Nilavembu kudineer interventions during Seasonal fever

Viral fever incidence have been on raise from 2007 onwards particularly during monsoon, Swine flu (H1N1), Chikunqunya and Dengue fever were affecting many areas of Tamil Nadu and the incidence varied in different districts. Often the incidence outbreak starts from the districts adjoining the states of kerala – (Coimbatore, Thirupur, Theni, Kanyakumari and Thirunelveli) by June every year and peaks around Oct- Nov and slows down by end Nov.

It was in the year 2006 for the first time swine flu was reported in epidemic proportion. The then commissioner of Indian medicine Tamil-nadu Dr. R. Vijaya kumar asked for suggestion for combating that. The departmental experts suggested Trithoda mathirai. He convened a meeting of external experts from CTMR Vd. Usman Ali and Dr. T. Thirunarayanan. They mentioned to him that the medicine was never prepared in large scale and no company had manufacturing license and moreover according to text it has to be stored for some months for maturity before using, so in a epidemic one can't wait and since it contains mercurial caution has to be made if it is distributed through public health delivery system. Instead they suggested the well known drug Nilavembu kudineer as it was used since the commencement of Govt college of Indian medicine in 1964, and also finds reference in Siddha Formulary of India They have also distributed it in a pharma company in Gujarat for 200 workers for three days when there was a epidemic there and in Mumbai. Since it gave protection from fever and also helped faster recovery the details were produced and NVKudineer was finalised for mass distribution. In 2009 CTMR wrote to Secretary AYUSH for evaluation of the drug for anti virus activity in National institute of Virology.

About Nilavembu kudineer- It comes as a coarse powder to be made into a decoction One such Siddha formulation which fulfills the entire requirement is the ‘Nilavembu kudineer’ which contains the following ingredients – Andrographis paniculata (herb), Vetiveria zizanioides (roots), Cymbopogon jwarancusa (roots), Santalum album (heart wood), Trichosanthes cucumerina (herb) Cyperus rotundus (tuber) Zingiber officinale (rhizome), Piper nigrum (fruit), and Mollugo cerviana(whole plant). Antiviral plants in the formulation are Andrographis paniculata, Santalum album and Trichosanthes cucumerina. Antipyretic plants in the formulation are Vetiveria zizanioides, Cymbopogon jwarancusa, Andrographis paniculata, Santalum albumand Trichosanthes cucumerina. Immunomodulant plants are Zingiber officinale, Piper nigrum. Analgesic ingredients are – Andrographis paniculata, Zingiber officinale and Cyperus rotundus. Antibacterials are Vetiveria zizanioides, Cymbopogon jwarancusa, Santalum album and Trichosanthes cucumerina.

Dose: 2 gram of the powder boiled with 60 ml like tea – With a lid to prevent evaporation of essential oils, filtered and taken. The decoction is freshly prepared every time and taken twice a day preferably after food as for diabetes taking in empty stomach can rarely cause hypoglycemia and for people with gastric irritation can cause nausea or vomiting This is taken for three days for prevention The same medicine is taken thrice a day after food for five days in pts with fever Rehydration with water, tender coconut water, butter milk is essential. Avoidance of spicy food is good. Since platelet lowers leading to internal bleeding in small blood vessels monitoring of platelets count is essential even if fever disappears. Good Brands are IMPCOPS, SKM Siddha ayurveda pharma or Lakshmi Seva sangam

Tamil Nadu Govt efforts

The initiative of the Govt. of Tamil Nadu (2012) particularly the Chief minister to mass distribute Nilavembu kudineer has started paying results in containing the 'Panic' caused by the outbreak of the dengue epidemic in Tamil Nadu. Initially there was a resistance from Public health personnel to admit the outbreak, subsequently efforts were taken to get the actual data on the outbreak from both Govt. Hospitals and Pvt. Health providers. The approach to the management of the outbreak was first to identify the actual number of dengue from all fever patients with ELISA in major hospitals and subsequently in major secondary level centres and disease surveillance by making it mandatory for Pvt. clinics and hospitals to inform public health dept. Awareness about controlling mosquito breeding was also made.  The treatment approach was to provide simple Anti-pyretics and wherever necessary platelet transfusion. Along side outbreaks of water borne diseases like Jaundice and Typhoid also occurred making it difficult for the public health authorities. 

