International Journal of Research in Indian Medicine Ayurveda approach in the management of Covid-19 in pregnancy-A review study.

The covid-19 Pandemic in india is part of the worldwide pandemic of coronavirus disease 2019 (Covid-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first case of Covid -19 in India which is originated from china. COVID-19is type of coronavirus disease belonging to the Family Corona viriadae. The disease is originate through bats and spread from unknown medium to People. Ideally, the condition is spread by Inhalation or close contact with infected patient’s Droplets. Incubation Periods in between 2 and 14 days there are so many infections and Death that have been caused by the disease. The symptoms of disease include fever, cough, Sneezing, sore throat, difficulty in breathing, genaralized weakness. The diagnosis of disease is depends upon multiple symptoms of upper and lower respiratory tract. Based on the available evidences, various clinical guidelines for management of COVID-19 have been formulated. Ayurveda has documented has given scientific insight to its causes, effect and prevention along with management strategies. This article intends to compile and summarise guidelines from esteemed organisations along with their implication in the Indian ethical scenario, and offers an easy tool for clinicians managing pregnant women in times of COVID-19. The clinical profile of COVID-19 matches which pharmaceutical and management strategies through Ayurveda


INTRODUCTION
Pregnancy is the most important and critical and precious part of every woman's life so that systematic Examination as well as healthy diet and other advice which are helpful for boosting her immunity are very important; this systematic supervision is called as Garbhini Paricharya (Anti Natal Care).
There is a new public health crises threatening the world with the emergence and spread of 2019 novel coronavirus (2019-nCoV) or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Its impact on pregnant women is not yet clear owing to limited data and the knowledge is evolving in several aspects. Supervision should be regular and periodic in nature and according to need of Garbhini (ANC Mother). Ayurveda considers food to be the best source of nourishments as well as medication for the pregnant woman. Ayurveda has been described concept of the nine month diet in Garbhini. This diet changes in according to the growth of the foetus in the womb and at the same time ensures health of the mother. The things which are contraindicated in pregnancy are known as Garbhopaghatakara Bhavas and avoidance of these things is necessary for well being of foetus. In this paper we have described monthly dietary regimen and Living style for whole pregnancy according to Samhita. Considering the mode of transmission (Oro-nasal route through droplets/hand contact), Covid-19 has Agantuja hetu (external cause i.e. SARS-CoV 2). Disease symptoms manifest abruptly without having the prodromal phase when the cause is agantuj and the clinical presentation will depend upon the status of already deranged doshas at the site where they are maximally concentrated. After gaining entry in a host Agantuja hetu ultimately leads to derangement of Sharirika dosha (Vata, Pitta and Kapha) and gets converted to Nija (internal) type45 following the incubation period (variable, from 2-14 days in COVID19).
Although the route of entry of SARS-CoV-2 is Oro-nasal and it mainly hits the respiratory system but multiple organ system involvement is seen in different hosts.
Other associated symptoms of COVID-19 are headache, body aches and arthralgia which are general symptoms associated with all the fevers. In severe stage, disease manifests as pneumonia, ARDS, shock, coagulation disorders with multi organ failure. All these symptoms are described in Jwara under different types and COVID-19 can be categorized as Vata-Kapha dominant Sannipataja Jwara with variable involvement of Pitta. Hence, the line of treatment mentioned under Jwara chikitsa must be adopted for its management. In addition to this, principles of Shwasa and other diseases like Atisara (Diarrheal diseases), Chardi (Vomiting), Raktapitta (bleeding disorders and Coagulopathies) can be employed depending upon the presenting case. Jwara (fever) according to Ayurveda arises from Amashaya and has been classified as a disease due to vitiation of Rasavaha srotas. Aggravated Dosha (Vata, Pitta or Kapha) due to underlying etiology, either alone or in combination of two or three, gets mixed with the improperly formed rasa (the first Dhatu formed after digestion) which cause sluggish circulation and further blocks the micro channels of rasa and sweda (thermoregulatory apparatus). The Agni (digestive fire) gets displaced out of its original site (Paktisthana), spreading out through the body which is not able to dissipate heat due to blocked sweat channels, causing fever. Moreover, displacement of Agni from its seat impairs all the metabolic functions of the body and leads to impaired immune response. Greater the derangement of Agni greater will be the accumulated Dosha and poor will be the prognosis as is seen in Covid-19 cases with comorbidities like hypertension, diabetes, cardiac and hepatic disorders, cerebrovascular accidents, cancer and cases with renal impairment.

