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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 5-8

COVID-19 prevention through Ayurveda: A literature review


Lecturer, Department of Samhita and Siddhant, North Eastern Institute of Ayurveda and Homoepathy, Shillong, Meghalaya

Date of Submission20-Mar-2021
Date of Decision23-Mar-2021
Date of Acceptance25-Mar-2021
Date of Web Publication09-Jul-2021

Correspondence Address:
Dr. Sikha Lekharu
House No. 26, B.R.B Road, Happy Villa, Uzanbazar, Guwahati, Assam
Meghalaya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AYUHOM.AYUHOM_22_21

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  Abstract 


The pandemic disease of late 2019-2020 is not unknown to anyone. Severe acute respiratory syndrome-coronavirus-2 or COVID-19 has created havoc globally. Much fast-track research in clinical trial is going on worldwide, but till now, no such successful outcome achieved against this virus. The mutagenic strains of the virus are significantly causing difficulty in understanding the course of the disease and different trials and hypothesis are coming in front. Different preventive aspects of the disease have been discussed and advised by the scientist worldwide. The present review paper aims at focusing on the traditional beliefs of Ayurveda and its role in developing immunity for the prevention of infection by this virus. The role of food, proper sleep, and Yoga in immunomodulation has been discussed in detail in relation to prevention from COVID-19 in specific and seasonal viral diseases in general.

Keywords: Ayurveda, COVID-19, prevention


How to cite this article:
Lekharu S. COVID-19 prevention through Ayurveda: A literature review. AYUHOM 2020;7:5-8

How to cite this URL:
Lekharu S. COVID-19 prevention through Ayurveda: A literature review. AYUHOM [serial online] 2020 [cited 2021 Oct 25];7:5-8. Available from: http://www.ayuhom.com/text.asp?2020/7/1/5/321040




  Introduction Top


Severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) or COVID-19, the pandemic of late 2019, is creating a global health threat with involvement of health practitioners all over the globe to understand the nature of the disease and to find out ways to have a control over the disease and in the long run, thereby eradicating the disease. Novel diseases are not new to the human civilization and many vaccines and medicines were result of the vigorous inputs put forward by the medical fraternity through various trial and error experiments. Along with the contemporary clinical trials and vaccine development procedures being taken across different continents, traditional health-care systems are also being evaluated in different countries. In India too, the Ministry of AYUSH has taken up various steps for evaluating the prophylaxis of Ayurvedic drugs in combating the disease spread by acting on the immune modulation. In this paper, we are discussing the probable role of immune modulation through diet, yoga, and sleep in COVID-19 through reviewing available scientific articles.


  Materials and Methods Top


  1. All the available text of modern medicine and Ayurveda classics has been reviewed
  2. Electronic databases such as e-books, journals, and PubMed were being studied for writing this review article.



  Discussion Top


Role of immune response in COVID-19

Ayurveda describes about the role of immune modulation through various concepts of Vyadhiksamatwa, Prakriti Bala, Rasayana drugs, Ahara (food), and Nidra (sleep). The novel COVID-19 has different hypotheses till date. One of them is preventing the occurrence of COVID-19 through immune modulation. Ministry of AYUSH, Government of India, has also initiated various measures to combat this disease through Ayurveda prophylaxis using various drugs which has proven immunomodulatory activity. Understanding the etiopathogenesis of COVID-19, the role of immune modulation cannot be ignored.

The clinical features of SARS–COV-2 have severe involvement of the lower respiratory tract leading to an acute respiratory syndrome. It has been postulated that there is a systemic elevation of the pyrogenic cytokines such as interleukin-6 (IL-6), IL-10, tumor necrosis factor-α (TNF-α).[1] Even the treatment proposed for chloroquine, the previous studies show that chloroquine's immunomodulation depends on the suppression of cytokines (IL-6 and TNF-α).

SARS-COV being a viral infection, in vitro studies have found that SARS-COV infection initiates a pro-inflammatory cytokine response at 24 h post infection, but interferons (IFNs) and stimulated genes (ISGs) are delayed in expression until 48 h post infection.[2] The association of SARS-COV with aberrant cytokine, chemokine, and IFN ISG responses in patients provided evidence that SARS-COV pathogenesis is at least partially controlled by innate immunity signaling. Using models for SARS-COV infection, key components of innate immunity signaling pathways have been identified as protective factors against SARS-COV disease.

