E-ISSN:2456-3110

Review Article

Covid-19

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 1 Jan-Feb
Publisherwww.maharshicharaka.in

Ayurvedic interpretation and management of Covid-19 and Post Covid Symptoms

Deolekar S.1*, Thatere A.2, Kabra P.3
DOI:

1* Shweta Deolekar, Post Graduate Scholar, Department of Kayachikitsa, Government Ayurved College & Hospital, Nagpur, Maharashtra, India.

2 Ashish Thatere, Assistant Professor, Department of Kayachikitsa, Government Ayurved College & Hospital, Nagpur, Maharashtra, India.

3 Prakash Kabra, Professor & Head, Department of Kayachikitsa, Government Ayurved College & Hospital, Nagpur, Maharashtra, India.

World community is facing an unprecedented pandemic of novel corona virus disease (Covid-19) caused by Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-COV-2). Despite worldwide efforts to contain it, the pandemic is continuing to spread because of nonspecific drugs trial and still the exact medicine is yet to discovered. Ayurveda an ancient science has already described the pandemic with reference to Janapadodhwamsa along with its prevention and cure with reference to Aupsargika-Rogas. All kinds of Jwara are mentioned in our Ayurvedic classics with details of patho-physiology and management. Thus, Covid-19 whose main manifestation is Jwara can be managed and prevented by following the Ayurvedic daily regimen and treatment protocols which lessens the bad prognosis of Covid-19 thereby preventing the Post Covid Symptoms. Covid-19 can be managed by the treatment protocol mentioned in Jwara-Chikitsa, Janapadodhwamsa, Aupsargika Rogas while the Post Covid Symptoms can be managed by Jirna Jwara Chikitsa along with different forms Rasayana based on feasibility. Rasayana Chikitsa works well in the preventive as well as curative in both Covid-19 and Post Covid Symptoms. Role of Panchakarma in Covid-19 and Post Covid Symptoms has a special place in treating the Strotodushti of various level mainly the Pranavaha Strotas. Vyadhikshamatva and Agni play an important role in developing Covid-19 and Post Covid Symptoms therefore, attention should be given to increase the Vyadhikshamatva and maintain the optimum power of Agni of the public health. In this way Covid-19 infection is prevented thereby minimizing the further health hazards. Therefore, Ayurvedic principles should be adopted to prevent and manage the Covid-19 infection by interpreting the elements of patho-physiology in Ayurvedic perspective so as to plan an effective management protocol and to recover the Swasthya.

Keywords: Covid-19, Post Covid Symptoms, Jirna Jwara, Vyadhikshamatva, Agni

Corresponding Author How to Cite this Article To Browse
Shweta Deolekar, Post Graduate Scholar, Department of Kayachikitsa, Government Ayurved College & Hospital, Nagpur, Maharashtra, India.
Email: 		Shweta Deolekar, Ashish Thatere, Prakash Kabra, Ayurvedic interpretation and management of Covid-19 and Post Covid Symptoms. J Ayu Int Med Sci. 2022;7(1):119-129.
Available From
https://jaims.in/jaims/article/view/1521

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-01-04 2022-01-06 2022-01-13 2022-01-20 2022-01-27
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Shweta Deolekar, Ashish Thatere, Prakash Kabraand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)119
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

Introduction

A Coronavirus is a kind of common virus that primarily causes respiratory infection. Most Coronaviruses are not dangerous. In early 2020, after a December 2019 outbreak in China, the World Health Organization identified SARS-COV-2 as a new type of Coronavirus. The outbreak quickly spread around the world. The WHO has declared the coronavirus disease 2019 (Covid-19) a pandemic. Covid-19 is a disease caused by SARS-CoV-2 that triggers respiratory tract infection. It affect upper respiratory tract (sinuses, nose, and throat) and lower respiratory tract (windpipe and lungs).[1]

Coronaviruses are a family of viruses known for containing strains that cause potentially deadly diseases in mammals and birds. In humans, they are typically spread via airborne droplets of fluid produced by infected individuals.[2]

The Covid-19 outbreak has brought the number of identified coronaviruses that infect humans to seven. Four of these are community acquired and have circulated through the human population continually for a very long time. The four community-acquired human Corona viruses typically cause mild cold-like symptoms in humans. Two of them, hCOV-OC43 and hCOV-229E, have been responsible for between 10% and 30% of all common colds since about the 1960s. Three of these (SARS-COV, MERS-COV and SARS-COV-2) appear to have jumped to the human population more recently. Worryingly, these three results in a high mortality rate.[3]

All Coronaviruses are zoonotic. They start off in animals and can then, following mutation, recombination and adaptation, be passed on to humans. It has been determined that MERS-COV was transmitted from dromedary camels to humans and SARS-CoV from civet cats to humans.  The source of the SARS-COV-2 (Covid-19) is yet to be determined, but investigations are ongoing to identify the zoonotic source to the outbreak.[4]

