Evidence-Based Yoga and Naturopathy for COVID-19

1.0 Background:

1.1 The Definition:

Coronavirus disease 2019 (COVID-19) is defined as an infectious illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV).

1.2 Route of Transmission:

The principal mode by which people are infected with SARS-CoV-2 is through exposure to respiratory droplets carrying infectious virus (generally within a space of 6 feet).

Additional methods include contact transmission (eg, shaking hands) and airborne transmission of droplets that linger in the air over long distances (usually greater than 6 feet).

Virus released in respiratory secretions (eg, during coughing, sneezing, talking) can infect other individuals via contact with mucous membranes.

The virus can also persist on surfaces to varying durations and degrees of infectivity, although this is not believed to be the main route of transmission.

Transmission of covid

1.3 Signs and symptoms:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

2.0 Management through Naturopathy

2.1 WHO Guidelines for Prevention of Infection:


2.1.1 Hand Hygiene

Wash your hands often with soap and water for 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.

Use a hand sanitizer (at least 70% alcohol based) if soap and water not available cover all surfaces of your hands and rub them together until they feel dry.

2.1.2 Respiratory Hygiene

Use a handkerchief or a tissue to cover your face while coughing or sneezing.

Throw the used tissues immediately into a closed dustbin.

Cover your sneeze into your bent upper arm in case you are not carrying a tissue or a kerchief.

Wash hands immediately after you have covered your sneeze or cough.

2.1.3 Social Distancing

Stay at home unless absolutely necessary.

Keep a distance of at least two meters (6 ft) between yourself and another person.

2.2 Hydrotherapy

Procedure

Duration

Rationale

Hot water drinking

Throughout the day

Increases nasal mucus velocity. Therefore helpful in displacing any fluids in the upper respiratory tract (Saketkhoo et al., 1978).



Warm water gargling with salt and turmeric

5-10 min, once a day in the early morning


Scientific evidence supports the anti-microbial activity of curcumin.

Gargling helps expel virions from the mucous membranes.


Facial Steam and Steam Inhalation with tulsi and tea tree essential oils

5-10 min, twice a day

Heat inactivates the SARS-CoV-2. At about 60oC it becomes weak, and at 70oC, the virus gets killed.

The essential oils also have anti-viral properties.

Steam inhalation increases muco-ciliary clearance and nasal patency, and provide symptomatic relief (Cohen, 2020).


Warm water bath before bed

5 min, once daily before bed.

Produces a sedative effect and helps overcome corona virus anxiety.




Hot foot and arm bath

20 min, once daily before bed.

Helps relieve lung congestion by improving circulation to the lower limbs.

Results in faster sleep onset and less body movements during sleep.



Neutral chest pack

20 min, once every alternate day

Increases chest wall mobility thereby facilitating an increase in volume of breathed air (Bito et al., 2020).


Enema

SOS

Helps detoxify the bowel. It can be taken in case of GI symptoms.

2.3 Mud Therapy

Procedure

Duration

Rationale

Mud eye pack

15 min

Reduces perseverative thinking, improves positive affect thereby producing a feeling of wellness. Helps reduce corona virus related anxiety.

Hot mud application to the chest

45 min

Heat application is found to be helpful in managing COVID symptoms (Cohen, 2020).

Mud is also anti-inflammatory in nature thereby will help reduce risk of cytokine storm development.

2.4 Heliotherapy

Procedure

Duration

Rationale


Sun exposure for 15-20 minutes before 10:00 AM and after 5:00 PM

Once, daily

Evidence shows the beneficial effect of Vitamin D in improving immunity and reducing COVID related morbidity (Grant et al., 2020).



2.5 Acupressure

Patients can be taught to apply self-pressure to these acupressure points in order to improve immunity and pulmonary functions (Zhang et al., 2020).

