E-ISSN:2456-3110

Review Article

SARS-CoV-2

Journal of Ayurveda and Integrated Medical Sciences

2022 Volume 7 Number 5 June
Publisherwww.maharshicharaka.in

An integrative approach of SARS-CoV-2 through Ayurveda

Negi J.1*, Dikshit M.2, Sharma V.3, Kumar S.4
DOI:

1* Jyoti Negi, Post Graduate Scholar, Dept. of Agad Tantra evum Vidhi Vaidyak, Uttarakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India.

2 Manisha Dikshit, Associate Professor, Dept. of Agad Tantra evum Vidhi Vaidyak, Uttarakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India.

3 Ved Bhushan Sharma, Assistant Professor, Dept. of Agad Tantra evum Vidhi Vaidyak, Uttarakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India.

4 Shobhit Kumar, Assistant Professor, Dept. of Swasthavrutta, Uttarakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India.

Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2 and WHO declared SARS-CoV-2 outbreak as a Public Health Emergency of International Concern (PHEIC). COVID-19 has become a global health threat. Till now COVID has affected large number of populations of world and still new variants affecting human’s life. Scientists worldwide are striving vigorously to discover the etiology, spread, and pathogenesis of new COVID-19 disease and pragmatic approach of this knowledge for development of standard drugs as well as treatment protocols for its successful management. Present review study is to formulate pathogenesis of COVID-19 in light of Ayurveda through an integrated approach. COVID-19 pandemic is considered as one type of Janapadodhwamsa mentioned in Charak Viman Sthan. In Ayurveda, microbial infection can be elucidated in terms of Bhuta, Rakshasa, Graha, etc., having idiosyncratic manifestations. Coronavirus can be contemplated as distinct type of Bhuta affecting Pranavaha Srotas and causing Bhutabhishangaja Jwara, which is one type of Agantuja Jwara. Later as disease advances, it gets metamorphosed into Nija Vyadhi (endogenous form) exhibiting as different forms of Jwara depending on extent of vitiation of Dosha along with extensive Pranavaha Srotodushtijanya Vikaras. Factors involved in pathophysiology of any disease mainly Nidana (etiology), Dosha, Dushya (Dhatu, Srotasa), and Agni are reciprocally interlinked with severity and stage of disease. It is crucial to recognize extent of vitiation of each of these factors in order to determine customized diagnosis and management for patients of COVID-19. Integrative approach plays a vital role in meticulous comprehension of COVID-19 in terms of Ayurveda to recognize each stage for specific management.

Keywords: Ayurveda, Bhuta, Bhutabhishangaja Jwara, COVID-19, SARS-CoV-2, Janapadodhwamsa, Pranavaha Srotodushti Lakshana

Corresponding Author How to Cite this Article To Browse
Jyoti Negi, Post Graduate Scholar, Dept. of Agad Tantra evum Vidhi Vaidyak, Uttarakhand Ayurved University, Rishikul Campus, Haridwar, Uttarakhand, India.
Email: 		Jyoti Negi, Manisha Dikshit, Ved Bhushan Sharma, Shobhit Kumar, An integrative approach of SARS-CoV-2 through Ayurveda. J Ayu Int Med Sci. 2022;7(5):53-62.
Available From
https://jaims.in/jaims/article/view/1833

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2022-04-23 2022-04-25 2022-05-02 2022-05-09 2022-05-16
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
Nil Nil Yes 18%

© 2022by Jyoti Negi, Manisha Dikshit, Ved Bhushan Sharma, Shobhit Kumarand 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].

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Introduction

Epidemics or highly communicable disease or intermittent outbreaks of infectious disease have wreaked havoc on human communities since ancient times and lasting effects on societies throughout the history. Ayurveda described terminologies Sankramaka Roga and Aupsargika Rogas for communicable diseases and another term Janapadodhwamsa elaborated for pandemic situation.

