Ayurveda interpretation, diagnostic, and probable management of COVID-19 pandemic

Sanjay Kumar

doi:10.4103/JISM.JISM_54_20

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Year : 2020 | Volume : 8 | Issue : 2 | Page : 91-101

Ayurveda interpretation, diagnostic, and probable management of COVID-19 pandemic

Sanjay Kumar
Department of Panchakarma, Faculty of Ayurvedic Science, Jayoti Vidyapeeth Women’s University, Jaipur, Rajasthan, India

Date of Submission	17-Jun-2020
Date of Decision	11-Jul-2020
Date of Acceptance	14-Jul-2020
Date of Web Publication	07-Sep-2020

Correspondence Address:
Dr. Sanjay Kumar
Department of Panchakarma, Faculty of Ayurvedic Science, Jayoti Vidyapeeth Women’s University, Jaipur, Rajasthan.
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JISM.JISM_54_20

Abstract

Viral infections play a significant role in human illnesses. In late December 2019, a previously unidentified coronavirus, named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 by ICTV on February 11, 2020), also named as 2019 novel coronavirus, originated from Wuhan, China, and caused outbreak in many countries. Presently, despite the advancement made in immunization and drug development, this virus lacks preventive vaccines and effective antiviral remedies. Thus, identification of specific antiviral medicine is of critical importance. However, classical Ayurveda preparations may play an excellent role in the management of this outbreak. Ayurveda has a unique method of approaching the newly detected disease. Rather than focusing on the microbial etiology, Ayurveda embraces a holistic technique for elaborating the details of the disease at hand. In this paper, we summarize the interpretation, diagnosis, treatment principles, and medicines described in different texts of Ayurveda to treat viral infections.

Keywords: Ayurveda, COVID-19, Infectious disease, Krimi, Panchakarma, pandemic

How to cite this article:
Kumar S. Ayurveda interpretation, diagnostic, and probable management of COVID-19 pandemic. J Indian Sys Medicine 2020;8:91-101

How to cite this URL:
Kumar S. Ayurveda interpretation, diagnostic, and probable management of COVID-19 pandemic. J Indian Sys Medicine [serial online] 2020 [cited 2023 Mar 21];8:91-101. Available from: https://www.joinsysmed.com/text.asp?2020/8/2/91/294437

Introduction

A number of viral infections are responsible for human pathogeneses comprising pandemic diseases. Rapid urbanization and increased global travel cause pandemic outbreaks, and re-emerging viruses create a serious threat to social health.^[1],[2],[3] Currently, a number of viruses remain without actual immunization, and a few antiviral medicines are licensed for clinical practice. The condition is further exacerbated by the latent development of drug-resistant mutants, especially when using viral enzyme-specific inhibitors, which significantly obstructs drug efficacy.^{[4],[5],[6],[7]} Thus, there is a crucial need to develop specific antiviral drugs that are very effective and cost-effective in the treatment and control of viral infection. Ayurveda medicines and Panchakarma may provide an effective treatment for COVID-19 outbreak. In this paper, a summary of several Ayurveda preparations and herbal medicines against this coronavirus has been reported.

In December 2019, an epidemic of an unknown pneumonia characterized by fever, dry cough, fatigue, and infrequent gastrointestinal symptoms happened in a seafood market in Wuhan, Hubei, China.^[8],[9],[10] This pandemic emerged from China and has rapidly spread to most countries in the world. It was confirmed as a pandemic by the WHO on March 11, 2020, as it has confirmed its presence in all continents except Antarctica.^{[11],[12],[13],[14]}

Coronavirus is an enveloped, positive-sense, single-stranded RNA (ss-RNA) virus belonging to the Orthocoronavirinae subfamily of Coronaviridae family, with “crown-like” spikes on their surface.^[15] The precise source, location, and natural reservoir of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remain uncertain, although it is believed that the virus is zoonotic, and bats may be the culprits because of the sequence identity to bat-CoV^{[8],[16],[17]} Initially, SARS-CoV-2 eruption was reported as limited person-to-person transmission, and a contaminated source from infected animals in the wet market may have been the common origin.^[18] But more and more evidences came out, with clusters of outbreaks among families confirming the possibility of person-to-person transmission.^{[19],[20],[21],[22],[23],[24],[25]}

