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Principles of Rajayakshma management for COVID-19

Dr Sarvesh Kumar Singh, Assistant professor, Dr Kshipra Rajoria, Prof Sanjeev

Sharma, Director

PII: S0975-9476(20)30065-6
DOI: https://doi.org/10.1016/j.jaim.2020.08.002
Reference: JAIM 349

To appear in: Journal of Ayurveda and Integrative Medicine

Received Date: 3 May 2020

Revised Date: 1 August 2020
Accepted Date: 1 August 2020

Please cite this article as: Kumar Singh S, Rajoria K, Sharma S, Principles of Rajayakshma
management for COVID-19, Journal of Ayurveda and Integrative Medicine, https://doi.org/10.1016/
j.jaim.2020.08.002.

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Sciences and Technology and World Ayurveda Foundation
Title - Potential Ayurveda Strategy for COVID 19; A review

1. Dr Sarvesh Kumar Singh *

Assistant professor

P.G. Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India.

Email - [email protected]

Phone no.8739860237

* Corresponding author

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2. Dr Kshipra Rajoria

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P.G. Department of Panchkarma, National Institute of Ayurveda, Jaipur, Rajasthan, India.

Email- [email protected]
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Phone no.9001454100
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3. Prof. Sanjeev Sharma

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Director, National institute of Ayurveda Jaipur Rajasthan

Email – [email protected]
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Phone no – 8290996996
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 COVID-19

Differential Diagnosis in
Ayurveda

Shwas, Abhisangaja, Jwara,

Different types of Sannipataja
Jwara, Rajyakshma

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Analogy of COVID- 19 with

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Rajyakshma
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Management Strategy of Rajyakshma

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is proposed for COVID -19

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Title- Principles of Rajayakshma management for COVID-19

Abstract – The pandemic spread of corona virus disease 2019 (COVID-19) has become a global

threat. No cure is available for this condition till date. Ayurveda, may come to rescue in these

times of COVID -19 spread. In this review we have analyzed that the COVID-19 has analogy

with the Rajayakshma (~a wasting disease indicating suboptimum immune response) and the

established treatment of Rajayakshma disease can be proposed for preventive as well as curative

purpose.

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Keywords – Ayurveda; COVID -19; Rajayakshma

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1. Introduction – Corona virus disease (COVID -19) is caused by 2019 novel coronavirus
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(2019-nCoV). The genome of this 2019-nCoV partially resembled severe acute respiratory
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syndrome-like corona virus (SARS-CoV) and Middle East respiratory syndrome coronavirus
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(MERS-CoV)MERS-CoV, which had global outbreak in the latter half of year 2019. [1] The
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COVID -19 causative is closely related with the SARS-COV. [2] It is established that the spread

of the disease in human is through direct contact via droplets and touching the contaminated
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surface before touching the eyes, nose and mouth. [3] The incubation period of the disease is
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between 3-14 days. It is observed that elderly patients and patients with co morbidities like

diabetes, cardiovascular conditions, chronic respiratory diseases, malignancy, chronic kidney

diseases, immune compromised patients and patients undergoing chemotherapy or radiotherapy

are more prone to fatality. Symptom of the disease is flu like (lower respiratory illness) or the

infected patients may remain asymptomatic also. Most of the patients (around 81%) observe mild

symptoms as dry cough, fever, fatigue, sputum production, shortness of breath, muscle or joint

pain, headache, diarrhea, nausea or vomiting, nasal congestion, sore throat, loss of smell and

abdominal pain. In moderately affected patients, around 14% cases show symptoms of moderate

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pneumonia, cough and shortness of breath. In severely affected patients, around 5% exhibits

severe pneumonia, dyspnea, respiratory distress, tachypnea, hypoxia and fever. Critical patients

may develop Acute Respiratory Distress Syndrome, Sepsis and Septic Shock resulting in multi

organ failure. [4] Presently the symptomatic management, oxygen therapy, mechanical

ventilation, hemodynamic supports are used for COVID-19 patients. Even the scope of plasma

therapy is being explored in the cases of COVID-19. [5] Presently we must aim for a practical

and feasible therapeutic regime for management of disease for large populations. In this review

