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\begin{document}


\def\RunningAuthor{Swapnil Borage et al.}
\firstPage{1551}
\articleType{Review Article}
\receivedDate{05 Oct 2020}
\acceptedDate{09 Nov 2020}
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\title{Ayurvedic management for COVID-19 {\textendash} A review}
\author{Tejashree~Kantak\textsuperscript{1},  
            Swapnil~Borage\textsuperscript{*}\textsuperscript{1}, 
            Priyanka~Shelotkar\textsuperscript{2}~\\[5pt]{\textsuperscript{1}Department of Shalakya Tantra, Mahatma Gandhi Ayurved College, Hospital and Research Center, Salod(H), Wardha, Datta Meghe Institute of Medical Sciences (DU), Nagpur, Maharashtra, India}~\\{\textsuperscript{2}Department of Kaumarbhritya, Mahatma Gandhi Ayurved College, Hospital and Research Center, Salod(H), Wardha, DattaMeghe Institute of Medical Sciences(DU), Nagpur, Maharashtra, India}}

\begin{abstract}
As the corona pandemic has emerged, researchers around the globe are working on finding specific treatment for it. But till date, no conclusive specific treatment has been found, and we are following the protocols with symptomatic management. Ayurveda is an ancient science of healing, with highly sophisticated literature about diseases, their pathogenesis, clinical features, and management. The evaluation of different modalities for treating COVID-19 pandemic patients is the foremost aim of the study. For review, we used the knowledge of the ancient classics and past literature regarding human treatment guidelines mentioned in Ayurveda classics, for prevention and treatment of communicable diseases, to provide appropriate direction in the prevention of COVID-19. The thorough review has been done, of literature, \textit{Samhitas }(Ayurveda Classics), and research articles which were published between January and June 2020 by PubMed, Google Scholar, WHO, Ministry of AYUSH. The opinions of experts have also been referred to. As individuals with lower immunity have a higher risk of COVID-19, so the herbal \textit{Rasayana (Rejuvenating)} drug, which has proven immunomodulatory activity, is also included in the given study. The Review for Ayurveda formulations, which might help in preventing the progression of COVID-19, has also been made. The Indian herbs are widely utilized in the preparation of Ayurvedic medicines or formulations or in the form of drinks to manage various respiratory disorders such as cough, cold, and flu. Hence, these drugs are formulated by using active parts of the plants, which are used for preventing and treating the COVID-19. These formulations are immunity modulators and they prevent the spread of the virus, by intruding at a different stage of virus multiplication in the infected person. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}AgantujaVikar,\newline Ayurveda,\newline Bhutabhisanga,\newline COVID-19,\newline Janpadodhwamsa,\newline Preventive Measures,\newline Ritusandhi,\newline Yamadamshtra
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Swapnil~Borage~\\ Phone:\ 9665859565~\\  Email:\ swapnilborage@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
In the present era, the indescribable COVID-19 disease is emerging in the world. In December 2019 the outbreak of the Coronavirus begun in Wuhan city, China.Covid19 is the disease caused due to Novel Corona Virus2, now named as SARS CoV-2 \unskip~\citep{957296:20990751,957296:20990750,957296:20990744}. The first case of the COVID-19 in India was reported in Kerala State, on 30th January 2020, and was amongst the passengers from China \unskip~\citep{957296:20990741}. The \textit{Ayurveda } principles, concepts and studies have been treating diseases and taking care of people for thousands of years. It might be difficult to understand COVID-19 because of the scattered epidemiology concept, but as these are put together, we can get a clearer image regarding the pandemic disease. On 11 March 2020 WHO declared it as a pandemic.COVID-19 has the following symptoms: High-grade fever, Cough{\textendash} Nonproductive, Breathlessness, running nose, gastrointestinal disturbances{\textendash} Diarrhea/nausea, Headache. The manifestation of symptoms is seen within 2{\textendash}14 days of exposure to the virus \unskip~\citep{957296:20990744}. In Ayurveda Classics,\textit{ the Jwara }(fever) is described as the major disease. The symptoms of the COVID-19 may be correlated with the features of \textit{SannipatikaJwara }(A type of fever)described in Ayurvedic classics. However, in critical cases of COVID-19, it best matches with symptoms described for \textit{SamaSannipatikajwara }(A type of fever). It comes under \textit{Janpadodhwamsavikara }(Epidemic diseases) and can be grouped in \textit{BhutabhisangaAgantujaVikara} (External cause of microbes) \unskip~\citep{957296:20990749}. As per Ayurveda Samhitas, the treatment of \textit{Janpadodhwamsa }(pandemic) is \textit{Langhana }(fasting),\textit{ Langhanapachana }(fasting along with digestive medicines), and \textit{doshaavasechana }(removal of vitiated humour from the body) \unskip~\citep{957296:20990741}.