In Charak Samhita Vimansthana 3rd chapter explains epidemic as Janapadodhwamsa. Janpada means group of people or community and Dhwamsa means demolition or annihilation. Therefore, Janapadodwansh means annihilation or destruction of community, an empire or people belonging to a country.[1]

जनपदानां जन समूहानां उध्वंसनं इति जनपदोध्वंसनम I (जल्पकल्पतरु)

In Janapadodhwamsa, persons having different Prakriti (constitution), Aahara (diet), Deha (body), Bala (strength), Satmya (suitableness), Mana (mind) and Vaya (age) may be affected by same disease simultaneously as happened during COVID-19 pandemic.[2] In Janapadodhwamsa, four factors viz. Vayu (air), Jala (water), Desha (land) and Kaala (time period/ season) are primarily affected. The sequences of these four factors in progressive manner are prerequisite because among these factors, Kaala being the most powerful of them in epidemic outbreak.[2]

The Greek physician Hippocrates known as ‘father of medicine’ examined the relationship between the occurrence of disease and environmental influence. He believed that disease is caused by an imbalance of four humors air, fire, water and earth or ‘atom’.[3] He has coined the term endemic and epidemic.

Janapadodhwamsa according to different Acharyas

रक्षोगणादिभिर्वा विविधै र्भूतसङ्घैस्तमधर्ममन्यद्वा अप्यपचारान्तरम उपलभ्याभिहन्यन्ते|| (च.वि.3/22)

Acharya Charaka mentioned that in Janapadodhwamsa, Janapada are also attacked by Raksasas etc. or other organisms due to that unrighteousness or other unwholesome act.[2]2. Acharya Charaka recommended that to manage catastrophic conditions associated

with outbreak of epidemics, one has to get hold and collection of drugs that are potent in all attributes (Rasa, Guna, Virya, Vipaka) well before any outbreak.[2]

In Vedic period, ancient Ayurveda practitioners and health philosophers were aware of the existence of microorganisms as well as the causation of infectious diseases by them.[14] The word Krimi was referred as infectious agent in Vedas. Ancient Indian classics described nearly hundred types of infectious agents. In Mahabharata, Vedavyasa narrated that Krimi are everywhere and nobody can avoid them. It is also mentioned in classics that Mahamari (communicable diseases) can spread from one person to another through air, water, animal, flies and physical contact.

According to Acharya Chakrapani, Vyadhijanak Hetu is of two types Asaadharan Hetu and Saadharan Hetu. In Asaadharan Hetu there is Doshaja Vyadhis, where as in Saadharn Hetu vitiation of air, water, land and season.

Sadharan Hetu

बहुजनसाधारणं वातजलदेशकालरूपं साधारण रोगकारणमभिधातुं जनपदोध्वंसनीयो अभीधीयते II

तासामुपयोगाद्विविधरोगप्रादुर्भावो मरको वा भवेदिति ||१७

Acharya Sushruta has termed Janpadodhwamsa as Maraka (destroying condition) while discussing Ritucharya Adhyaya and emphasized the utilization of Aushadha (herbs) and Jala (water) which are not affected or collected before the onset of Maraka. Here, according to Acharya Dalhana, Prasangaat means excessively and frequently if these activities are performed

Acharya Bhela used the term Janamaar for this devastating condition and focused on the fact that the fasting of a person due to outbreak of medical epidemics (Mitt Bhoji) and should remain Dhritiman. With the use of Mantras and medicines one should remain engaged in the salutation of Bramhins, Janamaar by doing this can be avoided.

भिन्नाहारवय: सात्म्यप प्रकृतीनां समं भवेत् |

एको विकृत वाय्वादियुगपत् सेवनाद् गद || (अ.स.9/71)

Acharya Vagbhatt described the concept of Janapadodhwansa under the chapter entitled Viruddhanna Vijnaniyam and mentioned that person whose food, age, habits, favorable conditions and


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constitutions are all different, get affected by same disease on same time, which is caused by vitiations of air, water, land and season when they are exposed to it. The cause for such natural abnormalities is the sinful acts of community.

