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\def\RunningAuthor{Sneha Dhakite and Sadhana Misar Wajpeyi}
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\articleType{Review Article}
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\title{Role of Rasayana in Prevention of COVID-19 - A Review}
\author{Sneha~Dhakite\textsuperscript{*}\textsuperscript{1}, 
            Sadhana~Misar~Wajpeyi\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital \& Research Centre, Salod (H), Wardha, Datta Meghe Institute of Medical Sciences (DU), Nagpur, Maharashtra, India}~\\{\textsuperscript{2}Department of Swasthavritta, Mahatma Gandhi Ayurved College, Hospital \& Research Centre, Salod (H), Wardha, Datta Meghe Institute of Medical Sciences (DU), Nagpur, Maharashtra, India}}

\begin{abstract}
The ``Coronavirus disease 19 (COVID-19)'' is caused by ``Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)'', a newly discovered member of the \textit{Coronaviridae} family of viruses which is a highly communicable. There is no effective medical treatment till date for Coronavirus disease hence prevention is the best way to keep disease away. \textit{Rasayana } proved to be highly efficacious and cost effective for the Prevention and Control of viral infections when vaccines and standard therapies are lacking. \textit{Rasayana Chikitsa } is one of the eight branches of \textit{Ashtanga Ayurveda} which helps to maintain healthy life style. \textit{Rasayana} improves immunity and performs many vital functions of human body. \textit{Vyadhikshamatva } that is immune mechanism of the body is involved in Prevention of the occurrence of a new disease and it also decreases the virulence and progression of an existing disease. In COVID-19 the Respiratory system mainly get affected which is evident from its symptoms like cold, cough and breathlessness. Here the drugs help in enhancing immune system and strengthening functions of Respiratory system can be useful. For this purpose, the \textit{Rasayana} like \textit{Chyavanprasha}, \textit{Agastya Haritaki}, \textit{Pippali Rasayana, Guduchi, Yashtimadhu}, \textit{Haridra}, \textit{Ashwagandha}, \textit{Tulsi} are used. \textit{Rasayana }working on Respiratory system are best for Prevention of Coronavirus and boosting immune system. \textit{Rasayana Chikitsa} can be effective in the Prevention as well as reducing symptoms of COVID-19.
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}Coronavirus,\newline COVID-19,\newline Immunity,\newline Rasayana,\newline Vyadhikshamatva
\end{keywords}
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Sneha~Dhakite~\\ Phone:\ 7774997824~\\  Email:\ dhakitesneha4@gmail.com
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\section{\textbf{Introduction}}
The ``Coronavirus disease 19 (COVID-19)'' is caused by ``Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2)'', a newly discovered member of the \textit{Coronaviridae} family of viruses which is a highly communicable which emerged in Wuhan, China and extend all over the world \unskip~\citep{853371:20023748}. The primary target for Corona viruses is Respiratory system. Corona virus disease spreads mostly through contact with an infected person when they sneeze or cough. It also spreads by touching a surface or object infected by virus, through eyes, nose or mouth. The common symptoms of COVID-19  are pyrexia, cough and breathlessness. Associated symptoms include weakness, body ache, sore throat, loss of smell, diarrhoea and abdominal pain \unskip~\citep{853371:20023816}. The incubation period of COVID-19 ranges between 2-14 days \unskip~\citep{853371:20023744}. More than 1.77 million cases have been accounted in more than 210 countries and union territories at April 2020, causing more than 108,000 deaths. The number of recovered people is more than 404,000 \unskip~\citep{853371:20023815}. Diagnosis can be made from samples obtained by a nasopharyngeal swab, similarly samples from nasal swab or sputum may also be used. The Respiratory system is the most affected system by COVID-19 because the virus enters the host cells through the enzyme angiotensin-converting enzyme 2 (ACE2), which is abundantly present in type II alveolar cells of the lungs \unskip~\citep{853371:20023755}. \textit{Rasayana} are compounds or herbs that support the functioning of the immune system including the production of immune cells, detection of antigens, and the elimination of infectious agents. As no effective medical treatment till date for Corona virus disease, Prevention is the best way to keep disease away. \textit{Rasayana } is the highly efficacious and cost-effective therapy for the Prevention and Control of viral infections when vaccines and standard therapies are lacking.

