COVID-19 was identified as a new pandemic in the year 2019 and declared a global emergency by WHO. It is caused by severe acute respiratory syndrome coronavirus (SARS-CoV2) which is a type of RNA virus and belongs to the Coronaviridae family. The disease is believed to have originated from bats and spread to people through an unknown means in Wuhan, China. Ideally, the disease spreads by droplet or aerosol infection with an incubation period ranging between two to fourteen days. The clinical features of the disease can progress from asymptomatic to symptoms of fever, cough, sneezing, sore throat, difficulty in breathing, acute respiratory distress syndrome, pneumonia, and even death.
In the second wave of COVID 19, evidence has shown that the inflammatory response plays a key role in the progression of the disease. The diagnosis of the disease is done through RT-PCR, chest X-ray and thoracic CT scan along with some inflammatory markers TLC, CRP, LDH and D-dimer. However, there is no specific treatment available till date. Preventive strategies include isolation of infected individuals, proper ventilation, hand hygiene and use of personal protective equipment, etc. The severity of the disease and the unavailability of a definite treatment has caused great alarm and panic among the public across the world. Covid 19 which is a pandemic can be correlated to Janpadodhwamsa in Ayurveda. In this article we will discuss about the efficacy of Ayurvedic diet in mild to moderate cases of Covid 19 patients.Introduction
We are facing the pandemic of Covid-19 and its devastating effect on the body and mind. The outbreak of Corona virus started in late 2019 and developed into a global pandemic in March 2020. Now the deadly second wave of Corona virus has started again which has devastated a large population in every way. Apart from this, there is a shortage of space in hospitals and crematoriums. Many small cities, towns and villages are in the grip of this second wave of corona virus. The virus that causes COVID-19 is a type of corona virus i.e. Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV2) which is a type of RNA virus and belongs to the Coronaviridae family. The corona virus is named like the spike protein present on its surface. Since these viruses are constantly changing through mutation, and new versions of the virus emerge over time. Therefore, it has become a difficult task for scientists to find its exact cure. Also, the effectiveness of the vaccines and medicines available so far may also change. The symptoms of the second wave of corona virus are more deadly which include fever, cough, sore throat, loss of taste and smell, fatigue, dizziness, unexplained weakness along with some neurological problems. Its more severe form can lead to pneumonia, ARDS and even death. However, based on the degree of symptoms of COVID-19, it can be classified into different stages. Which can be stated as follows - Asymptomatic - Individuals who test positive for SARS-CoV-2 using virological testing but do not have any symptoms that are consistent with COVID-19. Mild illness - Individuals with symptoms of fever, cough, sore throat, malaise, headache, muscle pain, nausea, vomiting, diarrhea, loss of taste and smell but who do not have shortness of breath, difficulty breathing, or abnormal chest imaging. Moderate illness - Individuals who show evidence of mild respiratory disease during clinical evaluation or imaging and who have oxygen saturation (SpO2) ≥ 94% in room air at sea level. Severe illness - Individuals who have SpO2 30 breaths/minute, or lung infiltration more than 50%. Critical illness - individuals who have respiratory failure, septic shock, and/or multiple organ dysfunction.Investigations
The following radiological and laboratory investigations should be done for people with SARS-CoV-19 infection. Lab investigations should include complete blood count with ESR, renal and liver function tests, lipid profile, serum ferritin, lactate dehydrogenase, coagulation profile and blood sugar level. Inflammatory markers such as C-reactive protein, D-dimer and ferritin levels are also included. X-ray chest PA view, ECG (electrocardiogram) should be evaluated. Oxygen saturation and temperature should be monitored at least twice a day.COVID 19 As Per Ayurveda
First of all we should understand that COVID-19 is a disease which was identified as a new pandemic in the year 2019 and declared as a global emergency by WHO. Till date scientists are trying hard to understand the nature of the virus. This disease is completely new to the world and is not described in our Ayurvedic Samhita. Hence this type of disease is called Anukta Vyadhi. Acharya Charaka has mentioned that the diseases which are not mentioned here due to the vastness of their name and form are called Anukta Vyadhi. Such diseases should be treated according to the consideration of dosha and dusya. For the treatment of the disease, diagnosis should be done according to the Prakopa Lakshan and treatment should be done according to the general principle. In Ayurveda, natural calamities like epidemics and pandemics can be included under 'Janapadodhwamsa'5 which means destruction of a state, kingdom or country. In Janpadodhwamsa, the death of large population is due to the attack of 'Bhoot'. In modern literature 'Bhoot' can be correlated to microorganisms (bacteria, viruses and microorganisms). These are the external factors responsible for Agantuja Vyadhi. Abhisanga means association with or contagion by microbes. Bhutabhisanga is a term mentioned in the Ayurvedic classics in the context of Jwar Nidanas which means association with or contagion by microbes.
