Summary

In this piece, I provide an overview of the human immune system and the Coronavirus (COVID-19). I then describe the Ayurvedic approach to boosting immunity and existing research that backs the Indian ministry of Ayurveda’s recommendations for herbal treatments that can potentially help people strengthen their immune systems and ability to fight viruses like the Coronavirus.

• We need to adopt an integrative approach to build immunity and fight such outbreaks, now and in the future.
• The contextual use of traditional medical systems such as Ayurveda, a sensible diet/lifestyle, and authentically sourced plants and herbs may help build immunity.
• Resorting to the indiscriminate use of “Dr.Google” prescribed miracle remedies may lead to serious cytotoxic drug-herb, herb-herb, or food-drug interactions, especially for those already on medications.
• Stick with precautions stipulated by CDC, without panic.
• Human ingenuity has not failed us, wait for your turn to get vaccinated.

The Indian government’s recent Coronavirus advisory included Ayurvedic formulations for building immunity, which appears to have drawn considerable flak from the intelligentsia. 

This is an opportune moment to take a closer look at how our immune systems work and dig deeper into the use of traditional medicines in managing infectious diseases.

Immunity 101:

In overly simplified terms, the human body has two types of immunity: innate and acquired. These mutually influence and reinforce each other. The innate system is non-specific; when it recognizes microbial invaders, it produces an inflammatory response. Our skin, salivary, respiratory and gastrointestinal secretions, and beneficial microbiota all work in harmony with the innate defense system. The inflammatory response increases blood flow to the site and is often associated with pain and fever. This blood brings in an array of different kinds of white blood cells which kill invaders, destroy compromised host cells, and eat and clean up the waste. Other cells ensure that the signatures (antigens) of invaders become clearly visible for easy detection by the second line of defense, orchestrated by the adaptive immune system.

The adaptive immune system, using B and T type memory cells, goes after the visible invader signatures. Upon replication, these cells memorize and remember the invader’s signature for future battles. 

Our  immune system does not function in isolation and interacts with the rest of the body. For example, it is impacted by the hormones secreted in the endocrine system, levels of Vitamin D, amount of sleep, and nutrition/diet. 

Microbial invaders cause damage directly from their toxic potential and replication and indirectly from an excessive or inappropriate immune response. For respiratory viruses, this indirect impact, resulting from excessive inflammation, has been found to be the main driver of injury. Moreover, coronaviruses have also been found to evade the immune system, and the mechanism of this evasion is still not fully understood. 

To add to this complexity, we all respond differently to microbes:

Human immune systems vary as a consequence of heritable and non-heritable influences, but non-heritable influences, like symbiotic and pathogenic microbes, explain most of this variation. Even the same individual’s immunity could vary significantly by circadian rhythms, seasons and age.

Compounding the problem is that the heritable (genetic) basis of individual susceptibility for even well studied viruses remains an active area of research.  

As a general rule, immunocompromised individuals, like the very young and the old,  are more susceptible to severe symptoms of flu. 

What is this Coronavirus?

Coronaviruses in general are zoonotic, i.e., they spread between animals and humans. An original host like a bat infects an intermediate host like a pig, cow, or bird, and finally infect humans (known as the novel hosts). Other examples of zoonotic viruses include HIV, Ebola, influenza A, hantavirus and henipavirus. For reasons not entirely understood, while the reservoir host remains relatively healthy, the coronaviruses, which have high viral diversity, cause a variety of diseases in intermediate hosts and often lethal respiratory infections in the final human host. Different coronavirus types include alpha and beta, which are found in mammals, and gamma and delta, which infect mostly birds.

Source:”Reservoir Host Immune Responses to Emerging Zoonotic Viruses” Judith N. Mandel and others-study on NCBI 

COVID-19

The COVID-19 is a betacoronavirus. Like MERS and SARs, it’s origin in bats. 

According to genomic characterization for COVID-19 published by researchers on Lancet, it “is sufficiently divergent from SARS-CoV to be considered  new type of  human-infecting betacoronavirus”. Their phylogenetic analysis “suggests that bats may be the first host of this virus; an animal sold at the seafood market in Wuhan might represent an host facilitating the emergence of the virus in humans. Importantly, structural analysis suggests that 2019-nCoV may be able to bind to the angiotensin-converting enzyme (ACE) 2 receptor in humans”. ACE is secreted in human lungs and kidneys, whose endothelial cells get impacted by the invading virus. It is very disconcerting that some reports are now pointing to a possibility of a Chinese lab as an inadvertent source for this virus.

