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Introduction

The present pandemic ‘Coronavirus Disease-2019 (COVID-19)’ has greatly stumbled the whole world. This disease was first acknowledged in December 2019 at Wuhan, China1. Since then, it is been spreading in lightning speed, affecting the well-being of worldwide population as well as the day-to-day life of every sector of people leading to adverse global socioeconomic impact. The WHO had declared the outbreak as Public Health Emergency of International Concern on January 30, 20202 and as pandemic on March 11, 20203. Globally, as of 4 November 2020, there have been 47,362,304 confirmed cases of COVID-19, including 1,211,986 deaths, reported to WHO4.This high surge in mortality and incidence rate has alerted every system of medicine for their active contribution in fighting against this disease. Hence numerous researches are being carried out across the globe. Ayurveda, being an ancient Indian medicinal system, had already explained and treated many pandemics since its dawn, considering them as Janapadoddhva?sa vikara5. The present article focuses on bringing to light, the close affinity of the pandemic COVID-19 and Shleshmaka jvara6, a disease explained as Janapadoddhvasa vikara by Acarya Gaanatha Sen.

COVID-19 – A Brief Modern Review:

Coronavirus disease- 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2)7 which belongs to the family Coronaviridea7. The coronaviruses are responsible for mild to moderate respiratory tract infections like the flu in humans8. Out of the seven known human corona virus strains, four are generally mild; while the other 3 are, Severe Acute Respiratory syndrome corona virus SARS-CoV (2002-2004), Middle East respiratory syndrome related corona virus- MERS-CoV (first emerged in 2012) and the most recent Severe Acute Respiratory Syndrome corona virus-2 (SARS-CoV-2) are more severe and sometimes deadly.  Recent researches reported that SARS-CoV-2 is likely to be originated from bats and shares 79.5% gene sequence identical to SARS-CoV9. Transmission occurs mainly through respiratory droplets in persons who are in contact with each other. Aerosol transmission can occur in indoor, crowded and inadequately ventilated spaces10. The entry of SARS-CoV-2 into the host cell is mediated by the angiotensin- converting enzyme 2 (ACE-2) receptors which are found in the heart (endothelium of coronary arteries, myocytes, fibroblasts, epicardial adipocytes), vessels (vascular endothelial and smooth cells), gut (intestinal epithelial cells), lung (tracheal and bronchial epithelial cells, type 2 Pneumocystis, macrophages), kidney (luminal surface of tubular epithelial cells), testis, brain11. ACE-2 receptors are abundantly distributed in the epithelia of the lungs and the small intestine12.The incubation period may extend to 14 days, with a median time of 4-5 days from exposure to the onset of symptoms13.

The symptoms of COVID-19 range from mild to severe; sometimes asymptomatic as well. The most common symptoms include fever, dry cough and fatigue14. Symptoms of severe COVID-19 disease has symptoms like confusion, persistent pain or pressure in the chest, high temperature (above 38°C) shortness of breath and loss of hunger. Other less common symptoms are irritability, confusion, reduced consciousness (sometimes associated with seizures), nervousness, unhappiness, sleep disorders, more severe and rare neurological complications such as strokes, brain inflammation, hallucination and nerve damage. Without hospitalisation, most of the people nearly 80% have recovered, some complications leading to decease include respiratory failure, ARDS, thrombo-embolism, multi-organ failure, sepsis and septic shock ect.14

table 1

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Discussion

COVID-19 – An Ayurvedic Perspective:

Various clarifications and indications found in the Ayurvedic classics have paved the way for us to recognise COVID-19 like pandemics as Janapadoddhva?sa vikara. The term ‘Janapadoddhva?sa’ is of two words ‘Janapada’ (meaning mankind), and ‘uddhva?sa’ (meaning destruction).  Therefore Janapadoddhva?sa vikara can be literally defined as disease resulting in mass destruction of people. Vayu (air), Jala (water), De?a (land) and Kala (time),15 being the four common factors in a community often getting contaminated, result in producing Janapadoddhva?sa (outbreak causing mass destruction). Adharma16 (unrighteousness) is said to be the root cause for Janapadoddhva?sa. However, Janapadoddhva?sa is a broad term and a vast number of diseases can be included under this; hence deducing COVID-19 pandemic to a separate disease entity as per Ayurveda is crucial. Later Acaryas like Acarya Ga?anatha Sen had described a disease named Shleshmaka Jvara in his book ‘Siddhanta Nidana’ which is in accordance with the characteristics of the present pandemic COVID -19.