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the analogy of the COVID-19 disease with the Rajayakshma (~a wasting disease indicating

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suboptimum immune response) is analyzed and the use of various therapeutic measures
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prescribed in the Rajayakshma Chikitsa (treatment) for COVID-19 patients are discussed.
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2. Differential diagnosis -Regarding differential diagnosis COVID-19 in Ayurveda, the disease
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have similarity with Shwasa (dyspnea), Abhisangaja Jwara (fever of infectious origin), different
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type of Sannipataja Jwara (~ Tridoshaja fever) and Rajayakshma. Here only some type of

Jwara (fever) and Rajayakshma diseases are contagious in nature like COVID-19. [6] All the
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symptoms and concerns for COVID-19 are also addressed in Rajayakshma. Furthermore
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treatment strategies of all these diseases are also adoptable in the management of Rajayakshma.

Hence there is analogy between COVID-19 and Rajayakshma.

3. Analogy of COVID 19 with Rajayakshma

There is lot of similarity in COVID-19 and Rajayakshma disease. Rajayakshma disease is

Tridoshaja and the epidemiology and pathogenesis of COVID-19 suggests it as Tridoshaja.[7] In

Rajayakshma spread is like Kustha (contagious disease), with Agantu anubandhtvat (the

causative factor is acquired from outside not resultant of the body’s metabolisms) and

Naanurakshataha (by getting exposed to the causative) this is also true for COVID-19.[7 verse

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4] Patient gets affected due to Sharira sneha ksheenta (loss of unctuousness), Dhatukshaya

(depletion of tissues) , Sukrakshaya (depletion of Sukra Dhatu) , Ojakshaya (~decreased vitality)

and all these factors indicate the low immune response.[7 verse 4 ] This factor may be somewhat

true in the case of the COVID-19 as the immune response is the main key factor that contributes

to the prognosis of the disease. There are two sets of symptoms described in the Rajayakshma

first is the Shadrupa (six symptoms). [7 verse 46-47] It includes Kasa (cough), Jwara (Fever),

Parshva Shoola (pain in lateral), Swarabheda (hoarseness of voice), Atisaara (diarrhea), and

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Aruchi (loss of appetite). These symptoms are majorly present in most of the affected individuals

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and if the patients have Mamsa Bala Kshaya (weight and strength loss) then the disease can
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prove fatal. [7 verse 47] The same is true for viral disease also in which such type of loss cause
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depletion of natural killer cells, cytotoxic T-cells and helper T-cells which make individual more
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prone to infection.[8]The second set of the symptoms are the Ekadasharupa (eleven symptoms).
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[7 verse 45-46] These symptoms are observed in some patients and their severity also depends

upon the individual’s own response. These symptoms include Shirahashoola (headache), Jwara
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(Fever), Pratishyaya (cold), Praseka (running of nose, mouth, nausea), Kanthaudhvansa (sore
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throat), Kasa (cough), Swarabheda (hoarseness of voice) or Swarakshay (laryngitis), Parshva

Shoola (pain in lateral), Shwasa (dyspnea), Urahashoola (Pain in chest) or Urahakshata (damage

in lung tissues) or Raktavamana (hemoptysis), Jrimbha (indicating fatigue) or Ansavamardana

(malaise in scapular region), or Angamardana (generalized malaise) or Ansasantapa (weakness

or fatigue in scapular region), Aruchi (loss of appetite), Muhur – Muhur Chardi ( repetitive

vomiting) or Vaman (vomiting ), Atisara (diarrhea) or Trilakshan Varchabheda (severe

diarrhea). All of these symptoms described in Shadarupa and Ekadasharupa are observed in

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patients of COVID-19. [9, 10] Thus there is close resemblance between the clinical presentation

of COVID-19 and Rajayakshma. [9, 10] [Table-1]

In Ayurveda pandemic are mentioned as Janpadodhvansha [11] or Maraka. [12] In these

Pandemic one or more conditions like Kasa (cough), Shwasa (dyspnea), Vamathu (vomiting),

