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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 15  |  Issue : 4  |  Page : 311-316

Ayurvedic management of COVID-19/SARS-CoV-2 along with chronic diabetes mellitus: A case study


1 Director All India Institute of Ayurveda, New Delhi, India
2 Department of Rasashastra and Bhaishajyakalapana, AIIA, New Delhi, India
3 Department of Panchakarma, AIIA, New Delhi, India
4 Department of Roganidana, AIIA, New Delhi, India
5 Department of Kaumarabhritya, AIIA, New Delhi, India
6 Department of Prasutitantra and Streeroga, AIIA, New Delhi, India
7 Department of Kayachikitsa, AIIA, New Delhi, India
8 Department of Shalakyatantra, AIIA, New Delhi, India

Date of Submission16-Sep-2020
Date of Decision16-Jul-2021
Date of Acceptance09-Aug-2021
Date of Web Publication16-Dec-2021

Correspondence Address:
P S Arshath Jyothi
Department of Kayachikitsa, All India Institute of Ayurveda, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_103_20

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  Abstract 


Introduction: SARS-CoV-2, a global pandemic that caused significant morbidity and mortality worldwide, even in the second wave. Multiple factors influence the disease burden including the vicious circulating virus characteristics, complications, limitations of the existing medicine, aggravation of the disease, and comorbidities in older people. In the present scenario, effective traditional treatment modalities should be scientifically applied to reduce massive disasters. Objectives: Here is the necessity to develop an appropriate treatment protocol from the field of Ayurvedic medicine. Diagnosis: It is a case study of a confirmed case of COVID-19/SARS-CoV-2 with uncontrolled diabetic history. Significant Clinical Findings: Presented intermittent fever, cough, headache, and dyspnea, along with symptoms associated with diabetes mellitus. Interventions: The case was successfully managed with Ama pachana (~carminative), Agnideepana (digestive), Jwara hara Oushdha, and simultaneously Prameha (~diabetes mellitus). Outcomes: The entire treatment course competed with a minimum number of hospitals stay compared with the national average. Ayurvedic management has a significant positive impact on the mental and physical quality of life. Both physical and mental scores got improved by more than 50% in this case. Marked radiological improvement noted, in this case, is associated with excellent quality of life after treatment. Conclusion: Ayurvedic management can be used in multiple levels preventive, curative, and restorative aspects.

Keywords: Acute respiratory distress syndrome, Ayurveda, COVID-19, SARS-CoV-2, traditional medicine


How to cite this article:
Nesari TM, Galib R, Dharmarajan P, Rai S, Kumari S, Rathuri S, Arshath Jyothi P S, Dileep A, Devarajan D, Sharma A. Ayurvedic management of COVID-19/SARS-CoV-2 along with chronic diabetes mellitus: A case study. J Ayurveda 2021;15:311-6

How to cite this URL:
Nesari TM, Galib R, Dharmarajan P, Rai S, Kumari S, Rathuri S, Arshath Jyothi P S, Dileep A, Devarajan D, Sharma A. Ayurvedic management of COVID-19/SARS-CoV-2 along with chronic diabetes mellitus: A case study. J Ayurveda [serial online] 2021 [cited 2022 Jan 27];15:311-6. Available from: http://www.journayu.in/text.asp?2021/15/4/311/332595




  Introduction Top


The pandemic outbreak of COVID-19 caused significant morbidity and mortality, finally led to an emergency of primary international concern.[1] The virus has created an unfavorable socioeconomic impact globally. The initial cluster of cases was reported in December 2019 at Wuhan. The current testimonies indicate that SARS-CoV-2 spread to humans through transmission from wild animals illegally sold in the Huanan Seafood Wholesale Market.[2] On January 07, 2020, the causative agent was identified as a new coronavirus (2019-nCoV). Later renamed COVID-19 by the WHO.[3] Compared with other viral diseases, the hallmark of the novel coronavirus is the wide range of disease severity experienced by the patients. Only a minority of COVID-19 patients require hospitalization. The effects of infection for these people are dramatic. In some cases, life-threatening disease with SARS-CoV-2 causes severe pneumonia, intermittent fever, and cough. Symptoms of rhinorrhea, pharyngitis, and sneezing have been less commonly observed. Patients often develop acute respiratory distress syndrome (ARDS) within 2 days of hospital admission, requiring ventilatory support. It has been observed that, during this phase, mortality tends to be high. For this infection pathology, there is no specific proven treatment available to date. COVID-19 can be provisionally understood from the Ayurvedic perspective as Vata-kapha predominant Sannipatajvara of Agantu origin with mild Pittanubandha. The severity staging analyzed based on Nidana (etiology), Dosha, Dushya, Roga bala (strength of disease), Rogi bala (strength of patient), Satwa bala (~strength of mind), and Shatkriyakala (six stages of illness) to present a preliminary clinical profile of the condition. From the Ayurvedic point of view, the treatment plan varies for every individual based on the above factors. This is a case presented with uncontrolled diabetes in an elder male.


