|Year : 2021 | Volume
| Issue : 4 | Page : 185-191
Management of moderate cases of COVID-19 through treatment protocol of Ministry of AYUSH: A case series
Meenakshi Sharma1, Sisir Kumar Mandal2, Shagufta Raahat1, Ankita Sunil Pawar1, Shalini Rai1, Anand More1, Tanuja Nesari1
1 All India Institute of Ayurveda, New Delhi, India
2 Vikriti Vigyan, IMS, BHU, Varanasi, Uttar Pradesh, India
|Date of Submission||26-Jul-2021|
|Date of Decision||12-Feb-2022|
|Date of Acceptance||15-Feb-2022|
|Date of Web Publication||29-Apr-2022|
All India Institute of Ayurveda, New Delhi
Source of Support: None, Conflict of Interest: None
The global resurgence of coronavirus 2 (SARS-CoV-2) has severely affected the medical infrastructure, posing a serious public health concern. The present case series documents the successful management of four moderate cases of confirmed coronavirus disease (COVID-19) based on the Ayurveda approach without any adverse effects and any post-COVID presentation. A retrospective analysis of four patients with moderate COVID-19 symptoms was conducted in this study at the All India Institute of Ayurveda. The patients were between the age of 23 and 38 years, were diagnosed as COVID-19 positive through a rapid antigen test (RAT), in July–August 2020, and were managed through Ayurveda interventions. The interventions include Ayush Kwath (10 g twice a day) and Sanshamani Vati (500 mg thrice a day) along with dietary restrictions and nonpharmacological suggestions. The therapeutic interventions were carried out for 7 days. Symptomatic assessment was done every day telephonically, and RAT was conducted after 7 days. Post-COVID complications were assessed in individual cases during the follow-up period (3 months after the completion of treatment). Complete relief in symptoms was observed within 6–7 days in all the cases. No side effects or adverse drug reactions were noticed both during and after the treatment. No post-COVID complications were observed in the four studied cases. The case series suggests that timely Ayurveda intervention has very good potential not only in treating mild-to-moderate patients of COVID-19 infection but also in preventing the post-COVID complications. It could also have a role in reducing the burden of a patient’s turning into a severe category or with complications. However, large-scale randomized controlled trials are required to further validate the same.
Keywords: Ayush Kwath, COVID-19, infection, moderate, rasayana, Sanshamani vati
|How to cite this article:|
Sharma M, Mandal SK, Raahat S, Pawar AS, Rai S, More A, Nesari T. Management of moderate cases of COVID-19 through treatment protocol of Ministry of AYUSH: A case series. J Res Ayurvedic Sci 2021;5:185-91
|How to cite this URL:|
Sharma M, Mandal SK, Raahat S, Pawar AS, Rai S, More A, Nesari T. Management of moderate cases of COVID-19 through treatment protocol of Ministry of AYUSH: A case series. J Res Ayurvedic Sci [serial online] 2021 [cited 2022 Nov 26];5:185-91. Available from: http://www.jrasccras.com/text.asp?2021/5/4/185/344408
| Background|| |
Coronavirus disease (COVID-19) has become a global challenge that has demanded researchers, policy makers, and the government to address multiple dimensions to contain such a pandemic. Since, COVID-19 requires a structured approach covering preventive (exposed), curative (early and advanced stages of the confirmed case), and hospitalization (critical patients) care, the role of traditional Ayurveda medicines having immunomodulatory and adeptogenic effects is gaining momentum. On the basis of the traditional Chinese medicine (TCM) treatment used very effectively to treat COVID-19 infections, a reduction in the overall duration of treatment, shortening of the clinical recovery period improvement rate of CT image and clinical cure, a reduction in the rate of conversion of mild-to-moderate symptoms into severe disease, a reduction in the time of polymerase chain reaction test turning negative, and a reduction in the average length of stay in hospital by more than 2 days in the severe cases were reported., A good number of trials are registered for evaluating the efficacy of Ayurveda interventions in the prevention and management of COVID-19, out of which 107 studies (as on August 20, 2020) are based on the guidelines issued by the Ministry of Ayush.