Fundamentally, Ayurveda classifies diseases as Nija (from Intrinsic Causes), Agantuja (Extrinsic causes) and Manasa (Psychosomatic). The concept of pathogenic agents is interpreted in terms of Agantuja Karana and infectious disease caused by it is called Agantuja Vyadhi.[5] Jwara

(Hyperthermia) is cardinal symptom in many of the infectious diseases.[6]

The initial stage of Covid-19 is exogenous (Agantuja Jwara) disease which later converts into systemic (Nija Jwara) disease.[7] Chakrapanidatta clarifies that Bhuta means Vishakṛimi or a virulent organism;[8] Krimi may be Sahaja (natural) or Vaikarika (pathogenic) organisms that may be visible (macroscopic) or invisible to the naked eye (microscopic).[9] Hence SARS-COV-2 comes under Vaikarika Krimi. Abhishangaja Jwara which is one of the forms of Agantuja Jwara is the term for those caused by the contact of the poisonous air or toxic plants or other such toxins (Visha).[10] However, this Abhishangaja Jwara later may complicates with involvement of multiple tissues and organs. Thus, Abhishangaja Jwara can be corelated with Covid-19.

Janapadodhwamsa is an Ayurvedic term for epidemics or pandemics. In Ayurvedic literature, the communicable diseases are mentioned under Janapadodhwamsa i.e., communicable diseases affecting an entire country or the whole world. Janapada refers to particular geographic consideration. Impairment of Vayu (air), Udaka (water), Desha (land), and Kala (season) and are more lethal in their consecutively increasing order. Adharma (unrighteousness) is the root cause of vitiation of all factors and is led by Pragyaparadh (intellectual error).[11] Interestingly there is mention of an epidemic fever with respiratory system presentation (fever, cough, breathlessness, rhinorrhoea, headache and even anosmia) caused by entry of pathogenic agent through the nasal passages.[12] Dalhana in his commentary has mentioned that symptoms like anosmia, cough, catarrh will occur after the entry of contaminated air through the nasal opening which is similar to typical clinical features of Covid-19.[13] This clinical presentation by Sushrut is amazingly analogous to epidemics/pandemic like SARS, MERS, Swine Flu and even Covid-19 as Janapadodhwamsak Roga. Contagious diseases and means of contagion as physical contact, inhalation, eating together, sleeping, sitting together and sharing used linens and garlands are well discussed under Aupsargika Vyadhis like Kushtha, Jwara, Shosha and Netra-Abhishyanda by Sushruta.[14] Thus, Covid-19 can also be considered as Aupsargika Vyadhi.

From above explanation, Covid-19 disease can be interpreted as Agantuja Jwara, Abhishangaja Jwara, Janapadodhwamsak Roga and Aupsargika Vyadhi.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)120
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

Immunity level plays an important role in Covid-19 disease because of its different prognosis gradation. It is found that patients with comorbidities tend to have low immunity level suffer more than the healthy individual. Strength, health, lifespan, and vital breath are dependent on the condition of Agni.[15] Charaka has mentioned the term Vyadhikshamatva and states that during certain conditions, or due to certain factors, even unwholesome (unhealthy) food does not produce disease immediately; all unwholesome diet are not equally harmful, all Doshas are not equally powerful, all persons are not capable of resisting diseases.[16] This suggests that the body’s immune system plays a crucial role in disease development. The equilibrium state of Dhatu is called Swasthya.[17] The person who is desirous to be healthy should adopt healthy practices related to diet, conduct, and activities.[18] Thus, immunity can be considered in Ayurveda as Vyadhikshamatva and Ojas (Sarvadhatu Sara); which depends on the condition of Agni, Dosha, and Dhatu.

Vijayrakshit has classified Hetu as Utpadaka Hetu and Vyanjaka Hetu. Utpadaka Hetu is those which favour accumulation of respective Dosha in respective season due to seasonal effect. For example: in Hemanta Ritu due to indulgence of Madhura Rasa, accumulation of Kapha is observed. Vyanjaka Hetu is those which stimulate the development of diseases. For examples: accumulated Kapha in Hemanta Ritu produces disorders of Kapha in Vasanta Ritu due to effect of the Sun. Here effect of the Sun is the Vyanjaka Hetu.[19] Similarly, SARS COV-2 can be better interpreted as Vyanjaka Hetu (etiological factor acting at time of genesis of disease), whereas Utpadak Hetu are etiological factors which disturbs Vyadhikshamatva and Ojas, by mainly faulty diet and lifestyle leading to accumulation of Dosha. In Ayurvedic conceptualization; accumulated Doshas makes the body susceptible to disease. Even in an exogenous disease, there is involvement of Dosha and the role of Agni in prognosis of disease. As Covid-19 prognosis is associated with comorbidities like HTN, CVA, Diabetes Mellitus, Obesity, IHD, etc, this concept of Utpadaka Hetu becomes important. When these Hetus are consumed or are found, Doshas get aggravated and will tend to move into a Kha-Vaigunya (Defective Space) of Dhatus. If the Dhatwagni Bala is weak, vitiated Doshas favours pathogenesis (i.e., Dosha-Dushya Sammurcchana) leading to Covid-19.[20]

