Immunity Through in COVID- 19 (Prevention, Control and Mitigation of the impact of COVID 19 - in the context of Ayurveda)

Dr. Y. Ratna Priya Darsini, MD, (PhD), Assistant professor, Dept. Of Kaya Chikitsa, Dr. Nori Rama Shastry Govt. Ayurvedic Medical College, Vijayawada. A.P [email protected], Mob. 9440353825 AYUSH Systems A- Ayurveda

 The Ministry of Ayush was formed in Y- Yoga and 2014 to ensure the optimal Naturopathy development and propagation of Ayush systems of health care.

 Indian System of Medicine and U- Unani Homeopathy (ISM&H) renamed Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (Ayush) in 2003, S- Siddha  With focused attention for development of Education and Research in AYUSH systems which H-HomoeoPATHY also includes Sowa Rigpa AYURVEDA Ayu = Long Life; Veda = Knowledge/ Science ఆ뱁ర్వే దం 푈దయ �స్త్ంర మాత్ర롇 吾顁, 灀వన �స్త్ంర / 퐿鰾నం

AYURVEDA Knowledge System that directs to Healthy Long Life Concepts: . Tridoshas – Vata, Pitta, Kapha . Pancha Maha Bhutas . Trigunas – Satwa, Rajas, Tamas

Dr. Y.R.Priya Darsini, MD,( Ph.D.), Asst. Professor, Dr.NRSGAC, Dept.Of AYUSH 3 Objectives of Ayurveda

“స్వ స్​స్యథ ​స్వవ స్యథ ​రక్షణం,​ఆ遁రస్య ​퐿కార​ꡍరశ​మనం"-​ చరక​స్ంత “To Protect the Healthy and Cure the Diseased” Dinacharya Ritu Charya (Daily (Seasonal Promotion Regimen) Regimen) Ahara (Diet) Prevention Maintenance

Nidra Brahma Swasthya Charya Sadachara (Sleep) (Celibecy) Sadvritta /Health

Emphasis on Promotion of Positive Health and Prevention of Disease

Management of Disease with Drugs/Medicines (Herbal, Herbo-mineral), Therapeutic procedures, Panchakarma therapies, Ahara , Vihara, Pathya and Apathya, etc,. Specialties in Ayurveda

Internal Pediatrics Psychiatry Medicine

ENT, Eye and Surgery Toxicology Dental

Rejuvenation Geriatrics

 Individualized PRAKRUTI and based approach  Panchakarma Therapies -Bio Purification/ Detoxification  Rasayana – Rejuvenation, Immune boostup,, Immuno- HOLISTIC modulation MANAGEMENT  Oral Medication, Therapeutic procedures  Diet & Life style TIME TESTED  Spiritual Approach - Yoga, Dhyana, Pranayama Epidemics in Ayurveda

Janapadodhwansa Roga (Charaka Samhita)

Aupasargika Roga (Susruta Samhita)

Effects Entire Community Epidemic - Pandemic

Desa Jala

Kala Janapado Vayu dhwamsa vyadhi प्रसङगाद्गात्रसंस्पर्शनिश्वासात्​सहभोजिात्। सहर्य्यासिाच्चानि वस्त्रमाल्यािुलेििात्॥ COVID-19

• The out break of novel corona virus disease (COVID-19) has lead to greatest global health crisis. It has been declared as Public Health Emergency of International Concern by WHO. • Severity rose due to double & triple mutant COVID strains in India. caused a big surge in cases. • Due to high infectivity or lack of COVID appropriate behavior, it is giving rise to complications, early-stage severity and hospitalization risk for even the young and healthy • There is a big difference in the onset of COVID symptoms in the second wave compared to first wave. • In view of the present Pandemic situation, there is a possibility of a third wave of the pandemic in 6-8 months, as the virus mutates further, a third wave of COVID infection is inevitable and it is necessary to be prepared for new waves PATHO - PHYSIOLOGY

COVID- 19 Symptoms

• Fever, Cough Common • The mutant strains of COVID have the ability to attack the body more sharply and cause a Symptoms barrage of symptoms, which can hit a patient much before fever or a cough.