The therapeutic modalities for Janapadodhwamsa are incorporated in the disease prevention protocol in Ashtanga Hridayam. (A.H.Su.4)

Acharya Kashyapa also described the disease which occurs in Janpadvishesha.

Origin of Janapadodhwamsa

वाय्वादीनां यद्वैगुण्यमुत्पद्यते तस्य मूलमधर्मः, तन्मूलं वाऽसत्कर्म पूर्वकृतं; तयोर्योनिः प्रज्ञापराध I (च.वि.3/20)

Acharya Charak described the foremost reason of Janapdodhwamsa is Adharma and Pragyaparadh, where Adharma is Moolkarana and Pragyaparadh is Yoni for Janapadodhwamsa Vyadhies. Adharma is lack of morality in the people and to do unrighteousness, non-harmonious, sinful practices or act among communities and people. The root cause of Adharma is said to be Pragyaparadha (dereliction of wisdom). Acharya Charaka has also described the reason of Bhutasangha (contact with an organism), Abhishapa (curse) is Adharma. Asatmyendriyarth Asamyoga, Pragyaparadha and Parinama has been described as the main factors for emerging of any disease. The word Pragyaparadha is made from two words Pragya + Aparadh. Pragya = Dhee + Dhriti + Smruti, and Aparadh means misdemeanor. Deranged Dhee (intellect), Dhriti (patience) and Smriti (memory) results into Ashubh Karma (sinful act). This is called as Pragyaparadha and causes vitiation of all Doshas. The root cause of all Aagantuka (exogenous) and Manasika (mental) Vyadhi is Pragyaparadha.

Acharya Sushruta has mentioned Adrishta (invisible or idiopathic) reason behind the Maraka. Further Acharya Dalhana explained Maraka is caused by Adharma (immorality) of that particular population or community. Sometimes the Ritu Vyapad (seasonal variations) may also be caused due to various reasons like Abhishaap (curse), Rakshkrodh (demon resentment) etc.

Location of Sambhasha

In summer weather forest area near the banks of Ganga at Kampilya, capital city of Panchal region i.e., (today Kampilya is Farukhabad district

in Uttar Pradesh of India) which was the residence of the Dwija (elite of the twice born communities like brahmins). In this place Punarvasu Atreya speak to his disciple Agnivesha.[6]

Features of Janapadodhwamsa

In Janapadodhwamsa, mainly the vitiated four factors Vayu, Jal, Desh, Kaal results in mass annihilation.

As per Ayurveda, COVID-19 can be understood due to Vikriti of Vayu and Desh. Acharya Charaka has described Vikrita Lakshanas (altered characteristics) of the said factors are as follows;

Dushita Vayu (air)

तत्र वातमेवंविधमनारोग्यकरं विद्यात्; तद्यथा - यथर्तु विषममतिस्तिमितमतिचलमतिपरुषमतिशीतमत्युष्णमतिरूक्षमत्यभिष्यन्दिनमतिभैरवारावमतिप्रतिहत - परस्पर गतिमतिकुण्डलिनमसात्म्यगन्धबाष्पसिकतापांशुधूमोपहतमिति || (च.वि.3/1)

Vishama (absence of features in accordance with season), Atistimita (excessive calm), Atichalam (excessive violent), Atiparusha (excessive rough), Atishita (extreme cold), Atyushna (extreme hot), Atiruksha (excessive dry), Atyabhishyandi (excessive humid), Atibhairavaravam (wind blowing with excessive sound), Atipratihataparaspargati (colliding in nature), Atikundalinam (excessively cyclonic), Asatmya Gandha Bhashpa Sikta Panshu Dhumophatam (wind with unwholesome smell, mixed with gases, sand, ashes and smoke).

