|
 
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| REVIEW ARTICLE |
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| Year : 2020 | Volume
: 7
| Issue : 2 | Page : 69-74 |
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COVID-19: A new horizon for ayurveda
Bishnu Choudhury, PK Goswami
North Eastern Institute of Ayurveda and Homoeopathy (NEIAH), Mawdiangdiang, Shillong, Meghalaya, India
| Date of Submission | 14-Jul-2021 |
| Date of Decision | 22-Jul-2021 |
| Date of Acceptance | 25-Jul-2021 |
| Date of Web Publication | 25-Aug-2021 |
Correspondence Address:
Dr. Bishnu Choudhury
Department of Kayachikitsa, North Eastern Institute of Ayurveda and Homoeopathy (NEIAH), Shillong, Meghalaya - 793 018
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/AYUHOM.AYUHOM_38_21
Novel coronavirus disease (COVID-19), which was first noticed in Wuhan city of China in mid-December, 2019, has stormed health-care system along with the economy across globally. After hitting India in its 2nd wave causing devasting to human lives is about to hit again in its 3rd wave reports suggests. Even after putting every effort by the health-care workers, research scientists, microbiologists, and interdisciplinary authorities could not develop a gold standard strategy to contain COVID-19. Ayurveda documented epidemics/pandemics under the context of Janapadodhvamsa (conditions devastate the human settlements). Similarly, infectious diseases have been considered under Sankramika rogas. Pollution of air, water, climate, and environment is responsible for the spread of diseases on such a large scale, resulting in Janapadodhvamsa. Causes of vitiation of air, water, climate, and place along with their characteristics have been enumerated in ancient Ayurvedic classics which result in reasonable damage to the health of the society, ultimately leading to Janapadodhwamsa. Such conditions will manifest in symptoms such as cough, breathlessness, and fever. In Ayurveda, the initial phases of the manifestation can be comparable to Vata-Kaphaja Jwara. Uncontrolled conditions, further vitiate other Doshas and other Rasa, Rakta, and Mamsadi dushyas, thus entering into Sannipataja condition. Lots of drugs in Ayurveda are on the threshold of being identified as a potential treatment in COVID-19 which will be analyzed in this review article and along with other strategies to combat the COVID-19 pandemic though Ayurveda.
Keywords: Ayurveda, COVID-19, immunity, Janapadodhvamsa, Sankramika roga
How to cite this article:
Choudhury B, Goswami P K. COVID-19: A new horizon for ayurveda. AYUHOM 2020;7:69-74 |
| Introduction | |  |
COVID-19 caused by severe acute respiratory syndrome virus-2 (SARS-CoV2) has caused havoc consecutively in the second year and leads to mayhem and contributed to unsettling human life. After hitting India in its 2nd wave causing devasting to human lives is about to hit again in its 3rd wave reports suggests.[1] The recent outbreak in India, which started in early March 2021, has put the country in the top of the list among the countries worst affected by COVID-19. The sudden peak of cases in India coincides with high prevalence of more transmissible variants, associated with the failure in diagnostic tests and antibody escape.[2] The new variants of concern and variants of interest may be able to escape immunity, induced by natural infection or vaccines, although more data on this are needed. The current vaccines also seem to provide protection from serious disease and death but not necessarily from infection.[3]
Even after putting every effort by the healthcare workers, research scientists, microbiologists, and interdisciplinary authorities could not develop a gold standard strategy to contain COVID-19. Since the emergence of the virus, the Ministry of AYUSH, Government of India, has issued several guidelines as prophylactic measures, treatment guidelines as an independent or as an add-on to the contemporary guidelines. Intervention through Ayurveda is giving remarkable outcomes in the management of asymptomatic, mild-to-moderate COVID-19 patients.[4] Role in prophylaxis is worth paying. Potential in the diversified field of Ayurveda enriched with dynamic classes of drugs is yet to uncover completely; however, lots of drugs in Ayurveda are on the threshold of being identified as potential treatment in COVID-19. Thus, in this paper, an attempt has been made to discuss the different aspects of Ayurvedic intervention for prophylaxis as well as during infective stage and postinfective stage and along with other strategies to combat COVID-19 pandemic though Ayurveda.
| Materials and Methods | | |
A search was conducted for literature and various classical Ayurvedic texts, namely, Caraka Samhita, Sushruta Samhita, Astanga Hridaya, and Astanga Sangraha with their commentaries along with the modern literature, different research databases, journals, and Government health agencies websites to collect the relevant information.
