The Ayurvedic Approach to Coronavirus - Pathogenesis, Possible Prevention, and Treatment
DISCLAIMER: This article is not recommending measures or prescribing medicines to prevent or cure COVID-19 infection. This is a theoretical paper hypothesizing how, based on established principles, Ayurvedic Medicine might be useful in preventing or treating the symptoms of Coronavirus. DO NOT follow any of the measures or procedures given in this article (or on any website) without consulting your physician. I have not cured or even treated any patient with documented COVID-19 infection, nor do I claim that the approach outlined below will be effective. I urge you to consider this as a merely academic article. Om Shanti.
As COVID-19 is proving to the world, tiny viruses are powerful biological agents, capable of rapidly effecting massive damage and fatality. And yet, they’re so simple: a virus is merely comprised of pieces of genetic material—either RNA or DNA—wrapped in a protein envelope, which is known as a “capsid.” Yet this tiny organism carries with it a mortality rate (death rate) or about 10% for people over 70 years of age and 22% for those over 80.
In case you're still unsure the three most important symptoms of coronavirus infection are:
Dry cough
Fever
Difficulty Breathing
Other common symptoms are:
Nasal congestion
Phlegm accumulation
Sore throat (pharyngitis)
Fatigue
Muscular aches (myalgias)
Diarrhea
Headache
Joint pains
The Concept of Pandemic Diseases in Ayurveda
Outbreaks, epidemics, and pandemics of highly communicable diseases have afflicted mankind since the beginning of human history and were very well -known to the ancient Ayurvedic scholars. In the Charaka samhita (one of the principle textbooks of Ayurveda) both epidemics and pandemics are clearly described together with what preventive measures should be taken. Epidemics are defined as sudden, unexpected outbreaks of a disease within a fairly local area. Pandemics, in contrast, refer to a very widespread disease that affects an entire nation or the world. In Ayurveda epidemics are called aupasargika roga and pandemics are janapadodhvansa roga. Coronavirus is an example of the latter. Janapadodhvansa literally means “annihilation of society”.
Modes of Transmission
According to Ayurveda, all pandemics spread via one of the following four factors—all of which are capable of affecting the mass population: vayu (atmosphere). udaka (water), desha (land), or kala (season). More specifically, pandemics and outbreaks were observed to be transmitted by any of the following modes:
Prasanagat (physically close interaction)
Gatra samsparshat (physical contact with diseased individuals)
Nishwasa (via inhalation of infected respiratory droplets)
Sahabhojanat (sharing food)
Sahashayya (sleeping together)
Asana (sitting close together)
Vastra (sharing the same clothing)
Malya (via handkerchief and towels)
Understanding the Origin and Pathology of Coronavirus through Ayurveda
Samprapti ghatakas (etiopathogenesis)
Dosha: predominantly Kapha, with both Vata and Pitta secondarily affected to varying degrees
Dushya: Rasa dhatu (blood plasma). This tissue is disturbed in all febrile conditions.
Agni: mandagni
Ama: Sama roga affecting macro digestion and cellular metabolism
Srotasmi: Pranavaha srota (respiratory passages), Rasavahasrota (blood plasma)
Srotodushti prakara: sanga (obstruction), atipravritti (excessive flow)
Sthana: Udbhava sthana (upper region), Agantuja (external factor)
Vyakta: manifests in the upper body primarily in Kapha regions (lungs, sinuses, stomach, heart, blood, joints)
Ayurvedic Treatment for Widespread Communicable Diseases (Janapadodhvansa Roga)
In recent weeks, serious concerns have been raised recently regarding the widespread misuse of the term “Ayurvedic treatments,” particularly by self-proclaimed gurus both here in the U.S. and (mainly) in India..