Dushita Desha (land)

देशं पुनः प्रकृति विकृतवर्ण गन्धरसस्पर्शं क्लेदबहुलमुपसृष्टं सरीसृपव्याल मशक शलभ मक्षिका मूषकोलूकश्माशानिक शकुनिजम्बूकादिभि स्तृणोलूपो पवनवन्तं प्रतानादिबहुलम पूर्ववदवपतितशुष्कनष्टशस्यं धूम्रपवनं प्रध्मातपत त्रिगणमुत्क्रुष्टश्वगणमुद्भ्रान्त व्यथित विविध मृगपक्षि सङ्घमुत्सृष्टनष्टधर्मसत्यलज्जाचार शीलगुण जनपदं शश्वत्क्षुभितोदीर्ण सलिलाशयं प्रततोल्कापात निर्घातभूमिकम्प मतिभयारावरूपं रूक्षताम्रारुण सिताभ्रजालसंवृतार्क चन्द्रतारकमभीक्ष्णं ससम्भ्रमोद्वेगमिव सत्रासरुदितमिव सतमस्कमिव गुह्यकाचरितमिवाक्रन्दित शब्दबहुलं चाहितं विद्यात् || (च.वि.3/3)

मक्षिकामूषिकाव्यालबहूत्पातप्रदूषित: |

देशोsपथ्यान्नबहुलो नष्टधर्ममहौषधि: || (अ.स.9/94)

Contaminated land is the one having lot of flies, rats, reptiles, frequent natural calamities, full of unhealthy food, is devoid of righteousness and potent herbs.


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Vikrut Gandha Varna Rasa Sparsa (Abnormal smell, colour, taste and touch), Kledabahula (excessive stickiness), Abundance of serpents, wild animals, mosquitos, locusts, flies, rats, owls, vulture and jackals, Pratanaadi Bahulam (excessive orchard with grass, weeds and creepers), Atishuksha Nasta Shasyam (extremely dried land with destroyed crops), Dhumrapawanam (abundance of smoke in air), Suffering of different animals and birds due to bewilderment and agony, Land where religion, truth, modesty, manners, conducts and other qualities of the inhabitants are absent, Kshubhitudirnajalashayam (disturbed and turbulent water bodies), Pratata Ulkapata Nighata Bhumikampa (Frequent occurrence of meteorites, thunderbolts and earthquakes, Atibhayavaramroopam (hearing of fearful sounds), Sun, moon and stars appears as they are covered with coppery, reddish-brown and whitish coloured clouds, people living on the land appears as confused, bewildered, agitated, sorrowful,

Mode of transmission

प्रसङ्गाद्गात्रसंस्पर्शान्निश्वासात् सहभोजनात् |

सहशय्यासनाच्चापि वस्त्रमाल्यानुलेपनात् |

कुष्ठं ज्वरश्च शोषश्च नेत्राभिष्यन्द एव च |

औपसर्गिकरोगाश्च सङ्क्रामन्ति नरान्नरम् || (सु.नि.5/33-34)

Acharya Sushruta mentioned, by sexual intercourse, close contact with other person, breathing, eating together, sharing bed and exchange of clothes, garlands, cosmetics can cause transmission of disease from person to person. Hence it is necessary to avoid this thing to prevent spreading of disease.

Pathogenesis of Covid-19 in Ayurveda

Word Virus originated from the Sanskrit word Visha. In old persian/avestan language it is Visha, in Greek it is ἰός and in Latin it became virus, from that Virulentu came which means poisonous. So, the word virus which means poisonous has its origin in Visha. Chakrapani in his commentary on Ca.Sa.1/121 mentioned ‘Savishakrimi' to explain the word ‘Bhuta’. ‘Savishakrimi’ or simply ‘Vishakrimi’ may be an appropriate equivalent word for virus.