  Case Report Top


UHID-463718/I. P No. 4157

A 60-year-old male presented with fever, tinnitus, tastelessness, dry cough, and breathing difficulty for 5 days. History of chronic uncontrolled diabetes (10 years) with irregular medication. Considering his recent contact history in the containment zone, he underwent a SARS-CoV-2 reverse transcription-polymerase chain reaction, and the test was positive. Chest X-ray posteroanterior (PA) view showed scattered patchy opacities bilaterally. Undergone investigations as per the ICMR guidelines. The patient assessment was done according to Roga-RogiPariksha, and the treatment plan was decided [Table 1].
Table 1: Timeline of intervention

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Investigation

The following investigations were considered as baseline for assessment. Complete blood count, erythrocyte sedimentation rate, liver function test, kidney function test, lipid profile, serum ferritin, lactate dehydrogenase, C-reactive protein quantitative, fasting/random blood glucose-D-dimer, coagulation profile, electrocardiography, and X-ray chest PA view. In this case, chest X-ray PA view showed scattered patchy opacities bilaterally, and fasting blood sugar was 300 mg/dl.


  Discussion Top


It is a global concern and necessity to develop a scientific parallel line of management for COVID-19. Ayurvedic texts have no direct reference to coronavirus. However, the fundamental Tridosha Siddhanta is eternal and applicable to every disease condition. According to the Doshik analysis of the state, the Lakshanas (symptoms) fall under the following diseases mentioned in Charaka Samhita Jwara Chikits [Table 2].
Table 2: Ayurvedic understanding of COVID-19

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In this case, the age and diabetic history of the patient contribute higher risk compared with the other mild-moderate issues. The treatment must address Jwara (fever) and Prameha (diabetes mellites) simultaneously because the patient was not under regular conventional medication for Prameha. After observing Kapha-pitta Prakriti, Madhyama Roga bala, and Rogi Bala, the treatment plan was decided. The main objectives were AmaPachana (digestive stimulant), Pranavaha Sroto-Sudhikara (clearing-respiratory pathways), and Meha-Hara (~Anti diabetic) [Figure 1].[4]
Figure 1: Brief overview

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The main challenge was the uncontrolled Prameha (~Diabetes mellites) along with Jwara Lakshana.[5] Severe tinnitus developed after Jwara. Pathyadi kwatha (40 ml) is advised along with Lakshmi Vilas ras (125 mg) one tablet twice daily.[6]Tikta kashaya rasa pradhana (Bitter and astringent taste), Sula hara (Analgesic), Mehahara (antidiabetic), and ingredients such as Pathya (Terminalia bellirica Gaertn. Roxb.), Dhatri (Emblica officinalis. Linn) has anti-inflammatory and antipyretic property Lakshmivilas rasa specially selected due to the involvement of Vata kaphaSiroroga lakshana). Nishamalaki preparation was advised expressly to address Prameha (diabetes).[7]

Gargling with powdered Vyoshadi Vati was advised two times per day.[8] Shadanga churna thoya given for Pana (drinking).[9] From the 3rd day onward, intermittent fever developed and low oxygen saturation [Graph 1]. The rise of temperature was observed, especially at midnight. Considering the emergency circumstances, for Ama pachana (digestion of nonmetabolized food circulates in the body as toxins) Nagaradikwatha (30 ml) advised along with Sudarsan ghana vati (250 mg) two tablets after food.[10],[11]



Advised to take Vasaka swarasa (Juice of Justicia adhatoda. L), Tikta-kashaya rasa (bitter and astringent taste) combined with Kantakari churna (powder of Solanum xanthocarpum Schrad. And H. Wendl), Tikta katurasa (bitter and pungent taste), Guluchi swarasa (extract of Tinospora cordifolia), and Tikta kashaya rasa (bitter and astringent). All the combinations contain Tiktarasaas common. Tiktarasa is Deepana, Pachana, and Laghu (light) in property also helps in easy digestion of Ama (metabolic toxin) and pacifies pitta dosha. Vasaka and Kantakari are Agrya (~ maximum potency) in Rakta pita (bleeding disorder) and Kasa (cough).[12] Guduchi has proven immunomodulatory effects.[13] This combination was advised for the next 5 days. Later, temperature reduced, and oxygen saturation improved. Progressively, he got relief in tinnitus and other chief complaints. Baseline anteroposterior chest radiograph showed patchy ground-glass opacities in upper and lower lung zones and patchy consolidation in middle zones. After discharge and 14 days of medication, regular lung fields were noticed in the upper and lower zones. Consolidation and opacities were reduced. Fasting and postprandial blood sugars are monitored daily [Graph 2]. In this case, all the chief complaints were reduced completely, and hospital stay was less than the national average [Graph 3].[14] The following plot depicts the mean temperature (F°) and SpO2 (%) during the treatment time.