In many viral infections, the antiviral cytokine IFNs act not only to control viral infections but also to program the adaptive immune response to promote viral clearance. In the global Bacillus Calmette–Guérin vaccine (BCG) vaccine coverage relevant to the progression of SARS-COV-2 pandemic, Mayda Gursel I[3] and Mantlo E, Bukreyeva N, Maruyama J, Paessler S, Huang C have suggested that BCG vaccines[2] work effectively in acute respiratory tract infections mediated via induction of the innate immune memory of trained immunity, as was first proposed by Netea and collaborators.

Based on the above theories, we are exploring the probable role of immunomodulators described in Ayurveda which may be helpful in the prevention of COVID-19 outbreaks.


  Hypothesis: Role of Ayurveda in Combating COVID-19 Top


Ayurveda sites certain concepts on targeting a disease management by uplifting the immunity of a person through use of various Dravyas (Substances)- pharmacological activity and nonpharmacological activity. Among the tri-dandas (concept of three factors which is responsible for keeping the Tri-dosas in homeostasis), Ahara (food) and Nidra (sleep)[4] along with Yoga will be discussed in context to the proposed hypothesis.

Immune modulation by Ahara

Ahara (food) plays a very pivotal role in maintaining our body's homeostasis through diet-health linkage and helping the body to fight against microorganisms. Traditional eating and preparing food has proved to curb much seasonal flu-like ailments. Coronaviruses are believed to be active every year during late November and symptoms may be there in during February–March.[5] Based on the influence of the season, there are different combinations of the doshas which are aggravated during a particular time of the year. The concepts of Panchakarma (biopurification) measures may be done to prevent the occurrence of many seasonal diseases. The role of some herbs and food products used in Indian traditional culture helping immunomodulation is discussed after doing systematic analysis in PubMed and Google Scholar.

  1. Eleven papers were found on Guduchi (Tinospora cordifolia) and its significant role in immunity. In reverse transcription–polymerase chain reaction analysis, the expression of cytokines, namely IL-2, IL-10, and TNF-α was more in Tc-treated animals than vehicle and cyclophosphamide treatment. T. cordifolia and its constituents have been shown to possess immune-stimulating properties.[6] T. cordifolia and its constituent α-D-glucan stimulate natural killer (NK) cells, B-cells, and T-cells with simultaneous production of various immune-stimulatory cytokines. Macrophages are an important part of the innate immunity and play a critical role in defending the host against microbial invasion.[7] Classically activated M1 are characterized by the increased secretion of cytokines such as TNF-α, IL-1β, IFN-γ, IL-12, and IL-6 and show strong microbicidal activities, whereas alternatively, activated macrophages or M2 are characterized by increased secretion of IL-4, IL-10, and TGF-β and are considered poorly microbicidal.[6],[7] The results of the present study demonstrated the immune-stimulating activities of Aqueous extract of Tinospora cordifolia (AETC) and methanolic extracts of T. cordifolia as macrophages treated with them secreted higher levels of IL-1β, IFN-γ, and TNF-α.[7] In one study, the results indicate that Guduchi is a strong immunogen by itself and enhances the immunogenicity of mucosally administered antigen in BALB/c mice. Based on the results of this animal study, it appears that Guduchi shows a potential for future studies in humans[8]
  2. Aswagandha (Withania somnifera) has been proven to have a wide range of therapeutic potentials including antiviral activity in various studies. In one study, it was proved that the capability of W. somnifera-treated chicks (Group A) in effectively resisting Chicken infectious anemia virus (CIAV)infection may be attributed to the withanolides, the major chemical constituent of the herbal plant, which is a triterpenoid that has been reported to have antitumor, antioxidant, anti-inflammatory, and antimicrobial properties.[9] Withanolides can selectively help in the immune response toward T-helper1 (Th1) rather than Th2 side by increased IFN γ and IL-2 cytokine production, which is the actual key factor in immunity against viruses, besides augmenting the CD4+ and CD8+ T cell counts, and NK cell activity.[10]
  3. Glycyrrhiza glabra commonly known as Liquorice or Yastimadhu has proven immune-modulatory actions.[11] In a study done in nonmammalian hen models, the ethanolic extract of Yastimadhu showed enhanced innate or specific cell immunity. Another research has proved that the anti-inflammatory effect of Glycyrrhizin and its mode of action is production of IL-10 and IL-12 in a large amount.[9] Immune modulation and production of interleukins with production Glycyrrhetinic acid has several favorable pharmacological properties, such as immune modulation and production of interleukins along with T-Cells and gamma IFN which highlights its role as an antiviral[11]
  4. Curcuma longa commonly known as turmeric is a potent spice used in Indian foods and the guidelines issued by the Ministry of AYUSH has emphasized about the use of golden milk or Milk mixed with turmeric. It has been used significantly in diseases such as asthma, allergy, and diabetes to modulate the immunity and also to maintain metabolism. Curcumin can also downregulate[9] the expression of various pro-inflammatory cytokines including TNF, IL-1, IL-2, IL-6, IL-8, IL-12, and chemokines, most likely through inactivation of the transcription factor NF-κB.[12] In addition to this, curcumin has been shown to inhibit several pro-inflammatory cytokines (e.g., TNF, IL-1, and IFN) that play an important role in the initiation and progression of inflammatory responses.[13]


