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Ayurveda Practitioners Consensus to Develop Strategies for Prevention and


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Article · March 2020

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ORIGINAL ARTICLE Jan-Feb 2020

Ayurveda Practitioners Consensus to Develop Strategies


for Prevention and Treatment of Corona Virus Disease
(COVID-19)
Ashok Kumar Panda1, Amit Kumar Dixit2, Suvendu Rout3, Baidyanath Mishra4, Umesh V. Purad5,
Sarbeswar Kar6
1 2
Research Officer, Central Ayurveda Institute for Hepatobiliary Disorders, CCRAS, Ministry of AYUSH, Govt. of India, Bhubaneswar, Assistant
3
Director (Biochemistry), Central Ayurveda Research Institute for Drug Development, CCRAS, Kolkata, Head, Department of Kayachikitsa, SJS
4
Ayurveda College, Nazrathpet, Chennai, Director (R&D), Ingex Germany GmBH, Theodor-Heuss-Allee Business Center GmbH. Theodor-Heuss-
5
Allee 112, 60486 Frankfurt am Main, Germany, Principal, DGM Ayurveda Medical College Cum Post Graduation Centre and Hospital, Gadag,
6
Karnataka, Medical Superintendent, SDM Institute of Ayurveda and Hospital, Anchepalya, Bangalore, Karnataka, INDIA.

ABSTRACT
Background: The outbreak of Coronavirus disease (COVID-19) has been recently declared as Public Health
Emergency of International Concern (PHEIC) by World Health Organization and the virus has now spread beyond
the boundaries of countries and continents. At present, no specific antiviral treatment or vaccine is available or
recommended to counter the COVID-19, and the potential therapy is still symptomatic. Objective: The primary
aim of the study is to review ancient classical literatures and past human treatment protocols of Ayurveda for
prevention and treatment of infectious diseases and flu like illnesses, so as to provide guidance for the prevention
of COVID-19. Methods: Classical Ayurveda and recent modern literature with treatment protocols of Ayurveda for
prevention and treatment of flu and infectious diseases were reviewed and COVID-19 has been categorized in four
specific situations based on the severity of clinical condition. Total 110 Ayurveda practitioners of different parts of
India were participated in the survey. These specific situations were conveyed and described to these participants
and their opinions and options were collected through social media platform i.e. WhatsApp or SMS. Results:
Recommendation and suggestions received from more than 50% participants were taken into accounts to draft the
recommendation for probable preventive and therapeutic regimen for the disease. Conclusion: The results
obtained in the study may provide a preventive strategy to the Ayurveda practitioners as well as common people
across the globe by increasing the innate immunity of the body to combat COVID-19. However, till today, social
distancing is considered as most effective way to stop the spread of COVID-19. Further, pilot study for different
group is recommended.

Key words: Corona; COVID-19, Pathogenesis; Consensus; Rasayana.

INTRODUCTION the beginning of year 2020. Health organizations


COVID-19 is becoming a greatest threat to the across globe are performing exhaustive teamwork and
humanity and civilization by every passing day from research to control its spread and illness. In late
December 2019, China reported a cluster of
Address for correspondence:
Dr. Ashok Kumar Panda
pneumonia cases with unknown etiology in the
Research Officer, Central Ayurveda Institute for Hepatobiliary people of Wuhan.[1],[2] The pathogen is a novel corona
Disorders, CCRAS, Ministry of AYUSH, Govt. of India, virus named Severe Acute Respiratory Syndrome
Bhubaneswar, Odisha, INDIA.
E-mail: drashokpanda69@gmail.com Corona Virus 2 (SARS - CoV-2), which belongs to the
Submission Date: 22/02/2020 Accepted Date: 29/02/2020 same family of viruses responsible for Severe Acute
Access this article online
Respiratory Syndrome (SARS) and Middle East
Quick Response Code
Respiratory Syndrome (MERS) epidemics in the last
Website: www.jaims.in
two decades.[3] WHO described the onset of a
potential Coronavirus outbreak and given the
estimate of a reproduction number for the 2019
DOI: 10.21760/jaims.5.1.16 Novel (New) Coronavirus (COVID-19, name given by
WHO on 11 Feb, 2020).[1-4] It is known that the novel

