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

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

Preamble

The COVlD-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 (M0HFW). 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 All India Institute of Ayurveda (AMA), Delhi, Institute of Post Graduate Training and Research in Ayurved (IPGTRA), Jamnagar, and National Institute of Ayurveda (NlA), 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 COVlD-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 COVlD-19 and Protocol for Post COVlD-19 care (including care for COVlD-19 patients - as applicable

Dietary measures

  1. Use warm water or boiled with herbs like ginger (Zin giber 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. 
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 1-3g 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 improve recovery rate  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 and Piper longum IP)  375 mg twice 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. 

Clinical Severity Clinical Presentation Clinical Parameters  Medicines* Doses & Timing
Mild COVlD-19 Positive**  Symptomatic management Fever, Headache, Tiredness Dry Cough, Sore throat, Nasal congestion  Without evidence of breathlessness or hypoxia (normal situation)  Guduchi + Vippali (Aqueous extracts Tinospora cordifolia IF and Piper longum IP)  375 mg twice 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 Ayurveaa physician 

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

Physicians have to decide useful formulations from the above or from additional medicines 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 COVlD-19 notified by Ministry of AYUSH may also be referred. 

Clinical Severity Clinical Parameters Medicines* Doses & Timing
Post COVID Management Prevention of Post COVID Lung complications like Fibrosis, Faligue, Mental Health  Ashwagandha (Aqueous extract of Withania somnifera IF)
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 
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 

* 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.

Source : Ministry of AYUSH



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