Dwandwaja or Sannipatika is an Avastha with vitiation of two or all three Doshas in the pathogenesis. Agantuja varieties of any diseases may complicate into Dwandwaja or Sannipatika state with severe prognosis depending upon the presence of harshness of Utpadaka Hetu.[21] The viral or bacterial fevers, along with malignancy, auto immune diseases, etc. are needed to be considered as Sannipatika state. In Covid-19, primary manifestations are seen at Pranavaha Strotas as virus enters through nasal passage. When all the three vitiated Doshas gets involved in the Dhatus, it results in Sannipatika Avastha of Covid-19. Following are the symptoms of Sannipatika Avastha of Abhishangaja Jwara that can be co-related with Covid-19.[22]

SN Sannipatika Avastha of Abhishangaja Jwara Covid-19
1. Jwara Fever
2. Kasa Dry cough
3. Tandra Moha Tiredness
4. Asthi-Sandhi Ruja Joint aches and pain
5. Kantha Shukai Aavrut Sore throat
6. Alpa Mala-Mutra Pravritti, Ati Mala Pravritti (Vagbhat) Diarrhea
7. Sa Strave Kalushe Rakte Lochane Conjunctivitis
8. Shiro-Ruja Headache
9. Aruchi Loss of taste or smell
10. Kothanam Shyava Raktanam Mandalanam Cha Darshanam Skin-Rashes
11. Hridi Vyatha Chest pain
12. Mukatva, Swarasaad (Vagbhat) Loss of speech
13. Shwasa Breathlessness

It is difficult to co-relate Covid-19 with specific Ayurvedic terminology but, while interpreting the disease on the basis of Samprapti Ghatak by considering the causative agent and the clinical features mentioned above can be contemplated as an Agantuja Vyadhi which later on due to the involvement of Nija Dosha (faulty diet and lifestyle) develops to Nija Vyadhi as Vata Kapholbana Hina Pitta Sannipataja Jwara (Severe Vata and Kapha with mild Pitta).[23]

While talking about the Samanya Samprapti of Jwara, Charak mentioned that when Vataadi Dosha


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)121
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

either singly or in Sansrista (2 Doshas) or in Sannipataja (all 3 Doshas) get aggravated then it enters Amashaya and mixed with Rasa Dhatu causing obstruction of Agni; Agni then spreads out from its Sthana to whole over the body causing febrile condition.[24]

Hence, pathogenesis of Covid-19 can be explained by considering the entry of Corona virus resulting in Agantuja Abhishangaja Jwara which later converts to Nija Abhishangaja Jwara by involvement of either 2 or 3 aggravated Doshas on the basis of Utpadak Hetu Sevan. These aggravated Doshas further travels to Gastro-Intestinal (GI) tract where the toxins released by Corona virus are absorbed into systemic circulation and fever results. Although the Covid-19 is typically an airborne infection, the massive expression of its receptor, Angiotensin Converting Enzyme type 2 (ACE2) throughout the GI tract, the identification of virus in the surface epithelial cells of the stomach, small intestine and the colon, can involve the GI tract symptoms like anorexia, diarrhoea and shedding of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in faeces.[25]

Strotas means channels which are present all over the body through which nutrients i.e., Rasadi Dhatus are transported in and out. When the flow of appropriate nutrients and energies through these channels is unobstructed, there is health; when there is excess, deficiency, or blockage in these channels disease occurs (Strotodushti).[26] Therefore, Covid-19 patients may show involvement of Strotodushti Lakshana in the following ways-


  • Pranavaha - Kupitam Shwasam [27] (difficulty in breathing)
  • Annavaha - Aruchi, Avipaak [27]
  • Rasavaha - Aruchi, Aasyavairasya, Tandra, Angamarda, Jwara, Sada [27]
  • Raktavaha - Kothastramandalam, Raktapitta [27]
  • Mamsavaha - Myalgia, Myositis [28]
  • Medovaha - Higher level of visceral fat (Adiposity), intramuscular adipose tissue is shown to contribute to physical impairment, enhancement of insulin resistance and increased the risk of negative health-related events.[29]
  • Asthi - Majjavaha - Asthi-Shoola[27]
  • Shukravaha Strotas – affects seminal inflammatory mediators, antiviral therapies for Covid-19 may have additional harmful consequences on male fertility.[30]

Marmas are the vital areas of the body. The word Marma comes from Sanskrit word “Mri” meaning death. By definition, a Marma point is a junction on body where two or more types of tissue meet, such as muscles, veins, ligaments, bones or joints. Marmas are the seats of Jeeva or life. This means to tell that Marmas are important points where life elements exist. [31] Covid-19 is said to cause Pneumonia/Acute Respiratory Distress Syndrome (ARDS)/Cardiac failure/Disseminated Intravascular Coagulation, etc which may result into death. Since Acute Respiratory failure is a mode of death in Covid-19[32] by affecting Fuffusa and Hridaya which comes under Marmas shows that in severely bad prognosis or other pre-existing comorbid conditions, such as COPD, Bronchial Asthma, Chronic Bronchitis, IHD, Cancer and DM increases the risk of developing complications by affecting Marmas are considered as the underlying cause of death. Thus, symptoms or complications which manifest in Covid-19 stated from the Ayurvedic classics imply Covid-19 as multi-systemic disease.

