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Approach of Ayurveda for COVID-19

Abstract

The coronavirus disease 19 (COVID-19) pandemic is unique and unprecedented in several aspects and has challenged health care systems. At present, the global momentum is unabated, and a second wave is anticipated. The experience and lessons learnt from the earlier severe acute respiratory syndrome (SARS) epidemics appear inadequate and call for better approaches and strategies in public health and medical care. Conventional mainstream medicine is at the forefront when it comes to curbing this menace, especially at the critical care stage. The current prophylactic measures are insufficient, and suggested options such as hydroxychloroquine (HCQ) are still under investigation. The prophylactic and therapeutic potential of traditional and complementary medicine systems such as Ayurveda and Yoga is not really being considered during this crisis and global hunt for effective preventive and treatment measures. In this commentary, we have attempted to highlight the knowledge and practices from Ayurveda and Yoga that might be effectively utilized in the prophylaxis and adjuvant therapy of COVID-19. Several of our recommendations in this paper are driven by the emerging dynamics of the causative organism SARS coronavirus 2 (SARS-CoV-2) and the unraveling of the pathophysiology of COVID-19. While we focus here on prophylaxis and the protection of vulnerable target organs, Ayurveda and Yoga as an add-on therapy may support patients of COVID-19 by improving the quality of standard care.

Look Ahead

Ayurveda practitioners would require training in screening of the people for associated risk factors. They should also be equipped with modern personal protection equipment and access to diagnostic facilities. Ayurveda hospitals may also be turned as the primary care setups and quarantine for the people having mild symptoms and requiring a constant monitoring. A good networking of AYUSH healthcare authorities with local health authorities may help effective utilization of human resources in AYUSH community during the current crisis.

Ayurveda doctors following a pragmatic action plan should assess the prognosis and advise timely referrals to secondary or tertiary care facilities as per the need of patient. An extra and utmost care should be taken while treating COVID-19 patients/people suspected to have contracted infection of SARS-CoV-2.

Basic Prevention

The eyes, nose, and mouth are the main portals of entry of droplets carrying the SARS-COV-2. Prior to the final assault in the lungs, the virus gains access to the throat region and stays for some hours. The fatty acid coat of the virus adheres to the moist mucosal layers, which helps it gain entry into the cells by binding to specific cell receptors. Ayurveda classics mention several interventions that are likely to target these entry portals. This may help to improve the innate immunologic response of the mucus membranes and may thus inhibit the virus transmission to the lungs. These measures may hence function as “physiological masks” barricading the viral invasion. The general measures for respiratory illnesses described in Ayurvedic texts such as consumption of hot water, hot food, and herbal decoctions, gargling with medicated water, steam inhalation, and local applications may be helpful for symptomatic relief in mild cases.

Water

Drinking hot or warm water is a popular home remedy for many ailments. Ayurveda also advocates this as a measure for improving digestion. Traditionally, warm water is consumed in many parts of India for diverse disorders of fever, inflammation, metabolism, and allergy such as rhinitis and asthma. Several spices that are popularly used in the kitchen are added as single or multiple agents to the boiling water and consumed as medication throughout the day. These spices include dry ginger (Zingiber officinale), yashtimadhu (Glycyrrhiza glabra), and nut-grass (Cyperus rotundus) rhizomes; khus (Vetiveria zizanioides) and Indian sarsaparilla (Hemisdesmus indicus) roots; coriander (Coriandrum sativum) and fennel (Cuminum cyminum) seeds; and cinnamon (Cinnamomum verum) and catechu (Acacia catechu) barks.

Mouth Rinse & Gargle

Warm liquids and oils are used as gargles or mouth rinses to cleanse the mouth and throat thoroughly. This can also have a systemic effect. The oils or oily decoctions clean the oral cavity, pharynx, and tonsillar area and are likely to coat the mucosa as biofilm and induce additional immunomodulatory, antioxidant, and antimicrobial benefits. The paramount role of host mucosal immunity in controlling infectious agents is well known. Turmeric (Curcuma longa) rhizome, yashtimadhu or liquorice (Glycyrrhiza glabra) stem, neem (Azadiracta indica) and catechu (Acacia arabica) barks, and natural salt may be used to prepare medicated water/solutions for gargles/mouth rinse. Gargles with these medicated decoctions have demonstrated beneficial effects in xerostomia (dry mouth), postoperative sore throat, oral ulcers, gingivitis, and bacterial growth. Glycyrrhizin, an active component in liquorice was found to be more effective than common antivirals in inhibiting the replication of SARS virus and inhibited its adsorption and penetration. Yoga texts recommend cleansing of the nasal passage with salt water (Jala neti). The efficacy of salt water in upper respiratory infections has been reported in randomized controlled trials (RCTs), although more conclusive evidence is needed.

Nasal Oil Application

Ayurveda recommends the application of medicated oils made from butter oil (Ghee) and vegetable oils such as sesame or coconut in the nostrils. This may protect the respiratory tract from pathogen entry. This procedure known as nasya is well described in Ayurveda. Application of pure sesame oil was found to be effective for the treatment of dry nasal mucosa. Similar to gargles and mouth rinses, nasal oil application possibly forms a biofilm and can help as a barrier to the entry of the virus particles. Researchers of Traditional Chinese Medicine have already proposed the use of nasal oil application for preventing SARS-COV-2 infection.

Steam Inhalation

Steam inhalation and hot fomentation (with aromatic oils such as menthol) provide satisfactory clinical relief in nasal and throat congestion, bronchoconstriction, headache, and sinusitis. Its role in improving nasal conditioning, improving nasal mucus velocity, and reducing congestion and inflammation has been reported in several clinical studies.

Recommendations and Way Forward

Ayurveda has enough potential and possibilities to be employed both for prevention and treatment of COVID-19. This will provide an important opportunity for learning and generating credible evidence. It is pertinent to reiterate that participation of Ayurveda in addressing the COVID-19 challenge in India should not remain limited and seen as the extension of healthcare services and support to bio-medical system. Indeed, with adequate monitoring and data keeping during the implementation, important lessons and research directions are likely to emerge on the management of increasingly frequent and virulent communicable diseases. Implementation of proposed action is likely to provide evidence-based insights strengthening the scope of Ayurveda beyond preventive health care and care for non-communicable diseases. AYUSH system across the country has been put on alert for being called anytime to serve the nation. AYUSH healthcare facilities are also being readied to be converted into quarantine facilities in times of need. From this perspective, implementing the suggested intervention plan within AYUSH healthcare facilities by Ayurveda workforce may benefit the nation greatly. India is the country where the world’s oldest living health care system originated and therefore it is being carefully watched by the world community for how it handles the crisis using its own resources. 

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