Thus, in Ayurveda, microbial disease can be considered as Bhutabhisangaj Vyadhi. Further, Bhutabhisangaj fever involves vitiation of all the three doshas i.e. Vata, Pitta and Kapha and is a type of Agantuj fever. In Shushruta Samhita, certain infectious diseases are classified as Aupasargi Roga and Sansargaj Roga (spread from person to person). This can further turn into epidemic or pandemic diseases and result in Janpadodhamsa. From Ayurvedic point of view, the hypothesis of pathophysiology of infection with novel corona virus can be correlated with Bhutabhisangaj fever which is Sansargaj/Aupasargi in nature. In the disease of COVID 19, Bhutabhisanga i.e. corona virus infection turns into Nij Vyadhi by irritating the Tridoshas. Hence, fever with Pranavaha Shrotodushti (Nij Vyadhi) symptom is associated with it.
Pathogenesis of COVID 19 according to Ayurveda
The extent of manifestation of symptoms in COVID 19 depends on individual body strength (immunity). Similarly we can understand the degree of deterioration of trishosha from the magnitude of the infection involved. The attraction towards Pranavaha Srota can be attributed to the svabhava (nature) of the Bhuta (coronavirus). Hridaya (heart), Mahasrota (alimentary canal), and Rasavahi Dhamani are the moolasthanas (roots or origins) of Pranavaha Srota. In recent literature, it is cited that Hridaya includes the entire region adjacent to the heart/thoracic cavity which also includes the lungs. This region is the seat of Prana and Udana Vayu (related to respiration), Sadhaka Pitta (facilitating cell biological functions), and Avalambaka Kapha (protection and maintenance of organs). Pranavaha Shrota Drishti breathing therapy is recommended for the treatment of. Breathing disease is Pittasthana Samudbhava (originated from the seat of Pitta) as described in our literature. The seat of Pitta is stomach and it is also the seat of Kledaka Kapha. This Kledaka Kapha has an influence on other Kapha sthanas, Urah (thoracic cavity) being one of them. Thus, it also plays an important role in the pathology of Pranavaha Strotas Vyadhi. Since Mahasrota (alimentary canal) is the root-place for Pranavaha Srota, any disturbance in the gastrointestinal system will affect the Pranavaha Srota. The stomach is the common place of Kapha and Pitta doshas. Therefore, the dakshina of the sthana (abode) leads to Pitta Dushti. The vitiation of Kledaka Kapha in the stomach also vitiates the Prakriti Pitta dosha due to amalgamation. The vitiated Pitta and Kapha doshas lead to Rakta Dushti, which produces Daha, Raga, Paaka and Shofa (swelling) in the body. These are the symptoms corresponding to COVID-19 that can be observed when the Pranavaha Srota is contaminated by the Dushta Rakta Dhatu. In the mild stage of COVID-19 when the virus attacks the Pranavaha Srota, Shofa (swelling) may develop. Shofa (swelling) is the initial stage of vrana/kshata (injury). Therefore, it can be reasoned that the next stage of edema of the prana vaha shloka is the damage of this shloka, which may be the initial process for pulmonary tissue injury (may lead to urakshata). Urakshata which is the next stage of pulmonary tissue injury and no prodromal symptoms (latent symptoms) are seen before the full manifestation of the disease. This can be correlated with the symptomless stage of COVID-19, where the test is positive but the patients are symptomless. Jwar (fever) can be seen in the earlier stages of edema or as a manifestation of rakta dhuli. The symptoms of jwar related to the specific dosha are not seen at this point as it is an agantuja jwar. Pitta dushti with vata prakroka may cause kapha udirana (excessive increase), which may increase the impure dosha in the head, resulting in kathasaya (rhinitis). Kapha Prakrodha, combined with Pitta Dushti causes Shrotarhodha (obstruction in respiratory tract), which leads to reversal of the flow of Prana Vayu resulting in Kasa (cough).Usually in this stage, irregular breathing appears due to the initial disturbance of Pranavaha Sroto Moolasthan. Other symptoms like Chhardi (vomiting), Avipaka (indigestion), Atisara (diarrhea), and Udarashoola (abdominal pain) also appear due to the involvement of Mahasrotas. Mahasrotas mainly comprises of Amashaya to Pakkashaya. The vitiated Samana Vayu circulating in Amashaya and Pakkawashya causes gastrointestinal symptoms. The dosha aggravation is minimal in the occurrence of fever, cold, and Kasa. At this stage, the symptoms of Pranavaha Srota Drushti are mild in nature and easy to treat. It is similar to the symptoms of acute upper respiratory tract infection in the mild stage of COVID-19.
