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