\textit{\textbf{Langhana}} \textbf{\space }

\textit{Aam }(residual undigested food) formation is the vital factor to initiate \textit{Jwara}. The first treatment for curing the \textit{Jwara} and \textit{rasapradoshajvyadhi }(diseases of the essence of food) is \textit{Langhana}. Vitiated \textit{doshas} are pacified by doing \textit{Langhana}, as well as it stimulates \textit{Jatharagni }(digestive fire) which helps the body to attain \textit{laghutva }(lightness) and good appetite.\textbf{\space }

\textit{\textbf{Langhanapachana}} \textbf{\space }

Here, based on \textit{aharashakti }(capacity of food consumption) and Status of \textit{Agni }(digestive fire)\textit{,} one can increase the \textit{ahar }(diet)gradually, which is called \textit{Hinamatrabhojan }(Eating less than hunger) in the contest of \textit{Langhana}. Thus, the \textit{Pachandravyas }(drugs increasing digestive power) maintains the \textit{ahar} digestion, but \textit{Agni} does not increase. As \textit{Pachana} drugs are predominant in \textit{Agni} and \textit{Vayu mahabhoota }(basic 5 elements), they stimulate the digestive power.\textbf{\space }

For \textit{Pachana} karma, a single drug or compound of \textit{PachaniyaMahakashaya }(Ayurvedic formulation) is useful. \textit{DeepaniyaMahakashay }(Ayurvedic formulation) dravyas have both the quality of \textit{Deepan (boosting appetite)} and \textit{Pachana }(boosting digestion) action, so some of the \textit{deepandravyas} also do \textit{Deepan} and \textit{Pachana}.

\textit{\textbf{Doshaavasechana}} \textit{\textbf{\space }}

The \textit{Shodhan }(purification) therapy eliminates vitiated \textit{doshas} from the body. According to \textit{Vagbhata }(ancient Ayurveda physician), the \textit{Doshas} should be eliminated from the nearest route of the body. As this disease is involving \textit{PranavahaStrotasa }(respiratory system), the \textit{murdha }(crown) is the \textit{Moolasthana }(seat)\textit{ of Prana Vayu}. So Nasya (nasal insufflations) is most appropriate for \textit{Urdhavajatrugatavyadhi }(diseases of head and neck) as indicated by \textit{Sushruta }(ancient Ayurveda physician).\textbf{\space }

Not following \textit{Rutucharya }(seasonal regime), can be one of the major reasons behind this disease. However, the transitioning pattern may seem monotonous; \textit{Rutucharya} controls the great pattern. The complex nature of seasons is created by the course of the earth, sun, moon, and human life. The two most crucial transitional periods are when the southerly phase changes to the northerly phase and northerly phase changes to the southerly phase. In this period, \textit{Yama} is the lord who receives diseases and the phase is termed as \textit{Yamadamshtra }\unskip~\citep{957296:20990752}. The preceding seven days of the current season and the initial seven days of the forthcoming season together are termed as \textit{Ritusandhi} (seasonal junction). In this time, the prescribed regimen of the present season should periodically change, and that of the forthcoming season is to be slowly adopted. If this shift of regimen takes place all of a sudden, the disease may arise which are similar to the diseases generated due to the intake of unsuitable diet \unskip~\citep{957296:20990755}.\ensuremath{^{}}

\textbf{The choice of medicinal herbs or formulations for COVID-19} \textbf{\space }

\textbf{Unexposed Asymptomatic}

Different Ayurvedic preparations can be used, like \textit{BramhiRasayana, Chyawanprashaavaleha or Amrita Bhallatak}\unskip~\citep{957296:20990750}\textit{, Agastya Rasayana, Dashmool Rasayana}\unskip~\citep{957296:20990741} \textit{, and herbs like Ashwagandha }(WithaniaSomnifera)\textit{, Guduchi }(TinosporaCordifolia) \unskip~\citep{957296:20990742},\textit{ and Amalaki }(Emblica Officinalis) \unskip~\citep{957296:20990751}. 

\textbf{Exposed Asymptomatic(Quarantined)}

Herbs like \textit{Guduchi, Shunthi }(GingiberOfficinalis)\textit{, Haridra }(Curcuma Longa),\textit{ and Triphala, Trikatu, Sanjeevanivati, Chitrakadivati, Sudarshanghanavati, Guduchi vati, Chyawanprashaavaleha }(Ayurvedic preparations) can be given \unskip~\citep{957296:20990750}.\textit{}

\textbf{Mild Symptoms}

Ayurvedic preparations like \textit{PippaliRasayana, GojivantyadiKwath, KantakariAvaleha, ChitrakadiVati, Vyaghriharitaki, DashmoolKadha, Talisadi, Sitopaladichurna }and drugs like \textit{Ardrak }(Gingiber Officinalis) \unskip~\citep{957296:20990744},\textit{ Tulsi }(Oscimum Sanctum)\textit{, Yashtimadhu }(GlycyrrhizaGlabra), can be given \unskip~\citep{957296:20990750}.\ensuremath{^{}}