AIMS AND OBJECTIVE
 To understand the mode of action of Ayurvedic Perspective and Management in Covid-19  To review of covid -19 ayurvedic approach and management.  To understand the mode of Action and Effect of covid-19 on pregnancy and Fetus

Effect of COVID-19 on Pregnancy
Pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body's immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19. Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery. In other types of coronavirus infection (SARS, MERS), the risks to the mother appear to increase in particular during the last trimester of pregnancy. There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous. Pregnant women with heart disease are at highest risk (congenital or acquired). The coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact.

COVID-19 in Ayurveda
Ayurveda revealed that it is not always possible to name a disease in a definite term. Hence, this disease has to be analyzed according to the Nidana Panchaka theory of Ayurveda based on the concepts of Dosha, Dushya, Srotas, Samprapti, and its management. Since the Vedic period, Ayurveda practitioners have an insight into the existence of microorganisms inducing infectious diseases. The word Krimi was referred to as an infectious agent in Vedas. Ancient Indian classics described nearly 100 types of infectious agents. In Mahabharata, Vedavyasa narrated the unavoidable existence of Krimi. It is also mentioned in classics that Mahamari (communicable diseases) can spread from one person to another through air, water, animal, flies, and physical contact.

Historical evidence of infections and epidemics in Ayurveda
When any disease or conditions like natural calamities or disasters affected a Janpad, it was called as Janpandodhwansa. Factors responsible for such an outbreak resulting in mass casualties are as follows  Deranged Vayu (air),  Jala (water),  Desh (land)  Kala (seasons).
These four factors are in common to habitants of an area which when vitiated are responsible for outbreak of a disease. Sins of present life and bad deeds of past life, Pragyaparadha (intellectual misconduct), Adharma (unrighteousness) have been ascribed as the root cause of such type of calamities.

Ayurvedic approach to Covid-19
Considering the mode of transmission (Oro-nasal route through droplets/hand contact), Covid-19 has Agantuja hetu (external cause i.e. SARS-CoV 2). Disease symptoms manifest abruptly without having the prodromal phase when the cause is agantuj and the clinical presentation will depend upon the status of already deranged doshas at the site where they are maximally concentrated. After gaining entry in a host Agantuja hetu ultimately leads to derangement of Sharirika dosha (Vata, Pitta and Kapha) and gets converted to Nija (internal) following the incubation period (variable, from 2-14 days in COVID-19). Although the route of entry of SARS-CoV-2 is Oro-nasal and it mainly hits the respiratory system but multiple organ system involvement is seen in different hosts. SARS CoV-2 after entering the body, leads to derangement of Shareerika dosha and manifests mainly as Rasapradoshaja diseases like Jwara (fever) and Arasagyata (loss of taste) along with Pranavaha srotodushti symptoms (Pulmonary symptoms) like Shwasa (dyspnoea) and Kasa (cough). Annavaha Srotodushti (digestive system) symptoms like Aruchi (anorexia), Chardi (vomiting) and Purishavaha srotodushti (excretory system) symptoms like Atisara (diarrhoea) are also not uncommon. Other associated symptoms of COVID-19 are headache, body aches and arthralgia which are general symptoms.

