|Year : 2020 | Volume
| Issue : 4 | Page : 127-132
Efficacy of Ayurveda and Yoga in the management of SARS-CoV-2: Two case reports
Raja Ram Mahto1, Arshath Jyothi1, Aparna Dileep2, Archana Shukla1, Aleena Gauri3
1 Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi, India
2 Kaumarabhritya, All India Institute of Ayurveda, New Delhi, India
3 Rasashastra and Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi, India
|Date of Submission||29-Jan-2021|
|Date of Acceptance||18-Feb-2021|
|Date of Web Publication||18-Mar-2021|
Dr. Raja Ram Mahto
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi
Source of Support: None, Conflict of Interest: None
The current worldwide coronavirus disease 2019 (COVID-19) pandemic has caused a huge threat to public health. It includes a spectrum of clinical severity extended from asymptomatic to critical pneumonia, acute respiratory distress syndrome, and even death. Recent evidences have suggested that inflammatory responses play a critical role in the progression of COVID-19. Inflammatory markers such as C-reactive protein, lactate dehydrogenase, D-DIMER have been reported to be significantly associated with the high risks of the development of severe COVID-19. In this context, two cases diagnosed with COVID-19 were managed through Ayurvedic intervention is presented here. The patients of moderate COVID-19 were recovered from the symptoms with the personalized holistic treatment approaches.
Keywords: Acute respiratory distress syndrome, Ayurveda, inflammatory markers, SARS-CoV-2
|How to cite this article:|
Mahto RR, Jyothi A, Dileep A, Shukla A, Gauri A. Efficacy of Ayurveda and Yoga in the management of SARS-CoV-2: Two case reports. J Ayurveda Case Rep 2020;3:127-32
|How to cite this URL:|
Mahto RR, Jyothi A, Dileep A, Shukla A, Gauri A. Efficacy of Ayurveda and Yoga in the management of SARS-CoV-2: Two case reports. J Ayurveda Case Rep [serial online] 2020 [cited 2021 Apr 15];3:127-32. Available from: http://www.ayucare.org/text.asp?2020/3/4/127/311508
| Introduction|| |
A cluster of cases of pneumonia reported in a comparatively minor province of china in December 2019, eventually spread over the entire globe. Coronavirus disease 2019, also called COVID-19, a global pandemic resulted in significant morbidity and mortality worldwide. According to experts, not only the health but also other integral sectors of economy were highly affected, disrupting our life styles. Currently, we are living a new normal life style. Till date, lack of effective management strategy, complications and limitations of the existing medicines, aggravation of disease along with comorbid conditions in elderly people, etc., are add on burden to the pandemic. Accumulating evidences have suggested that inflammatory responses play a critical role in the progression of COVID-19. Inflammatory responses triggered by rapid viral replication of SARS-CoV-2 and cellular destruction can recruit macrophages and monocytes and induce the release of cytokines and chemokines. These cytokines and chemokines then attract immune cells and activate immune responses, leading to cytokine storms and further exacerbations of situations. Several inflammatory markers have some tracing and detecting accuracy for disease severity and fatality.
The Ministry of AYUSH has set up an Interdisciplinary Committee for Integration of Ayurveda and Yoga interventions and released “National Clinical Management Protocol to combat COVID-19” specially focusing on mild-to-moderate cases. The selection of these drugs is based on published scientific evidence, literary research supported by scientific relevance and rationale in support of repurposing of these medicines in COVID-19 and outcomes and trends of completed and ongoing studies taken up by the Ministry of AYUSH on a large cohort across India. Even though it is said to be a new disease entity to world, it is not beyond the fundamental Tridosha sidhanta of Ayurveda. The current pandemic crisis leaves a post pandemic scenario in which the patients may suffer from reduced immunity and body facilitate further infection. In order to regain Shareera bala (~strength of body), Rasayana (~rejuvenation) therapy is necessary. Unfortunately, conflicts are there between Ayurveda and modern practitioners regarding management strategies. Hope the ongoing evidence-based research outcomes will resolve and revive the future of Ayurveda. In light of this, two cases were managed through Ayurveda approaches that emphasize on the impact of Ayurvedic interventions on some of the inflammatory markers.
| Case Reports|| |
A 37-year-old female presented to the hospital with complaints of fever, body ache, head ache, for 5–6 days. Considering recent contact history, she underwent a Reverse Transcription-Polymerase Chain Reaction (RT-PCR), and the test was found positive. The patient did not present with any previous chronic illness, surgical history, and drug allergies. Appetite was decreased, bowels were regular, and sleep was sound.
