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TAM & COVID-19 in the US

Official Announcement from ĀYU Council

Updated April 19th 2020

Published March 18th 2020

Jessica Vellela, BAMS

The rapid spread of the novel coronavirus COVID-19 has affected normal life around the world. Social distancing and government-mandated restrictions are increasing daily in the United States in attempts to "flatten the curve." Millions of people are wondering if they have the disease, how to manage it and most importantly, how to prevent it.

Along with the spread of the virus, there has been a dangerous spread of misinformation of claims and remedies under the name of Āyurveda. Because the practice of Āyurveda is unregulated and unlicensed in all 50 US states today, it is an easy way for anyone to spread misinformation under the veil of good intentions. 

To address the needs of the professional community and the public to access reliable, accurate information about Āyurveda and COVID-19, ĀYU Council is providing these free resources on prevention and management using American Āyurveda.

This is not an exhaustive resource of Traditional Āyurvedic Medicine (TAM). The continuous practice of TAM for thousands of years has generated a vast knowledge base that requires years of dedicated, full-time, professional study to properly understand and apply. This resource is in no way intended to replace the expertise of the TAM profession. 

Please check back regularly for updates.

Understanding COVID-19 and medical management

According to the World Health Organization,

"Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

Coronavirus disease (COVID-19) is a new strain that was discovered in 2019 and has not been previously identified in humans."

This strain is new and does not have a known vaccine or definitive medical management protocol. There is no "known cure" for COVID-19 in any system of medicine now. Many countries are testing interventions in clinical settings using Western Medicine, Traditional Chinese Medicine, Traditional Āyurvedic Medicine (TAM) and other primary care systems and modalities.

Based on data from China prior to March 2020 analyzed by the WHO, the most commonly reported symptoms included

  • fever
  • dry cough
  • shortness of breath

Within the patient population studied, cases were generally graded as 

  • mild illness - 80%
  • severe - 14%
  • critically ill - 5%

Early reports suggest that illness severity is associated with age (>60 years old) and co-morbid disease.

It is important to note that the highest at-risk groups are believed to be those 60 years and older with pre-existing conditions. In younger populations, cases may present with mild symptoms or be asymptomatic. These cases can quickly and easily spread the virus within their community.

Since most cases (80%) will likely experience mild symptoms, they may not require intensive medical management. These cases may be effectively supported with management at home under appropriate professional supervision. They would be most likely to benefit from proper application of Traditional Āyurvedic Medicine (TAM) under direct supervision of a qualified specialist.

Because of the wide range of presentations found in the 80% of mild cases, ĀYU Council recommends that anyone seeking Āyurveda do so through an ĀYU Council clinician. Individuals should expect to be assessed in a private consultation which will review health, medical and personal histories. Appropriate recommendations, including referrals to other specialists, can be made during the initial visit.

Confirmation of diagnosis requires accurate testing. If an individual is unable to be tested in a timely fashion, they should assume infection with COVID-19 and enact all necessary precautions, most importantly self-quarantine. General measures of home-care including proper rest, nutrition and hygiene, will be appropriate for all types of infection and self-preservation.

Traditional Āyurvedic Medicine (TAM) and COVID-19 in the US

AYU Council recommends the specialized practice of Traditional Āyurvedic Medicine (TAM) that is customized for the people of the United States today. The framework of TAM is based on the holistic nature of the human body, mind and spirit in a fully integrated structure. ĀYU Council maintains the consistency of the foundation of TAM and its extensive knowledge base of signs and symptoms to understand health, pre-disease and disease states at the individual level.

Traditional Āyurvedic Medicine (TAM) provides valuable perspectives on the novel coronavirus and provide insights for innovative, holistic and sustainable management protocols.

Practice of Traditional Āyurvedic Medicine (TAM) is not intended to replace required medical care. Always contact your medical doctor or licensed health care provider if you need medical attention.

Traditional Āyurvedic Medicine (TAM) broadly classifies COVID-19 by stage of progression (avastha) and severity (roga bala). It can also identify potential causative factors (nidāna) that may indicate the predominance of one or more doṣas in the presentation. Understanding the behavior of the individual's doṣas can provide insight and broad guidance on potential pathological development (saṃprāpti).

The following description is a theoretical proposal to describe the basic information that is presently known about COVID-19. This discussion is for educational purposes only. 

