A conceptual study on management of COVID 19 through Ayurveda- A brief review

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182 Journal of Ayurvedic and Herbal Medicine 2020; 6(3): 182-184 Review Article ISSN: 2454-5023 J. Ayu. Herb. Med. 2020; 6(3): 182-184 © 2020, All rights reserved www.ayurvedjournal.com Received: 11-09-2020 Accepted: 17-10-2020 *Corresponding author: Dr. Katarmal Durga Harishbhai Ph.D. Scholar, P.G. Dept. of Shalya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India Email: bhanushalidurga 256@gmail.com A conceptual study on management of COVID- 19 through Ayurveda- A brief review Katarmal Durga Harishbhai 1 , P. Hemantha Kumar 2 1 Ph.D. Scholar, P.G. Dept. of Shalya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India 2 Professor & Head of Department, P.G. Dept. of Shalya Tantra, National Institute of Ayurveda, Jaipur, Rajasthan, India ABSTRACT Novel corona virus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Corona virus 2 (SARS-CoV- 2) is declared as pandemic by WHO. Numerous researches are going on to develop vaccine and treatment protocol for treating this disease but due to complexity of virus genome and variety of symptomatic presentation no particular protocol is completely successful till date. So, there is a need to think on different dimensions for combating this disease. Ayurveda , science of longevity can be an answer to this pandemic disease as it has both the aspect preventive as well as curative. In this article, an effort is made to brief out concepts which can be used in treatment of COVID-19. Validating these concepts by clinical studies on appropriate sample size and then applying it to treatment of masses can be a key towards combating COVID-19. Keywords: COVID-19, Corona virus, Ayurveda , SARS-CoV- 2. INTRODUCTION Novel corona virus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Corona virus 2 (SARS- CoV- 2) is declared as pandemic by WHO. This pandemic has affected world population either through direct effect by making person susceptible to physical illness causing morbidity and mortality or through indirect effect in the form of financial losses due to lockdown imposed for variable intervals in different countries of world. Numerous researches are going on to develop vaccine and treatment protocol for treating this disease but due to complexity of virus genome and variety of symptomatic presentation no particular protocol is completely successful till date. So, there is a need to think on different dimensions for combating this disease. Ayurveda , science of longevity can be an answer to this pandemic disease as it has both the aspect preventive as well as curative 1 Various symptomatic presentations occurring in patients infected with this virus are mentioned in Charaka Chikitsa Sthana – Jwara chikitsa Chapter under the heading of Sannipataja Jwara 2 along with prognosis 3 SAMPRAPTI OF COVID-19 Krimi (virus) - an Agantuka Nidana (external factors) enters the body through nasal or oral route. After entering the system, it causes vitiation of Dosha along with formation of excess Kleda . This leads to Agni dushti (deterioration of Agni ) which is considered at Dhatwagni level leading to dhatudushti of Rakta dhatu causing s opha (inflammation at organ and tissue level). If not treated at this stage, it may enter the next stage of Dhatupaka (fibrotic changes at cellular level) and further adversely affects Mamsa , Meda dhatu which is indicator of poor prognosis. Further worsening occurs in terms of Ojas kshaya and kotha (necrosis at cellular, tissue and organ level). ANALYSIS OF CONCEPT OF AGNI According to Acharya Charaka , deterioration of Agni is main culprit for occurrence of Jwara . Correlation of Agni with the digestive power only is one of the misconceptions. In true meaning, Agni should be considered as transforming energy working at cellular level in the form of various cellular activities. If cellular functions are normal, then an individual as whole will remain normal and healthy because cell is structural and functional unit of living organisms.