Observable impact from virus:

Coronaviruses in general potentially impact the upper and lower respiratory as well as gastrointestinal systems. Thus, their impact  includes common cold, cough, fever, shortness of breath, or pneumonia. In the case of MERS, kidney failures have also been reported. 

Unfortunately, as more COVID-19 data emerges, it now appears to be able to attack any point of the body ranging from: lungs, cardiovascular system, heart, toes, nervous system, musculoskeletal system, digestive system, throat, nose, eyes and kidneys. It has also manifested with Kawasaki disease like symptoms in young children.

Prevention:

To avoid exposure, doctors advise the usual common sense preventive steps for respiratory diseases. Besides disinfecting surroundings, these include properly washing hands, avoiding touching the face with dirty hands, and avoiding close contact with people who are sick. Researchers actively tracking COVID-19 say “Like other CoVs, … COVID-19 is …sensitive to ultraviolet rays and heat. Furthermore, these viruses can be effectively inactivated by lipid solvents including ether (75%), ethanol, chlorine-containing disinfectant, peroxyacetic acid and chloroform except for chlorhexidine.” Does it also mean that warmer temperatures in the Northern hemisphere will soon automatically reduce incidence?

Currently available treatments:

Painstaking as they are to get it right, it should be borne in mind that vaccines also represent some of the greatest medical achievements over the last two centuries- think of smallpox and polio. 

Unfortunately, there is no specific vaccine for COVID-19. Medical care is really limited to an attempt to relieve symptoms while the disease runs its course. It is a daunting task to produce effective and approved vaccines, especially for highly mutant single strand RNA virus like the Coronavirus. The original virus can mutate (through antigenic drift or antigenic shift) in the interim, or even worse, it can become resistant upon use of the vaccine. For example, the vaccine for SARS virus was available only when the 2002-2003 epidemic ended and it has not yet been extensively tested on humans. Similarly, the vaccine for the 2012 MERS coronavirus has so far completed only Phase 1 trials in the approval process. Meanwhile, as a desperate measure, there are some press reports that antiretroviral HIV drugs like kaletra are being used as experimental remedies for the Coronavirus in China. Similarly doctors in Thailand are reported to have used a combination of flu and HIV medications. The efficacy of these combinations is yet to be firmly established.

It is worth mentioning that besides working on vaccine cures drugmakers Regeneron and Sanofi are also testing use of rheumatoid arthritis drug as a treatment modality which uses suppression of interleukin-6 (IL-6) proteins which are responsible for triggering the body’s immune and inflammatory response, which in overdrive is harmful. See further discussions on IL-6 below.

More recently on March 24th, 2020 it was reported in the press that New York state was planning experimental use of convalescent plasma from recovered patients. Interestingly this was discussed by CDC earlier with reference to MERS-COV in 2016. Incidentally Regeneron and some others are also working on such antibody treatments which could reduce the fatality stemming from COVID-19.

How alarmed should we be?

To put it in perspective, as per CDC during this season in the US, there have so far been thirty four million cases of flu, resulting in 350,000 hospitalizations and 20,000 deaths, resulting in a death rate of <0.01%. COVID has, as of June 2022, in the US infected based on ~80,000,000(Johns Hopkins numbers) resulting in ~1,00,000 deaths which would equate to a similar death rate. An earlier death rate estimate for the COVID-19 was between 0.5% to 2% by mathematician Adam Kucharski( author of Rules of Contagion) and higher by others. For example, based on unadjusted Johns Hopkins reported global numbers this translates to ~3.1% ( 1.2% for US) case fatality rate(CFR=confirmed deaths/confirmed cases). These noisy numbers will vary greatly by age cohorts/geographies/underlying health conditions and could perhaps be significantly different as more substantiated data becomes available and the mild/unreported/false negative/unreported death cases are factored in. We may never get the correct numbers because they will not account for a) the untested people who stayed home and those who chose to die a more dignified death at home rather than ending up in a hospital morgue and b) sub-optimal tradeoffs between the true positive and true false rates for the COVID tests themselves c) deaths categorized for other underlying causes which were accelerated by COVID. It is critical that the infection/transmission rates are kept under control, and we can help. It appears that age/underlying condition based isolation may be prudent, even as the wheels of the economic engine start moving again. In the “free world” it will be interesting to watch how the traditional epidemiological transmission models need to be tweaked to include network effects/unique COVID-19 viral loads in order to get realistic transmission estimates. According to the CDC, the SARS Coronavirus death rate was around 10% (out of ~8100 infected)  and the MERS coronavirus, which is located mostly around the Arabian peninsula, had a death rate of 35%(out of ~250 infected). 