• Hearing loss, • Conjunctivitis Unusual • Dry mouth Symptoms • Red, bloodshot eyes • Skin rashes • Loss of taste

• Diarrhea GI Symptoms • Nausea • Vomiting of COVID-19 • Appetite loss • Metabolic imbalance Severity and Complications

 Severe level of breathlessness, Chest pain, Persistent cough , Pneumonia.  Oxygen deprivation, SP02 levels below 92% - critical and require emergency care  Endothelial damage of pulmonary vasculature, extensive alveolar and interstitial inflammation that ultimately *High-risk for severe disease or results in pulmonary intravascular mortality Age > 60 years, coagulopathy, hypercoagulability  Cardiovascular disease, impaired ventilation – perfusion, Acute hypertension, and CAD, Respiratory Distress Syndrome. ✓ DM (Diabetes mellitus) and other immune compromised states,  Sepsis and Septic shock, Multi organ ✓ Chronic Lung/Kidney/Liver failure including acute Kidney injury, disease, ✓ Cerebro-vascular disease Acute cardiac injury. ✓ Obesity Immune Response in COVID Ayurvedic Perspective

Covid – 19 compared and correlated Janapadodhwamsa Vyadhi , Agantuja vikara (Bhutabhishanga)

The co-existing Pitta Kapha – Vata Samsargaja Jwara with association of  Syandana and Shoshana in chest Pitta. which can not be countered due to Pitta  Dhatupaka, a dysregulated host response from the compromised Rogibala context of Sannipata Jwara

Intervening Pitta  Jwara  fatal forms of Sannipata Jwara .

If Vata This rapidly destabilizes the Ojus leading to sepsis predominant Vispharaka and and shock Vata-Kapha predominant The patients who are worsened progressively are those Sheeghrakari whose Rogi – bala is depleted due to the advanced age and co-morbidities Ayurvedic approach for the management of COVID- 19

Hetu Viparita Vyadhi Viparita Rasayana Achara Chikitsa Chikitsa rasayana • Restore • Addressing • Addressing the through Aetiology Pathology Life-Style Ayurvedic Modification • Ayurvedic • Symptomatic Immune and prophylactic Ayurvedic strength measures Management boosters • Protection of Immunity

Reducing the damage Preventing the virus Stopping the replication if it gets that has occurred to to enter into body inside the tissues Immunity

Immune: Relating to or conferring immunity (to disease or infection), Resistant, Insusceptible. Immune System: •A system of biological structures and process within an organism that protects against disease. •It deals with the protection of our body from harmful external influences. • Proper function of immune system – detect a wide variety of agents from bacteria, virus, parasites and distinguish from organism’s own healthy tissue. Immune Response: Layered response -3 main layers of defense 1.Surface factors 2.Innate immunity

15 3.Acquired or Adaptive immunity Vyadhikshamatva

• ‘Vyadhi’ (disease) and ‘Kshamatva’ (suppress or overcome).

• Vyadhi - non-equilibrium between (physiological factors i.e Vata, Pitta & Kapha), Dhatus (tissues systems) and (excretory products of the body)

• Vyadhikshamatwa means the factor which limits the pathogenesis and opposes the strength of disease

• Sleshma in normal state considered as Bala. Provides compactness, stability, heaviness, virility, immunity, resistance, courage.

• Essence of Dhatus begins with Rasa to Shukra is Ojus

Terms similar to Immunity in Ayurveda- Sleshma, Ojus, Bala, Vyadhikshamatva. Vyadhikshamatva - Bedha

(I) Vyadhi-Balavirodhitvam: It is the capacity to restrain or withstand the strength (severity) of the diseases i.e. strength to resist the progress of disease

(II) Vyadhi-Utpadakapratibandhakatva: The resisting power of the body competent enough to prevent the occurrence and re-occurrence of the disease.

These sub-types of Vyadhikshamatva , forms of resistance which now a days known as Immunity.

