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National Clinical Management Protocol based on Ayurveda and Yoga for management of COVID-19

Posted on: October 20, 2020 | Back | Print

Ministry of AYUSH

 

 

Preamble

The COVID-19 pandemic has created a global health crisis posing an unprecedented public health emergency. The number of deaths and people being infected are increasing daily throughout the globe. This situation is much more severe due to possible devastating situations because of several social and economic factors. Effective management to address this infection is still evolving and attempts are being made to integrate traditional interventions along with standard of care.

 

Ayurveda and Yoga can certainly play a pivotal role to augment preventive measures provided in the guidelines by Ministry of Health and Family Welfare (MoHFW). The current understanding of COVID-19 indicates that good immune status is vital to prevention and to safeguard from disease progression.

 

Following three aspects are considered while preparing this protocol:

1.      Knowledge from Ayurveda classics and experience from clinical practices

2.      Empirical evidences and Biological plausibility

3.      Emerging trends of ongoing clinical studies

 

This consensus document is developed by expert committees from AII India Institute of Ayurveda (AIIA), Delhi, Institute of Post Graduate Training and Research in Ayurved (IPGTRA), Jamnagar, and National Institute of Ayurveda (NIA), Jaipur , Central Council for Research in Ayurveda (CCRAS), Central Council for Research in Yoga and Naturopathy (CCRYN), other national research organizations. This protocol is for management of mild COVID-19. Moderate to Severe COVID-19 individuals may have informed choice of treatment options. All severe cases will be referred.

 

This protocol and its annexure are approved by the Chairman, Interdisciplinary Committee for inclusion of Ayurveda and Yoga in the management of mild COVID-19 and approved by the empowered committee of the Interdisciplinary AYUSH Research and Development Taskforce on COVID-19, both constituted by the Ministry of AYUSH.

 

General and Physical measures

1.        Follow physical distancing, respiratory and hand hygiene, wear mask

2.        Gargle with warm water added with a pinch of turmeric and salt. Water boiled with Triphala (dried fruits of Emblica officinalis, Terminalia chebula,


Terminalia bellerica) or Yashtimadhu (Glycyrrhiza glabra) also can be used for gargling.

3.        Nasal instillation/application of medicated oil (Anu taila or Shadbindu Taila) or plain oil (Sesame or Coconut) or nasal application of cow’s ghee (Goghrita) once or twice in a day, especially before going out and after coming back to home.

4.        Steam inhalation with Ajwain (Trachyspermum ammi) or Pudina (Mentha spicata) or Eucalyptus oil once a day

5.        Adequate sleep of 6 to 8 hrs.

6.        Moderate physical exercises

7.        Follow Yoga Protocol for Primary Prevention of COVID-19 (ANNEXURE-1) and Protocol for Post COVID-19 care (including care for COVID-19 patients) (ANNEXURE-2) - as applicable

Dietary measures

1.         Use warm water or boiled with herbs like ginger (Zingiber officinale) or coriander (Coriandrum sativum) or basil (Ocimum sanctum / Ocimum basilicum), or cumin (Cuminum cyminum) seeds etc., for drinking purpose.

2.         Fresh, warm, balanced diet

3.         Drink Golden Milk (Half tea spoon Haldi (Curcuma longa) powder in 150 ml hot milk) once at night. Avoid in case of indigestion.

4.         Drink Ayush Kadha or Kwath (hot infusion or decoction) once a day.

 

Specific Measures / Symptom Management

 

Clinical

severity

Medicines*

Doses & Timing

 

 

 

 

 

Prophylactic care (high risk population, primary contacts)

 

 

Ashwagandha (Aqueous extract of

Withania somnifera IP) or its powder

500 mg extract or 1-3 g powder twice daily with warm water for 15 days or one month or as directed by Ayurveda

physician

 

Guduchi Ghana vati [Samshamani vati or Giloy Ghana vati having Aqueous extract of Tinospora cordifolia IP] or the powder of Tinospora cordifolia

500 mg extract or 1-3 g

powder twice daily with warm water for 15 days or one month or as directed by Ayurveda

physician

Chyawanaprasha

10 g with warm water /

milk once a day

* In addition to these medicines; general and dietary measures are to be followed.


 

 

Clinical severity

Clinical

Presentation

Medicines*

Doses & Timing

 

 

 

 

 

 

 

Asymptomatic

– COVID-19

Positive

 

 

 

 

For prevention of disease progression to symptomatic and severe

form and to

Guduchi Ghana vati [Samshamani vati or Giloy vati having Aqueous extract of Tinospora cordifolia IP] or the powder of Tinospora

cordifolia

500 mg extract or 1-3 g powder twice daily with warm water for 15 days or one month or as directed by Ayurveda physician

Guduchi + Pippali (Aqueous extracts Tinospora cordifolia IP

375 mg twice daily with warm water for 15 days or as directed by

 

improve

and Piper longum IP)

Ayurveda physician

 

recovery rate

 

 

 

 

 

 

 

500 mg twice daily with

 

 

AYUSH 64

warm water for 15 days

or as directed by

 

 

 

Ayurveda physician

* In addition to these medicines; general and dietary measures are to be followed.

