|Year : 2021 | Volume
| Issue : 3 | Page : 102-116
A review on preventive and therapeutic potential of selected Ayurveda medicinal plants in viral pandemics
Shobhit Kumar1, Uday Ravi Sekhar Namburi2, Deepak J Londhe3, Ashwin C Chiluveri4, Amit K Rai5, Sudha K Chiluveri6, Shital Chinchalkar7, Bhogvalli Chandra Shekar Rao5, Narayanam Srikanth5
1 Health & Family Welfare Vertical, NITI Aayog, New Delhi, India
2 Regional Ayurveda Research Institute, Nagpur, India
3 Ministry of Women & Child Development, New Delhi, India
4 Education Policy-1 Section, Ministry of AYUSH, New Delhi, India
5 Central Council for Research in Ayurvedic Sciences, New Delhi, India
6 Central Ayurveda Research Institute for Cardiovascular Diseases, New Delhi, India
7 G.S. Ayurveda Medical College and Hospital, Hapur, Uttar Pradesh, India
|Date of Submission||23-Aug-2021|
|Date of Acceptance||20-Oct-2021|
|Date of Web Publication||22-Mar-2022|
Dr. Shobhit Kumar
Health & Family Welfare Vertical, NITI Aayog, Sansad Marg 110001, New Delhi.
Source of Support: None, Conflict of Interest: None
BACKGROUND: Viral pandemics/epidemics are emerging as one of the biggest challenge for medical fraternity and health-care policy makers. This is high time to explore traditional medicine systems such as Ayurveda, wherein measures such as Dincharya (daily regimen), Ritucharya (seasonal regimen), Sadvritta (good conduct/behavior), and Rasayana (rejuvenation measures) which are said to influence the homoeostatic mechanism of the host defense system along with interventions that may have a promising role in managing such diseases. OBJECTIVES: This review attempts to provide an informative analysis of the daily regimen, seasonal regimen, moral conduct, and interventions recommended in Ayurveda scriptures which can be helpful for the prevention and treatment of viral pandemics. METHODS: A narrative review was conducted and comprehensive search of Ayurveda classical texts, including Bhrihatrayi, Laghutrayi, Dhanwantari Nighantu, Raj Nighantu, Kaiyadev Nighantu, and texts related to Dravyaguna was done. Electronic databases such as PubMed, AYUSH Research Portal, DHARA, and Google Scholar were also searched for relevant literature, pertaining to Ayurveda prophylactic and therapeutic measures in viral pandemics from 2001 to 2020. RESULTS: Prophylactic and therapeutic measures, including daily and seasonal regimen, good conduct/behavior, rejuvenation measures, Dhoopana Karma (medicated fumigation), and medicinal herbs, explained in Ayurveda may be utilized during viral pandemics. Critical analysis of the available scientific evidence suggests potential of Ayurveda interventions in context of immunomodulatory and antiviral activities. CONCLUSION: Unique preventive dietary and lifestyle practices recommended by Ayurveda can play an important role in maintaining the health status and improving the disease resistance capacity. Evidence from preclinical/clinical studies indicates that several herbs used in Ayurveda exhibit immunomodulatory, antiviral properties. The preventive and therapeutic measures narrated in Ayurveda can contribute significantly towards the management of viral pandemics. Generation of more scientific evidence through quality research studies is needed to evaluate the role of Ayurveda approaches for management of viral diseases.
Keywords: Antiviral, COVID-19, immunomodulation, pandemic, Rasayana
|How to cite this article:|
Kumar S, Namburi UR, Londhe DJ, Chiluveri AC, Rai AK, Chiluveri SK, Chinchalkar S, Rao BC, Srikanth N. A review on preventive and therapeutic potential of selected Ayurveda medicinal plants in viral pandemics. J Res Ayurvedic Sci 2021;5:102-16
|How to cite this URL:|
Kumar S, Namburi UR, Londhe DJ, Chiluveri AC, Rai AK, Chiluveri SK, Chinchalkar S, Rao BC, Srikanth N. A review on preventive and therapeutic potential of selected Ayurveda medicinal plants in viral pandemics. J Res Ayurvedic Sci [serial online] 2021 [cited 2022 Dec 9];5:102-16. Available from: http://www.jrasccras.com/text.asp?2021/5/3/102/340292
| Introduction|| |
In 1918, the Influenza pandemic (Spanish Flu) had affected more than 500 million people and caused 50 million deaths. The Centre for Disease Control and Prevention, USA estimated that the influenza has resulted in 9–45 million illnesses, 0.14–0.81 million hospitalizations, and 12–61 thousand deaths annually since 2010 in the United States. The National Centre for Disease Control, Delhi also estimated that the seasonal Influenza (H1N1) had resulted in 28,798 cases and 1218 deaths in India in the year 2019. Further, the current COVID-19 pandemic has resulted in more than 111 million confirmed cases and more than two million deaths all over the world as on February 22, 2021. Viral pandemics has resulted in significant morbidity and mortality all over the world.