Pathophysiology
The pathological complex can be conceptualized as -Bhuta-abhishangajvara‖ in Ayurveda (∼fever due to infection of microbial organisms). Contributing aetiologies in the morbidity are Nija(∼endogenous factors) and Agantuka(∼exogenous factors). It can be co-related to Aagantuja jvara with (infectious disease) with a special reference to Vata dominant jvara (fever in Ayurveda), further manifested as the consequence of Janapadodhwamsa (epidemic). In this case, exposure to the virus refers to exogenous aetiology and exertion contributed to the pathology. The doshas inflict rasa vaha srotas and sweda vaha srotas, the foetus gets its mean of survival from rasa vaha srotas, thus it may also be affected by jwara. describes the pathogenesis of COVID 19 in pregnancy.
Decoction of candana, sariva, lodhra and mrdvika mixed with sugar should be prescribed.
Water medicated with payasya, sariva, pathya, nagara should be given for drinking. Hriberadi decoction prescribed for diarrhea is also beneficial.
Decoction of ayurvedic drugs like Tulsi, Guduchi, Shirish, Neem and Yastimadhu can prove to be an elixir for pregnant woman in COVID-19 pandemic and will aid to prevent and treat COVID-19 symptomatically as these drugs possess Antiviral, Anti-bacterial, Anti-oxidant, Anti-inflammatory, Anti-allergic and Immune-modulatory effects.
The ayurvedic properties of drugs and its effect on respiratory system & basal body temperature. the chemical constituents and biological activities of ayurvedic drugs effective for pregnant women in COVID-19 pandemic. Sitophaladi churna 2 g mixed with 125 mg of Godanti bhasma was advised to be taken twice a day with lukewarm water.

Godanti bhasma has Madhur Vipaka and Sheeta veerya
Phala ghrita was advised (5 gram) twice a day. The dietary interventions should be as gruel and vegetable soup along with regular diet.

Method of preparation of decoction
Fresh raw drugs (1 part each) are taken and washed off properly, and then all dirt and contamination are removed.
Decoction can be prepared from Tulsi patra, Shirish twak, Guduchi kanda, Madhuka mool, and Nimba patra by adding four times water and reducing it to one-fourth and is allowed to cool down. The pregnant woman is advised to drink 20ml ---0---20ml decoction ( twice a day)

DISCUSSION:
The world is facing a panic situation nowadays in the form of covid-19 pandemic. Which came in our life like a nightmare. There is no evidence till date exact protocol for treatment which can be use for covid-19 infection. So the only way to control the situation is prevention and symptomatic treatment to cure of corona infection. WHO, ICMR, AYUSH guidelines are made for the prevention of corona virus infection. But no any extra care suggested by the any health organisations for pregnant ladies. Pregnant ladies should be considered as vulnerable. As pregnancy is a immunecompromised state. Here are trying to suggest some remedies as preventive measure. Acharya Kashyapa has stated that fever in a pregnant woman is the most troublesome disease as the foetus suffers due to the transfer of heat of fever from the mother to the foetus. This case demonstrated Ayurvedic management for pregnant woman with COVID-19 disease. The safety and efficacy were the initial concerns in considering the mentioned therapeutics. The intervention included oral medications, dietary intervention and lifestyle intervention. The initial treatment on admission was administered as vyadhi-viprita upkrama (jwaraghna action of Sanshamani Vati and Godanti bhasma)and Sukumar ghrita was administered for its Vata-nashan karma and rasayana action.
Efficacy of Sanshamani Vati in the treatment of moderate infection of COVID-19 is evident through the recent researches.

CONCLUSION
The diet and lifestyle which are described thousands of years ago in the classical texts of Ayurveda is totally beneficial and one can follow it for prevention of COVID-19 in pregnancy. The disease COVID-19 can be considered as the clinical congruence of Sam-sannipataja jwara It comes under Janapada dhamsa vikara and can be grouped in Bhutabhisanga Agantuga Vikara (external cause of microbes) Garbhini should be treated circumspectly during this COVID-19 pandemic to prevent a deleterious effect.This article gives priority to the reduction of transmission of COVID-19 in pregnant women. In conclusion, the literature on the management of antenatal women in COVID times is extremely limited but rapidly growing and changing. The available guidelines too are updating