NATIONAL CLINICAL MANAGEMENT PROTOCOL BASED ON AYURVEDA & YOGA FOR COVID-19 MANAGEMENT BY MINISTRY OF AYUSH (GOVT. OF INDIA)

 

National Clinical Management Protocol based on Ayurveda & Yoga for Covid-19 management

General and Physical measures:-

1.	Follow physical distancing, respiratory & hand hygiene, wear face mask.
2.	Gargle with warm water added with a pinch of turmeric and salt. Water boiled with Triphala (dried fruits of Embilica officinalis, Terminilia chebula, Terminilia bellerica) or Yastimadhu/Mulethi (Glycyrrhiza glabra) also can be used for gargling.
3.	Nasal Instillation / application of medicated oil (Anu taila or Shadbindu taila) or Seasame/Coconut oil or nasal application of cow’s ghee (Goghrita) once or twice daily, 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 hours.
6.	Moderate physical exercises.
7.	Follow Yoga for primary prevention of Covid-19 and for post Covid-19 care.

 

Dietary measures:-

1.	Use warm water or boiled with herbs like ginger (Zingiber officinalis) 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 teaspoon haldi (Curcuma longa) powder in 150 ml hot milk) once at night. Avoid in case of indigestion or IBS.
4.	Drink Ayush Kwath (hot infusion or decoction) once a day.

 

Specific measures / Symptomatic management:-

Clinical Severity	Medicines	Dosage & Timing
Prophylactic care (high risk population, primary contacts)	Ashwagandha (Aqueous extract of Withania somnifera) or its powder	500 mg extract or 1-3 gm powder twice daily with warm water for 15 days or one month or as directed by Ayurveda Physician
	Guduchi ghanvati (Samshamani vati or Giloy ghanavati having aqueous extract of Tinospora cordifolia) or its powder	500 mg extract or 1-3 gm powder twice daily with warm water for 15 days or one month or as directed by Ayurveda Physician
	Chyawanprasha	10 gm with warm water or milk once a day

In addition to these medicines, general & dietary measures are to be followed.

 

Clinical Severity	Clinical Presentation	Medicines	Dosage & Timing
Asymptomatic COVID-19 Positive	For prevention of disease progression to symptomatic and severe to improve recovery rate	Guduchi ghanvati (Samshamani vati or Giloy ghanavati having aqueous extract of Tinospora cordifolia) or its powder	500 mg extract or 1-3 gm powder twice daily with warm water for 15 days or one month or as directed by Ayurveda Physician
		Guduchi + Pippali (Aqueous extract of Tinospora cordifolia & Piper longum)	375 mg twice daily with warm water for 15 days or as directed by Ayurveda Physician
		AYUSH 64 tablet/capsule	500 mg twice daily with warm water for 15 days or as directed by Ayurveda Physician

In addition to these medicines, general & dietary measures are to be followed.

 

Clinical Severity	Clinical Presentation	Clinical Parameters	Medicines	Dosage & Timing
Mild COVID-19 Positive	Symptomatic management Fever, Headache, Tiredness, Dry cough, Sore throat, Nasal congestion	Without evidence of breathlessness or hypoxia (normal situation)	Guduchi + Pippali (Aqueous extract of Tinospora cordifolia & Piper longum)	375 mg twice daily with warm water for 15 days or as directed by Ayurveda Physician
			AYUSH 64 tablet/capsule	500 mg twice daily with warm water for 15 days or as directed by Ayurveda Physician

In addition to these medicines, general & 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 judgment, suitability, availability and regional preferences. Dose may be adjusted based upon the patient’s age, weight and condition of the disease.

Clinical Severity	Clinical Parameters	Medicines	Dosage & Timing
Post COVID Management	Prevention of Post COVID Lung infections like Fibrosis, Fatigue, Mental Health	Ashwagandha (Aqueous extract of Withania somnifera) or its powder	500 mg extract or 1-3 gm powder twice daily with warm water for 15 days or one month or as directed by Ayurveda Physician
		Chyawanprash	10 gm with warm water or milk once a day
		Rasayana Churna (Compound herbal powder made up of equal amounts of Tinospora cordifolia,Embilica officinalis & Tribulus terrestris)	3 gm powder twice daily with honey for one month or as directed by Ayurveda Physician

In addition to these medicines, general & dietary measures are to be followed.

According to the physician’s discretion physician have to decide useful formulation from the above or substitutable classical medicines based upon their clinical judgment, suitability, availability and regional preferences. Dose may be adjusted based upon the patient’s age, weight and condition of the disease.