Stages of progression (avastha)

  1. Health (svastha)
  2. Exposure and incubation
  3. Pre-disease (pūrva rūpasthāna saṃśraya)
  4. Disease (rūpa, vyakta, bheda)
  5. Resolution (jvara mukta lakṣaṇas)
1. Health (svastha)

Traditional Āyurvedic Medicine (TAM) defines a normal state of health as a state of individual equilibrium marked by normal function and placement of the body's regulatory systems (doṣas), digestion, metabolism and transformation (agni), supportive structures and systems (dhātus), and waste products and elimination (malas) in conjunction with equanimity in the individual's permanent sense of self (ātma), their sense organs (indriya) and mental faculties or executive functions (manas).

In the context of COVID-19, svastha is the stage of normal health and well-being that generally precedes the disease and is reestablished after complete resolution of the disease, and restoration of prior strength in all aspects of physical body, mind and spirit. In some cases, it is possible that an individual may be exposed to the virus and maintain their normal state of svastha. However, it is impossible to know with certainty what percentage of people may be capable of this, or any individual's tolerance to exposure.

2. Exposure and incubation

Once an individual is exposed to the virus, they may contract the disease within a general period of 14 days. Very little specific guidance on exposure and incubation periods exists in classical Āyurvedic literature. Knowledge and understanding derived from Western Medicine is the preferred source for this stage.

3. Pre-disease (pūrva rūpasthāna saṃśraya)

Although the disease COVID-19 is not explicitly named in classical Āyurveda literature, it is possible to relate what is currently known about its common presentation with descriptions of relevant types of fever pathologies (jvara) and upper respiratory disorders (kāsa, śhvāsa). Based on clinical presentations studied in China, the data suggests a pathological presentation that impacts the channels of circulating nutrition (rasavaha srotas) and the channels of respiration (prāṇavaha srotas).

ĀYU Council clinicians should refer to Ca. Ci. 3/133-135 for the presentation of āma jvara. Clinicians should assume that pūrva rūpa lakṣaṇas may begin to present immediately following exposure, and throughout the incubation period.

4. Disease (rūpa, vyakta, bheda)

The onset of fever in the physical body is a strong indicator that the disease has progressed and is established. It is important to remember here that the presence of heat (santāpa) may appear in the body or mind, as stated classically (Ca. Ci. 3/31). During this stage, the individual's susceptibility to the disease will become clear as symptoms progress or resolve.

Progression of symptoms occurs during this stage. Complications, especially shortness of breath, may exacerbate. ĀYU Council clinicians should consider the presentation of pradhāna lakṣaṇas in management, particularly kāsa and śhvāsa cikitsā. Appropriate treatment methodologies should be guided by jvarakāsa and śhvāsa cikitsā. As the pathology progresses, symptomatic management must become more aggressive. 

Advanced management will require proper application of āhāra, vihāra, auhadha and kriyā. It is highly likely that effective Āyurvedic medicines for this disease will require the use of raaushadies as single dravya and complex formulations.

We propose a hypothesis that for individuals with a history of using OTC fever and pain suppressants, one action of these products is to reduce the appearance of outward symptoms of heat and pitta doha. This may cause a latent suppression of heat and pitta doha which could alter early clinical presentations of COVID-19. There may be cases that initially present without fever, but instead have the cardinal feature of respiratory distress, such as shortness of breath. In these cases,  ĀYU Council clinicians should expect the latent doha to appear and should be prepared to manage jvara even if it is not immediately present.

5. Resolution (jvara mukta lakṣaṇas)

The final stage involves resolution of the disease and return of normal individual homeostasis. ĀYU Council clinicians should refer to Ca. Ci. 3/329 for the assessment parameters of resolution of fever pathologies. Each parameter may be assessed in a variety of methods over a period of several days.

Severity (roga bala)

  1. Mild (alpa bala)
  2. Severe (madhyama bala)
  3. Critical (maha bala)
1. Mild (alpa bala)

Presentations which do not require acute medical intervention should be considered mild. These may be addressed through classical lines of management including jvara cikitsā (Ca. Ci. 3/), kāsa cikitsā (Ca. Ci. 18/) and śhvāsa cikitsā (Ca. Ci. 17/).

2. Severe (madhyama bala)

Presentations which do require acute medical intervention should be considered severe. While classical lines of management including jvara cikitsā (Ca. Ci. 3/), kāsa cikitsā (Ca. Ci. 18/) and śhvāsa cikitsā (Ca. Ci. 17/) may be supportive or adjunct therapies, they should only be considered in the context of appropriate medical care wherever available.

