Clinical experience in treating Covid 19 patients with Siddha Medicine

 

Just before the first case was reported in India on 28^th Jan 2020, a popular tamil TV Channel wanted me to participate in a talk show in their prime time slot to discuss about the preparedness of Tamil Nadu Govt. if there is a outbreak here. By then there was some understanding of the type of virus and its earlier outbreaks. So went through various scientific articles and looked at various herbs with potential for fighting corona virus. Immediately after the first case of a medical student testing positive (she arrived earlier but results was known on 30^th Jan 2020), we in CTMR discussed among ourselves and released a video clip on how to prevent spread and also the possible Siddha medicines and external therapies that could prevent the virus entry and multiplication in human cells. Then we focused on creating awareness among our patients and other organizations for which we have been providing health care support. (Experience in prevention is the previous blog).

 We waited for the Ministry of Ayush to release its guidelines to treat patients as initially Public health authorities were not in favour of any AYUSH treatment and also there was a warning under Pandemic Act. (Though we have sent our treatment protocol for approval) But a stage came were we needed to start treating patients. The first few were patients whose spouses  tested positive and moved to hospitals and house sealed with tin sheets. These patients also tested positive and were helpless because of financial constraints and ready availability of beds in Covid wards. (By then Covid care centres were not opened in a big way). We reached out to these people in our neighbourhood with our medicines through the corporation appointed volunteers. One of them recovered fast in two days free from fever and cough and said but her husband in the hospital still has fever, cough, loss of taste and smell and refusing to eat. She asked if she too can go and stay with him and give our medicines. The 60 plus person with history of diabetes and previous history of having two stents in the heart sounded very depressed. She took the medicines and prepared kashayam to him. He started feeling better with the medicine and the food she took from home. Few more cases were in similar situation of -one in hospital and other in home quarantine and Siddha drugs. Small family gatherings and visit to temples and work place has been the reason of spread in most patients as we could see people from same history.

 Then we evolved a methodology

• 1.      The health authorities of the area should be informed of the status and that of the treating physician’s details and share prescription and instructions note with them.
• 2.      All patients should strictly adhere to the prescription of medicine, diet (Non oily, non fat , non spicy food . intake of good quantity of boiled vegetables and fruits)and quarantine in a separate room with attached bathroom facility for 14 days
• 3.      All patients should record their oxygen saturation, pulse rate temperature every four hours and send whatsApp message and inform of other clinical features.
• 4.      Patients should have their BP and CBS recorded if diabetic and inform at regular interval (With digital apparatus and Glucometer)
• 5.      Patients were also instructed to locate and identify a neighbourhood hospital just in case of oxy saturation fall below 85 or develop severe respiratory distress ( Fortunately none required it)
• 6.      All patients who have co-morbidity were instructed not to stop their routine medication

•  The treatment included the following

 1.     Nilavembu kudineer churanam (one teaspoon of coarse) and Athimathura churanam ( half teaspoon of powder)as Decoction  thrice a day after mild food to avoid gastric irritation – irrespective of fever for five days

2.     2. Adathodai kudineer ( 5 gram) twice a day if cough, sore throat is present for five days

3.      3Thalisathy vadagam ( 500 mg tab)thrice a day as chewable tab for controlling cough and sore throat

4.     4  if Ground glass change is seen and Oxygen saturation going below 95 to lower level of 85 Adathoda kudineer , Thalisathy vadagam and Thippili Rasayanam ( 5 gram) 15 days.

5.      5 Milk with turmeric, black pepper and palm candy once a day

6.     6.  Steam inhalation – plain steam or with Vitex negundo leaf- twice a day

7.    7. Salt water gargling- twice a day

 

All medicines used are formulations listed in the Formulary of Siddha Medicine of Govt. of India based on classical texts.

 

(The much promoted drug during the season was not choosen as most manufacturers expressed difficulty in sourcing authentic raw material and the formulation was never prepared and dispenses officially in the oldest Govt Siddha Medical college hospital since its formation, many adverse reactions were reported by people)

 

The outcome of the treatment among 250 patients was positive with most people recovering from symptoms in third to fifth day while few with comorbidity continued to have fatigue and cough for 15 days. Nobody required further hospitalization.