How Ayurveda approaches immunity and disease:

Ayurveda considers disease to result from the disturbance of homeostasis in the human body, meaning that our doshas (i.e. our primary and subtle vital energies/life forces which are responsible for all physiological and psychological functions like intake, assimilation and transformation) are out of balance and our immune systems are compromised. 

“The three subtle doshas – prana, tejas and ojas – energize the immune system. Ojas is the basic endurance capacity of the immune system, or our potential ability to defend ourselves against external pathogens. Tejas is the immune system when activated, which burns and destroys toxins. It is responsible for the fever by converting ojas that the body produces to destroy pathogens that attack it.  Prana is the long-term activated form of the immune function to project and develop life-energy, which manifests when we are dealing with a chronic disease.” Dr. David Frawley explains in his book on this subject Yoga & Ayurveda- Self-Healing and Self-Realization.

Ojas, results from a strong jathargani or digestion system/fire, from which healthy dhatus (materials) are produced. In an efficiently working system, the malas/ama (waste material) is eliminated regularly. Ojas is the reservoir of healing, whereas ama diminishes it.

As a result an individual’s response to microbial infection is immunity dependent. Disease generally begins at one point/body tissue and eventually manifests at another. It evolves through the stages of accumulation (sanchaya), aggravation (prakopa), overflow (prasara), relocation (sthana samsraya), manifestation (vyakti) and diversification (bheda). Therefore a dosha could evolve from a shakha (periphery or the tissue elements) and migrate to koshtha (central body) or the other way around. This merely reflects the underlying unitary nature or connectedness of the human body.

The Ayurvedic approach to resolving disease is holistic rather than reductionist. Prior to prescribing herbs or lifestyle changes, an Ayurvedic practitioner will consider a patient’s natural constitution, general state of metabolism/digestion, and other lifelong habits. Also considered are the patient’s season and age, since ritusandhi or change of seasons, stress, and age also affect an individual’s immune response. One’s natural constitution is most easily revealed by the fixed attributes of his/her physical body, like frame and musculature. Also important are one’s general metabolic state, digestion, lifelong habits and proclivities, and disease tendencies.

Use of Herbs in Ayurveda 

An Ayurvedic practitioner of Kaya Chikitsa (internal medicine) will determine (i) which diseases an herb treats and (ii) the constitution of the person. Seasoned practitioners will also account for interactions such as drug-herb, herb-herb, food-herb before undertaking a synergistic path to disease mitigation. It is important to source herbs and plants from authentic sources which procure ethically and test for heavy metals and other contaminants.

Once we have these, we can pinpoint an effective treatment and decide how to deliver the herb and when. Generally, a dosha will be treated with herbs of the opposite nature to its qualities. In exceptional cases we may use herbs that further aggravate a dosha for short term usage that may be balanced out with other herbs. Even though the disease could be provoked externally, its manifestation and intensity will be determined by associative internal conditions and causes. 

In Ayurveda, all drugs (food/plants/herbs/concoctions) have multiple therapeutic actions, and the body’s response to them depends on one’s unique circumstances/ constitution.  Thus the treatment approach targets elimination of intrinsic circumstances that may facilitate specific pathogenesis.

It would be appropriate to keep the foregoing distinction between a drug effect (phala) and drug effectiveness (siddhi) which comports Ayurvedic treatment of agantu (out of balance) dosha  in mind as we adopt a reductionist active molecular study and testing mechanism to test the efficacy of an Ayurvedic drugs/formulations which be effective only in synergistic environments. It is important to maintain the chemical complexity of the original dry plant. Dose response relationships need to be also kept in mind so that we don’t go berserk binging on anything that is advertised to be a magical herb/drug.