\textbf{Need of study}

Now-a-days there is a gradual decrease in immunity of human beings. Many new and incurable diseases are spreading worldwide, COVID-19 is one such viral diseases. Currently there is neither effective antiviral drugs nor effective vaccines are available for COVID-19. Prevention is the best strategy to deal with it. Hence it is necessary to boost immunity in order to prevent this disease. It is possible with \textit{Rasayana Chikitsa} (Rejuvenating therapy). \textit{Rasayana} plays important role in boosting immunity for Fighting and Preventing from COVID-19. This review aims to study the role of \textit{Rasayana } described in \textit{Ayurveda} in Prevention of COVID-19.
    
\section{\textbf{Methodology}}
Relevant data was collected from \textit{Ayurvedic} classical books; internet and research articles were searched from PubMed and Google Scholar.

\textbf{Observations and Results}

\textbf{Concept of Immunity in \textit{Ayurveda}}

Immunity is the defence mechanism of body that protects against disease by identifying and destroying pathological organisms. It identifies variety of pathogens like viruses, bacteria, fungus and parasitic worms, and have ability to destroy them. The immune system mainly protects the body from foreign matters that causes damage by disturbing the homeostatic balance. Principles of \textit{Vyadhikshamatva } in \textit{Ayurveda} are free from ailments and lead healthy and wealthy life \unskip~\citep{853371:20023756}. Various factors which contribute towards \textit{Vyadhikshamatva } are normal \textit{Doshas}, equilibrium state of \textit{Dhatus}, normal \textit{Agni} and patency of \textit{Srotas } (microchannels) \unskip~\citep{853371:20023746}. \textit{Vyadhikshamatva} is involved in Prevention of the occurrence of a new disease and it also decreases the virulence and progression of an existing disease \unskip~\citep{853371:20023818}. \textit{Vyadhikshamatva } is an attribute of inherent \textit{Ojas, Dhatu } or vital immune strength. Immunomodulation is a process which can adjust the immune system of an organism by interfering with its functions and results in development of immune reactions that in turn decline the inflammatory response. \textit{Rasayana} means the way for achieving excellent \textit{Rasaadi} seven \textit{Dhatus}.

\textbf{Concept of \textit{Rasayana}}

The \textit{Dravyas} which promotes the \textit{Dhatus} are known as \textit{Rasayana}. \textit{Rasayana} therapy is one which delays the \textit{Jara} (old age) and helps to Cures the diseases. Hence \textit{Rasayana} is used for promotion of strength in the healthy, for Prevention as well as Curative purpose of the diseases.

\textbf{Types of \textit{Rasayana}}

\textit{Dravyabhuta Rasayana} and \textit{Adravyabhuta Rasayana} (\textit{Achara Rasayana}) are two types of \textit{Rasayana}. According to the mode of administration \textit{Rasayana} is divided into \textit{Kutipraveshika Rasayana } (Intensive indoor rejuvenate regimen) and \textit{Vatatapika Rasayana } (Outdoor rejuvenate regimen) \unskip~\citep{853371:20023751}. On the basis of diet and life styles it is categorized into \textit{Aushdha Rasayana} (Drug based \textit{Rasayana}), \textit{Ahara Rasayana} (Dietary \textit{Rasayana}) and \textit{Achara Rasayana} (Life style \textit{Rasayana}) \unskip~\citep{853371:20023749}. According to the purpose there are three types of \textit{Rasayana} namely \textit{Naimittika, Ajasrika and Kamya Rasayana} \textit{Naimittika Rasayana} is the type of \textit{Rasayana } therapy used for specific Curative purpose. It accelerates the recovery from prevailing diseases. \textit{Ajasrika Rasayana} is used in improving health and preserving good healthy lifestyle, diet or exercise. It involves utilization of milk, ghee, honey and maintenance of discipline life style. \textit{Kamya Rasayana } is used to improve certain function that is desirous.

\textit{Chyavanprasha}, \textit{Agastya Haritaki } and \textit{Pippali Rasayana } are mainly indicated in disorders of Respiratory system like cough, asthma and hiccough\textit{. }They also help in increasing immunity and strengthening Respiratory organs.