This case series presents the report of four moderate uncomplicated patients between the age of 23 and 38 years, diagnosed with COVID-19 through the Rapid antigen detection test (RADT). The disease corresponds to Kapha-Vata dominant Sannipatika Jvara in classics and was treated on the line of Jvara Chikitsa, with Ayurvedic interventions having antipyretic, anti-inflammatory, and immunomodulatory actions.
| Case Description|| |
Four cases having mild to moderate symptoms of COVID-19 and confirmed positive through RAT were treated with Ayurveda interventions at an outpatient/inpatient department (OPD/IPD) facility of the All India Institute of Ayurveda (AIIA) from July to August 2020 [Figure 1]. General and clinical examinations of observed cases are depicted in [Table 1] & [Table 2]. The summarized case information of the four cases is given next.
A 26-year-old male, a computer operator, a resident of Panchwati Exn. Ghaziabad (U.P.), reported to the COVID testing centre (CTC) at AIIA. He was suffering from fever, sore throat, tiredness, and body ache for the past two days. No contact history (with a COVID-positive patient) could be traced. No comorbidities/surgeries/drug allergy or addictions were reported.
A 35-year-old male dry cleaner, a resident of Gautampuri, Delhi, visited CTC, AIIA, with complaints such as body ache, fatigue, and loss of appetite for the past two days. There was contact history with a diagnosed COVID-19 positive patient. There was no history of previous surgeries/drug allergy/any chronic illness or addiction.
A 23-year-old female graduate student, from Jasola Vihar, Delhi, reported to CTC, AIIA, with chief complaints of fever, body ache, cough, and complete loss of taste and smell for the past two days. History of contact with COVID-positive cases could not be traced. Her past history suggested no major illness/surgery or drug allergy.
A 38-year-old housewife residing in Banadana Enclave, Ghaziabad, reported to Flu OPD, AIIA, with complaints of fever, headache, fatigue, body ache, and anorexia for the past two days. Her past history did not reveal any major surgery, illness, or drug allergy.
RADT confirmed the diagnosis of COVID-19 in all the four cases. From the Ayurvedic point of view, based on the manifested symptoms, the cases were diagnosed as Vata-Kapha dominant Sannipatika Jvara. The stage of Jwara was Amavastha as there were symptoms such as anorexia, loss of taste, heaviness of body parts, fatigue, drowsiness etc and the duration of fever was less than eight days.
| Intervention Timeline and Clinical Assessment|| |
Ayush Kwath in the dosage of 20–30 ml twice a day in the lukewarm state, half an hour before a meal, and Sanshamani Vati 500 mg thrice a day, after a meal with lukewarm water, were prescribed for seven days. The patients were kept in isolation at their home. Along with medication, the patients were also advised to take bed rest, adequate sleep, plenty of warm fluids, light, easily digestible food items (porridge, Yusha, Krishra, fruits); perform gargling with lukewarm water containing Saindhava Lavana (rock salt) thrice a day and drinking of Haridra [(Curcuma longa L.)] added milk [200 ml hot milk with 3 gm Turmeric powder]. Nonpharmacological interventions like Yogasana, such as Sukhasana, Vajrasana along with Kapalbhati and Bhramari Pranyama, were advised to the patients for a short duration based on their capacity to perform exercise. They were also advised to maintain their positive state of mind. Daily consultation was done through telephonic communication. Assessment of clinical improvement was done as per the established criteria for fever, headache, bodyache, cough, anorexia, fatigue, and sore throat,,,,, [Table 3].