Janapadodhwamsa Vikara are manifested mainly due to vitiation of Vayu, Jala, Desh, Kaal and Adharma (unethical practices)

is the fundamental causative factor. However, the invasion of Bhuta (micro-organism) also gives great contribution in the pathology of these Vikara/diseases.[4] A major aspect of Janapadodhwamsa Vikara is that such disease manifests in many people residing in a Janapada, with similar cardinal clinical features. As per Ayurveda Covid-19 can be understood due to Vikriti of Vayu and Desha. The contaminated air due to presence of Visha (toxins/bacteria/viruses) may cause diseases like cough, breathlessness, vomiting, common cold, headache, and fever irrespective of Desha (geographical area), Dosha, and Prakruti (body constitution).[5]

As per Ayurveda COVID-19 can be understood due to Vikriti of Vayu and Desh. Further COVID-19 infection may be considered as Upsargaj Roga (communicable disease) and can come under Bhootaj Abhisangaj Jwara. In Janapadodhwamsa, invasion Bhuta might be a cause of annihilation of community or death of large population.[6] In modern literature, the term Bhuta means creature/devil/spirit[7] with unknown entity. Acharyas has defined Bhutas as Pishacha (devil),[8] Devadi (spirit),[9] Graha[10] Amanusha (creature or organisms)[11] etc. According to Amarkosha, Bhoot is a type of microorganisms, when enter into the body aggravate the Doshas. So, it can be related with present concept of microbes (bacteria, viruses, and other microorganisms. These are considered as external causative factors for producing Agantuja Vyadhi.[12]

Abhishanga is union/association/possession.[13] The association or contagion with microbes can be equated with Bhutabhishanga as specified by the Acharyas while describing the Jwara Nidana. Acharya Dalhan considered Abhisangaj Jwara as Bhutabhisangaj Jwara. Thus, microbial diseases in Ayurveda can be grouped under Bhutabhishangaja Vyadhi. Further, it is emphasized that vitiation of all the three Dosha, viz., Vata, Pitta, and Kapha occurs in Bhutabhishangaja Jwara and the symptoms are explicit to the type of Bhutabhishanga.[14] Bhutabhishangaja Jwara is a type of Agantuj Jwara (fever caused due to exogenous factors).[15]

According to the Ayurveda perspective, the hypothesis of pathophysiology of infection of novel coronavirus can be explained by considering it as a Bhutabhishangaja Vyadhi, which is Samsargaja / Aupasargika in nature.


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Therefore, COVID-19 disease can be equated with Bhutabhishangaja Jwara having manifestations explicit to Bhuta (coronavirus). In progression of the disease, the Bhutabhishanga (viral infection of the body) vitiates the Tridosha and gets transformed into Nija Vyadhi with the features of Pranavaha Srotodushtijanya Vyadhi and different forms of Jwara (endogenous diseases). The severity of COVID-19 in patients depends on the degree of vitiation of Tridosha, magnitude of infection and individual Bala (immunity).

The affinity toward Pranavaha Srotasa can be attributed to Swabhava (nature) of the Bhuta (corona virus). The Hridaya (heart), Mahasrotasa (alimentary canal), and Rasavahi Dhamani are Moolasthana (root or origination) of Pranavaha Srotasa.[14] In the recent literatures, it has been cited that Hridaya includes whole area adjacent to heart/thoracic cavity that includes lungs.[16] Hridaya is the Adhisthan of Prana and Udana Vayu (related to respiration), Sadhaka Pitta (facilitating cell biological functions), and Avalambaka Kapha (protection and maintenance of organ) and in Vimansthana of Charak Samhita, Shwasa Chikitsa is recommended for treatment of Pranavaha Srotasa disorders.[17] The Shwasa Vyadhi is Pittasthana Samudbhava (originating from seat of Pitta). Further, it has been mentioned that Amashaya is Pittasthana[18] and is also seat of Kledaka Kapha, which is the crucial of all types of Kapha as it influences the status quo of other Kaphasthana, Urah (thoracic cavity) being one of them.[19] Thus, it also plays an important role in pathology of Pranavaha Srotasa Vyadhi. Amashaya is the common seat of Kapha and Pitta Dosha.[20] Therefore, Dushti of Sthana leads to Pitta Dushti. The amalgamation of Vikruta Kledaka Kapha in Amashaya also vitiates the Prakrit Pitta Dosha.[21] The vitiated Pitta and Kapha Dosha trigger Rakta Dushti[22] causing Daha, Raga, Paka, and Shopha (inflammation) in the body.[23]