 

Repeat tests were carried out for people who had symptoms for more than five days (32) at the end of 14 days and all of them tested negative. CT Scan for 16 who had changes initially showed significant progress (came down to 5/40  or 3/25 as two different scales are used by different labs)

 

We have also remotely treated patients in other countries and other towns in certain changes depending of availability of medicine (Thirikadu Dry ginger, black pepper and long pepper and licorice Ajwain turmeric were the primary ones until medicines reached them) There too results were encouraging

 

The treatment in home quarantine had many benefits – less crowding, good care and timely food and monitoring by family members, psychological strength and less cost ( Rs 500 for medicine for the patient and protective dose for the care giver ,cost of pulse oxymeter, bp apparatus, thermometer and glucometer). Many could start working from their rooms after initial five days and were engaged.

 

The patients in the initial stages did feel the social stigma of ambulance arriving and taking them to hospital, family members and friends not able to interact and this arrangement gave them a great sigh of relief.

 

The objective is only to say that not all patients require oxygen support and hospitalization but needs to be closely monitored. I am sure the patients who took treatment from us would also read this blog and as also critics who still feel Siddha or Ayurveda treatment were provided just to give a placebo effect.

 

 

Note on Medicines

Nilavembu kudineer churanam comes as a coarse powder to be made into a decoction This  Siddha formulation fulfills the requirement 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 

 

Adathodai kudineer churanam comes as a coarse comes as a coarse powder to be made into a decoction It contains Justicia adathoda  (malabar nut) leaf  Glycyrrizha glabra (licorice) Piper longum ( Long pepper) Taxus baccata ( Himalayan yew) . Glycyrrizha glabra has anti-viral action against corona virus and soothing to the throat. Adathoda is effective in preventinf constriction of the respiratory pathway. Long pepper is anti-viral, hepatoprotective and helps in respiratory diseases as well. Taxus baccata is useful in regulating IL6 and TNF-alpha.

Now with almost all Siddha Covid Care Centres closed. People who want to take Siddha treatment really do not know where to go. that is yet another reason why this post was written. Other purpose for posting at this point of time is we were waiting to observe the patients for three months for post covid complication if any. Atleast 100 plus patients have completed 3 months post quarantine now. 

 

 

 

CTMR Covid care

 Dr. T. Thirunarayanan of CTMR initiated an intervention to prevent Covid 19 among industrial workers at Valasaravakkam Zone of Greater Chennai Corporation. Awareness session on the clinical  manifestations, it's preventive methods including Social distancing , wearing mask and hand wash , healthy food and Role of Siddha medicine' were explained to 800 workers on 15th March 2020. This was followed by administration of herbal combination containing  Justicia Adathoda, Glycyrriza glabra and Piper longum twice a day for three days. In May 2020 immediately after the lock down was lifted A combination of a formulated drug Nilavembu kudineer along with Glycyrriza glabra was administered for three days. Every day the workers were screened for fever and clinical signs before entry into workplace. After the second lockdown when industry was allowed to function the Medicine was issued to all in early August. In end August RT PCR test for Covid was carried out in phases for all by GCC health  professionals.. Excepting one all others tested negative. The one person too was weakly positive without symptoms and test carried out after three days he too tested negative. While few members around 10 of the workers family who did not take this tested positive. Most workers were from Kodambakkam and Valasaravakkam which were zones of high incidence. 

In yet another group of 75 residents of an Gurukulam where mostly people over 60 years stay the intervention was carried out in March and again in September. Here again none developed any symptom . This is again in a high incidence district Coimbatore in Tamil Nadu.

Both sites were closely monitored and clearly proves that Simple Siddha intervention along with SMS was able to protect people from Covid19. Next write up will be on Home based treatment for Covid 19  

Siddha approach to control Covid-19

Siddha approach to control Covid-19

Coronavirus disease is an acute respiratory infection, caused by COVID-19 virus, (also called as SARS-CoV-2). Most people infected with the COVID-19 virus will experience mild to moderate respiratory illness and recover without requiring special treatment. Adults and children with underlying medical problems are likely, to have compromised immunity that could lead to serious illness.

