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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 46-50

Ayurvedic management of moderate COVID-19 infection: A case report


1 Department of Roga Nidana Evum Vikriti Vigyan, All India Institute of Ayurveda, New Delhi, India
2 Department of Prasuti Tantra Evam Stri Roga, All India Institute of Ayurveda, New Delhi, India

Date of Submission11-Aug-2020
Date of Acceptance05-Oct-2020
Date of Web Publication16-Oct-2020

Correspondence Address:
Dr. Sisir Kumar Mandal
Department of Rog Nidan Evum Vikriti Vigyan, All India Institute of Ayurveda, Sarita Vihar, New Delhi - 110 076
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_59_20

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  Abstract 


The global community is facing the pandemic of novel coronavirus disease (COVID-19) caused by Severe Acute Respiratory Syndrome Corona Virus - 2 (SARS- CoV- 2). In spite of worldwide efforts to contain it, the pandemic is spreading rapidly, and there is an urgent need for the development of evidence-based therapeutic strategy. The dimensions of this pandemic require an urgent harnessing of all knowledge systems available globally. So far, no cure specific to COVID-19 has been developed either in modern western medicine or in traditional medicine. In this case report, a 30-year-old male health worker, diagnosed with COVID-19, was managed with Ayurveda intervention within six days. The patient reported with predominantly moderate symptoms of COVID-19, and the management approach was personalized and holistic in nature incorporating diet, lifestyle, and Samshamana aushadha (~pacifying treatment) along with Satvavajaya chikitsa (~psychotherapy).

Keywords: Agantuja jwara, Ayurveda, Ayush kwatha, coronavirus, COVID-19, Godanti bhasma


How to cite this article:
Sharma M, Mandal SK, Sharma C, Rai S, More A. Ayurvedic management of moderate COVID-19 infection: A case report. J Ayurveda Case Rep 2020;3:46-50

How to cite this URL:
Sharma M, Mandal SK, Sharma C, Rai S, More A. Ayurvedic management of moderate COVID-19 infection: A case report. J Ayurveda Case Rep [serial online] 2020 [cited 2020 Dec 2];3:46-50. Available from: http://www.ayucare.org/text.asp?2020/3/2/46/298296




  Introduction Top


The COVID-19 pandemic has created havoc worldwide. Despite the fact that no evidence-based treatment for COVID-19 has been developed as yet, clinical interventions are being done worldwide. The World Health Organization (WHO) is also emphasizing on the use of traditional medicine in its COVID-19 strategic plan.[1] Indian system of medicine has always yield efficacious results when applied to the umbrella of chronic diseases. Indeed, this is the time to mainstream the AYUSH systems to transform global healthcare system [2] through realizing its potentials to combat communicable diseases as well.[3] Descriptive models of health and disease, pathology, clinical outcomes, and management protocols of epidemic (~Janapadodhwamsa) are explained in detail in classical text.[4] COVID-19 can be correlated to Agantuja jwara with special reference to Vata-kapha dominant Sannipatika jwara, further manifested as the consequence of Janapadodhwamsa.[5] This is a case report of a patient diagnosed with COVID-19 managed in six days with Samshamana therapy including oral administration of Ayush kwatha, Sanshamani vati, Fifatrol tablets, and Laxmivilasa rasa.


  Case Report Top


A 30-year-old, male health worker, resident of Ali village, New Delhi, presented with fever, severe headache, body ache, and fatigue. Along with this, he had pain in both eyes, loss of appetite, loss of taste, and partial loss of smell for two days. History revealed that one month back, he was diagnosed with typhoid fever and recovered from the same within 10 days. The patient did not present with any previous chronic illness, surgical history, and drug allergies. On further inquiry, it was found that the appetite was decreased, bowel was constipated, sleep had increased, and bladder was regular. There was no history of any addiction.

Clinical examination

Atura bala pramana (~strength of an individual) was assessed by Dashavidha atura pariksha (~tenfold examination of the patient).[6] Prakriti (~constitution) of the patient was Kapha-vataja and Vikriti (~abnormal state) was Vata-kaphaulbana-hinapitta sannipata; Sara (~proper nourishment of tissue) was Pravara; Samhanana (~body built) was Madhyama (~medium); Pramana (~body proportion) was Madhyama; Vyayama shakti (~physical strength) was Pravara; Ahara shakti and Jarana shakti (~digestive and metabolic capacity) were Madhyama; Satva (~psychological strength) was Madhyama; Satmya (~compatibility) and Vaya (~age) were Madhyama.

Samprapti ghataka

Doshik predominance was Vata-kapha pradhana tridosha. Dushya (~vitiated body tissue) was Rasa (~circulatory fluid). Srotas (~body channels) involved were Rasavaha, Swedavaha, and Pranavaha. Srotodushti (~vitiation of channels) was Sanga (~obstruction) and Vimarga gamana (~entering path other than normal). Adhishthana (~source of origin) of disease was Amashaya (~stomach). Agni was Manda (~slow). Svabha va (~nature of disease) was Ashukari (~acute).