Symptoms of COVID-19

The mean incubation period of COVID-19 is 5.2 days (95% confidence interval, 4.1–7.0).^[24] The symptoms begin with non-specific syndromes, comprising fever, dry cough, body pain, and fatigue.^[23] The symptoms may appear 2–14 days after exposure to the virus^[26]:

fever

cough

shortness of breath or difficulty in breathing

chills

repeated shaking with chills

muscle pain

headache

sore throat

loss of taste or smell

These symptoms may become more severe in some people:

trouble breathing

confusion or inability to arouse

persistent pain in the chest

bluish lips and/or face

excessive drowsiness

The most serious complication of COVID-19 is a type of pneumonia called the novel coronavirus-infected pneumonia (NCIP). So far, NCIP is the only complication specifically linked to the 2019 coronavirus. Researchers have seen the following complications in people who developed COVID-19:

acute respiratory distress syndrome (ARDS)

irregular heart rate (arrhythmia)

cardiovascular shock

severe muscle pain (myalgia)

fatigue

heart damage or heart attack

Commonest signs and symptoms are fever (83–98%), cough (76–82%), and shortness of breath (31–55%). There were about 15% with fever, cough, and short of breath.^[27] These symptoms are usually mild and gradually worsen. Approximately 80% of COVID-19 cases showing mild symptoms require only primary medical treatment. In rest of the 20% cases, 15% need emergency medical attention at secondary healthcare hospitals and 5% critical cases need an intensive care and a transfer to tertiary healthcare centers equipped with an ICU.^[28] In the 5% cases needing intensive care, the disease development is gradual and takes nearly 9–10 days to progress from symptoms of upper respiratory tract infection (URTI) to ARDS. ARDS often is followed by uncorrectable hypotensive shock, multiorgan failure, and eventually death.^[29]

Understanding Janapadoddhwamsa in Ayurveda and COVID-19 Pandemic

As COVID-19 has developed itself into a pandemic, affecting a large population irrespective of their physical features, dietary patterns, psychological attributes, climate, etc., Ayurveda considers it as a Janapadoddhwansa.^[30],[31] The concept of epidemic/pandemic is very well defined in Ayurveda under the heading of Janapadoddhwansa. In Ayurveda, the destruction of mass (Janapadoddhwansa) is said to be caused due to the degeneration (Dushti) of factors like Kala (time/season), Desha (region), Vayu (air), and Jala (water), which are common to all humans.^[32] The whole population gets Ksheena Bala (diminished body immunity) due to the consumption of polluted water, food, and air by which the virus enters the body to produce different symptoms. This is the reason why people with varied physical dispositions get afflicted with the same disease within the same timeframe.^[30],[32]

Acharya Sushruta, described the concept of pandemic/endemic in Ritucharya (seasonal regimen) as Maraka (lethal), where he explains how attacks (infections) of Rakshasa (viruses, bacteria) and Dushita (infected) air cause Janapadoddhwansa. Cause of Janapadoddhwansa are unsuitable season, wrong activities, curse of animals, demons (viruses, bacteria), disrespectful for nature and non-religious activities (killing and eating of innocent animals and birds) vitiates the environment affects nation by nation and produces breakdown of living culture produces endemic/pandemic disease. Infected people show symptoms of Kasa (coughing), Shwasa (breathlessness), Vamana (vomiting), Pratishyaya (running nose/rhinitis), Shirovedana (headache), and Jwara (fever); thus, various diseases and epidemics are manifested.^[33]

Janapadoddhwansa in Vasanta Ritu (season) results in incidence of Vata-Shlaishmika predominant Sannipaata Jwara (fever). The incidence of this Jwara points toward the rapid and violent vitiation of Vayu (air), Jala (water), Desha (ground) and Kala (time) due to the activities that can be assigned as Prajnaaparadha. Moreover, the predisposing factors such as old age and comorbidities like cardiovascular diseases, diabetes mellitus, respiratory diseases, hypertension, malignancies, etc., are causes of weakened Rogi Bala, which will result in fatality.^[34]

Krimi and the Novel Corona Virus

The concept of microorganisms has been well emphasized in Ayurveda in the context of Krimi, Bhoota, Graha, etc. The knowledge of three basic principles such as Hetu (cause), Linga (symptoms), and Aushadha (management) in Swastha and Atura is needed to treat any disease in Ayurveda.^[35] In the context of COVID-19, the cause of pandemic disease is a virus. Ayurveda classics like Charaka Samhita and Sushruta Samhita have described an infection almost like the novel coronavirus. The invisible Raktaja Krimi or Kaphaja Krimi is described as something that cannot be seen by the naked eye as they are Maha Sukshnma. It has a round shape, heavy with Roma (spikes) on them. Charaka Samhita description is so close to that of the novel coronavirus. Charaka explained how Kaphaja Krimi, after settling in the respiratory system, creates cough, severe congestion, and breathlessness and sometimes leads to death.^[36],[37]

