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 Table of Contents  
REVIEW ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 3  |  Page : 228-235

A systematic review on health scenario after COVID19: Conditions and solutions in ayurvedic perspective


1 Department of Swasthavritta, National Institute of Ayurveda, Madhav Vilas Palace, Amer Road, Jaipur, Rajasthan, India
2 Department of Swasthavritta and Yoga, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
3 Department of Roga Nidana, Prakash Institute of Ayurvedic Medical Sciences and Research, Bulandshahar, Uttar Pradesh, India

Date of Submission01-Nov-2020
Date of Decision02-Jan-2021
Date of Acceptance03-May-2021
Date of Web Publication28-Sep-2022

Correspondence Address:
Mangalagowri V Rao
Department of Swasthavritta and Yoga, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221005, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joa.joa_268_20

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  Abstract 


Objective: Corona virus has appeared after 100 years of the influenza pandemic and is causing more devastation in terms of physical, mental, and economical losses. It is evident from the previous experiences that a disease in the convalescent stage is more agonizing and more damaging. Data Source: Systematic review of the readily accessible, peer-reviewed full clinical trials and survey studies published on coronavirus-19 (COVID-19) from December 31, 2019 to May 1, 2020. Review Methods: The protocol was developed using the PRISMA statement. Review of conditions that can appear and their treatment. The review is based on the main symptom that appeared in the patient and it's possible after effect in the convalescence stage. Results: The first part of this article, i.e., systematic study showed that symptoms in COVID-19 range from mild to severe and the involvement of many vital organs. The second part is a review study to provide Ayurvedic solutions for the protection and management of involved organs and organ systems. Conclusion: Here, special emphasis is given to the protection of Marmas, i.e., Hridaya (heart and cardiovascular system), Basti (bladder and kidneys), and Shiras (brain including nervous system), and other vital organs and organ systems. The use of Ayurvedic medicines as mentioned in classics such as Sthiradi Panchamula, Bilvadi Panchamula Siddha Yavagu etc should be given as per the condition and body constitution. Whole some diet that enhance Agni and protect liver and strengthen respiratory and cardiovascular system should be given.

Keywords: Bilvadi panchamula siddha yavagu, dvirittara hingvadi churna, hridya, kalyanaka grita, sthiradi panchamula


How to cite this article:
Raj MS, Rao MV, Singh VR. A systematic review on health scenario after COVID19: Conditions and solutions in ayurvedic perspective. J Ayurveda 2022;16:228-35

How to cite this URL:
Raj MS, Rao MV, Singh VR. A systematic review on health scenario after COVID19: Conditions and solutions in ayurvedic perspective. J Ayurveda [serial online] 2022 [cited 2022 Dec 4];16:228-35. Available from: http://www.journayu.in/text.asp?2022/16/3/228/357298




  Introduction Top


At present, the whole world is in the clasps of pandemic, which suddenly hit most of the countries in a very short span. Most of the world was not prepared to face such a condition both mentally, economically, and in terms of resources. The Gross Domestic Product of the countries is falling; worldwide lockdown has shutdown many small industries. So now, the countries are employing ways to recover from this economic crisis. However, the crisis of health, due to coronavirus pandemic with exponential growth of cases and loss of life is difficult to manage. Eventually with time the threat will be over. However, the recovered cases developing complications will be a long-standing issue that has to be considered during the management of COVID. For example, Chikungunya fever and dengue fever when they are cured leaves body with agonizing polyarthralgia.[1] This makes people suffer more than they were suffering when they had the disease. It is too early to survey the after effects in the recovered patients but we have to be prepared. This article is a hypothesis of possible conditions that could appear in the patients recovering from the COVID-19 infection. Our hypothesis is based on the systematic review of the published articles, which has information regarding signs and symptoms and the systems affected.


  Materials and Methods Top


The review included core areas of symptomatology and post-COVID-19 complications and possible Ayurvedic intervention for the prevention and management, keeping in view the basic principles. The systematic review of the readily accessible, peer-reviewed full clinical trials and survey studies published on coronavirus (COVID-19) from December 31, 2019 to May 1, 2020 using the keywords “COVID 19,” “coronavirus and lungs,” “coronavirus and liver,” “coronavirus and heart” and “coronavirus and convalescence stage.” The words were searched manually, followed by manual screening. The protocol was developed using the PRISMA statement. Articles for review were selected from PubMed central. There was no restriction on the type of the study to be included, but randomized controlled trials and quantitative studies were preferred. The focus of the review was to obtain information about the symptoms that has appeared in the disease COVID-19 and the signs and symptoms in the convalescent patients. This extensive review would help in proposing the possible intervention for COVID and its after effect in convalescence stage, based on the basic principles of Ayurveda and already available research evidences in the area.