Pratisyaya (Rhinorrhoea), Shiroruja (headache) and Jwara (fever) may be present. [12, verse 21]

In COVID-19 disease nearly all these symptoms are commonly found. Rajayakshma is

considered as Roga Samuhanam (a condition with many disease or symptoms). [13] As various

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new symptoms are also appearing in COVID-19 hence it can also be considered as Roga

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Samuhanam. Asymptomatic and mild symptomatic cases are more prevalent in COVID-19.
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Reason for this is also described in Rajayakshma as presence of optimum Bala, Mamsa and
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Rakta (strength, weight, blood etc.). If patients have all symptoms of disease even then it should
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be considered as suffering from less symptoms (asymptomatic and mild symptomatic). [11,
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verse15).This is responsible for the fast recovery in these types of patients. In some cases death

resulted in COVID-19 from hypoxia due to cytokine storm in body. [14] The same situation is in
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Asadhyavastha (incurable condition) and death in Rajayakshma due to Urdhwashwas.[12,

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chapter 33 verse20] Among the four pattern of pathogenesis and occurrence of symptoms in

Rajayakshma - Dhatukshayajanya (~due to depletion of tissues and immunity) seems to be the

most apt reason for COVID-19. Ayurveda advocate Panchakarma (five folds Ayurvedic

purification therapy) and Rasayana Chikitsa [11, verse13, 14] in pandemic condition. Mridu

Panchakarma of shorter durations may be beneficial for COVID-19 as in Rajayakshma. [7, verse

87-88] The Achara Rasayana (behavioral therapy) is indicated in management of

Janpadodhwansa [11, verse 15-18] and Rajayakshma. [7, verse 179-189] Thus it seems that

COVID-19 is analogous with Rajayakshma.

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4. Principles for the management of COVID 19 in Ayurveda - In Janpadodhvansha

Panchakarma and uses of Rasayana are indicated. In Rajayakshma Mridu Panchakarma,

treatment strategy of Jwara and Khataksheena is advisable .[7,verse 117,183] In the treatment of

Abhisangaja Jwara, Visha Chikitsa (anti-poisonous treatment) is advised.[7, chapter 3 verse 117-

118].Thus as per the principles of Ayurveda the diet and drug formulation with Snigdha

(unctuous), Sukravardhaka (~aphrodisiac), Ojovardhaka ( increasing the vitality), Jwaraghna

(antipyretic), Vishanashaka (anti-poisonous), Rasayana (immune modulation),

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Tridoshasamyakara (balancing the harmony of body humors), Manaprasadana (psychotropic),

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Sarvsatmya ( homologous to body) qualities and Satvaavajaya Chikitsa (behavioral therapy and
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psycho-somatic management) will be useful in managing the COVID-19 cases. It prescribes the
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use of medicated decoctions and liquids, protein based diet for rapid recovery. The main concern
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of COVID-19 is dyspnea (Shwasa). In this condition Mridu Swedana [7, chapter17 verse 83]
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Mridu Vamana with Lavanambu (salty water) [7, chapter17 verse85], Mridu Virechana [7,

chapter17 verse 87], and Nasya [7, chapter 17verse131] are useful and this is also according to
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the Rajayakshma treatment. The Swedana (heat therapy) is used for relieving painful conditions,
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congestion and accelerate healing (as Sankara, Nadi, Upanaha, Parisheka and Avgahana

Swedana). [7, verse 65] Snehana (lipid replacement therapy) is used in various form [orally after

meals with milk, Nasya (nasal instillation), Abhyanga (massage), Avgahana (tub bath), Lepa

(topical application of herbal paste), Udvartana (topical application of Ayurvedic powder or

paste), Bastikarma (rectal administration)] as per requirement and condition of the patients.[7,

verse 65] If required mild forms of Bloodletting (Shringa, Jaloka and Alabu) is also

employed.[7, verse82] An important aspect of Nidan Parivarjana (avoiding causative) is also

employed in COVID-19 by limiting exposure. [15]

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5. Treatment approach of Rajayakshma for COVID-19 management

5.1 Preventive measures – It is extreme important for survival at this time to develop a body

status with a good immune response for prevention and limiting severity of the disease. For this

purpose the principle of daily regime, night regime and seasonal regime are to be followed.