These Raktaja Krimi cause Dushita Rakta, which in turn does Avarana (covering) of Vata leading to Vranashopha, to produce Santapa (burning sensations like fever), Atidourbalya (weakness), Aruchi (anorexia), Shiroruka (headache), and other symptoms as told in Charaka Samhita. In the context of coronavirus, Krimi (Raktaja Krimi) produces Rakthadusti by different Doshas to produce Raktavarana Vata Prakopa, leading to Vranashopha at Kantha Pradesha (viral pharyngitis); thus, there will be sore throat and throat congestion.^[38] If Krimi produces Vata-dominant Rakta Dusti, it shows Vataja symptoms like coughing, difficulty in breathing, sore throat, body ache, etc.; if Pitta-dominant Rakta Dusti occurs, it shows Pittaja symptoms like Jwara, Daha, Mukhapaka, etc. Similarly, if Kapha-dominant Rakta Dusti occurs, it shows Kaphaja symptoms like Pratishyaya, Gaurava, Tandra, Aalasya, throat congestion, etc. When these two or three Doshas are associated with each other, mixed symptoms will be produced according to the predominant Dosha involved. In the case of COVID-19, it occurs at throat as Pidaka. Probably initial Vatakaphaja symptoms will be predominant. Then it spreads to larynx (causes laryngitis), trachea (causes tracheitis), bronchus (causes bronchitis), and finally to alveoli (causes pneumonia) due to Parisarpana (AbhyantaraVisarpa/Vranashopha) nature of aggravation of Pitta in association with Rakta.^[39]

In COVID-19 infection, initially Vata-Kapha predominant symptoms produced, like low-grade fever (Manda Jwara), sneezing, and throat congestion. The infection then produced dry cough (suggesting involvement of Vata Dosha) and high-grade fever (Teevra jwara) (suggesting involvement of Pitta Dosha). Later on when there is involvement of alveoli, patient produces shortening of breath or breathlessness (Shwasa).

Bhootaabhishangaja Jwara and Symptoms of COVID-19

COVID-19 can be grouped under the class of Aagantuja Roga with special reference to the Bhootaabhishangaja Vikaara. In Bhootaabhishangaja Jwara, attack of Bhoota (bacteria, virus, other invisible microorganism, super natural power) happens first on the body and then aggravation of the three Doshas occurs. This Jwara is transmitted from one person to other person by close contact with infected persons, touching the air which passed from them, or air contaminated with Bhoota or poison (Visha).^[40] The management of Aagantuja disease should also follow the lines of Nija vikaara treatment. No disease can develop without involvement of Vata, Pitta, and Kapha.^[41] Identification of a suitable pathological model along with the associated features is very important. Charaka had been advised Vishghna medicine (anti-poisonous drugs) in the treatment of Bhootabhishangaja Jwara^[40] and also advised Dhoopa and Anjana in all types of Aagantuja Jwara, including Bhootaabhishangaja Jwara and when Jwara present only in skin.^[42]

Considering all the clinical features of COVID-19 and comparing with the clinical features mentioned in Ayurveda classics, COVID-19 can be considered as a Vata-Kaphaja Jwara^[43] of course, with some extent of Pitta involvement,^[44] in the beginning. But it obtains the status of a complete Sannipata jwara^[45] as disease progresses in certain groups of population. The clinical progression can be monitored as follows: symptomatic mild infection at presentation, leading to moderate disease to severe conditions, and then terminating in very fatal illness. Clinical features of Vata-Kaphaja Jwara and Sannipataja Jwara are as follows.

In Charaka Samhita,

Vata-Kapha Jwara: Sheeta, Gaurava, Tandra, Staimitya, Parvaruka, Shirograha, Pratishyaya, Kasa, Swedapravartam, Santapa, Madhyavega of Jwara.^[46]

Sannipata Jwara: Shwasa, Kasa, Pratishyaya, Mukhashosha, Atiparshvaruka^[47]

Samsannipata Jwara: Kanthah Shukairivavritah, Kasa Shwasa, Pratata Kanthakujanam^[45]

In Sushruta Samhita

Vata-Kapha Jwara: Staimitya, Parvabhrda, Nidra, Gaurava, Shirograha, Pratishyaya, Kasa, Swedapravartam, Santapa, Madhyavega of Jwar.

On other place also described Shoola, Kasa, Kaphotklesh, Sheeta, Vepathu, Peenasa, Gaurava, Aruchi, and Vistambha.^[48]

In Ashtanga Hridayam

Vata-Kapha Jwara: Tapahaani, Aruchi, Parvaruka, Shiroruka, Peenasa, Shwasa, Kasa, Vibandha, Sheeta, Jadyata, Timira, Bhrama, and Tandra.^[43]

Aaupsargika Disease of Ayurveda and Transmission of Infectious COVID-19

Healthy people can become infected with SARS-CoV-2 from already infected people and develop COVID-19 disease. The disease can spread in human being through small droplets from the nose or mouth which spread when a person with COVID-19 coughs or sneezes. These droplets land on objects and surfaces around the person. Other people can then be infected by touching those contaminated objects or surfaces, and then touching their eyes, nose, or mouth. People can also be infected if they breathe in droplets from a person with COVID-19 who coughs or sneezes in close proximity.^{[19],[20],[21],[22],[23],[24],[25]}

