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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 33-39

Ayush Kwath to combat COVID-19: The current understanding and potential therapeutic action


1 Stree Rog and Prasuti Tantra, All India Institute of Ayurveda, New Delhi, India
2 Rog Nidan, Gangaputra Ayurvedic Medical College, Kandela, Haryana, All India Institute of Ayurveda, New Delhi, India
3 Vikriti Vigyan, IMS, BHU, Varanasi, Uttar Pradesh, India

Date of Submission02-Jun-2021
Date of Decision21-Jan-2022
Date of Acceptance25-Jan-2022
Date of Web Publication31-Mar-2022

Correspondence Address:
Dr. Meenakshi Sharma
Rog Nidan, Gangaputra Ayurvedic Medical College, Kandela, Haryana 126102.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_51_21

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  Abstract 

Background: Public health crises threatening the world have emerged as Covid pandemic. The present analysis is aimed to analyze and summarize the therapeutic potential of the herbal formulae—Ayush Kwath as a preventive, curative, and restorative intervention. The treatment for COVID-19 should primarily aim for the resolution of symptoms, arresting the pathogenesis at the earliest and shortening the recovery phase. With these objectives, the clinical efficiency of Ayush Kwath is being traversed in this study. Materials and Methods: A thorough search of classical text and databases was done using key terms Ayurveda, Jwara, Tulsi, Sunthi, Dalchini, and Krishna Marich. Results: The study found that Ayush Kwath can serve as an empirical drug for the disease. Our findings are categorized under (1) clinical perspectives of Ayush Kwath, (2) pharmacology and reverse-pharmacology of the formulation—its role in therapeutics of COVID-19, (3) psychoneuroimmunological mechanism of the formulation w.r.t. each of the constituents’ drugs, (4) therapeutic potential of the formulation—levels of prevention. Conclusion: From this review, efficacy of traditional medicines in Covid pandemic might be evidenced. This can back the clinical evidence of Ayurveda management of COVID-19. The drug can be labeled under “Vyadhiviprita chikitsaupakrama” and its application is a function of a Vaidya’s rationality. Considering lower economical value, therapeutic efficacy, and good availability of the drug makes it a potent entity to deal with a public health concern such as coronavirus disease.

Keywords: Ayurveda, Ayush Kwath, COVID-19, psychoneuroimmunology, toxicity


How to cite this article:
Sharma C, Sharma M, Mandal SK, Nanoti L. Ayush Kwath to combat COVID-19: The current understanding and potential therapeutic action. J Indian Sys Medicine 2022;10:33-9

How to cite this URL:
Sharma C, Sharma M, Mandal SK, Nanoti L. Ayush Kwath to combat COVID-19: The current understanding and potential therapeutic action. J Indian Sys Medicine [serial online] 2022 [cited 2022 Jun 26];10:33-9. Available from: https://www.joinsysmed.com/text.asp?2022/10/1/33/342315




  Introduction Top


Rationale of the Study

Coronavirus disease has been declared as a public health emergency of international concern, and its negative impact on every section of the society globally is a matter of concern. No therapeutic measures specific to it have been developed yet. The World Health Organization (WHO) is taking various measures to develop effective and safe traditional medicines to combat the pandemic. In India, integrative medicine is gaining momentum for treating certain diseases. Ayurveda is extensively used by wide sections of the population. Interventions in Ayurveda can be used for preventive, curative, and restorative measures in COVID-19. In current practices, a herbal decoction is being commonly used for prophylaxis and therapeutic purposes known as Ayush Kwath. It is composed of four herbal drugs. Moreover, the Ministry of AYUSH has also issued guidelines for treating the infection through Ayurveda formulations. But evidence-based practice must comprise best research evidence and clinical observations. As per our best knowledge, there is no work done yet on exploring the therapeutic efficiency of the drug. Hence, this review provides the descriptive analysis of clinical and pharmacological mechanisms of the drug.

Objectives of the Study

  • (a) Exploring the efficiency of AYUSH Kwath in COVID 19—a reverse pharmacological aspect;


  • (b) Different drug administration modalities for varying clinical presentations of COVID-19.


Methods

Searching

The searching methodology included two parallel grounds—classical texts and databases like PubMed, Google Scholar, and Cochrane. MeSH terms that were used for searching COVID were “Ayurveda,” “Jwara,” “Tulsi” (Ocimum sanctum Linn.), “Dalchini” (Cinnamomum zeylenicum Breyn.), “Sunthi” (Zingiber officinale Roxb.), and “Krishna Marich” (Piper nigrum Linn.).