While talking about Vishesh Samprapti of Agantuja Abhishangaja Jwara, initial pathogenesis is of Agantuja (exogenous) Jwara and later converts to Nija Jwara thus exhibit symptoms of Rasavaha Strotodushti i.e., tastelessness, headache, nausea, body ache.[27] This is followed by symptoms of Pranavaha due to same Moolasthana of Rasavaha Strotas and Raktavaha Strotodushti due to Uttarottar Strotodushti.[33] As we all know that Prana Vayu and Udana Vayu primarily function at Pranavaha Strotas i.e., Urasthana,[34] which when get affected Prana Vayu Dushti and Udana Vayu Dushti results. Vitiated Prana Vayu causes disease like Shwasa, Pratishyaya, Swarabheda, Kasa etc. Udana Dushti is evident as there is extreme loss of Bala [35] i.e., deterioration of immune response, speech related symptoms in few. Raktavaha Strotodusthti is also evident from coagulopathies and extremity discolorations. Fatal complications are possible because ‘Prana’ (vitality or oxygen) follows ‘Rakta’ (blood). In Ayurveda, embryological point of view, Fuffusa (lungs) are made from froth of blood i.e., Rakta Phenodhbhava Fuffusa.[36] In respiratory mechanism Ayurveda considers the cardiopulmonary unit as


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)122
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

a whole without differentiating heart and lungs. Mahasrotas (Gastro-Intestinal Tract) is also associated with Pranavaha Strotas as Moolasthana.[37] When pathogenesis get worsened, it later involves heart and kidney which are considered as third ‘Roga Marga’ i.e., Marma-Asthi-Sandhi Marga (disease pathway).[38]

In Ayurveda, haematuria is seen as associated symptom under Kasa-Roga i.e., Kshayaja Kasa[39] indicating involvement of urinary system as complication of respiratory pathologies. Pathogenesis worsens or complicates depending upon the Kha-Vaigunya i.e., the site or organ affected like in ARDS, or in individuals who are having involvement of Marma like Heart or Kidney. Kshayaja Kasa means cough produced by destruction of body tissues (Dhatu-Kshaya). This condition is said to be caused by aggravation of all three Doshas and is dreadful in nature.

In Kshayaj Kasa, there are symptoms which mimic Covid-19 like chest pain, runny nose, anorexia, fever, weakness (asthenia) inspite of good appetite, disturbed bowel function and slurred speech.[40] Hiccup, dyspnoea, cough and complications in vital organs are symptoms when pathogenesis of Majja Dhatu Gata Jwara occurs.[41] Thus, the later stage of Covid-19 with aggravated immune response indicates invasion of Jwara in Uttarottar Dhatu.

Presently, there is no cure for the disease and the treatment is symptomatic. In some countries, patients are being treated using existing combinations of antivirals used for other viral infections. Clinical evidence explaining the efficiency of these antivirals against SARS-COV-2 are limited and not defined. Traditional medicine systems such as Ayurveda, have a holistic approach of considering mind-body-physiology to deal with disease conditions.

Enhancement of immunity plays an important role in maintaining optimum health and preventing such communicable diseases. Ayurveda’s insights of preventive care are based on the concepts of “Dinacharya” (daily regimes) and “Ritucharya” (seasonal regimes). These help in maintaining health, immunity and longevity. Panchakarma (bio-purification) and Rasayana (immunomodulators) can be planned for people in the risk-prone areas to improve immunity and minimize the risk of infection. It is noted that certain

viral infections occur in a specific period of the year when either the weather is favourable for viral potency or there are potent vectors to primarily infect individuals with low immunity. 

The word ‘Rasayana (Rasa & Ayana)’ refers to nutrition and its transportation in the body for attaining excellent Rasadi Dhatus; which leads to gain longevity, freedom from disorders, optimum strength of physique and sense organs.[42] Rasayana promotes nutrition by explicitly enriching the nutritional value of Rasa by enhancing Agni, i.e., digestion, metabolism, and absorption (by Strotashodhana). Consequently, any medication that improves Rasa’s consistency would enhance the health of all body tissues. The Ayurvedic philosophy suggests delivering “a group of phytoconstituents” that holds potential to give adaptogenic, immunomodulatory effects and also act on drug targets. Thus, in Ayurveda Rasayana botanicals are used for rejuvenation by boosting the immune system and alleviating disease condition. Of several known botanicals Asparagus racemosus (AR) commonly known as Shatavari, Tinospora cordifolia (TC) known as Guduchi and Withania somnifera (WS) known as Ashwagandha, are known to modulate the immune system and possess antiviral activities. The ideal Covid-19 therapy should show (a) antiviral properties against SARS-COV-2, (b) be safe for concomitantly administered drugs like anti-hypertensive, anti-diabetic, antiasthmatics, and drugs those are used in respiratory tract infections (c) should modulate immune system with rejuvenation ability (mainly for cardio-respiratory and nervous system) (d) should show therapeutic adjuvant activity with drugs used in WHO Solidarity trials. An Ayurvedic intervention can be made to fulfil these criteria when used judiciously.

