|Year : 2020 | Volume
| Issue : 3 | Page : 91-94
Management of a mild COVID-19 infection through Ayurvedic intervention: A case report
Adil Rais1, Tarun Kumar2, Amita Yadav3, Devendra Singh Negi4
1 Ayurved Medical Officer, Sultanpur, Uttar Pradesh, India
2 TRISUTRA, CSIR-IGIB, New Delhi, India
3 Chief Medical Superintendent, Lokbandhu Rajnarayan Combined Hospital, Uttar Pradesh, Lucknow, India
4 Director General, Health and Medical Services, Uttar Pradesh, Lucknow, India
|Date of Submission||10-Aug-2020|
|Date of Acceptance||12-Dec-2020|
|Date of Web Publication||18-Jan-2021|
Dr. Adil Rais
293/28, Old Haiderganj, Lucknow - 226 003, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Coronavirus has emerged as a global threat worldwide. India has also been severely affected by the dreadful virus and is currently the second worse affected nation worldwide. As it is a novel virus, there is no specific treatment strategy as on date. A mild symptomatic case of COVID-19 admitted in a Level II COVID-19 management hospital was managed through Ayurvedic drug intervention. Vyaghryadi kashaya and Samshamani vati were given to the patient for ten days of her stay in the hospital. The symptoms were pacified and Agni improved after treatment. The patient was discharged after testing negative for COVID-19 infection. The results obtained were encouraging in the control of symptom progression in the patient. The promising results in the study showed that an approach involving Ayurveda in mild cases can be helpful in the management of COVID-19 patients. Ayurveda can be used to limit community spread and check disease progression.
Keywords: Agni, Ayurveda, COVID-19, Samshamani vati, Vyaghryadi kashaya
|How to cite this article:|
Rais A, Kumar T, Yadav A, Negi DS. Management of a mild COVID-19 infection through Ayurvedic intervention: A case report. J Ayurveda Case Rep 2020;3:91-4
|How to cite this URL:|
Rais A, Kumar T, Yadav A, Negi DS. Management of a mild COVID-19 infection through Ayurvedic intervention: A case report. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Feb 28];3:91-4. Available from: http://www.ayucare.org/text.asp?2020/3/3/91/307222
| Introduction|| |
The rapid spread of severe acute respiratory syndrome Cov-2 or COVID-19 has almost jeopardized the globe and presented a challenge in front of whole medical fraternity across the world. Currently, India stands as second most severely affected country. The figures are expected to worsen promptly due to rapid exponentiation of virus. So far, no specific cure or vaccine has been found. Ayurveda intervention was planned in a COVID-19 positive patient after taking prior approval from the concerned authorities and consent from the patient under a planned protocol.
| Case Report|| |
A 36-year-old female tested positive for COVID-19 was admitted in the isolation ward of Lokbandhu Rajnarayan Combined Hospital, Lucknow, with complaints of gradual rise in fever, dry cough, and mild irritation in throat for the last two days. She was diagnosed with a case of mild symptoms and placed on Ayurvedic drug regimen for ten days [Table 1]. Her husband and two children also tested positive for COVID-19. Children were placed along with her while husband was diabetic so shifted to a Level III hospital.
The patient reported loss of smell two days before her admission. She was admitted with mild fever (99°F), sore throat, dry cough, breathlessness, and body ache. Loss of taste and mild headache were also reported. There was no history of abdominal disturbance, running nose, or any other long-term past illness or treatment. She was well built, height 5'1” and weight was 63 kg. All vitals were well within the normal limits. The patient was conscious and alert. Prakruti of patient was predominantly Vata kaphaja, Bala was moderate and Satva was good. The severity of sore throat, dry cough, generalized weakness, and headache were increased on the 2nd and 3rd days of admission [Table 2].