\textbf{Moderate to Severe (Hypoxemia and Dyspnoea Phase)}

Ayurvedic preparations like\textit{ Guduchi vati/SamshamaniVati, NityaRasayana, VyaghriHaritaki, KushmandaAvaleha, Agastya haritaki, Bilvadigutika, Siddhamakardhwaj, TalisadiChurna, Arogyawardhini, PippaliRasayana, Laghumalini Vasant, Sanjeevanivati, Tribhuvankirtiras, Siddha makardhwaj}should be given \unskip~\citep{957296:20990750}.\ensuremath{^{}}

AYUSH Ministry (Ayurveda, Siddha, Homeopathy, Yoga and Naturopathy, Unani) India, issued an advisory, where it suggests to consume \textit{Kwath}  (herbal tea/decoction), contain \textit{Tulsi }(Oscimum Sanctum\textit{), Dalchini }(Cinnamomum Verum),\textit{ Kalimirch }(Piper nigrum), \textit{Shunthi and Munakka }(Vitis Vinifera) for self-care which will ripen immunity against severe infection caused by COVID-19. Moreover, consumption of milk made of turmeric is recommended; for making it one should take half teaspoon of turmeric powder in 150 ml hot milk once or twice a day \unskip~\citep{957296:20990754}. The choices of medicines here are \textit{Jwarahara }(Antipyretic),\textit{ Kasahara }(Anti cough),\textit{ Aamhara }(digestives)\textit{, Tridoshahara }(Pacifying humour\textit{), Swasahara }(Breathlessness relieving)\textit{, Pratishyahara }(anti-cold),\textit{ Rasayana }(Rejuvenating),\textit{ Deepaniya }(Appetite boosters),\textit{ Krimighna }(anti helminths). 

\textbf{Following preventive measures can be taken}

Tooth brushing with herbal based \textit{Neem }(Azadirachta Indica)toothpaste for Maintaining Oral Hygiene \unskip~\citep{957296:20990751,957296:20990747}.

Bathing with Leaves of \textit{Neem}, \textit{Aloes}, \textit{Karanj }(PongamiaPinnata), \textit{Nirgundi }(VitexNirgundo) and Gomutra (Cow urine)Arka for treating Virus \unskip~\citep{957296:20990751}.\ensuremath{^{}}

Gargling with \textit{kwath }(decoction) made with \textit{Turmeric, Triphala, Shunti, Yashtimadhu, Tankan }(Borax) and \textit{Saindhava }(Rock Salt) is useful for creating unfavourable contact surface for viruses at portal entry, i.e. Oropharynx and Nasopharynx \unskip~\citep{957296:20990751}. \textit{Nasya karma} with \textit{Shadbindu tail }(Medicated Oil) \unskip~\citep{957296:20990741}.\ensuremath{^{}}

Drinking Herbal/ Medicated Tea made \textit{Tulsi, pepper, Shunthi, yashtimadhu, Guduchi Stem, Ashwagandha, Sariva }(HamidesmusIndicus)\textit{, Ela }(Elettariacardamomum) with lemon Juice and Jaggery creates unfavourable contact surface for viruses at portal entry, i.e. Oropharynx and Nasopharynx \unskip~\citep{957296:20990751,957296:20990742,957296:20990747}.\ensuremath{^{}}

Sanitization, Social Distancing, Home quarantine, and Personal Isolation should be followed strictly \unskip~\citep{957296:20990751}.  

\textit{Bhumi Shuddhi }(Land purification): by a sprinkling of extracts of \textit{Neem, Karanj} with \textit{Gomutra} to create an unfavourable environment for viruses \unskip~\citep{957296:20990751}.\ensuremath{^{}}

\textbf{Air Sanitization}

 Fumigation with \textit{Divyadhoop }(essence sticks)in the aerosol form at home, hospitals and community places or \textit{LakshadiDhoopa }(Sushruta Kalpasthan.6/4) or Turmeric, garlic peel, Dried \textit{Neem} leaves, \textit{Vacha }(Acorus calamus), Sarjaras (Shorea Robusta), added with \-\-\-ghee to create an unfavourable environment for viruses \unskip~\citep{957296:20990751}. 

\textit{\textbf{Ahar}}

Pathya (Efficient) Diet: Freshly prepared and hot served diet. Light diet includes - Rice gruel /Ragi (Eleusinecoracana)gruel{\textendash} with Ginger or \textit{Yavaagu }(soup) Prepared with Rice with Coriander, Cumin, Ginger, Turmeric, and pepper. \textit{Yusha }(soup)prepared with green gram or similar pulses added with Krishna jeeraka (black cumin). Khichadi / Pongal / Daliya (cooked grains) with Coriander, Ginger, Turmeric, and pepper can be given. Vegetables - \textit{Katu}and \textit{tikta rasa pradhana }(spicy and bitter in taste)- \textit{Patola }(\textit{Trichosanthesdioica}), Brinjal, Tender radish, Punarnava \textit{(BoerhaaviaDiffusa}) leaves, Tanduliya leaves (\textit{Amaranthusviridis}), Sarshapa (\textit{Brassica campestris})leaves,\textit{ Pudina}leaves (\textit{Menthe Arvensis}), Mustard greens, Coriander leaves, Sweet neem leaves, Cluster beans Kakamachi (Solanumnigrum), etc. Amalaki '(Emblicaofficinale) payasya/ Jam / Chutney with Pudina and coriander are good options \unskip~\citep{957296:20990751,957296:20990744}. 

