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

Posted on: October 15, 2020 | Back | Print

Ministry of AYUSH

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

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.
    1. 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.
    2. Steam inhalation with Ajwain (Trachyspermum ammi) or Pudina (Mentha spicata) or Eucalyptus oil once a day
    3. Adequate sleep of 6 to 8 hrs.
    4. Moderate physical exercises
    5. 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

        • 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.
        • Fresh, warm, balanced diet
        • Drink Golden Milk (Half tea spoon Haldi (Curcuma longa) powder in 150 ml hot milk) once at night. Avoid in case of indigestion.
        • Drink Ayush Kadha or Kwath (hot infusion or decoction) once a day.

        Specific Measures / Symptom Management

        Clinical
        severity
        Medicines*
        Doses & Timing
        Prophylactic care (high riskpopulation,primarycontacts)
        Ashwagandha (Aqueous extract ofWithania 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
         
         
        AsymptomaticCOVID-19Positive
         
         

        Forprevention of disease progression to symptomatic and severeform 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
        375 mg twice daily with warm water for 15 days or as directed by
         


        and Piper longum IP)
        Ayurveda physician
         
         
         
         
         
         
         
         
        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:

        == == == ==

        ANNEXURE - 1

        Yoga Protocol for Primary Prevention of COVID- 19

        Objectives:
          1. To improve respiratory and cardiac efficiency
          2. To reduce stress and anxiety
          3. 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

          1. Advised Jalaneti kriya weekly thrice.
          2. Advised steam inhalation every day or alternative day.
          3. Advised gargling with lukewarm saline water regularly.

        ANNEXURE - 2

        Yoga Protocol for Post COVID- 19 care (including care for COVID-19 patients) Objectives:
          1. To improve pulmonary function and lung capacity
          2. To reduce stress and anxiety
          3. 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.

          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.