17 Relation of Bala and Vyadhikshamatva

▰ Health of an individual depends upon good strength of the body tissues. It is difficult to treat the disease occurred in one whose body strength is low.

Types of Bala 1. Sahaja Bala - Constitutional strength is the one which exists in the mind and body from the very birth. 2. Kalaja Bala -Temporal strength is the one which is based on seasons and age of the person. 3. Yuktikruta Bala - Acquired strength is the one which is achieved by the combination of diet and physical activities.

18 Factors Responsible For Promotion of Bala

Favorable Birth in a . Season when Excellence deposition of country where people of the time (pleasant people are naturally gain ingested naturally strong. strength and moderate climate) food

Excellence of the Young age of both physique the parents i.e. they should not be over aged .

Excellence of the mind Excellence in the genetical qualities

Excellence of Satmya (wholesomeness of Favorable various factors Habitual Cheerful disposition Young age of both deposition of responsible for performance and immense love maintenancethe parents of the i.e. they the nature for each other. body) should not be over of exercise

19 aged Dinacharya (Daily Regimen) A chronological Perspective – An Ayurvedic way to Prolonged &Healthy Living

Brahma Muhurta Jagarana (Early rising) • Pre dawn availability of nascent oxygen easily combines with Hb • Boosts immune response, Blood pH maintenance, Good absorption of vitamins and minerals

Malotsanga (attending nature call) • Timely defecation – Probiotics stimulates T cells production • Vega vidharana (suppression ) If not done timely – harmful bacteria develops –confuses own immunity system attacking own cells.

Danta Dhavana (Care of teeth) • Maintenance of oral • Muco cilliary clearance, surface immune factors

Nasya – (Medicated Nasal Drops) • Prevents diseases of head, eyes, ENT and teeth •Muco cilliary clearance, surface immune factors Gandusha (Mouth wash/gorgling) • Filling mouth with medicated oil and decoction • Improves circulation in oral cavity and near by praranasal sinuses and tracts initiates activation of immune response.

Abhyanaga (Oleation) Application of medicated oil daily • Increases activity of WBC  T Cells and B cells help fight against disease • Maintains skin ‘s health , improves circulation –appropriate transport of O2 Nutrients, detoxifies - carries away meatbolic waste

Vyayama (Exercise), Yoga • Exert to half your capacity

Nidra (sleep) Timely sound sleep, Avoid day sleep • Enhances health and longevity

An Ayurvedic Regime of proper living is designed for maintenance of health, achievement of long, healthy and active life. Provides relief from diseases Lifestyle and Wellness

Physical wellness ▰ Diet Sadvritta and Sadachara Inter personal and ▰ Exercise Achara Inter Personal social wellness ▰ Sleep Rasayana and Social code . Unbiased and fair mind ▰ and conduct . Modest humble and civic ▰ Regular bathing & . Following Ahimsa Cleaning (Hygiene) Spiritual wellness Mental and Emotional . Maintenance of cordial relationship with wellness ▰ Tolerance, family members, neighborhood, ▰ Yoga, Pranayama ▰ Acceptance colleagues, country men etc. ▰ Dhyana, ▰ Kindness . Harmony, Honesty, truthfulness ▰ Quality sleep ▰ Coexistence .Builds better living space and social ▰ Satvavajaya Chikitsa networks ▰ Self realization / inner awakening Stress and Immunity: Increased stress has detrimental effect on Immune functions, may lead to decreased NK cells, lymphocyte proliferation, anti body production. Sadvritta, Sadachara, Achara Rasayana - Good immune response, substantial proliferation and potentiated function of immune cells eg: Macrophages, Dendrite cells Circadian Rhythm – Sleep - Immunity