3. Critical (maha bala)

Presentations which do require acute medical intervention and life supporting interventions should be considered critical. At this stage, it is highly unlikely that Traditional Āyurvedic Medicine (TAM) interventions would be implemented within the context of the US health care system.

Stop the spread

Everyone can help stop the spread of the virus immediately. Read and follow the WHO and CDC guidelines and make changes now to make a difference.

    • Avoid exposure
    • Wash your hands frequently
    • Sneeze and cough into your elbow or tissue
    • Do not touch your face
    • Clean your environment regularly

And help stop the spread of misinformation from unreliable sources. Do not share information on social media without confirming its validity.

Traditional Āyurvedic Medicine (TAM): Guidelines for prevention in the US

ĀYU Council provides the following guidelines for prevention for use in healthy individuals prior to the appearance of signs of active infection, such as fever. These guidelines are appropriate for maintenance and promotion of health in general, and should be used for educational purposes only. They should be used in addition to recommendations from reputable sources.

General personal hygiene

  • When going out in public, wear long protective clothing. Cover the body fully.
  • Always remove shoes before entering the home. Use separate shoes or slippers for inside the home only.
  • Remove all clothes upon returning home and segregate them or wash them as soon as possible. Take a full shower and wash from head to toe.
  • Always excrete waste products from the body and allow urges like coughing, sneezing, crying, etc to be expressed.
  • Avoid cold exposure and intake of cold foods and drinks.

Oral, nasal and respiratory hygiene

  • Clean the mouth before and after each meal by rinsing several times with plain warm water.
  • Always expel accumulated phlegm and mucous from the throat and nasal cavities as soon as possible.
  • Brush the teeth early in the morning before consuming any liquid or food. This reduces bacterial growth from the previous night and reduces the load on the digestive system.
  • Floss and brush the teeth nightly before bed.
  • Rinse the mouth and gargle daily with plain warm water, or warm salty water, or warm water with a pinch of turmeric.
  • Inhale steam for 15-30 minutes daily, covered under a blanket, using plain water, or water gently simmered with tumeric. Caution use with turmeric as it may stain the enamel of the teeth for certain people. 

General nutritional guidelines

  • Eat the correct quantity of food at each meal. Do not overeat.
  • Avoid snacking. Eat two or three meals each day at the same time.
  • Always prefer hot, freshly cooked meals.
  • Sip on freshly boiled hot water with meals. Avoid intake of any cold beverages or foods. Do not consume iced beverages or foods.
  • Prefer a plant-based diet whenever possible. Consume animal products on an as-needed basis.
  • Prefer foods that are familiar to you based on your ethnic heritage and lifetime habits.
  • Prefer foods that always make you feel healthy even when you use them frequently.
  • Vary foods and drinks to consume several different foods over the course of a week.
  • Prepare meals so that they focus on a specific flavor. Do not attempt to prepare meals with the correct proportions of "six flavors" unless you have proper training and experience cooking this way.
  • Simple meals are safest. Steam or gently saute foods with minimal oil, seasoning and salt.

General guidelines for activities and rest

  • Follow a regular schedule. Go to bed, fall asleep and wake up around the same time each day. This is the best way to enhance immunity quickly.
  • Practice an appropriate amount of exercise daily. Prefer activities that produce a moderate amount of sweat in the body like Yoga āsanas, walking outside, cycling and appropriate strength training.
  • Get out of bed when you wake up anytime after 4am.

Daily wake up routine

  • Get up early between 4-6 am (Brahma muhūrta), preferably at the same time each day without an alarm. When the body naturally wakes during this period, it is stimulated by the normal rise of the cortisol cycle and getting up during this peak promotes hormonal function. Create the habit of jumping out of bed so that you can easily distinguish when you begin to feel "off" and this becomes more difficult.
  • Go to the bathroom and eliminate wastes from the body by emptying the urinary bladder and bowels if the urge is patent.
  • Eliminate mucous and phlegm from the nasal and oral cavities. Blow the nose and expectorate any accumulated phlegm.
  • Wash hands with warm water and soap. Rinse or wash the face with tepid water and soap.
  • Rinse the mouth. Gargle with warm water or warm salt water. Brush the teeth.
  • Dry the hands and face well.
  • Drink one half to three cups of freshly boiled hot water or room temperature water. Younger and more active individuals may prefer room temperature water.
  • Drinking water may initiate a bowel movement. Encourage the bowels to pass fully each morning as early as possible. Afterwards, wash the hands thoroughly with warm water and soap, and dry them.