Some claim that their particular secret herbal formulas can prevent the attachment of the COVID-19 virus to the respiratory tract cells. Some claim that vitamin C alone or in combination with other vitamins can boost your immune system. Others claim that drinking copious amounts of water will protect against infection. Still, others claim that positive thoughts and meditation can actually affect DNA, or that health somehow exists in reserves coded into your DNA--eagerly waiting to spring to life at the command of your beliefs, positive emotions, and behavior! In general, it happens quite often – a scientific buzzword finds its way into the media spotlight and soon its meaning distorted for the exploitation of the desperate patient. “Quantum”, for instance, captured the attention of many back in the 1980s. This catchy and scientifically intriguing word was layered onto a bit of basic Ayurveda and voila-- phrases such as “quantum healing” were created. Do you remember? Thank you, Deepak. And despite a veil of scientific credibility as thin as air, it was nonetheless believed by many much to the chagrin of the true Ayurvedic physician community. Even words such as “neuro” or “nano” are often found lending a hand in conjuring up and promoting pseudoscientific nonsense.
What follows is derived from two sources, the ancient Ayurvedic textbooks which outline the general treatment for communicable diseases and secondly a review of some possible strategies for Coronavirus management.
Charaka samhita, Vimanasthana, Chapter 3:
Overview of Treatment Strategy:
Panchakarma Chikitsa – patients should undergo an appropriate regimen of elimination therapies including emesis, purgation, basti (both anuvasana and niruha types), errhine therapy (nasal medications and smoke), bahu snehana (external oleation), swedana (wet and dry fomentation), and others according to individual symptoms, history, tolerance, and strength. Obviously, because of the danger of transmitting the COVID-19 virus, Panchakarma in the clinic setting does not apply to the current pandemic.
Rasayana Chikitsa – Following Panchakarma, patients should receive rejuvenation treatment with immune-boosting, nutritive, and strengthening herbal and herbomineral medicines. This must obligatorily be accompanied by an appropriate diet.
Symptomatic Treatment – During the treatment, appropriate medical management of disease-related symptoms must be treated.
Possible Principles of Ayurvedic Prevention and Management of Coronavirus
For any condition affecting pranavaha srotas (respiratory channels) one should apply the treatment protocols recommended for Shvasaroga Chikitsa—Breathlessness, cough, and related disorders.
Main Focus for Management of Shvasaroga
To reduce the aggravated and accumulated Vata and Kapha doshas.
To purify rasavaha srotas (blood plasma)
To purify and unblock pranavaha srotas
Secondarily to optimize agni.
Treatment
Sarve Abhyanga (full body external friction-type oil massage) with Dhavantaram taila, Dashmooladi taila, or karpooradi taila with added lavana (crushed rock salt).
Ruksha sweda (dry heat), nadi sweda (steam administered locally through tubes).
Pinda sweda (boluses of hot herbalized rice balls) applied to chest and back.
Vamana (physician-assisted gentle vomiting) using Madanaphala decoction + yastimadhu + vacha = salt
Alternating Anuvasana and Niruha basti (oil-based and decoction-based enemas)
Management of Specific COVID-19 Symptoms
Dry Cough
This is one of the most common features of this infection. It is effectively managed through the administration of various snehana measures (administering oleaginous substances).
Oral medicines. For oral administration, we commonly use ghritas to great advantage. Ghritas are herbalized ghees which are made individually for each patient. The most useful ones are variations on these: dashmoola Rasna ghrita, vasa ghrita, kantakari ela ghrita, yastimadhu pippaladi ghrita. These are several others as well.
Enemas (Bastis). Oily substances also must be given per rectum in the form of anuvasana bastis (small volume, oil-based herbalized enemas for a consecutive number of days). These are very simple to self-administer—once you’ve been taught the proper technique. The quantity of oil injected is generally very small (3-4 ounces) and the herbs used are kapha-vata ahara (kapha and vata lowering).
Ahara (Diet). The diet used to treat or prevent a condition such as COVID -19 is generally a standard Ayurvedic ovo-lacto-vegetarian diet modified according to each persons constitution and doshic disease predominance. The few specific food items which are included in most diets regardless of prakriti or symptoms are pippaladi ksheer (milk with added pippali powder), lasunadi ksheer (garlic milk), Kritayusha (vegetable barley soups spiced liberally with trikatu (ginger, black pepper, and pippali), barley, millet, buckwheat, and oats.
