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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 84-90

Three case reports of moderate COVID-19 infection managed through Ayurvedic approach


1 Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India
2 Kaumarabhritya, All India Institute of Ayurveda, New Delhi, India
3 Shalakya Tantra, All India Institute of Ayurveda, New Delhi, India
4 Roga Nidana, All India Institute of Ayurveda, New Delhi, India
5 Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India
6 Panchakarma, All India Institute of Ayurveda, New Delhi, India
7 Director, All India Institute of Ayurveda, New Delhi, India

Date of Submission08-Aug-2020
Date of Acceptance14-Dec-2020
Date of Web Publication18-Jan-2021

Correspondence Address:
Dr. P S Arshath Jyothi
Department of Kayachikitsa, All India Institute of Ayurveda, Sarita Vihar, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacr.jacr_57_20

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  Abstract 


Coronavirus disease 2019 (COVID-19), a global pandemic, is resulting in significant morbidity and mortality worldwide. The overburden of the disease is due to the vicious circulating virus characteristics, lack of potent vaccine, complications and limitations of the existing medicine and aggravation of disease along with comorbid conditions in elderly people, etc. In the present scenario, effective traditional treatment modalities should be scientifically applied to reduce the impact of massive disaster. Here is the necessity to develop an appropriate treatment protocol from the field of Ayurveda. This is a documentation of three confirmed COVID-19 cases managed with Ayurvedic medication with minimum number of hospital stay compared with the national average. Ayurvedic management has a significant positive impact on the mental and physical quality of life in COVID-19 patients. Both the physical and mental scores got improved of more than 50% percentage in each case after treatment. Ayurvedic science has a unique approach to COVID -19 and can be adopted wisely to overcome the current crisis. Marked radiological changes were observed in three cases. Ayurvedic interventions can be used to counteract the pathogenesis of SARS-CoV-2.

Keywords: Acute respiratory distress syndrome, COVID-19, SARS-CoV-2


How to cite this article:
Arshath Jyothi P S, Dileep A, Devarajan D, Sharma A, Kumari S, Rathuri S, Rai S, Dharmarajan P, Nesari TM. Three case reports of moderate COVID-19 infection managed through Ayurvedic approach. J Ayurveda Case Rep 2020;3:84-90

How to cite this URL:
Arshath Jyothi P S, Dileep A, Devarajan D, Sharma A, Kumari S, Rathuri S, Rai S, Dharmarajan P, Nesari TM. Three case reports of moderate COVID-19 infection managed through Ayurvedic approach. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Feb 28];3:84-90. Available from: http://www.ayucare.org/text.asp?2020/3/3/84/307221




  Introduction Top


The pandemic outbreak of coronavirus disease 2019 (COVID-19) caused significant morbidity and mortality, finally led to an emergency of major international concern.[1] The virus has created an unfavorable socioeconomic impact globally. The initial clusters of cases were reported in December 2019 at Wuhan. The current testimonies indicate that SARS-CoV-2 spread to humans through transmission from wild animals illegally sold in the Huanan Seafood Wholesale Market.[2] On January 7, 2020, the causative agent was identified as a new coronavirus (2019-nCoV), and the disease was later named as COVID-19 by the WHO.[3] The COVID-19 has spread across the world at a vicious pace, gripping more than 218 countries, 16 lakh deaths, and more than 20 million active cases in the mid of December.[4] Compared with other viral diseases, the hallmark of the novel coronavirus is the wide range of disease severity experienced by the patients. Only a minority of COVID-19 patients require hospitalization, the effects of infection for these people are dramatic, in some life threatening cases. Infection with SARS-CoV-2 causes severe pneumonia, intermittent fever, and cough. Symptoms of rhinorrhea, pharyngitis, and sneezing have been less commonly observed. Patients often develop acute respiratory distress syndrome within two days of hospital admission, requiring ventilatory support. It has been observed that during this phase, the mortality tends to be high. For this infectious pathology, there is no specific proven treatment available till date. COVID-19 can be provisionally understood from the Ayurvedic perspective as Vata-kapha, predominant Sannipata jvara of Agantu (~exogenous factors) origin with mild Pittanubandha. The severity staging was analyzed on the basis of Nidana (~etiology), Dosha (~regulatory functional factors of the body), Dushya (~any bodily structure that gets vitiated by aggravated Dosha), Nidana panchaka (~five diagnostic principles), Roga bala (~severity of disease), Rogi bala (~strength of patient), Satwa (~psychic condition), and Shatkriyakala (~stages of disease manifestation and its management) to present a preliminary clinical profile of the condition. In the Ayurvedic point of view, the treatment plan varies in every individual based on the above factors. These three cases are selected based on the following reasons. The first case presented with uncontrolled diabetes in an elder male. The second case dealt with intermittent complications like dyspnea during the course of treatment and managed successfully without oxygen supply. The last case recovery attained in a smaller number of days.