Accumulating enough meta study data, per a modern scientific approach, employing the rigor of double blind placebo control, is a long process that faces funding and practical difficulties. It’s hard to replicate effects in simplified in vitro studies, particularly in rats/animals which have very different in metabolization rates, immune systems and nucleotide structures compared to humans. Dr. Azra Raza, professor of medicine/oncologist at Columbia University, has written about this in her book The First Cell.

Can herbs boost immunity?

The short answer is yes, which should not be surprising, since newest drugs are sourced from active ingredients from natural sources. The food that we eat is the predominant source of our immune response. In a very recent CDC conference it was opined that “Epidemiologic and clinical data,….. experimental studies, suggest a bidirectional interaction between micronutrients and infectious pathogens.”

Most herbs are well-known to exhibit immunomodulatory responses, making them good vehicles for disease prevention/intervention. A number of the active phytochemical ingredients are terpenes, phenolics, glucosides, alkaloids, flavonoids, saikosaponins, tannins, polysaccharides, saponins, plant steroids, and essential oils. Anti-viral activity of natural products is also attributed to many mechanisms like inhibition of viral attachment/replication, protease inhibition, induction of type-1 interferon response, TNF-alpha/IFN inhibition, inhibition of virus entry through GAG protein competing properties of constituents like chebulagic acid (like in Triphala) and punicalagin (like in pomegranate).

According to Sloan Kettering,“An in vitro study investigated the activity of extracts from eight plants that are traditionally used as immunomodulators in Ayurveda medicine against HIV: Garlic(Allium sativum), Asparagus racemosus, Coleus forskohlii, Emblica officinalis, liquorice(Glycyrrhiza glabra), long pepper(Piper longum), Tinospora cordifolia and Withania somnifera. The extracts significantly reduced viral production in human lymphoid CEM-GFP cells infected with human immunodeficiency virus (HIV-INL4)” ( Please also note the cautionary statements listed on the web-site). Here, it’s worthwhile to notice that a group of researchers in an early non-peer reviewed COVID-19 report “found 4 insertions in the spike glycoprotein (S) which are unique to the 2019-nCoV and are not present in other coronaviruses. Importantly, amino acid residues in all the 4 inserts have identity or similarity to those in the HIV- 1 gp120 or HIV-1 Gag”. Gag proteins of HIV-1 are a sort of  a retrovirus, which is important for the assembly of virus-like particles. Essentially  a retrovirus is a type of RNA virus that inserts a copy of its genome into the DNA of a human host cell.  

It appears that the Coronavirus attaches to angiotensin-converting enzyme(ACE) 2 receptor in humans. This may potentially disturb the “renin–angiotensin system (RAS) that regulates blood pressure and fluid/electrolyte balance, as well as systemic vascular resistance. Severe complications arise due to cytokine cascade.” As per researchers on Lancet “In most moribund patients, 2019-nCoV infection is also associated with a cytokine storm, which is characterised by increased plasma concentrations of interleukins 2, 7, and 10, granulocyte-colony stimulating factor, interferon-γ-inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1 alpha, and tumour necrosis factor α(TNF-α)”. This subject remains an area of active research and further discussion is beyond the scope of this piece.

Indian Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) recommendations for boosting Immunity

Let’s now have a look at AYUSH recommendations*, which are meant for adoption only in consultation with Ayurvedic practitioners, to grasp and appreciate the rationale behind the suggested use of some of these herbs and formulations. A thorough discussion and analysis is best left to botanists, immunologist scientists and Ayurvedic experts.

1*:“Shadang Paniya (Musta, Parpat, Usheer, Chandan, Udeechya & Nagar)”

This drink is a decoction of six (shadang) drugs in water and is employed to alleviate fever, burning sensation and thirst. While the mechanisms of action may not yet be fully understood, it’s worthwhile to examine the properties, mentioned in illustrative research, attributed to some of its underlying components. 