Special emphasis is to be given to healthy and nutritious diet, and immune boosting drugs should

be incorporated as a part of life style in forms of various formulations like juice, lickables,

decoctions, teas, tonics etc. The various examples of such immunoboosting formulations for

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general population are Chyawanprasha [16] Tulsi (Ocimum basilicum L.) [17], green tea, [18]

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Ginger tea [19], Cinnamon tea [20], Turmeric milk [21] etc. Uses of Rasayana after

Panchakarma procedures is also helpful.

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5.2 Non infected but exposed population (quarantine) – For these types of population a bit
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advanced strategy is to be planned since they are exposed to the virus and may cause disease
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later. Thus certain medication is to be added for general protection along with the rigorous
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following of the preventive measures. In this condition Ojovardhaka (immunomodulation)

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Vishaghna (anti-toxic) and Krimighna (anti-histaminic, anti-allergic, and anti-viral) drugs are

useful. Sitopaladi Churna which is an anti-allergic compound [22, 23], Tulsi Patra Swarasa,

[24] Guduchi Swarasa [7, verse 72] or Guduchi Ghan Vati can be prescribed for

immunomodulation.

5.3. Infected but asymptomatic population (quarantine) – In these types of patients

precautions should be taken since the symptoms may develop few days later. Patient should take

optimum rest and he should be advised for plenty of intake of plain warm water or Shadanga

Paniya- ~ 2 L in a day,[7, chapter 3 verse 145-146] and Draksharista-15 to 20 ml [23, verse73-

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76] with equal amount of water after meals, in addition to therapeutic regime prescribed above

for quarantine population.

5.4 Mild symptomatic population (non – pneumonia) - In mild symptomatic population with

absence of pneumonia. There is presence of primary symptoms like dry cough, fever, body ache,

sore throat, nasal congestion, headache and diarrhea. The additional medication could be

prescribed for various symptoms as per individual need.

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5.4.1. Fever - For the management of febrile condition the treatment guidelines for Jwara

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Chikitsa can be adopted as described in Rajayakshma Chikitsa. [7, verse 117]
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5.4.2. Body ache – In body ache water bottle fomentation or Swedana with salt may be applied
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to relieve the pain.
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5.4.3. Sore throat - In sore throat gargling with warm salt water could ease symptom. Even the
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use of Yashtimadhu (Glycyrrhiza glabra L. var. Violace) or ginger (Zingiber officinale Rosc.)
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slice coated in rock salt can also soothe sore throat.

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5.4.4. Nasal congestion – The nasal congestion can be relieved by Swedana (fomentation) and

Dhuma (steam inhalation). [7, verse 67] eatables made from barley are useful. Uses of mutton

and chicken soup, high protein diet are recommended. [7, verse66-68] Shirahaparisheka with

decoction of Bala (Sida cordifolia L.), Guduchi (Tinospora cordifolia (Willd.) Hook.F. &

Thoms) and Madhuyasti can be done. [7, verse 72] Nasya (nasal therapy) with Madhuyashti

Ghrita is also useful. [7, verse 90]

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5.4.5. Headache – For headache Nasya, Dhumpana (inhalation of fume), Vasti (medicated

enema), Raktavsechana (bloodletting) and various Lepa (topical application) can be done

according to the need.[7,verse 81-84] Dashmooladi Ghrit is useful in this condition.[7 verse 93]

5.4.6. Diarrhea – Here Agnideepaka (appetizer), Atisarnashaka (anti-diarrheal)

Mukhasudhikaraka (mouth refreshing) and Aruchinashaka (anti-anorexia) treatment should be

adopted. Pathadi Churna, Jambvadi Churna, sour soup, sour Sthiradi Panchamool Kwatha can

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be prescribed. [7, verse126-133] The diarrhea can be managed with use of Yavanishadhava

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Churna [7 verse 145-148], and Talishadi Churna [7, verse 145-148]

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5.4.7. Abdominal discomfort – In Abdominal discomfort, nausea and vomiting- Kaphapraseka
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Nashak (anti-vitiated Kapha Dosha) treatment should be done. [7, verse118-120] Talishadi
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Churna or Karpooradi Churna [23, verse 35-36] can be used.