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ISSN: 2456-3110 ORIGINAL ARTICLE Jan-Feb 2020

coronavirus invades human cells through its surface chain reaction (rRT- PCR) based molecular assay tests
spike proteins which attaches to the angiotensin- are being used to detect viral RNA load in clinical
converting enzyme-2 (ACE-2) receptor on the surface samples of COVID-19 subjects. In rare serological
of a host cell. The ACE-2 is like a "knob on door" or tests, enzyme-linked immune-sorbent assay (ELISA), is
ridge and the virus "hijacks" the "knob" using its spike also considered as a screening test used to detect the
protein, facilitating the opening the door into human presence and concentration of specific antibodies that
cells.[5] bind to this viral protein. However, serological
investigation is only for surveillance or investigational
As the COVID-19 outbreak continues to spread in
purposes and still it is not considered for diagnostic
different part of the world, knowledge about its
purposes.[4-7]
pathogenesis, etiology, behaviour and management is
also increasing every day. Results of published At present, no specific antiviral treatment or vaccine is
epidemiological and virological studies provides available or recommended to counter the COVID-19,
evidence that COVID-19 is mainly transmitted from and the potential therapy is still symptomatic. Oxygen
symptomatic people to others, having close contact therapy represents the major treatment intervention
through respiratory droplets, by direct contact with for patients with severe COVID-19 infection. The
infected persons, or by touching contaminated primary difficulty in treating COVID-19 is to combat
surfaces and objects.[6] The incubation period for the over reaction of the immune system, which
COVID-19, which is the time between exposure with damages lungs and its links for multiple organ failure.
the virus and symptom onset, is on average 5-14 days. Studies suggests that mechanical ventilators may be
During this period, patients can be pre-symptomatic necessary in cases of respiratory failure refractory to
but can be contagious.[4-7] The common signs of oxygen therapy and hemodynamic support is of
corona virus infection include flu-like, respiratory upmost importance for managing septic shock.[8] The
symptoms, fever, fatigue, cough, shortness of breath, clinical studies proved that Traditional Chinese
breathing difficulties, while severe conditions may Medicine (TCM) can alleviate symptoms of mild and
causes pneumonia, acute respiratory syndrome, acute moderate COVID-19. The severe patients suffering
cardiac injury, kidney failure, multi organ failure and from hypoxia, can able to ease symptoms, including
even death.[7] Patients of COVID-19 can be with fever, coughing and shortness of breath.[9] Studies
nausea, cough, chills, respiratory symptoms and high also suggests that baicalin in Scutellaria baicalensis, a
temperature is not a general presentation in the early TCM herbal ingredient and hesperetin in dried
stages of infection. Elevated level of C-reactive tangerine peel can combine with ACE-2, thus serving
protein (CRP) lymphopenia and impaired immunity as a potent chemical compound for COVID-19.[10],[11]
are important characteristics for COVID-19. A cytokine Xuebijing Injection, a TCM medicine, also suggested a
profile resembling secondary haemophagocytic significant result in lowering the risk of community-
lymphohistiocytosis (sHLH) is associated with COVID- acquired pneumonia and reduce the time ventilators
19 disease severity, characterised by increased use time of severe patients and their stay in the
interleukin (IL)-2, IL-7, granulocyte-colony stimulating ICU.[12]
factor, interferon-γ inducible protein 10, monocyte
The first case of the COVID-19 infection in India was
chemo attractant protein 1, macrophage
reported from Kerala State on 30th January 2020, in
inflammatory protein 1-α, and tumour necrosis factor-
passengers travelled from China and medical
α. All these factors suggests cytokine storm and
fraternity including AYUSH practitioners been put on
immunosupression.[6] Researchers are developing
high alerts to stop its further propagation and
various rapid molecular and serological laboratory
management. AYUSH sector with its classical
investigations for diagnosis of COVID-19 infection. At
knowledge has a long tradition of keeping the nation
present, real-time reverse-transcription polymerase
healthy and its role has increased manifold in the