After seven days of treatment, the post-treatment follow-up to observe for any post-COVID complications was done at the 30th day.
| Outcome|| |
Significant relief in such as fever, cough, and anorexia was observed in all cases within the first two days. The cases also showed marked improvement in headache, body ache, and sore throat. Within four days of medication, the majority of the symptoms had subsided totally. On day 6, case 4 achieved smell and taste perception. By the 10th day, fatigue in cases 1 and 4 had subsided [Table 4]. No post-COVID symptoms and any adverse events were reported in any of the cases. All cases were advised to repeat RADT after six days or after turning asymptomatic, whichever was earlier, and were recorded as COVID-19 negative [Figure 2].
| Discussion|| |
In classical texts of Ayurveda, health, disease, and pathogenesis, clinical outcomes and management protocols of epidemics are described that can aid in the management of epidemic situations up to a certain extent. According to the classical concept of Ayurveda, if a disease is not found mentioned in literature, then the treatment plan can be made on the basis of determination of etiopathogenesis, the involved body system, the affected organ, attributes of vitiated Dosha, and manifested clinical symptoms. Based on this classical concept, the pathogenesis of studied cases can be decided as Kapha-Vata dominant Tridoshas, which affected the nutrient circulatory body fluid (Rasa Dhatu) along with blood (Rakta Dhatu) as well as the respiratory system (Pranavaha Srotasa) and manifested with the clinical features of fever, body ache, anorexia, loss of taste, fatigue etc. As per the prognostic criteria of Ayurveda, the cases may be included easily in the curable category due to the mild to moderate presentation of the disease symptomatology, moderate Dhatu Samhanan, Prakriti of the patients not being congruent to the Doshas of the disease, and good resilience of the patients.
Considering the components of pathogenesis, the management principle of Amavastha Jvara was adopted, which included the stimulation of digestion (Agnideepana and Amapachana), purification of circulatory channels (Srotosodhana), and pacifying Kapha-Vata. The four drugs in Ayush Kwath, by virtue of the digestive stimulant, channel the purification property along with immunomodulatory actions and may have certain pharmacological action in resolving the pathogenesis in mild to moderate cases of COVID-19, [Table 5]. Ocimmum sanctum has antimicrobial, antiviral, antidiarrheal, antimalarial, antioxidant, antipyretic, and immunomodulatory potential.,,,C. zeylanicum has immunomodulatory, antimicrobial, antimicrobial A2 receptor antagonist, anticoagulative, and anti-atherosclerotic action, which can help in boosting the immune system and prevent the coagulopathies associated with COVID-19. A study in mice demonstrated an increase in humoral and cell-mediated immune responses after the administration of crude and alcoholic extracts of Z. Officinales. Gingerols and shogaols component extracted from the rhizome of ginger are proven to possess anti-inflammatory, antioxidative, and antiaggregant potential. Evidence from various experimental and cell line studies confirms the immunomodulatory, antioxidant, analgesic, antiplatelets, antiasthmatic, antipyretic, anti-inflammatory, antidiarrheal, antidepressants, hepatoprotective, antiulcer, antiapoptotic, antimetastatic, antimutagenic, antibacterial, antifungal, and antiamoebic properties of P. nigrum.,,,Sanshamni Vati has Guduchi (Tinospora Cordifolia [Willd.] Hook.f. and Thomas) as the main content. Studies have revealed the immunomodulatory, analgesic, anti-inflammatory, antipyretic, and adeptogenic action of T Cordifolia.In silico studies have also shown the high binding efficacy of T Cordifolia against SARS-CoV-2 targets engaged for viral attachment and replication, as evaluated in Remdesivir, Favipiravir, and Lopinavir/Ritonavir. These evidences of the action of herbal ingredients of Ayush Kwath and Sanshamani Vati are supportive of the intended action and observed results in the studied COVID-19 cases. The interventions of Ayush Kwath and Sanshamani Vati along with the holistic care approach implemented simultaneously using a conducive diet and behaviors have shown the potential role in reversing the pathology in mild to moderate stages of COVID-19. Though milk is contraindicated in fever as per the classics, yet here milk containing Turmeric (C. longa) was prescribed due to the antioxidant, analgesic, antibacterial, and antiviral action of C. longa., Milk was advised as it has nutrient, rejuvenating, enlivening, and nourishing effects and it improves the immunity of the body, which is expected while treating an illness such as COVID-19.