-          Cardiovascular disease

-          Diabetes

-          Chronic respiratory disease

-          Cancer

The best way to prevent and slow down transmission is by being well informed about the COVID-19 virus, the symptoms it causes and how it spreads. Preventive and safety measures include,

-          Wash hands using mild soap or use an alcohol based rub frequently

-          Avoid touching your face

-          Self-isolation

-          Social distancing

The COVID-19 virus spreads primarily through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, so it’s important that respiratory etiquette is practiced (for example, by coughing into a flexed elbow, sneezing into a tissue paper/handkerchief).

At this time, there is no vaccine or treatment for COVID-19. However, there are many on-going clinical trials evaluating potential treatments. WHO will continue to provide updated information as soon as clinical findings become available.

Siddha medical system, has manages various contagious viral diseases in the past (Eg. HIV[1], swine flu [2], HPV [3], etc.). Numerous Siddha-based herbal formulations have been effective in treating viral diseases and respiratory disorders. Some of them are even evaluated using modern methods and are listed in the table below.

Table 1. List of Siddha-based herbal drugs evaluated for viral diseases.

S.no.	Disease	Virus	Siddha recommended medicinal plant	Ref.
1.	Hepatitis	Hepadnaviridae. Double-Stranded DNA Reverse Transcribing Virus	Phyllanthusamarus (Keezhanelli)	[4]
2	Chikungunya	Chikungunya virus, positive-sense, single stranded RNA virus	Andrographis paniculata (Nelavembu)	[5], [6]
3	Dengue	Dengue virus (DENV). positive-sense, single stranded RNA virus	Andrographis paniculata	[7], [8], [9], [10]
4	Swine flu	H1N1 (Influenza virus), negative-sense, single stranded RNA virus		[11]
5	Severe acute respiratory syndrome (SARS)	SARS-CoV, positive-sense, single stranded RNA viruses	Glycyrrhiza glabra (Athimaduram)	[12], [13]

High doses of the liquorice extract, containing glycyrrhizin, practically wiped out the SARS virus in infected monkey cells, find virologist JindrichCinatl of Frankfurt University Medical School, Germany. The drug is more potent than ribavirin, which is most commonly used treat SARS. Glycyrrhizin makes it difficult for the coronavirus to attach to and invade the cell. It also hinders virus reproduction, therefore slowdownviral spread from one cell to another [13].

Glycyrrhizin, the primary identified active principle in licorice, glycyrrhizin is a triterpene saponin. Triterpene refers to the 30 carbon molecules attached to a compound's chemical structure. Saponins are widely distributed in nature—most saponins are triterpenes—and form a frothy, soaplike solution when shaken in water. Glycyrrhizin has a chemical structure similar to that of steroid molecules. Its similarity to steroids may account for its anti-inflammatory action, one of licorice's important effects on immune response. [19] Hirohiko Akamatsu, M.D., and colleagues from the department of dermatology at Kansai Medical University in Japan, identified the ways in which licorice appears to exert its beneficial effects. Rather than demonstrating steroidal, cortisonelike effects on inflammation—reduction of tissue swelling from histamine, increased blood flow and leukocyte infiltration of damaged or infected tissues—licorice root has been shown in in vitro studies to effectively reduce inflammation by mopping up excess free radicals liberated in a free radical burst at the site of inflammation. [20] Superoxide, hydrogen peroxide and hydroxyl radicals are released during inflammation to disable targeted bacteria and viruses, a beneficial effect that is often overdone. Similar results were obtained in a 1983 study in which licorice root reduced the number of free radicals liberated by macrophages. [21]

The activity of licorice on the immune system has been described as "nonspecific" by most investigators. [22] This means licorice stimulates, activates or promotes an immune response in multiple ways. Earlier studies identified several of these effects. For example, researchers found that licorice appears to promote proliferation of B (from the bone) and T cells and stimulate production of interleukin-19, which stimulates T cells. Licorice also appears to stimulate the production of gamma-interferon by lymphocytes [23,24] and the differentiation of T3, T4 and T8 cells, specific kinds of activated lymphocytes. [23-25]