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183 Journal of Ayurvedic and Herbal Medicine|July-September|2020 RELATION BETWEEN KLEDA AND AAMA Kleda is moisture required for smooth functioning of the subtle digestion at the point of dhatus . It is physiologically present and it flows from one dhatu to next dhatu helping in transformation of substances in the absorbable forms. When Kleda increases in amount it causes Srotorodha (obstruction) and it stagnates instead of flowing from one dhatu to next one leading to deterioration of normal physiological processes of metabolism. Aama can be described as toxic end resultant of improper digestion and cause of diseases. If Aama is present it accelerates srotorodha in conjunction with excess Kleda . So, it can be established that Aama and Kleda acts synergistically to cause obstructive pathologies. CONCEPT OF CO-MORBIDITIES IN DECISION OF PROGNOSIS OF COVID- 19 It is well known fact that co-morbid conditions like diabetes, hypertension, asthma, cardiac diseases etc. are considered as risk factors and also poor prognostication in management of COVID-19. According to Ayurveda , Aama and Kleda are cause of these co-morbid conditions. So, deterioration in the form of obstruction causes various symptoms in these co-morbid diseases. Also, there is immunocompromisation or immune-suppression either due to disease or due to medication used to treat these diseases. This immune-compromised or immune-suppressed state further makes individuals more susceptible to COVID-19. So, there is multi-factorial worsening of prognosis due to association of co-morbidities. PREVENTIVE ASPECT This should further be divided as – healthy individuals and asymptomatic patients which are tested positive. For healthy individuals, maintenance of healthy life style by following Dincharya (daily routine) and Rutucharya (adapting as per seasonal variation) is sufficient along with precautions like wearing mask and sanitisation SOPs given by WHO. Thought behind describing in this way is after the declaration by various researches that if immunity is strong person can remain unaffected by this virus, there is flood of immunity booster medications in market just to cash on the fear of pandemic. This is a myth that overnight magic will occur in building immunity by consuming immunity booster. Development of immunity is a continuous process rather than one day phenomenon. Following Dincharya and Rutucharya as per Ayurveda is itself sufficient for developing immunity against all diseases. For asymptomatic patients with positive test result of COVID -19, isolation along with consumption of lukewarm water, steam inhalation should be included in daily routine. Proven immune-modulators like Guduchi ( Tinospora cordifolia ), Haridra ( Curcuma longa ), Ashwagandha ( Withania somnifera ), Gokshura ( Tribulus terrestris ) etc. should be given as per Prakruti of patient. Luke warm water causes Aama-pachana. Steam inhalation has direct effect on respiratory system thus helping in reducing viral load. A preparation mentioned as Shadangapaniya 4 is worth mentioning here as it is first preparation included in treatment regimen in all types of Jwara . Here one more myth is to be cleared in terms of advertisement of various Kwatha with the claim of preventing and treating this viral disease. As per text, various Kashaya should be used only after 6 or 7 days of Jwara and not from the first day onwards. Instead there is mentioned clear contraindication of Kashaya in TarunaJwara 5 CURATIVE ASPECT Single Drugs: In all cases including mild, moderate and severe cases repeated steam inhalation is given. One drug of choice for treating all cases is Pushkarmoola ( Inula racemosa ) with variation in doses as per severity of diseases. Pushkarmoola is time tested medicine for treating respiratory diseases. Tikta, Katu Rasa of Pushkarmoola acts on Aama which can be considered as toxin responsible for causing deterioration of Agni which in turn causes Jwara . Aama-pachana helps in curing Jwara. Laghu, Teekshna Guna (property) and Ushna Virya (potency) acts on Kapha Dosha which is usually involved in respiratory diseases. Inula racemosa exhibited analgesic, anti-inflammatory 6 , cardio protective 7 and antiallergic 8 , bronchodilator and rejuvenating properties. Considering these properties of Pushkarmoola it can be effectively used in management of COVID 19. Nagara ( Zingiber officinale ) is proven