Duplicate articles were removed, after meticulous manual screening for any duplicity in titles and authors. Initially headings and abstracts were precisely screened, followed by review of full articles.

Inclusion criteria

  1. Clinical trials and case studies, all age groups including both male and female
  2. Articles containing mild, moderate, and severe cases
  3. Articles in English.


Exclusion criteria

Letter to editor, Commentaries, Call for paper, Conference reports, Situation reports, People and company reports, articles in other languages.

The data were recorded following PRISMA guidelines. Points as per Critical appraisal checklist[2] appropriate to the study design was applied.

  • Question for the present study was to assess the future risks for the COVID-19 recovered patients
  • All the articles taken into consideration were from high-quality indexed journals
  • All the studies relevant to the question were included
  • All the full articles were read in detail and the cross-referred articles were also checked to ensure the quality
  • Overall results include the number of articles reviewed in the process and the human systems that coronavirus affects
  • All studies were clinical trials and case studies with sophisticated statistical analysis
  • The results can be applied to the local population
  • All the systems that can be affected due to corona and the diseases were taken in consideration
  • The benefit from the study is worth because by knowing the future outcomes of the coronavirus we can start prophylactic or primary preventive treatment for the affected individuals to avoid further harm.


Ethical clearance was not essential as this article is a review article comprised review of peer-reviewed published literature.

Systematic review

A total of 9066 items were obtained during the search with the keywords “COVID-19,” “Coronavirus and lungs,” “Coronavirus and liver,” “Coronavirus and heart” “Coronavirus and convalescence stage” (from December 31, 2019 to May 1, 2020). Studies including clinical trials and case studies, all age groups including both male and female were taken into considerations. Articles containing mild, moderate, and severe cases were included. Duplication removal was done manually, 3987 articles with same title and authors appeared with different keywords were removed. Further 5079 full articles were read. 1995 articles not having content about the symptoms of coronavirus or related complications were further removed. 1748 articles were removed due to the reasons such as language and type of the articles (Other language – 102, Letter to editor – 521, Commentaries – 536, Call for paper – 04, Conference reports – 02, Situation reports – 17, and People + company reports – 05). After the completion of manual screening process, 1336 full articles were obtained. Out of them 312 contained similar observations and results; hence, total 1024 articles were used.


  Results Top


Currently, there is no confirmed data about the cardinal symptoms of COVID-19. Different symptoms have appeared in different patients. Symptoms seen in maximum people include[3],[4],[5] fever, cough, myalgia, headache diarrhea, dyspnea, etc. Symptoms in COVID-19 range from mild to severe, and the involvement of many vital organs has been recorded in various studies. Many recent studies have shown liver injury incidence up to 53%.[6] There are evidences that show the raised level of alanine aminotransferase (ALT), aspartate transaminase (AST), and bilirubin in the CoV2-infected individuals.[7],[8],[9] In certain cases, serum albumin was recorded below the normal levels.[6] Many viruses including the CoV2 use angiotensin-converting enzyme 2 (ACE2) receptors, ACE2 is membrane protein that serves many physiological functions in the lungs, heart, kidneys, and other organs.[10] Many studies have reported cardiovascular manifestations, by elevated cardiac biomarkers, cardiac arrhythmia, arterial and venous thromboembolism, and cardiogenic shock and arrest.[11] Lungs are most commonly affected by the severe acute respiratory syndrome coronavirus 2 (SARS CoV2). Lung infections and affected epithelium integrity play a crucial role in the induction and exacerbation of a multitude of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease.[12] Studies have shown that most of the severe cases develop, acute respiratory distress syndrome (ARDS) increases alveolar-capillary barrier permeability, reduces surfactant production, amplifies cytokine and interleukin production, and increases the risk of septic shock, which all culminate in severe pulmonary endothelial damage.[13]

Gastrointestinal (GI) symptoms have been seen frequently associated with SARS CoV2 infection. It include diarrhea being the most common, other are nausea, anorexia, vomiting, acid reflux, and epigastric discomfort. In a few studies, upper GI hemorrhage has also been reported. The GI symptoms can be explained by the inflammation, hypoxia, liver function derangements, stress, or as a response to the treatment. Various neuronal manifestations have also been reported that includes central nervous system and peripheral nervous system. Myalgia and muscle injury is emphasized in many reports.[14] Li et al. have reported the occurrence of stroke in the initial phase of infection.[15] In various cases, Guillain–Barré syndrome has been reported after the episode of COVID-19.[16],[17],[18]