Dhoomapana (Medicinal Smoke). If the dry cough is accompanied by difficulty breathing or by high-pitched musical wheezing, this indicates srotodushti sanga—obstruction in the small passages of the respiratory tract. In this case we administer dhoomapana: the nasal inhalation of herbalized smoke. Dhoomapana is useful in relieving blockages and congestion in the lower respiratory tract. The method of performig dhoomapana is beyond the scope of this article but the herbs which are traditionally used in these cases include:
Devadaru (Cedrus deodara)
Kantakari (Solanum xanthocarpum)
Eranda (Ricinus communis)
Neem (Azadirachta indica)
Laksha (Laccifer lacca)
Guggulu (Commifora mukul)
Swedana (Fomentation or “Sweat” Therapy)
I have written extensively elsewhere on the benefits of swedana so here I will confine my thoughts to its application with respect to COVID-19 early treatment and prevention.Swedana is almost always indicated but especially when there is nasal, sinus, or chest congestion. Both localized (i.e. heat applied only to the chest, back, sinuses, etc) or generalized, whole-body heat may be indicated. Fomentation (induction of perspiration) can be in the form of wet or dry heat.
The wet heat procedures include:
Dhara (pouring of warm or hot oils, ghee, or other liquids over a specific body region)
Pinda sweda (partially fermented herbalized rice boluses applied to body regions)
Bashpa sweda (whole-body herbalized steam treatment)
Pizicchili (continuous application of thick layers of very warm oil over the whole body by two or more therapists simultaneously). Oils used for this procedure in COVID-19 are marichadi taila, sarshapa taila, ajamodadya taila, and haritaki-danti taila.
Dry heat procedures include:
Ashmaghna (The patient lies on a stone slab on which has been burning special varieties of wood. The wood is removed and the patient clothed in cotton and wool)
Bhu (Same as above except the patient lies directly on the earth instead of on a stone slab.)
Karshu (The patient lies in the bottom of a pit, which has a smokeless fire, well wrapped in protective clothing. The heat is produced by burning wood or hot stones.)
Kupa (The patient lies on a woven bamboo bed suspended over a pit containing the burning.)
A modern version of dry heat which is very effective is full-spectrum infrared heat systems.
In every case, to choose the proper form of swedana the physician must take into account the constitution of the patient, the disease and bodily organs most affected, the season, the age of the patient, and the place where the treatment is being given.
Vamana (Therapeutic Physician-supervised vomiting)
Vamana is a process in which vomiting is induced with herbal emetic substances for the purpose of eliminating vitiated Kapha and Pitta doshas from the body. However, the stomach (amashaya) and lungs (kloman) being the chief seats of Kapha dosha it is accurate to say that vamana is principally a treatment for eliminating Kapha dosha from the body and secondarily removes Pitta dosha as well.
Vamana Karma is of fundamental importance to the entire schema of Panchakarma. Vamana is not merely a procedure undertaken to cleanse and empty the chest and stomach of its toxic contents, as in the treatment of bronchitis, bronchiectasis, pneumonia, asthma, or toxicosis. But rather vamana karma is the supreme method of eradicating aggravated Kapha dosha from the physiologies of healthy individuals as well in order to maintain their health.
In this case it involves the patient drinking a cold mixture (hima) of several herbs dissolved in water: madana phala, yastimadhu, vacha, and rock salt. This hima will induce efforttless vomiting without making the person nauseous.
If vamana therapy is less than appealing to you, consider these two final points. As kapha dosha accumulates in excess, this will predispose to diseases at the site of the accumulation—the stomach and respiratory tract. And as you know COVID-19 has a specific affinity for the respiratory tissues. Therefore, it is an extremely good idea to radically eliminate excess Kapha dosha from that region of our body. Second, this being Vasant Ritu (Spring season), this is the time of year when kapha naturally increases in the body. So all of us should be considering vamana therapy. It’s a one-time procedure (not repeated daily!) and is surprisingly easy and distress-free to do with expert guidance.
Useful Preventive Herbal Medicines for COVID-19
This section is intended to be a reality check.
The intended purpose of herbal medicines in the context of COVID-19 treatment and prevention is to enhance the human immune system.
Speaking as a primary care Ayurvedic physician, Ph.D. scholar, herbal scientist, and human immunity research scientist all for over thirty years, it is unlikely that any single or even combination herbal formula could promote the multi-factorial and complex immune response required to combat a COVID-19 infection.