\textit{\textbf{Apathyaahar }} \textbf{(Inefficient diet)}

 -Heavy, spicy, oily or fried foods, curd, cool, drinks, head bath, mental stress, exposure to fan/AC should be strictly avoided. 

\textit{\textbf{SatwavajayaChikitsa }} \textbf{(Ayurveda Psychotherapy) }

The \textit{Doshas }(humour) has classified mainly two types, \textit{Shareerikan }(related to the body)and \textit{Manasika }(related to mind) \textit{doshas}. In the manifestation of diseases, \textit{ManasikaDosha} may not have direct influence, but indirectly that has a role in the manifestation of the disease. For in example,\textit{ Jwara }(fever),\textit{ Kama }(Lust),\textit{ Bhaya }(Fright), \textit{Soka }(mourning),\textit{ Krodha }(Anger)\textit{ are the responsible manasikadoshas. In Atisara }(diarrhoea),\textit{ Bhayaja and Shokaja }(due to fright and mourning) are the types explained in Ayurveda)\textit{. To} avoid such \textit{ManasikaDosha}, it is necessary to concentrate and control over the \textit{Manas }(mind) which by \textit{SatvavajayaChikitsa} like \textit{Dhyan }(meditation), \textit{Pranayama }(breathing exercises),\textit{ yoga asana }(stretching exercises),\textit{ Sadvrittapalan }(daily regime), and \textit{AcharRasayana }(behavioural regime) \unskip~\citep{957296:20990751,957296:20990744,957296:20990741}. 
    
\section{RESULTS }
After the analysis of the above drug, the conclusion has been expressed below.

The COVID-19 is communicable disease affects multiple systems, including respiratory, cardiovascular system and also affects intravascular coagulopathy. Hence, while treating the group of symptoms, we have to use a single drug in multiple ways or use multi-drug combination. Thus, the gross review of the different drug is helpful. Some drugs are vital for treating COVID-19. 

They can be given for preventing and treating clinical features of COVID-19 in Table~\ref{tw-6a0213253119}, and there is a list of the different drugs with their probable actions. For example `\textit{Guduchi}' is used as a \textit{Rasayana,} having properties of Jwar\textit{ahar}a and \textit{Aamhara}. \textit{Tulsi} is having a property of \textit{Kasahara}, Swasahara and it is Jwaraghna and used as \textit{Rasayana}. \textit{Amalaki} is \textit{Tridoshahara }and also used as Rasayana.

These drugs can be utilized while formulating yoga (formulations) for internal and tropical uses such as Nasya karma, dhupan karma etc. While considering society as responsible and to prevent the further spread of the COVID19, we have to be the social wellbeing by following the personal and social activities such as Aharvihar\textit{, Dincharya }(daily regime)etc. As mentioned in Tables~\ref{tw-acc8b418c5fc}, \ref{tw-2f5e673ddae2} and~\ref{tw-492c508a3632}.