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5.4.8. Loss of taste and loss of smell sensation - Two time tooth brushing, Kaval (medicated

gargling and holding the paste or fluid in the mouth for certain time), Dhumpana (medicated
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fumes/smoking), and Mukhavairasya Nashaka Yoga (medication for ageusia) should be given for
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loss of taste. [7, verse135-140] In loss of taste Yavanisadava Churna [7, verse 141-144] and

Talishadi Churna [7, verse 145-148] are effective. For loss of smell sensation- Pratimarsha

Nasya (administration of oil based nasal drops in doses of 0.5 ml to 1ml), Prayogika or Snehika

Dhuma Nasya (inhalation of medicated fume) may be used.

In Kasa (cough),Swarabheda (hoarseness of voice) or Swarakshaya (laryngitis), Shwasa

(dyspnea),Ansavmardana (malaise in scapular region), Angamardana (generalized malaise),

Ansasantapa (weakness or fatigue in scapular region) and headache- Kharjuradi Ghrita,

Dashmool Ghrita, Sitopaladi Churna, Vasa Ghrita, Shatavari Ghrita, Duralabhadya Ghrita,

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Jivantyadi Ghrita, [7 verse 96-105] Yavanisadava Churna and Talishadi Churna can be used

according to the individual patient condition.

5.5. Moderate pneumonia population – In the cases of moderate pneumonia- line of

management of Shwasa (respiratory disorders) may be adopted. Shati Pushakar Mool Yoga, [7,

verse101] Sringarabhra Rasa, [23, verse 101-110] Chandamrita Rasa [23, verse214-218] can

also be added in above line of management. Regular monitoring is necessary in for prognosis of

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these cases.

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5.6. Severe pneumonia population –
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In this condition Rasoushadhi (herbo-mineral compounds), preparation of Manahshila (As2O3) -
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an Arsenic ore, considered as Rasayana and Vishaghna (anti-toxic) [25] and Preparation of gold
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are needed.Rasmanikya and Lakshmi Vilas Rasa which also have anti oxidative property are

useful in this condition. [26]These drugs are having Rasayana (immunomodulation) property. In
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cases of severe pneumonia the patients should be hospitalized and should be under regular
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monitoring. Karpooradi Churna, [23, verse 35-36] Vasavleha [23, verse 37-39] Lakshmi Vilas
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Rasa [23, verse214-218], Hemagarbha Pottali Rasa [23, verse 186-188] could be prescribed for

various symptoms as per individual need.

5.7. COVID-19 patient with associated comorbidities- COVID-19 patient with various

comorbidities -Diabetes mellitus-2(Madhumeha), cardiovascular complications(Hrida Roga),

respiratory disorders(Shwasa Roga), chronic kidney disease(Mutrakriccha or Mutra Vikara) and

immune compromised patients undergoing chemotherapy or radiotherapy (Ojo Kshaya/Bala

Kshaya) needs special attention. In this condition, line of management of these specific

comorbidities should also be added in COVID-19 treatment. Some medicine which are described

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in Rajayakshma Chikitsa are also useful in these comorbidities. Herbs used in Rajayakshma

Chikitsa and having Rasayan or anti-oxidative properties may also be useful in this

Vyadhishankara (comorbidities) condition. Raktachandana (Pterocarpus santalinusL.F.), [27]

Bala (Sida cordifolia L.), [28] Madhyasti (Glycyrrhiza glabra L. var. Violace), [29] Vidarikanda

(Pueraria tuberosa (ROXB. EX. WILLD.) DC.),[30,31] Shigru (Moringa oleifera Lam),[32]

Manjistha (Rubia cordifolia L.),[33,34] Shatavari (Asparagus racemosus WILLD.),[35]