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ongoing efforts to tackle COVID-19. The government Ayurveda principles observe life from outside to
through its regulatory bodies, policy makers and inside, from macro to micro, grade of diseases
research councils emphasized the importance of condition (Vyadhi bala) or from factors such as
countering and fact checking the claims of AYUSH climate, constitution of patient (Prakruti),
having prevention and treatment for the disease and psychological influence (Satva), body symmetry
requested to come together for evidence based (Samhanana), appetite (Ahara sakti) and physical
research. Historically, it is well known that whenever strength (Vyayama Shakti). While understanding the
there is outbreak of any flu like illness or viral etiology and pathogenesis of a disease involving
infection in India, Ayurveda principles and its biological agents like bacteria and viruses due
approaches including oral administration of attention may be given to immunity (Vyadhi
preventive drugs, herbs, formulae, decoction, indoor kshyamatva) and self-recovery of the human system.
herbal medicine fumigation, etc. were recommended Although there is no direct evidence of Ayurvedic
for effective prevention and treatment. Research medicine for COVID-19, some of the classical and
Councils under the Ministry of AYUSH, Government of herbal medications with proven immunomodulatory
India have also issued advisory based on the Indian potential can be used as preventive medicines to
traditional medicine practices i.e. Ayurveda, counteract its symptoms.[15-20]
Homeopathy and Unani before the outbreak in
Therefore, the primary aim of the study is to review of
India.[13] Therefore, it is necessary to review of ancient
ancient classical literatures and past human treatment
classics of Ayurveda and previous human studies on
protocols of Ayurveda for prevention and treatment
infectious diseases and flue like illnesses to draft
of infectious diseases and flu like illnesses, so as to
protocols for prevention and treatment of COVID-19.
provide guidance for the prevention of COVID-19.
Since, Vedic period, ancient Ayurveda practitioners Presently, there are no comprehensive evidence
and health philosophers were aware of the existence based practice guidelines in Ayurveda to define the
of microorganisms as well as the causation of therapeutic option for COVID-19. Therefore, this study
infectious diseases by them.[14] The word Krimi was comprises consensus survey of Ayurveda practitioners
referred as infectious agent in Vedas, where on preventive measures and probable treatment
Rakshyasa (drink blood), Yatudhana (cause pain), option for asymptomatic, mild and moderate clinical
Pisacha (eats raw flesh), Apsara (swims in water) etc. conditions of COVID-19.
have been described. Ancient Indian Classics
described nearly hundred types of infectious agents.
MATERIALS AND METHODS
In Mahabharata Vedavyasa narrated that Krimi are Classical Ayurveda and recent modern literature with
everywhere and nobody can avoid them. It is also treatment protocols of Ayurveda for prevention and
mentioned in classics that Mahamari (Communicable treatment of flu and infectious diseases were
diseases) can spread from one person to another reviewed and COVID-19 has been categorized in four
through air, water, animal, flies and physical contact. specific situations based on the severity of clinical
Ayurveda the oldest medical system described fever condition. Four specific situations were described to
(Jvara) as a major disease in its Caraka Samhita. The the practitioners as 1) Ayurvedic Preventive measures
symptoms of the COVID-19 may be correlated with including the Government declared options for
the features of Sannipata Jwara described in apparently healthy individual having no sign and
Ayurvedic classics. However, In critical cases of symptom of diseases; 2) High risk individuals those
COVID-19, it best matches with symptoms described have co-morbidity factors like - COPD, Bronchitis, DM,
for Sama Sannipata jwara. It comes under Janapada heart diseases, chronic liver diseases (CLD), Immune
dhamsa vikara and can be grouped in Bhutabhisanga suppression therapy and geriatric person/those
agantuga Vikara (External cause of microbes). having history of immigration to other country/who

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Ashok Kumar Panda et al. Ayurveda Practitioners Consensus to Develop Strategies for COVID-19