General examination

He was well built with 70 kg weight and 1.7-m height, and the body mass index was 24.2 kg/m 2. He was febrile (101°F), pulse rate was 100/min, respiratory rate was 18/min, and SpO2 level was 98%.

Diagnosis

Rapid Antigen Detection (RAD) test confirmed the diagnosis of COVID-19.[7] Considering the symptoms manifested, the case was diagnosed as Agantuja jwara belongs to Vata-kapha dominanttype of Sannipatika jwara.[8]


  Timeline Top


Considering involved Dosha and Dushya, he was advised Shamana chikitsa (~pacifying therapy) including Deepana, Pachana karma, and Sroto shodhana (~detoxification of body channels), a comprehensive Ayurvedic modalities, consisting of Aushadha (~compound Ayurvedic formulations), Ahara (~dietary modifications), and Vihara (~lifestyle modifications). Home isolation was advised for 14 days. Day-wise assessment of symptoms was done to evaluate the efficacy of interventions according to the grading criteria mentioned in [Table 1].[9],[10],[11],[12],[13],[14],[15]
Table 1: Assessment criteria for symptoms

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  Follow-Up and Outcome Top


The patient was given Ayush kwatha with Godanti bhasma as Prakshepa and Sanshamani vati as the baseline treatment from the 1st day. There was regression of symptoms such as fever and body ache in the first two days; however, headache, fever, and loss of taste and smell were not subsided. From day three, tablet Fifatrol and tablet Laxmivilasa rasa were started. On day four, fever, breathlessness, anorexia, sore throat, and cough were completely subsided with significant relief in headache, body ache, and fatigue. There was complete regression of all the symptoms on day five along with perception of taste and smell [Table 2]. He was advised RAD test on the 6th day. RAD test was found negative on day six. In the follow-up period of seven days, he was prescribed Sanshamani vati and Chyawanprasha avaleha as Rasayana (~rejuvenation) to improve immunity and to restore health as the complaint of fatigue was still persistent.[16] Therapeutic interventions administrated according to the daily assessment of symptoms are mentioned in [Table 3].
Table 2: Daily assessment of symptoms

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Table 3: Therapeutic interventions with dose administrated according to day-wise symptomatic assessment

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Along with medication, Pathyapathya (~wholesome and unwholesome) was explained to him. He was advised light easily digestible food (porridge, soup, gruel, and fruits such as papaya, pear, and apple). He was suggested for gargling with Saindhava lavana (5 g) and luke warm water (350 mL) thrice a day. Among non-pharmacological interventions, he was advised home isolation, healthy lifestyles such as mild exercises, Yoga asana (Trikonasana and Matsyasana) and Pranayama (Anuloma-viloma, Kapalabhati, and Bhramari), adequate sleep of seven h during night, rules of good conduct, and to follow the Vegadharana niyama (~concept of retainable and non-retainable urges) of Ayurveda.


  Discussion Top


Case conceptualization and prognostic consideration

COVID-19 is an illness caused due to Severe Acute Respiratory Syndrome Corona Virus - 2 (SARS- CoV- 2), the pathological complex that can be conceptualized as “Bhuta-abhishangajvara” in Ayurveda (~fever due to infection of microbial organisms). Nija (~endogenous factors) and Agantuka (~exogenous factors) are the contributing etiologies in the morbidity. Further, Samprapti (~pathogenesis) of a disease is mapped by the Gati of Dosha in Srotas, responsible for varying presentations. Nijahetu comprises Dosha vitiation due to Apathya ahara and Vihara, particularly in this patient; Kha-vaigunya (~ deformity in channels) was persistent in Koshtha (~cavity/space) as there was a recent history of typhoid fever. Considering these factors in this case, Sanga type of Srotodushti with Vimarga gamana was observed from Rasavaha srotas to Pranavaha srotas. The case as per the prognostic criteria of Ayurveda, mentioned by Acharya charaka, comes under the category of Sadhyaroga[17] which was evident by its outcome, i.e., recovery within six days. The factors deciding the curability of this disease include signs and symptoms were mild to moderate, Dhatu samhanana (~constitution of body tissue) was moderate; Doshas constituting the Prakriti of the patient were not congruent to the Doshas of disease. Further, the Sara and Bala of the patient was Pravara and the patient had no complications; he responded well to the medications as well.