\textit{Guduchi }(\textit{Tinospora cordifolia}), \textit{Yashtimadhu }(\textit{Glycyrrhiza glabra} Linn.), \textit{Haridra }(\textit{Curcuma longa} Linn.), \textit{Ashwagandha }(\textit{Withania somnifera}), \textit{Tulsi }(\textit{Ocimum sanctum }Linn.) and \textit{Triphala} are mainly used for enhancement of immune system. Some research studies proved the immunity boosting property of \textit{Rasayana} are mentioned in Table~\ref{tw-ed9ed8c9b63c}.
\bgroup
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\makeatother 
\caption{\boldmath {Mode of action of Rasayana}}
\label{f-578501ba8722}
\end{figure*}
\egroup

    
\section{\textbf{Discussion}}
\textbf{Probable mode of action of Rasayana}

\textit{Rasayana} helps to improve digestion and metabolism as well as microcirculations, thus allowing to obtain the best qualities of all \textit{Dhatus}. \textit{Rasayana} acts on seven \textit{Dhatus } which further improves the \textit{Oja } which is responsible for producing good immune power in the body. This \textit{Oja} gives immunity to the body by nonspecific way mediated through neutrophils and monocytes and by specific way mediated by B lymphocytes which acts against the virus and bacterial pathogens. Humoral mediated by B lymphocytes become plasma cells and produces immunoglobin which destroys antigens. Majority of \textit{Rasayana } drugs works on numerous organs by improving their functions by acquiring \textit{Vyadhikshamatva} through its appetizer, digestive, cognition enhancement, antioxidant, adaptogenic and immunomodulators properties are as shown in Figure~\ref{f-578501ba8722} ,\unskip~\citep{853371:20023740}.

\textit{\textbf{Ayurveda }} \textbf{\& COVID-19}

As the changes in lifestyle and environment are bound to happen, newer conditions are gaining to come up hence it can be tackled as per the \textit{Tridosha} theory explained in classics of \textit{Ayurveda}. \textit{Acharya Sushruta} has described \textit{Aupasargika rogas }i.e. communicable \& contagious diseases which can be transmitted through breathing or touching. Centre for Disease Control \& Prevention \unskip~\citet{853371:20023747} says that human Corona viruses are most commonly spread between an infected person and others by touching infected surface, coughing or sneezing \unskip~\citep{853371:20023977}. In \textit{Ayurveda } a term called ``\textit{Srotas}'' ie Channel or path which carry essential nutrients to different organs, acts as one of the significant factors in the pathogenesis of diseases. Obstruction in the \textit{Srotas} is one of the processes in pathogenesis of disease. The transportation \& transfusion of \textit{Pranavayu} is the main function of \textit{Pranavaha Strotas } (Respiratory system). This \textit{Pranavaha Srotas } gets vitiated because of various reasons like \textit{Raja} (dust particles containing viruses), \textit{Dhuma} (smoke containing air pollutants) \textit{Sheetasthana} (cold environment). This \textit{Raja} when enters through mouth and nose develops disease like \textit{Kasa} (cough), \textit{Hikka }(hiccups), \textit{Shwasa} (asthma), \textit{Pratishay a }(running or stuffy nose) which are similar to Coronavirus.\textbf{\space }

\textbf{Prevention and management of COVID-19 through \textit{Rasayana}}

\textit{Pranavaha Srotas }carries \textit{Pranavayu, }in connection (\textit{moolsthna}) with \textit{Hruday} (heart) and \textit{Dashadhamanis}. In COVID-19 the Respiratory system mainly get affected which is evident from its symptoms like cold, cough and breathlessness. Here the drugs working on Respiratory system and strengthening its functions can be useful. For boosting immune system for Prevention of Coronavirus \textit{Giloy}, \textit{Tulsi}, \textit{Agastya Rasayana}, \textit{Pippali Rasayana} are the best \textit{}