anti-inflammatory drug which acts on IL-1, IL-6 and TNF. Consumption of Nagara Swarasa (fresh juice) as per Prakruti and Dosha involvement may be beneficial in all symptomatic as well as asymptomatic patients. A few contraindications to this are Pittaja prakruti patients, patients taking blood thinners. Combinations: As explained earlier, there is Dhatudushti specifically of Rakta dhatu and Meda dhatu dushti. Use of Rakta-dhatu Pachak Dravya 9 Medo dhatu Pachak Dravya 10 should be used in all stages in different doses. These drugs are primarily Tikta Rasatmaka hence causing Aama-pachana , Kleda-pachana , pacification of Rakta Dhatu , Meda Dhatu thus relieving obstruction at cellular and tissue level as well as helps in reversing pathology. In the inflammatory phase, where Vata - Kapha predominance is present Dashmoola Kwatha can be used as it has analgesic as well as antiinflammatory properties. DIET AND LIFE STYLE As mentioned earlier, for healthy individuals following Dincharya and Rutucharya along with few dietary precautions is sufficient in terms of prevention of infection. Pathya Ahara (Dietary regimen) ➢ Soup of Mudga (Green lentil), Kulatha (Horse gram) ➢ Patola (Bitter gourd), Karela (Bitter gourd) ➢ Amalaki ( Emblica officinalis ), Dry fruits like Figs, Black grapes ➢ Spices - Dry ginger, Cloves, Curcuma etc. ➢ Consumption of lukewarm water

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184 Journal of Ayurvedic and Herbal Medicine|July-September|2020 Pathya Vihara ➢ Adequate sleep is must in healthy as well as diseased state. ➢ Following hobbies to feel happy. ➢ Yoga - Pranayama Apathaya Ahara (Dietary restrictions) ➢ Watermelon, Yoghurt, Sea food, Sweets, Refrigerated food. Apathaya Vihara (Restrictions) ➢ Sleeping during daytime ➢ Remaining awake till late night ➢ Stress, Anger etc. should be avoided. CONCLUSION Clinical studies should be carried out with the above-mentioned protocols in various stages of COVID-19 to find out the solution of pandemic condition. Acknowledgement: None Source of Support: None Conflict of interest: None REFERENCES 1 Agnivesha, Charaka, Charaka Samhita revised by Dridhabala, Sutra Sthana Arthedashamahamooliyadhayaya 30/26, edited by Dr. Brahmanand Tripathi (Vol.-I), Chaukhamba Surbharati Prakashan, Varanasi. 2009. p. 565. 2 Agnivesha, Charaka, Charaka Samhita revised by Dridhabala, Chikitsa Sthana Jwarachikitsadhayaya 3/103-108, edited by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi (Vol.-II), Chaukhamba Sanskrit Pratishthan, Delhi. 2009. p. 85. 3 Agnivesha, Charaka, Charaka Samhita revised by Dridhabala, Chikitsa Sthana Jwarachikitsadhayaya 3/109-110 , edited by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi ( Vol.-II), Chaukhamba Sanskrit Pratishthan, Delhi. 2009. p. 87. 4 Agnivesha, Charaka, Charaka Samhita revised by Dridhabala, Chikitsa Sthana Jwarachikitsadhayaya 3/145 , edited by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi ( Vol.-II), Chaukhamba Sanskrit Pratishthan, Delhi. 2009. p. 92. 5 Agnivesha, Charaka, Charaka Samhita revised by Dridhabala, Chikitsa Sthana Jwarachikitsadhayaya 3/161-162 , edited by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi ( Vol.-II), Chaukhamba Sanskrit Pratishthan, Delhi. 2009. p. 85. 6 Arumugam P., Marudhamuthu M. and Thangaraj N. (2013). Evaluation of anti-inflammatory and analgesic effects of aqueous extract obtained from root powder of Inula racemosa Hook. f. Internet J Adv Res Life Sci; 1 (3), 43-47. 7 Chabukswar A.R. Kuchekar, B.S. Jagdale, S.C Lokhande et al (2010). Cardioprotective activity of Inula recemosa. Int J Chem Sci: 8(3), 2010, 1545-1552. 8 Srivastava, S.Gupta, Rajendra Prasad et al (1999). Evaluation of Antiallergic activity (type 1 Hypersensitivity) of Inula racemosa in rats. Indian J Physiol Pharmacol 43 (2): 235-241. 9 Agnivesha, Charaka , Charaka Samhita revised by Dridhabala, Chikitsa Sthana Jwarachikitsadhayaya 3/201 , edited by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi ( Vol.-II), Chaukhamba Sanskrit Pratishthan, Delhi. 2009. p. 99. 10 Agnivesha, Charaka , Charaka Samhita revised by Dridhabala, Chikitsa Sthana Jwarachikitsadhayaya 3/201, edited by Acharya Vidyadhar Shukla and Prof. Ravi Dutt Tripathi ( Vol.-II), Chaukhamba Sanskrit Pratishthan, Delhi. 2009. p. 99. HOW TO CITE THIS ARTICLE Harishbhai KD, Kumar PH. A conceptual study on management of COVID 19 through Ayurveda- A brief review. J Ayu Herb Med 2020;6(3):182-184.