Musta (Cyperus Rotundus/Motha/Nagarmotha)

• According to some Indian researchers “The nutgrass, Cyperus rotundus L. (Family: Cyperaceae), is a colonial, perennial herb considered to have originated in India 2000 years ago and is  widely used in Ayurveda to treat several ailments…..it is used in several systems of medicine for treating a variety of diseases. The synergistic actions of the Cyperus’ compounds have added advantage over that of a single constituent. In the past decade, numerous studies proved analgesic, anti-allergic, anti-arthritic, anti-candida, anti-cariogenic, anti-convulsant, anti-diarrheal, antiemetic, anti-helminthic, antihistamine, anti-hyperglycemic, anti-hypertensive, anti-inflammatory, anti-malarial, anti-obesity, antioxidant, anti-platelet, antipyretic, anti-ulcer, anti-viral, cardioprotective, cytoprotective, cytotoxic, gastroprotective, hepatoprotective, neuroprotective, ovicidal, and larvicidal, wound healing and inhibition of brain Na+ K+ ATPase activities of C. rotundus and its chemical constituents. However, the exact mechanism of action is not very clear and requires further evaluation. These properties strongly suggest an extensive use of C. Rotundus for clinical applications”.

• Other researchers found that..“ the mechanism of action behind the antioxidant and anti-inflammatory properties of Cyperus rotundus is through gene modulation in pro-inflammatory cytokines, viz. IL-4, IL-6, IL-12, and IFN-γ”.

Parpat (Fumaria officianis/Pitta papada/Dham Gajara) 

• A pre-clinical study by Singh and others said: “Fumaria indica Linn. (Syn: Fumaria parviflora, Fumariaceae) is an herbaceous annual plant….claimed to possess various curative properties for ailments of the blood, skin, gastrointestinal system and central nervous system. Recently, we have reported Fumaria indica as safe during an acute and subchronic oral toxicity study in rodents and it displays central nervous system depressant activity”. 

• Another study on antimicrobial effects of Parpat says, “It was revealed that aqueous fraction of F. indica showed very good antibacterial activity against P. multocida with zone of inhibition 26mm and MIC of 98μg/mL. Its CHCl3 and n-BuOH fractions also displayed good results. Its CHCl3 fraction showed good antifungal activity against G. lucidum with zone of inhibition 24mm and MIC of 115μg/mL. Other polar fractions of F. indica showed good activity against some fungal strains”.

• The anti-inflammatory effect of Parpat was studied by another group of researchers who said “F. parviflora demonstrated significant (p<0.001) decrease in paw edema in carrageenan-induced paw edema method. It diminished the serum tumour necrosis factor-α (TNF-α), IL-6 and IL-1 levels and also significantly attenuated the malondialdehyde (MDA) levels. Our study suggests that leaves of F. parviflora possess anti-inflammatory effect which might be attributed to the inhibition of various cytokines, their antioxidant effects due to increase in the activities of antioxidant enzymes and their free radical scavenging effect”.

Usheera (Vetiveria zizanioides/Khas-Khas)

• A study on anti-microbial aspects of Usheera says: “Almost all parts of vetiver are exploited in traditional medicines: reported to be among other things carminative, diuretic, diaphoretic and emmenagogue, vetiver also constitutes a renowned parasitic and anthelmintic agent ….evaluated against twenty bacterial strains and two Candida species using the in vitro microbroth dilution method, vetiver oil demonstrated notably some outstanding activities against Gram-positive strains and against one Candida Glabrata strain”. 

• An in-vitro study opined that: “The extract showed strong antioxidant activity in a dose dependent manner. The results obtained in the present study clearly indicates that V zizanioides scavenges free radicals, ameliorating damage imposed by oxidative stress in different disease conditions and serve as a potential source of natural antioxidant. The study provides proof for the ethnomedical claims and reported biological activities. The plant has, therefore, very good therapeutic and antioxidant potential”.

Chandan(Santalum album/Rakta chandan/Lalchandan)

• A study on Wnt signal (that which is responsible for inter or intra cell communication of disease) compounds found  “Upon screening compounds having Wnt signal inhibitory activity through evaluating TCF/β-catenin transcriptional (TOP) activity, eight cadinane sesquiterpenoids, including three new compounds (1-3), were isolated from wood extracts of Santalum album (Santalaceae)”.