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\begin{longtable}{p{\dimexpr.167\linewidth-2\tabcolsep}p{\dimexpr.22910000000000004\linewidth-2\tabcolsep}p{\dimexpr.30229999999999993\linewidth-2\tabcolsep}p{\dimexpr.30160000000000004\linewidth-2\tabcolsep}}
\caption{\boldmath {Following research studies proved the immunity boosting property of Rasayana} }
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\tbltoprule \rowcolor{kwdboxcolor}\textbf{Author,Year } & \textbf{Title} & \textbf{Treatment given} & \textbf{Outcome}\\
\tblmidrule 
\unskip~\citep{853371:20023743} &
  ``Evaluation of Chyavanprasha on Health and Immunity related Parameters in Healthy Children: A Two Arm, Randomized, Open Labelled, Prospective, Multicentre, Clinical study''  &
  (Gr-A) (N=313): Chyavanprasha orally two times followed by a cup of milk daily. \mbox{}\protect\newline (Gr-A) (N=314): A cup of milk only twice daily for 6 months  &
  Results showed more than 2 times protection from immunity related illness in Chyavanprasha Group as compared to the Control group. It also showed better percentage improvement in energy levels, physical fitness, strength, stamina and quality of life .\\
\unskip~\citep{853371:20023761} &
  Tinospora \mbox{}\protect\newline cordifolia \mbox{}\protect\newline enhances \mbox{}\protect\newline Vyadhiksha \mbox{}\protect\newline matwa \mbox{}\protect\newline (immunity) in Children'' &
  (Gr-A) (N=200): \mbox{}\protect\newline Tinospora \mbox{}\protect\newline cordifolia \mbox{}\protect\newline powder(Gr-B)(N=200): Placebo (wheat flour) for 2 months  &
  Tinosporacordifoliashowed statistically significant increase in TLC, ALC and lymphocyte percentage as compared to Placebo.Hence it can be used as an adjuvant to vaccination in order to boost the immune system.\\
\unskip~\citep{853371:20023760} &
  ``Effect of Chyavanprasha on Cognitive, Autonomic and Respiratory parameters in college students'' &
  (N=128):Zandu SonaChandi \mbox{}\protect\newline ChyavanprashaPlus of Hemma Herbs for 150 days  &
  Chyavanprashahelps in improvement in Cognitive activity, wellbeing and the Respiratory parameters like PO2, pulse rate and blood pressure in college students.\\
\unskip~\citep{853371:20023753} &
  ``Adjunct therapy of Ayurvedic medicine with anti-tubercular drugs on the therapeutic management of pulmonary tuberculosis'' &
  (N=99): ATD as an adjunct with Ashwagandha (Withaniasomnifera) and a multi-herbal formulation Chyavanprasha &
  Body weight showed improvement, appreciable change in IgA and IgM patterns and significantly increased bioavailability of isoniazid and pyrazinamide were recorded.Hence it brings up solutions in public health initiatives to boost health care delivery system in India in pulmonary tuberculosis care. \\
\unskip~\citep{853371:20023752} &
  ``Clinical Evaluation of ShilajatuRasayana in patients with HIV Infection''  &
  (Gr-A)(N=12): ART along with ShilajatuRasayana for 3 months \mbox{}\protect\newline (Gr-B)(N=8): HAART Therapy from the AIDS Clinic of Modern Medicine  &
  ShilajatuRasayan enhances the immunity by increasing CD4 T helper cell counts, prevents the resistance of HIV virus to ART drugs also decreased the intensity of the Clinical symptoms and signs thereby protected the liver from the hepatotoxicity of ART\\
\unskip~\citep{853371:20023750} &
  ``Role of Rasayana in Cure and Prevention of Recurrence of Vicharchika (Eczema)'' &
  (Group SR) -Guduchi-Bhringaraja \mbox{}\protect\newline Rasayana with external application of SnuhyadiLepa \mbox{}\protect\newline (Group S) -Shirishadi \mbox{}\protect\newline decoction administered orally with external application of SnuhyadiLepa for 60 days &
  No recurrence was reported in Group SR due to addition of Guduchi-BhringarajaRasayanawhile recurrence rate was more in Group S \\
\unskip~\citep{853371:20023757} &
  ``A Clinical study to evaluate the efficacy of PippaliRasayana in certain Respiratory disorders'' &
  (Gr-I)(N=15): Pippali Rasayana prepared from Palash Ksharabhavit \mbox{}\protect\newline Pippali for 45 days \mbox{}\protect\newline (Gr-II)(N=12): On respective allopathic drug treatment &
  PippaliRasayana helps in increasing Hb\% and reduction in ESR also showed improvement in frequency and duration of exacerbation. Hence it is very much effective in the management of Respiratory diseases as an adjuvant\\
\unskip~\citep{853371:20023754} &
  ``Immuno \mbox{}\protect\newline modulatory effect of Tinospora \mbox{}\protect\newline cordifolia \mbox{}\protect\newline extract in human immuno-deficiency virus positive patients'' &
  68 patients of HIV positive divided into two groups, one receiving TCE and other placebo for six months.  &
  Tinosporacordifolia extract, group showed significant improvement in reduction of symptoms due to immunostimulant, property of Tinosporacordifolia so they concluded that it could be used as an adjunct to HIV/AIDS management. \\
\unskip~\citep{853371:20023759} &
  ``Effect of Sonachandi \mbox{}\protect\newline Chyavan \mbox{}\protect\newline prasha and Chyavanprasha Plus--two herbal formulations on immuno \mbox{}\protect\newline modulation''  &
  Sonachandi \mbox{}\protect\newline Chyavan prasha and Chyavan prasha Plus--two herbal formulations &
  Both the drugs increased the macrophage activity and enhancement of non-specific immune response and reduction of chances of infection. Protected Cyclosporine A induced immunosuppression suggesting the immunoprotected role of the aforesaid herbal formulations.\\
\tblbottomrule 
\end{longtable}
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\textit{Rasayana} working on \textit{Pranvaha Strotas \textit{}(Respiratory \textit{}}system). \textit{Tribhuvankirtiras, Laxmivilasras, Mahalakshmi Vilas ras, Chitrak Haritaki, Eladivati, Talisadichurna, Sitopaladichurna, Kantakarighrita, Vasa ghrita}can be used due to their antipyretic, antiallergic, immunomodulatory, anti-inflammatory and analgesic properties. \textit{Kantakari }(\textit{Solanum surattense }Burm. F.)\textit{, Pushkarmool }(\textit{Inula racemosa }Hook. f.)\textit{, Haritaki }(\textit{Terminalia chebula} Retz)\textit{, Pippali }(\textit{Piper longum} Linn.)\textit{, Tulsi }(\textit{Ocimum sanctum }Linn)\textit{, Brihati} (\textit{Solanum indicum} Linn.) and \textit{Amalaki }(\textit{Emblica officinalis }Gaertn.) can be used in \textit{Pranavaha Strododushti }for strengthening it.