\begin{table*}[!htbp]
\caption{\boldmath {Drugs and their probable actions } }
\label{tw-6a0213253119}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.08949999999999996\linewidth-2\tabcolsep}p{\dimexpr.3278\linewidth-2\tabcolsep}p{\dimexpr.58269999999999996\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}\multicolumn{2}{p{\dimexpr(.4173\linewidth-2\tabcolsep)}}{\cAlignHack Drugs } & \cAlignHack Karya(Action) \\
\tblmidrule 
1. &
  \textit{Guduchi}(TinosporaCordifolia)  &
  \textit{Jwarahara, Aamhara, Deepan, Kasahara, Rasayana} (Immunomodulation and Rejuvenation property), Antioxidant, Antipyretic, Antiviral \\
2. &
  \textit{Haridra}(Curcuma Longa)  &
  \textit{Kaphaghna}(pacifying Kapha humour), \textit{Vishamjwaraghna}(anti-fever), \textit{Krimighna, Dhupanadravya}(Used for fumigation), \textit{Rasayana}\\
3. &
  \textit{Shunthi}(Zingiber Officinale)  &
  \textit{Vatakaphahara}(pacifying \textit{Vata} and \textit{Kapha humour}), \textit{Jwarahara, Amapachana }used for gargling \\
4. &
  \textit{Yashtimadhu}(Glycyrrhizaglabra)  &
  \textit{Jeevaniya}(Increasing life span), \textit{swarabheda}(Better for throat) \\
5. &
  \textit{Tulsi}(Oscimum Sanctum)  &
  Immunomodulator,Antiviralagent, \textit{Jwaraghna,Kasahara,Pratishyahara,Vishamajwarahara,Krimighna}\\
6. &
  \textit{Amalaki}(EmblicaOfficinale)  &
  \textit{Tridoshahara}(pacifying all humour), \textit{Rasayana}\\
7. &
  \textit{Vidanga}(Embeliaribes)  &
  \textit{Kaphavatahara, Krimighna}\\
8. &
  \textit{Neem}(AzadirachtaIndica)  &
  Antiviral\\
9. &
  \textit{Pippali}(Piper Longum)  &
  \textit{Vatakaphahara, Kasahara, Swasahara}, used as \textit{Rasayana}\\
10 &
  \textit{Adrak}(ZingiberOfficinale)  &
  \textit{Agnimandya, Krimighna, Kasahara, Dhoopandravya}\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Preventive Measures at a personal level} }
\label{tw-acc8b418c5fc}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2536\linewidth-2\tabcolsep}p{\dimexpr.4243000000000001\linewidth-2\tabcolsep}p{\dimexpr.3221\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Regime & Drug & Purpose\\
\tblmidrule 
\textit{Dantadhavan}(Tooth Brushing) &
  \textit{Neem} &
  For Maintaining Oral Hygiene\\
\textit{Snana}(Bathing) &
  Leaves of \textit{Neem, Aloes, Karanj, Nirgundi}(VitexNirgundo), and \textit{GomutraArka} &
  Prevents Virus\\
\textit{Kaval }(Gargling) &
  Add turmeric, \textit{Triphala, shunti, yashtimadhu, tankan,} and \textit{Saindhava }and make a \textit{Kwath}. &
  \multicolumn{1}{p{\dimexpr(.3221\linewidth-2\tabcolsep)}}{\multirow{3}{\linewidth}{To create unfavourable contact surface for viruses at portal entry, i.e. Oropharynx, Nasopharynx. \mbox{}\protect\newline Immunity-Boosting}}\\
\textit{Nasya karma} &
  \textit{Shadbindhu tail} &
  \\
Drinking Herbal/ Medicated Tea &
  \textit{Tulsi, pepper, Shunthi, yashtimadhu, Guduchi Stem, Ashwagandha, Sariva, Ela can be added with lemon Juice and Jaggery.} &
  \\
\textit{Rasayana} &
  \textit{Chyawanprashaavalehaor Amrita Bhallataka, NityaRasayana, Haridradugdha, Agastya haritakiRasayana, DashmoolRasayana, BramhiRasayana, Amrita Bhallatak} &
  \textit{Apunarbhavachikitsa}(Treatment to avoid recurrence) \mbox{}\protect\newline Immunity Strengthening \mbox{}\protect\newline Antioxidant \mbox{}\protect\newline Antistress \mbox{}\protect\newline Vaccine adjuvant and can confer against disease.\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Preventive measures at the community level: To follow Sanitization, Social Distancing, Home quarantine, Personal Isolation} }
\label{tw-2f5e673ddae2}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.2378\linewidth-2\tabcolsep}p{\dimexpr.43790000000000006\linewidth-2\tabcolsep}p{\dimexpr.3243\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Measures & Drugs & Justification\\
\tblmidrule 
\textit{Bhumi Shuddhi} &
  The sprinkling of extracts of \textit{Neem, Karanj }with \textit{Gomutra}. &
  To create an unfavourable environment from viruses.\\
Air Sanitization &
  Fumigation with \textit{Divyadhoop} at home and in aerosol form hospital and community place or \textit{LakshadiDhoopa} or Turmeric, Garlic peel, Dried Neem leaves, \textit{Vacha, Sarjaras}, added with ghee. &
  To create an unfavourable environment for viruses.\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

\begin{table*}[!htbp]
\caption{\boldmath {Ahar and Vihar} }
\label{tw-492c508a3632}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.4978\linewidth-2\tabcolsep}p{\dimexpr.5022\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Ahar  & Vihar \\
\tblmidrule 
Cereals, Pulses, wheat/gram flour products, corn, \textit{old barley } (Bere), wheat, rice are preferred. In the group of pulses, \textit{Mudga}(Vignaradiata) is advised, ginger, garlic, \textit{Pippali}, sugarcane products, \textit{Haridra} are taken in more quantity. &
  Avoid unnecessary gathering, social distancing, Maintain isolation, Avoid \textit{Divaswapna}(day time sleeping), Avoid exertion for example- excessive walking or jogging, Avoid mental Stress and Anxiety. \mbox{}\protect\newline \textit{SatwavajayaChikitsa}- Which Includes \textit{Yoga} and \textit{pranayama}\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}

    
\section{DISCUSSION}
In the current scenario, it is evident that the spread of COVID-19 is difficult to prevent. So we need to follow a preventive approach for this disease. As per Ayurveda classics or Samhitas, this should be prevented at the earlier stage itself. 