In all studied cases, the major symptoms were relieved within five days of the commencement of medication and complete recovery was seen within 10 days. There were no post-COVID complications observed during the study period, which indicates the potential role and efficacy of the Guidelines of Ministry of Ayushin while curing the pathogenesis of mild to moderate cases of COVID-19. The results of other trials based on the Guidelines of Ministry of Ayush are yet awaited in the public domain, but this case report provides some proof to the efficacy of the interventions such as TCM. Though at this juncture, no certain conclusions can be drawn, yet younger age, coupled with no comorbidity and hypoxemia, could also have been the contributing factors for early recovery with the Ayurveda intervention.
| Conclusion|| |
Ayurveda intervention (Ayush Kwath and Samshani Vati) has good clinical efficacy in mild to moderate cases of COVID-19. The intervention can relieve symptoms within 5–10 days and may also help in nullifying the possibility of post-COVID complications. However, further clinical studies on a larger sample size are required to validate the findings of this case series.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Borse S, Joshi M, Saggam A, Bhat V, Walia S, Marathe A, et al
. Ayurveda botanicals in COVID-19 management: An in silico multi-target approach. PLOS One 2021;16:e0248479.
Ren JL, Zhang AH, Wang XJ. Traditional Chinese medicine for Covid-19 treatment. Pharmacol Res 2020;155:104743.
Publicity Department of the People’s Republic of China. Press conference of the joint prevention and control mechanism of state council on Feb 17, 2020. Available from: http://www.nhc.gov.cn/xcs/fkdt/202002/f12a62d10c2a48c6895cedf2faea6e1f.shtml
. [Last accessed on 23 Feb 2020] (in Chinese).
ICMR. Cilinical Trails Registry- India. ICMR National Institiute of Medical Statistics. 2020. Available from: http://ctri.nic.in/Clinicaltrials/advancesearchmain.php
. [Last accessed on 20 Aug 2020].Google Scholar
Agnivesh . Charak Samhita, Acharya YT (editor), Ayurved Dipika commentary by Dutt C. 2nd ed. Chikitsa sthana,3/92. Varanasi: Chaukhambha Surabharti Prakshan; 2009. p. 406.
Ogoina D. Fever, fever patterns and diseases called ‘fever’–a review. j Infect Public Health 2011;4:108-24.
McCormack HM, Horne DJ, Sheather S. Clinical applications of visual analogue scales: A critical review. Psychol Med 1988;18:1007-19.
Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, et al
. Clinical practice guidelines for diagnosis and management of cough-chinese thoracic society (cts) asthma consortium. j Thorac Dis 2018;10:6314-51.
Burrowes JD, Larive B, Chertow GM, Cockram DB, Dwyer JT, Greene T, et al
; Hemodialysis (HEMO) Study Group. Self-reported appetite, hospitalization and death in haemodialysis patients: Findings from the hemodialysis (hemo) study. Nephrol Dial Transplant 2005;20:2765-74.
Spazzapan S, Bearz A, Tirelli U. Fatigue in cancer patients receiving chemotherapy: An analysis of published studies. Ann Oncol 2004;15:1576.
Kajal K, Dharmu D, Bhukkal I, Yaddanapudi S, Soni SL, Kumar M, et al
. Comparison of three different methods of attenuating postoperative sore throat, cough, and hoarseness of voice in patients undergoing tracheal intubation. Anesth Essays Res 2019;13:572-6.
] [Full text]
Agnivesh . Charak Samhita, Acharya YT (editor), Ayurved Dipika commentary by Dutt C. 2nd ed. Chikitsa sthana,3/115, Varanasi: Chaukhambha Surabharti Prakshan; 2009. p. 407.
Available from: http://www.ccras.nic.in/sites/default/files/Notices/25042020_Letter_to_States_UTs_for_Ayush_Kwath.pdf
. [Last accessed on 12 Oct 2021].
Sharma PV. Dravyaguna Vijnana. Vol. II. 2nd ed. Varanasi: Chaukhambha Surabharti Prakshan; 2006. p. 514,251,333,363.