A total of 31 major phytoconstituents are identified from Withania somnifera, Tinospora cordifolia and Asparagus racemosus. Clinical application of Rasayana botanicals is important in prophylaxis because of their potential in inhibiting the replication of SARS-COV-2 by increasing Vyadhikshamatva. Thus, these botanicals can also be used as adjunct or mainstream treatment for Covid-19 when the disease is manifested with its symptom. The activities on immune mechanisms provide a sound logic for use of these botanicals in treatment. Some of the phytoconstituents have a possible role in arresting disease progression


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)123
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

and preventing organ failure by reducing inflammatory responses.[43]

High mortality among immune-compromised and those with some underlying pathology implies that the factors that improve Vyadhikshamatva can prevent serious manifestations due to Covid-19 infection. Considering the importance of immunity boosting measures in the wake of Covid-19 outbreak, the Ministry of AYUSH, Government of India with the interest of health promotion of the masses, recommends ‘Ayush Kvatha’ or ‘Ayush Kudineer’ or ‘Ayush Joshanda’ which comprises of four medicinal herbs like Holy Basil, Cinnamon, Ginger, Black Pepper are highly available, accessible and widely used in the kitchen and are convenient to educate and train about its use to community health workers, community and even to all public that they can have cost-effective treatment with herbal home remedies. Thus, Ayush Kvatha due to its immunomodulatory, anti-viral, anti-oxidant, anti-inflammatory, anti-platelet, anti-atherosclerotic, hepato-protective, reno-protective properties; seems to be effective in immune regulation for controlling viral infection like Covid-19.[44]

When the Rugna Bala experiencing Kshayaj Kasa is fair or moderate, Brumhana and Dipana Chikitsa can be administered to promote Jatharagni Bala. If there is severe accumulation of Doshas, the patient should be given Snigdha Mrudu Virechana. Also, there is a reference of Mamsa-Rasa administration orally. Because of its Ushna and Pramathi Guna, it eliminates the Leena Dosha stuck in the Strotas thus purifying the channels of the body. When the channels get cleansed, the nutritive juice flow easily throughout the body (Rasa-Samhanan) and nourish all the tissues which have got depleted in the process of Covid-19.[45]

Ayurveda and Yoga can certainly play a pivotal role to augment preventive measures provided in the guidelines by Ministry of Health and Family Welfare (MoHFW). The current understanding of Covid-19 indicates that good immune status is vital to prevention and to safeguard from disease progression.[46]

The Covid-19 symptoms last for 7 to14 days. However, a significant proportion of patients have been found to remain unwell at post-discharge follow-ups. Post Covid-19 syndrome is defined as (1) persistence of illness signs and symptoms

(except fever, respiratory distress, and hypoxia) after viral clearance (negative real time-polymerase chain reaction [RT-PCR] results for Covid-19 at day 14 after initial positivity) or meeting the World Health Organization (WHO) clinical criteria of improvement,[47] including no fever for >3 days, improved respiratory symptoms, pulmonary imaging showing obvious absorption of inflammation, and no hospital care needed for any pathology or clinician assessment; (2) fresh development of symptoms within a month after initial clinical and virological cure, the aetiology of which is postulated to be a viral infection (occurring after recovery); (3) exaggeration of previously experienced chronic disease, such as migraine, mental disorder, bronchial asthma, and rheumatologic disorders, within a month after initial recovery from Covid-19.[48]

The incidence of post-Covid-19 syndrome is 46%. The median (IQR) interval between the recovery and development of post-Covid-19 symptoms was 7 (5–10.5) days. Covid-19 symptoms persisted beyond recovery in approximately 17% cases, whereas they developed after 7 days of recovery in 43% cases. In total, 105 (30%) patients show at least one post-Covid-19 symptom, while 57 (16%) patients showed multiple symptoms. Post-viral fatigue was the most prevalent feature (117 [33%]). Other features included persistent cough (8.5%), post-exertional dyspnoea (7%), headache (3.4%), vertigo (2.3%), and sleep-related disorders (5.9%).[48]