These types of disease are considered as Aaupsargika Roga (infectious disease) in Ayurveda. Sushruta had described that Jwara, Kushtha, Shosha, and Netra Abhishyanda is Aaupsargika disease and its infection is spread by direct contact with infected persons. Dalhana, the commentator of Sushruta Samhita, said that air escaped from the nose of these infected persons causes Shwasa (breathlessness), Kasa (cough), Pratishyaya (rhinitis), Twak Vikara (skin disease) Jwara (fever), Masurika (small/chicken pox), etc.^[49]Abhishangaja Jwara also transmitted from one person to other person by close contact with infected persons, touching the air which passed from them, or air contaminated with Bhoota or poison.^[40]

ProbableAyurveda Samprapti (Pathogenesis) of COVID-19

Virus enters the body through nasal passage, eye conjunctiva, or mouth mucosa, settles in Kantha Pradesha (pharynx) for some time, mixes with body mechanism by damaging the mucosa, and starts replications. After replication in large numbers, it shows their symptoms like pharyngitis, sore throat, sneezing, dry cough, and fever. Then it moves toward trachea, causes tracheitis, and causes bronchitis which causes excessive dry cough and shortening of breath. As disease progresses, it causes pneumonia and eventually multi-organ failure or death.

Management Protocol of COVID-19 through Ayurveda

The knowledge of Hetu (cause), Linga (symptoms), and Aushadha (management) in healthy and diseased persons are the three basic principles needed to treat any particular disease in Ayurveda.^[35] According to Ayurveda, the line of treatment should be planned to breakdown the aetiopathogenesis (Samprapti) of the disease. On the basis of the above-mentioned epidemiology, pathogenesis, and clinical features of COVID-19 disease, here, a rational and acceptable proposal for interventions of Ayurveda medicines and Panchakarma therapy is presented. Though, it is not limited to prophylaxis only, it is also effective for the therapeutic and an integrative management of COVID-19 disease. Here, we classified the different stages of contamination and immediacy with disease among individuals. Although till date no medical system has any specific treatment for COVID-19, clinical interventions are being done worldwide. Ayurveda mediations become more relevant by the fact that there is a vast explanation of causation and management of pandemic (Janapadoddhwansa) in Ayurveda.^[30],[50]

The line of treatment for COVID-19 is as follows:

Nidaana Parivarjana (moving to safe places or isolation or quarantine from infected persons/area)

To deactivate the viruses through antiviral medicines (no specific medicine yet developed)

To treat the symptoms of viral infections and complications on the basis of Doshika involvement.

To enhance the body immunity system and body strength of infected person.

Detoxification of body by Shodhana of aggravated Doshas by Panchakarma treatment

To protect the healthy persons from viral infection by increasing their immunity

The aims of Ayurveda are to preserve and retain the good health of healthy persons and to treat the diseased persons without any complications.^[51],[52] In the context of pandemic COVID-19, it is very important to follow the aim of Ayurveda. So, we can divide the whole populations into three major groups: healthy population, infected population, and cured population from infection. These groups of population can also be categorized into subgroups on the basis of their exposure to viral infection and symptoms shown in their body [Table 1].

Table 1: Classification of whole population for management of COVID-19

Click here to view

Prophylaxis and Preventive Measures for Group I (Healthy Population) and Preventive Measures for Subgroups 1 and 2

They should be in quarantine in their home and try not to expose to other persons of population. Follow the guidelines given by the local authorities and Government.^[53]

They should follow the Dinacharya and Ritucharya mentioned in different texts of Ayurveda.

Use of diets rich in Katu, Tikta, KashayaRasa (taste), fibres, and vitamin A, C, and E.

Drink adequate amount of lukewarm water whole day.

Regular practice of Yogasana, meditation, and Pranayama for at least 30 min and physical activity and exercise for healthy life-style

Adequate sleep of 7–8h in night; avoid daytime sleeping

Exposer of sunlight on whole body for 10–15 min daily.

Care for retainable and non-retainable urges; do not suppress the coming urges.

Avoidance of disease causing and aggravating factors (exposure to infection and excessive cold). Avoid air conditioning, cold water, cold drinks, fridge items.

Physical and social distancing for all groups must be necessary to avoid any viral contamination.

In addition to the above, the guidelines of Janpadoddwansha described in Ayurveda texts^[54],[55] needs to be followed:

Sthana Parityaga: return to home

Shanti Karma: work and maintain peace

Prayaschita: ready to pay penalty

Mangala: Being prosperous

Japa: keep mind Busy with chanting mantra and meditation

Homa: Fumigation, ritual habits which can disinfect air

Upahara: Gift rightly to right people

Iejya: sacrifices (Yagya karma)

Anjali Namaskar:- salute with both hand bind, avoid hand shake

Tapo: Austerity

Niyama: make and follow rules

Daya: kind toward living beings

Daana: give contribution to combat disease

Deeksha: provide knowledge to other persons

Abhyugama: acceptence

Devtabrahminguruparairbhavitavyam: pray together to god and elders

Preventive Measures for Subgroups 3 and 4

In addition to the above-mentioned preventive measures, subgroups 3 and 4 the below-mentioned measures needs to be followed^[26],[56]:

Wash the hands regularly and thoroughly with an alcohol-based hand wash or disinfectant frequently for at least 20 seconds at a time with warm water and soap.