The disease COVID-19
The WHO (under International Health Regulations) has declared COVID-19 outbreak as a “Public Health Emergency of International Concern” on January 30, 2020. The WHO subsequently declared COVID-19 a pandemic on March 11, 2020.[5]
Available resources of modern science suggest that SARS-CoV-2 which is a single-stranded positive RNA virus has a zoonotic source closely related to bat origin SARS-like coronavirus. Further, it has been shown to use angiotensin-converting enzyme 2 (ACE2) receptor for cell entry. The “S” protein of coronavirus can bind to host cells through the ACE2 receptor found in the oral and nasal mucosa. Other sites where ACE2 receptors are found are lungs, stomach, intestine, bladder, heart, pancreas, and kidney. Variable presentation of disease in different age groups and serious manifestations that are seen more commonly in immune-compromised, old aged, and in those with underlying pathology, many asymptomatic cases in pediatric age group, and the presence of lymphopenia in the majority of the cases; these factors impliy that the immunity has a vital role in the pathogenesis of COVID-19.[6]
The median incubation period is 5.1 days (range: 1–14 days). The precise interval during which an individual with COVID-19 is infectious is uncertain. As per the current evidence, the period of infectivity starts 2 days before onset of symptoms and declines rapidly within the 1st week of symptom onset. In the majority of adult patients' involvement of respiratory tract, involvement has been noticed. Nevertheless, dysregulated immune response with hyperinflammation has been observed with the subsequent development of acute respiratory distress syndrome (ARDS) in a little percentage of the population. Endothelialitis (endothelial damage of pulmonary vasculature), microvascular thrombosis, and extensive alveolar and interstitial inflammation which finally results in pulmonary intravascular coagulopathy, ventilation-perfusion mismatch was addressed in the autopsy findings.[5],[7] The clinical presentation of coronavirus is quite diversified, ranging from asymptomatic to ARDS and multiorgan failure. The common symptoms include fever, sore throat, cough, headache, myalgia, and breathlessness.[8] It was witnessed that mostly persons-associated comorbidities and elderly reach the fatal stage due to the development of pneumonia, ARDS, or multiorgan dysfunction.[9]
Categorization of patients in mild, moderate, and severe stage becomes significantly important in infectious stage for the proper intervention. Another major concern of COVID-19 patients is developing pneumonia, which leads to damaging to the blood vessels, complement-mediated vasculitis in lung parenchyma, and release of tissue factor. This complement-mediated damage plus release of tissue factor activates the clotting system which leads to the formation of microthrombi in the lungs which is the main culprit in making it complex.[10] In Stage 1 or early infection, anosmia, fever, cough, diarrhea, etc., symptoms are seen. It is Stage 2 or the pulmonary phase of the disease which is characterized by the SpO2<94% and respiratory rate >24/min from where the game begins. From this stage, either the patient resolves or enters into the third stage of the disease, i.e., severe stage with hyperinflammatory phase.[11] At present, there are no any specific markers which can actually predict that whether the patient will progress into severe stage or not. Hyperinflammatory stage can be identified with the alarming markers such as D-Dimer assay, C-reactive protein, lactate dehydrogenase, Ferritin, and interleukin-6, but these markers cannot predict the severity.[12] Early intervention rescues the patient from entering into either moderate stage or severe stage and also reduces the transmission, thus breaking the chain of transmission and lowering the burden of the health care system.