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declared self isolation or quarantine/pre-symptomatic Sudarsana Ghana Vati in recommended dose were
phase patients; 3) Asymptomatic positive cases / advised for all participants for asymptomatic positive
Afebrile with only chills and respiratory symptoms in cases/Afebrile with only chills and respiratory
early stage of infection without dyspnea and symptoms in early stage of infection without Dyspnea
hypoxemia; 4) Uncomplicated Corona-19 infected and hypoxemia patients (Table 3). Sudarsana Ghana
patients means febrile without dyspnea and Vati, Amrutadi Kasaya and Suvarna Vasanta Malati
hypoxemia. The Institutionally qualified Ayurveda Rasa in its recommended doses were advised by all
practitioners and who are willing to participate in this participants for Uncomplicated COVID -19 infected
survey were included in the working force. Total 110 patients whose temperature > 370 c without dyspnea
Ayurveda practitioners of different parts of India and hypoxemia (Table 4).
participated in the survey. These specific situations
Table 1: Ayurvedic preventive measures including
were conveyed and described to these participants
the government declared options for apparently
and their opinions and options were collected through
healthy individual with no sign and symptom of
social media platform i.e. WhatsApp or SMS.
COVID-19(n=110).
RESULTS
Ayurveda Dose No. of
The information was asked from total 202 Ayurveda medicaments practitioners
practitioners from different parts of India and only with positive
response
110 have participated in the survey, out of which 76
participants (69%) are with post graduate degree in
Decoction of Sunthi, 2 gm each in 200ml 75
various disciplines of Ayurveda. Recommendation and Lavang, Pippali, water reduced to 50
suggestions received from more than 50% participants Maricha, cinnamon ml
were taken into accounts to draft the bark, teja patra
- 50 ml twice
recommendation for probable preventive and empty stomach
therapeutic regimen for the disease. Nitya Rasayana
in form of Haridra milk or 10 ml of Cow ghee Haridra milk or Cow 5 gm Haridra boiled in 110
(Emulsified fat) with rice/roti, Chyawanprash Avaleha ghee (Emulsified fat)- 250 ml of milk and
10 ml with rice/roti reduced to 200 ml
- 10g and Pranayama along with fumigation with
Ayurvedic drugs were collectively recommended by all
Chyawanprash Avaleha 10gm once before 110
participants as Ayurvedic Preventive measures break fast
including the government declared options for
apparently health individual who no sign and Aswagadha tablet - 2 tab twice after food 59
symptom of COVID-19 illness (Table 1). Nitya 250mg
Rasayana in form of Haridra milk or 10 ml of Cow
ghee (Emulsified fat) with rice/roti and Gudduchi Amalaki Churna 10 gm at night along 67
with Luke warm
tablet/Samsamana Vati in recommended dose and water
along with fumigation were recommended by all
participants for High risk group/geriatric Dhopana of house by Morning and evening 110
person/having history of immigration to other Resin of saal (Sarjja
Fumigation
country/who declared self isolation or quarantine/ re- rasa), Neem leaves,
coconut shell and Smoke allergic
symtometic phase patients (Table 2). Nitya Rasayana
hingu patients should avoid
in form of Haridra milk - or 10 ml of Cow ghee
(Emulsified fat ) with rice/roti and Gudduchi tablet/
Pranayama 10-10 min twice 110
Samsamana Vati in recommended dose and

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Morning and Evening Haridra milk or Cow in 250 ml of milk


