As a child, N. Meena, a 58-year-old Ayurvedic nurse from Kottayam, Kerala, remembers that every garden in her hometown, Changanassery, had an Ashwagandha shrub. It was the answer to most ailments—stress, insomnia, poor height, ulcers, pain, even low sperm count. “Whatever you had, Ashwagandha could cure. It is one of the most powerful medicines in Ayurvedic texts,” she says. Currently, in India, clinical trials for four Ayurvedic remedies are underway and many believe that this native plant could be the much-needed immunity booster to combat the ill-effects of COVID-19. Indeed, ancient records (from as far back as the 1200 BC Atharvaveda) and, more recently, small-scale clinical studies have hinted that various properties of the Ashwagandha plant could be beneficial in fighting off viral infections. The root, the smell of which is commonly likened to that of a horse (and hence the name ashwa, which means horse in Sanskrit), is an analgesic that soothes the nervous system in case of pain response. It also contains a natural chemical (Withaferin A) which has been shown to demonstrate anti-inflammatory and immunomodulating effects. After decades of use as an addition to milk or tea, the plant’s properties will, for the first time, are being examined in a scientific setting.
Despite a wealth of anecdotal and written knowledge, India has never tested Ayurveda in large clinical trials before. Seen in this light, the current trials by the Ayush Ministry and the Council of Scientific and Industrial Research (CSIR) with technical support from the The Indian Council of Medical Research (ICMR) will go a long way towards gaining a modern and scientific understanding of Ayurvedic remedies. Those in the field are encouraged by the development. Patanjali managing director Acharya Balkrishna says, “To promote Ayurveda, it has to be developed as an evidence-based science. The clinical trial is a big step towards this”. Dr Sanjay Jain, a senior orthopaedic surgeon at Anand Hospital in Meerut, has similar views. “We have neglected Ayurvedic science for many years. Germs are everywhere but only those with poor immunity fall ill. Ayurvedic medicines can boost immunity to stop the coronavirus from entering your body,” he says.
Pandya is in talks with the Civil Hospital in Ahmedabad to start administering Ayurvedic medicines to Covid patients. The family of Pankaj Patel*, 50, of Ahmedabad, is among the patients Pandya has treated. Patel lost his father to Covid and he, along with his wife and 18-year-old daughter, tested positive to the virus as well. Patel says that they took Ayurvedic medicines on the advice of a cousin. They took Anu Taila, Swasari Ras (Vati), Shuddh Giloy Ghanvati, Shuddh Ashwagandha capsules and Shuddh Tulsi Ghanvati. After seven days, he recovered from Covid. Ayurvedic physician Dr. Arti Bhatt, who administered the medicines to Patel and his family, says, “I have so far treated a number of Covid patients. On an average, these patients recover within seven to 10 days. Those with mild symptoms recover within four to five days.”
The trials are using some preliminary observations made in Covid patients. “More than a 100 coronavirus patients have recovered with Ayurvedic medicines. These were the cases exhibiting mild symptoms,” says Vaidya Nishchal Pandya, co-principal investigator in the Patanjali Research Foundation team engaged in the research on treatment of Coronavirus. Although mild cases typically test negative even without any medical intervention, what the treatment might be suggesting is that Ayurvedic herbs prevent the onset of severe symptoms by strengthening immune responses. The trials, which were announced by Union Health Minister Dr. Harsh Vardhan on May 7, aim to provide confirmation of this in the next 12 weeks.
Four medicines—Yashtimadhu, Ashwagandha, Guduchi Pippali, and Ayush-64—are currently being studied. These will be tested in three phases of Covid infection—prevention, treatment and recovery phase. While Dr. Vardhan specified in his address that the trials will follow the gold standard in clinical studies (they will be randomised, placebo-controlled with a sufficient number of participants and open design for peer-review), the guidelines from the Ayush Ministry don’t mandate the same. “A placebo group is crucial, it rules out people reporting a change in status simply to please the researcher. A randomised trial also helps ensure those being tested will not favour the research,” says Dr Rajan Sharma, president of the Indian Medical Association. “Be it allopathy or Ayurveda or homoeopathy—clinical analysis remains the same. If you can prove a treatment is effective across ages and populations, you have a conclusive argument. But you have to prove it.” Recently, a study of 96,000 people on the effects of the allopathic drug hydroxychloroquine published in The Lancet medical journal was withdrawn because of the failure of the researchers to provide data for peer review.
In terms of universality of use, Ayush guidelines for trials do not include those with unstable comorbidities (who are also the highest risk category for Covid) and pregnant women. Plus the treatment has to be stopped if a patient has to go on ventilator support. Commenting on this, Dr Bhushan Patwardhan, chairman of the Interdisciplinary AYUSH Research and Development Task Force, says, “There is a protocol (inclusion and exclusion criteria) in every clinical trial even if they are related to other medical sciences. Once it gets approved as a medicine, it will be used as an add-on therapy to help patients recover faster. Standard treatment would continue as usual.”
While critics argue that medication has to be tested universally, it is important to recognise that Ayurveda has very specific rules on treatment and medicines. Remedies are adjusted based on a person’s dosha, symptoms and time of the day. Some even rely on the season. “A popular local tale from Kerala, the land of Ayurveda, recalls two socialites from Mumbai attempting to try the ‘monsoon’ cure which helps maintain a youthful appearance. By only taking the medicine but not following its detailed rules, they ended up leaving as wrinkled old hags. Ayurveda is a mix between science and faith, you have to respect the procedure,” says Meena.
There is no denying that Ayurveda has had its share of successes, but there are lessons to take note of when from its approach towards immunity. “The Janapadodhwans section in Ayurvedic science mentions systems to deal with pandemics like Covid. There are medicines and protocols which may be useful in containing such a virus,” says The All India Institute of Ayurveda director Tanuja Nesari. However, claims made by manufacturers on definitive Covid cures with no medical backing or clinical evidence have been underscoring efforts to give Ayurveda scientific acceptance. The Ayush ministry has taken some strong steps to control it, even issuing a notice to discourage such claims. In Ayurveda’s rules for administration lie certain inherent limitations for comparing it with allopathic science. Ayurvedic treatments are more accessible, cost-friendly and natural, but they are also not fast-acting, nor can they be given when a person is suffering from severe Covid symptoms, such as hypoxia or thrombosis. Their promise largely lies in being able to halt the progression of Covid from mild to severe symptoms. With the race to find treatments to mitigate the impact of Covid on the immune system still far from over, any positive results from Ayurvedic drug trials will certainly come as a relief to many.