Ayurvedic concept of COVID-19
It is difficult to correlate this disease with specific Ayurveda terminology but, whereas interpreting the disease on the basis of Samprapti (pathogenesis) by considering the causative agent and the clinical features such as fever (Jwara), cough (Kasa), anorexia (Aruchi), fatigue (Tandra), generalized body ache or myalgia (Angamarda), and tiredness (Daurbalya); it can be contemplated as an Agantuja Vyadhi which later on due to the involvement of dosha develops to Nija Vyadhi as Kapha-Vatolvana Hina Pitta Sannipataja Jwara (Severe Vata and Kapha with mild Pitta). While talking about the pathogenesis of fever in Ayurveda, Charaka mentioned that when Vata dosha either singly or in Sansristi (two dosha) or in Sannipataja (all three dosha) got aggravated, then it enters Amashaya and mixed with Rasa Dhatu causing obstruction of Rasavaha and Swedavaha Srotas, resulting in the destruction of Agni; Agni then spreads out from its Sthana (functioning location) to whole over the body causing the febrile condition.[13]
Agantuja Vyadhi (diseases of exogenous origin) occurs due to physical/external factors such as Bhuta, Visha, Vayu, Agni, and Prahara (trauma) without any involvement of Vataadi Dosha initially; however, in later stage, dosha is involved in the disease process.[13] Cakrapaṇidatta clarifies that Bhuta means Visakṛimi or a virulent organism;[13] Krimi may be Sahaja (natural) or Vaikarika (pathogenic) organisms that may be visible (macroscopic) or invisible to the naked eye (microscopic),[13] In Ayurveda, initial phases of the manifestation of COVID-19 can be comparable to Agantuja Vata Kaphaja Jwara or all communicable diseases including COVID-19 can be compared with Abhishanga jwara (fever due to microorganisms). Uncontrolled conditions further vitiate other Doshas and other Rasa, Rakta, and Mamsadi dushyas, thus entering into Sannipataja condition.
In Ayurveda, epidemics are discussed under the term of Janapadodhwamsa,[13] by Charaka and Maraka by Sushruta.[14] The symptoms such as fever, cough, breathing difficulty, headache, and vomiting resemble with clinical features of SARS. Dalhana in his commentary has mentioned that symptoms such as anosmia, cough, and catarrh will occur after the entry of contaminated air through the nasal opening which is similar to the typical clinical features of COVID-19.[14] Furthermore, this disease can be classified as Upsargaja and Aupasargika Roga. Upasargaja Vyadhi is those fever-like diseases that manifest due to close contact with diseased persons,[14] whereas Aupasargika Vyadhi is defined in two different ways by Sushruta; one as a disease which spreads from one person to another person[14] and another as “…Upadravasangyah,” i.e., complications or associated diseases that manifest after primary disease.[14] Susruta mentions the diseases such as Jwara (fever), Kustha (skin diseases), Shosha (tuberculosis), Netrabhisyanda (conjunctivitis), and other Aupasargika roga (alike communicable diseases) can be spread through Prasanga (intimate relationship), Gatra Sansparsha (direct contact), Nishwasa (breathing or airborne), Sahabhojana (eating together), Sahashayana (sleeping together), sharing and using of others' clothes, ornaments, and ointments.[14] whereas Ayurveda described the general causes for all diseases are Asatmyendriyartha samyoga (Misuse of senses), Kala/Parinama (Seasonal Variation), and Prajnaparadha (Misuse of intellect).[15]
Ayurveda described prophylactic measures such as Dinacharya (daily regimen), Ritucharya (seasonal regimen), Trayopastambha palana (proper observance of Ahara (Food), Nidra (Sleep) and Brahmacharya (Celibacy/safe sexual practices), Sadvritta palana (Good conducts/ethics), and Rasayana sevana (Rejuvenation therapy/immune-modulator/antioxidant) which promotes comprehensive health as well improves general immunity against of diseases thus prevents the occurrence of diseases. Daily practices of Yoga and Pranayama are the key to fight against the virus. The proper maintenance of Agni (digestive factors), good sattwa bala (mental strength), and the use of Rasayana drugs (immunemodulator and antioxidant/rejuvenator) would be highly beneficial. If we can start the Ayurvedic intervention in the initial stages of the disease, which may control the disease progression and so early clinical recovery without having much more post-COVID complications.[16]
