|Year : 2021 | Volume
| Issue : 2 | Page : 80-86
A retrospective analysis of Ayurvedic clinical management of mild COVID-19 patients
Sumit Srivastava1, Harbans Singh2, Sanuj Muralidharan3, Rijin Mohan1, Shikha Chaudhary4, Poonam Rani5, Unnikrishnan Payyappalli6, Narayanam Srikanth7
1 Department of Roganidana, SDACH, Chandigarh, India
2 Central Ayurveda Research Institute, Patiala, Punjab, India
3 Department of Dravyaguna, SDACH, Chandigarh, India
4 Department of Kayachikitsa, SDACH, Chandigarh, India
5 SDACH, Chandigarh, India
6 Centre for Local Health Traditions and Policy, TDU, Bangalore, India
7 CCRAS, New Delhi, India
|Date of Submission||23-Jul-2021|
|Date of Acceptance||23-Sep-2021|
|Date of Web Publication||23-Dec-2021|
Dr. Harbans Singh
Central Ayurveda Research Institute, Moti Bagh Road, Patiala, Punjab 147001.
Source of Support: None, Conflict of Interest: None
BACKGROUND: The COVID-19 virus is a new contagious pathogen which has made a huge impact on health, economic and societal perspectives of our country. Early detection, rapid isolation, and adoption of effective infection prevention and control (IPC) measures are key to preventing and controlling COVID-19 infection. Patients are now receiving symptomatic treatment. This retrospective study aims to assess and comprehend the effectiveness of Ayurvedic interventions in the treatment of mild symptomatic COVID-19 patients. OBJECTIVE: The objective of this study is to analyze the outcome of Ayurvedic interventions in managing mild symptomatic COVID-19-infected cases. MATERIALS AND METHODS: COVID-19 patients (diagnosed through RT-PCR test) admitted at Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh were treated with Ayurvedic interventions. The data were collected and have been analyzed retrospectively. Data collected were systematically analyzed and presented using appropriate software (SPSS version 21). RESULTS: The treatment given in this particular study were aimed at dissipating the pathogenesis based on Ayurvedic principles of management. Relief in major clinical symptoms such as fever, cough, and throat pain has been observed in studied cases of COVID-19. The clinical recovery rate observed in this study was 94.3%, which is comparatively high with reference to the current clinical recovery rate, i.e., 69.5% in Chandigarh (India). CONCLUSION: The Ayurvedic interventions, AYUSH-64, Agasthya Hareetaki Rasayana, and Anu Taila Nasya, may play a major role in managing mild symptomatic cases of COVID-19. IEC number: 8-55/2020-CARIRD/TECH/COVID/149
Keywords: Ayurveda, COVID-19, Agasthya Hareetaki Rasayana, AYUSH-64, Anu Taila
|How to cite this article:|
Srivastava S, Singh H, Muralidharan S, Mohan R, Chaudhary S, Rani P, Payyappalli U, Srikanth N. A retrospective analysis of Ayurvedic clinical management of mild COVID-19 patients. J Res Ayurvedic Sci 2021;5:80-6
|How to cite this URL:|
Srivastava S, Singh H, Muralidharan S, Mohan R, Chaudhary S, Rani P, Payyappalli U, Srikanth N. A retrospective analysis of Ayurvedic clinical management of mild COVID-19 patients. J Res Ayurvedic Sci [serial online] 2021 [cited 2022 Jan 22];5:80-6. Available from: http://www.jrasccras.com/text.asp?2021/5/2/80/333535
| Introduction|| |
The COVID-19 epidemic has impacted the lives of everyone on the planet. Since December 2019, the illness has claimed the lives of over 3 million individuals throughout the world, drastically altering our way of life and social relationships. In January 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency; on March 11, the virus was formally declared a pandemic, the highest level of health emergency. COVID-19 has been confirmed in 179,241,734 instances worldwide as of June 24, 2021, with 3,889,723 fatalities. In India, it has reached around 30,082,778 cases out of which 391,981cases deceased. In Chandigarh, 61,520 have been confirmed till date, out of which 807 cases deceased. The ongoing COVID-19 outbreak in industrialized nations also underlines