Practitioners of Traditional Siddha  Medicine started using the conventional 'Nilavembu kudineer' which showed promise of controlling fever and different siddha vaidyars suggested different herbs including Adathoda, Manjista, Pidangunaari to improve platelet counts. Social media was full with posts on Papaya leaves. Individual Siddha doctors and Groups conducted Camps to distribute Nilavembu kudineer. That is the point when CM intervened and issued not just a Govt. Order instructing all hospitals to co-administer Nilavembu kudineer and Juice of Papaya and Malai Vembu but released publicity material in both print and visual media. This became a Game changer. More and more people consumed these herbal medicines from Govt. Hospitals, Pvt. Clinics and even as 'Over the counter product'. Studies where initiated at the King Institute, Chennai which reconfirmed many earlier studies on the anti-viral properties of the herbs which Siddha physicians were insisting on.

CTMR experience

CTMR has been promoting Nilavembukudineer as a preventive measure a dose already stated  decoction made from 2 gram of powder, twice a day for three days at regular intervals of six months ie. twice a year from 2006 to People for whom CTMR provides primary  health care ( About 1000 families in two health centres and two outreach mobile clinics).

During 2015 Chennai floods due to sudden railfall of 50 cms in one day and 100 cms within a week. Many areas were under water and outbreak of infectious disease was feared in many localities. CTMR conducted camps with the help of volunteers in multiple locations (Saidapet, Velacherry, Chinnandikuppam, Velankadu, Amoor etc) and about 5000 households were provided Nilavembu kudineer for three days as per protocol and also provided care for other common conditions including diarrhea, gastritis, Tinea pedis etc. There was no significant outbreak of fever for  a month the people who were provided Nilavembukudineer.

The same was repeated in affected areas after Cyclone Vardha which devastated large residential areas of Chennai.

In Industrial unit

From 2012 CTMR started following this protocol-The Nilavembu decoction (Material sourced from IMPCOPS – a multi-state cooperative was prepared in house) and  was implemented  in an industrial unit (Aravind Laborotaries- Eyetex) manufacturers of religious cosmetics (Kumkum , eyeliners) and colour cosmetics. 450 employees majority of them 385 are women of age group 18- 40 years of age and rest men. There were some 30 who were working in office and rest of them all either in manufacturing and packaging. Except 20 all were from Lower middle class households residing in cluster houses which are densely populated closer to adyar river and channels nearby- Good Mosquito breeding grounds. After this intervention incidence of fever and absence due to fever was much less according to the attendance register and health records maintained by the in-house health unit.

 Though the efficacy of Nilavembu kudineer in containing fever was known by now CTMR decided to carry out a Systemic documentation of the benefits of intervention

In  July 2017 also incidence of Dengue were reported from Coimbatore districts CTMR provided Nilavembu kudineer to the employees  (450) of Aravind Laboratories in last week of July following the same protocol and dose. This year it was decided to collect the data on intervention in a structured questionnaire at the end of 3 months from providing NV.

The observations are as under

           385 Females  of whom 380 work in manufacturing and packaging  19  Office or Senior position in R & D,  65 Males of whom 51 were Casual workers and 14 in office or manufacturing management cadre.

People with fever for more than 3 days were sent for Lab tests to rule out different fever (16 were tested)

The observations are as under

-          63 patients did get one episode of fever within the three months period

-          1 of them tested positive for dengue

-          1 tested positive for Typhoid – Male worker

-          12 members from the family of workers affected by dengue ( Not consumed Nilavembu kudineer)

-          38 Patients recovered in a day and rejoined duty (One day of absence due to fever – Fitness recd from Employees State Insurance hospital)

-          9 patients rejoined duty after two days of leave due to fever

-          16 patients took leave beyond three days

They above findings suggest that Nilavembu kudineer cannot prevent all types of viral fevers but can help faster recovery from fever

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