  Case Reports Top


Case 1

A 56-year-old male admitted to the hospital with complaints of fever, bilateral earache, dry cough, chest pain, and myalgia in the last two days. Past history of chronic uncontrolled Type II diabetes was present. Considering his recent contact history, he underwent a SARS-CoV-2 Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR), and the test was positive. X-ray chest posteroanterior view showed scattered patchy opacities bilaterally. Fasting blood sugar was found 300 mg/dl. The patient assessment was done according to Roga-rogi pariksha and the treatment plan was decided. Pathyadi kwatha (20 ml) was advised two times before food along with Lakshmi vilasa rasa (125 mg) one tablet twice daily.[5],[6] Shadanga thoya was advised for Pana.[7] Nagaradi kwatha (30 ml) given along with Sudarshana ghana vati (250 mg) two tablets after food twice daily.[8],[9] Vyoshadi vati for chewing and Nishamalaki kwatha (10 ml) were advised at bedtime.[10] From 5th day, along with above medicines, a combination of of 15 ml Vasa swarasa (~juice of Justicia adhatoda L.), 10 ml Guduchi swarasa (~juice of Tinospora cordifolia.Wild. Miers), 5 g Kantakari churna (~powder of Solanum virginianum. L), one pinch Saindhava (~rock salt) given two times morning and evening on fixed schedule. Complete relief from all chief complaints noticed after eight days. Rapid antigen test on 11th day was found negative and the patient was discharged. Follow-up was done after 14 days.

Case 2

A 32-year-old male admitted to the hospital with complaints of fever, tastelessness, dry cough, and breathing difficulty for five days. Considering his recent contact history in the containment zone, underwent a SARS-CoV-2 RT-PCR, and the test was positive. Chest X-ray posteroanterior view showed scattered patchy bilateral opacities. A childhood history of bronchial asthma was present. No relevant long-term previous medical history was noticed. The patient assessment was done according to Roga-rogi pariksha and the treatment plan was decided. Gojihvadi kwatha

(40 ml) with Sudarshana ghana vati (250 mg) two tablets twice daily before food was given.[11] Dasamularishta (20 ml) was advised with lukewarm water after food two times.[12] Agasthya rasayana (10 g) given along with Haridrakhanda (5 g) on Muhurmuhu (divided dose at regular interval).[13],[14] Severe dyspnea developed after four days. SpO2 dropped down to 93%. From 5th day, along with above medicines, a combination of of Vasa swarasa (15 ml), Guduchi swarasa (10 ml), Kantakari churna (5 g), and one pinch Saindhava was given two times morning and evening on fixed schedule. Progressively condition became stable. No further deterioration in SpO2 was observed after that. Rapid antigen test on 12th day was found negative and the patient was discharged. Follow-up was done after 14 days.

Case 3

A 27-year-old female admitted to the hospital with complaints of mild fever, fatigue, heaviness of head, and mild cold for the last one week. She underwent a SARS-CoV-2 RT-PCR, and the test was positive. She had not any relevant previous illness or medical history. Chest X-ray posteroanterior view showed scattered patchy opacities bilaterally. The patient assessment was done according to Roga-rogi pariksha and the treatment plan was decided. Nagaradi kwatha (40 ml) was advised twice daily before food with Sudarshana ghana vati (250 mg) one tablet twice daily. Kumaryasava (15 ml) was given after food with equal quantity of lukewarm water.[15] Talisadi churna (5 g) was advised with honey for Lehana (~electuary) in Muhurmuhu (~divided dose at regular interval).[16] A combination of Vasa swarasa (15 ml), Guduchi swarasa (10 ml), Kantakari churna (5 g), and one pinch Saindava was given two times morning and evening on fixed schedule. Rapid antigen test on 10th day was found negative and the patient was discharged. Follow-up was done after 14 days [Table 1].
Table 1: Timeline of intervention