the reality that developed countries and wealthy populations are not immune to infectious disease outbreaks. The lack of proven effective pharmacological therapy regimens for COVID-19 makes treating newly emerging COVID-19 infections across the world difficult. There is currently no effective care for this illness, and efforts are being undertaken to combine a few conventional treatments with standard COVID-19 treatment methods. It has also been noted that there is a lack of empirical data to guide effective COVID-19 management. Masks have been shown to help reduce coronavirus transmission in several studies., It is impossible to exaggerate the relevance of Ayurveda in the treatment of different communicable and non-communicable disorders. Ayurvedic treatments are effective and affordable as Ayurveda offers epidemic and pandemic based on natural remedies.,, Emesis therapy, purgation therapy, medicated enema, and nasal insufflation therapy are some of the purifying processes used in Panchakarma therapies and rejuvenative therapy, which can help in prevention and management of epidemics and pandemics. In context of COVID-19, according to Ayurveda perspectives, a patient with fever should practice use of herbs having appetizer, intestine cleansing and immunomodulatory actions accompanying Ayurveda body purification procedures such as emesis therapy. With this background, it was decided to retrospect the data of COVID-19 PCR-positive patients who were treated with three Ayurvedic interventions, namely, Tablet AYUSH-64, Agasthya Hareetaki Rasayana,,, and Anu Taila.
Out of the 182 screened patients, data of 70 patients who fulfilled the inclusion criteria were taken and analyzed retrospectively to assess the clinical outcome of Ayurvedic interventions in managing mild symptomatic cases of COVID-19 infection.
| Materials and Methods|| |
Present study is a retrospective analysis of 70 confirmed cases of COVID-19, categorized as mild COVID-19 disease who were being treated through Ayurveda management from May–July 2020 at Shri Dhanwantry Ayurvedic College and Hospital, Chandigarh. All asymptomatic cases, moderate cases, and severe cases of COVID infection were excluded from this study. Data was collected in a case record form after receiving a signed consent form from the patient. Ethical clearance from IEC of Central Ayurveda Research Institute (Peripheral Institute of CCRAS, Ministry of AYUSH, Government of India), Patiala, Punjab, India was obtained on 02.07.2020 (IEC no.: 8-55/2020-CARIRD/TECH/COVID/149). The medicines were provided by the Central Council for Research in Ayurvedic Sciences, New Delhi, India.
Retrospective analysis of clinical outcome from Ayurvedic interventions in confirmed cases of mild symptomatic COVID-19 patients.
Duration of clinical recovery of COVID-19 subjects and changes in vital data were the outcome measures.
| Clinical data from a cohort of COVID-19 subjects|| |
Data for present retrospective analysis was collected from the patients having mild symptoms of COVID-19 such as fever, anorexia, sore throat, nasal discharge/congestion and cough with RT-PCR positive report and who were treated with Ayurveda interventions viz. Agasthya Hareetaki Rasayana, AYUSH-64 tablets and Anu taila (an oil as nasal drop). The RT-PCR tests were conducted at the Regional VRDL, Department of Virology, PGIMER, Chandigarh, India.
Patient age group
All patients of either gender between 16 and 65 years without any co-morbidity were included in the study.
All relevant data including symptoms and vitals were collected from hospital medical records. According to the symptoms observed in the 70 participants at the time of admission, we have classified them into common and less common symptoms.
Fever was the most common symptom in this group throughout their stay in the hospital. The subjects (n=17) with high grade fever (>101°F) were given paracetamol as rescue medication as and when required prescribed by an allopathic physician.