Another organ system that can be affected by the intricate and complex mechanism of COVID-19 is the renal system. ACE 2 is involved in the pathophysiology of COVID-19, and it directly affects the rennin-angiotensin aldosterone system and may lead to vasodilatory shock.[19] One retrospective cohort study, which included 191 adult inpatients with laboratory-confirmed COVID-19 and definite clinical outcome (death or discharge) from Jinyintan Hospital and Wuhan Pulmonary Hospital, reported 15% of all patients and 50% of nonsurvivors had acute kidney injury[20] In the SARS of 2002–2003, many cases reported peripheral neuromuscular manifestations in Taiwan.[21] In a study of COVID-19 patients of the 214 consecutive patients with COVID-19, 36.4% (78 patients) had the symptoms of the nervous system.[22]

Confections are a common occurrence when the immunity is compromised because of a present disease condition. Co-infections have been reported as complications in COVID-19 in many studies.[23] Patients who have suffered from the COVID-19 apart from being having systemic problems may also face remission of COVID-19.[24],[25]

The impact of COVID-19 infection on different systems

The virus attacks different systems in the body shown by the levels of biological markers. The most common include liver, heart, lungs, GI system, and nervous system. The injury to liver shown by the abnormal AST, ALT, bilirubin, and albumin level.[26] The injury to the heart is shown by the abnormal troponin, creatine kinase isoenzyme-MB[27] myohemoglobin[28],[29] and levels. Cytokine storm syndrome also causes damage of the heart leading to arrhythmia. Damaged epithelium integrity of lungs is shown by abnormal ALB, LYM, LYM (%), LDH, NEU (%), and C-reactive protein levels.[30] The impact on the GI system is shown by symptoms such as diarrhea, vomiting, and GI bleeding. Nervous system impact is shown by symptoms such as headache, dizziness, and complications such as seizures and stroke. Impairment of the peripheral nervous system is shown by loss of smell and taste during the course of disease, which is a reversible effect.

Adverse effects of standard allopathic treatment protocol

Medications most commonly being used for the treatment of COVID-19 includecorticosteroids in case of severe ARDS (methylprednisolone and dexamethasone. Antiviral drugs (lopinavir/ritonavir 400/100 mg orally every 12 h) are being used in few cases,[31] but open-label trials have shown no significant benefit with lopinavir/ritonavir treatment compared to standard care.[32] These produce side effects such as diarrhea and nausea, headache, dizziness, and dyslipidemias on long-term uses.[33] Antiviral or immunomodulatory drugs such as chloroquine (500 mg every 12 h) and hydroxychloroquine (200 mg every 12 h) were suggested with azithromycin, but this can lead to increased risk of QT interval prolongation and cardiac arrhythmias.[34] They also produce side effects such as nausea, vomiting, itching, anorexia, epigastric pain, etc.[35] Further, corticosteroids such as methylprednisolone and dexamethasone have adverse effects such as fragile skin, risk of development of diabetes, and susceptibility for infection.[36]

Role of Ayurveda in the management as add on therapy and therapy during convalescence period

Protection of the “Tri-Marma” is very essential. The above observations it is clear that Tri-Marma may severely affected by the COVID. Following are the protocols for the protection of “Tri-Marma” can be included in the management.

For the protection of heart and kidney

Hingu (Ferula foetida L) Churna, salt, juice of Matulunga (Citrus medica L) fruit or other sour fruits such as pomegranate, Amla (Emblica officinalis L), Kokum (Garcinia morella Gaertn.), and lemon. Decoction of Sthiradi or Laghupanchamula, it is a combination of roots of Shaliparni (Desmodium gangeticum [L] DC), Prishniparni (Uraria picta), Brihati (Solanum indica), Kanthakari (Solanum xanthocarpum Schrad. and Wendl), Gokshura (Tribulus terrestris L) can be advocated to prevent renal complications. Bilvadi Panchamula Rasa siddha Yaavagu, i.e., medicated gruel preparation prepared from cooking rice in combination of Bilva (Aegle marmelos L), Gambhari (Gmelenia arboria), Shyonaka (Oroxylum indicum L. Benth), Agnimantha (Premna mucronata), and Patala (Stereospermum suaveolens Roxb DC) and 14 times of water.[37] Dwiruttara Hingvadi churna is fine powder of Hingu (Ferula fetida), Vacha (Acorus calamus) 2 Parts, Chitraka (Plumbago zeylanica L) 4 Parts, Kushtha (Sasuria lappa [Falc.] Lipsch) 8 Parts, Suvarchika (Sarjika Kshara) 16 Parts, Vidanga Churna (Embelia ribes Burm. f) 32 Parts should be taken with hot water. This is beneficial in bloating of abdomen, diarrhoea, cardiac ailments, abdominal ailment and abnormality of Udana Vayu.[38] This may be especially beneficial in counteracting the abdominal complaints and also side effects caused due to intake of medicines in the management of COVID 19.