Health is defined as a ``state of complete physical, mental and social well-being and not merely an absence of disease or infirmity to lead a socially and economically productive life'' \unskip~\citep{853371:20023741}. \textit{Ayurveda} can be used effectively in the management of immune-compromised conditions like acquired immune deficiency syndrome (AIDS), Tuberculosis and malignancy. The \textit{Rasayana } therapy or rejuvenation therapy makes it easily possible with its remarkable benefits on immunity, health, longevity, regeneration of cells and tissues in the body. \textit{Rasayana} as immunomodulator herbs are perhaps the only drug that can be taken securely for long period, even in a healthy state, without any specific contradictions. \textit{Acharya Charaka} has described \textit{Chyavanprasha} which rejuvenated \textit{Chyavana Rishi } whereas \textit{Acharya Sushruta} described many \textit{Rasayana} formulations that increase the life span and refers to them as \textit{Ayuskara}. \textit{Rasayana} therapy has various beneficial effects on our body like \textit{Jaravyadhi Nashana}, promotion of body strength including immunity, promotes body tissues and alleviation of disorders. Immunomodulators corrects the immune functioning that is out of balance. The immunomodulators have ability to stimulate natural and adaptive defence mechanism of the body that can be helpful in boosting immunity for Prevention of COVID-19.
    
\section{\textbf{Conclusion}}
\textit{Rasayana }are effective in enhancing immunity of the body. \textit{Rasayana} working on Respiratory system helps in strengthening function of Respiratory organs as well as reducing symptoms of Respiratory disorders. Immunity plays an important role in Prevention of diseases. So, it can be concluded that \textit{Rasayana Chikitsa } can be effective in the Prevention as well as reducing symptoms of COVID-19.
\section*{\textbf{Acknowledgement}}I am very thankful to Mahatma Gandhi Ayurved College, Hospital \& Research Centre, Salod (H), Wardha, constituent unit of Datta Meghe Institute of Medical Sciences (DU), Nagpur, Maharashtra, India for giving me opportunity and environment to conduct such review study.

\textbf{Funding support}

The authors declare that they have no funding support for this study.

\textbf{Conflict of interest}

The authors declare that they have no conflict of interest for this study.
    

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