Immuno modulation by Nidra

Nidra (sleep) plays a very vital role in maintaining the health of an individual. It has been postulated that an extreme level of sleep deprivation may lead to an increased risk of infections.[14] Mundane urban lifestyle which has a direct relationship on health due to the optimum level of stress related to nocturnal sleep deprivation. It has been observed while going through various research articles that the autonomic sympatho-adrenal system and the hypothalamic–pituitary–adrenal (HPA) axis are involved in stress response.[15] Through the release of cortisol, which suppresses the pro-inflammatory as well as the antiviral immune response, it has been observed that it helps in regulation of the adaptive and the innate immune response in the body. During nocturnal sleep, T-cell production of IL-2 as well as IFN-γ is increased, thereby supporting innate immunity particularly during the early phase of the night. NK cell activity also depends on sleep. The number of NK cells and its activity is less during the early phase but gradually increases during the late phase of night or early morning hours. Late sleep or complete abstinence from sleep decreases the increase of IL-6 cells to half. Nocturnal sleep serves to expose the immune system to infectious challenges and to induce nocturnal activation of inflammatory signaling[16] Hence, in the absence of sleep, nocturnal levels of inflammatory cytokines are lower.

Immunomodulation by Yoga

With the anticipation of the pandemic of COVID-19, data and details of the diseases being bombarded everywhere, people are being succumbed to anxiety, depression, and stress related to the exposure of information. As mentioned in Charak Vimansthana that over the period of times, a psychological disease converts into somatic disease and vice versa. It is thereby very important to thereby concentrate on the mental health which will have intermediate benefit on the well-being of an individual through yoga. Yoga, meditation, helps in reducing anxiety and also contributes to improving the immune status of an individual. The physiological status of an individual is altered by stress as it affects the neurohormonal axis, thus suppressing the body's immune system. As stated by the American Psychological Association, stress is known to have a negative impact on the immune system, thereby having disturbing the homeostasis of a healthy individual. Many researchers globally have found that yoga has a significant effect on the functions of the autonomic, endocrine, HPA axis, as well as on the psychological aspects.[17] A previous study has reported the influence of stress in neuro-endocrine and hypothalamus function effecting immune modulation and immune homeostasis. In response to stress, activation of HPA axis results in secretion of corticotrophin-releasing factor (CRF) from hypothalamus. CRF stimulates the secretion of Adrenocorticotropic hormone (ACTH) from the pituitary, which further activates the adrenal glands to produce glucocorticoids, which are powerful immune regulators.[18] Through Yoga, it helps in curbing the stress response in the body by increased activity of anti-inflammatory glucocorticoid receptor (GR), which indicates a change in the HPA axis in terms of responding better to cortisol.[19] Many studies on the role of yoga on immunity have shown a lower level of IFNs and interleukins than the control groups. Increased yoga practices decrease levels of IL-6 andIL-1β production. Bagchi and Wenger reported that yogic meditation induces inner relaxation of ANS without inducing sleep as well as raising immune levels in the body.[20]


  Conclusion Top


After going through the various reviews and scientific experiment-based articles available in PubMed on most of the potent immune-modulatory drugs and nonpharmacology therapy, i.e., Yoga and Nidra, a conclusion can be drawn that it has the potentiality to improve the body immunity and so preventing the occurrence of COVID-19 and thereby reduce the disease burden through the easily available resources. This is a review paper trying to establish a probability. This paper gives a vision and thereby experiments can be framed in this line along with Randomized Clinical Trials in COVID-19 using these herbs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Totura AL, Baric RS. SARS coronavirus pathogenesis: Host innate immune responses and viral antagonism of interferon. Curr Opin Virol 2012;2:264-75.  Back to cited text no. 1
    