When the hands are dirty, then avoid touching face, eyes, nose, or mouth

Objects like phones, computers, utensils, dishware, and doorknobs disinfectants.

Maintain at least 2 m (6 feet) distance between yourself and anyone who is coughing or sneezing.

Make sure that the people around, follow good respiratory hygiene. It means covering mouth and nose with their bent elbow or tissue when they cough or sneeze. Then dispose the used tissue immediately.

The Centres for Disease Control & Prevention (CDC) recommends placing the person in an airborne infection isolation room (AIIR) in addition to using standard precautions, contact precautions, and airborne precautions

Respirator or facemask

Gown

Medical gloves

Eye protection

Prophylaxis Measures for Groups 1 Medications

Use of Rasayana as Immune Booster

Rasayana is the rejuvenative therapy used to boost the immune system of the body.^[30] Those Rasayana having the principal effects upon respiratory tract may be useful. Rasayana not only improves the immunity but also treats diseases at times. It may interrupt the course of disease and prevent from becoming a full-blown stage of the disease.^[55] It is already proved that fresh juice of Cynodon dactylon has immunomodulatory properties and DNA protective activities. Drugs like Amalaki, Haritaki, Guduchi, Ashwagandha, Garlic, etc. act as Rasayana and also cure diseases.^[57]Rasayana act as an antioxidant, anti-inflammatory, anti-stress, anti-microbial, and vaccine adjuvant, and provides immunity against diseases.^{[58],[59],[60],[61]}

Antioxidants and immunomodulators could help to prevent the occurrence of infectious diseases like swine flu; antioxidant supplement may be used in the management of swine flu and it may be taken as a preventive medicine throughout any infection phase.^[62] This theory can be adopted in the management of all types of endemic/pandemic diseases. There are a number of medicines in Ayurveda providing antioxidant properties.

Uses of Panchakarma therapy

Panchakarma is the natural detoxifying therapy comprising five purificatory measures. It has been scientifically proven that natural purificatory treatments can successfully eliminate toxins and infectious substances without damaging or causing any side effects. Charaka described that Panchakarma is the best treatment for Janpadodwansha.^[63]

Many Panchakarma procedures described in Dinacharya and Ritucharya as described in classics should be used by Group I populations. These are Anjana with Sauviranjana, Rasanjana, three types of herbal Dhoompana, Nasya with Anutail, Kaval Dharana, Taila Gandoosh, Murdhataila, Karnapurana, Abhayanga (Massage).^[64] In context of COVID-19, Seasonal Panchakarma like Vamana and Nasya karma in Vasanta Ritu (season) may provide effective prophylaxis by detoxifying the body.^[65]

Nasya (nasal application): Use sesame oil/coconut oil/cow ghee in both the nostrils (Pratimarsh Nasya) in morning and evening.

Gandoosha (oil pulling therapy): Fill the mouth with 1 table spoon sesame or coconut oil. Do not drink, swish in the mouth for 3 to 5 min and spit it out followed by warm water rinse. This can be done once or twice a day.^[66]

Uses of medicines:

Drops (concentrated medicine/Bindu): Swarna-Bindu Prashana, Panchtulsi (Ocimum)

Tablets (Vati): Guduchi Ghan vati, Mahasudarshan Ghan Vati, Panchnimbadi Vati

Herbal powder (Choorna): Amalaki, Haritaki, Guduchi, Ashwagandha Garlic, Sitopladi choorna, Garlic (Allium sativum), Triphala Choorna, Panchkola, Turmeric (Curcuma longa) powder, Eranda Bhrista Haritaki Choorna, Carom or Ajwain (Trachyspermum ammi) seeds.

Decoctions (Kashaya): Gojihwadi Kashaya, Kiratatiktadi Kashaya, Panchkola Kashaya, Dhanyaka-Shunthi Phant

Avaleha:Chyavanprash, Brahma Rasayana, Amrit Bhallataka, Bhallatakavaleha, Vasavleha

Bhashma/Pishti- Godanti Bhashma, Pravala pishti

Fumigation (Dhoopana): Guggulu, Loban (Styrax benzoin) and Shallaki (Boswellia species)

Drink herbal tea/decoction (Kashaya): made from Tulsi (Basil). Dalchini (Cinnamon). Kalimirch (Black pepper). Shunthi (Dry Ginger) and Munakka^[66]

Spices: Haridra (tumteric), Jeera (cumin), Dhanyaka (coriander) and Lashuna (garlic) are recommenced in cooking.^[66]

Golden milk: Half tea spoon Haridra (Turmeric) powder in 150ml hot milk, once or twice a day.^[66]

Curative and Preventive Measures of Group II (Infected Population)

The Ayurveda treatment not only helps to treat infection caused by a pathogen, but also rejuvenates the immune response, at different levels, to fight against invasions while strengthening the host to resist the virulence of infection. This group of individuals was treated according to their symptoms shown by dominating vitiated Doshas. In the context of COVID-19, primarily Vata and Kapha Dosha aggravated after that, as disease progresses, Pitta also involved showing high fever.