▰ Intrinsic ability of organisms to align themselves with 24hr day/dark cycle. Internal biological clock, sleep wake cycle ▰ Drives many aspects of human psychology. ▰ Daily variations in blood pressure, Body temperature, Cortisol ▰ Both Innate and Adaptive immunity substantial response -Leukocytes mobilization, cytokine release –Interleukin1 and tumor necrosis factors. ▰ Better sleep improves B-cells T Cell differentiation is influenced by sleep  C.R misalignment, sleep deprivation are detrimental to immune function.  Increased risk of CVD, Metabolic syndrome, Carcinoma, Myocardial infarction, Asthma. Vyayama - Exercise and Immunity

 WHO reports – physical inactivity has been identified as 4th leading risk factor for global mortality.  People engaged in regular moderate exercise possess enhanced immunity, substantial production of T Cells  Exercise modifies thrombotic process, fibrinogen levels and blood viscosity is considerably low amongst physically active than sedentary individuals. **Note: Exhaustive exercise can lead to reduced immunity (Disturbance of leukocyte function, damaged erythrocytes, suppression of CD4 and CD8, T cells High incidence of respiratory infections. Yoga & Immunity ▰ India’s gift of wisdom to the world that can make life healthy and happy. ▰ Ayurvedic Medicines & Life style and Practice of Yoga can support the patients of COVID-19 with improvement in quality of standard care. ▰ Asanas and kriyas can cure lung breathing ability and improves exercise tolerance of the body. Positive immune status can be achieved. ▰ An effective self management strategy to cope up with stress, anxiety and depression and to maintain wellbeing. Stress (speeded up thoughts of mind disturbs the physical autonomic, endocrine and immune responses). ***Obesity- inflammatory markers secreted by abdominal adipocytes suppress the replication of T and B cells YOGA for Immunity AHARA –Diet and Wellness

Shadrasopeta Ahara (Inclusion of all six rasas in diet) Ashta Ahara Vidhi Visheshayatana Prakriti – (Natural qualities food and individual’s prakriti) Karana – (, Processing and preparation) Samyoga – (Combination) Rasi – (Quantum) Desa- ( Habitat) Kaala- (Time) Upayokta- (Rules of use) Upayogasamstha – (User) Ahara

. Our Immune system is influenced greatly by quality and quantity of food we eat. . Quantity of Food- Malnutrition and infection aggravate each other and commonest cause of immune deficiency and increased susceptibility to infections. . Lack of Proteins, vitamins and minerals reduces competence in cell mediated immunity, neutrophils and the complimentary system . Probiotic flora (lactobacilli – buttermilk, yohurt) improves both local and general innate immunity and also have anti inflammatory properties. . Carbohydrates supply energy to immune cells makes them work better. . High blood sugars increase cartisol secretions and reduces immune function, neutrophils activity reduces. Suggested Diet

• Amalaki, Nimbuka :Vitamin C rich foods – enhancers of immune system – boosts antibodies and WBC activity, enhances macrophages activity that engulf and destroy foreign particles. Eg. Amalaki, Nimbuka • Lasuna/Garlic : Increases number and potency of NK cells, Helper T cells are stimulated. • Ginger – Stimulates production of interferon and has direct anti inflammatory properties • Suryanamaskaras, Atapa sevana : Vitamin-D, enhances anti inflammatory and immuno regulatory properties plays crucial role in immune system activation process. • Yasada Bhasma : Zinc essential for immuno competence especially for mucosal immunity. Suggested Diet • Cereals and grains – Old, lighter, easy digestible cereals. Green gram preferred. • Meat - Meat soups, (Consumed by persons who do more exercise and physical work) • All fresh vegetables and fruits rich in Vitamins and Minerals. • Ksheera Gritabhyasam – Regular intake of Milk and Ghee – strength promoting and nourishment. • Curd- not consumed at night, heated, improperly solidified. • Butter milk preferred as it balances all doshas Some rules to be followed after intake of food- Lying and Sitting for long time, Intake of excessive fluids, Strenuous exercise. RASAYANA

 Rejuvenation Induce tissue regeneration Life style Immune modulation -  homeostasis of immune response Diet  Restores positive mental states Medicines  Potentiates physical strength Anti oxidants  Enhance growth

