High Commission of India
Ottawa
National Clinical Management Protocol based on Ayurveda and Yoga for management of Covid-19
Ministry of Ayush has created 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:
- Knowledge from Ayurveda classics and experience from clinicalpractices
- Empirical evidences and Biologicalplausibility
- Emerging trends of ongoing clinicalstudies
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 ofAYUSH.
General and Physical measures
- Follow physical distancing, respiratory and hand hygiene, wear mask
- 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.
- 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 tohome.
- Steam inhalation with Ajwain (Trachyspermum ammi) or Pudina (Mentha spicata) or Eucalyptus oil once aday
- Adequate sleep of 6 to 8hrs.
- Moderate physicalexercises
- 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) - asapplicable
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, balanceddiet
- Drink Golden Milk (Half tea spoon Haldi (Curcuma longa) powder in 150 ml hot milk) once at night. Avoid in case ofindigestion.
- Drink Ayush Kadha or Kwath (hot infusion or decoction) once aday.
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 andsevere
form andto
|
Guduchi Ghana vati [Samshamani vati or Giloy vati having Aqueous extract of Tinospora cordifolia IP] or the powder ofTinospora
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 thedisease
** Guidelines for Ayurveda Practitioners for COVID-19 notified by Ministry of AYUSH may also bereferred.
|
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 befollowed.
- 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 thedisease.
** Guidelines for Ayurveda Practitioners for COVID-19 notified by Ministry of AYUSH may also bereferred.
References:
- Guidelines for Ayurveda practitioners for COVID-19; available athttps://www.ayush.gov.in/docs/ayurved-guidlines.pdf
- Guidelines on Clinical Management of COVID-19; Government of India, Ministry of Health & Family Welfare; available athttps://www.mohfw.gov.in/pdf/GuidelinesonClinicalManagementofCOVID1912020.pdf
- Advisory from Ministry of AYUSH for meeting the challenge arising out of spread ofcorona virus (COVID-19) in India; available athttps://www.ayush.gov.in/docs/125.pdf
- Ayurveda’s immunity boosting measures for self-care during COVID-19 crisis; available athttps://www.ayush.gov.in/docs/123.pdf
- Post COVID management protocol of Ministry of Health & Family Welfare; availableathttps://www.mohfw.gov.in/pdf/PostCOVID13092020.pdf
- Revised SOP on preventive measures to be followed while conducting examinations to contain spread of COVID-19; available athttps://www.mohfw.gov.in/pdf/RevisedSOPonpreventivemeasurestobefollowedwhileconductinpdf
== == == ==
ANNEXURE - 1
Yoga Protocol for Primary Prevention of COVID- 19
Objectives:
- To improve respiratory and cardiacefficiency
- To reduce stress andanxiety
- To enhanceimmunity
|
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 alternativeday.
- Advised gargling with lukewarm saline waterregularly.
ANNEXURE - 2
Yoga Protocol for Post COVID- 19 care (including care for COVID-19 patients) Objectives:
- To improve pulmonary function and lungcapacity
- To reduce stress andanxiety
- To improve Muco-ciliary clearance Morning Session (30Minutes):
|
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 alternativeday.
- Advised to gargling with lukewarm saline waterregularly.
Note:
- Loosening Exercises: Forward/ Backward bends, Spinaltwist,
- 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 pulmonaryfunctions.
- Kriya: Jalaneti practice to cleanse and decongest the upper airways. Not to be used in drycough.
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 befollowed.
- 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 thedisease.
- Guidelines for Ayurveda Practitioners for COVID-19 notified by Ministry of AYUSH may also bereferred.