The choice of medicines was according to the guidelines of the Ministry of AYUSH. Tablet AYUSH-64 in the dosage of 1000 mg twice daily and Agasthya Hareetaki Rasayana 5 g twice daily were administered to the patients after food with water as vehicle for a period of 10 days. The patients were also administered 2 drops of Anu Taila through nasal route in the morning before food.
Statistical analysis was done by using paired “t” test for quantitative parametric paired data. It was done by using Sigma Stat version 3.5 software. The P < 0.05 is considered as significant, P < 0.01 as highly significant, P < 0.001 very highly significant and P > 0.05 as insignificant. The confidence interval was set at 95%.
| Results|| |
The descriptive statistical analysis of decline in temperature pattern indicates that there is significant decline in temperature (p<0.001) from 3rd day till the 10th day [Table 1]. Improvement in SpO2 is seen from 3rd day of the treatment however it is not significant till 5th day. Compared to initial SpO2 level, the significant improvement is detected at 7th day (p=0.006) which further increased on 10th day (p=0.003). This may indicate that the intervention require 3 days for improving SpO2 level significantly [Table 2]. Body temperature and pulse rate have proportionate relationship. The temperature showed significant decline from 3rd day of treatment and the same is also noted in descriptive statistical analysis of pulse rate. The decrease in pulse rate is significant on 3rd day (p<0.004) and it is slightly more significant later period (p<0.001) [Table 3]. The analysis of symptoms showed that parameters such as body ache, chest pain, nausea and abdominal pain has not changed significantly. It may indicate that these symptoms may require additional drug intervention to get better relief. However the major symptoms related o COVID-19 such as fever, cough, sore throat, headache, nasal discharge and dyspnea are significantly decreased [Table 4]. In the current study, 98.57% drug compliance was found [Figure 1].
| Discussion|| |
Even though COVID-19 is a novel ailment, the treatment approach toward such diseases can be understood using the concept of novel disease. A physician must have to analyze the vitiated humors, tissues, channels as well as stage of disease and strength of patients before planning the treatment. Suśruta Saṃhitā depicts pandemic fevers with a slew of symptoms including cough, trouble in breathing, vomiting, and headache. It also enlists fever among diseases that are contagious. The external fever is one of the eight main kinds of fevers mentioned in Ayurveda, and they are induced by external causes. There are eight kinds of fever narrated in Ayurveda and fever caused due to external factors is also included. As viruses are external pathogens, hence the fever caused by them can be included in type of external fever in perspectives of Ayurveda. Moreover, Vijayarakṣita, commentator on the Ayurveda text Madhavanidana, adds that ailments induced by incursion of pathogens can be communicable and spread from person to person.Dosha imbalance develops ultimately even in viral fever produced by extrinsic factors. Even a novel disease may be assessed via research into its etiology, involved Dosha, patho-physiological location, and other variables involved in disease causation, progression, and clinical sequel, as demonstrated by classical text like Mādhavanidāna.
Microorganisms and their role in disease manifestation have been described in Ayurvedic classics. The variability of symptoms in COVID-19 infection is extensive and large from asymptomatic to critical. This kind of variability may be due to body’s specific and non-specific immunity. So it is important to understand the pathogenesis of the disease based on Ayurvedic diagnostic parameters without bothering about its naming and plan the management accordingly.
The severity of manifested symptoms depends on the strength of factors causing disease as well as factors obstructing the manifestation. When the factors which provoke the manifestation of the disease are strong, then the strength of the disease will be strong. The symptom manifestation depends on the association of causes, bodily humors, and vitiated tissues.
When the symptoms of COVID-19 were investigated in this cohort study, it was obvious that symptoms like fever, anorexia, and body aches are manifestations of circulatory illnesses, whereas symptoms like cough, dyspnea, rhinosinusitis, and so on are indications of cardiorespiratory disorders.,
On analyzing the signs and symptoms and pathogenesis, it can understand that main humors involved are Vata and Kapha stipulated with Pitta. When the circulatory channels are affected, the main symptom which appears is fever due to obstruction in channels with associated symptoms such as anorexia, headache, malaise, and nausea. When the cardio-respiratory channels are affected, the symptoms which appear are dry cough, productive cough, dyspnea, pleuritic pains, rhinitis, and sore throat.