In mild stage of COVID-19 after entering of virus into the Pranavaha Srotasa, Shopha (inflammation) might develop and the primary stage of stage of Vrana/Kshata (injury) is Shopha (inflammation).[24] Therefore, the mild stage can be justify that the subsequent phase of Shopha of Pranavaha Srotasa is the damage to this Srotasa, which may be the initial process for pulmonary tissue injury (may be Urakshta). In Charak Chikitsa chapter 11, Urakshata is caused due to injury to the thoracic region

and no prodromal symptoms (Avyakta Lakshana) are observed prior to full manifestation of disease.[25] This can be correlated with the stage of COVID-19 where test is positive, but patients are asymptomatic. Jwara (fever) may be observed in prior stages of Shopha[26] or as a manifestation of Rakta Dushti.[27] The symptoms of Jwara related to specific Dosha are not observed at this point as it is an Agantuja Jwara.[28]

According to Acharya Vagbhatt, Vata Prakopa along with Pitta Dushti cause Kapha Udirana (excess increase), thereby amplify the unctuous Dosha in head resulting in Pratishyaya (rhinitis).[29] Kapha Prakopa along with Pitta Dushti cause Srotorodha (blockage of respiratory channels), thereby Vimargaman of Prana Vayu resulting in Kasa (cough).[30] Due to the involvement of Mahasrota symptoms like Chhardi (vomiting), Avipaka (indigestion), Atisara (diarrhea), and Udarshoola (pain in abdomen) are also produced. The Mahasrotasa mainly comprises of Amashaya to Pakwashaya.[31] These symptoms are analogous with symptoms of acute upper respiratory tract infection in mild stage of COVID-19.

Jwara originate in Amashaya.[32] After reaching Amashaya the vitiated Doshas obstructs the seat of Jathargni, resulting into Agnimandya and Sama Rasa Dhatu. The vitiated Dosha along with Sama Rasa Dhatu blocks the Rasavaha and Swedavaha Srotasa, thereby pulling out Ushma from its abode and propagating it via Rasavahi Dhamani carrying Rasa Dhatu into the whole body consequently resulting in Jwara.[33] The intermediate vitiation of Vata and Kapha with Pittanubandha causes Vata Kaphaja Jwara. symptoms of Vata-Kapha involvement, is rigidity, feeling of heaviness in head, rhinitis, cough, pain in small joints, drowsiness, heaviness, moderate fever, and excess sweating.[34]

In the later stage of Shopha/Dushti of Pranavaha Srotasa, the patient may develop Urakshat. It is characterized by cough with phlegm, hematemesis, chest pain, pain at the costal angels, and diminution of body tissues (Sapta Dhatu). This sequelae progress to deterioration in vigor, color, taste, digestion, myalgia, fever, depression, diarrhea, and hematuria. The phlegm is yellow/greyish in color, having bad odor, string like appearance, and mixed with blood.[35] Rasavaha Srotasa and Pranavaha Srotasa have similar Moolasthana i.e., Hridya so, can vitiate other.[36]



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The symptoms related to Pranavaha Srotodushti are evident in the diseases of Rasavaha Srotasa, viz., Hridroda.[37] Hence, Rasavaha, Srotodushti further increases the Pranavaha Sroto Dushti, thus aggravating the symptoms. Due to the vitiation of other Srotasa especially Rasvaha Srotas the vitiation of Tridosha will occur.[38] These may be parallel with symptoms of acute lower respiratory tract infection with moderate stage of COVID-19. The substantial vitiation of all the three Dosha leads to Sannipata Jwara.