• Incidentally red sandalwood upon investigation revealed: “The present results indicate the efficacy of Pterocarpus santalinus methanolic wood extract as an efficient therapeutic agent in acute anti-inflammatory conditions. The extract showed strong analgesic action in mice, by inhibiting the acetic acid-induced writhing and by increasing the latency period in the hot-plate test. These findings seem to, in part, justify the folkloric uses of this plant. The methanolic wood extract was screened for various phytochemical tests and found to contain glycosides, essential oils, flavonoids and polyphenolic compounds. Further, Polyphenolic compounds, like flavonoids, tannins and phenolic acids, commonly found in plants have been reported to have multiple biological effects, including antioxidant activity”.

Udeechya( Pavonia odorata/Sugandbala/Netrabala) 

• An antimicrobial and cytotoxicity study said that: “Pavonia constitutes the largest genus of flowering plants in the mallow family, Malvaceae, which is represented by over 250 species, with 134 occurring in Brazil. Several species are used in traditional medicine in several countries including India, Tanzania, and Brazil. Some traditional applications of Pavonia include the treatment of gastrointestinal problems such as dysentery and gut hemorrhage, antimicrobial applications, and treatment of cancer”.

• Prolific researcher C.P Khare has this to say about Udeechya: “Plant—anti-inflammatory and spasmolytic. Used in rheumatic affections. Root—stomachic, astringent, demulcent. Used in dysentery, haemorrhages from intestines; ulcers and bleeding disorders”.

• A study of antimicrobial activity of essential oil opined that: “The essential oil from the rhizomes of Pavonia odorata Willd was extracted in an yield of 0.2% by hydrodistillation, and screened for antibacterial and antifungal activity against ten bacteria and thirteen fungi using paper disc agar diffusion technique. The oil was found to inhibit the growth of Staphylococcus aureus, Diplococcus pneumoniae, Escherichia coli and Klebsiella sp at 0.55 concentration. The oil was also found to inhibit the growth of keratinophilic fungi Trichophyton mentagrophytes and Chrysosporium indicum along with Aspergillus sp., Botryodiplodia sp. Fusarium solani etc”.

Nagara (Zingiber officinale/dried ginger/”Soonth”)

See discussion under Trikatu below*.

2*: “Agastya Harityaki “

Agastya Haritaki (Terminalia Chebula/Harad)

• Agastya Haritaki  is a very important Ayurvedic balancing herb mainly used in the formulaic form of Triphala.

• Supporting clinical research says: “Terminalia chebula (T. chebula) Retz. (Combretaceae), which exhibited a number of medicinal activities due to the presence of a large number of different types of phytoconstituents. The fruit of the tree possesses diverse health benefits and has been used as traditional medicine for household remedy against various human ailments since antiquity. T. chebula has been extensively used in Ayurveda, Unani and Homoeopathic medicine and has become a cynosure of modern medicine. The observed health benefits may be credited to the presence of the various phytochemicals like polyphenols, terpenes, anthocyanins, flavonoids, alkaloids and glycosides”.

• “The plant has been demonstrated to possess multiple pharmacological and medicinal activities, such as antioxidant, antimicrobial, antidiabetic, hepatoprotective, anti-inflammatory, antimutagenic, antiproliferative, radioprotective, cardioprotective, antiarthritic, anticaries, gastrointestinal motility and wound healing activity.” 

• “T. chebula exhibited antibacterial activity against a number of both Gram-positive and Gram-negative human pathogenic bacteria. Ethanedioic acid and ellagic acid isolated from butanol fraction of T. chebula fruit extract had strong antibacterial activity against intestinal bacteria, Clostridium perfringens and Escherichia coli. It is effective in inhibiting the urease activity of Helicobacter pylori.”

• “T. chebula fruits afforded four immunodeficiency virus type 1 (HIV-1) integrase inhibitors, GA (I) and three galloyl glucoses (II-IV). Their galloyl moiety plays a major role for inhibition against the 3′-processing of HIV-1 integrase of the compounds. T. chebula has also retroviral reverse transcriptase inhibitory activity. It protects epithelial cells against influenza A virus, supporting its traditional use for aiding in recovery from acute respiratory infections. The methanol and aqueous extracts of T. chebula showed a significant inhibitory activity with IC50≤5 µg/mL on human immunodeficiency virus-1 reverse transcriptase. It also demonstrated the therapeutic activity against herpes simplex virus both in vitro and in vivo tests. These findings prompted a team of Japanese researchers to investigate T. chebulas’s effect on human cytomegalovirus (CMV). They found that T. chebula was effective in inhibiting the replication of human cytomegalovirus in vitro and in an AIDS model with immunosuppressed mice and concluded that it may be beneficial for the prevention of CMV diseases and immunocompromised patients. It is also helpful in sexually transmitted diseases and AIDS. Tannins from T. chebula are effective against potato virus x.”