The idea of “boosting your immune system” with herbs alone is enticing, but the ability to do so has proved elusive for several reasons. The immune system is precisely that — a system, comprised of mind and body, not a single entity. To function well, it requires balance and harmony. There is still much that researchers don't know about the intricacies and interconnectedness of the immune response. For now, there are no scientifically proven direct links between herbs alone and enhanced immune function.
The immune system refers to a collection of cells, chemicals and processes that function to protect the skin, respiratory passages, intestinal tract and other tissues from foreign antigens, such as microbes (organisms such as bacteria, fungi, and parasites), viruses, cancer cells, and toxins. The immune system can be simplistically viewed as having two types: innate immunity and adaptive immunity.
Innate immunity represents the first line of defense to an intruding pathogen. It is an antigen-independent (non-specific) defense mechanism that is used by the host immediately or within hours of encountering an antigen.
Adaptive immunity, on the other hand, is antigen-dependent and antigen-specific and, therefore, involves a lag time between exposure to the antigen and maximal response. Human beings require both of these mechanisms to operate efficiently and in synergy in order to protect against COVID-19. It is beyond the scope of this article to go into further detail except to reiterate that effective immune response against the COVID-19 virus requires a tightly regulated interplay between T-cells, antigen presenting cells, B-cells, cytokines, type1 interferon, Th1 cells, major histocompatibility complexes, etc. Even intricate and personalized herbal formulas containing hundreds of natural molecules cannot accomplish this, no less supplements of vitamin C, antioxidants, or what have you.
So how can you improve your immune system? On the whole, your immune system does a remarkable job of defending you against disease-causing microorganisms. But sometimes it fails: A virus invades successfully and makes you sick. Is it possible to intervene in this process and boost your immune system?
Your best line of defense is to choose a healthy lifestyle. Following general good-health guidelines is the single best step you can take toward naturally keeping your immune system strong and healthy. Every part of your body, including your immune system, functions better when protected from environmental assaults and bolstered by healthy-living strategies such as these:
Try to minimize stress
Eat a diet high in grain, fruits and vegetables.
Exercise regularly.
Maintain a healthy weight.
If you drink alcohol, drink only in moderation.
Get adequate sleep.
Observe meticulous hygiene, such as washing your hands frequently
Don’t smoke.
Judicious use of herbal medicines in combination with all of the above
Regarding this last point, if I were to choose ten herbs for preparing a formula for COVID-19/Coronavirus prevention here are my choices (in no particular order). These ten herbs could and should be combined in innumerable proportions and combinations to suit a given unique individual.
Vasa (Adhatoda vasica)
Kantakari (Solanum xanthocarpum)
Tulsi Ocimum sanctum)
Guduchi (Tinospora cordifolia)
Kalmegh.(Andrographis paniculata)
Amalaki (Embelica officinalis)
Ashwagandha (Withania somnifera)
Yastimadhu (Glycyrrhiza glabra)
Haridra (Curcuma longa) with Maricha (Black Pepper)
Pippali (Piper longum)
One of my favorite ways of taking herbs for the prevention of respiratory illness of any kind, is to make a decoction of the selected herbs, allow it to cool until just warm, and add honey just before drinking. Honey acts as a perfect anupana—a catalyst for augmenting the effect of the herbs. Because honey is kaphahara (reduces Kapha), marganusari (penetrates deeply), and yogavahi (connects the actions of many herbs), it will increase the efficacy of these herbs multifold. Just ensure to allow the decoction to cool until just warm before adding the honey.
There are many, many other plants, herbomineral combinations, teas, tableted medicines, etc which could be useful as well. But for our purposes I will conclude here with this final remark. Ayurvedic treatments will definitely not help in curing corona virus infection. However, the Ayurvedic holistic approach to health which focuses on prevention is the key to managing this outbreak. Ayurveda emphasizes avoidance of causative factors and enhancing immunity through Panchakarma (extremely important), diet, herbs, sleep, lifestyle, and managing anxiety. Typhoid fever, bubonic plague, cholera, smallpox, leprosy, COVID-19. Despite the changing names of pandemic diseases in every generation, the wisdom of Ayurveda remains recognized throughout the ages, and this never changes.