Hence we need to use drugs formulations, \textit{Rasayana}, which helps in increasing our immunity and which ensures that even after getting exposed to the pathogens of the infectious disease, its manifestation can be prevented. Most of the formulations are recommended by the Ayush ministry \unskip~\citep{957296:20990754}.

\textbf{Some formulations which are made from the vital ingredients used for COVID-19\ensuremath{^{}}}

\textbf{SudarshanGhanavati or Sudarshan Churna}

Ingredients: \textit{Amalaki, Guduchi, Haritaki, Yashtimadhu, Haridra, Pippali, Trikatu}

\textit{Karya}(action): The formulation corrects the \textit{Tridosha} imbalance and used in all types of \textit{jwara.}

Dose: 2vati twice a day, After Food with warm water

It is used when all \textit{doshas} are aggravated. (Used for maintaining Tridosha) \unskip~\citep{957296:20990751,957296:20990741,957296:20990743}. 

\textbf{Chyawanprashaavaleha}

Ingredients:\textit{Yashtimadhu,Guduchi,Haritaki,Pippali,Amalaki,Brahmi,Gokshura,Kesar,Arjun,Ghrit,Tulsi,Marich, Dalchini.}

\textit{Karya}: Used as \textit{Medhya, Balya, Rasayana.}

Dose: 10gm once before breakfast, pacifies \textit{Vata, pitta, Kapha}\unskip~\citep{957296:20990750,957296:20990746}.

\textbf{VyaghriHaritaki}

Ingredients\textit{: Haritaki, Guda, Shunthi, Marich, Pippali, Twak, Patra, Ela, Madhu, Nagkeshar}

\textit{Karya: }Used in \textit{Kasa, Swasa,} Hoarseness of voice, Loss of voice

Dose: 10gm twice daily before food with lukewarm water

Balances aggravated \textit{Vata} and\textit{ pitta dosha}\unskip~\citep{957296:20990750}.

\textbf{TalisadiChurna}

Ingredients: \textit{TalisPatra}, Black pepper, \textit{Dalchini, Elaichi, Misri}

Medical Property: Antiviral, Bronchodilator, Antibacterial, Antimicrobial, Carminative

Karya: Used in Ashtama, cough, common cold, Chronic Bronchitis, Whooping cough

Dose-10gm twice before food with honey or lukewarm water

Pacifies aggravated\textit{ Vata} and \textit{Kaphadosha} involved in \textit{Kasa }\unskip~\citep{957296:20990749}.

\textbf{Arogyawardhinivati}

Ingredients: \textit{Parad, Gandhak, Loha, Bhasma, AbhrakBhasma, ShiddhaShilajit, ShuddhaGuggul, Katuki}

\textit{BhavanaDravya (Solvent for triturating): Neem Patraswarasa} (it is antiviral, due to which it reduces virus load virulence)

Indication: All types of \textit{jwara}

Dose: 1\textit{vati} twice a day with water after food

Balances \textit{Tridosha}\unskip~\citep{957296:20990749}.\textit{\space }

\textbf{Tribhuvankirti Rasa}

Ingredients: \textit{Pippali, Tankan, Tulsi, Adrak, Trikatu, Vatsanbh, Hangul}

Indication: All types of \textit{Jwara}, Allergic rhinitis

\textit{Karya: Jwaraghna, Kaphaghna}

Dose: 125 mg twice a day after food with honey

Balances the aggravated \textit{Vata} and \textit{Kaphadosha}, should not use it in  \textit{pittapradhanSannipata }or \textit{pittapradhan }any type of \textit{jwara }due to its \textit{tikshna properties. } \textit{\space }

\textbf{Shadbindu Tail}

Ingredients: \textit{Yashtimadhu, Shunthi, Rasona, Tagar, Bhringraj, Saindhava}, Black sesame oil

Indication: Beneficial for treating cold, Allergic Rhinitis, and sinusitis.

Dose: 2 drops each nostril

Balances \textit{Tridosha}\unskip~\citep{957296:20990751}.

\textbf{SanjeevaniVati}

Ingredients: \textit{Vidanga, Shunthi, Pippali, Haritaki, Amalaki, Vacha, Guduchi, ShuddhaBhallatak, ShuddhaVatsanbh}

\textit{Karya: Amapachana, Kaphaghna, Vataghana}

Dose: 125mgBefore Food

Reduces Aama and Kaphadosha, pacifies Vatadosha, it might increase pitta dosha \unskip~\citep{957296:20990741}.

\textbf{Swasakuthar Rasa}

Ingredients: \textit{ShuddhaParad, ShuddhaGandhak, Shuddha Tankan, Trikatu}

Indication\textit{: Swasaroga}

Dose: 2vati twice a day with lukewarm water

Balances aggravated \textit{Vata} and \textit{Kapha doshas }\unskip~\citep{957296:20990751}. 