Every viral epidemic/pandemic challenges the health-care system as well as the world economy. Contemporary science is striving hard and placing efforts in finding effective solutions for such conditions. The contemporary management of viral diseases includes symptomatic and supporting care along with active prophylaxis through vaccination. The vaccines have certain limitations as various strains of viruses have different genetic structure and tendency to undergo mutation making the vaccine as ineffective against the new strain. In other words, a vaccine may not be beneficial in all strains of the same virus. Further, the manifestation and progression of any viral disease is dependent on the nature of the host–pathogen interaction, in which the immune system of the host plays a vital role. Apart from vaccination in conventional medicine, the viable measures to strengthen the host defense system are limited. Therefore, there is a need to adopt a holistic approach of traditional medicine systems such as Ayurveda for the prevention and effective management of such pandemics.
Ayurveda mentions a variety of modifiable factors that are said to influence the homoeostatic mechanisms of the host defense system, as well as medications that may have a potential role in the treatment of many viral disorders. Preventive measures suggested in Ayurveda such as Dincharya (daily regimen), Ritucharya (seasonal regimen), Sadvritta (good conduct/behavior), and Rasayana (rejuvenation measures) may be utilized for strengthening the host defense system. There are several potential Ayurveda interventions which can help in the management of various infectious diseases. These drugs can be repurposed to generate evidence as potent antiviral agents through appropriate clinical study designs. It is also essential to explore the existing scientific evidence related to potential Ayurveda prophylactic and therapeutic measures for managing infectious diseases and pandemics.
The World Health Organization (WHO) has also suggested that traditional and complementary medicine (TCM) can make a significant contribution to the goal of universal health coverage. And it is required to look at areas where TCM and conventional medicine converge to help tackle the unique health challenges of the twenty-first century.
Present work is a critical appraisal of available scientific evidence on Ayurveda measures and interventions such as daily regimen, seasonal regimen, moral conduct, and interventions narrated in Ayurveda texts which can be helpful in prophylaxis and management of viral diseases.
| Materials and Methods|| |
Narrative review pertaining to Ayurveda prophylactic and therapeutic measures in viral pandemics from 2001 to 2020.
Ayurveda classical texts, including Bhrihatrayi, Laghutrayi, Dhanwantari Nighantu, Raj Nighantu and Kaidev Nighantu, and relevant text of Dravyaguna were reviewed for literary information in relation to aim of present of study. Electronic databases such as PubMed, AYUSH Research Portal, Digital Helpline for Ayurveda Research Articles (DHARA), Google Scholar, and official websites of government health agencies were searched for relevant literature. The search terms used were Ayurveda, Ayurveda herbs, Traditional Medicine, immunity, immunomodulatory, antioxidant, and antiviral.
| Results|| |
The database was searched for observational or interventional studies in Ayuveda or contemporary science, conducted during the viral pandemics and a total of 295 studies were reviewed from the aforementioned timeline. Among the reviewed studies, 68 studies are included in preset work. The observed data from the selected research studies is presented and interpreted under discussion section.