Punarnava (Boerhavia diffusa L.),[36] Pippali (Piper longum L.),[37] Dashmool [38] Kharjura

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(Phoenix dactylifera L.),[39] Mridwika (Vitis vinifera L.),[40,41] Shati (Hedychium spicatum

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BUCH.-HAM.),[42] Pushkarmoola (Inula racemosa HOOK. F.), [43] Vasa (Adhatoda
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vasica NEES), [44] Gokshuru (Tribulus terrestris L), [45] Arjuna (Terminalia Arjuna (ROXB.)
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WIGHT & ARN.), [46] Tulsi (Ocimum basilicum L.), [17] and Aswagandha (Withania
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somnifera DUNAL) [47] are suitable for this purpose. [Table-2] These herbs or their compound
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may be helpful in combating the COVID-19 and all the associated comorbidities. Sringa-

Arjunadi Churna,[23,verse26] Lavangadi Churna,[23,verse23-25]Eladi

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Churna,[23,verse34]]Kakubhadi Ksheera[23,verse12],Trayodashanga Kwatha[23,

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verse21],Aswagandhadi Kwatha[23,verse20] can be used in these comorbidities associated

COVID-19.

5.8. Specialized Dietary modifications – A viral disease causes a metabolic crisis in the body.

Thus it becomes necessary to plan a diet that is rich in protein and calories to replenish the loss

and maintain the physiological function of the body. The few example of the protein calorie rich

diet suitable in the condition are Barley water, Barley recipes,[48] warm liquid lentils recipes

[49]flesh soup [50]etc. Study on chicken soup showed that is effective in viral symptomatic

upper respiratory diseases. Additionally there is always a need of cleansing of the body which

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can decrease the toxic load of the body. The plain warm water or medicated water like

Lavangajala (water processed with fruits of Syzygium aromaticum (L.) Merrill & Perry) should

be used in plenty. The fruits like pomegranate (Punica granatum L.), grapes, [51] dates, coconut

(Cocos nucifera L.) [52] intake should be encouraged. Use of functional foods like garlic (Allium

sativum L.)[53], onion (Allium cepa L.), basil, ginger, turmeric (Curcuma longa L.), black

pepper (Piper nigrum L.), cardamom (Elettaria cardamomum MATON var. miniscula),

cinnamon (Cinnamomum aromaticum NEES), bay leaves (Cinnamomum tamala NEES &

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EBERM.), curry leaves (Murraya koenigii (L.) SPR.), fennel (Foeniculum vulgare GAERTN),

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Rock salt etc. are also helpful. Emphasis should be given on maintenance of optimum weight.
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Individual should avoid complex diet (containing preservatives and unnatural compounds, empty
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calories). Overeating, excessive eating, fasting or experimentation with various types of diets
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should not be done at this stage.

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5.9. Specialized Yoga intervention – Yoga can prove an additional asset in the management of
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COVID-19. Individual should indulge in regular physical exercises incorporating Mindful

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breathing and appropriate Yogic postures. In these cases only mild Yoga practices which

promotes healing of the body is permissible that too for a very short time (the individual should

not feel any fatigue in these efforts). Individual should prefer mindful breathing practices that

promote the physical and mental wellbeing.

5.10. Behavioral modifications – The various behavioral modifications have to be adopted by in

this time of crisis. One should refrain from smoking, tobacco and alcohol intake. Certain stress

managing activity should be taken up like Agri-gym, gardening, reading. The individual should

try to follow the biological rhythm of the body. Try to avoid going to sleeping late at night or

sleeping for long hours at day time. The individual should try to have optimum sleep and wake

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up early. Special emphasis should be given to oral hygiene and upper respiratory tract cleaning

though (brushing, tongue scrapping, gum massage, gargling with warm salt water or medicated

herbs water). The individual should avoid all sorts of Physical and mental and emotional stress

till the complete strength is regained. The examples of the Physical stress are rigorous exercise,

travelling etc. Individual should refrain from excessive talking, excessive walking, being in a

posture for too long time. Excessive strain on sense organs like (eyes, ears) should also be

avoided. Individual should stay in moderate temperature. Exposure to excessive cold temperature

