Introduction:

Ayurveda, a system of Indian medicine, literally means ‘the Science of Life’. It does not deal only with the symptomatology of the disease, but also deeply explores the science of health, well-being, and harmony. From an Ayurveda standpoint, health/Swasthya is a state of dynamic harmony between the body, the mind, the soul, and the world. As every individual has a unique body, mind, and a unique relationship with the world, Swasthya is also unique to each individual. There is no prescriptive prototype. Health in the human being is also dependent upon the health of the world he/she lives in, whether a tree, a close other, the air we breathe, or the soil. An Ayurveda understanding of health considers the many strands of the delicate web that constitute the dynamic world in which we live. It is only when these are allowed to thrive and find their own balance, that true harmony of the larger web, of which the human is one part, becomes possible.

Any understanding of a novel disease from the Ayurveda lens must, therefore, be based on this unique and holistic understanding of health and disease. An attempt has been made here to analyze the COVID-19 disease from an Ayurveda perspective.

Epidemics in Ayurveda:

Based on causality, diseases in Ayurveda are classified in numerous ways. One is the Asadharana and Sadharana classification – Asadharana – diseases caused by unique individual predispositions, lifestyles, diets, and histories; and Sadharana – diseases that transcend individual susceptibilities and affect large populations of people.1 This is called Janapadodhwamsa, a concept which has been elaborately described in the Caraka Samhita, a nodal text of Ayurveda, and may be correlated with epidemics or pandemics. The causes of Janapdodhwamsa are further classified into two – a) those that occur due to natural causes b) those that occur due to man-made causes. Both of these may further be classified into four – they are vitiation of air, vitiation of water, vitiation of land, and vitiation of climate.2 These causes have been summarized in Table 1.

These are entities that are a) not subject to demographic variability b) extend over wide geographic regions. Vitiation of any one of these entities, therefore, results in widespread disease and spread of infectious agents. The same disease-causing agent may be both man-made and natural. For instance, a landslide may occur due to nearby volcanic activity, or due to extensive soil erosion resulting from unsustainable deforestation.

Another classification of disease due to causality is based on the source of disease – Nija – causes that are specific to individual predispositions and histories (internal causes), and Agantuja – causes that are external and irrespective of individual predispositions (external causes). These include trauma, natural calamities, etc.3 While epidemics, though affecting large populations, still affect different people differently (for example, in case of the COVID-19 pandemic, people with a history of respiratory illness are more susceptible), they fall under the Agantuja disease category.

 

Understanding the Janapadodhwamsakara Bhavas (Causes of Janapadodhwamsa)

Air: 

The features of vitiated air include air that is stagnant, violent and turbulent, excessively dry, cold, hot, or having excessive humidity, frequently blowing in different directions, heavy cyclones, and riddled with unwholesome toxic gases, sand ashes or smoke.

 Water:

The features of vitiated water include water that has abnormal taste, texture, colour or smell, having toxic taste or odour, water that is excessively turbid or mucilaginous, and have a reduced number of or complete absence of aquatic animals and birds.

Land:

The features of vitiated land include land that is withered and dry, is rife with grass and weeds and few trees or forests, is excessively moist – like a bog or marsh, has an abundance of predatory animals like vultures, jackals, carnivores and serpents, and is riddled with smoke and dust.

Climate:

Features of vitiated climate include continuous climatic agitation, unseasonal variations, the incidence of meteorites, earthquakes, etc, and appearance of poisonous fumes that veil the skies, etc.

The manifestation of these and other features indicative of vitiation of land, air, water, and climate, is responsible for the incidence of epidemics and pandemics, and transcend demographic dynamics.

Understanding infectious agents in Ayurveda

Bhuta is a term that has been used variously in different contexts in Ayurveda. One of them is in the context of the Panchamahabhootas – the fundamental building blocks of the microcosm and the macrocosm of this phenomenological world. It is also used to reference invisible microorganisms or ‘Jeevanus’. The role that microbes or microorganisms play in disease manifestation has been recognized since Vedic times. Terms such as Rakshas, Krimi, Bhuta, Jantu, Jeevanu, and Pishacha have been used to describe them.8 These have been classified in three ways – based on visibility, based on place of origin, and based on the seats of infection.9 These have been summarized in Table 2 below.