The above-mentioned drugs or formulation should be given after making history, \textit{PrakritiParikshan }and \textit{KoshthaParikshan.} \textit{\space }

COVID-19 is read under the concept and m\textit{agni}tude of \textit{Janpadodhwamsa}. In COVID-19, there is the involvement of multiple \textit{Nidana, Srotas, } and \textit{Lakshanas} where this is transmitting from one person to another person it can be correlated to pandemic disease. The same concept explained in \textit{Janpadodhwamsa} with \textit{ChikitsaSiddhanthaLanghana, Langhanapachana, } and \textit{Doshaavasechana. } In this disease, the pathogenesis starts with \textit{Agni}mandya and \textit{Aama} formation. Hence to improve \textit{Agni} and to do Ama\textit{pachana}, \textit{Langhana}, \textit{Langhanapachana} can be indicated, as there is an involvement of \textit{Tridosha,} and multiple \textit{Srotas}\unskip~\citep{957296:20990741}. 

\textit{Janpadodhwamsavikara} can be grouped in \textit{BhutabhisangaAgantujaVikara} (External cause of microbes). The concepts of \textit{AgantujaJwara}, As it is considered as Airborne diseases. To reduce virus load, virus clearance in the air contact surface, prevention modalities have been outlined in the best possible way. 

To reduce virus load, virus clearance in the air and contact surface, i.e. at home, at Hospital, and community place in large. Proposed modalities could be Air sanitization and contact surface. \textit{Dhoopana} at Home by medicated \textit{Varti-DivyaDhoomaVarti. }

Medicated Air Aerosol at Hospital and another contact surface through medicated extract prepared from the composition of natural anti-microbial agents such as \textit{Neem} leaves or bark; \textit{Karanja} leaves/bark/seed, \textit{Nirgundi} leaves, Aloe vera, etc. are indicated.  

Herbal disinfectant lotion with the above drugs in \textit{Gomutra} base can be used for \textit{Bhumi Shuddhi}. To increase host immunity, for better defence from virus virulence reactions. One should follow proper \textit{Dinacharya, Rutucharya, Rasayana seven ahar, } and \textit{vihar}. It also reduces viral load in the host, by creating unfavourable conditions at the portal entry and contact surface (Naso-pharynx and Oro-pharynx) through different methods. 

\textit{PratimarshaNasya} with \textit{Shadbindu tail}, \textit{Dantadhavan} using \textit{Neem} Bark or toothpaste, Gargling, steam inhalation, \textit{Dhumapana/ DhoomaNasya}are also indicated \unskip~\citep{957296:20990740}. 

However, it is Agantuja\textit{vyadhi}/disease, \textit{Ritusandhi} (junction of two ritus) and \textit{Yamadamshtra} (period of increased mortality) can be the major reason behind the manifestation of this disease.


\begin{table*}[!htbp]
\caption{\boldmath {Effect of seasonal variation on recovery rate} }
\label{tw-dbcee2992777}
\def\arraystretch{1.1}
\ignorespaces 
\centering 
\begin{tabulary}{\linewidth}{p{\dimexpr.25\linewidth-2\tabcolsep}p{\dimexpr.2568\linewidth-2\tabcolsep}p{\dimexpr.2432\linewidth-2\tabcolsep}p{\dimexpr.25\linewidth-2\tabcolsep}}
\tbltoprule \rowcolor{kwdboxcolor}Months & Confirmed  & Recoveries & Death\\
\tblmidrule 
January  &
  2 &
  0 &
  0\\
February  &
  84 &
  42 &
  0\\
March  &
  9495 &
  795 &
  219\\
April  &
  41644 &
  78039 &
  13350\\
May  &
  1987468 &
  840869 &
  62560\\
June  &
  7530368 &
  171207 &
  45860\\
\tblbottomrule 
\end{tabulary}\par 
\end{table*}
\textbf{Transitioning of seasons}

The two most indispensable-intermediate phases are when southernly and northernly phases change from one to the other. The term \textit{Yamadamshtra}is defined as the preceding eight days of Kartika month and initial eight days of Margashirsha month. One should take slightly less amount of food during this period for good health or else it is harmful to health. Southern phase changes to the northern phase, in the period between Nov. 22 to Dec. 9, and the period when northernly phase changes to the southern phase, in the period between May 24 and June 24 is critical.\textit{ Yama} is a lord who receives diseased. During the seasonal junctions, our bodies are at a sensitive stage. The junction is the crucial period when bodies are more prone to diseases. Thus one should take extra care during the intersection and eight days before and after the intersection by taking proper rest, maintaining good physical and mental health \unskip~\citep{957296:20990752}. 