Hepatoprotective medicines should be included in the protocol. Bhumi Amalaki (Phyllanthus neruri L) is a good hepatoprotective and antiviral that can be used as an add-on for protection for the liver.[39]

For prevention of complications and relief of symptoms

Kalyanaka ghrita, a medicated ghee prepared from multiple herbs like Vidanga (Embelia ribes Burm. f.), Triphala (Terminalia chebula Retz., Terminalia bellirica Gaertn. Roxb., Emblica officinalis Gaertn.), Danti (Baliospermum montanum), Bhadra Daru (Berberis aristate DC), Harenu (Pisum sativum L.), Talis (Abies webbiana Lindl.), Manjishtha (Rubia Cardifolia L), Keshara (Mesua ferria L), Utpala (Nelambo nucifera Gaertn), Padmaka (Prunus cerasoides D. Don), Dadima (Punica granatum L), Malati pushpa (Jasminum officinale), Haridra (Curcuma longa L), Daru Haridra (Berberis aristate DC), Sariva (Hemidesmus indica [L] R. Br), Shali Parni (Desmodium gangeticum [L] DC), Prishniparni (Uraria picta), Priyangu (Aglaia elaeagnoidea (A. Juss) Benth.), Tagara (Valeriana wallichii), Kushtha (Sasuria lappa Clarke), Brihati (Solanum indicum), Kanthakari (Solanum xanthcarpum Schrad. and Wendl), Elavaluka (Prunus avium L), Chandana (Santalum alba L), Gavakshi (Trichosanthes palmata Roxb.) will be beneficial in Apasmara (epilepsy), Pandu (anemia), Gara (chronic poisoning), Shvasa (dyspnea), Agnimandya (loss of digestive and assimilative power), Jvara (fever), Kasa (cough), Shosha (emaciation), and Alpashukra (reduced male or female hormones/sperm count).[40]

Advocated diet

Principles

The diet should be light, easily digestible, Amapachana (digests the accumulated morbid matter), Rasayana (rejuvenating) and Kapha pittahara diet, that replenishes the Rasakshaya (depleted Rasa) incorporating the different food groups as mentioned in Ayurveda as well as contemporary medicine. The wholesome diet and lifestyle for COVID 19 have been provided in [Table 1].
Table 1: Pathya and Apathya (conducive and nonconducive foods and regimen) for coronavirus disease 2019

Click here to view



  Discussion Top


Various complications of the liver, lung, heart, and GI tract need to be addressed properly at different stages accordingly. During the convalescent stage, for the protection of “Tri-MarmaHingu can be advocated as it enhances the memory,[41],[42] digestive activity,[43],[44] protects heart by providing hypotensive and antispasmodic activity.[45] Hingu can also be used to provide secondary protection from bacterial infection due to weakened immunity by COVID.[46] Another category of protective herbs are the “Sour” ones. Amla Rasa (Sour taste) is the best for the heart (Hridya).[47] The main effect of Kokum and Pomegranate, etc., has been observed on the heart.[48] Most of the sour food items such as Pomegranate, cherries, etc., contain polyphenols, which have antioxidant property. Polyphenols belong to a group of powerful antioxidants that supplement and enhance the function of endogenous antioxidants and enzymes involved in defensive action against the increased oxidative load caused by the overproduction of reactive oxygen species (ROS).[49] Various findings suggest that overproduction of ROS and oxidative stress accompany different cardiovascular diseases, including hypertension, atherosclerosis, and heart failure.[50] Natural unprocessed pomegranate juice has higher polyphenol contents in comparison to commercial juices with mean polyphenol levels 421 and 382 mg per 100 ml, respectively. Daily intake of pomegranate juice for 3 weeks improved the plasma and urinary anti-oxidative activities and decreased the urinary excretion of (TBARS) to statistically significant levels.[51] Grapefruit has beneficial effect on diseases such as diabetes mellitus and cardiovascular disorders. The rich flavonoid content in grapes contributes toward cardioprotective action.[52] Amalaki (Emblica officinalis Gaertn.) is effective against many cardiovascular risk factors.[53] Vrikshamla (Garcinia morella) having sour taste has antioxidant properties and reduces stress on the heart.[54] Other herbs and their mixed decoctions also play an important role. Laghu Panchamoola has been proven to have protective effects on the heart and liver by alleviating Vata. The properties of Kaniyapanchamula/Laghupanchmoola are also ascribed, i.e., Kashaya, Tikta, and Madhura in Rasa as having Vataghna, Pittashamana, Brimhana, and Balavardhana Karma.[55] The Dravyas of Laghu Panchamoola in the form of decoction serves as Ashmarighna[56] and hence protects the kidneys. In Charak Samhita Laghupanchamula are mentioned under a single group, i.e., Shvayathuhara Mahakashaya;[57] Brihat Panchamoola siddha Yavagu also have protective effect on Trimarma, by alleviating Vata.[58]