As per the principles of treatment in Ayurveda, one must aim at reversal of pathophysiology and avoidance of diseases causing and aggravating form.
AYUSH-64 is a well-studied and documented formulation in influenza-like illness. It is a choice of drug for reversal of pathophysiology by removing the obstruction in bodily tissues, which in turn pacifies fever and associated symptoms. The composition of AYUSH-64 includes Saptaparna (Alstoniascholaris R. Br.) Katuki (Picrorhiza kurroa Royle ex. Benth.), Kiratatikta (Swertia chirata Buch.-Ham. Ex Wall.), and Kuberaksha (Caesalpinia crista Linn.). Studies on the ingredients of AYUSH-64 have shown anti-inflammatory and immuno-modulator activities too. In the current study, a gradual declining trend was observed in temperature and fever-associated symptoms from day 1 to day 10. Traditionally, Agasthya Hareetaki has been mentioned in the management of chronic cough, dyspnea, chronic rhino-sinusitis, and fever like malaria. Agasthya Hareetaki removes the obstruction in the channels as well as balances the humors. It also acts as rejuvenator therapy, which further assists in minimizing the sickness from becoming more chronic and thus prevents any impairment to the respiratory tract tissues. In the present study, statistically significant improvement was observed in cough and dyspnea after intervention.
The interventions must also target reducing the inflammation of the upper respiratory tract (mainly nasal mucosa) based on the clinical symptoms observed in the COVID-19 patients. Medicinal oils prepared from vegetable oils such as sesame or coconut are advocated by Ayurveda for nasal instillation, which may help to keep pathogens out of the respiratory tract. Ayurveda has a detailed description of this process termed as nasal insufflation therapy. It has been established that using pure sesame oil to treat dry nasal mucosa is effective. Nasal oil application, gargles. and mouth rinses may induce a biofilm that serves as a barrier to virus particles entering the body. Traditional Chinese Medicine researchers have earlier advocated the application of nasal oil to prevent SARS-COV-2 infection. The ingredients in Anu Taila constitute anti-inflammatory substrates. Anu Taila has a significant spreading capacity through minute channels and removals obstruction in body channels which help to clear the natural sinus ostia and to promote the clearance of purulent discharge. The strength, nourishing effect, and improved function of sense organs are the properties of rejuvenatory therapy which will help to nourish the seven body tissues.
A diminution of digestive fire in fever induces the formation of pro-inflammatory indicators, which leads to pro-inflammatory state and a weakened immune system. According to the Ayurvedic philosophy, through appetizers and digestive syrup, the Ayurvedic strategy aims to restore normal digestive fire state, resulting in reduction in pro-inflammatory symptoms, reversing the pathology, and boosting immune function. Drugs which are bitter in taste act as appetizers and anti-inflammatory, and Picrorhiza kurrooa which is one of the best bitter taste drug is a major component of AYUSH-64 tablets. These properties of AYUSH-64 may act as modifier of cell’s status from pro-inflammatory to non-inflammatory and promotes in the re-establishment of normal metabolism and immune system function. From the 5th to the 10th day of the interventions, a downward trend was found in COVID-19 symptoms as per the retrospective analysis. The components of AYUSH-64 and Agasthya Hareetaki Rasayana relieve fever, cough, and dyspnea and may also act as rejuvenation. In 46% of the patients, recuperation and return to normal life took place on the 5th day, whereas in 58% of the patients, it took place on the 10th day. SpO2 saturation patterns improved as well.
| Conclusion|| |
Ayurvedic interventions, namely, AYUSH-64, Agasthya Hareetaki Rasayana, and Anu Taila Nasya, may play a major role in managing mild symptomatic cases of COVID-19 as there were no complications noticed nor a single patient advanced to progressive stages. Prospective, controlled randomized clinical studies are required to validate the obtained outcome. An integrative approach is also needed to develop the proper care and management of COVID-19.