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After assessing the cases, investigations (complete blood count, erythrocyte sedimentation rate, liver function test, kidney function test, lipid profile, s. ferritin, lactate dehydrogenase, c-reactive protein quantitative, fasting/random blood glucose-d-dimer, coagulation profile, electrocardiogram, and X-ray chest posteroanterior view) were done in all the three cases. Oxygen saturation and temperature were continuously monitored and the mean value was taken on daily basis. Along with these, quality of life was assessed using the SF12 scale.[17]


  Discussion Top


It is evident that Ayurvedic texts have no direct reference related to coronavirus. However, the fundamental Triḍosha sidhanta (~fundamental principles of Ayurveda) is stable and applicable to every disease condition. The cases presented with mild fever, cough, sore throat, myalgia, and headache. According to the Dosha analysis of the condition, the Lakshanas (~symptoms) fall under the different conditions mentioned in Charaka samhita[18] [Table 2].
Table 2: Ayurvedic understanding of COVID-19

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In the first case, the age and diabetic history of the patient contribute higher risk compared with the rest of the cases. The treatment has to address Jwara (~fever) and Prameha (~diabetes) simultaneously because the patient was not under regular conventional medication for diabetes. The treatment plan was decided after the evaluation of Kapha -Pitha prakruti (Ayurvedic aspect of individual constitution), Madhyama roga bala (~moderate severity of disease), and Rogi bala (~moderate strength of patient). The main objectives were Ama pachana (~digestive stimulant), Pranavaha sroto sudhikara (~clearing respiratory pathways), and Meha hara (~anti diabetic).

Pathyadi kwatha is advised along with Lakshmi vilasa rasa, having Tikta kashaya rasa pradhana (~bitter and astringent taste), Sulahara (~analgesic), and Mehahara (~antidiabetic). The combination of Pathya (Terminalia chebula. Retz), Aksha (Terminalia bellirica Gaertn.Roxb.), and Dhatri (Emblica Officinalis. Linn) has anti-inflammatory and antipyretic property.[19] Lakshmi vilasa rasa was specially selected due to its involvement in Vata -kapha siroroga lakshana. For the purpose of Ama pachana (~digestion of nonmetabolized food circulates in the body as toxins), Nagaradi kwatha was advised along with Sudarshana ghana vati. Nishamalaki kwatha churna was advised considering Prameha. Blood glucose level was continuously monitored along with temperature and oxygen saturation [Graph 1]. The resolution of symptoms was quick, and there was no progression of the disease to a severe stage. There were no adverse or unanticipated events.



In the second case, the treatment plan was decided after the evaluation of Vata -Pitta prakruti, Madhyama roga bala (~moderate strength of disease), and Pravara rogi bala (~supreme strength of individual). The main objectives were Ama pachana (~digestive stimulant), Agni deepana, and Pranavaha sroto sudhikara (~clearing respiratory pathways).

Considering the dominant Dosha pradhanya, Deha prakruti (~individual constitution), and Bala (~strength) of patient, Gojihwadi kwatha and Sudarshan ghana vati were administered. Gojihvadi kwatha efficient in Vata kapha vikaras such as Pratisyaya (~coryza), Sleshma jwara (~fever due to Kapha dosha), Kasa (~cough), and Svasa (~dyspnea/asthma). For the purpose of Pachana (~digestant) along with Balya (~promoting strength) and Rasayana karma (~rejuvenation), Agastya rasayana was administered along with Haridra khanda. It is one among the Rasayana kalpas explained by Acharya charaka especially for the diseases of Pranavaha srotas. It performs both functions – Rasayana (~rejuvenative treatment) as well as Vyadhihara (~curative treatment). Haridra khanda possesses Rasayana, Balya, and Brumhaniya properties. From the 4th day onward, his SpO2 level dropped progressively and presented with severe dyspnea. SpO2 dropped down to 93%. A combination of Vasa swarasa, Guduchi swarasa, Kantakari churna, and one pinch Saindhava was given two times morning and evening on fixed schedule was started. Oxygen saturation was monitored continuously. From there onward, his condition improved significantly without further deterioration.