Subgroup I COVID-19-suspected cases showing no symptoms of infection (quarantined)

Subgroup I individuals do not have any clinical symptoms, but they are at high risk due to travel and contact history from pandemic COVID-19 areas. They require to be quarantined cautiously. This subgroup also requires Group I prophylaxis and preventive measures. In this subgroup, Deepana, Pachana, Rasayana (immune enhancing medicines), Vrishya and Jwaraghna, Kasahara, Shwasahara medicine should be practiced.

Tablets (Vati): Agnitundi vati, Chitrakadi vati, Vishtinduk Vati, Sanjivani Vati, and Tribhuvana Kirti Ras

Avaleha: Chyavanprasha,

Herbal powder (Choorna): Trikatu Choorna, Panchakola Choorna,

Decoction (Kashaya): Triphala, Vasa (Adhatoda vasica), Haridra (Curcuma longa), Tulsi (Ocimum sanctum), Madhuyasti (Glycyrrhiza glabra), Guduchi (Tinospora cordifolia), Shunthi (Zingiber officinale) and Haridra (Curcuma longa) Kalmegha (Andrographis paniculata), Kirattikta (Swertia chirata), Shigru (Moringa oleifera) can be used in pandemic COVID-19.

These medicines have broad-spectrum antivirals and protease inhibitors.^{[67],[68],[69]}

Drinking water: Shadanga Paneeya Kashaya for drinking whole day

Drink herbal tea/decoction (Kashaya): made from Tulsi (basil). Dalchini (cinnamon). Kalimirch (black pepper). Shunthi (dry ginger) and Munakka^[66]

Steam inhalation: with tulsi or haridra water, fresh pudina (mint) leaves or Ajwain (caraway seeds) should be used once in a day.

Gargling: water boiled with tulsi/Haridra/Triphala/Yashtimadhu/Saindhava salt

Dhoompanam: Prayogika Dhooma described by Charaka.

During dry cough/sore throat/throat irritation. Lavanga (Clove) powder mixed with natural sugar/honey can be taken 2–3 times a day^[66]

Subgroup II COVID-19-confirmed cases with mild COVID-19 symptoms (isolation ward)

Subgroup 2 individuals are positive to COVID-19 with clinical symptoms having mild fever, cold, dry cough, sneezing, etc. They should be shifted to isolation ward and carefully supervised for development of the COVID-19 disease, along with providing proper treatment to diminish the clinical symptoms by harmonizing the vitiated Dosha to control disease advancement. Those patients who are showing advancement of the disease may immediately require shifting to ICU.

Rasa Aushadi has better bioavailability and absorption through sublingual and oral route due to the nano size of their particles.^[70],[71]Swarna Bhasma mixed with black pepper powder and Ghrita had been found to get well absorbed through sublingual administration.^[72]

Symptomatic Treatment

Sneezing, mild rhinitis (running nose) and mild cold: Haridrakhand, Lakshmivilas ras, Kaphketu Ras, Samshamani Vati, Guduchi Ghanavati, Vyoshadi Gutika, and Gojihvadi kashaya

Mild fever: Sanjivini Vati, Sudarshana Ghanavati, Naradiya Lakshmi Vilasa Rasa

Sore throat: chewing of Marichayadi vati, Lavangadi vati, Eladi vati, Yastimadhu vati, andVyaghri haritaki

Mild throat pain: Shotharilauha, Kanchanara Guggulu, Triphala Guggulu, and Arogyavardhini vati

Dry cough: Sitopaladi/Talisadi Choorna/Gutika, Kantakari Avaleha, Dashamool kashaya, and Yashtimadhu

Mild headache: Godanti Bhasm, Shirashooladi Vajra Ras, and Pathya shadandadi Kashaya

Panchakarma Treatment

Nasya:Anutail, Shadabindu Tail, Till Tail, and Karanja Tail

Kavala:Nimba Patra Kalk

Gandoosha:Till Tail, Tilakalkodaka, and Milk

Dhoomapana:Vairechnika Dhooma, and Yava Choorna + Ghrita

Anjana:Sauviranjana

Shiro Abhayanga:Brahmi Tail, Mahanarayana Tail

Subgroup III COVID-19-confirmed cases with moderate symptoms

Subgroup II individuals are positive to COVID-19 with moderate clinical symptoms having moderate grade fever, rhinitis (running nose, cold), excessive dry cough, shortening of breath, difficulty in respiration, Body ache, headache, etc. They should be shifted to isolation ward and may require tertiary care for progression of the COVID-19 disease. In this condition, conventional treatment should be used, and also patients may require ventilator. In this stage, we can also co-prescribed Ayurveda preparations to combat the effect of the pathology by balancing the vitiated Doshas.

