Involvement Top


On the basis of presentation and progress of the disease, it can be considered as Vayu-Kapha predominant Pitta associated Sannipataja Jwara. If Kapha gets dried up by extreme heat of fever (Ushna property of Pitta); that will lead to creation of more dryness in the throat and lungs, hence the patient develops extreme sore throat with dry cough and damage of interstitial tissue of the lungs.[30]


  Prognosis Top


Kapha is the basic strength of the body. With due course of the disease, if it gets dried up (as mentioned above), the patient may be at risk. As per the common phenomenon, the presence of all the symptoms along with high-grade fever, cessation of digestive fire, and insufficient elimination of Mala, association of Shwasa (severe hypoxia), leads to worse prognosis.[31]


  Conclusion Top


On the basis of this brief analysis, the condition COVID-19 can be classified as Agantuja Jvara with Vayu-Kapha predominant Sannipataja presentation. The dominance of Pitta is seen in the later stages of the disease.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

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WHO COVID-19 Situation Report 205. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports/. [Last accessed on 2020 Aug 13].  Back to cited text no. 1
    
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Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med 2020;26:450-2.  Back to cited text no. 2
    
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Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 3
    
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Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature 2003;426:450-4.  Back to cited text no. 7
    
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Zou X, Chen K, Zou J, Han P, Hao J, Han Z. Single-cell RNA-seq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to 2019-nCoV infection. Front Med 2020;14:185-92.  Back to cited text no. 8
    
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Joshi S, Bhatiya A, Tayal N, Nair D. Hemoptysis as an initial presentation of COVID-19 – An bservation. Journal of the Association of Physician of India 2020. Available from: https://www.japi.org/v2c49454/hemoptysis-as-an-initial-presentation-of-covid-19-an-observation. [Last accessed on 2020 Aug 15].  Back to cited text no. 11
    
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Puthiyedath R, Kataria S, Payyappallimana U, et al. Ayurvedic clinical profile of COVID-19 - A preliminary report. Journal of Ayurveda and Integrative Medicine 2020:1-14.  Back to cited text no. 12
    
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Report of the WHO-China Joint Mission on Coronavirus Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). Available from: https://www.who.int/docs/default source/coronaviruse/who-china-joint-mission-on-covid-19-final report.pdf. [Last accessed on 2020 Aug 17].  Back to cited text no. 13
    
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Goyal M. Strategies and avenues for COVID – 19 – Ayurveda perception. AYU 2019;40:139-40.  Back to cited text no. 14
  [Full text]  
15.
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Dalhan on SushrutSamhita, Sutrasthana, Rituchatyamadhyayam, 6/19. Available from: http://niimh.nic.in/ebooks/eshushruta. [Last accessed on 2020 Aug 10].  Back to cited text no. 18
    
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21.
Chakrapani on Charak Samhita, ChikitsaSthana, Jwarachikitsa 3/111-113. Available from: http://niimh.nic.in/ebooks/echarak. [Last accessed on 2020 Aug 10].  Back to cited text no. 21
    
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SushrutSamhita, UaraTantra, Jwarapratishedhadhyaya, 39/65. Available from: http://niimh.nic.in/ebooks/eshushruta. [Last accessed on 2020 Aug 10].  Back to cited text no. 22
    
23.
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29.
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30.
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31.
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Abstract
Introduction
Clinical Manifes...
Classical Unders...
Observation
Clinical Aspect
Presentation Var...
Dosha Involvement
Prognosis
Conclusion
References

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