Although the literature on Post Covid symptoms is still in its earlier stages, “long-haulers” report a plethora of symptoms affecting different systems: neurocognitive post-Covid (brain fog, dizziness, loss of attention, confusion), autonomic post-Covid (chest pain, tachycardia, palpitations), gastrointestinal Post-Covid (diarrhoea, abdominal pain, vomiting), respiratory post-Covid (general fatigue, dyspnoea, cough, throat pain), musculoskeletal post-Covid (myalgias, arthralgias), psychological-related post-Covid (post-traumatic stress disorder, anxiety, depression, insomnia), and other manifestations (ageusia, anosmia, parosmia, skin rashes). In fact, most published studies to date on Post-Covid symptoms have found that 50–70% of hospitalized patients exhibit several post-Covid symptoms up to 3 months after hospital discharge.[49]

In Ayurveda, Post Covid Syndrome can be correlated with Jirna Abhishangaja Jwara


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)124
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

which lasts for more than 21days. [50] Although Covid-19 patient is tested negative after 14 days, vitiated Doshas (i.e., virus) are present in Leena Avastha resulting in Daurbalyata in Deha Dhatu.[51]

People with severely vitiated Doshas and fever when treated with aggressive management results into Dosha-Pak and fever subside suddenly leaving behind Post Covid Symptoms (Daruna Moksha). [52]

Thus, there will be Dhatu-Kshaya and Agnimandya Avastha in Post Covid-19 Syndrome where Dhatuposhana and administration of Rasayana drugs like Amalaki, Guduchi, Draksha for atleast 45 days can be given to combat the residual effects of the virus on the body. Vishaghna Chikitsa with Shirisha or Haridra Churna is suggested after clinical recovery. Deepana Pachana drugs like Shadanga Paneeya may be used in case of vomiting, diarrhoea or loss of appetite.

Rasayana Dravya acts on micro and macro cellular level with reference to Rasa, Agni and Strotas followed by required Shodhana Chikitsa improving digestion, metabolism, and micro-circulation and tissue perfusion resulting in nourishment of good quality of Saptadhatu which further provides the rewarding properties of Rasayana like longevity, strong immunity, mental competence, etc.

Rasayana improves overall Agni produces Uttama Ahara Rasa making Uttama Rasa Dhatu nourishing the further Dhatus achieving Saptadhatu Sarata and Prakrut Kapha Dosha enhances the Ojas in terms of similar Panchabhautik properties.

Ajastrik, Naimittik, Kamya and Vatatapik are the forms of Rasayana which are taken internally while external employment of Achara Rasayana and Sadvritta Palana helps to prevent Pradnyaparadha induced Vyadhis as Pradnyaparadha create Adharma which is said to be the root cause of Janapadodhwamsa.[53]

Ministry of Health & Family Welfare, Directorate General of Health Services (EMR Division) has issued Post-Covid management protocol which includes Immunity promoting AYUSH medicine like Ayush Kwatha, Samshamani Vati or Guduchi Churna, Ashwagandha Churna daily for 15 days and Amalaki fruit one daily/Amalaki Churna. Mulethi Churna (in case of dry cough) with lukewarm water twice daily. Warm Milk with ½ teaspoonfuls Haldi (turmeric) in morning/evening.

Gargling with warm water containing turmeric and salt. It is also suggested by the Ministry of AYUSH that the use of Chyawanprash is highly recommended (under the direction of Registered Ayurveda physician) as in the clinical practice it is believed to be effective in post-recovery period. Daily practice of Yogasana, Pranayama and Meditation, as much as health permits or as prescribed/ Breathing exercises as prescribed by physicians. Diet has a very important role in the management of Post Covid-19 and it should be Shadrasatmaka (with all six tastes) and may include ginger, turmeric, pepper, cinnamon, Amla (Indian gooseberry), mint in their diet to boost immunity.[54]  

Depending on the condition of Dhatu and Dosha, Shamana in the form of Brumhana Chikitsa can be adopted to restore the function of Tridosha. Beside this, Satvavajaya Chikitsa (ayurvedic psychotherapy), Sadvritta, and Achara Rasayana (behavioural therapy) can play an important role to manage Post Covid Symptoms.

These are the non-pharmacological approach aimed to maintain mental health. Regular practice of Yogasana and Pranayama with Achara-Rasayana is useful for mental stability. Rasayana like Chyawanprash, should be given in respiratory tract illnesses like Kasa, Shwasa. It improves the retention power, intelligence, provides Aarogya (disease Free State), longevity, and improves Uro‑Roga (diseases of chest region), Hrid‑Roga (diseases of heart) etc. Pippali Rasayana is said to be best for Kasa, Gala‑Roga (diseases of the throat), Vishama‑Jwara (fever with irregular nature, action, and time of onset).

The transmission of virus occurs in the form of air droplets through eyes, nose and mouth. Shira (Mastishka), Netra, Karna, Mukha, Kantha and Nasika are collectively called them as Urdhvajatru. Urdhvajatrugata Rogas and their management have a special place in Ayurveda. Shira (Brain) being the prime seat of knowledge and also the prime controller of the entire body has been termed as ‘Uttamanga’.  Hence the diseases occurring in the Urdhvajatru have been very clearly highlighted in the Ayurvedic classics along with their management.

NASA is considered to be that Indriya, whose functions are not only limited to respiration but it is considered as a pathway for drug administration. This special procedure is called Nasya.