In case of Sannipata Jwara, moreover, variable extent of permutation and combinations of Vata, Pitta, and Kapha Dushti manifest differently.[39] The Pranavaha Srotasa Dushti may exacerbate into Shwasa Upadrava may be parallel to Pratamaka Shwasa. It may be associated with Jwara (fever) and Murccha (giddiness) due to auxiliary vitiation of Pitta with predominance of Vata and Kapha Dosha.[40] It can be equated with the severe stage of COVID-19.

The vitiation of Jatharagni owing to Tridosha Prakopa in Sannipata Jwara impairs various Dhatwagni and thereby results in the formation of Vikruta Dhatu.[41] Formation of Vikruta Dhatu precedes vitiation of corresponding Dhatu and its Srotasa,[42] consequently developing complications related to varied Srotasa in the body. The persistent Pranavaha Srotodushti along with comorbidities of other Srotasa instigate considerable vitiation of Vata Dosha directly causing Urdhvashwasa (labored respiration with Cheyne Stokes breathing) and/or Chhinashwasa (stertorous breathing/failing respiration) wherein there is progressive collapse of respiratory function.[43] The Sannipata Jwara may aggravate into the most dangerous form Sama Sannipata Jwara with extensive and homogeneous vitiation of all the three Dosha.[44]

It manifest as intermittent cold and warm sensation, body aches in the form of pain in bones, joint pain, headache, tinnitus, choking sensation in throat, varying degree of drowsiness, giddiness, stupor, delirium, cough, dyspnea, disorientation, the sputum contains phlegm with blood, flaccidity insomnia, dehydration, restlessness, chest pain, decreased or absence of urine output and stool, subcutaneous bleeding, or purpura with patient either groaning or mute.[43] It resembles to critical stage of COVID-19 with multiorgan failure, which ultimately leads to death.

Pathogenesis according to Nidan Panchak and Shat Kriyakala


SN Shatkriyakala Nidana Panchaka Pathogenesis
1. Samchaya Nidana Aupsargika/Samsargaja, and Bhutabhishangaja, a type of Agantuja Vyadhi. In the early manifestation stage of disease, no involvement of Dosha in the development of disease. The Chaya, Prakopa, and Prasara of Dosha occur subsequently.[38] This stage is comparable with asymptomatic stage of COVID-19.
2. Prakopa    
3. Prasara    
4. Sthanasamshraya Purvarupa The infection of corona virus in Pranavaha Srotasa can be compared with Sthansamshraya Avastha where the vitiated Dosha (here Agantu Dosha - virus) incorporates with vulnerable Srotasa[45] This results in vitiation of all the three Dosha due to innate characteristic of Bhutabhishanga.[46] In this stage, prodromal symptoms of disease occur with mild symptoms like Jwara, Pratishyaya, and Kasa due to minimal vitiation of Doshas (mild stage of COVID-19).
5. Vyakti Rupa It is associated with occurrence of classical sign and symptoms of disease.[45] The primary symptoms of COVID-19 disease are concurrent with Vata Kaphaja Jwara, Urakshat, Pratamaka Shwasa, and Sannipataja Jwara (moderate to severe stage of COVID-19).
Samprapti Vata-Kapha Pradhana Pittanubandhi; Bhutabhishangaja Jwara
Upashaya Laghu, Tikshna, Snigdha, Tikta, Katu Rasatmaka, Ushna Virya Aahara Dravya, and Aushadhi
Anupashaya Guru, Ruksha, Khara, Madhura, Amla, Kashaya Rasatmaka, Shita Virya Aahara Dravya, and Aushadhi. Further, there is need for conducting the clinical trials to confirm the provisional assessment as per the Doṣhas/stage of disease, etc. on basis of Upashaya and Anupashaya
6. Bheda   It is the stage of chronicity and complications.[45] The prognosis becomes poor in this stage. The Bheda stage of COVID-19 can be associated with Sama Sannipata Jwara, Urdhwashwasa, and Chhinnashwasa (severe and critical stage of COVID-19).

