Aupasargika vyadhi

The word aupasargika means contagious. The diseases that spread from one person or organism to another person or organism are ‘aupasargika roga’. These types of diseases can spread through the same or the other pathogenic factors (microbes) like protozoa, yeast, bacteria, viruses etc. Ayurveda classics have mentioned the concept of epidemic/pandemic in the context of janapadodhvansa (community destruction). Air pollution, water pollution, climate change, and environmental factors are responsible for the spread of diseases on a large scale, resulting in epidemics/pandemics. Causes of vitiation of air, water, climate and place along with their characteristics are described in context of janapadodhvansa. The causes of contagious diseases are also described in ancient classical texts at various places. Technological advances in medical science have enabled us to know precise micro-organisms responsible for causing and spreading contagious diseases. This chapter deals with the diagnosis and principles of management of contagious diseases described in ayurveda and its contemporary practices.

Contributors

Section/Chapter/topic	Concepts & Contemporary practices/Vyadhi/Aupasargika vyadhi
Authors	Sapra Umesh 1, Deole Y.S. 2
Reviewer & Editor	Basisht G.3
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2 Department of Kayachikitsa, G. J. Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 3 Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	umeshsapra123@gmail.com, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	September 27, 2023
DOI	10.47468/CSNE.2023.e01.s09.149

Etymology

1. The word Aupasargika is derived from ‘upasarga’ meaning (औपसर्गिक)- superior to adversity, able to cope with calamity [gana] [Pāṇini 5-1, 101]
2. superinduced, produced in addition to (or out of another disease), [Suśruta]
3. infectious (as a disease), [Suśrutai, 271, 13]

Synonyms

• Sankramaka vyadhi (contagious diseases)
• samsargaja vyadhi (infectious diseases)

Difference in infectious disease and contagious disease

A clinically manifested disease of man caused by a micro-organism is an infectious disease. The disease that spreads from one person to another person is a contagious disease. All infectious diseases are not contagious.

Mode of transmission

Sushruta observed the modes of transmission of contagious diseases and listed them as follows. [Su.Sa.Nidana Sthan 5/33-34]

• Close physical contact (prasangat)
• Touching the affected person (gatra samsparshat)
• Droplets exhaled in air (nishwasat)
• Sharing bed with affected person (saha shayya)
• Eating together or sharing food with affected person (sahabhojanat).
• Sitting together / closely with the affected person (saha aasanat).
• Using clothes, ornaments etc. of affected person (vastra mala anulepanat).

There are seven types of diseases as per acharya Sushruta. [Su.Sa. Sutra Sthana 24/4 Vyadhisamuddeshiya] These are

1. Adibala pravrutta (hereditary diseases)
2. Janmabala pravrutta (congenital diseases)
3. Doshabala pravrutta (dosha dominant diseases)
4. Sanghatabala pravrutta (accidental bites, attack of animals)
5. Kaala bala pravrutta (time/age/season related based diseases)
6. Daiva bala pravrutta (diseases caused due to previous deeds etc.)
7. Swabhava bala pravrutta (diseases occurs due to natural processes like ageing, death) [Su.Sa. Sutra Sthana 24/4]

Daiva bala pravrutta diseases (previous deeds) are classified as [Su.Sa.Sutra Sthana 24/7]

1. Contagious or communicable (aupasargika roga)
2. Accidental (akasmik)

List of contagious diseases

Ayurveda texts have listed the diseases that can spread through above means as below:

• Kushtha (~skin diseases)
• Jwara (~fever)
• Netrabhishyanada (~conjunctivitis)
• Shosha (~emaciation/tuberculosis)
• Visuchika (~cholera)
• Shleshmak jwara with pratishyaya (fever with rhinitis)
• Upadamsha (~chancroid/soft chancre)
• Hepatitis A, B, C, D
• Influenza
• Masurika (chickenpox)
• Romantika (measles)
• Visarpa (erysipelas)
• Kandu (pruritus)

Aupsargika diseases described by Bhavamishra

• Kandu (pruritus)
• Kushtha (skin diseases)
• Upadansha (sexually transmitted disease like chancroid/soft chancre)
• Bhuta-unmada (psychosis due to infection of micro-organisms)
• Jwara (fever)

Dalhana described following aupasargika diseases

Shwasa (respiratory disorder), kasa (cough) and pratishyaya (allergic rhinitis) diseases can spread through droplet infection. Jwara (fever) and masurika can spread through skin contact.