Daily physical conditioning, exercise and shower

  • If possible, apply a moderate layer of sesame oil to the body and rub it into the tissues for 5-10 minutes. Wear an old set of comfortable clothes and get ready to exercise.
    • Some individuals, especially those who are younger and more active, may feel the need to eat a small snack prior to exercising. A banana, granola bar or other small snack is ok before or after applying oil. If this happens, also try exercising one day on empty stomach to check if the feeling of hunger stops after the body becomes active. If so, try to skip the snack even if you feel hungry.
  • Try to do at least 30 minutes of physical activity to induce sweating. This promotes absorption of the beneficial qualities of the oil into the skin while aiding waste excretion through the sweat glands.
    • Depending on age, capacity and many other factors, exercise may be appropriate in a low, medium or high level for 15 to 90 minutes.
    • The ideal type of exercise also varies widely based on these factors, but in general is good to include cardio, strength and flexibility training.
  • After exercising, take a warm to hot shower with mild soap and shampoo to remove the majority of oil from the head and body. Dry off completely and get dressed appropriately to maintain proper body temperature.

Daily breakfast (8am)

  • In general, prefer freshly cooked foods that are simple and made from all natural, known ingredients. Prefer foods that pair well together, and that your body is adapted to based on culture and habit, wherever these regularly promote an increased state of health.
  • Honey is a strong immune builder and may be taken first thing in the morning as a breakfast replacement to reduce kapha. Honey acts as a lekhana, and it scrapes the kapha out of the body. To take it as a breakfast replacement, the honey is mixed into room temperature water and drunk on an empty stomach. Nothing else is eaten until the mid day meal. Honey is contraindicated in situations with provoked heat, and it should never be cooked or used in hot food or beverages.
  • Simple toast (cooled a bit) with honey on it.
  • Cold milk and simple cereal for very active individuals with strong digestive capacity (typically Americans of European ancestry).
  • Granola with warm milk or almond milk and berries.
  • Hot cereal with one spice (oats, cream of wheat, cream of rice, cream of quinoa, barley flakes, hot millet cereal etc.) with cinnamon, clove, nutmeg and optional milk or nut milk.
  • Frozen waffles are an easy and convenient emergency breakfast.
  • Eggs and toast will generally increase pitta and heat. They can be tempered by scrambling and adding coriander or cilantro leaf.

Daily work or activity (9am - 12pm)

  • This is the ideal period of the day to perform mental work.
  • This can be a good time to have a hot caffeinated beverage (tea or coffee). Be sure to drink the right amount at the right time. The right amount is that which does not interfere with sleep.

Daily lunch (11:30am - 12:30pm)

  • Before eating, use the bathroom to empty the bladder and bowels (if required). Wash your hands and rinse your mouth.
  • Always eat the right quantity of food - not too much and not too little. If you aren’t feeling well, eat a smaller quantity of freshly cooked or heated food.
  • If eating leftovers, make sure to only warm the portion you will eat in this sitting. Bring the food up to a boil or simmer for 2-5 minutes.
  • After eating, empty the bladder and bowels (if required), wash hands, rinse mouth and brush teeth.
  • Walk 100 steps slowly. Then sit or lay on the left side if feeling tired. Do not exert yourself too much for an hour after eating a full meal and keep the body and extremities warm.

Daily work or activity (1pm - 5pm)

  • This time should include a variety of work and activities.
  • For some, the evening is the ideal time to cook a meal and reserve some for the next day's lunch.
  • An hour or two before dinner is also a good time to go for a walk or do light to moderate exercise.

Daily dinner (5pm - 6pm)

  • Eat dinner following the same guidelines for lunch but eat a smaller portion than lunch.
  • Drink freshly boiled hot water before and after you eat. You can also sip on hot water with the meal.
  • Generally begin to slow down, relax, and wind down as the sun sets.
  • Listen to pleasant music, watch something enjoyable, read, reduce stress, etc.