 

Clinical severity

Clinical

Presentation

Clinical

Parameters

Medicines*

Doses & Timing

 

 

 

 

 

 

Without evidence of breathlessness or hypoxia (normal situation)

Guduchi +

 

 

 

Pippali

375 mg twice

 

 

 

 

Mild COVID-19

Positive**

Symptomatic management Fever, Headache, Tiredness Dry Cough, Sore throat Nasal congestion

(Aqueous

extracts Tinospora cordifolia IP and Piper longum

IP)

daily with warm

water for 15 days or as directed by Ayurveda physician

 

 

AYUSH 64

500 mg twice

daily with warm water for 15 days or as directed by

 

 

 

Ayurveda

 

 

 

physician

*           In addition to these medicines; general and dietary measures are to be followed. Refer ANNEXURE-3 for additional medicines. Physicians have to decide useful formulations from the above or from ANNEXURE-3 or substitutable classical medicines based upon  their clinical judgement, suitability, availability and regional preferences. Dose may be adjusted based upon the patient’s age, weight, and condition of the disease


**    Guidelines for Ayurveda  Practitioners  for COVID-19 notified by  Ministry  of AYUSH may  also be referred.

 

Clinical severity

Clinical Parameters

Medicines*

Doses & Timing

 

 

 

500 mg extract or 1-3 g

 

 

Ashwagandha

powder twice daily with

 

 

(Aqueous extract of

warm water for 15 days

 

 

Withania somnifera IP)

or one month or as

 

Prevention of

or its powder

directed by Ayurveda

 

Post COVID

 

physician

Post COVID Management

Lung complications

like Fibrosis,

Chyawanprasha

10 g with warm water /

milk once a day

Rasayana Churna

 

3 g powder twice daily with honey for one month or as directed by Ayurveda physician

 

Fatigue,

(compound herbal

 

Mental Health

powder made up of

 

 

equal amounts of

 

 

Tinospora cordifolia,

 

 

Emblica officinalis and

 

 

Tribulus terrestris)

*           In addition to these medicines; general and dietary measures are to be followed.

*                      According to physician’s discretion. Physicians have to decide useful formulations from the above or substitutable classical medicines based upon their clinical judgement, suitability, availability and regional preferences. Dose may be adjusted based upon the patient’s age, weight and condition of the disease.

**    Guidelines for Ayurveda  Practitioners  for COVID-19 notified by  Ministry  of AYUSH may  also be referred.

 

References:

1.        Guidelines for Ayurveda practitioners for COVID-19; available at https://www.ayush.gov.in/docs/ayurved-guidlines.pdf

2.        Guidelines on Clinical Management of COVID-19; Government of India, Ministry of Health & Family Welfare; available at https://www.mohfw.gov.in/pdf/GuidelinesonClinicalManagementofCOVID1912020.pdf

3.        Advisory from Ministry of AYUSH for meeting the challenge arising out of spread of corona virus (COVID-19) in India; available at https://www.ayush.gov.in/docs/125.pdf

4.        Ayurveda’s immunity boosting measures for self-care during COVID-19 crisis; available at https://www.ayush.gov.in/docs/123.pdf

5.        Post COVID management protocol of Ministry of Health & Family Welfare; available at https://www.mohfw.gov.in/pdf/PostCOVID13092020.pdf

6.        Revised SOP on preventive measures to be followed while conducting examinations to contain spread of COVID-19; available at https://www.mohfw.gov.in/pdf/RevisedSOPonpreventivemeasurestobefollowedwhileconductin gexaminationstocontainspreadofCOVID19.pdf

== == == ==


ANNEXURE - 1

Yoga Protocol for Primary Prevention of COVID- 19

 

Objectives:

    To improve respiratory and cardiac efficiency

    To reduce stress and anxiety

    To enhance immunity

 

S. No.

Practices

Name of the Practice

Duration (Minutes)

1

Prayer

 

1

2

Loosening Practices

Neck Bending

2

Shoulder's movement

2

Trunk Movement

1

Knee Movement

1

3

Standing Asana

Tadasana

1

Pada-hastasana

1

Ardha Chakraasana

1

Trikonasana

2

Sitting Asana

Ardha Ushtraasana

1

Sasakasana

1

Utthana Mandukasana

1

Simhasana

1

Marjariasana

1

Vakrasana

2

Prone Lying Asana

Makarasana

1

Bhujangasana

1

Supine Lying Asana

Setubandhasana

1

Utthanapadasana

1

Pawana Muktasana

1

Markatasana

1

Shavasana

2

 

4

 

Kriya

Vata Neti 2 rounds (30 secs each with 30 sec relax)

 

2

Kaphalabhati

(2 rounds, 30 strokes each )

 

2

5

Pranayama

(i) Nadi Shodhana (5 rounds )

2

(ii) Surya Bhedhana Pranayama (5 rounds )

2

(ii) Ujjayee Pranayama (5 rounds )

2

(iii) Bhramari Pranayama (5 rounds)

2

6

 

Dhyana

5

7

 

Shanti Patha

1

Total Duration for Each

45

    Advised Jalaneti kriya weekly thrice.