A 55-year-old male presented to the hospital with complaints of fever, loss of taste, weakness, and mild constipation for one week. Past medical history was significant for diabetes three years. Considering his recent contact history, he underwent RT-PCR, and the test was found positive. On further inquiry, decreased appetite, constipated bowels, increased sleep, and regular bowels were found.
The observations of clinical examination of both the patients are placed at [Table 1].
Samprapti ghataka (~pathogenesis)
Analyzing the symptoms presented of patients, it was observed that Doshik predominance of COVID-19 is Vata-kapha pradhana with mild Pitta. Dushya (~vitiated body tissue) was Rasa (~circulatory fluid) and Rakta (~blood tissues). Srotas (~body channels) involved were Rasavaha srotas (~micro channels for the transport of digested food), Swedavaha srotas (~micro channels for the transport of sweat) and Pranavaha srotas (~micro channels of respiration). Srotodushti (~vitiation of channels) was Sanga (~obstruction in the channels of circulation) and Vimarga gamana (~entering paths other than normal). Adhishthana (~source of origin) of disease was Amashaya (~stomach). Agni was Manda (~poor digestive power). Svabhava (~nature of disease) was Ashukari (~acute).
Complete blood count, erythrocyte sedimentation rate, liver function tests, kidney function tests, lipid profile, serum ferritin, lactate dehydrogenase, C-reactive protein (quantitative), fasting and random blood glucose-D-dimer, coagulation profile, electro cardio gram, X-ray chest (posteroanterior view) were evaluated before and after treatment. Oxygen saturation and temperature were monitored two times daily or as per the requirement.
| Timeline|| |
In the first case, the patient was provided with Ayush kwath (a combination of 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. Samshamani vati, Mahasudarshana ghana vati, Lakshmi vilas rasa, Dashmularishta were prescribed. In addition, Anu taila nasya (three drops in each nostril) daily morning was also started. Chyawanprasha avaleha two times daily after breakfast and dinner was also started. There was regression of symptoms such as fever and body ache in the first two days; however, headache, and loss of taste and smell were not subsided. From day 6 onward, Lavanabhaskara churna (5 gm) before food was started. After that she attained proper taste and smell. During the hospital course, she had gone through sessions of Yoga, Pranayama and Dhyana guided by doctors. Daily life style schedules were prescribed that are summarized in [Table 2].
|Table 2: Pratikarartha pravrithi (~daily life style advises and activities)|
Click here to view
On day seven onward, she got significant relief in headache, body ache, and fatigue. There was complete regression in all the symptoms from 10th day. She was advised RT-PCR test on 13th day. Test result received negative on 15th day and she was discharged from hospital. In the follow-up period of 14 days, she was prescribed Samshamani vati and Chyawanprasha avaleha as Rasayana (~rejuvenation) to improve immunity and to avoid post COVID complications.
In the second case, the patient was given Guduchyadhi kwatha, with Samshamani vati, Triphala churna and AYUSH-64. Anutaila nasya (three drops in each nostril) daily morning was also initiated. During the hospital course, he had gone through the sessions of Yoga, Pranayama, and Dhyana guided by doctors.
There was regression of symptoms such as fever and body ache during the first three days; however, abdominal burning was not subsided. From day five onward Suteshekhara rasa was started before food. There was complete regression of all the symptoms from 7th day onwards. He was advised RT-PCR test on 13th day. Test was received negative on 15th day and he was discharged. In the follow-up period of 14 days, was prescribed Samshamani vati and Nishamalaki churna as Rasayana (~rejuvenation) to improve immunity and to avoid post COVID complications.
Along with medication, Pathyapathya (~wholesome and unwholesome) were explained to both patients, which includes light easily digestible food (Yusha, Vegetable soup gruel, Khichadi). They were advised home isolation with healthy lifestyles such as mild exercises, Yoga asana (Suryanamskara) and Pranayama (Anuloma-viloma, Kapalabhati, and Bhramari), adequate sleep of 7 h during night, rules of good conduct, and to follow the Vegadharana niyama (~concept of retainable and non-retainable urges) of Ayurveda [Table 3].
| Follow Up and Outcome|| |
Medications, diet advises, and Yoga were strictly followed by both the patients throughout the period. None of the symptoms were appeared during that time. Overall quality of life improved. Health-related quality of life is multidimensional consist of mobility, self-care usual activities, pain/discomfort, and anxiety/depression. Changes in subjective symptoms during different time period are shown in [Table 4] and [Graph 1].
| Discussion|| |
The methodology of diagnosing an unknown disease has been described in Charaka samhita based on Aptopadesha pramana. The key points such as Prakopanam, Yoni, Uthana, Atmana, Adhisthana, Vedana, Samsthana, Shabda-Sparsha-Rupa-Rasa-Gandha, Upadrava, Vridhi, Sthana, Kshaya, Udarka, Nama, Yoga and Pratikarartha Pravritti-Nivritti should be considered to form a concrete base to formulate suitable regimen for this disease [Table 5].