Objectives
1. To understand the etiology and pathogenesis of COVID 19 as per the recent guidelines given by WHO. 2. To establish analogy in the pathogenesis of COVID 19 as per Ayurveda. 3. To understand the effectiveness of Ayurvedic diet especially juice preparation in the treatment of COVID 19.Materials and Methods
The information in this article is collected from various Ayurvedic literatures along with their commentaries. The information related to COVID is collected from various websites including WHO, Ministry of Health and Family Welfare. Apart from this we have also searched various articles from Google Scholar, Pubmed etc. Case description A 48-year-old male patient weighing 60 kg came to the emergency OPD of Government PG. Ayurvedic College and Hospital with the following symptoms - fever, sore throat, dry cough, body ache - temperature was -100.6◦F and SpO2 - 95% for 3 days. There was no chest tightness and breathing problem. We advised him to get tested for COVID 19 as per his clinical symptoms. Symptomatic treatment including both allopathic and ayurvedic was given till that time. After 3 days his RT-PCR came positive. This time he was feeling breathless with some chest tightness. Though he got satisfactory relief in previous symptoms but fever was recurring. Thereafter he was advised to undergo X-ray. X-ray showed clouding in the right lower lobe of the lung. All these symptoms were indicating moderate COVID-19 disease. He was strictly put on COVID-19 treatment protocol as mentioned by WHO and MHFW which are as follows 1. Tab Paracetamol 500 mg TDS 2. Anti Tussive Syrup SOS 3. Tab Vit C 500 BD 4. Tab Zinc 50 mg BD 5. Cap Omeprazole 20 mg BD 6. Tab Azithromycin 500 mg OD for 5 days 7. Tab Amoxiclav 625 mg BD for 7 days along with adequate hydration, pranayama, dashmool kwatha, steam inhalation with Tulsi leaves and camphor. After following this protocol the patient got satisfactory relief in fever and sore throat within 5 days. However there was not much relief in chest tightness and breathlessness. So we advised some Ayurvedic Rasa Aushadhi preparation. Antibiotics were stopped after 7 days. Ayurvedic medicines were as follows-
1. Sahasrabhraka Bhasma 30 mg
Naradiya Lakshmi Vilas Ras 10 mg
Talisadhi powder 2 grams
Tankan Bhasma 250 mg
Yastimadhu powder 1 gram
Sutshekar Ras 60mg 1xBD with Honey
2 Agastya Haritaki Rasayan with 2 tsp BD with lukewarm water
Follow Up And Results
After 5 days of treatment he observed improvement in chest tightness and breathlessness. By 10th day all the symptoms subsided. However the treatment continued for next 5 days. Follow up was taken after 7 days. He was completely cured from his illness and his prana was stable. Yoga, pranayama, steam inhalation and adequate hydration were strictly followed by the patient during the follow up period. After 15 days of complete Ayurvedic treatment he tested negative for COVID-19.Discussion
Considering the above symptoms of COVID-19, from Ayurvedic point of view this case was considered as Vata Kaphaja type of Sannipataj fever with Alpa Pitta. Secondly respiratory tract was also involved hence Pranavaha Sroto Drishti Chikitsa is done. Here we will understand the mode of action of Ayurvedic herbal-mineral preparation in case of COVID 19 according to Dosha and Dusya.Sahasrabhraka Bhasma
Bhasma is a type of herbal Ayurvedic preparation in which various metals/or their ores are mixed with decoction of various herbal products and consumed in a puta (repeated cycle) system. These preparations are often considered as nano medicine. These Bhasmas are usually prepared through Shodhana, Bhavana and Marana process, hence free from toxicity in therapeutic doses. It shows Rasayana properties due to its ability to penetrate the smallest units of the body and gives therapeutic benefits when administered correctly. Abhrak Bhasma is a type of Bhasma prepared by repeatedly burning the mineral mica with decoction of about 72 herbs. The particle size of Abhrak Bhasma has been shown to be in the range of 29-88 nanometers and Fe, Ca, Se, Mg and K have been found as major constituents. These metals are required in small quantities to maintain metabolic activity in humans. The quality of Abhrak Bhasma varies according to the number of putas performed. Sahasraputi Abhrak Bhasma which undergoes 1000 putas is considered to be of the best quality. It has the ability to pacify the Tridoshas i.e. Vata, Pitta and Kapha. Due to its intrinsic anti-inflammatory, anti-biotic and anti-asthmatic properties it is important in treating cough, chest congestion and breathlessness. It also acts as a Rasayana (immuno modulator).Laxmi Vilas Rasa