Ist Phase- Protective phase of innate immunity host response eliminates the virus in large proportions

II nd Phase-  Viral infection progresses Intense release of cytokines  Lung and Co- attendant multi organ damage *** Well contained immune response to maintain homeostasis is also important for good recovery and reduced mortality RASAYANA

S. No CATEGORY DRUGS

1. Single Drugs Guduchi, Ashwagandha, Amalaki, Shatavari, Pippali, Tulasi, Nimba, Bhumyamalaki, Yashtimadhu, Katuki, Bhringaraja, Punarnava, Rasona, Vidari, KirataTikta

Medhya Rasayana– Mandukaparni, Brahmi, Yasti Madhu, Jatamamsi etc.

2. Compound Agastya Rasayana, Chyavanaprasha, Kushmanda Preparations Rasayana, Vyaghri Haritaki Rasayana, Vardhamana Pippali, Agastya Hareetaki Rasayana, Chitraka Hareetaki, Narasimha Rasayana. Guduchu Aswagandha

Amalaki

Tulasi Yasthimadhu Immuno modulatory drugs in Ayurveda in prevention and management of COVID -19 According to WHO, 80% of world’s population currently depends on herbal medicine for some aspects of primary health care.

Drug Name Possible approach to prevent and manage Covid-19 Aswagandha Immuno- modulator, improves mental and physical health, (Withania Enhances nitric oxide synthetase activity of macrophages. Effective somnifera) improvement of host immuity Tel: Penneru Anti inflammatory effect, maintaining vascular integrity, conserving alveolar space. WS glycoprotein- antimicrobial activity. It helps modulation of host Th-1 and Th-2 immunity. Guduchi/Amrita Immuno- modulator, Improves innate immunity against Covid -19 infections (Tinospora Tinosporin, diterpinoid has effective anti viral activity cordifolia) Potent hepato- protective, Enhances the levels of Vit. C and acts as Tel : Tippa teega antioxidants Aqeous extracts of T.cordifolia has influence on cytokine production and activation of immune effectors cells Increases the number and phagocytic activity of Macrophages. Good Preventive and Prophylactic drug for Covod-19 Drug Name Possible approach to prevent and manage Covid-19 Amalaki Rich Source of Vitamin .C, Best rasayana drug, (Phyllanthus Improves both cell mediated and humoral immune response. It emblica) enhances Il-2, gamma IFN and NK (natural killer cell activity. Tel: Usirikaya Known drug for anti-oxidant, detoxification and anti aging drug. Pulmonary antioxidant defense is widely distributed in lungs non enzymatic antioxidants are membrane bound vitamin –C and Vitamin –E. And Amalki is richest source of Vitamin C Yashti madhu/ Good Medhya Rasayana, Kanthya Muleti Glycyrrhin which is promising inhibitor of replication of several (Glycerrhiza viruses, like HSV, HIV etc, glabra) Potent immuno-modulating and anti -oxidant activity Tel: Ati madhuram Tulsi Mother medicine of nature, (Ocimum sanctum) Shortens the course of all diseases. Anti- Bacterial, Anti fungal, and Tel: Tulasi shown broad spectrum Anti- Viral activity, beneficial in treating respiratory disorders (bronchitis, asthma, cough, and cold) Immuno modulator, increases IL-4, NK, Helper cells GENERAL MEASURES FOR COVID-19 INFECTIONS

Measure Possible mode of action DRINK WARM WATER Hot liquids are free from contamination, makes body lighter, helps easy digestion and metabolism and absorption of nutrients. Muco-lytic, prevents entry of microbes to upper respiratory tract AYUSH KWATH – Improves appetite, helps easy digestion, metabolism and absorption of Herbal decoction nutrients. For individuals having acid peptic disorders, Ayush kwatha should be taken as per physicians advice

STEAM INHALATION Helps in muco-ciliary clearance in the respiratory tract Smoothens and clears microbial load in the tract and enhances the respiratory inflow. NASYA – Nasal Daily nasal application of two drops of sesame oil/ Anu tail in both the Instillation of medicated nostrils (Pratimarsha Nasya) in the morning and evening. Oil This can act as preventive layer for entry and procreation of virus like bio mask when used regularly