• A study on cytoprotective of Haritaki opines: “The ethanolic extract of T. chebula fruit exhibited a notable cytoprotective effect on the HEK-N/F cells”.

3*: “Samshamani Vati“

Samshamani Vati  (Guduchi/Tinospora Cordifolia/Giloy)

• Guduchi is another balancing Ayurvedic herb which is employed for a range of conditions like as low grade fever, fever, convalescence, malaria, hepatitis, jaundice, diabetes, cardiovascular disease, tuberculosis, arthritis, gout, hemorrhoids.

• A study on diverse roles of Guduchi says: “A myriad of biologically active compounds, including alkaloids, diterpenoid lactones, glycosides, steroids, sesquiterpenoid, phenolics, aliphatic compounds, and polysaccharides have been isolated from different parts of the plant body. These compounds have been reported to have different biological roles in disease conditions thus enabling potential application in clinical research”. 
• “Tinospora root extract (TCE) has been shown to demonstrate a decrease in the recurrent resistance of HIV virus thus improving the therapeutic outcome. Anti-HIV effects of TCE were revealed by reduction in eosinophil count, stimulation of B lymphocytes, macrophages and polymorphonuclear leukocytes and hemoglobin percentage thus, revealing its promising role of application in management of the disease”.
• “The methanol extracts of Tinospora cordifolia have been reported to have potential against microbial infections. The anti-bacterial activity of Tinospora cordifolia extracts has been assayed against Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Proteus vulgaris, Salmonella typhi, Shigella flexneri, Salmonella paratyphi, Salmonella typhimurium, Pseudomonas aeruginosa, Enterobacter aerogenes, and Serratia marcescens (Gram-positive bacteria).”
• A clinical study on the analgesic activity of Guduchi says: “Commercially available extract of T. cordifolia “guduchi” was found to possess analgesic activity. As it showed analgesic activity in both the methods so its analgesic activity might involve central (opioid receptors) as well as peripheral (inhibition of PG synthesis) mechanisms”.

4*: “Trikatu (Pippali, Marich & Shunthi) and Tulasi leaves…“

Trikatu

Trikatu is comprised of long pepper, black pepper and dried ginger.  

Supporting study on the anti-inflammatory, analgesic activity of Trikatu compound says: “Trikatu has also been found to exhibit significant analgesic and antipyretic effects with the absence of gastric damage. In conclusion, the present results clearly indicated that Trikatu exert a potent anti-inflammatory effect against monosodium urate crystal-induced inflammation in rats in association with analgesic and antipyretic effects in the absence of gastrointestinal damage”.

Underlying elements of Trikatu:

Pepper(Piper Nigrum/Kali mirch and Piper longum/Pippali)

• A study on the anti-inflammatory activity of Pippali says: “Pippalı (Piper longum Linn.) fruit contains a number of constituents, including volatile oil, alkaloids, isobutylamides, lignans and esters. Piperine, which is the prime constituent of fruit, is reported to be having significant anti-inflammatory activity. In this study also, Piperine may be responsible for observed anti-inflammatory activity. This study shows that Chhoti (Small) variety of Pippali suppressed inflammation of both acute and sub acute phase while Badi(Long) variety of Pippali only of acute phase”.

Shunti Ginger* (Zingiber officinale)

• Herbal text book authors Bode and Dong have this to say about mighty ginger:  “Ginger (Zingiber officinale Roscoe, Zingiberaceae) is one of the most commonly consumed dietary condiments in the world. The oleoresin (i.e., oily resin) from the rhizomes (i.e., roots) of ginger contains many bioactive components, such as [6]-gingerol (1-[4′-hydroxy-3′- methoxyphenyl]-5-hydroxy-3-decanone;… which is the primary pungent ingredient that is believed to exert a variety of remarkable pharmacological and physiological activities. Although ginger is generally considered to be safe, the lack of a complete understanding of its mechanisms of action suggests caution in its therapeutic use”. 
• A study on anti-inflammatory effects of ginger oil opines: “Ginger and its extracts have been used traditionally as anti-inflammatory remedies, with a particular focus on the medicinal properties of its phenolic secondary metabolites, the gingerols. Consistent with these uses, potent anti-arthritic effects of gingerol-containing extracts were previously demonstrated by our laboratory using an experimental model of rheumatoid arthritis, streptococcal cell wall (SCW)-induced arthritis”. 