Points

Location

Rationale

Hegu, LI 4

Between the base of the thumb and index finger, highest point on the bulge of muscle Powerful analgesic point

Yintang, Ex 1

Between the inner eyebrows Anti-anxiety point

Quchi, LI 11

Outer end of the elbow crease Homeostatic point

Neiguan, P 6

2 cun below transverse wrist crease between the tendons, palmaris longus & flexor carpi radialis Influential point for chest disorders

Sanyinjiao, Sp 6

On the medial aspect of the lower leg, 3 cun above the medial malleolus, on the posterior border of the medial aspect of the tibia. It is the intersection of three yin channels, which has a calming effect. It improves sleep quality

Danzhong, CV 17

The centre of the sternum between the nipples. Point that is related to lung viscera

Zusanli, St 36

The lateral side of the leg below the knee (patella), 3 cun below St 35. Immunity improving point.

2.6 Aromatherapy

Essential oils

Administration

Rationale


lavender, ylang ylang, and bergamot

Inhalation

Reduced blood pressure, subjective stress, state anxiety and serum cortisol in a study

Tulsi essential oil

Inhalation

Anti-viral property

Peppermint essential oil

Inhalation

Acts as a vasoconstrictor thereby causing bronchodilation.

Tea tree essential oil

Inhalation

Anti-microbial action

Eucalyptus essential oil

Inhalation

Anti-microbial action

Thyme essential oil

Inhalation

Anti-microbial action against URT pathogens (Ács et al., 2018).

2.7 Massage

Procedure

Duration

Rationale

Self-massage to the chest with warm oil, before bath.

Essential oils can be mixed with mustard oil for massage.

10-15 minutes, once daily

Warm oil massage increases cutaneous circulation.

Ayurveda advocates use of mustard oil in chest disorders.

3.0 Nutrition

3.1 Functional Foods

Food

Dosage/day to meet RDA

Rationale

Amla, Indian gooseberry

150 ml as juice every morning on empty stomach

Rich source of Vitamin C.

Zinc rich food

  • Almonds

  • Cashew nuts

  • Sunflower seeds

  • Pumpkin seeds

4-5 pieces soaked in water for 3-4 hours

Zinc is essential to preserve natural tissue barriers such as the respiratory epithelium, preventing pathogen entry (Wessels et al., 2020).

Omega 3 fatty acids

  • Flax seeds

  • Chia seeds

  • Walnut

1-2 tsp as powder mixed with one glass of warm water.

Anti-inflammatory: Improves the endothelial cell functions.




Vegetables:

Brinjal, Bitter gourd, Drumstick, Pointed gourd, Amaranth, Giloy

To be used regularly in cooking

Ayurvedic texts advocate the consumption of these vegetables.

Foods that improve the expression of nitric oxide:

Beetroot, Garlic, Meat, Dark Chocolate, Leafy Greens, Citrus Fruits, Pomegranate, Nuts and Seeds, Watermelon

To be used regularly in cooking

Nitric oxide has anti-viral properties.

Alkaline foods:

Bananas, Lime

Yellow lemon

Avocado

Garlic

Mango

Mandarin

Pineapple

Oranges - 9.2 pH

pH

9.9

8.2

15.6

13.2

8.7

8.5

12.7

9.2

The pH of coronavirus ranges from 5.5 to 8.5.

So, consuming alkaline foods neutralizes the blood pH.

Calcium rich food:

Boiled chickpeas, black til, raw almonds, moringa powder, orange, dried figs, methi greens, boiled soyabeans, amaranth seed powder

To be used regularly in cooking

Improves absorption of Vitamin D

3.2 Phytonutrients

Food

Dosage/day

Rationale

Polyphenols

  • Orange

  • Red onion

  • Blueberry

  • Strawberry

  • Apple


Plenty of fresh fruits and juices must be taken every day.


Anti-inflammatory

Anti-oxidant


Terpenes

  • Lemon peel

  • Orange peel

1 tsp of lemon+orange peel powder mixed with half a glass of warm water.