ghee (Emulsified fat) and reduced to 200
- 10 ml with rice/roti ml, Twice a daily
Table 2: Ayurvedic preventive measures for High risk
group/geriatric person/those have history of Vyagri haritaki 10gm twice daily 59
immigration to other country/who declared self- with luke warm
water before food
isolation or quarantine/ pre-symtometic phase of
COVID-19 (n=110). Kusmanda Avaleha 10gm twice daily 76
with luke warm
Ayurveda Dose No. of water before food
medicaments practitioners
with positive Agathi haritaki 10gm twice daily 62
response with luke warm
water before food
Sudarsana ghana vati - 2 tab twice daily 75
250mg after food Bilvadi gulika -125mg 2 tab twice daily 73
with luke warm
Gudduchi tablet / 2 tab twice after 110 water before food
Samsamana Vati - food
250mg Siddha Makaradwaja 1 tab with 2-4 drop 78
-125mg of honey in mornig
Nitya Rasayana Haridra 5 gm Haridra boiled 110 empty stomach
milk or Cow ghee( in 250 ml of milk and
Emulsified fat ) - 10ml reduced to 200 ml, Kapha ketu rasa -125 2tabs with one 82
with rice/roti Twice a daily mg spoon of fresh tulsi
juice
Chyawanprash Avaleha 10gm once before 99
/ Fortified Chauvan break fast Saubhgya vati - 2tabs with one 90
prash with Gold and 125mg spoon of fresh
silver particle parijata leave juice

Dhupana of house by Morning and evening 110 Talisadi churna 10gm twice before 72
Resin of saal (sarjja Fumigation with honey /luke
rasa), Neem leves, warm water
Smoke allergic
coconut shell and patients should Arogya vardhini Rasa 1 tablet –twice daily 67
hingu. avoid. -250 mg with water after
food
Pranayama 10-10 min twice 100
Table 4: Ayurvedic preventive measures for
Table 3: Ayurvedic preventive measures for
uncomplicated COVID-19 infected patients having
asymptomatic positive cases/Afebrile with only chills
temperature > 370 c without dyspnea and hypoxemia
and respiratory symptoms in early stage of infection
(n=110).
without Dyspnea and hypoxemia phase of COVID-
19(n=110). Ayurveda Dose No. of
medicaments practitioners
Ayurveda Dose No. of with positive
medicaments practitioners with response
positive response
Sudarsana ghana vati 2 tab twice daily after 110
Sudarsana ghana vati 2 tab twice daily 110 food
after food
Amrutadi kasayam 20ml twice ith 20 ml 110
Gudduchi tablet/ 2 tab twice after 110 luke warm water
Samsamana Vati food before food

Nitya Rasayana- 5 gm Haridra boiled 110 Sanjeevani vati -125mg 1 tablet before food 80

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Suvrnna Vasanta 1tabs twice with one 110 precautionary measures drugs and life saving
Malati Rasa -125mg spoon of fresh equipments between the countries having experience
parijata leave juice of COVID-19 management will be very valuable
Sadanga Paneeya Quantity sufficient as 92 lessons to pass on.
required when felt
In India, Ayurveda being the ancient medical science
thirst
has a great importance in diseases management with
Sammera Parnaga One tablet twice with 65 its ultimate goal of ensure complete and
Rasa -60 mg tab honey when kapha
comprehensive health i.e. Mental, physical and social
predominant more
and the classical literature of Ayurveda is all about
Vyagri haritaki 10gm twice daily with 99 maintaining the equilibrium status of the of body
luke warm water
tissues. As per Ayurveda the progression of any
before food
disease should be stopped at the earliest possible
Ayush -64-250 mg cap 2 capsule twice with 66 stage (Sanchaya & Prokapa). In case of infectious
water
diseases, it is always advisable that stopping the
Agathi haritaki 10gm twice daily with 92 further progression is the most ideal for controlling
luke warm water the disease, and immunity whether innate or acquired
before food
should be increase by various means, which ultimately
Bilvadi gulika -125mg 2 tab twice daily with 73 ensures, that even with the exposure of the infectious
luke warm water disease pathogens, disease is not going to be
before food
manifested in the body.
Purna chandra Rasa 1 tab with 2-4 drop of 78
In the present study, all Ayurveda Practitioners
125mg honey in mornig
empty stomach recommended Ayurveda medicines are classical,
however Ayush-64 is research based formulation of
Kapha ketu rasa -125 2tabs with one spoon 82
CCRAS, which is widely used in malaria and different
mg of fresh tulsi juice
fever by Ayurveda practitioners. Most of the
Saubhgya vati -125mg 2tabs with one spoon 90 recommended formulations were also advised by
of fresh parijata leave
Ministry of AYUSH. The decoction of Sunthi (Zingiber
juice
officinale Roscoe.), Lavanga (Syzygium aromaticum
Talisadi churna 10gm twice before 72 (L.) Merr. & L.M. Perry) and Maricha (Piper nigrum
with honey /luke
Linn.) advised in healthy person is not only provide
warm water
humoral and cell mediated responses but also reduce
Arogya vardhini Rasa - 1 tablet –twice daily 62 the air way hyper responsiveness and nasal
250 mg with water after food
congestion.[21-23] Ayurveda products and fatty acids in
form of ghee are implicated in the up-regulation of
DISCUSSION
immune function. They control the immune system in
In present scenario, it is clear evident that spread of a pleiotropic manner and participate in various
COVID-19 is unstoppable and it has infected more processes of the adaptive/innate immunity.[24] Haridra
than 77,000 people and already taken lives of 2200 (Curcuma longa Linn.) has active constituent curcumin
people worldwide (as on 22 Feb 2020). Therefore, a which blocks cytokine release, most importantly the
coordinated global response between the health key pro-inflammatory cytokines, interleukin-1,
organizations with a collaborative and co-operative interleukin-6 and tumor necrosis factor-α, which is
intention is the ultimate requirement to meet this advisable to take with milk. The suppression of
unprecedented challenge of COVID-19. Sharing of cytokine release by curcumin correlates with clinical
medical advices, clinical data, investigations protocols, improvement in experimental models of flu and