50 ml Vyaghryadi kashaya (~decoction) was prepared by boiling equal parts of Kantakari (Solanum xanthocarpum Schrad, and Wendl.), Shunthi (Zingiber officinale Rosc.) and Guduchi (Tinospora cordifolia Thrunb.) in 200 ml potable water, reducing to 50 ml (straining through a clean cotton fabric) was prescribed for 10 days to the patient by adding 250 mg of powdered Pippali (Piper longum L.). Along with this, Samshamani vati 2 tablets of 500 mg each twice a day was administered. The patient was also administered 500 mg of Vitamin C once a day [Table 1].
Patient was advised with Pathya (~things to be done and consumed) and Apathya (~things to be avoided) during the treatment regimen and afterward. She was provided diet comprising onions, green grams, and green vegetables. Food items such as curd, potatoes, black grams, cheese and those prepared from Maida (~refined flour), which are heavy to digest were avoided. She was advised to take warm water and saline gargling.
| Follow-up and outcomes|| |
Gradual improvement was noticed in the symptoms after 6th day of admission. On 6th day, temperature was 97.4°F. Sore throat was relieved completely by seven days of treatment. Headache was relieved after the 6th day. Dry cough and body ache persisted but gradually reduced till the 10th day but relieved completely on the 11th day. Breathlessness was relieved by the 9th day. Her appetite improved after the 5th day, and there was no complaint of indigestion after that. Mild loss of taste that developed on the 1st day persisted till the 6th day. Anxiety that developed on the 3rd day in the patient was relieved completely by the 11th day. Patient complained of sleeplessness and burning sensation in eyes on the 4th day. She was advised to rinse face and eyes with cold water and Padabhyanga (~massage on soles) with Goghrita (~Cow ghee). Sleep gradually improved and burning sensation also resolved. The only symptom which persisted in the patient was weakness and exertion on performing routine household activities. It took about a month for the weakness to get resolved.
Reverse-Transcriptase Polymerase Chain Reaction (RT-PCR) test became negative on the 10th day. The patient was discharged from the hospital on the 11th day. After discharge, the patient was advised to remain home quarantine for 14 days, continue taking warm water, saline gargling and steam inhalation. She was also advised to take Sitopaladi churna 3 g twice daily with honey for 15 days. She continued taking light diet, follow proper routine and meditation. She was suggested to report her condition to the hospital or the doctor, after the quarantine period.
| Discussion|| |
The basic concept of disease in Ayurveda has been said to be an imbalance of Doshas (~bio-humours) and derangement of Mandagni (~digestive fire) which leads to a decreased level of immunity and subsequently making body susceptible to infectious agents.
The manifestation of this disease can be compared to Sannipatika jwara especially of Kaphaja or Vataja predominance wherein symptoms such as Pratishyaya (~running nose), Kasa (~cough), Tandra (~drowsiness), Aruchi (~decreased appetite), Ajirna (~indigestion), Shirahshula (~headache) are present, or Shwasa (~breathlessness), Shushka kasa (~dry cough), Pratishyaya (~running nose), Mukha shosha (~dryness of mouth) and Atiparshvaruk (~pain in the thoracic region). The choice of drugs made is to emphasize on improving digestion, protection of respiratory system, and improvizing the bodies' defense.
Loss of taste and smell could be considered due to deranged Prana vayu. Dysosmia and dysgeusia is a common feature of COVID-19 infection. There have been various studies evaluating coronavirus' effects on the Central Nervous System (CNS). These studies suggest that the human CNS may be susceptible to coronavirus infection. Routes intended for CNS infection are peripheral trigeminal or olfactory nerves following intranasal inoculation. The findings of studies on rodents show that these viruses cause demyelination and stimulate T-cell-mediated autoimmune reactions against CNS antigens producing the question about relation coronaviruses and neurological infections in humans.
Vyaghryadi kashaya is indicated in Sannipatika jwara. Vyaghri or Kantakari is stated to have anti-inflammatory, anti-tussive properties. This drug is efficacious for respiratory illnesses through its mucociliary stimulatory action removing excessive mucous, relieving breathlessness due to its bronchodilatory effects.