2.
Mantlo E, Bukreyeva N, Maruyama J, Paessler S, Huang C. Antiviral activities of type I interferons to SARS-CoV-2 infection. Antiviral Res 2020;179:261.  Back to cited text no. 2
    
3.
Gursel M, Gursel I. Is global BCG vaccination-induced trained immunity relevant to the progression of SARS-CoV-2 pandemic? Allergy 2020;75:1815-9.  Back to cited text no. 3
    
4.
Dwivedi BK, Goswami PK. Trieshaniya Chapter; Sutrasthana; Volume 1; Sloka Number-35: Charak Samhita. Varanasi: Chaukhamba Krishnadas Academy; 2013. p. 261.  Back to cited text no. 4
    
5.
Harrison; Principles of Internal Medicine. 19th ed., Vol. 2. Year: 2015 pg no. 794.  Back to cited text no. 5
    
6.
Dhama K, Sachan S, Khandia R, Munjal A, Iqbal HM, Latheef SK, et al. Medicinal and beneficial health applications of Tinospora cordifolia (Guduchi): A miraculous herb countering various diseases/disorders and its immunomodulatory effects. Recent Pat Endocr Metab Immune Drug Discov 2017;10:96-111.  Back to cited text no. 6
    
7.
Aranha I, Venkatesh YP. Humoral immune and adjuvant responses of mucosally-administered Tinospora cordifolia immunomodulatory protein in BALB/c mice. J Ayurveda Integr Med 2020;11:140-6.  Back to cited text no. 7
    
8.
Aranha I, Clement F, Venkatesh YP. Immunostimulatory properties of the major protein from the stem of the ayurvedic medicinal herb, guduchi (Tinospora cordifolia). J Ethnopharmacol 2012;139:366-72.  Back to cited text no. 8
    
9.
Dorhoi A, Dobrean V, Zăhan M, Virag P. Modulatory effects of several herbal extracts on avian peripheral blood cell immune responses. Phytother Res 2006;20:352-8.  Back to cited text no. 9
    
10.
Davis L, Kuttan G. Effect of Withania somnifera on cyclophosphamide-induced urotoxicity. Cancer Lett 2000;148:9-17.  Back to cited text no. 10
    
11.
Sultan MT, Butt MS, Qayyum MM, Suleria HA. Immunity: Plants as effective mediators. Crit Rev Food Sci Nutr 2014;54:1298-308.  Back to cited text no. 11
    
12.
Jagetia GC, Aggarwal BB. “Spicing up” of the immune system by curcumin. J Clin Immunol 2007;27:19-35.  Back to cited text no. 12
    
13.
Gautam SC, Gao X, Dulchavsky S. Immunomodulation by curcumin. Adv Exp Med Biol 2007;595:321-41.  Back to cited text no. 13
    
14.
Besedovsky L, Lange T, Haack M. The sleep-immune crosstalk in health and disease. Physiol Rev 2019;99:1325-80.  Back to cited text no. 14
    
15.
Irwin MR. Why sleep is important for health: A psychoneuroimmunology perspective. Annu Rev Psychol 2015;66:143-72.  Back to cited text no. 15
    
16.
Irwin MR, Opp MR. Sleep health: Reciprocal regulation of sleep and innate immunity. Neuropsychophramacology 2017;42:129-55.  Back to cited text no. 16
    
17.
Segerstrom SC. Resources, stress, and immunity: An ecological perspective on human psychoneuroimmunology. Ann Behav Med 2010;40:114-25.  Back to cited text no. 17
    
18.
Micale V, Drago F. Endocannabinoid system, stress and HPA axis. Eur J Pharmacol 2018;834:230-9.  Back to cited text no. 18
    
19.
Kulkarni DD, Bera TK. Yogic exercises and health – A psycho-neuro immunological approach. Indian J Psysiol Pharmacol 2009;53:3-15.  Back to cited text no. 19
    
20.
Singh VP, Khandelwal B, Sherpa NT. Psycho-neuro-endocrine-immune mechanisms of action of yoga in type II diabetes. Anc Sci Life 2015;35:12-7.  Back to cited text no. 20
    




 

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