| Discussion|| |
Current status of management of viral diseases
Symptomatic and supportive care has remained the primary component in the management of many viral diseases in conventional medicine. The available treatment includes antiviral chemotherapy comprising viricidal agents, antiviral agents, immunomodulators, and interferon alpha. However, the role of these therapies is limited, which can be observed by the significant morbidity and mortality caused by the viral diseases.,,,
Ayurveda measures suggested for improving the host-defense system
Daily regimen, seasonal regimen, good conduct, and rejuvenation measures have been suggested by Ayurveda for the maintenance of healthy state and prevention of diseases. Daily regimen includes guidelines to be followed in daily routine for better physical, psychological, and mental well-being, such as Bramhamuhrata Jagrana (early morning awakening), Abhyanga (body massage), Vyayama (exercise), Snana (bathing), Nasya (errhine therapy), Gandush/Kavala (oil pulling/gargling), and Aahaar Vidhi,, (dietary guidelines) [Supplementary Table 1]. Further, based on the season-specific environmental changes, various rules and regimens regarding diet and lifestyle have been suggested to acclimatize the seasonal enforcement easily without altering body homeostasis [Supplementary Table 2] and [Supplementary Table 3]. Negligence in following the suggested daily and seasonal regimen may result in many diseases due to disturbance of Agni (factors related to digestion and metabolism) and vitiation of Dosha (regulatory functional factors of the body). Along with daily and seasonal routine, adoption of measures indicated under Achara Rasayana (good conduct) can provide rejuvenation effect through superior mental, social, and spiritual well-being. Ayurveda also recommends to control urges such as anger, fear, grief, anxiety, greed, envy, and arrogance. On the other hand it is advised not to suppress natural urges such as flatus, urine, and bowel movement for better physical and mental health. As per contemporary evidence, several drugs mentioned for rejuvenation are found to have immunomodulatory, antioxidant, antistress, anti-inflammatory and antimicrobial properties. These drugs helps to confers immunity against diseases and promotes longevity.,
|Supplementary Table-2: Seasons specific indicated and contraindicated dietary habits1|
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|Supplementary Table-3: Seasons specific indicated and contraindicated lifestyles1:|
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Ayurveda interventions having antiviral and immunomodulatory activities
The recent evidences obtained from experimental and clinical investigations represents that many therapies employed in daily Ayurveda clinical practice have potential immunomodulatory, antioxidant, adaptogenic, antibacterial, and antiviral action. Some of the available scientific evidences are depicted in [Table 1] and [Table 2].
|Table 1: Antiviral and immunomodulatory effect of selected Ayurveda interventions (single drugs)|
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|Table 2: Correlative approach towards therapeutic indications of selected Ayurveda interventions and available evidences|
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Limited available options in conventional medicine to manage viral pandemics suggest the need to explore additional prophylactic and therapeutic measures from Traditional Medicine systems such as Ayurveda. Ayurveda has scientific and holistic time-tested principles which can be applied to prevent infectious diseases as well as their management. In view of correlative approaches, it can be interpreted that in Ayurveda the infectious diseases and epidemics/pandemics have been described in the context of Aupasargika roga, Janpadodhvamsa, Agantuja vyadhi, etc. Ayurveda principles of the management of Janapadodhwamsa (diseases causing societal collapse) includes rejuvenative measures to enhance immunity, noble conduct, balanced diet, administration of medicinal herbs collected before the origin of such epidemics, and medicated fumigation with drugs having antimicrobial properties to sanitize the surrounding environment. Ayurveda's comprehensive approach towards prevention and treatment of such diseases may provide possible leads for generating evidence for efficient treatment and prophylaxis.
The variability of manifestation of disease and its progression among the infected individuals depends on the host–pathogen interaction, wherein the host response plays a pivotal role. Ayurveda gives paramount importance to various diet and lifestyle practices such as daily and seasonal regimen, good moral conduct, and rejuvenation, which may have a role in strengthening the host defense mechanism, thereby enabling the prevention of various infectious diseases. The available contemporary evidence suggests that body massage, oil pulling/gargling, errhine therapy, exercise, and proper sleep intake advocated by Ayurveda in the daily regimen have a positive effect on the specific physiological mechanism and thereby immunity. The daily practice of body massage improves body strength by nourishing tissues, ensuring sound sleep, and increasing life span. Contemporary evidence with limited studies have shown the positive effect of oil massage in maintaining immune-competence by increasing CD4, CD8, and CD3 cell counts as compared with the control group in a pilot study conducted on HIV+ children. Moreover, it is also observed that massage has a positive effect on immunity by decreasing the level of cortisol as it is evident that cortisol negatively affects immune function.
Oil pulling with sesame oil has antioxidative properties, which helps in damaging the cell walls of micro-organisms. Coconut oil used in oil pulling contains lauric acid comprising monalaurin and monoglycerides. These two possess antimicrobial activity. Monalaurin also possesses virucidal activity by causing the disintegration of viruses.
Exercise reduces the risk of several chronic diseases and premature death through various mechanisms such as improvement in body composition, lipid lipoprotein profiles, glucose homeostasis, insulin sensitivity, autonomic tone, coronary blood flow, psychological well-being and reduction in blood pressure, and systemic inflammation, augmenting cardiac function and enhancing endothelial function. Ayurveda advocates the practice of exercise in healthy individuals to half of their strength/capacity and it is evident that regular exercise of moderate intensity improves and maintains immunity by increasing T-cell proliferation, neutrophil phagocytic activity, IL-2 production, better NK-cell cytotoxic activity, resulting in less numbers of exhausted/senescent T cells and circulating inflammatory cytokines. On the other hand, excessive intensity and volume exercise can result in transient or sometimes long-term depression in immunity, which can increase the risk for opportunistic infection, especially upper respiratory tract infection. This observation indicates that the practice of exercise that is half of its strength/capacity is more appropriate and beneficial.