Considering the symptoms manifested, the case was diagnosed as Agantuja jwara belongs to Vata-kapha dominant type of Sannipatika jwara with Alpa pitta. The principle of management includes Deepana of Jatharagni and Rasadhatvagni, Pachana of Ama, Shamana of Vata and Kapha, and Sroto-shodhana karma. Formulations were selected based on Roga pariksha and Rogi pariksha explained in Ayurveda. In the first case Ayush kwatha was advised. The combination is having 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 Sroto shodhana. Mahasudarshana ghana vati is having Tikta-kashaya rasa pradhana that helps in Ama pachana. Lakshmi vilasa rasa was specially selected due to its involvement in Vata-kapha siroroga lakshana. Nasya is the chief Shodhana procedure selected because it is the one and only procedure which can perform Uttamanga (~supra clavicular region) Shuddhi. Due to Sukshma and Vyavayi guna, Anu taila possess a good spreading capacity through minute channels. Tikta, katu rasa; Laghu tikshna guna; Ushna veerya and Katu vipaka make Sroto shodakatwa (~clearance of obstruction in channels of the body). By the above two properties, the Nasya drug removes the obstruction of natural sinuses. Indriya dardhya karatwa (~provide strength to sense organs), Balya (~increases strength), Preenana and Brimhana (~nourishes the body) properties can increase general and local immunity. Madhura rasa, Sheeta veerya, Snigdha guna and Tridosha hara properties will promote the nourishment of Dhatus that ultimately increases the general and local immunity. This immunomodulation will reduce the inflammatory process in nasal cavity and sinuses. Lavanabhaskara churna given to improve Ruchi (taste) and to promote Vatanulomana.
In the second case, the Dehaprakruti of patient was Vata pitta. Considering predominance of Dosha and Dushya; Guduchyadhi kwatha was advised along with Samshamani vati. Guduhyadi kwatha contains Tiktha kashaya rasa pradhana ingredients that help in Pachana and Deepana. Samshamani vati contains Guduchi ghana as the major ingredient. It facilitates Vata-Pitta-Kapha shamana, Trishna shamana (~cures thirst), Mehaghna (~anti-diabetic), Agnideepaka (~improves digestive fire) and Rasayana. Guduchi [Tinospora cordifolia (Willd.) Miers] possesses anti-diabetic as well as anti-inflammatory activities. Since the patient is having chronic history of diabetes, formulations of Guduchi are highly beneficial. Triphala churna given at bed time to promote Malasudhi (~promote excretion of metabolic waste) and Srotosodhana (~purification circulatory channels). Sutasekhara rasa was advised to control the burning sensation.
It is important to restore the strength of the body after disease. Rasayana therapy has significant role in post COVID state. In the first case, Samshamani vati and Chyawanprasha avaleha were advised as Rasayana. Chyawanprasha has specific action related to Pranavaha srotas especially in Kasa, Swasa, and Jwara. Avaleha kalpana was avoided in second case due to elevated blood sugars and advised Nishamalaki chura as Rasayana. Status of inflammatory markers before and after treatment reveals significant response during the management period [Table 6]. Along with medication, specific focus was given to Yoga, Pranayama and diet. Oushadha (~medicines), Ahara (~diet) and Vihara (~lifestyle) are three important factors in Ayurveda that determines the success of disease management. Here Medicines are selected based on the factors such as Prakriti (~individual constitution), Vikriti (~imbalance of Dosha), Roga bala (~disease severity), and Rogi bala (~strength of patient). Customized diet given to patient consisting of Tikta rasa (~bitter taste), Laghu guna. Both of the factors help in the digestive process while Laghu guna in addition promote Vatanulomana (~pacification of obstructed Vata). Yoga, Pranayama and Dhyana are capable to enhance immune response, physiological healing, and over all wellness.
| Conclusion|| |
It is evident from both the cases that, majority of the parameters got decreased with the management inferring beneficial effects of Ayurveda interventions in mild-to-moderate case of COVID-19 infection in short period with complete regression of the symptoms. The efficacy also can be seen through maintained inflammatory marker levels. The treatment was personalized, holistic, and purely based on Ayurvedic principles, and no conventional medicines were used. These reports inferred that Ayurveda has vast potential to address the COVID-19 like pathologies. Further studies with large sample-sized, multicentric studies can be planned to evaluate and establish the usefulness of Ayurveda efficacies systematically.