Daily bedtime (8pm - 9:30pm)

  • Begin slowing down for bed as the sun starts to set, or at least two hours before falling asleep.
  • Prior to getting into bed (around 7 - 8pm) drink 1-2 glasses of freshly boiled hot water.
  • Avoid drinking ginger tea or anything else that might excite or stimulate the enteric nervous system. A few hours before sleeping, the channels of the body naturally close and slow their functions.
  • For those with a very strong digestion and metabolism, or who are young and physically active, a small cup of hot milk before bed can act as a strengthening restorative. However, anyone with a compromised digestive capacity should generally avoid milk. 
  • Floss and brush the teeth. Optionally rinse the mouth and gargle with warm salty water. 
  • Aim to be in bed early between 8 - 9:30pm and be asleep by 10pm.
  • To slow the mind and calm the senses, read a relaxing book in bed. Avoid using electronic devices in bed.

American Āyurveda: Recommendations for management in the US

At the time of this writing, there is no system of medicine that has a confirmed protocol for managing COVID-19.

Management of mild cases may be supported by Traditional Āyurvedic Medicine (TAM) as a primary or complementary approach. Management should always be performed under direct supervision of a qualified ĀYU Council clinician. For high-risk cases or in cases where symptoms are more progressed, management should be done under an Āyurveda Āchārya (Āyurvedic Doctor, with BAMS qualification) or equivalent.

Improving natural immunity 

  • Using products, herbs or formulations to suddenly enhance the natural state of immunity should be done under professional supervision. The recommendation of Āyurvedic formulations for enhancing immunity is only effective when all factors about the individual are considered.
  • Contrary to popular belief, many Āyurvedic formulations which are intended to promote immunity carry potential side effects when used improperly.
  • The most effective ways to enhance natural immunity are to follow regular daily schedules and maintain appropriate self-care. Eat meals at the same time, in the correct quantity, and follow a regular sleep schedule. 

Use of Āyurvedic herbs, products, formulations and medicines

  • The prescription of Āyurvedic products and medicines in India requires the completion of 5.5 years of full-time Āyurvedic medical education. Licensed Āyurvedic Doctors in India will only prescribe or recommend Āyurvedic medicines after a proper assessment of the individual.
  • With the spread of COVID-19, some Āyurvedic practitioners of Westernized Āyurveda (New Age Āyurveda) have been promoting products such as immune-boosting formulations for disease prevention. Blanket recommendations of non-food Āyurvedic products should be banned by the professional community. The discerning public should understand that these promotion attempts are often ill-informed, and dangerous, and they should always be avoided.
  • If you are considering using any Āyurvedic products, especially those which are considered Āyurvedic medicine in India and are regulated substances, please do so only under the direct supervision of a qualified ĀYU Council clinician.

Traditional Āyurvedic Medicine: Classical discussion

Traditional Āyurvedic Medicine is replete with literature on the prevention and management of disease over a recorded period of history spanning at least 3,000 years. Prior to written records, the practice had been active for an unknown period of time.

Many topics from classical Āyurvedic literature are appropriate in the context of COVID-19. Some which may be relevant to American Āyurveda are discussed here.

Emergency management, according to Suśruta, the Father of Surgery

The Suśruta Saṃhita is the world's oldest surviving surgical text. It details dozens of surgical tools, pre-operative, operative and post-operative procedures, and complex surgeries such as intestinal repair, rhinoplasty and management of advanced sepsis.

The text instructs professional ethical behavior in emergency situations. It states:  

अतिपातिषु रोगेषु नेच्छेद्विधिमिमं भिषक् |

प्रदीप्तागारवच्छीघ्रं तत्र कुर्यात् प्रतिक्रियाम् || ४१ || (सु. सू. ५।४१)

atipātiṣu rōgēṣu nēcchēdvidhimimaṁ bhiṣak |

pradīptāgāravacchīghraṁ tatra kuryāt pratikriyām ||41|| (Su. Sū. 5/41)

During an emergency, the physician (or surgeon) is not required to adhere to routine protocols. Instead, they should respond as if their own house is on fire.

This instruction intends to convey the need to respond quickly in an emergency. In the US, increase in the number of active cases will strain the health care system. It is possible that everyone who needs certain levels of care may not have access when required.

This global pandemic has the potential to become a major emergency for all health care professionals and people. It is a once in a multi-generational event. Everyone should take precautions to prevent the spread of the disease very seriously. Our actions today will have recognizable effects in the coming weeks and months.

Advancing Traditional Āyurvedic Medicine (TAM) in the West

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