Acts as a natural anti-histamine. Anti-allergic in nature.

3.3 Healing Herbs

Herb


Dosage

Rationale

Ginger, pepper, turmeric, long pepper, tulsi, adhimadhuram/liquorice root.

Mix all the ingredients and boil with 500ml of water, until the water reduces to half.

Add a spoon of honey and few drops of lemon juice to the kashayam.

250 ml taken as kashayam, once or twice a day.

The Ministry of Ayush advocates the use of this “Ayush kwatha”.

These herbs have been shown to be helpful in managing “kapha” disorders.

Moringa leaf powder

1 tsp with warm water

Immunity enhancer

Giloy

150 mL as juice

Anti-pyretic property


3.4 Natural Supplements

Supplement


Dosage

Mechanism of action

Immune Aid

1 – 0 – 1

Improves immunity

VSL #3

1 – 0 – 0

Probiotic supplement

Inulin

1 tsp in 150ml warm water

Prebiotic

Omega-3

1 – 0 – 1

Balances LDL:HDL cholesterol ratio and is anti-inflammatory

Ashwagandha

1 – 0 – 1

Helps manage lethargy and malaise

L-arginine

1 – 0 – 0

Pre-cursor of nitric oxide (NO)

Sleep Aid

0 – 0 – 1

Melatonin supplementation helps improve anti-viral efficiency of interferons (Dinicolantonio et al., 2021).

3.5 Gut health

Food

Rationale

Probiotics

Increase the bioavailability of polyphenols

Improve gut microflora diversity

Prebiotics

Provide a substrate for the flourishing of intestinal microflora


4.0 Yoga

(1) Yoga lowers the stress hormones and helps to manage the stress and tension

(2) It helps to improve the immune response

(3) It stimulates the lymphatic system and thereby facilitate to carry away the toxins from the body

(4) It improves the lung functions

(5) It calms the mind and helps in better sleep quality.

4.1 Yoga Special Technique

Practice


Time

Prayer and affirmation

2 min

Hands in and out breathing

2 min

Hand stretch breathing with A,U,M

4 min

Kati chakrasana

2 min

QRT in matsya kridasana on right side

3 min

Bhujangasana breathing

2 min

QRT in matsya kridasana on left side

3 min

Vibhagiya pranayama

3 min

Kapalabhati

1 min

Bhastrika

2 min

Nadi shuddhi

2 min

Ujjayi

2 min

Brahmari

2 min

Nada anusandhana in prone posture

8 min

Affirmation and concluding Prayer

2 min

4.2 The Art of Breathing

Practice 5 rounds of brahmari pranayama once every 2 hours.

Evidence shows the beneficial anti-viral effects of nitric oxide (NO) which inhibits the replication of SARS-CoV-2 (corona virus).

The practice of bhrahmari pranayama increases the NO Expression dramatically (M. Taneja, 2016).

It takes 5 minutes for the exchange of gases in nasal sinusus during bhrahmari, whereas it takes 30 minutes for the same amount of gaseous exchange during quiet breathing.

NO is also anti-inflammatory and improves oxygen uptake by the lungs (M. K. Taneja, 2020).

4.3 Kriyas

Procedure

Dosage

Rationale


Jala Neti

Once every day in the morning

Salt exercises an anti-viral effect by inhibiting replication of viral DNA and RNA. This action is mediated by formation of hypochlorous acid.

Saline nasal irrigation helps cleanse the nose and paranasal sinusus and drains inflammatory exudates (Panta et al., 2021).

Vamana Dhauti

Once in 3 days, early morning on empty stomach

Enhances the endurance of the respiratory muscles, decreases airway resistance and therefore improves pulmonary functions (Balakrishnan et al., 2018).

4.4 Special Techniques

Cyclic meditation

MSRT

These techniques are helpful in reducing anxiety associated with the corona virus.