Symptomatic Treatment

Acute rhinitis (running nose): Nardiya Lakshmivilas ras, Kaphketu Ras, Samshamani Vati, Rambana Ras, Panchamrita Ras, Shleshmashlendra Ras, Abhrak Bhasma, Guduchi Ghanavati, Vyoshadi Gutika, Naga vati, Haridrakhand, Chitrak Haritaki, Gojihvadi kashaya, Bharangadi kashaya, and Vanphasadi Kashaya

Moderate fever: Sanjivini Vati, Tribhuvana kirti Rasa, Mrityunjaya Rasa, Hinguleshwar Rasa, Lakshmi narayana Rasa, Jwarakeshari Rasa, Sarvajwarhar lauha. Sudarshana Ghanavati

Moderate headache: Godanti Bhasm, Shirashooladi Vajra Ras, and Pathya shadandadi Kashaya

Severe sore throat: chewing of Marichayadi vati, Lavangadi vati, Eladi vati, Yastimadhu vati, Khadiradi vati, Vyaghri haritaki

Severe throat pain: Shothari lauha, Kanchanara Guggulu, Triphala Guggulu, Arogyavardhini vati, and Vishtinduk vati

Moderate coughing: Chandramrita Ras, Vasantmalti Ras, Sitopaladi Choorna, Talisadi Choorna/Gutika, Shringyadi Choorna, Tankana Bhasma, Dashamool kashaya, Yashtimadhu, Lavangadi vati, Khadiradi Vati, Vyaghri haritaki, Agastya Haritaki, Kantkaryavaleha, Kantkari Ghrita, Pippalyadi Ghrita, etc.

Shortness of breath: Shringa Bhasma, Shringadi Kashaya, Muktadi Choorna, Shatyadi Choorna, Shwasakuthar Ras, Kasturyadhi Gutika, Shwasananda Gutika, and Vasavleha

Muscle pain: MahaVatavidhvansana Ras, Vatari Guggulu, and Vishtinduk Vati

Panchakarma Treatment

Nasya:Anutail, Shadbindu Tail, Pathadi Tail, Rasanjanadi Tail

Kavala:Matulung keshar + Saindhava + Trikatu

Gandoosha:Ghrita, Madhu

Dhoomapana:Prayogika Dhooma and Haridra+ Erandmoola+ Laksha+ Manahshila+ Devdaru + Jatamansi + Yava

Shirodhara:Brahmi Tail, Mahanarayana Tail

Vamana: Recommend Sadya Vamana

Virechana: Recommend

Abhyanga:Sarvanga Abhyanaga and Swedana

Subgroup IV COVID-19-confirmed cases with severe symptoms

Subgroup IV are positive to COVID-19 with severe clinical symptoms having high fever, severe cough with with expectoration, difficulty in respiration, severe body ache, severe headache, etc. They should be shifted to ICU ward and require tertiary care for progression of the COVID-19 disease. In this condition, conventional treatment must be used, and patients generally require ventilator. In this stage, we can also co-prescribed Ayurvedic preparations to subside the effect of the vitiated Doshas.

Symptomatic Treatment

Acute rhinitis: Same as those medications in Sub group -III

High fever: Putapakva Vishama Jwarantak lauha, Sarvajwarhar lauha. Sanjivini Vati, Tribhuvana kirti Rasa, Mrityunjaya Rasa, Jwarakeshari Rasa, Jaya Mangala Rasa, Amar Sundari Vati, Lakshmi Narayana Rasa Sudarshana Ghanavati, Chausatha Prahara Pippali, Pippali rasayana,^[42]Laghu Vasant Malati, Panchatikta Kashaya, Guduchayadi Kashaya, Kiratatiktadi Kashaya

Chills: Vrihata vata chintamani Rasa, Vrihata Kasturi Bhairava Ras, Krishna Panchanana Rasa, SheetaBhanji Rasa, Sheetanshu Rasa, Mahajwarankusha Rasa, AYUSH-64, and Jwaramurari vati

Severe headache: Godanti Bhasm, Shirashooladi Vajra Ras, Chandra kant Rasa, Kamdugha Rasa, Pathya shadandadi Kashaya

Severe sore throat: chewing of Marichayadi vati, Lavangadi vati, Eladi vati, Yastimadhu vati, Vyaghri haritaki

Throat pain: along with those medicines mentioned in Subgroup III Brihata Vata Chintamni rasa

Severe coughing with expectoration: Kasa-Shwasa Chintamani Ras, Kaphachitamani Ras, Chandramrita Ras, Vasantmalti Ras, Talisadi Choorna/ Gutika, Shringyadi Choorna, Tankana Bhasma, Kantakari Avaleha, Vibhitakavleha, Vyaghri haritaki, Agastya Haritaki, Lavandi vati, Khadiradi Vati, Kantkari Ghrita, Pippalyadi Ghrita, etc.