Selection

Studies and reviews were coded under six categories of

  • (1) COVID-19,


  • (2) Tulsi (O. sanctum L.),


  • (3) Dalchini (C. zeylenicum Breyn.),


  • (4) Sunthi (Z. officinale Roxb.),


  • (5) Krishna Marich (P. nigrum L.), and


  • (6) inflammation [Figure 1].
Figure 1: Methodology of screening and selection of research articles

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The studies were selected if

  • (a) they included a link between COVID-19 and ayurveda,


  • (b) drugs were studied in relation to their action on inflammatory changes in COVID,


  • (c) treatment modalities for the disease were targeting the immune system,


  • (d) they identified a mechanism of therapeutic action, and


  • (e) there is an Ayurvedic understanding of COVID and/or pharmacological action of these drugs.



  Review Results Top


Results of the work are categorized under three groups of findings:

  • Clinical perspectives of Ayush Kwath


  • Pharmacology and reverse-pharmacology of the formulation—its role in the therapeutics of COVID-19,


  • Psychoneuroimmunological mechanism of the formulation w.r.t. each of the constituent drugs;


  • Toxicological studies.


Ayush Kwath has the following contents in the proportion as mentioned earlier[

1-3 ]


  • (1) Tulsi (O. sanctum Linn.) leaves—4 parts;


  • (2) Dalchini (C. zeylenicum Breyn.) stem bark—2 parts;


  • (3) Sunthi (Z. officinale Roxb.) rhizome—2 parts;


  • (4) Krishna Marich (P. nigrum Linn.) fruit—1 part.


The Ayurvedic conceptual framework of drug action includes drug-related pharmacological properties, i.e., Rasa (taste), Guna (quality), Virya (potency), Vipaka (transformed state after digestion), and Prabhava (action). Chikitsa is the Upkrama framed to reverse the Samprapti. Samprapti is defined as the process of disease formation or transformation to a balanced state—the disturbed action of Dosa leading to the manifestation of a disease. The described formulation has an active role in reversing the pathology in different stages. The flowchart is the descriptive pathway of disease manifestation when compared with the potential role of Ayush Kwath in reversing the pathology at each step [Figure 2].
Figure 2: Descriptive pathway of disease manifestation and potential role of Ayush Kwath in reversing the pathology at each step

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Pharmacology and Reverse-pharmacology of the Formulation: Its Role in Therapeutics of COVID-19

Previous clinical studies suggested the following therapeutic and pharmacological characteristics of contents of Ayush Kwath [Table 1].
Table 1: Contents and pharmacological action of Ayush Kwath[1],[2],[3]

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Tulsi

Clinical studies proved that O. sanctum aqueous extract remarkably enhanced antioxidant enzymes activity when compared with control.[4] It was revealed by another study that higher content of linoleic acid in O. sanctum L. fixed oil aiding toward its antibacterial activity.[5] In a cell-based assay, the aqueous extract of O. sanctum L. treatment reduced the bacterial count and increased lymphocyte and neutrophil counts with increased phagocytic activity proving its immunomodulatory potential. In a clinical study, the immunomodulatory effect of O. sanctum seed oil (OSSO) in both non-stressed and stressed animals was established.[6] Another study reported that O. sanctum L. has the capacity to block both the cyclooxygenase and lipoxygenase pathways of arachidonate metabolism contributing toward its anti-inflammatory action due to the presence of linoleic acid in fixed oil of its species.[7] It was found that O. sanctum fixed oil increased blood clotting time compared with aspirin due to the inhibition of platelet aggregation.[8]