Rationale of the intervention

The principle of management includes Deepana of Jatharagni and Rasadhatvagni, Pachana of Ama, Shamana of Vata and Kapha, and Sroto-shodhana karma. Based on these principles, and considering Roga pariksha and Rogi pariksha, the formulations were selected. Ayush kwatha is a formulation, comprising four parts of Tulsi (Ocimum sanctum Linn.) leaves, two parts each of Shunthi (Zingiber officinale Roxb.) rhizome, Dalchini (Cinnamomum zeylanicum Breyn.) stem bark, and one part of Krishna maricha (Piper nigrum Linn.) fruit, as recommended by the Ministry of AYUSH in COVID-19 cases.[18] Tikta-katu rasa (~bitter, pungent taste), Ushna virya (~hot potency), and Kapha-Vata shamaka karma (~Kapha-Vata pacifying action) of Kwatha were utilized for Ama pachana and Srotoshodhana kriya.[19],[20],[21],[22] Godanti bhasma was administered considering its antipyretic and antimicrobial potential.[23] Sanshamani vati has Guduchi (Tinospora cordifolia [Willd.] Hook. f. and Thoms.) as its main content. It possess Guru and Snigdha guna (~heavy and unctuous property), Tikta and Kashaya rasa (~bitter and astringent taste), Madhura vipaka (~sweet post digestion effect), and Ushna virya (~hot in potency).[24] It pacifies all the three Doshas and has Jwaraghna (~antipyretic) effect.[24] Various clinical studies revealed its immunomodulatory,[25] anti-inflammatory,[26] and antipyretic properties.[26] Tablet Fifatrol is a herbomineral compound that has salient features of fighting flu, infection, and aches.[27] It comprises herbs Guduchi (T. cordifolia [Willd.] Hook. f. and Thoms.), Daruharidra (Berberis aristata D. C.), Apamarga (Achyranthes aspera L.), Chirayata (Swertia chirata Buch.), Karanja (Pongamia pinnata L.), Kutki (Picrorhiza kurroa Royle ex Benth.), Tulsi (Ocimum tenuiflorum Linn.), Musta (Cyperus rotundus L.), and compounds Godanti bhasma, Mrityunjaya rasa, Tribhuvana kriti rasa, and Sanjeevini vati. Mrityunjaya rasa is mentioned for the treatment of Jwara.[28] Tribhuvana kriti rasa is also extensively used in different kinds of Jwara including Sannipatika along with symptoms of cough and cold.[29] Mrityunjaya rasa and Sanjeevini vati contain Vatsanabha (Aconitum ferox Wall.) as one of its ingredients, which is a processed Sthavara visha (~poison of plant origin) having antipyretic, analgesic, and digestive effects.[30] These drugs were used rationally in the patient after digestion of Ama to counteract the effects of Jangamavisha (~toxin or poison of microbial or animal origin) as the origin of this disease is microbial as per the treatment principle of Visha.[31] Laxmivilasa rasa is a herbomineral preparation having Abhraka (mica) as one its main ingredients, which has Tridosha shamaka (~pacify three biological humors) Clinically, Abhraka bhasma has its action predominantly on Pranavaha, Raktavahai and Mutravaha strotas[32],[33] an Samprapti of this Vyadhi is marked by specific changes at the levels of Srotas, Agni, and Ama. The diagram [Figure 1] traces the pathological markers on physiological structures of RogiKostha, Srotas (Rasavaha, Pranavaha, and Swedavaha), and Agni. Pachana of Sarvadehabhoota ama is done by the actions of Tikta and Katu rasa and Ushna veeryata of Ayush kwatha and Sanshamani vati. Considering Srotasdushti; Rasavaha, Pranavaha, and Swedavaha srotas are vitiated. Pachana of Ama in Rasavaha srotas is achieved by Ayush kwatha, Guduchi, and Sanjeevini vati. The symptomatic complex denotes Sanga sroto vaha dushti in Pranavaha srotas, which is resolved by Abhraka present in Laxmivilas rasa. Sanjeevini vati has Jwaraghna effect and Srotorodha clearance in Swedavaha srotos is done by Tribhuvana kriti rasa.
Figure 1: Mode of action of interventions on Srotas jatharagni and Ama

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The mentioned treatment plan was effective in the symptomatic relief (fever, dyspnea, anorexia, fatigue, anosmia, and dysgeusia) as well as in the resolution of viral load, as the patient tested negative in the RAD for COVID-19 within six days of intervention and RT-PCR test was also done on day 16, which was reported negative. The holistic approach was implemented through the interventions of Ahara (dietary intervention), Vihara (~lifestyle intervention), and Aushadha (~medications). The patient was then shifted to Rasayana chikitsa (Chyawanprash avaleha and Samshamana vati) in the follow-up period of seven days. As the patient had a persistent compliant of fatigue, therefore, with an objective of restoration of health, these measures were given. The average time to recovery is found to be 22.4 days in a study,[34] and it was comparatively less in this particular case.


  Conclusion Top


The present case study proved efficacy of Ayurvedainterventions in mild-to-moderate case of COVID-19 infection in a very short period with complete regression of the symptoms. The treatment was personalized, holistic, and purely based on Ayurvedic principles, and no conventional medicines were used. With this case study, it can be inferred that Ayurvedahas vast potential to address the COVID-19 and such other pandemics; a large sample-sized, multicenter randomized and controlled clinical studies are the need of the hour.

Declaration of patient consent

Authors certify that they have obtained patient consent form, where the patient/caregiver has given his/her consent for reporting the case along with the images and other clinical information in the journal. The patient/ caregiver understands that his/her name and initials will not be published and due efforts will be made to conceal his/her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]



 

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