Sleep is one factor among Trayo-Upastambha (three supporting pillars in relation to human physiology) and Ayurveda states that waking at night causes the vitiation of Doshas (regulatory functional factors of the body)., Scientific studies have shown that sleep is one of the important modulators of the immune response and a lack of sleep can adversely affect the immunity. Sleeplessness can also increase susceptibility to infection due to impaired mitogenic proliferation of lymphocytes, decreased HLA-DR expression, the upregulation of CD14+, and variations in CD4+ and CD8+ T lymphocytes.
The effect of photoperiod due to seasonal changes on immune function and hormone synthesis has been found in animals, which influences the development of opportunistic disease. Several animal studies have reported the seasonal physiologic changes, for instance under constant conditions, red deer have distinct seasonal changes in digestive features and seizure thresholds in mice. Thus, adopting the diet and lifestyle practices according to a daily regimen and seasonal changes may help in the prevention of opportunistic diseases.
Contemporary evidence has highlighted that the regulation mechanism of circadian rhythm plays a vital role in people’s healthy lives and regulates several physiological, behavioral, and metabolic functions with periods close to 24 hrs. It is affected by factors consisting of cosmic events related to the universe and earth, environmental factors (light, night and day duration, seasons), and lifestyles. Thus, adopting the diet and lifestyle practices recommended by Ayurveda under daily and seasonal regimen can help in the prevention of opportunistic diseases such as viral ailments. Although the lifestyle measures cited earlier do not exhibit specific antiviral activity, they are essential in maintaining the host defense mechanism, so that the infective diseases can be either prevented or managed easily without significant morbidity and mortality. It is evident that a poor host defense mechanism and comorbidity with chronic diseases are poor prognostic factors in case of viral pandemics.
In addition to this, Rasayana drugs such as W. Somnifera, T. cordifolia, E. officinale, G. glabra, P. longum etc. may help in disease prevention on regular intake, as suggested among the treatment principles of pandemics in Ayurveda. The evidences from experimental and clinical studies represent immunomodulatory, antioxidant, anti-inflammatory and antimicrobial properties of these drugs.
Several studies on Ayurveda interventions in the recent past have produced supporting evidence for use of Ayurveda herbs in different viral diseases. Ayurveda interventions such as T. cordifolia, O. sanctum, P. longum, Z. officinale, P. urinaria, S. chirata, A. paniculata, A. scholaris etc. may be advised in the management of the initial stages of the viral diseases for the early recovery and prevention of any significant morbidity. These interventions enhance cellular and humoral immunity through increased production of lymphocyte count, including T and B cells, stimulation of NK cells activity, increase in neutrophil index and macrophage migration index, activation of macrophages, and by increasing phagocytosis. They may also help to block the viral attachment and internalization, protect epithelial cells, inhibit viral adsorption and penetration, inactivate the initial titer of the virus, and inhibit virus replication due to viricidal activity. These drugs may prove effective in managing the prominent symptoms associated with different viral diseases such as fever, cold, cough, dyspnea, bodyache, and poor appetite as represented by classical indications and contemporary evidence.
Accordingly, the present review proposes the utilization of Ayurveda prophylactic measures and interventions with immunomodulatory and antiviral activity in managing the viral diseases. Further evidence to establish their efficacy in the prophylaxis and management of viral ailments could be generated through research studies with appropriate research designs. It would be valuable to conduct prophylactic and therapeutic research studies on the multi-strategy approaches of Ayurvedic treatment with appropriate leads from available contemporary preclinical/clinical evidence as well as classical literature. However, the study designs for such studies should incorporate all the holistic aspects of disease management suggested by Ayurveda.
| Conclusion|| |
Unique preventive dietary and lifestyle practices advocated by Ayurveda play an important role in maintaining the health status and improving the disease resistance capacity. Several herbs practiced in Ayurveda exhibits immunomodulatory and antiviral properties which can help in prevention and development of supportive management strategies for infectious diseases. The preventive and therapeutic strategies described in Ayurveda, as well as herbs with immunomodulatory and antiviral characteristics, can help manage viral pandemics significantly. More scientific data in the form of high-quality research studies is needed to support Ayurvedic strategy in context of effective prevention and treatment of viral infections.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]