Tulasi (Ocimum sanctum)

• Tulasi is plant grown in most homes in India. “Of all the herbs used within Ayurveda, tulsi (Ocimum sanctum Linn) is preeminent, and scientific research is now confirming its beneficial effects.There is mounting evidence that tulsi can address physical, chemical, metabolic and psychological stress through a unique combination of pharmacological actions. Tulsi has been found to protect organs and tissues against chemical stress from industrial pollutants and heavy metals, and physical stress from prolonged physical exertion, ischemia, physical restraint and exposure to cold and excessive noise. Tulsi has also been shown to counter metabolic stress through normalization of blood glucose, blood pressure and lipid levels, and psychological stress through positive effects on memory and cognitive function and through its anxiolytic and anti-depressant properties. Tulsi’s broad-spectrum antimicrobial activity, which includes activity against a range of human and animal pathogens, suggests it can be used as a hand sanitizer, mouthwash and water purifier as well as in animal rearing, wound healing, the preservation of food stuffs and herbal raw materials “
• “Despite the lack of large-scale or long term clinical trials on the effect of tulsi in humans, the findings from 24 human studies published to date suggest that the tulsi is a safe herbal intervention that may assist in normalizing glucose, blood pressure and lipid profiles, and dealing with psychological and immunological stress.”

5*: “Pratimarsa Nasya, …. Anu taila/Sesame oil”

Anu Taila

• This is an Ayurvedic a medicated sesame based oil remedy used among other things for sinusitis and headaches. 

Updates

Please note that AYUSH sent out an updated advisory which also contains an Ayurvedic anti-malarial (Vishama Jwara) drug formulation AYUSH-64, which was field tested and used particularly in drug resistant malaria cases in India. What makes this interesting is Elon Musk’s recent tweets on efficacy of anti-malarial quinine/hyroxychloroquine for COVID-19 following reports of use of this drug by some doctors across the world. Subsequently on March 19th in a press conference the US President mentioned potential use of hydroxychlorquine. A FDA COVID-19 update states “The FDA has been working closely with other government agencies and academic centers that are investigating the use of the drug chloroquine, which is already approved for treating malaria, lupus and rheumatoid arthritis, to determine whether it can be used to treat patients with mild-to-moderate COVID-19 to potentially reduce the duration of symptoms, as well as viral shedding, which can help prevent the spread of disease.” WSJ has also opined on the subject. Here is some data accumulated by James Todaro on the subject.

Another AYUSH update was made on April 10, 2020 with a simplified advisory.

Other pertinent things:

Ayurvedic herbs should be taken only in consultation with an Ayurvedic practitioner. Likewise, herbs should be sourced from authentic sources which are testing for heavy metal contamination. The herbs discussed above are not an exhaustive list of Ayurvedic herbs/other herbs that may have a beneficial immunomodulatory response. 

 One should also look at all the studies with a sceptical view. In statistics and in any scientific or social science research one can often prove what you set out to prove. The sample size is pertinent, as also is the gold standard double blind placebo method of testing which also robustly accounts for confounding factors. However there is often a paucity of robust data sets to enable proper validation. In view of the above, we are essentially trying to connect the dots and letting the experts go about their business from here. 

DISCLAIMER

All content is for informational purposes only. Please consult your medical practitioner before attempting any therapeutic, nutritional/herbal, exercise or meditation related activity.

Nothing in my writing is original thought. It simply attempts to connect the dots. I owe my rudimentary understanding of Vedic philosophies/Ayurveda/nutrition to the writings of  Dr. Govind Chandra Pande, Dr. David Frawley and Prof. Subhash Kak, and all the learned who have written about these topics in general, specifically all the authors whose research published on NCBI is referenced above . All errors in interpretation and lack of understanding are mine. 

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