GOLDEN MILK - Hot Highly beneficial in boosting immunity and preventing infections milk mixed with turmeric Post COVID-19 Management

Target Remedy

Weakness and •Tarpana- soups made of cereals, vegetable, green gram, Lethargy thin meet processed with S.lav, jeera, ginger etc. Reduction •Nutritional food with shadrasaa considering digestion & Physical capacity of patient. Strength •Medicines- Aswagandha, Shatavari, Narasimha Rasayana, Buildup Kushmanda Lehya etc

Mental Health •Satvavajaya Chikitsa, Recovery •Yoga, Dhyana, •Medya – Yasti, Brahmi, Sankha pushpi, Guduchi Immune Boost •Rasayana Therapy- Diet- Ksheera, gritha up •Life style – Dinacharya, Ritucharya etc. Achara Rasayana •All Rasayana Drugs – Amalaki, Haritaki, Amrita, Tulsi, Aswagandha, Bhallataka, Shilajitu, etc Post COVID-19 Management

• Lung function Restoration Prana Yama- Anoloma Vilomana, Sheetali, Brahmari etc . Medicines : Agastya Hareetaki Rasayana, Abraka bhasma, Shringi bhasma, Malla sindura, Rasasindura, Pippali Vardhamana Rasayana , Kanakasava, Vasaristam,etc • Kidney function Restoration – Punarnava, Kokilaksha, Gokshura, Chandraprabha Vati, Punarnavadi Kashayam etc. • Cardiac Restoration – Arjuna ksheera paka, Lasuna, Pushkaramula, Nagarjunabhra Ras etc. Post COVID-19 Management

• Liver function Restoration: Katuki, Kalamegha, Kirata tikta, Bhumi Amalaki, Arogya vardhini Rasa etc. • Sleeplessness -Tagara, Sarpagandha, Jatmamsi, Aswgandha, Brahmi taila, Madhuyashtyadi taila, Shirodhara, Shiropichu, Shirovasti • Hoarseness of voice – Yastimadhu , Khadhiradi vati, Kavala, Gandusha –Tila taila, Irimedhadi taila . • Mucormycosis - Nimba taila Nasya ; Haridra, Aguru, Gandhaka etc., for Dhuma Nasya, Nisamalaki Vati, Gandhaka Rasayana, Subhra Bhasma, Yasada Bhasma etc. Conclusion PREVENTIVE MEASURES: • Avoid Prasanga (Droplet spread) Gatra Samsparsha, , Sahasyya, Saha bhojana, Gandha maalyanulepana (Direct and indirect contact) • Avoid factors of Sankramikaroga (factors responsible for transmission of disease) LIFE-STYLE MODIFICATIONS: • Hitahara - Ashta Ahara Vidhivisheshayatana , Dietic rules to be followed • Vihara (Active and appropriate life style, Daily regimen and Seasonal regimen) • Vyayama, Yoga, Dhyana and Pranayama to build up physical stamina and mental stability. • Sadvritta, Sadachara –Achara Rasayana (Proper personal and social code and conduct) ENHANCE YOUR IMMUNITY : • Best quality Ahara Rasa, Sleshma, Bala, Ojas, Vyadhikshamatva. • Lifestyle, Immune boosters, Immuno-modulators AYURVEDIC MEDICINES : • Samshamani/Guduchi Ghana Vati • Aswagandha, Amalaki, Yastimadhu. • AYUSH -64 • Chyavana Prasha Rasyaana, Agastyahareetaki Rasayana. ఆ뱁ర్వే 顋 అమృతానా롍.. Dr. Y. Ratna Priya Darsini, MD, (PhD), Assistant professor, Dept. Of Kaya Chikitsa, Dr. Nori Rama Shastry Govt. Ayurvedic Medical College, Vijayawada. A.P [email protected], Mob. 9440353825