Different daily and seasonal regimen suggested by Ayurvedic scholars are Kavala/Gangusha (Gargling with plain hot water/hot water and salt/decoction prepared with Triphala), Mukha, netra, pada, and pani prakshalana (frequent washing of face, oral cavity, eyes, hand, and feet with lukewarm water), Anjana/Souviranjana (application of collyrium to the eyes), Pratimarsa nasya (nasal medicaments – two drops medicated oil/ghee into each nostril minimum of two times daily morning and night), Dhoomapana (medicated smoking – turmeric + ghee spreading over cotton gauze rolled and ignited for inhalation of smoke two times daily), Vyayama (physical exercise to be done with half of the persons strength or moderate), Abhyanga (body massage daily with suitable oil such as sesame or mustard oil), Snana (daily bathing), Vastramalyanulepa (wearing clean dress, having fresh garlands, and natural perfumes to maintain personal hygiene), Ahara vidhi (follow rules and regulations of food intake principles such as when to take, what to take, where to take, how much to take, and how to take), Nityam ksheera ghritashinam (drinking of milk and intake of ghee every day), Rasayana sevana (intake of immune-modulator, antioxidant/rejuvenator medicaments including Achara rasayana– observing moral conducts), Sadvritta palana (observance of disciplines and social disciplines such as obeying rules and regulations made by authorities), Dhoopana (frequent fumigation of dwelling places with Nimba (neem), Tulsi (basil), Haridra (Turmeric), Vacha (Acorns) + Ghee etc.).[16]
PostCOVID-19 aspects
Steroids are the only drugs which have been seen to decrease the mortality in the severe COVID-19.[17] However, in addition, it has markedly landed the patients in opportunistic infections due to low immunity of the patients. Mucormycosis cases have been seen to rise in patients with low immunity post-COVID treatment.[18] It becomes a matter of concern about the usage of high dosage steroids in the COVID-19 treatment. Due to massive doses of steroids and antiviral therapy, there is the possibility of the Dhatu Kshaya and hepatorenal toxicity in post-COVID-19 infection. Hence, the Ministry of AYUSH, Government of India has laid down guidelines to use Dhatuposhana and Rasayana for a minimum of 45 days, Vishaghna Chikitsha to overcome the residual effect of the virus on the body, hepatorenal protective drugs to combat toxicity.[19] Patients recovering from the COVID-19 are they susceptible to get reinfection, do they develop immunity to the disease still remains a question, and at present, there are no clear data to answer the same. New variants are thought to be responsible for reinfections, either after natural infection or after vaccination. There is evidence that reinfections are already happening in India; a recent survey identified a reinfection proportion of 4.5% from a pool of 1300 participants infected between January 2020 and October 2020. In patients getting relief from the symptoms after treatment may take around 3 weeks to shed the virus. Thus, there is uncertainty in using the term recover as well.[20]
After acute COVID-19 illness, recovered patients may continue to report a wide variety of signs and symptoms including cough, low-grade fever, and fatigue, all of which may relapse and remit. Other reported symptoms include shortness of breath, chest pain, headache, neurocognitive difficulties, muscle pains and weakness, gastrointestinal upset, rashes, metabolic disruption (such as poor control of diabetes), thromboembolic conditions, and depression and other mental health conditions. Skin rashes can take many forms including vesicular, maculopapular, urticarial, or chilblain-like lesions on the extremities (so-called COVID toe)[21] which can be manage successfully by different Ayurvedic interventions described in [Table 1]. | Table 1: Anticipated Ayurvedic interventions for mitigation of COVID-19 pandemic and their rationalea, b
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Diet has a very important role in the management of post-COVID-19 complications and it should be Shadrasatmaka (with all six tastes). Depending on the condition of Dhatu and Dosha, Shamana in the form of Brimhana chikitsa can be adopted to restore the function of Tridosha beside this Satvavajaya Chikitsa (Ayurvedic psychotherapy) Sadvritta (good conduct), and Achara Rasayana (behavioral therapy) can play an important role to manage post-COVID-19 symptoms. These are the nonpharmacological approach aimed to maintain mental health.[24] The herbometallic formulations containing gold bhasma play a key role in overall efficacy. Research works had been proved that the herbometallic 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.[25]
Further, the Ministry of Ayush, Government of India has listed Yoga Protocol for post-COVID-19 care (including care for COVID-19 patients) to improve the pulmonary function and lung capacity, reduce stress, and anxiety and improve mucociliary clearance. Yoga with pranayama could be a simple, useful, costless home-based practice for the prevention and postrecovery management of COVID-19.[26],[27],[28],[29] Ayurvedic interventions for combating of COVID-19 pandemic have been described in [Table 1].