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
Conflicts of interest
There are no conflicts of interest.
| References|| |
Coperchini F, Chiovato L, Croce L, Magri F, Rotondi M. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev 2020;53:25-32.
Muralidar S, Ambi SV, Sekaran S, Krishnan UM. The emergence of COVID-19 as a global pandemic: Understanding the epidemiology, immune response and potential therapeutic targets of SARS-CoV-2. Biochimie 2020;179:85-100.
Acharya YT, editor. Commentary Nibandha Sangraha of Dalhanacharya on Sushruta Samhita of Sushruta, Sutra Sthana, Doshadhatumalakshayavriddhi Vigyaneeyam Adhyaya. Ch. 15., Ver. 41. Varanasi: Chaukhamba Bharati Academy; 2002. p. 75-6.
Shastri K, Chaturvedi G, editors. Hindi Commentary on Charaka Samhita of Agnivesha, Chikitsa Sthana. 2nd
ed., Ch. 1., Ver. 1. Varanasi: Chaukhamba Bharati Academy; 2007. p. 35-6.
Rao GP, editor. Sarṇgadhara Samhita of Sarṇgadhara, Madhyama Khanda. Ch. 2., Ver. 22-23. Varanasi: Chaukamba Publications; 2013. p. 143.
Mishra SN, editor. 'Siddhiprada' Hindi Commentary of Kaviraj Govind Das Sen on Bhaishajya Ratnavali, Jwaradhikara. Ch. 5., Ver. 1200-13. Varanasi: Chaukamba Publications; 2017. p. 193.
Rao GP, editor. Sarṇgadhara Samhita of Sarṇgadhara, Madhyama Khanda. Ch. 10., Ver. 77-92. Varanasi: Chaukamba Publications; 2013. p. 205.
Shastri HP, editor. Ashtanga Hridayam of Vagbhata, Sutra Sthana. Ch. 20., Ver. 38. Varanasi: Chowkhambha Surbharati Prakashan; 2017. p. 294.
Shastri K, Chaturvedi G, editors. Charaka Samhita of Agnivesa. Chikitsa Sthana. Vol. 2., Ch. 2., Ver. 70-4. Varanasi: Chaukhambha Bharati Academy; 2011. p. 16-7.
Mishra SN, editor. 'Siddhiprada' Hindi Commentary of Kaviraj Govind Das Sen on Bhaishajya Ratnavali. Ch. 10., Ver. 79-87. Varanasi: Chaukamba Publications; 2017. p. 343.
The Ayurvedic Pharmacopoeia of India Part 2 Department of Indian Systems of Medicine and Homeopathy, Vati 10:13. Civil Line, Delhi: The Controller of Publications; 2000. p. 145.
Sharma KD, Kapoor ML, Vaidya SP, Sharma LK. Clinical trial of 'AYUSH 64” (A Coded Antimalarial Medicine) in cases of malaria. J Res Ay Sid 1981;2:309-26.
Ayurvedic Formulary of India, Part-2 1st
English Edition Printed by National Institute of Science Communication CSIR. New Delhi: The Controller of Publication; 2000. p. 292.
Mishra SN, editor. 'Siddhiprada' Hindi Commentary of Kaviraj Govind Das Sen on Bhaishajya Ratnavali, Jwaradhikara. Ch. 5., Ver. 436-45. Varanasi: Chaukamba Publications; 2017. p. 128.
Arab-Zozani M, Hashemi F, Safari H, Yousefi M, Ameri H. Health-related quality of life and its associated factors in COVID-19 patients. Osong Public Health Res Perspect 2020;11:296-302.
Acharya YT, editor. Commentary Ayurveda Dipika of Chakrapanidatta on Charaka Samhita of Agnivesha, Vimana Sthana. 5th
ed., Ch. 3., Ver. 20. Varanasi: 2011. p. 273.
Upadhyay AK, Kumar K, Kumar A, Mishra HS. Tinospora cordifolia
(Willd.) Hook. F. and Thoms. (Guduchi) – Validation of the Ayurvedic pharmacology through experimental and clinical studies. Int J Ayurveda Res 2010;1:112-21.
Taneja MK. Modified bhramari pranayama in Covid 19 infection. Indian J Otolaryngol Head Neck Surg 2020;72:395-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]