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(Air conditioners, intake of cold food like cold drinks, cold juices, milk shakes, ice creams

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should be avoided). Natural urges of defecation, flatus, urination, coughing, sneezing, yawing,
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sleep, hunger, thirst etc. should be respected and forceful expulsion or withholding should be
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avoided to maintain the body harmony. Utmost importance is given to Bahirmarjana
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(sanitizations, disinfection procedures like hand washing, bath with medicated water, rubbing of
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medicated powder on body) and uses of Madhya (alcoholic preparations) in prophylaxis of

Rajayakshma [7, verse164] which is also the major prophylaxis in the COVID-19. The habit of
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Bahirmarjana should be adopted. Madhya and Sugandhit Dravya Dhupana (fumigation with
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fragrant herbs and compounds) can be used in sanitization process.

6. Discussion – COVID-19 is a very new disease with age less than a year and not much is

known about it and every day something new is added about it. In these times our main focus

should be to maximally utilize the time tested knowledge present at our dispose rather than

experimenting with the valuable lives. This principle is also mentioned in Ayurveda in dealing

with a new disease. It is stated that in emergence of new disease it is not wise to worry about the

naming of the disease or search for the standard treatment instead in times of emergency the

conditions of Dosha ( body humors), Dhatu (~tissues) and Mala (excretory waste

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products),Prakriti (individual body constitution),Adhisthan (site of disease) and Samutthan (site

of body for origin of disease) are analyzed and the available standard line of treatment should be

adopted accordingly.[ 13,Chapter18 verse 44-46] Same approach is advocated here by using the

present available knowledge about COVID-19 and analyzing it under the light of Ayurveda. In

this review the COVID-19 was found analogous with Rajayakshma and an attempt was made to

develop an applicable approach of management guidelines of Rajayakshma in COVID-19. In this

approach various symptom present at varied stages of the COVID-19 are discussed with a

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rationale and formulation are also suggested appropriately as needed.

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7. Conclusion – In the present state of emergency across the global time tested knowledge of

Ayurveda may come to rescue in both preventing and managing the cases of the COVID-19.
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There is analogy between Rajayakshma and COVID-19. The management strategy of
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Rajayakshma which also follow the management strategy of Janpadodhvansa is useful in

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COVID-19. This management strategy might be helpful in managing the pandemic with the least
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resources and most economical way in large populations.

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References –

[1]. Xie M, Chen Q.Insight into 2019 novel coronavirus — An updated interim review and

lessons from SARS-CoV and MERS-CoV. Int J Infect Dis.;94:119-124.

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Table-1- Comparing of Symptoms of the Rajayakshma and COVID 19 [9,10]
Sno. Variables Rajayakshma COVID 19
1. Shirahashoola (headache) + Headache present in
14.0%, Dizziness
(Indriya Vibhram)
present in 7.6%
2. Jwara (Fever) + Present in 83.3%
3. Pratishayaya (cold) + Rhinorrhea present in
3.5%, nasal congestion
present in 1.8%, Chills
present in 15%

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4. Kanthaudvansa (sore throat) + Present in 12.3%
5. Kasa (cough), Swarabheda (hoarseness + Cough present in

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of voice), Swarakshaya (laryngitis) 60.3% (increased
sputum production –
-p 26.9%)
6. Shwasa (dyspnea) + Present in 24.9%
(shortness of breath)
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7. Parshwa Shoola (pain in lateral) + Chest pain present in
,Urahashoola (Pain in chest) 14.9%
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8. Urahaskshata (damage in lung tissues) + Ground-glass opacities

present in 80%,
Bilateral pneumonia
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present in 73.2% Acute

respiratory distress
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syndrome present in
15.7%
9. Raktavamana (hemoptysis) + Present in 2.0%
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10. Jrimbha (indicating fatigue) + Present in 38.0%