This is a type of Khalviya Rasayan described in Rasashastra. To understand the medicinal action of Laxmi Vilas Rasa we will see the list of ingredients present in it along with their properties. Since there was chest congestion and shortness of breath, to deal with the condition we will follow Kasa Shwas method of treatment in Ayurveda. Shwas Roga mainly involves Vata and Kapha doshas. So the medicine to be selected will be the one which has Vata Kapha Shamak property. Most of the ingredients in Naradiya Laxmi Vilas Rasa act on Vata and Kapha doshas. Also it is mainly indicated in respiratory system disorders. Since it is a herbomineral preparation, this medicine can rapidly enter our body undergoing various pharmacodynamics and pharmacokinetics called sanskar. Also this medicine reaches various subtle channels of the body due to its subtle preparation and is therapeutically effective in low doses.Talishadi Churna
Talishadi Churna is mainly effective in Vata and Kapha imbalance disease hence indicated in Kasa and Shwasa. It is very effective in viral fever patients associated with cough and cold symptoms. It is effective in treating gastrointestinal disorder specially Vatanulomaka. In Covid 19, the origin of the disease is Pranavaha Strota (Respiratory symptoms) and its Moolasthan is Mahasrota (GIT). Hence Talishadi Churna is selected as it has effect on both Pranavaha and Mahasrota.Tankan Bhasma
It has Vata and Kapha Shamaka properties. Due to Ushna Virya it is Kapha Nissaraka in action i.e. it melts thick mucus and helps in expelling it from lungs. Yashtimadhu Churna The method of treatment in Covid 19 disease is according to breathing disease which is Pitta Sthan Samudbhava. The place of Pitta is Adho Amashaya. Apart from this, the type of fever present in it is Vata Kapha Pradhan Sannipathaj fever. Therefore, it should be understood that along with Vata and Kapha, Pitta dosha is also bad. Therefore, we should also pay attention to Pitta Shamak Chikitsa. Yashtimadhu has Madhura Rasa, Madhura Vipaka and Sheeta Virya. Due to these properties, it has excellent Pitta Shamak action. Apart from this, it also has a very good role on breathing disease. The active ingredient Saponin present in it has mast cell inhibitory activity. This confirms the anti-asthmatic action of Yashtimadhu. Like the active component of medicinal herbs, Glycyrrhizin potentially inhibits viral replication and has antiviral properties.Sutshekhar Rasa
Its action is Pitta Shamak, so it is used in Covid 19 disease to remove Pitta vitiation. As it is a herbo mineral preparation, it has high absorption capacity in body tissues. It shows its action by reaching the subtle nadis of the body.Agasthya Haritaki Rayaan
It improves respiratory power. Useful in many acute and chronic respiratory disorders. Excellent in all types of asthma and also useful as Rasayana. From the above discussion it is clear that Rasa aushadhi plays a vital role in preventing disease progression and is very effective in acute condition of disease. Most of the medicines mentioned above are immunomodulatory which have a vital role in combating COVID-19. The innate quality of Rasaushadis like quick action, low dosage, tastelessness, better taste has helped in meeting the patient demand. We report this case to show the effectiveness of ayurvedic medicine especially herbo mineral compound in case of COVID 19. It is observed that the above treatment helped the patient to recover from the existing ailments and he did not become critically ill. Thus Ayurvedic medicines are not only used for prophylactic treatment but also have a therapeutic role in combating COVID 19 infection.Conclusion
Bringing Ayurveda protocol for management of COVID 19 is a step towards progress. Unlike microbial etiology in modern medicine, Ayurveda treats COVID 19 on the basis of dosha, dhatu, mala etc. and manages accordingly. All the symptoms of COVID 19 can be linked to pitta relation with vata kaphaja sannipathaj fever. Samprapati bhanga (breaking the pathophysiology) is the treatment of any disease so more emphasis should be given on understanding the pathophysiology. Before treating any COVID-19 patient, prognosis should be taken into consideration and timely referral of critically ill patient should be advised. India is the country where the oldest surviving health care system of the world originated. So it is time to show the potential of our ancient Ayurvedic medical system during this pandemic crisis.
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AYURVEDIC MEDICINES