Causes

• The causes of abovementioned diseases are described in the respective chapters. However, the contagious nature of the diseases can affect other person susceptible for similar diseases.
• Ayurveda believe in seed and soil theory, where seeds are microorganisms like bacteria, virus etc., and soil is body. When the soil is healthy, then no disease can prevail in the body. But if the seeds are more potent, they can produce a disease. Therefore, the occurrence of diseases depends on the interaction of dosha, Dushya, and causes (hetu). If the inherent immunity (vyadhikshamatva) is superior, then the affecting micro-organisms cannot multiply and cause diseases. However, if the immunity is poor, then the micro-organisms can lead to infectious diseases. The transmission of microbes from one person to other depends on nature of microbe and availability of its favourable transmission mode like air, soil, water etc.
• As per contemporary medical literature, communicable diseases are caused by viruses or bacteria. These micro-organisms are transmitted to one another through contact with contaminated surfaces, bodily fluids, blood products, insect bites, or through the air. The modes of transmission are described by Sushruta as mentioned earlier.

Role of aupsargika roga in current era

With every passing era, mankind has faced healthcare challenges in the form of pandemics like COVID-19, epidemics like cholera, plague etc. These are all aupasargika in nature. Understanding aupsargika roga not only helps to prevent the diseases at individual level, but also helps to prevent epidemics or pandemics.

Root cause for epidemics (janapadodhavansa)

Root cause for vitiation of air etc. factors is 'adharma' or misdeeds performed by intellectual errors (prajnaparadha). Sinful acts may be in the form of wars, demons, germs & curse. In the present day, sinful acts can include different activities like antinational elements indulging in bomb blast, crime, deforestation, not obeying government rules in the industries, discharge of untreated polluted water in to the river, automobile pollution etc., which produce air pollution. Disposal of wastewater in an improper method on land leads to pollution of soil. The basic cause of such act is intellectual errors (prajnaparadha), due to rajas & tamas predominance resulting in greed, selfishness, tendency to harm people, jealousy & anger. All these factors influence not only the individual, but also the society, leading to janapadodhvansa.

Preventive aspects

Ayurveda durably gives priority to preservation of health of healthy person. Immunity plays a major role in occurrence and non-occurrence of any disease, especially in such type of infectious disease. Ayurveda believes in ‘Sahaja bala’ (inherent immunity) of person. If that is reduced, then the possibility of getting an infection is greater. So, ayurveda recommends a comprehensive regimen for safeguarding health and increasing vyadhikshamatva (immunity) as a code of the health conduct viz ‘swasthavritta’. It includes the following practices: [Cha. Sa. Sutra Sthana 7/53-60], [Cha.Sa.Vimana Sthana 3/13-17]

• Dinacharya (daily code of health conduct)
• [[Ritucharya (conduct in relation to various seasons)
• Sadvritta (details about life style, diet, exercise, personal and social hygiene)
• Avoiding prajnaparadha (intellectual errors)
• Controlling senses (indriya upashama)
• Memorizing the health protocols and following it
• Shodhana (suitable purification therapies as per season and constitution).
• Following advices given by authorities and elder persons
• Ahara vidhi (dietary guidelines) [Cha.Sa. Sutra Sthana 7/53-54]

These all-precautionary measures not only aid to increasing immunity, but also resist the mode of transmission of infectious agents like bacteria, viruses, and fungi. The preventive measures as advised in janapadodhwansa shall also be followed.

Treatment measures

Krimi is an organism that invades human body. It is generally referred as worms and micro-organisms. The treatment protocol for krimi is as follows [Cha.Sa.Vimana Sthana 7/14]

Apakarshana: Removing krimi manually or with techniques or therapeutically by purification procedures

Prakritivighat: The therapies to eradicate favorable environment for krimi are done so as to prevent recurrence.