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)125
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

Nasya Karma also acts on Shukra Dhatu; hence this procedure has importance in Pumsavan-Sanskar. Thus, showing the strong relationship between Ghranendriya and Prajanana Indriye.[55] Covid-19 can impair male fertility with alterations in sperm morphology and DNA integrity could be a major Post Covid-19 Complication in men.[56] Therefore, Nasya Chikitsa can be administered to prevent infertility.

Sharangdhara has classified Nasya according to the functions into two group’s viz. Rechana ana Snehana. Snehana Nasya is subdivided into Marsha and Pratimarsha Nasya.[39]

Marsha and Pratimarsha Nasya both consist of administration of oil through the nostrils. It is well tolerated and is very much convenient procedure. Marsha and Pratimarsha are same in principle, but the main difference between them is of dose. In Pratimarsha Nasya 1-2 drops are given while in Marsha Nasya the dose is 8/16/32 drops.

Marsha Nasya may cause side effects (Vyapada) but it gives quick result and hence it is more effective in aggravated vitiated Doshas where the Vyadhi Bala is at peak.

Pratimarsha Nasya can be given daily and even in all the seasons at morning and evening. It is given by dipping the finger in the required Sneha then dropping it in each nostril. The patient is advised not to sniff the Sneha given in the form of Nasya. The Sneha should at least reach from nose to gullet, but it should not be too much to produce secretion in the gullet. Pratimarsha can be given in any age, any season and even in Akala. i.e., in Varsha and Durdina.

It can be given to Bala, Vridhdha, Bhiru and Sukumara patients. It is contraindicated in Dushta Pratishyaya, Bahudosha and Krimija Shiroroga and also in Madhyapi (Drunkers habitual), Badhirya (deafness) and the persons having Utklishta Doshas. It should not be given to them because as Sneha Matra is quite insufficient to eliminate Doshas and already aggravated Doshas may get vitiated further.

Jirna Jwara Rugna who are experiencing Shirogaurava, Shir-shoola, Vibaddha-Indriye (lose/reduced normal functions of sense organs) can be given Ruchikara Shiro-Virechana.[57]

Orally intake of medicated ghee called as Ghritapana

Chikitsa can be given to Jirna Jwara Rugna in Shamana Matra decided by Jatharagni Bala. Charak has mentioned Pippalyadi Ghrita, Vasadi Ghrita as Jirna-Jwaraghna.[58]

Anuvasana Basti can be administered in Jirna or Purana Jwara, where Kapha-Pitta Doshas are decreased, Jatharagni is Balwana along with Ruksha-Baddha Purisha (constipation).[50]

When vitiated Doshas are present in Pakvashaya, Jwara-Nashaka Niruha and Anuvasana Basti is given.

In any airborne disease, Dhupana Chikitsa (Medicinal Fumigation) is used to purify the environment from infectious viruses around the patient. It helps in pacifying the Doshas present in Twak Dhatu. Similarly, Dhumapana (Inhalation of medicated fumes through the nose) can be used for Urdhvajatru-Gata Vyadhis especially Vata-Kaphaj. [59]

Anjana is said as Drikbalam i.e., strengthens the eyesight. Anjana (Collyrium) is the procedure of applying medicinal pastes or liquid to the inner side of the lower lid, either by fingertip or with applicator (Anjana Shalaka). It contains Chakshushya drugs which are useful in curing and controlling the progression of disease and improve the eyesight as well. Therefore, Anjana can be used in Jirna Abhishangaja Jwara to pacify and prevent ophthalmic infection and complications.

Jirna Abhishangaja Jwara may be managed by Balya and Brumhana Chikitsa by means of food and medicines as mentioned by Charak.[60] Milk, is one of the most important foods to promote Ojas because of their similar ten Gunas.  Milk is also the most suitable diet in all types of Jirna Jwara given in the form of Dugdhapana.[61]

Heating the milk with added water makes it lighter to digest, process called as Kshirpaak. It reduces the heaviness of the milk and reduce Kapha Vardhak side effects. Dravyas having properties of Balya and Brumhana like Aswagandha, Shatavari, Bala etc. can be added to Kshirpaak Vidhi acting as both food and medicine.

In Jirna Jwara, there is also the mention of Bahyopchar to reduce the temperature of the body with respect to causative factors. For example, Ushna Bahyopchar in case of Shita Hetu Sevan and vice versa.[62]


Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)126
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms

Thus, the role of prevention of Covid-19 plays an important role in the management of Covid-19 and Post Covid Symptoms with the help of Ayurvedic management mentioned in classics. The body’s resistance is of tremendous importance in the daily welfare of living beings not only for disease prevention but also for rapid recovery after disease affliction therefore, Ayurveda propounds that prevention is an equally important aspect of disease management as cure and thus, strengthening the immune system, is a natural way to help the body fight against the disease-causing pathogens with the help of Ayurveda to maintain Swasthya.