Piperine from Piper longum has also been found effective in SARS virus and single positive-stranded RNA virus

SARS-CoV-2 (COVID-19), is a positive-sense, single stranded RNA virus (subgenus sarbecovirus, Orthocoronavirinae subfamily). Thegenome sequence of SARS-CoV-2 is 79.5% identity to SARS-CoVand the lifecycle, transmission is similar for theseviruses [14]. Most importantlyboth the virususesthe same host cellular entry receptor, angiotensin-converting enzyme 2 (ACE2) to invade the cell.ACE2, is found in the lower respiratory track (lungs) of humans.

Therefore, the herbal products found effective onSARS-CoVare potential candidatesto treatSARS-CoV-2.

Adathodaikudineer (ADK) is used to treat respiratory infections in Siddha system and is been prescribed to the patients for over 55 years in the Govt. Siddha Medical College Hospitals and no adverse effect of this drug has been reported so far. This formulation finds place in the Hospital Pharmacopeia of Siddha medicine, and contains the following drugs:

1. Adathodavasica (Adathoda)
2. Glycyrhizaglabra (Atimaturam)
3. Piper longum(Thippili)
4. Taxusbaccata(Thalisapatri)

Phytochemicalvasicinonefrom Adathoda is known for itsbronchodilator activity [15], glycyrrhizin andpiperinefrom Atimaturam[16]andThippili[17], respectively are reported for inhibiting viral replication, and taxol from Thalisapatri for supressing intercellular communication that enhance viral spread [18].

Recommendation for SARS-CoV-2: It is advised that ADK is consumed twice a day for three days in suspected case SARS-CoV-2.The single herb Nelavembu could be added to the above formulation in case of fever.

This will certainly reduce the symptoms of SARS-CoV-2 and prevent the multiplication and spread of virus.

Reference:

[1]      K. V. Thilagavathi, M Harihara Mahadevan, Eswaran, “A Case Study on Management of HIV by Integrated Treatment with Siddha Medicine and ART,” J Res Sid Med, vol. 1, no. 1, pp. 59–62, 2018.

[2]      Thillaivanan S, Kanakavalli K, and Sathiyarajeshwaran P, “CODEN (USA): IJPSPP A Review on ‘Kapa Sura Kudineer’-A Siddha Formulary Prediction for Swine Flu,” 2015.

[3]      A. Riyasdeen, V. S. Periasamy, P. Paul, A. A. Alshatwi, and M. A. Akbarsha, “Chloroform extract of Rasagenthi Mezhugu, a Siddha formulation, as an evidence-based complementary and alternative medicine for HPV-positive cervical cancers,” Evidence-based Complement. Altern. Med., 2012, doi: 10.1155/2012/136527.

[4]      S. P. Thyagarajan, T. Thirunalasundari, S. Subramanian, P. S. Venkateswaran, and B. S. Blumberg, “EFFECT OF PHYLLANTHUS AMARUS ON CHRONIC CARRIERS OF HEPATITIS B VIRUS,” Lancet, 1988, doi: 10.1016/S0140-6736(88)92416-6.

[5]      J. Jain, S. Pai, and S. Sunil, “Standardization of in vitro assays to evaluate the activity of polyherbal siddha formulations against Chikungunya virus infection,” VirusDisease, 2018, doi: 10.1007/s13337-018-0421-0.

[6]      M. V. Viswanathan, D. K. Raja, and S. D. Khanna, “Siddha way to cure Chikungunya,” Indian J. Tradit. Knowl., 2008.

[7]      E. S. Edwin et al., “Anti-dengue efficacy of bioactive andrographolide from Andrographis paniculata (Lamiales: Acanthaceae) against the primary dengue vector Aedes aegypti (Diptera: Culicidae),” Acta Trop., 2016, doi: 10.1016/j.actatropica.2016.07.009.

[8]      R. Kalai arasi, R. Jeeva Gladys, S. Elangovan, D. K. Soundararajan, H. and Mubarak, and A. Kanakarajan, “A Combination Of Nilavembu Kudineer And Adathodai Manapagu In The Management,” Int. J. Curr. Res., vol. 5, no. 04, pp. 978–981.

