Union Health Minister releases COVID-19 management protocol based on Ayurveda, yoga; Details

Published On 2020-10-07 04:00 GMT   |   Update On 2020-10-07 04:00 GMT

New Delhi: Union Health Minister, Harsh Vardhan, recently released The 'National Clinical Management Protocol based on Ayurveda and Yoga for Management of Covid-19'.The protocol lists dietary measures, yoga, and Ayurvedic herbs and formulations such as Ashwagandha and AYUSH-64 for the prevention of coronavirus infection and treatment of mild and asymptomatic cases. The details of the...

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New Delhi: Union Health Minister, Harsh Vardhan, recently released The 'National Clinical Management Protocol based on Ayurveda and Yoga for Management of Covid-19'.

The protocol lists dietary measures, yoga, and Ayurvedic herbs and formulations such as Ashwagandha and AYUSH-64 for the prevention of coronavirus infection and treatment of mild and asymptomatic cases. The details of the protocol reads;

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 is 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 the standard of care.

Ayurveda and Yoga can certainly play a pivotal role to augment preventive measures provided in the guidelines by the 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.

The following three aspects are considered while preparing this protocol:

1. Knowledge from Ayurveda classics and experience from clinical practices

2. Empirical evidence and Biological plausibility

3. Emerging trends of ongoing clinical studies

This consensus document is developed by expert committees from All 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 the management of mild COVID-19. Moderate to Severe COVID-19 individuals may have an informed choice of treatment options. All severe cases will be referred to.

This protocol and its annexure are approved by the Chairman, Interdisciplinary Committee for the 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 a 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 installation/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 teaspoon 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 I 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


Clinical
severity

Clinical
Presentation

Medicines*

Doses & Timing

Asymptomatic

— COVID- ic

19

Positive

For prevention
of disease

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 COVID-19
Positive**

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

Without
evidence of
breathlessness
or hypoxia
(normal
situation)

Guduchi + Hippaii

(Aqueous extracts

Tinospora cordifolia IP and Piper longum

IP)

:31b 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. 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 judgment, suitability, availability and regional preferences. The 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 the Ministry of AYUSH may also be referred.

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

According to the physician's discretion. Physicians have to decide useful formulations from the above or substitutable classical medicines based upon their clinical judgment, suitability, availability, and regional preferences. The 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 the Ministry of AYUSH may also be referred.

References:

1. Guidelines for Ayurveda practitioners for COVID-19; available at. https://www.ayush.qov.in/docs/ayurved-quidlines.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 the spread of coronavirus (COVID-19) in India; available at https://www.ayush.gov.in/docs/125.pdf

4. Ayurveda's immunity-boosting measures for self-care during the COVID-19 crisis; available at https://www.ayush. pov. in/does/123.pdf

5. Post COVID management protocol of Ministry of Health & Family Welfare; available at https://www. mohfw.gov. in/pdf/PostCOVI D 13092020. pdf

6. Revised SOP on preventive measures to be followed while conducting examinations to contain the spread of COVID-19; available at https://www.mohfw.govin/pdf/RevisedS0Ponpreventivemeasurestobefollowedwhileconductin gexaminationstocontainspreadofCOVID19.pdf

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 gargle 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.

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 Churns 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 an 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 the physician's discretion. Physicians have to decide useful formulations from the above or substitutable classical medicines based upon their clinical judgment, suitability, availability, and regional preferences. The 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 the 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 an informed choice of treatment options.

For more details click on the link below-

https://medicaldialogues.in/pdf_upload/pdf_upload-135453.pdf

Also Read: WB launches COVID Patient Management System to deal with admission, treatment-related issues

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