Reference

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7307707/#
  2. https://www.who.int/health-topics/coronavirus#tab=tab_1
  3. https://www.webmd.com/lung/coronavirus-strains#1
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7086482/
  5. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sutrasthana Adhyaya 11/45, page number 184.
  6. Shah S.N. et all:(2009): API Textbook of Medicine,8th edition, volume 1, chapter 1, page number 10.
  7. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 1/128, page number 88.
  8. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sharirasthana Adhyaya 1/121, page number 695.
  9. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Vimanasthana Adhyaya 7/9,11, page number 604, 605.
  10. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 1/112, page number 86.
  11. Charak: (2014): A Textbook
  1. entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Vimanasthana Adhyaya 3/20, page number 571.
  2. Sushrut:(2016): A Textbook entitled Sushrut Samhita, edited by Shashtri A., Chaukhamba Sanskrit Publication, Varanasi, Sutrasthana Adhyaya 6/19.
  3. https://niimh.nic.in/ebooks/esushruta/ Sutrasthana Adhyaya 6/19.
  4. Sushrut:(2016): A Textbook entitled Sushrut Samhita, edited by Shashtri A., Chaukhamba Sanskrit Publication, Varanasi, Nidanasthana Adhyaya 5/33-34.
  5. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sutrasthana Adhyaya 27/342, page number 426.
  6. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sutrasthana Adhyaya 28/6(4), page number 432.
  7. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sutrasthana Adhyaya 9/4, page number 156.
  8. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sutrasthana Adhyaya 7/60, page number 139.
  9. https://niimh.nic.in/ebooks/madhavanidana/ Sutrasthana Adhyaya 1/5
  10. https://niimh.nic.in/ebooks/madhavanidana/?mod=read Madhav Nidana, Madhukosh Tika, edited by Vijayrakshit; Prathama Khanda 1/6
  11. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Nidanasthana Adhyaya 1/28, page number 478.
  12. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/103-108, page number 84.
  13. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/92, page number 83.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)127
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms
  1. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/129-131, page number 88.
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445869/.
  3. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Vimanasthana Adhyaya 5/23, page number 592.
  4. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Sutrasthana Adhyaya 28/9-12, page number 433.
  5. https://link.springer.com/article/10.1007/s00256-021-03734-7
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685947/
  7. https://www.healio.com/news/primary-care/20210129/covid19-reduces-fertility-in-men-study-suggests.
  8. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 26/3-4, page number 610.
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7584845/
  10. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Vimanasthana Adhyaya 5/6(1)(4), page number 587-588.
  11. Vagbhat:(2015): A Textbook entitled Sartha Vagbhat, edited by GaradeG.K., Chaukhamba Surbharti Publication, Varanasi. Sutrasthana Adhyaya 12/4-5page number 55.
  12. Sushrut:(2016): A Textbook entitled Sushrut Samhita, edited by Shashtri A., Chaukhamba Sanskrit Publication, Varanasi, Nidanasthana Adhyaya 1/14-15.
  13. Sushrut:(2016): A Textbook entitled Sushrut Samhita, edited by Shashtri A., Chaukhamba Sanskrit Publication, Varanasi, Sharirasthana Adhyaya 4/24.
  14. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Vimanasthana Adhyaya 5/6(1), page number 587.
  1. Vagbhat:(2015): A Textbook entitled Sartha Vagbhat, edited by GaradeG.K., Chaukhamba Surbharti Publication, Varanasi. Sutrasthana Adhyaya 12/47-48 page number 58.
  2. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 18/154, page number 447.
  3. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 18/125-128, page number 435.
  4. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 1/81, page number 81.
  5. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 1:1/4-8, page number 05.
  6. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0248479
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430223/
  8. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 18/149-157, page number 447-448
  9. https://www.ayush.gov.in/docs/ayush-Protocol-covid-19.pdf
  10. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.
  11. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249644
  12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967389/
  13. Siddhinandan Mishra (2021): Bhaishajya Ratnawali; Chaukhamba Surbharti Prakashana, Varanasi. Jwara Adhyaya 5/45, page number 81.
  14. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 1/336, page number 116.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)128
Deolekar S. et al: Ayurvedic interpretation and management Covid-19 Post Covid Symptoms
  1. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 1/327, page number 115.
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6369608/
  3. https://www.mohfw.gov.in
  4. Upadhyay S, Singh AJ. Sex Selection Through Traditional Drugs in Rural North India. Indian J Comm Med 2007; 32 (1): 32-34.
  5. https://pubmed.ncbi.nlm.nih.gov
  6. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/173, page number 94.
  7. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/219-223, page number 100.
  8. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/172, 307; page number 94, 113.
  9. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/291, page number 112.
  10. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/239, page number 103.
  11. Charak: (2014): A Textbook entitled Charak Samhita, edited by Kale V.S, Chaukhamba Sanskrit Publication, Delhi. Chikitsasthana Adhyaya 3/174, page number 94.

Journal of Ayurveda and Integrated Medical Sciences 2022;7(1)129