    Advised steam inhalation every day or alternative day.

    Advised gargling with lukewarm saline water regularly.


ANNEXURE - 2

Yoga Protocol for Post COVID- 19 care (including care for COVID-19 patients) Objectives:

    To improve pulmonary function and lung capacity

    To reduce stress and anxiety

    To improve Muco-ciliary clearance Morning Session (30 Minutes):

S. No

Practices

Name of Practice

Rounds

Duration (in Minutes)

1

 

 

 

Preparatory Practices (In sitting)

Tadasana

 

 

 

 

 

6

2

Urdhva Hastottanasana

 

3

Uttana Mandukasana

 

4

Shoulder rotation

3 rounds

5

Trunk twisting

3 rounds

6

Ardha ustrasana

 

7

Sasakasana

 

8

 

Breathing Practices

Vaataneti

2 rounds (30 secs/round)

2

9

Kapalabhati

3 rounds (30 secs/round)

2

10

Deep Breathing

10 rounds

2

11

 

Pranayama Practices

Nadishodhana

10 rounds

6

12

Ujjaayee

10 rounds

3

13

Bhramari

10 rounds

3

14

 

Meditation

 

Dhyana

Awareness of breathing or Awareness of Positive thoughts /emotions /actions

6

Total Duration

30

 

*Period of exhalation shall be more than the period inhalation, preferably 1:2 (Inhalation: Exhalation).


Evening Session (15 Minutes):

 

S.

No.

Name of the practice

Rounds

Duration (in Minutes)

1

Savasana (Corpse Pose) arms stretched

1

1 minute

2

Abdominal Breathing

10 rounds

2 minutes

3

Thoracic Breathing

10 rounds

2 minutes

4

Clavicular Breathing

10 rounds

2 minutes

5

Deep Breathing (lying down position)

10 rounds

2 minutes

6

Relaxation in Shavasana with awareness on Abdominal breathing

 

5 minutes

Total Duration

15 minutes

 

    Period of exhalation shall be more than the period inhalation, preferably 1:2 (Inhalation: Exhalation).

    Advised steam inhalation every day or alternative day.

    Advised to gargling with lukewarm saline water regularly.

 

 

Note:

·         Loosening Exercises: Forward/ Backward bends, Spinal twist,

·         Breathing Exercises: Sectional Breathing, Yogic Breathing, Hands in and Out Breathing, Hands Stretch Breathing Yogic Breathing exercises and asanas found to improve lung volumes and reduce asthma attacks and inflammation in respiratory tract.

·         Breathing and Pranayama: Vaataneti, Kapalabhathi kriya, Bhastrika pranayama, Nadishodana pranayama for improvement in pulmonary functions.

·         Kriya: Jalaneti practice to cleanse and decongest the upper airways. Not to be used in dry cough.


ANNEXURE - 3

Management of Mild COVID-19 Cases

 

Clinical

severity

Symptom

Formulation*

Dose*

 

 

 

 

 

 

 

 

 

 

 

Mild COVID-19

Fever with Body ache, Headache

 

Nagaradi Kashaya

20 ml twice a day or as directed by Ayurveda

physician

 

Cough

Sitopaladi Churna with Honey

2 g thrice daily with Honey or as directed by Ayurveda physician

Sore throat, Loss of taste

 

Vyoshadi vati

Chew 1-2 pills as required

or as directed by Ayurveda physician

Fatigue

Chyawanprasha

10 g with warm water / milk

once a day

 

Hypoxia

 

Vasavaleha

10 g with warm water or as directed by Ayurveda

physician

 

Diarrhoea

 

Kutaja Ghana Vati

500 mg - 1 g thrice daily or as directed by Ayurveda

physician

 

Breathlessness

 

Kanakasava

10 ml with equal amount of water twice a day or as directed by Ayurveda

physician

 

*   In addition to these medicines; general and dietary measures are to be followed.

*   According to physician’s discretion. Physicians have to decide useful formulations from the above or substitutable classical medicines based upon their clinical judgement, suitability, availability and regional preferences. Dose may be adjusted based upon the patient’s age, weight, and condition of the disease.

*   Guidelines for Ayurveda Practitioners for COVID-19 notified by Ministry of AYUSH may also be referred.

 

Text Box: This is a general advisory. Attending physicians need to use their discretion to select the drugs based upon the stage of the disease, symptom complex and availability of the medicines. The recommended formulations in this attempt are in addition to standard approaches of care and prevention as well as other Ayurvedic approaches recommended for prevention earlier. Moderate to Severe COVID-19 individuals may have informed choice of treatment options.

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