Guduchi is an immunostimulatory drug has broad-spectrum immunotherapeutic qualities such as antipyretic, anti-inflammatory, anti-allergic, anti-diabetic, and anti-hepatotoxic properties. Its property to increase the number of white blood cells also helps to neutralize the toxicity produced by any pathogen. The immunostimulatory action may be attributed to the presence of alkaloids cordifolioside and syringin. Guduchi is also considered as a Rasayana, promoting longevity.
Shunthi is one of the most potent drugs for Ama pachana (~digestion of undigested material). It is useful in headaches, abdominal pain, has digestive and carminative actions. It is also useful in cold, hoarse voice, and is a good appetizer. Recent studies have reported its anti-inflammatory effects. Its supplementation alleviated the inflammation by reducing the levels of tumor necrosis factor alpha and high-sensitivity C-reactive protein without any significant effects on interleukin-6 levels.
Pippali was used in fine powder form in a dose of 250 mg as its higher dose and long-term usage is not recommended. It is known to increase the bio-availability of drugs, manifold. The action of Pippali is alleviation of Kapha and Vayu, which was the prime cause of pathology here. Thus, the decoction is expected to possess the collective properties of digestive, appetizer, anti-inflammatory, mucolytic, anti-pyretic actions, and immuno-modulatory actions. Samshamani vati whose prime constituent is Guduchi is an anti-pyretic drug with potent anti-inflammatory effects.
Onion has been said to alleviate Vayu and improves appetite. It has a therapeutic property of providing substantial relief in common cold, fever, cough, and respiratory ailments due to presence of sulfur rich compounds and Quercetin. It is also a rich source of Selenium which facilitates the absorption of Vitamin C known to enhance the general immunity. Warm water facilitates digestion and proper bowel evacuation along with alleviation of Kapha and Vayu doshas.
The patient was advised to gargle with saline water to clear the throat and nasal cavity, thus preventing extramucous formation. It reduces local inflammation and pain. Gargling with warm salt water helps reduce the risk of developing an upper respiratory tract infection. The patient was advised to follow a healthy daily routine along with breathing exercise in the form of Pranayama to improve the vital capacity of lungs as well as cardiopulmonary functioning. It also reduces the effects of stress and strain on the various systems. Hence, overall physical and mental health improves by having a positive impact on cardiovascular, respiratory functions, and improving the autonomic system toward parasympathetic dominance.
The earlier negative detection of RTPCR was indicative of effective viral clearance and lesser transmission of disease to others, thereby checking community spread. The symptomatic progression was also restricted to avoid the morbidity passing to severe stages which is a deep concern, owing to increasing number of deaths due to coronavirus infection worldwide.
| Conclusion|| |
It is difficult to conclude actual effectiveness of the treatment on the basis of a single-case study, but the results are encouraging enough to conduct more work on COVID-19 involving Ayurveda. The most significant finding in this study was early negative RTPCR detection, and a restrain observed in the disease progression to rigorous stage. Almost all the symptoms resolved within a period of 11 days. This may pave the way to a more integrated approach toward resolution of the morbidity.
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Paradkar HS, editor. Commentary Sarvangasundara and ayurved rasayana of hemadri on ashtanga hridaya of vagbhatta, chikitsa sthana. Ch. No 1, Verse 61. Varanasi: Chaukhambha Surbharti Prakashan; 2014. p. 395.
Acharya YT, editor. Siddha yoga samgraha, Jwara rogadhikara, Allahabad: Shri Baidyanath Ayurved bhavan; 2013. p. 4.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Chikitsa Sthana. Ch. No 3, Verse 97. Varanasi: Chaukhambha Prakashan; 2011. p. 406
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Chikitsa Sthana. Ch. No 1, Verse 101. Varanasi: Chaukhambha Prakashan; 2011. p. 406.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. No 12, Verse 8. Varanasi: Chaukhambha Prakashan; 2011. p. 78.
Bergmann CC, Lane TE, Stohlman SA. Corona virus infectionof the central nervous system: Host-virus stand-off. Nat Rev Microbiol 2006;4:121-32.
