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AYURVEDA AND SARS By Dr Raghunandan Sharma

Severe acute respiratory syndrome (SARS) is a respiratory illness that has recently been reported in Asia, North America, and Europe. The symptoms are somewhat like Pneumonia but not exactly.

Causative organism By the last week of March ? 27.03.2003 ? Hong Kong scientists had identified the causative organism as a mutated strain of Coronavirus. The finding is said to have been ratified by the Centre for Diseases Control and Prevention. As such, this virus is the second leading cause of common cold after the rhinoviruses. It is speculated that other organisms like Chlamydia species may also be involved in the outbreak. Southern China, livestock and historically a source of new virus strains, has been recognised as the most likely source of the disease. The diagnosis is clinically ascertained with the help of laboratory feedback by demonstrating either the organism or the antibodies to it. The molecular technique-based tests like polymerase chain reaction using different primers have also been utilised to ascertain the suspected cases. Symptoms of SARS

The illness generally begins with flu-like symptoms ? high-grade fever greater than 100.4°F [>38.0°C]. , dry, and non-productive cough accompanied by breathlessness, rapidly developing into acute pneumonia of atypical type. The other associated symptoms may be headache, muscular stiffness, loss of appetite, confusion, rash and rarely diarrhoea. 

The incubation period is generally taken as two to seven days. The SARS figure is amazing as it carries a mortality rate of over 5 per cent, which is much higher than any other respiratory infection. How SARS spreads The primary way that SARS appears to spread is by close person-to-person contact. 

Most cases of SARS have involved people who cared for or lived with someone with SARS, or had direct contact with infectious material (for example, respiratory secretions) from a person who has SARS. Potential ways in which SARS can be spread include touching the skin of other people or objects that are contaminated with infectious droplets and then touching your eye(s), nose, or mouth. This can happen when someone who is sick with SARS coughs or sneezes droplets onto themselves, other people, or nearby surfaces. It also is possible that SARS can be spread more broadly through the air or by other ways that are currently not known. 

Clinical Criteria · Asymptomatic or mild respiratory illness · Moderate respiratory illness o Temperature of >100.4º F (>38º C)*, and o One or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia). · Severe respiratory illness o Temperature of >100.4º F (>38º C)*, and o One or more clinical findings of respiratory illness (e.g., cough, shortness of breath, difficulty breathing, or hypoxia), and § radiographic evidence of pneumonia, or § respiratory distress syndrome, or § autopsy findings consistent with pneumonia or respiratory distress syndrome without an identifiable cause Epidemiologic Criteria · Travel (including transit in an airport) within 10 days of onset of symptoms to an area with current or recently documented or suspected community transmission of SARS?, or Close contact- within 10 days of onset of symptoms with a person known or suspected to have SARS infection

Ayurveda view: SARS as such if seen from an Ayurveda eye has some similarity with Shwasa roga though not exactly the same can be referred. Doshas involved in the pathogenesis of SARS are mainly Prana Vayu and Udana Vayu along with Sadhaka Pitta and Avalambaka Kapha. Like in Shwasa Kapha obstructs the passage of Prana vayu and afflicts the Pranavaha srotas. · When this feature is observed along with fever we get the indication of ?Antarvegi Jwara? according to Charaka Chikitsa 3/39 whereas the same if observed from Sushruta?s point of view can be considered as ?Gambhir Jwara?(Deep seated). 

As in SARS the duration between the invasion of the pathogen and the manifestation of disease is not long; we consider this as the Agantuja jwara(Charaka nidana 1/30) or Bhutabhishangaj(Sushruta uttartantra 39/68 ) where the pathogen enters in the body and develops a disease or symptom and later the involvement of the doshas/dushyas and srotasa may convert it in to a syndrome or in further complications.(?Vyadheupri yo bhavet uttarkalja??.?). Here the invasion is of Coronavirus as bhuta. Now as the pathogenesis is developing in a complicated manner thus involves the doshas in direct and also in overlapping manner i.e.Avaran. *Kapha avritta prana vayu ?Difficulty in breathing *Udanavritta Apana vayu ? Dyspnoea and cough. *Pranavritta Udana vayu ? Shirograha (Heaviness in head) and Pratishyaye (Rhinitis). Prognosis: * Charaka says that Prana and Udana Vayu are the important doshas for body stability. As ?Prana? is life and its Vikriti leads to Death. Similarly disturbance of Udana vayu causes loss of strength. [Charaka chikitsa sthana 28/234]. * Kapha Avritta Prana vayu is considered as very difficult to treat or incurable in Charaka Chi.28/233, which ultimately explains the incurability of SARS.

Herbs to Support the Immune and Respiratory System: Kalmegh -Andrographis panniculata. Rasa -Bitter ;Guna ? Light,Dry;Virya -Hot ;Vipaka ? Pungent. It is a useful antipyretic,anthelminthic,Blood purifier,antiinflamatory and Hepato protective.(Wealth of India). In Scandinavia, andrographis has been used as a treatment for colds. . Reasonably good evidence tells us that it can reduce the severity of cold symptoms. It may also help prevent colds. Andrographis has been used to treat a wide range of parasites and microbial infections. The herb is also credited with stopping the spread of influenza in India during the 1919 epidemic. However, laboratory studies have shown no direct biocidal activity on bacteria such as Staphylococcus pseudomonas and coliform species. Laboratory investigations with a purifed andrographis compound have shown no effects against the HIV virus. It is now thought that the mode of action of andrographis is via an effect on the immune response rather than specific antimicrobial activity. This effect on immune response is thought to be mediated via the adrenal glands. Shati :Hedychium spicatum .It is perennial shrub. It has Rasa- Pungent;bitter;astringent. Guna ?Light;Sharp; Virya ?Hot ;Vipaka ? Pungent.Pacifies vata ?kapha. It is an appetizer,analgesic,digestive.It is useful in anorexia, cough, cold, asthma,hiccups,diseases of blood and pyrexia.(Dhanwantri nighantu) Part used ?Tubers.In the form of powder 1-3 gm. Vanapsha: Viola odorata. It has Rasa:Sweet,Bitter.Guna:

Light,Dry;Virya:Cold;Vipaka:sweet. It pacifies vata and pitta and expectorates kapha.. Decoction of whole plant is used in cold,cough and bronchitis.It?s anti microbial,analgesic ,anti pyretic and anti inflammatory. Dosage ?3-6gm in the form of decoction. Yashtimadhu:Glycyrrhiza glabra. Rasa-sweet,Guna ? Heavy and unctuous.Virya ?Cold;Vipaka ?Sweet. It is one of the best vitalizing herb.It enhances the energy level quickly when its fine powder is taken along with ghee.In tubercular cough fine powder of Yashtimadhu and Sitopaladi churna in 2:1 proportion to be licked with honey and ghee relieves the phlegm. It nurtures all seven dhatus hence works well as a Rasayana,boosts ojus formation. Other herbs that may prove quite useful in SARS could be ? Tulsi, Pippli,Gaujawan,Khatmi,Khoobkalan,Kooth,lavanga,shunthi etc. According to the Siddha and Ayurveda system of Indian medicine, tulsi, turmeric and pepper contained anti-viral active ingredients. Similarly, papaya, which contained anti-oxidants, could also be used as a medicine for SARS.

Dr.Raghunandan Sharma. M.D.(Ayu.)