| Discussion | | |
The spike in the cases in the 2nd wave might be due to the increase in the number of testing due to more testing facility availability and better knowledge about the disease condition. Overall, mortality rate although remains same as per the 1st wave, but the number of mortalities has tremendously increased in the 2nd wave. One of the facts that must be admitted is the afraid of testing, quarantine, isolation, and hospitalization by the common people. The common people either because of the inadequate knowledge or fear or due to negligence testing got delayed and so the early intervention would not have taken place in the timely fashion which might have increased the mortality. Again, the comorbidity factor can never be ignored which was adding fuel to the fire. Nonfollowing of the COVID-19 protocols properly and delaying in taking vaccination is not behind too. Although vaccines against COVID-19 virus have been developed, it seems to provide the protection from serious disease and death but not necessarily from infection. New variants have potential to increase the transmission and also reduces the effectiveness of vaccines. Hence, it is imperative to use preventive as well as therapeutic Ayurvedic interventions as much as possible and boosting the immunity remains the key to fight such dreadful virus. On the other hand, it is scientifically proved that Ayurveda treatment as adjunctive is more effective in mild-to-moderate COVID-19 patients as compared to stand-alone conventional care.[23],[30],[31] Daily practice of Surya Namaskar, Matsysana, forward bending, backward bending, spinal twist, Anulom Vilom, Kapalbhati, Kumbhak, Bhramari, and Nadi Suddhi Prayanam found effective in combating COVID-19 manifestations.[26],[27]
Future plan: Strategies for combating 3rd wave
Reports suggest that the 3rd wave is inevitable and probably will hit the younger age groups mostly affecting the children.[32],[33] Thus, it becomes utmost necessary to take all the precautionary and prophylaxis measures to tackle the 3rd wave. Although the children's immunity is quite strong, but with different mutant virus strains emerging day by day, it will not be wise to take it lightly. The Ministry of AYUSH, Government of India has already issued home care guidelines for children and advisory for AYUSH practitioners about prophylactic care in children during the COVID-19 pandemic.[34]
- ”Swarna Prashana Abhiyaan” can be carried out as an immune booster for children against viral disease, as it has been seen that it builds the immunity against viral illness[35]
- In Ayurveda, Rasayana therapy (immune-modulator, antioxidant/rejuvenator) is most suitable for the enhancement of immunity. Further, many herbs such as Guduchi (Tinospora cordifolia (Thunb.) Miers), Bala (Sida cordifolia), Amalaki (Emblica officinalis Gaertn), Yashtimadhu (Glycyrrhiza glabra Linn), Ashwagandha (Withania somnifera (Linn.) Dunal), and Pippali (Piper longum L), as well as medicinal formulations such as Chyavanaprasa, Brahma Rasayana, Vardhamana Pippali Rasayana, and Agastya Haritaki potentially boost the Bala (immunity) of the person.[36] Other needful measures have been described in [Table 1]
- Strict maintenance of the COVID appropriate behavior.
| Conclusion | | |
At present, there are no full-proof interventions as such to prevent or stop the COVID-19 mortality; however, early testing, limiting the transmission, integrative intervention at the proper time, and enhancing individuals body immunity remains the ultimate choice. Skyrocketing of infections and mortality can be lighten through improvisation body immunity and congruous interference through Ayurveda and Yoga and Pranayama. Hence, holistic as well as integrative approach is suggested to mitigate COVID-19 pandemic and should create needful awareness so that the spread of this dreaded disease can be controlled to a great extent.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1]
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