5.0 Lifestyle Changes

• Rest and sleep for at least 7-8 hours.

• Drink 1 and a half liters of water per day.

• All food should be hot (not cold).




6.0 References

Ács, K., Balázs, V. L., Kocsis, B., Bencsik, T., Böszörményi, A., & Horváth, G. (2018). Antibacterial activity evaluation of selected essential oils in liquid and vapor phase on respiratory tract pathogens. BMC Complementary and Alternative Medicine, 18(1), 1–9. https://doi.org/10.1186/s12906-018-2291-9

Balakrishnan, R., Nanjundaiah, R. M., & Manjunath, N. K. (2018). Voluntarily induced vomiting – A yoga technique to enhance pulmonary functions in healthy humans. Journal of Ayurveda and Integrative Medicine, 9(3), 213–216. https://doi.org/10.1016/j.jaim.2017.07.001

Bito, T., Suzuki, Y., Kajiwara, Y., Zeidan, H., Harada, K., Shimoura, K., Tatsumi, M., Nakai, K., Nishida, Y., Yoshimi, S., Kawabe, R., Yokota, J., Yamashiro, C., Tsuboyama, T., & Aoyama, T. (2020). Effects of deep thermotherapy on chest wall mobility of healthy elderly women. Electromagnetic Biology and Medicine, 39(2), 123–128. https://doi.org/10.1080/15368378.2020.1737803

Cohen, M. (2020). Turning up the heat on COVID-19: Heat as a therapeutic intervention. F1000Research, 9. https://doi.org/10.12688/f1000research.23299.2

Dinicolantonio, J. J., McCarty, M., & Barroso-Aranda, J. (2021). Melatonin may decrease risk for and aid treatment of COVID-19 and other RNA viral infections. In Open Heart(Vol. 8, Issue 1). BMJ Publishing Group. https://doi.org/10.1136/openhrt-2020-001568

Grant, W. B., Lahore, H., McDonnell, S. L., Baggerly, C. A., French, C. B., Aliano, J. L., & Bhattoa, H. P. (2020). Evidence that vitamin d supplementation could reduce risk of influenza and covid-19 infections and deaths. In Nutrients(Vol. 12, Issue 4). MDPI AG. https://doi.org/10.3390/nu12040988

Panta, P., Chatti, K., & Andhavarapu, A. (2021). Do saline water gargling and nasal irrigation confer protection against COVID-19? Explore, 17(2), 127–129. https://doi.org/10.1016/j.explore.2020.09.010

Saketkhoo, K., Januszkiewicz, A., & Sackner, M. A. (1978). Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance. CHEST Journal, 74(4). https://doi.org/10.1378/chest.74.4.408

Taneja, M. (2016). Nitric oxide Bhramari Pranayam and deafness. Indian Journal of Otology, 22(1), 1. https://doi.org/10.4103/0971-7749.176507

Taneja, M. K. (2020). Modified Bhramari Pranayama in Covid 19 Infection. Indian Journal of Otolaryngology and Head and Neck Surgery, 72(3), 395–397. https://doi.org/10.1007/s12070-020-01883-0

Wessels, I., Rolles, B., & Rink, L. (2020). The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis. Frontiers in Immunology, 11. https://doi.org/10.3389/fimmu.2020.01712

Zhang, S., Zhu, Q., Zhan, C., Cheng, W., Mingfang, X., Fang, M., & Fang, L. (2020). Acupressure therapy and Liu Zi Jue Qigong for pulmonary function and quality of life in patients with severe novel coronavirus pneumonia (COVID-19): A study protocol for a randomized controlled trial. Trials, 21(1), 751. https://doi.org/10.1186/s13063-020-04693-5



Dr Krithika A Ramaswamy

Dr Krithika A Ramaswamy

Resident Medical Officer, Spa Ritual Healthcare Pvt Ltd, Bengaluru
Bengaluru, Karnataka, India