One of the crucial reasons behind COVID-19 is \textit{Ritusandhi}. \textit{Ritusandhi} refers to the time period between two ritus. According to Ayurveda classics or Samhitas, the occurrence of disease during this period is due to changes in \textit{Kala}(time), that is shifting of one ritu to another, and the human body fails to acclimatize for such changes. It has been noticed that the COVID-19 outbreak to place in India during \textit{Ritusandhi} Kala. Taking care of \textit{Ahar} and Vihar is a preventive measure. Hence, \textit{Ahar} and Vihar carefully followed. The kind of A\textit{har} that can be followed in this should be similar to the one which is followed during \textit{Shishirritu} and \textit{Vasant ritu}. This is because the outbreak took place during the \textit{Ritusandhi} of \textit{Shishir}and \textit{Vasant ritu}. 

The period of \textit{Shishirritu} is from mid-Jan to mid-march, during which the weather becomes cold. In such weather, the strength of the human body lowers down; however, there is the deposition of \textit{Kaphadosha} and digestion remains good. \textit{Ahar} followed during corn are advised, \textit{ginger, garlic, Pippali}, sugarcane products, \textit{Haridra} are taken in more quantity. 

The period of \textit{Vasant ritu} extends from midway of march to midway of May. In this period, the power of the person rests in the mediocre state; Imbalance of\textit{ Kapha dosha} occurs and results in \textit{Agni}mandya. The food taken during this period should have \textit{tikta, Katu}, and \textit{kashaya} taste. \textit{Ahar} taken should be easily digestible and should include Wheat, Cereals, Rice, old barley. Amid pulses, \textit{Mugda}, and others can be taken. 

\textit{\textbf{Vihara}}

Avoid unnecessary gathering, social distancing, maintain isolation, avoid \textit{Divaswapna}(day time sleeping), avoid exertion(for example- excessive walking or jogging), avoid mental stress, and anxiety. 

\textit{SatwavajayaChikitsa}- Includes Yoga and Pranayama. 

\textit{Pranayama}- Particularly \textit{Bhastrika} and \textit{Kapalabhati} for 10 min each should be performed. 

\textit{Yoga and Asanas {\textendash} Bhujangasan, Vajrasan}and \textit{Padaangushtasana} for respiratorysystem strengthening should be performed \unskip~\citep{957296:20990744,957296:20990741,957296:20990745}

It has been observed that the new cases of COVID-19 have been reported every day since March 2, 2020. Till dated June 15, 2020India reported over 549 thousand cases of the Coronavirus (COVID-19), with recoveries of more than 321 thousand people and the mortality rate is 16.5 thousand. The patient who tested positive, they have made full recoveries under quarantined \unskip~\citep{957296:20990753}. 

\textbf{\textbf{Effect of seasonal variation on recovery rate}}

February: 50\% 

March: 8.3\% 

April: 1.87\% 

May: 42.3\% 

June: 2.27\% (Table~\ref{tw-dbcee2992777}).

\textit{\textbf{Shishirritu }} \textbf{(mid-Jan-mid march)} \textbf{\space }

The recovery rate is higher in February and slows down in the ending of Shishirritu. 

\textit{\textbf{Vasant ritu }} \textbf{(mid-March to mid-May)} \textbf{\space }

The recovery rate is too low in March, April and higher in May month. 

\textbf{Iceberg phenomenon in COVID-19}

The phenomenon is used to explain the summary of the recognized and unrevealed cases of a specific virus, infection or diseases.`John M Last' is the one who instigated this theory. According to this theory, the tip of ice is observable externally expresses the progress (pathogenesis and spread) of a disease from its sub-clinical stages to an apparent disease state. It denotes the diagnostic cases what the clinicians see and the main percentage of the iceberg which immersed they symbolize the cases which are undiagnosed with misdiagnosed cases subclinical/pre-symptomatic phase, mild case and vulnerable citizens (health workers, family members) \unskip~\citep{957296:20990748}. 
    
\section{Conclusion}
The outcome achieved in the study may produce a preventive plan to the Ayurveda physicians as well as commonalityallover the world by augmenting the innate immunity of the body to battle the coronavirus. This new strain of virus pandemic globally resulting in mortality can be prevented by ensuring suitable food intake, maintaining proper sanitation, and performing social distancing. Precautionary measures can be taken by giving direction regarding preparations made by the medicated drugs such as \textit{Guduchi, Haridra, Shunthi, yashtimadhu, Tulsi, Amalaki, Vidanga, Neem, Pippali, Adrak}and \textit{Dalchini;} Distancing should be followed from the affected individual is a crucial key. One should follow respiratory and private sanitization to protect from the disease. An individual should not move to the daily routine immediately after the recovery. He should wait until he rejuvenates, regains strength, and bring back his \textit{Agnibala} (digestive fire) to normalize agni. The purpose of Ayurveda is not to cure the disease but also focuses on the maintenance of an individual's health. Hence, the pragmatic plan for the management of disease must be followed by a healthy person as a part of preventive measures from the disease.

\textbf{Funding Support}

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

\textbf{Conflict of Interest}

The authors declare that there is no conflict of interest for this study.
    

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