Nidana anupsevana: The specific dietary causes are avoided.

Protocol for prevention of spread of infection

• Maintaining hygiene to prevent growth of microorganism
• Avoiding direct contact with an infected individual
• Safe handling of patient care
• Controlling the spread of micro-organisms in the environment

Effect of Ayurveda treatments in management of COVID-19

New disease like COVID19 is one of recently known aupasargika roga (contagious or infectious diseases). The studies on the effect of Ayurveda formulations and therapies in the management of COVID-19 are supportive of the protocol of management of aupasargika roga. Few important studies related with the ayurvedic management of COVID-19 are highlighted as follows:

1. In a case report, P.L.T Girija et al noticed that the COVID-19 patient’s condition did not deteriorate when ayurvedic treatment was taken. Despite the patient having severe cough and fever more than 39.1°C, the patient’s condition did not worsen and develop breathlessness. Median time for onset of symptoms to recovery in mild and severe cases was 2 and 3–6 weeks, respectively. Furthermore, time interval between onset and developing severe symptoms such as hypoxia was one week. This patient had recovered in 7 days. Hence, it can be said that the duration of the disease was presumably shorter, because of the ayurvedic medicines. The regulated diet played an important supportive role in the cure. The diet advised was soup made of mung dal and cooked parboiled rice which is easy to digest (laghu) and stimulated the digestive power (agni deepana) and it nourished the patient.
2. Ram Deo Pandit et al concluded that polyherbal drugs in the protocol should be taken into series of clinical trials to test its effectiveness against COVID-19 and discover the pharmaco-clinical evidences and prove effectiveness. Immunity is vital factor in the management of COVID-19 pandemic condition. The prevention /arrest of pandemic can be achieved by adopting proper food habits and life styles as well as regularly taking the rasayana. It is need of time to implement these principles in National health policies to make the Nation healthy.
3. In a case report on COVID-19 patient with hypoxia by Jyoti Anand Joshi suggested the potential of ayurvedic supportive care for recovery of COVID-19 patients even when they are oxygen-dependent. In this case, the patient declined Fabiflu because of the prohibitive cost, uncertainty of benefits and potential side-effects. Ayurvedic care based on an individualized and whole system approach could fill gaps and unmet needs in our response to the COVID-19 challenge.
4. A study conducted by Anup Thakar et al. suggested that ayurveda treatment as adjunctive might be more effective in mild/early-stage COVID-19 patients as compared to stand alone conventional care. This may provide leads to generate hypotheses for designing future studies, such as by helping identify the potential drug candidates from Ayurveda treatment and provide preliminary evidence for further clinical use in COVID-19 patients.
5. Shivangi Talwar et al. reviewed ayurveda and allopathic therapeutic strategies in Coronavirus pandemic treatment and summarizes the utility of currently opted therapies for COVID-19. No suitable medicine was found to exist for this virus infection. The rapidly increasing patient’s data of COVID-19 is triggering scientific communities to come forward to develop some possible therapy. The most reassuring treatment is considered to be remdesivir. This drug is known to possess strong antiviral activity as proven by several in vitro studies. Oseltamivir has not presented with suitability, and corticosteroids are at present not recommended. On the other hand, homeopathy and Ayurveda may be promising, but not applicable towards all types of patients. Therefore, the present study concluded that COVID-19 infection can be prevented by following government guidelines and opting immune-boosting Ayurveda routes.
6. In a study, Alka Mishra et al found that the Integrative therapy was effective in mitigating the symptoms of COVID-19 in a patient with multiple comorbidities. Moreover, a significant improvement in blood sugar levels was also achieved.