The majority of the patients had symptomatic relief after 10 days of treatment with AYUSH-64, Agasthya Hareetaki Rasayana, and Anu Taila Nasya. All COVID-19 symptoms showed a downward trend with a reasonable recovery; nevertheless, a longer course of these medicines may have yielded greater outcomes in terms of metabolic restoration and immune system strengthening. The 10-day administration of AYUSH-64 with Agasthya Hareetaki Rasayana and Anu Taila Nasya was well tolerated in this research, with no side effects reported.
Limitations of the study
RT-PCR for COVID-19 after the treatment, other laboratory investigations, and radiological investigations were not done before and after the treatment due to technical and financial constraints for COVID.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Chappell B. COVID-19: COVID-19 is now officially a pandemic, WHO says. National Public Radio, March 11, 2020. Available from: https://www.npr.org/sections/goatsandsoda/2020/03/11/814474930/COVID-19-COVID-19-is-now-officiallya-pandemic-who-says. [Last accessed on 24 Jun 2021].
World Health Organization. Coronavirus Disease (COVID-2019) Situation Reports. Geneva:World Health Organization; 2021.
Lyu W, Wehby GL. Community use of face masks and covid-19: Evidence from a natural experiment of state Mandates in the US. Health Aff (Millwood) 2020;39:1419-25.
IHME COVID-19 Forecasting Team. Nat Med 2021;27:94-105 (PubMed, Article, Google Scholar).
Vrata Sharma Priya. English translation on Charaka Samhita
by Agnivesha, Vol. 1. Varanasi: Chaukhambha Orientalia, 1st ed. 1981. p. 314-5.
Kunjalal Bhishagratna, English translation on Sushruta Samhita, edited by Laxmidhar Dwivedi-Chowkhambha Sanskrit Series Office, Varanasi, 2nd ed. 2002. p. 49-50.
Sharma Priya Vrata, edited by Bhela Samhita text with English translation, Commentary and critical note by Dr Krishnamurthy KH , Chaukhambha Vishvabharati, Varanasi, India. Reprint. 2003, p. 58-61.
Sharma RK, Bhagawan Dash. Eng. translation on Charaka Samhita, Chowkhambha Sanskrit Series Office, Varanasi. 2009. VimanaSthan
, Chapter 3/12–20.
Sharma RK, Bhagawan Dash, Eng. translation on Charaka Samhita. Varanasi: Chowkhambha Sanskrit Series Office. 2009. VimanaSthan
, Chapter 3/40–44.
The Ayurvedic Formulary of India E book, Part I, 2nd ed. Aveleha Prakarana. New Delhi: The Controller of Publications; 2000. p. 111-2.
Anonymous. The Ayurvedic Pharmacopoeia of India Part I Vol-IV. Department of AYUSH, Ministry of Health and Family Welfare, Government of India; 2006. p. 112-4.
Sri Bhavamishra. Bhavaprakash Nighantu. In: Chunekar KC Pandey GS . Reprint Edition. Varanasi: Chaukhamba Bharati Academy; 2015.
The Ayurvedic Pharmacopoeia of India Part II Vol-III Department of AYUSH, Ministry of Health and Family Welfare, Government of India; 1st ed. 2010 (formulations). p. 55-7.
Advisory from Ministry of AYUSH. D.O. No. S.16030/18/2019-NAM. Dated 06.03.2020.
Agnivesha, Charaka Samhita, Sastri Sri. Satya Narayana, Elaborated Vidyotini Hindi Commentary by Pt. Sastri Kasinatha Natha Chaturvedi Gorakha , Sutra Sthana, 18/43–47. Varanasi: Choukhamba Bharti Academy; 2009, p. 353.