11. Ansavmardana (malaise in scapular Myalgia present in
region), Angamardana (generalized 28.5%
malaise), Ansasantapa (weakness or
fatigue in scapular region)
12. Aruchi (loss of taste, appetite) + Presence of acute smell
and taste dysfunction.
Lack of appetite present
in 78%, abdominal pain
in 1.9%
13. Praseka (nausea), Muhur – Muhur Chardi + Nausea and vomiting
(repetitive vomiting), Vamana (vomiting ) present in 3.6%,
14. Atisara (diarrhea), Trilakshana + Present in 8.4%
Varchabheda (severe diarrhea)
15. No obvious symptoms - Present in 5.6%

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Table-2 Useful plants in COVID-19 patient with associated comorbidities

S.No. Plant name Properties

1 Raktachandana Anti-oxidative, anti- diabetic, antimicrobial, anticancer, and
(Pterocarpus anti-inflammatory properties and protective effects on the
santalinusL.F.) nervous system, liver and gastric mucosa [27]
2 Bala (Sida Has anti-diabetic, antioxidant, hepatoprotective, analgesic and
cordifolia L.) antihelmintic properties [28]
3 Madhuyasti Effective as anticoagulant, antiviral, antioxidant, anti-
(Glycyrrhiza glabra L. inflammatory and having immunomodulation activity [29]
var. Violace)
4 Vidarikanda (Pueraria Useful in cardiovascular diseases and diabetic nephropathy
tuberosa (ROXB. EX. and also is a potent antihypertensive and antioxidant [30,31]

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WILLD.) DC.)
5 Shigru (Moringa Diuretic, anti-diabetic, antihypertensive, cholesterol lowering,

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oleifera Lam) antitumor, and antipyretic activities [32]
6 Manjistha (Rubia Potent antioxidant and having cardio protective, metal

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cordifolia L.)
Shatavari (Asparagus
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chelant and anti-inflammatory properties [33,34]
Anti-carcinogenic, antioxidant, immunomodulation,
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racemosus WILLD.) antitussive and antiulcer drug [35]
8 Punarnava (Boerhavia Having immunomodulation, anticancer, anti-diabetic, anti-
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diffusa L.), fibrinolysis, hepatoprotection, and diuresis properties [36]

9 Pippali (Piper longum It is a proved herbal bio enhancer and has immunomodulation
L.) , cardio protective, antioxidant, anticancer, radio protective
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and antiviral activities [37]

10 Dashmool(roots of ten Act as analgesic and anti-inflammatory drug and shows anti-
plants) platelet effects [38]
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11 Kharjura (Phoenix Considered as anti-diabetic, antioxidant, immunostimulant

dactylifera L.) antimutagenic, anticancer, anti-inflammatory,
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hepatoprotective, gastro protective and nephroprotective [39]

12 Mridwika (Vitis vinifera Effective in metabolic syndrome such as hypertension,
L.), hyperlipidemia and hyperglycemia and has hepatoprotective,
antioxidative, anti-inflammatory, cardio protective,
neuroprotective effects and antiviral effect [40,41]
13 Shati (Hedychium Useful in asthama,bronchitis,vomitting ,diarrhea and blood
spicatum BUCH.- disorders and having antimicrobial, anti-inflammatory and
HAM.), anti-oxidant activities [42]
14 Pushkarmool (Inula Cardioprotective in nature [43]
racemosa HOOK. F.)
15 Vasa (Adhatoda Widely used in respiratory disorders and having antimicrobial
vasica NEES) and antioxidant properties [44]
16 Gokshuru (Tribulus Has cardio protective, anti-diabetic, antioxidant, antitumor
terrestris L) and antiurolithic properties [45]
17 Arjuna (Terminalia Can protect the cardiovascular system and also having the
Arjuna (ROXB.) anti-hypertensive, antioxidant, anti-carcinogenic, anti-
WIGHT & ARN.) mutagenic and gastro-protective effect [46]

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18 Aswagandha (Withania Immunomodulation, anti-microbial, anti-arthritic,anti-
somnifera DUNAL) inflammatory, anti-tumor, anti-oxidant, neuroprotective,
cardio-protective, and anti-diabetic properties [47]

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No conflict of interest

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