Dalchini

In a clinical study, anti-inflammatory action of the C. zeylanicum bark extract was revealed. It was found that the extract inhibited tumor necrosis factor (TNF).[9] Cytokines storm, i.e., upregulation of proinflammatory cytokines in the blood, [interleukin (IL)-1, IL-6, TNF, and interferon-γ] is associated with severe COVID-19. Anti-TNF therapy in treating viral pneumonia is suggested in clinical trials, and C. zeylanicum can be a candidate. Hong et al.[10] demonstrated that serum levels of TNF-α and IL-6 were remarkably decreased by oral administration of cinnamon water extract (CWE) to mice. In-vitro CWE treatment decreased the mRNA expression of TNF-α and inhibited the lipopolysaccharide-induced degradation of IκBα and activation of ERK1/2, JNK, and p38. Cinnamyl derivative compounds of the drug showed potent anti-pyretic action by inhibiting IL-1alpha production.[11] Essential oil and powder of C. zeylanicum possess antiviral activity by virtue of its immune stimulatory property.[9] Angiotensin-converting enzyme inhibitory activity of cinnamon is documented in studies. The efficacy of this class of drugs along with angiotensin receptor blockers in treating COVID-19 is under trial.[12] There is another theory that these drugs cause repression of ACE-2, which is the surface receptor of SARS-CoV-2 virus.[13] Thus, while considering the therapeutic action of this drug, both the aspects should be considered.

Sunthi

Shogaol and Gingerol compounds in Z. officinale were found to inhibit prostaglandin and leukotriene synthesis. These also suppress the synthesis of proinflammatory cytokines (IL-1, IL-8, and TNF-α).[14],[15] Shogaol also down-regulated COX-2 gene expression, revealed in another study.[16] Certain in-vivo and in-vitro studies explored antioxidative properties of ginger and its components help in strengthening immunity that protects us from morbidities.[17] The in-vitro aqueous extract of ginger inhibited platelet aggregation due to inhibition of thromboxane and prostacyclin synthesis.[18] The drug can be beneficial in thrombotic diseases associated with COVID-19 (which is present due to excessive inflammation, platelet activation, endothelial dysfunction, and stasis). Z. officinale inhibited viral replication inside the HCV-infected HepG2 cells; hence, it might be considered a drug candidate in Covid scenario.[19]

Krishna Marich

Various clinical and experimental studies have proved that the alkaloid extracted from P. nigrum possesses piperine contributing to antioxidant, anti-amoebic, anti-carcinogenic, anti-asthmatic, anti-inflammatory, and immunomodulatory properties.[20] The effect of piperine was evaluated on B cell functioning and humoral immune response through a clinical study, and its anti-proliferative action was reported. It was also found that piperine not only inhibited secretion of IgM antibody, but reduced expression of cluster of differentiation CD86 too.[21] Piperine in combination with gamma-aminobutyric acid enhanced EPO and EPO-R expression, resulting in the repression of IL-10 and NF-κB.[22] Anti-inflammatory activity of piperine was observed by inhibiting i-NOS and COX-2.[23] In a cell-based assay, the extract of P. nigrum inhibited Coxsackievirus type B3. In another study, it was found that piperine inhibited the synthesis of prostaglandin E2 even at 10 μg/mL and depression of IL-6.[24]

Probable mode of action of Ayush Kwath in reversing the pathology of COVID-19 is depicted in [Figure 3].
Figure 3: Probable mode of action of Ayush kwath in reversing clinical and immuno-pathology of Covid-19

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Psychoneuroimmunological Mechanism of the Formulation w.r.t. Each of the Drugs

The relation between psychosomatic distress and immune responses in Covid-19 has been established by researchers. Upper respiratory tract infections are strongly associated with psychosocial factors such as stress, depression, and anxiety.[25] Psychoneuroimmunology is based on an evident relationship among the neural, endocrine function, and immune systems[26] and explicates the findings mentioned in [Figure 4].
Figure 4: Psychoneuroimmunological mechanism of Ayush Kwath

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Adverse Effects on Prolonged Use

High dose of O. sanctum extract (OSE) at 2000 mg/kg did not produce toxic effects in an acute toxicity. Subacute studies in rats at 800 mg/kg OSE administration did not illustrate any change in the hematological profile and spleen and liver function.[26] In toxicological studies on ethanolic extracts of C. zeylanicum, a significant increase in the spleen and lungs weight was noticed in treated animals when compared with the controls.[27] In acute toxicity studies of piperine, in albino rats receiving test drug five times higher than the therapeutic dose, no sign of mortality was observed. Similarly, subacute toxicity study also did not reveal any change in biochemical parameters at three times the therapeutic dose.[28] However, in a toxicity study, piperine was found to be acutely toxic to rat hamsters and mice. In lethal doses, the animals died within 3–17 min due to respiratory paralysis.[29] Results of in-vivo and in-vitro studies of black pepper’s constituent piperine confirmed that it does not cause genotoxicity.[30] Toxicity studies on Z. officinalis oil indicate that long-term use may induce some undesirable effects such as oxidative stress, among others. Findings suggest caution on chronic use of ginger oils.[31],[32]