 

However, perhaps the most interesting classification of microorganisms is as pathogenic (Vaikarika) and non-pathogenic (Sahaja).10Ancient Ayurveda scholars recognized that there are certain microorganisms that remain with us from birth till death and that are necessary for the survival of the human body. Sushruta, in his nodal text, the Sushruta Samhita, describes in detail disease-causing and health-sustaining organisms invisible to the naked eye, that colonizes the body, further adding that these are innumerable in number – over one thousand crore. 11 Modern science today tells us that there are indeed trillions of microorganisms that inhabit the human body, many of which are vital to human sustenance.12 Dalhana, in his commentary of the Sushruta Samhita, says, that though these agents remain unseen, their presence is inferred through their action on the body.13 Vyasa, in his epic Mahabharata, stated that Krimis were everywhere and that nobody could avoid them entirely, or stay free of them.14 While terms such as Krimi, etc. denote harmful microorganisms, terms such as Pinga and Paidava denote beneficial microorganisms.15 Beneficial micro-organisms, Sushruta says, colonize hygienic and healthy bodies, and also impart cleanliness and health, while disease-causing microorganisms pervade blood, fat, muscle or deeper tissues.16 While the human microbiome was discovered a mere two hundred years ago 17, it is incredible to note that similar concepts were mentioned in texts dated at least 3000 years back. Perhaps, therefore, it would be an interesting venture to delve deeper into the Ayurveda lens, to understand better a source of knowledge that has not only survived for over five thousand years, but also yields insights on health and disease that are as relevant today as they were five thousand years ago.

Krimi are said to originate and breed in Sweda (moisture) – an environment conducive to them. During certain periods, such as during epidemics, the body undergoes Paka (or physiological and temperature changes) that make it conducive for colonization by harmful microorganisms. Hence, Sushruta considers Krimi to be ‘Swedaja’, or originating from Sweda.18 He describes these microorganisms using various terms such as Anu (minute), Vritta (disc-like), etc. In the context of Kushta (a spectrum of skin disorders), it is said that disease progression takes place when Krimis invade the skin (Twak), flesh and muscles (Mamsa), blood (Rudhira), tendons and ligaments (Snayu), and vessels (Siras and Dhamanis).19 While describing several diseases, Krimija or infective causes have been included – eg. Krimija hridroga20 (infective causes for cardiac diseases), Krimija Shiroroga21, etc. However, it is interesting to note that Vagbhata, the author of Ashtanga Hridaya, one of the three nodal textbooks of Ayurveda, used the term ‘Avahana’ to describe the process of microbial infestation of skin diseases. Avahana means to ‘invite or invoke’.22 This indicates that according to Ayurvedic thought, intrinsic pathological derangement within the body makes it susceptible to colonization by infectious agents – i.e. not all people exposed to an infectious agent will become infected. The body, is called the ‘Kshetra’ – the field/site, both of health and of disease.23 It is only when the Kshetra is unhealthy, that Avahana of the disease can take place. Thus, the notion of infectious agents colonizing a healthy body and becoming the primary cause of the disease is absent in Ayurvedic thought.

 

Transmission of infectious diseases

Sushruta describes in detail modes of spread of infectious diseases. He includes) frequent contact with an infected person, b) physical contact, c)respiratory droplets, d) sharing food, e)proximity, f)sharing common items such as blankets, combs, etc., g) and exchange of body fluids.24 Interestingly, the concept of vector-borne disease transmission is also found – while describing ulcers and wounds, Sushruta observes that flies deposit pathogens in wounds that cause their suppuration.25

Management of infectious diseases

Caraka elaborates on a threefold strategy for the management of pathogenic organisms. These are (1) Apakarshana – removal or extraction of pathogenic organisms, (2) Prakritivighata – creating an environment unfavorable for pathogenic organisms to thrive in, and (3) Nidanaparivarjana – complete avoidance of causative factors.26 The methods of Apakarshana include diet, medication, and therapy such as suitable Panchakarmas that are krimighna – help to destroy pathogenic organisms.

In the context of surgery or treatment of physical trauma, Sushruta advocated fumigation with specific herbs and resins to prevent colonization by ‘Rakshas’ or harmful pathogens, recognizing the propensity for suppuration and development of complications.27 These include drugs such as Nimba (Azadirachta indica), Guggulu (Commiphora mukul), Sarshapa (Brassica campestris) etc. Interestingly, these fumigants have now been shown to have microbicidal activity. He also describes in detail certain Yamas and Niyamas (disciplines) that the patient has to follow to prevent complications that include rigorous cleanliness, frequent dressing, dietetic protocols, etc.

Conclusion

Ayurveda in detail enumerates epidemics, infections, their modes of transmission, and tools for management. While it is necessary to evaluate the COVID-19 pandemic through the lens of Ayurveda and find effective integrative approaches to its management, it is important to keep in mind the person-centric holistic approach that Ayurveda brings to disease evaluation and management.

References

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