Difficulty in breathing: Shwasa-kasa Chintamani Ras, Muktadi Choorna, Shwasakuthar Ras, Rasasindoor, Purna Chandrodaya Ras, Kasturyadi Gutika, Shwasananda Gutika, Siddha makardhvaja rasa

Severe muscle pain: Same as those medications prescribed in subgroup III

Anorexia: Agnitundi Vati, Chitrakadi vati, Hingwadi vati, Lavanabhaskar Chroorna, dadimashatak Choorna, Drakshavaleha, Draksharista, Tintidika Paanak

Panchakarma Treatment

Nasya: Anutail, Karanja Tail

Kavala: Combination of Tripahla, Nagaramotha, Madhu, Tail

Gandoosha: Madhu, Sarpi, Kshara Jala

Dhoomapana: Vairechanika then Snaihika Dhooma, Manahshiladi Dhooma

Vamana: not recommend

Virechana: Recommend

Shirodhara: Brahmi Tail, Mahanarayana Tail

Abhyanga: Sarvanga Abhyanaga and Patrapinda Pottali Swedana

Subgroup V COVID-19-confirmed cases with critical illness and complications, patient on ventilator in ICU

Subgroup V individuals are positive to COVID-19 with critical clinical symptoms and complications having high fever, severe cough with expectoration, trouble breathing (breathlessness), repeated shaking with chills, loss of smell or taste, inability or confusion to arouse, persistent pain in the chest, bluish lips or face, excessive drowsiness and pneumonia (NCIP), etc. They must be shift in ICU ward and requires tertiary care for the COVID-19 disease. In this condition, conventional treatment must be used and patients generally require ventilator. In this stage, we can also co-prescribe Ayurveda preparations to subside the effect of the vitiated Doshas.

Symptomatic Treatment

High fever: Same medications as described in subgroup 4 can be used

Severe throat pain: Same medications as described in subgroup 4 can be used

Severe coughing with expectoration: Same medications as described in subgroup 4 can be used

Difficult breathing (breathlessness): Shwasa-kasa Chintamani Ras, Brihada Shwasa Chintamani Ras, Nagavallabh Ras, Brihada Kasturi Bharava Ras, Suryavarta Ras, Shringa Bhasma, Mukta Bhasma, Muktadi Choorna, Shwasakuthar Ras, Rasasindoor, Purna Chandrodaya Ras, Kasturyadi Gutika, Shwasananda Gutika, Siddha Makardhvaja rasa, Soma choorna, Vijaya vati, Vyaghri haritaki, Agastya Haritaki, Bharngi Guda, Kanakasava, Vasarista, Vasa Ghrita, Manahshiladi Ghrita, Shringadi Ghrita, Shataputi Abhraka bhasma, Rasamanikya, Gold Bhasma, Shwasananda Gutika, Sameera Pannaga Rasa

Pneumonia and persistent pain or pressure in the chest: Shwasa Kasa Chinthamani Rasa, Vrihata vata chintamani Rasa, Chaturbhuja Rasa, Trailokya Chintamani Rasa, Hemagarbha Pottali Rasa. Shataputi Abhraka bhasma, Karpooradi Choorna, Chausatha Prahara Pippali, Suvarna Malini Vasanta Rasa

Repeated shaking with chills: Vrihata vata chintamani Rasa, Vrihata Kasturi Bharava Ras, Vatakulantak Rasa, Murchchhantak Rasa, Swarnamakshika Bhasma, Siddha makardhvaja rasa, Krishna Chaturmukha Rasa, Panchanana Rasa, SheetaBhanji Rasa, Sheetanshu Rasa, Mahajwarankusha Rasa, AYUSH-64, Jwaramurari vati

Confusion or inability to arouse: Yogendra Rasa, Chandeshwar Rasa, Brahmi Vati, Smriti Sagar Rasa, Vatakulantak Rasa, Saraswatarista, Jatamansi Choorna/Kashaya

Anorexia: Yavanishadava Choorna, Hingwastak Chroona, Lavangadi Choorna, Karpooradi Choorna, Karavyadi Gutika, Sutashekhar Rasa, Aadrarakavaleha, Panchasava, Saptarisita, Jirakadi Ghrita

Bluish lips or face: use ventilator

Panchakarma treatment:

Not recommend as in emergency condition.

Conclusion

Ayurveda has mentioned Janpadoddhwansa, a number of invisible and very minute objects like Krimi, Bhoota, etc. that cause serious diseases, different types of Aagantuja Vikara (including unknown causes), and different kinds of Aupasargika Vyadhi. The conclusion drawn from above-mentioned interpretations, it is clear that COVID-19 is Aupasargika, and Janpadoddhwansa Vyadhi caused by a type of Krimi or Bhoota (SARS-CoV-2) which comes from outside of the body. The clinical symptoms of COVID-19 resemblances with Abhishangaja Jwara, Vata-Kaphaja Jwara and Sannipataja Jwara and management are proposed symptomatically.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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