7. In a paper published by Ram Manohar et. Al. on ayurvedic clinical profile of COVID-19 suggested that COVID-19 can be classified as agantuka jvara with a vata kapha pradhana sannipata presentation. The dominance of pitta in certain stages of the disease and in some patients should be considered. However, COVID-19 needs to be further subclassified under the category of vata kapha pradhana sannipata jvara on the basis of a more detailed analysis of clinical symptomatology of a cross section of COVID-19 patients representing diverse populations from different geographical regions in the world. It is possible to develop provisional Ayurvedic clinical classifications of COVID-19 in consultation with modern medical doctors treating COVID-19 patients an Interdisciplinary AYUSH research Task force for COVID -19 is the need of the hour. Such policy decisions may create a better integrative environment in the future which underlines the significance of this study.
8. Srivastava Niraj et al. reviewed that Ayurveda recommends ‘rasayana dravyas’ like Ashwagandha (Withania somnifera (L.) Dunal), Amalaki (Phyllanthus emblica L.), Tulasi (Ocimum sanctum L.), Guduchi (Tinospora cordifolia (Willd.)Miers), Pippali (Piper longum L.) etc exhibit antiviral, anti-inflammatory and antioxidant properties, it may be favorable to consider them for the treatment of COVID-19.
9. Shankar Gautam et. al concluded that Ayush kwatha due to its antiviral, immune-modulatory, antioxidant, anti-inflammatory, anti-platelet, anti-atherosclerotic, hepato-protective, reno-protective properties; seems to be effective in regulating immunity for the prevention and reduction of viral disease complications. As there is lack of enough evidence to support its specific role against coronavirus, there is a requirement to validate the effectiveness of these formulations with extensive biotechnological, pharmacological, and clinical research.
10. Sanjeev Rastogi concluded that Ayurvedic interventions have supported complete recovery in severe COVID-19 infection with a chest severity score 18/25. This case report highlighted that despite prolonged hospitalization in an ICU, Ayurvedic intervention can prevent deterioration leading to complications, and enable complete recovery.
11. Domenico Nuzzo suggested that the use of antiviral therapies combined with neuroprotective drugs. For example, using antiviral drugs that can cross the blood-brain barrier combined with agents that specifically target both inflammation and oxidative stress could be considered.
12. Ganpat Devpura concluded that Ayurvedic treatment can expedite virological clearance, help in faster recovery and concomitantly reduce the risk of viral dissemination. Reduced inflammation markers suggested less severity of SARS-CoV-2 infection in the treatment group. Moreover, there was no adverse effect observed to be associated with this treatment.
13. Abhimanyu Kumar concluded that Guduchi Ghana Vati could benefit in treating asymptomatic covid patients.
14. Himesh Soni Synergistic effect of herbs (Piper betle leaves) and swarna bhasma in combination taken regularly in dosage dependant manner can be used as prophylaxis and therapeutic treatment for corona patient.
15. Priya Shree el al. concluded that active phytoconstituents of Ayurvedic medicinal plants Withania somnifera (Ashwagandha), Tinospora cordifolia (Giloy) and Ocimum sanctum (Tulasi) predicted to significantly hinder main protease (M^pro or 3Cl^pro) of SARS-CoV-2.Through molecular docking and molecular dynamic simulation study, Withanoside V, Somniferine, Tinocordiside, Vicenin, Ursolic acid and Isorientin 4′-O-glucoside 2″-O-p-hydroxybenzoagte were anticipated to impede the activity of SARS-CoV-2 M^pro.

Summary

From the above literature and research studies, it can be concluded that aupasargika roga (contagious diseases) are well described in the ayurvedic literature and the incidence has increased now. As ayurveda believe in seed and soil theory, where seeds are microorganisms like bacteria, virus, etc and soil is the body. So if the soil is intact, then no disease can prevail. Harrison's textbook of medicine describes that no disease can prevail in the body until or unless the body is prepared for that. From the experience of COVID19 pandemic, it can be understood that the immunity of the person is most important. If the person is having good immunity, the diseases like COVID19 may not be able to produce any harm to the patient. Therefore, just by following the proper diet, life style pattern, devoid of stress, greed, jealousy etc. along with dinacharya and ritucharya, one can maintain a healthy body and mind and the disease incidence will be negligible.

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