In the third case, the treatment plan was decided after the evaluation of Vata kapha prakruti, Madhyama roga bala, and Pravara rogi bala. The main objectives were kept as Ama Pachana (~digestive stimulant), Agni deepana, and Pranavaha sroto sudhikara (~clearing respiratory pathways). The case presented with mild symptoms. Considering the need of Malanulomana (~elimination of metabolic toxins), Nagaradi kwatha was advised along with Sudarshana ghana vati. Kumaryasava selected for Agni deepana (~enhancing metabolic fire) and Pachana (~carminative). Sometimes, slight elevation of temperature was noted in this case during the initial days of treatment. Later, after medication, it became normal within 2–3 days. It may be due to the involvement of Ama in Samprapthi of Jwara.

All the patients were administered with Vasa swarasa which has Tikta- kashaya rasa (~bitter and astringent taste) combined with Kantakari churna which has Tikta katu rasa (~bitter and pungent taste) and Guduchi swarasa which has Tikta kashaya rasa (~bitter and astringent). All these combinations have Tikta rasa in common. Tikta rasa is Deepana-pachana (~enhancing metabolic fire) and Laghu (~light) in property. Tikta rasa helps in both Pachana of Ama and Shamana of Pitta. Vasa and Kantakari are Agrya (~foremost substance) in Rakta pitta (~bleeding disorder) and Kasa (~cough).[20] Guduchi is Rasayana and has proven immunomodulatory effect.[21] In all the three cases, chief complaints reduced completely, and mean recovery time or hospital stay is less than the national average based on the pilot study.[22] It is significant that within the short duration of time, they recovered from all the symptoms presented at the time of admission [Graph 2].



Positional advice was given in the second case during severe dyspnea as per standard guidelines.[23] Therapeutic Yoga, Pranayama, and meditation were also advised to all the three patients. Patients involved in indoor activities and recreation programs are conducted to relieve psychological stress. The third case presented especially with aggravation of Jwara especially in the evening time, later it was observed that the condition subsided after Ama pachana. For daily monitoring, temperature and oxygen saturation measured 5–6 times, and the mean value was noted. Complete recovery from symptoms considered as endpoint along with good oxygen saturation [Graph 3] and[Graph 4]. In general observation, health-related quality of life is poor among COVID-19 patients. Patients develop significant physical and psychological disturbances. Therefore, prospective monitoring of individuals exposed to SARS-CoV-2 is needed in order to fully understand the long-term impact of COVID-19, as well as to inform prompt and efficient interventions to alleviate suffering. In these cases, the quality of life assessed using the SF-12 Scale got improved significantly after two weeks of treatment.[17] Both the physical and mental scores got improved of more than 50% in each case and maintained in follow-up also [Table 3].
Table 3: Quality of life

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Baseline anteroposterior chest radiograph showed patchy ground-glass opacities in the upper and lower lung zones and patchy consolidation in middle zones. After 14 days of medication, normal lung fields were noticed in the upper and lower zones. Consolidation and opacities reduced in all the cases [Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6].
Figure 1: Case number 1: Chest X-ray postero-anterior view - Before treatment

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Figure 2: Case number 1: Chest X-ray postero-anterior view - After treatment

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Figure 3: Case number 2: Chest X-ray postero-anterior view - Before treatment

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Figure 4: Case number 2: chest X-ray postero-anterior view - After treatment

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Figure 5: Case number 3: chest X-ray postero-anterior view - Before treatment

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Figure 6: Case number 3: chest X-ray postero-anterior view - After treatment

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  Conclusion Top


Since the series is limited in three cases only, large sample size is required to reach in a definite conclusion. Rather than single remedy to manage all the patients, multiple factors were evaluated and prescribed to each patient, thereby creating more options in management according to Ayurvedic principles. Here, the system has to concentrate on the care of the subjects with supreme priority than the cure-oriented approach. It is evident that the mental and physical quality of life in patients improved and the average recovery time of these cases is faster than the current national average. The treasure of wisdom available in the indigenous systems of medicine is potent enough to reduce the burden of the current pandemic. Further multicentric researches should be permitted in the national and international level to establish protocols which can be formulated by classifying patients and providing Ayurvedic treatment.

Declaration of patient consent

The 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

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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