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Prognosis
In Ayurveda, Janapadodhwamsa Vyadhis are Sudaruna (not having good prognosis) and therefore it is advised to treat population before manifestation of disease.[47] Bhutabhishanga instigate Tridosha Prakopa (Sannipataja) and it is always Dushchikitsya (difficult to alleviate).[48]

The prognosis of any disorder is not good in pregnant women, children, and elderly; therefore, any disease is Kricchrasadhya (difficult to treat) in these populations.[49]

The magnitude of Bhutabhishanga (coronavirus infection), variable degree of vitiation of the Tridosha (Tar-Tama Bhava), and individual Sharir Bala, which is downgraded in the presence of comorbidities and old age, further contributes to the poor prognosis of COVID-19.

Prognosis is poor in severe cases if the symptoms of Urakshata develops completely.[50] The development of Pratamaka Shwasa, which is a Yapya Vyadhi,[51] and presence of comorbidities can exacerbate the situation into severe stage further worsening the prognosis.

In critical cases the prognosis is very poor or irreversible as disease progresses in to Sannipata Jwara along with Sama Sannipata Jwara[52] and associated with Urdhwashwasa and Chhinnashwasa,[48] which are Asadhya Vyadhi.


SN Shatkriyakala Covid-19 symptoms Prognosis
1. Sthanasamshraya Asymptomatic, Jwara, Pratishyaya, Kasa Good
2. Vyakti Vata Kaphaja Jwara, Urakshat, Pratamaka Shwasa Development of all symptoms of Urakshta, Sannipata Jwara. Fair Poor
3. Bheda Sama Sannipata Jwara, Urdhwashwasa, Chhinnashwasa Comorbidities of other Srotasa in any stage. Poor   Poor

Management of pandemic through Ayurveda

येषां न मृत्युसामान्यं सामान्यं न च कर्मणाम् |

कर्म पञ्चविधं तेषां भेषजं परमुच्यते II (च.वि.3/13)

रसायनानां विधिवच्चोपयोगः प्रशस्यते |

शस्यते देहवृत्तिश्च भेषजैः पूर्वमुद्धृतैः ||

सत्यं भूते दया दानं बलयो देवतार्चनम् |

सद्धृत्तस्यानुवृत्तिश्च प्रशमो गुप्तिरात्मनः ||

हितं जनपदानां च शिवानामुपसेवनम् |

सेवनं ब्रह्मचर्यस्य तथैव ब्रह्मचारिणाम् |

तत्र, अव्यापन्नानामोषधीनामपां चोपयोगः ||(च.वि.3/14-17)

तत्र, स्थानपरित्याग शान्तिकर्म प्रायश्चित्तमङ्गल जपहोमोपहारेज्याञ्जलि नमस्कार तपोनियम- दयादान दीक्षाभ्युपगम देवताब्राह्मण गुरुपरैर्भवितव्यम्, एवं साधु भवति || (सु.सू.6/20)

The line of treatment should be planned at breaking of etiopathogenesis of pandemic disease and according to symptoms.

Some preventive measures mentioned in above explained Shlokas and Ayurvedic classics are;

1. Procurement of medicine or herbs in their high potential phase well before the outbreak of epidemic.

2. Panchkarma therapy, Rasayana consumption, Sadvrutt Palana

3. Improving the immunity and strength of the body.

4. Moving to safe places away from polluted/ infected environment.

Reference

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2. Acharya Vidyadhar Shukla, Prof. Ravi dutt tripathi ed. Caraka Samhita of Agnivesha, Vimana Sthana, vol. I,Ch. 3; Varanasi: Chowkhamba Bharati Academy 2011 pp.571.

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