Ministry of AYUSH
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.
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
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 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.
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 and severe
form and to
|
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
|
|
|
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 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:
1.
Guidelines for Ayurveda practitioners for COVID-19;
available at https://www.ayush.gov.in/docs/ayurved-guidlines.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 spread of corona
virus (COVID-19) in India; available at https://www.ayush.gov.in/docs/125.pdf
4.
Ayurveda’s immunity boosting measures for self-care
during COVID-19 crisis; available at https://www.ayush.gov.in/docs/123.pdf
5.
Post COVID management protocol of Ministry of Health
& Family Welfare; available at https://www.mohfw.gov.in/pdf/PostCOVID13092020.pdf
6.
Revised SOP on preventive measures to be followed
while conducting examinations to contain spread of COVID-19; available at https://www.mohfw.gov.in/pdf/RevisedSOPonpreventivemeasurestobefollowedwhileconductin gexaminationstocontainspreadofCOVID19.pdf
== == == ==
ANNEXURE
- 1
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 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.