Siddhanta Nidana, written by Acarya Ga?anatha Sen in 1922 was a book of Nidana which was compiled meticulously in accordance with updated modern diseases. Acarya Caraka had clearly mentioned that diseases are innumerable17. Considering this, Acarya Ga?anatha Sen had made an attempt to update some of the teachings of old classics according to the present world wherever necessary and named some diseases according to the nomenclature norm stated by Acarya Caraka. Explaining Prasiddha Agantu Jvara18 (famous exogenous fevers) under Jvaradhikara was one such attempt by him. They can also be interpreted as Vishabhisha?gaja Agantuja Jvara. they specified that Nanavidhavishotthana (different finds of poison) as the cause for these types of Agantuja Jvara. They also highlighted that such Visha are Prayena Jivanu sambhavam (predominantly produced by microorganisms such as bacteria, virus etc.) or Kvacidanyavidha? (some others also); they cause Samanyam dvitradoshaprakopanam (vitiation of two or three dosha generally).18 Shleshmaka Jvara is one of these Agantuja Jvara whose features are in accordance with the present pandemic ‘Coronavirus disease-2019 (COVID-19)’.

Shleshmaka Jvara is defined as a Jvara (fever) associated predominantly with much ?leshmaupadrava (complication of strong increase of Kapha dosha), sometimes appearing as Janapadoddhva?sa (epidemic) as well. J?vanu visha (toxins of microorganisms) Vayuvahita (carried through the air) spreads quickly through the community; they predominantly enters through the ?vasamarga (respiratory route) and cause Jvara (fever), sometimes they also enter through Annamargam (oral route); with the feature of Janajjane ca sa?kranti? (transmitting from person to person) through ?vasanadhi nimitta? (through respiration)19.

Most of the symptoms of Shleshmaka Jvara are confined to the ?vasayantra (respiratory system), sometimes Annamargam (gastrointestinal system) and sometimes Sarvadhatu (all tissues) as well. It is Sannipatikam (vitiation of all three doshas) with Kaphavatolba?a? (predominance of Kapha and Vata). As a result of this doshic imbalance and vitiation, endotoxins are generated, which thus hinders the normal physiological activities of the body and results in progression of pathological changes in the tissue either mildly or grossly19.

Prati?yaya (coryza), ?ira??ula (headache), ?itakampa? (chillness and shivering), A?gamarda (malaise), Ka??p?sh?horasamt?vra?cavedana (severe pain in the hip, back and chest), Kasa (cough), Jvara (fever), Avasada (lassitude), Kar?yañcalpairdinairbh??am (becoming emaciated within few days), Atyartha balahani (increased loss of strength) are the Samanya laksha?a (general symptoms) of Shleshmaka Jvara20.

Precisely, if Phuppusa (lungs) is invaded there will be Sarakta sh?ivanam (spitting of sputum mixed with blood), Pralapa (delirium) and Shvasanam (shortness of breath). If gastrointestinal system is attacked there will be Vami (vomiting), Atisara (diarrhoea) or both; when anyone of vomiting or diarrhoea is relieved then Shula (abdominal pain) or Kamala (jaundice) will manifest. With Atyartha Visha (too much toxin) occurs Sarva dhatupradusha?at (vitiation of all tissues) which leads to the development of symptoms similar to Abhinyasa Jvara, from which none will escape; it becomes difficult to treat when there is Bahudosha (excessive doshas), Balahani?ciraya (loss of strength that continues for long period)20.

Conclusion

From the above illustration, it can be clearly understood that the features of both Shleshmaka Jvara and COVID-19 are analogous. Diseases are innumerable with multi-fold clinical presentation; due to combination of various etiological factors new diseases are emerging, hence any new disease condition must be understood in terms of dosha and dushya only as stated by Caraka. The criteria like type of pain, appearance, aetiology, site, symptoms and name shall be applied for identification. Based on clinical presentation, dosha and dushya’s identified in COVID 19 in this study we have correlated it with Shleshmaka Jvara with due respect to the Ayurvedic diagnostic principles. Understanding the nature of the disease, its location and etiological factors is of prime importance for the physician to initiate the best treatment appropriate for the disease. Now, it is therefore, the responsibility of present Ayurvedic physicians to apply their yukti (knowledge) to fight against this pandemic effectively.