  Discussion Top


Besides ongoing developments in mechanical prevention strategy and the disease surveillance system, neonatal drug discovery is the need of hour. Recapitulation and adaptation of the knowledge of Ayurveda to modern drug discovery processes can bring precise and personalized therapeutic solutions for the pandemic. Traditional medicines from diverse habitats and geological location may act as the novel drug for Covid-19 infection.[33] They can be administered for preventive, curative, and restorative purposes. Ayush Kwath has anti-viral, immunomodulatory, anti-pyretic, analgesic, digestive, and hepatoprotective action achieved by virtue of its ingredients. As per classical perspective, Tikta, KatuRasa, Usna Virya and Jvaraghna, Deepana, Pachana, Yakritduttejaka, Srotoshodhakakapaha-shamaka, Raktashodhaka, Krimighna, Swasahara action of the constituents has a direct role to pacify various clinical signs, symptoms, and complications. Ayush Kwath help to improve Agni and promotes metabolism, digestion, and absorption and acts as rasayana for the development of preceding Dhatu and finally promoting immunity. Reutilizing the available drugs in treating COVID-19 will reduce the time and cost to develop effective therapeutic measures against the pandemic.[34] Hence, there is a need to analyze the effectivity of Ayurveda management in COVID-19, but it has to be based on personal observations, peer interactions, and published research. At a preliminary level, this study is a screening process in the direction of determining the efficacy of AYUSH Kwath in COVID-19, considering the reverse pharmacological aspect, and it also probed different drug administration modalities for varying clinical presentations of the disease. The review concludes that the drug can be a potent candidate for combating the pathology of COVID-19 in mild-to-moderate clinical cases as it serves as “Hetuviprita” and “VyadhivipritaUpakarma.

Limitations

During the review, the authors did not find any clinical evidence of therapeutic potential of the conventional treatment, drug interaction, and adverse effects of the combinations.

Scope for Future Study

The authors advocate that case studies and clinical trials are required to generate sincere evidence for the same. Future research works shall be conducted with the proposed clinical models, abiding the principles of clinical therapeutics.


  Clinical Significance Top


The therapeutic science of Ayurveda is a multifactorial decisive choice made by the clinicians based on the principles of precision and personalized medicine. The factors considered are as follows: (a) Doshaevumdoshaawastha, (b) Prakriti, (c) Roga, (d) Koshtha, (e) Vaya, (f) Aturabala, and (g) Roga-marga. In the treatment of COVID-19, AYUSH Kwath can be the drug of choice, implying its role in prophylactic care, curative care, and therapeutic care. With respect to the pandemic, the population can be divided into four groups [Figure 5]:
Figure 5: The proposed methodology to utilize Ayush Kwath for different levels of prevention

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  • Unexposed group (requires primary prevention);


  • Exposed asymptomatic group (requires secondary prevention);


  • Diagnosed case of COVID-19 (requires curative care);


  • Follow-up period of treated patients of COVID-19 (requires restorative care).


  • Ayush Kwath is a single formulation that can be used in all the four classes of population, serving different objectives. The proposed methodology to use this formulation is described in [Figure 5].Tertiary prevention includes treatment based on varying clinical presentations and Sroto-dushti. As this Kwath has the properties that increase Pitta dosha, it should therefore be administered considering the Prakriti and Doshaawastha of the diseases; otherwise, it may lead to Raktadushti.

    Conclusion

    A pandemic should not be considered a single exclusive event: it is more of an interconnected cycle of events. In the same way, approaches to cope up with such challenges should also be holistic. Harnessing the potential of traditional system of medicines in developing rational strategies against Covid-19 is the requisite of time. This article deals with the mechanistic model of clinical pharmacology of an Ayurveda formulation, which has been mentioned in advisory of the Ministry of AYUSH to combat COVID-19 and is being used as a therapeutic choice for the management of COVID-19 patients.

    Acknowledgments

    We would like to acknowledge Prof. (Dr.) Tanuja Manoj Nesari ma'am, Director, All India Institute of Ayurveda, New Delhi for her guidance and support.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.



     
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        Figures

      [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
     
     
        Tables

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