[9]      C. G.J. et al., “Protective effect of polyherbal Siddha formulation-Nilavembu Kudineer against common viral fevers including dengue - a case-control approach,” Int. J. Pharm. Sci. Res., 2015, doi: 10.13040/IJPSR.0975-8232.6(4).1656-60.

[10]    J. Jain et al., “Antiviral activity of ethanolic extract of Nilavembu Kudineer against dengue and chikungunya virus through in vitro evaluation,” J. Ayurveda Integr. Med., 2019, doi: 10.1016/j.jaim.2018.05.006.

[11]    C. Seniya, S. Shrivastava, S. K. Singh, and G. J. Khan, “Analyzing the interaction of a herbal compound Andrographolide from Andrographis paniculata as a folklore against swine flu (H1N1),” Asian Pacific J. Trop. Dis., 2014, doi: 10.1016/S2222-1808(14)60692-7.

[12]    J. Cinatl, B. Morgenstern, G. Bauer, P. Chandra, H. Rabenau, and H. W. Doerr, “Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus,” Lancet, 2003, doi: 10.1016/S0140-6736(03)13615-X.

[13]    G. Hoever et al., “Antiviral activity of glycyrrhizic acid derivatives against SARS-coronavirus,” J. Med. Chem., 2005, doi: 10.1021/jm0493008.

[14]    Y.-R. Guo et al., “The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak – an update on the status,” Mil. Med. Res., 2020, doi: 10.1186/s40779-020-00240-0.

[15]    A. H. Amin and D. R. Mehta, “A bronchodilator alkaloid (vasicinone) from Adhatoda vasica Nees,” Nature, 1959, doi: 10.1038/1841317a0.

[16]    M. Michaelis et al., “Glycyrrhizin exerts antioxidative effects in H5N1 influenza A virus-infected cells and inhibits virus replication and pro-inflammatory gene expression,” PLoS One, 2011, doi: 10.1371/journal.pone.0019705.

[17]    C. Mair, R. Liu, A. Atanasov, M. Schmidtke, V. Dirsch, and J. Rollinger, “Antiviral and anti-proliferative in vitro activities of piperamides from black pepper,” Planta Med., 2016, doi: 10.1055/s-0036-1596830.

[18]    K. L. Roberts, B. Manicassamy, and R. A. Lamb, “Influenza A Virus Uses Intercellular Connections To Spread to Neighboring Cells,” J. Virol., 2015, doi: 10.1128/jvi.03306-14.

 [19]    Tang W, Eisenbrand G. Chinese drugs of plant origin. Berlin: Springer-Verlag; 191-7, 567-91.

[20]  Akamatsu H, et al. Mechanism of anti-inflammatory action of glycyrrhizin: effect on neutrophil functions including reactive oxygen species generation. Planta Medica 1991;57:119-21.

[21]   Igaku A, et al. The effect of glycyrrhizin and glycyrrhetic acid on production of superoxide and hydrogen peroxide by macrophages. Chem Abstracts 1983;98:155082a.

[22] Chavali SR, et al. An in vitro study of immunomodulatory effects of some saponins. Intl J Immunopharmacol 1987;9:675.

[23] Nara IZ. The role of interferon-gamma (IFN-gamma) producing cells in clinical immunology. Chem Abstracts 1984;35:424.

[24]  Sugawa I. OK432, glycyrrhizin and CCA (lobenzarit disodium) are good in vitro inducers of IFN-gamma production. Chem Abstracts 1991;114:135740j.

[25] Shinada M, et al. Enhancement of interferon-gamma production in glycyrrhizin-treated human peripheral lymphocytes in response to concanavalin A and to surface antigen of hepatitis B virus. Proc Soc Exp Bio Med 1986;181:205.

Dr.T.Thirunarayanan,

Siddha Physician,

Member – GB National Institute of Siddha

Member – ASU DrugTechnical Advisory Board - GoI

Centre for Traditional Medicine & Research

Chennai-88

Ph no. 9444018158

Email: thiru64@gmail.com