Barthold SW, de Souza MS, Smith AL. Susceptibility of laboratory mice to intranasal and contact infection with coronaviruses of other species. Lab Anim Sci 1990;40:481-5.
Paradkar HS, editor, Commentary Sarvangasundara and Ayurved Rasayana of Hemadri on Ashtanga Hridaya of Vagbhatta, Chikitsa sthana. Ch. 1, Ver. 61. Varanasi: Chaukhambha Surbharti Prakashan; 2014. p. 395
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. No 4, Verse 16. Varanasi: Chaukhambha Prakashan; 2011. p. 34.
Nasreen A, Divya K. Evaluating clinical efficacy of kantakari aerosol in the management of bronchitis: A case report. IJAPR 2019;7:35.
Hussain L, Akash MS, Ain NU, Rehman K, Ibrahim M. The analgesic, anti-inflammatory and anti-pyretic activities of tinospora cordifolia. Adv Clin Exp Med 2015;24:957-64.
Sunanda SN, Desai NK, Ainapure SS. Antiallergic properties of Tinospora cordifolia in animal models. Indian J Pharmacol 1986;18:250-2. [Full text]
Sharma S, Amin H, Galib, Prajapati PK. Antidiabetic claims of Tinospora cordifolia (Willd.) Miers: Critical appraisal and role in therapy. Asian Pac J Trop Biomed 2015;5:68-78.
Sharma V, Pandey D. Protective Role of Tinospora cordifolia against lead-induced Hepatotoxicity. Toxicol Int 2010;17:12-7.
] [Full text]
Sharma U, Bala M, Kumar N, Singh B, Munshi RK, Bhalerao S. Immunomodulatory active compounds from Tinospora cordifolia. J Ethnopharmacol 2012;141:918-26.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. No 4, Verse 18. Varanasi: Chaukhambha Prakashan; 2011. p. 34
Srinivasan K. Ginger rhizomes (Zingiber officinale): A spice with multiple health beneficial potentials. Pharma Nutrition 2017;5:18-28.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. No 4, Verse 50. Varanasi: Chaukhambha Prakashan; 2011. p. 98.
Mahluji S, Ostadrahimi A, Mobasseri M, Ebrahimzade Attari V, Payahoo L. Anti-inflammatory effects of zingiber officinale in type 2 diabetic patients. Adv Pharm Bull 2013;3:273-6.
Shukla Y, Singh M. Cancer preventive properties of ginger: A brief review. Food Chem Toxicol 2007;45:683-90.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Vimana Sthana. Ch. No 1, Verse 16.Varanasi: Chaukhambha Prakashan; 2011. p. 677.
Patgiri B, Umretia BL, Vaishnav PU, Prajapati PK, Shukla VJ, Ravishankar B, et al.
Anti-inflammatory activity of guduchi ghana (aqueous extract of tinospora cordifolia miers.). Ayu 2014;35:108-10.
] [Full text]
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Sutra Sthana. Ch. No 27, Verse 175. Varanasi: Chaukhambha Prakashan; 2011. p. 545.
Sampath Kumar KP, Bhowmik D, Chiranjib, Biswajit, Tiwari P. Alliumcepa: A traditional medicinal herb and its health benefits. J Chem Pharm Res 2010;2:283-91.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charak Samhita of Agnivesha, Vimana Sthana. Ch. No 3, Verse 40. Varanasi: Chaukhambha Prakashan; 2011. p. 246.
Satomura K, Kitamura T, Kawamura T, Shimbo T, Watanabe M, Kamei M, et al.
Prevention of upper respiratory tract infections by gargling: A randomized trial. Am J Prev Med 2005;29:302-7.
Singh S, Gaurav V, Parkash V, Effects of a 6 week longnadishodhana pranayama training on cardio-pulmonary parameters. J Phys Educ Sports Management 2011;2:44-7.
Udupa KN, Singh RH. The scientific basis of yoga. JAMA 1972;220:1365.
Pal GK. Yoga and heart rate variability. Int J Clin Exp Physiol 2015;2:2-9. [Full text]
[Table 1], [Table 2]