 

 

Yoga Protocol for Primary Prevention of COVID-19

Objectives:-

1.    To improve respiratory & cardiac  efficiency

2.    To reduce stress & anxiety

3.    To enhance immunity

Practices	Name of the Practice	Duration (Minutes)
Prayer		1
Loosening Practices	Neck bending	2
	Shoulder movement	2
	Trunk movement	1
	Knee movement	1
Standing Asana	Tadasana	1
	Pada-hastasana	1
	Ardha chakrasana	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	Setubhandhasana	1
	Utthanpadasana	1
	Pawana Muktasana	1
	Markatasana	1
	Shavasana	2
Kriya	Vata neti 2 rounds (30 sec with 30 sec relax)	2
	Kapalbhati (2 rounds, 30 strokes each)	2
Pranayama	Nadi sodhana (5 rounds)	2
	Surya bhedi pranayama (5 rounds)	2
	Ujjayee pranayama (5 rounds)	2
	Bhramri pranayam (5 rounds)	2
	Dhyana	5
	Shanty patha	1
Total Duration		45 minutes

 

·       Advised Jalneti kriya weekly thrice.

·       Advised steam inhalation every day or alternative day.

·       Advised gargling with lukewarm saline water regularly.

 

Yoga Protocol for Post COVID-19 care (Including care for COVID-19 patients)

Objectives:-

1.    To improve pulmonary function & lung capacity

2.    To reduce stress & anxiety

3.    To improve Muco-ciliary clearance

Morning Session (30 minutes):-

Practices	Name of the Practice	Rounds	Duration (Minutes)
Preparatory practices (In sitting)	Tadasana		6
	Urdhwa hastottanasana
	Uttana mandukasana
	Shoulder rotation	3 rounds
	Trunk twisting	3 rounds
	Ardha ustrasana
	Sasakasana
Breathing practices	Vaatneti	2 rounds (30 sec/round)	2
	Kapalbhati	3 rounds (30 sec/round)	2
	Deep breathing	10 rounds	2
Pranayama practices	Nadisodhana	10 rounds	6
	Ujjaayee	10 rounds	3
	Bhramari	10 rounds	3
Meditation	Dhyana	Awareness of breathing or awareness of positive thoughts/emotions/actions	6
Total Duration			30 minutes

Period of exhalation shall be more than the period of inhalation, preferably 1 : 2

(Inhalation : Exhalation)

Evening Session (15 minutes):-

Name of the Practice	Rounds	Duration (Minutes)
Savasana (Corpse pose) arms stretched	1	1
Abdominal breathing	10	2
Thoracic breathing	10	2
Clavicular breathing	10	2
Deep breathing (lying down position)	10	2
Relaxation in Shavasana with awareness on abdominal breathing		5
Total Duration		15 minutes

·       Period of exhalation shall be more than the period of inhalation, preferably 1 : 2

         (Inhalation : Exhalation)

·       Advised steam inhalation every day or alternative day.

·       Advised to gargling with lukewarm saline water regularly.

 

Note:

·       Loosening exercise: Forward / Backward bends, Spinal twist,

·       Breathing exercise: Sectional breathing, Yoga breathing, Hand in and out breathing, Hand stretch breathing Yogic breathing exercise and asanas found to improve lung volumes and reduce asthma attacks and inflammation in respiratory tract.

·       Breathing and Pranayanama: Vaataneti, Kapalabhati kriya, Bhastrika prayanama, Nadishodana for improvement in pulmonary functions.

·       Kriya: Jalaneti practice to cleanse and decongest the upper airways. Not to be used in dry cough.

 

Management of Mild COVID-19 Cases

Clinical severity	Symptom	Formulation	Dose
Mild COVID-19	Fever with body ache, Headache	Nagradi kashaya	20 ml twice a day or as directed by Ayurveda physician
	Cough	Sitopaladi churna with honey	2 gm thrice daily with honey or as directed by Ayurveda physician
	Sore throat, loss of taste	Vyosadi vati	Chew 1-2 pills as required or as directed by Ayurveda physician
	Fatigue	Chyawanprash	10 gm with warm water / milk once a day
	Hypoxia	Vasableha	10 gm with warm water or as directed by Ayurveda physician
	Diarrhea	Kutaj ghan vati	500 mg -1 gm 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 & dietary measures are to be followed.

·        According to the physician’s discretion physician have to decide useful formulation from the above or substitutable classical medicines based upon their clinical judgment, 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

·        This is a general advisory. Attending physicians need to use their discretion to select the drug based upon the stage of disease, symptom complex & availability of the medicines. The recommended formulations in this attempt are in addition to standard approaches of care and prevention as well as other Ayurvedic approaches recommended for prevention earlier. Moderate to severe COVID-19 individuals may have informed choice of treatment options.

 

Reference:-

National Clinical Management Protocol based on Ayurveda & Yoga for Covid-19 management, Ministry of AYUSH; Govt. of India.