Positional advice was given in this case during the severe dyspnea as per the standard guidelines.[15] Therapeutic yoga, pranayama, and meditations are advised to this patient. The patient involved indoor activities and recreation programs conducted to relieve psychological stress.

Assessment of quality of life

In general observation, health-related quality of life is poor among COVID-19 patients. They suffer from significant physical and psychological impairment. Therefore, prospective monitoring of individuals exposed to SARS-CoV-2 is needed to fully understand the long-term impact of COVID-19 and inform prompt and efficient interventions to alleviate suffering. In this case, the quality of life assessed using the SF-12 Scale improved significantly after 2 weeks of treatment.[16] Both physical and mental scores improved by more than 50% in each case and were maintained in follow-up [Graph 4].



Hospital anxiety depression scale

Focusing on the concept of anhedonia (inability to feel pleasure in normally pleasurable activities), Hospital Anxiety Depression Scale assessment done before, after, and follow-up course of the treatment, indoor activities, games, and psychological counseling would be better to reduce anxiety and depression.[17] The assessment was done on the 1st day of admission and at the time of discharge and rechecked 1 week after release [Graph 5].




  Conclusion Top


80% of the Covid 19 cases don't have many complications.Patients with comorbidities have more deteriorating outcomes compared with asymptomatic cases. COVID-19 patients with a history of hypertension, obesity, chronic lung disease, diabetes, and cardiovascular disease have the worst prognosis and often end up with outcomes such as ARDS and pneumonia. The geriatric population tends to have more complications, thus requires careful nursing, observation, and systemic treatments. This report suggests that Ayurvedic interventions are competent enough to manageCovid -19 with comorbidities like diabetes.Radiological improvement also observed in the follow up period [Figure 2], [Figure 3], [Figure 4]. It is significant to note that even after the hospital course, the patient maintains a good quality of life. Effective management strategies are available in Ayurveda to address Covid 19 associated with comorbidities.
Figure 2: Chest X-ray posteroanterior view before treatment

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Figure 3: Chest X-ray posteroanterior view after treatment

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Figure 4: Chest X-ray posteroanterior view follow up

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that their name and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
  References Top

1.
Contini C, Di Nuzzo M, Barp N, Bonazza A, De Giorgio R, Tognon M, et al. The novel zoonotic COVID-19 pandemic: An expected global health concern. J Infect Dev Ctries 2020;14:254-64.  Back to cited text no. 1
    
2.
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433. doi: 10.1016/j.jaut.2020.102433.  Back to cited text no. 2
    
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Akhila VG. Management Of Sannipata Jwara Wsr To Covid-19 - Case Report. J Ayurveda Integr Med 2021 Mar 6. doi: 10.1016/j.jaim.2021.02.007.  Back to cited text no. 4
    
5.
Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, et al. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med 2020:1-8. Epub ahead of print.  Back to cited text no. 5
    
6.
Mishra SN, editor. BhaishajyaRatnavali, Jwaradhikara, Chapter 5, Verse 1200-1213 Varanasi: Chaukamba Publications; 2017,p .193.  Back to cited text no. 6
    
7.
SinghR H. Charak Samhita of Agnivesha., ChawkhambhaSurabharatiPrakashana, Varanasi.1st edition, reprint, 2011;2:1042.  Back to cited text no. 7
    
8.
Mishra SN, editor. BhaishajyaRatnavali, Jwaradhikara, Chapter 5, Verse 298, Varanasi: Chaukamba Publications; 2017, p.113.  Back to cited text no. 8
    
9.
Namboothiri SD, editor. Chikitsamanjari, Jwarachikitsa, Chapter 1, Verse 50 Alappuzha; Vidyarambham Publishers 2013,p. 58.  Back to cited text no. 9
    
10.
Rao GP, editor. Sarṇgadharasaṁhita of Sarṇgadharacarya, Sanskrit Text with English Translation.Madhyama khanda, gutikakalpana, Chapter 2, Verse 22-23Varanasi: Chaukamba Publications; 2013, p no. 143  Back to cited text no. 10
    
11.
Mishra SN, editor. BhaishajyaRatnavali, Jwaradhikara, Chapter 5 Verse 436-445, Varanasi: Chaukamba Publications; 2017, p.128.  Back to cited text no. 11
    
12.
Tripathi B, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Ch. 25., Ver. 40. Varanasi: ChaukhambhaSurbharatiPrakashan; 2016. p. 453-9.  Back to cited text no. 12
    
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Barman MP, Rahman T, Bora K, Borgohain C. COVID-19 pandemic and its recovery time of patients in India: A pilot study. Diabetes MetabSyndr 2020;14:1205-11.  Back to cited text no. 14
    
15.
Availble from: https://www.mohfw.gov.in/pdf/ClinicalManagementProtocolforCOVID19/ [Last accessed on 2020 Sep 02].  Back to cited text no. 15
    
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17.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361-70.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2]



 

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