Bhumi Amalki (Phyllanthus niruri L) was found to have hepatoprotective properties in various studies. It also has proven to have therapeutic effects on nonalcoholic fatty liver disease[59] and liver cirrhosis[60] both of which are considered as outcome of hepatocellular/cholestatic/mixed injury. Antioxidant properties of the most of the drugs of Kalyanaka Ghrita have been scientifically proven, for example, Emblica officinalis L,[61] Terminalia belerica (Gaertn.) Roxb.[62] Citrullus colocynthis (L.) Schrad.,[63] Valeriana wallichii,[64] etc.

During the symptomatic phase, liquid diet preparations such as Manda (thin gruel prepared by cooking 1 part of rice in 14 parts of water), Peya (Gruel with few rice grains prepared by cooking 1 part of rice in 14 parts of water), Vilepi (Thik gruel with less water prepared by cooking 1 part of rice in 4 parts of water), Krishara, Yusha (Semisolid preparation made by cooking pulses in 14 or 18 parts of water, followed by seasoning with cumin seeds, pepper, and asafoetida in ghee) would be more beneficial. They help in overcoming problems such as loss of appetite, nausea, and tastelessness symptoms resulting from Agnimandya. This should include energy giving foods such as rice and barley that would provide energy and keep the body hydrated due to liquid part in food. Among the pulses, green gram is preferred as it is light for digestion at the same time fulfils the protein needs of the body. They can also be consumed in combination as in Krishara, i.e., semisolid preparation made by cooking rice and green gram properly followed by seasoning with ghee, cumin seeds, ginger, black pepper powder, asafoetida, turmeric for imparting flavor and salt as per taste. The use of spices helps in easy digestion. Black pepper helps in the absorption of nutrients. Further, the rice can be used after roasting for making it light for digestion. The light and hepatoprotective vegetables such as bottle gourd, ridged gourd, bitter gourd, ash gourd, pumpkin, brinjal, and drum stick[65] can be used in the form of soup or stir fry with less amount of ghee. If the digestion power is weak, then preparations such as Manda, Peya, and Vilepi can also be used. This helps in kindling the digestive power. Among the fruits, pomegranate, grapes, Indian goose berry, or Amla help to reduce Pitta, and act as rejuvenators, thus help to bring back the immunity by their antioxidants. As per Ayurveda, pomegranates and Amla are cardioprotective.[66] Grapes are very good for the cardiovascular and respiratory system.[67],[68] Grapes are also good for the prevention of renal problems.[69] Among the sugars, honey and jaggery are good. Animal studies show that jaggery helps in counteracting the effect of coal dust instilled into the lungs of rats. The histological lesions reduced in the rats administered with jaggery in dose 0.5 g/rat for 5 days per week for a period of 90 days.[70] Further, the protection of the heart by process of Hridayavarana (Cardiac shielding) through medicines and diet are mentioned. In the diet, regular intake of ghee, milk, and honey is advocated in Ayurveda. Medicated ghee like Ajeya ghrita or Amrita ghrita is also prescribed for the protection of the heart.[71]


  Conclusion Top


The systemic after effects can affect the quality of life of the COVID-19-infected person. The coronavirus attacks, the “Marmas” like Hridaya (heart and cardiovascular system), Basti (bladder and kidneys), and Shiras (brain including nervous system), and other vital organs and organ systems. Hence, the protection of these organs in the convalescence stage is prime and important. The use of Ayurvedic medicines as mentioned in classics such as Sthiradi Panchamula, Kalyanaka Grita, Dviruttara Hingvadi Churna, and Bilvadi Panchamula Siddha Yavagu should be given as per the condition and body constitution. Holistic approach of inclusion of wholesome diet to enhance Agni and protect liver and strengthen the respiratory and cardiovascular system becomes the key during the infection and convalescence phase.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.





 
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