Susruta , Susrutasamhita, P.V. Sharma, Dalhana’s Commentary, Nidana Sthana, 5/34. Varanasi: Choukhamba Visvabharati; 2005. p. 44.
Agnivesha, Charaka Samhita, Sastri Sri. Satya Narayana, Elaborated Vidyotini Hindi Commentary by Pt. Sastri Kasinatha Natha Chaturvedi Gorakha , Chikitsa Sthana, 3/114–115. Varanasi: Choukhamba Bharti Academy; 2011. p. 124.
Madhava KR, Madhavanidana, Prof. Kushtha Srikantha, Murthy Nidanama, 49/42–43. Varanasi: Chaukhambha Orientalia; 2007. p. 164.
Vagbhata Kaviraj, Astangahrdayam, Atridev Gupta, Chikitsa Sthana 1/171. Varanasi: Chaukhambha Prakshan; 2009, p. 406.
Agnivesha, Charaka Samhita, Sri. Satya Narayana Sastri , Elaborated Vidyotini Hindi Commentary by Pt. Sastri Kasinatha Natha Chaturvedi Gorakha , Nidana Sthana, 4/4. Varanasi: Choukhamba Bharti Academy; 2009. p. 631.
Agnivesha , Charaka Samhita, Sri. Satya Narayana Sastri, Elaborated Vidyotini Hindi Commentary by Pt. Sastri Kasinatha Natha Chaturvedi Gorakha , Sutra Sthana, 28/9–11. Varanasi: Choukhamba Bharti Academy; 2009. p. 571.
Agnivesha , Charaka Samhita, Sri. Satya Narayana Sastri, Elaborated Vidyotini Hindi Commentary by Pt. Sastri Kasinatha Natha Chaturvedi Gorakha , Vimana Sthana, 5/7. Varanasi: Choukhamba Bharti Academy; 2009. p. 710.
Susruta , Susrutasamhita, PV Sharma, Dalhana’s Commentary, Uttaratantra Sthana, 1/25. Varanasi: Choukhamba Visvabharati; 2005. p. 110.
Pandey DN, Rastogi S, Agarwal GG, Lakhotia SC. Influenza like illness related clinical trial on AYUSH-64 requires cautious interpretation. J Ayurveda Integr Med 2020:S0975-S9476(20)30058-30059. doi:10.1016/j.jaim.2020.07.005.
Vinjamury SP, Vinjamury M, Sucharitakul S, et al
. Panchakarma: Ayurvedic detoxification and allied therapies—Is there any evidence? Evidence-Based Practice in Complementary and Alternative Medicine. Berlin: Springer; 2012. p. 113-37.
Johnsen J, Bratt B, Michel-Barron O, Glennow C, Petruson B. Pure sesame oil vs isotonic sodium chloride solution as treatment for dry nasal mucosa. Arch Otolaryngol Head Neck Surg 2001;127:1353-6.
Fan W, Zeng J, Xu Y. A theoretical discussion of the possibility and possible mechanisms of using sesame oil for prevention of 2019-nCoV (COVID-19 coronavirus) from the perspective of colloid and interface science. Research Gate2020; DOI: 10.13140/RG.2.2.31786.98248.
The Ayurvedic Formulary of India E Book, Part I, Vol. II, edition 2, Taila Prakarana
. Vol. II, 2nd ed. New Delhi: Controller of Publications; 2000. p. 365-6.
Dave Bhatta, P Vaghela, KH DB, Dhiman KS. Role of Vyaghri Haritaki Avaleha
and Anu Taila
Nasya in the management of Dushta Pratishyaya
(chronic sinusitis). Int J Ayurved Med 2016;2016:49-55.
[Table 1], [Table 2], [Table 3], [Table 4]