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infectious diseases and can be compared with COVID- infection. However, till today, social distancing and
19 where a cytokine storm plays a significant role in sanitizations measures is considered as most effective
mortality.[25] Chauvan prasha has been demonstrated way to stop the spread of COVID-19. The ultimate
useful in treating respiratory problems, allergic cough requirement at this point is that Ayurveda or other
and bronchitis, common cold and strengthens medicine systems needs interdisciplinary research and
respiratory tract as immune-boosting agent.[26] should be performed in chorus with the researchers
Similarly, Sudarshana Ghana Vati is the derived who can contribute to such research. Further, pilot
formulation of Sudarsana churna which has good studies for different groups are recommended.
response in malarial fever and allegic rhinitis.[27] One
of the recommended drug in the present consensus
ACKNOWLEDGMENT
i.e. Gudduchi Tablet (Tinospora cordifolia (Willd.) The authors are very grateful to Director General and
Miers) is a potent immuno-modulator in viral Deputy Director General, CCRAS, New Delhi for
infection.[28-29] Vasanta Malati Rasa is a well known providing encouragement and guidance. The authors
Kharaliya Rasayana.[30] Parijata (Nyctanthes arbor- are thankful to all the Ayurveda practitioners, who
tristis L.) is used to treat fever of all kind including have actively participated in the survey for collection
malarial fever and have analgesic, anti-inflammatory, the data for the welfare of mankind.
anti-viral, anti-bacterial, anti-spasmodic, anti-pyretic,
anti-allergic, Anti-fungal, immuno-modulator,
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How to cite this article: Ashok Kumar Panda, Amit
Literary Review of Parijata (Nyctanthus Arbor-Tristis
Kumar Dixit, Suvendu Rout, Baidyanath Mishra, Umesh
Linn.) An Herbal Medicament with Special Reference to
V. Purad, Sarbeswar Kar. Ayurveda Practitioners
Ayurveda and Botanical Literatures. Biomed Pharmacol
Consensus to Develop Strategies for Prevention and
J (2016), 9(3).
Treatment of Corona Virus Disease (COVID-19). J
32. Saxena RS, Gupta B, Saxena KK, Srivastava VK, Prasad Ayurveda Integr Med Sci 2020;1:98-106.
DN. Analgesic, antipyretic and ulcerogenic activity of http://dx.doi.org/10.21760/jaims.5.1.16
Nyctanthes arbor tristis leaf extract. J
Ethnopharmacol (1987), 19 (2):193-200. Source of Support: Nil, Conflict of Interest: None
declared.

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which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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