Cohen MM. Tulsi - ocimum sanctum: a herb for all reasons. J Ayurveda Integr Med 2014;5:251-9.
] [Full text]
Suanarunsawat T, Ayutthaya WD, Songsak T, Thirawarapan S, Poungshompoo S. Lipid-lowering and antioxidative activities of aqueous extracts of ocimum sanctum l. Leaves in rats fed with a high-cholesterol diet. Oxid Med Cell Longev 2011;2011:962025.
Mohan L, Amberkar MV, Kumari M. Ocimum sanctum
Linn. (TULSI) – an overview. Int J Pharmaceut Sci Rev Res 2011;7:51-3.
Mondal S. Antimicrobial and immunomodulatory effects of Tulsi (Oscimum snctum Linn.). 2010. Available from: http://ayushportal.nic.in/EMR/CLINICAL_FINAL_REPORT-4.pdf
Niphade SR, Asad M, Chandrakala GK, Toppo E, Deshmukh P. Immunomodulatory activity of Cinnamomum zeylanicum
Bark. Pharmaceut Biol. 2009;47:1168-73.
Valizadeh S, Katiraee F, Mahmoudi R, Fakheri T, Mardani K. Biological properties of Cinnamomum zeylanicum essential oil: Phytochemical component, antioxidant and antimicrobial activities. Int J Food Nutr Saf 2015;6:174-84.
Tsui PF, Lin CS, Ho LJ, Lai JH. Spices and atherosclerosis. Nutrients2018;10:1724.
Mashhadi NS, Ghiasvand R, Askari G, Hariri M, Darvishi L, Mofid MR. Anti-oxidative and anti-inflammatory effects of ginger in health and physical activity: Review of current evidence. Int J Prev Med 2013;4:S36-42.
Verma SK, Singh M, Jain P, Bordia A. Protective effect of ginger, zingiber officinale rosc on experimental atherosclerosis in rabbits. Indian J Exp Biol 2004;42:736-8.
Peterson CT, Rodionov DA, Iablokov SN, Pung MA, Chopra D, Mills PJ, et al
. Prebiotic potential of culinary spices used to support digestion and bioabsorption. Evid Based Complement Alternat Med 2019;2019:8973704.
Damanhouri ZA, Ahmad A. A review on therapeutic potential of piper nigrum l. (Black Pepper): The king of spices. Med Aromat Plants 2014; 3:161.
Nahak G, Sahu RK. Phytochemical evaluation and antioxidant activity of Piper cubeba
and Piper nigrum
. J Appl Pharma Sci 2011;1:153-7.
Srivastava AK, Singh VK. Biological action of Piper nigrum - the king of spices. Eur J Biol Res 2017;7:223-33.
Supe A, Purandare H. Immunomodulatory role of Tinospora cordifolia as an adjuvant in surgical treatment of diabetic foot ulcers: A prospective randomized controlled study. Indian J Med Sci 2007;61:347.
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.
Rege NN, Thatte UM, Dahanukar SA. Adaptogenic properties of six rasayana herbs used in ayurvedic medicine. Phytother Res 1999;13:275-91.
Badri K, Aramgam S, Muppuru K, Kona A, Kona A. Efficacy of Tinospora cordifolia in treating SARS-CoV-2: In silico studies. FASEB J 2021;35(Suppl 1). doi: 10.1096/fasebj.2021.35.S1.04976.
Panahi Y, Hosseini MS, Khalili N, Naimi E, Majeed M, Sahebkar A. Antioxidant and anti-inflammatory effects of curcuminoid-piperine combination in subjects with metabolic syndrome: a randomized controlled trial and an updated meta-analysis. Clin Nutr 2015;34:1101-8.
Moghadamtousi SZ, Kadir HA, Hassandarvish P, Tajik H, Abubakar S, Zandi K. a review on antibacterial, antiviral, and antifungal activity of curcumin. Biomed Res Int 2014;2014:186864.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]