Epidemics in Ayurveda: The medical and non-medical dimensions

P. Rammanohar, Research Director, Amrita School of Ayurveda

Epidemics were described in classical Ayurvedic literature dating back to centuries before the common era.
In Sanskrit, Epidemics were called Janapadodhvamsa - Janapada - large human settlements, Udhvaṃsa -
to be affected, to be destroyed. The third chapter in the Vimānasthāna of the Carakasaṃhitā deals
exclusively with this topic raising the important question as to why people of different body constitutions,
lifestyle, diet and genetic inhertiance become afflicted with the same disease. अिप तु खलु जनपदोद्ध्वंसनमेकेनैव
व्यािधना युगपदसमानप्रकृत्याहारदेहबलसात्म्यसत्त्ववयसां मनुष्याणां कस्माद्भवतीित || The text replies with the answer that
Climate, Air, Water and Land can become a common medium through which the same disease can affect a
large human settlement. प्रकृत्यािदिभभार्वैमर्नुष्याणां येऽन्ये भावाः सामान्यास्तद्वै गुण्यात् समानकालाः समानिलङ्गाश्च
व्याधयोऽिभिनवर्तर्माना जनपदमुद्ध्वंसयिन्त| ते तु खिल्वमे भावाः सामान्या जनपदेषु भविन्त; तद्यथा- वायुः, उदकं, देशः, काल इित ||

Today the whole world has come to a standstill due to the outbreak of the COVID-19 pandemic. A glance at
classical Ayurvedic texts reveal that Suśruta was perhaps the first whistle blower warning us about the
possibility of epidemic outbreaks like COVID-19 which primarily affects the respiratory system.
Suśrutasaṃhitā, an ancient text book of surgery in Ayurveda describes illnesses manifesting as epidemics
affecting the respiratory system time and again, presenting with the symptoms of fever, cough, breathing
difficulty, rhinorrhoea, headache and even anosmia - िवषौषिधपुष्पगन्धेन वा वायुनोपनीतेनाक्रम्यते यो देशस्तत्र
दोषप्रकृत्यिवशेषेण कासश्वासवमथुप्रितश्यायिशरोरुग्ज्वरैरुपतप्यन्ते।। The clinical presentation of such diseases described
in the Suśrutasaṃhitā are strikingly similar to epidemics like SARS, Ebola, MERS, Swine Flu and even
COVID-19 exhibiting severe respiratory symptoms. Dalhaṇa, the commentator of this text specifies that
causative agent of such diseases enters the human body through the nasal passages. When Dalhaṇa
comments on the passage in Suśruasaṃhitā referring to symptoms of the epidemic manifesting respiratory
illnesses that is seen to be caused by airborne transmission, he lists a very interesting symptom -
gandhājñāna or anosmia अन्ये तु कासश्वासेत्यािदपाठमन्यथा पठिन्त-
‘कासश्वासप्रितश्यायगन्धाज्ञानभ्रमिशरोरुग्ज्वरमसूिरकािदिभरुपतप्यन्ते’ इित, व्याख्यानयिन्त च- तत्र नासारन्ध्रानुगतेन वायुना
कासश्वासप्रितश्यायगन्धाज्ञानभ्रमिशरोरुजः।।

Anosmia has been reported in COVID-19 patients. Writes Prof. Claire Hopkins, President of British
Rhinological Society, "There is potential that if any adult with anosmia but no other symptoms was asked to
self-isolate for seven days, in addition to the current symptom criteria used to trigger quarantine, we might
be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors, not
realising the need to self-isolate”. Post-viral anosmia is one of the leading causes of loss of sense of smell
in adults, accounting for up to 40% cases of anosmia. Viruses that give rise to the common cold are well
known to cause post-infectious loss, and over 200 different viruses are known to cause upper respiratory
tract infections. Previously described coronaviruses are thought to account for 10-15% cases. It is therefore
perhaps no surprise that the novel COVID-19 virus would also cause anosmia in infected patients. There is
already good evidence from South Korea, China and Italy that significant numbers of patients with proven
COVID-19 infection have developed anosmia/hyposmia. In South Korea, where testing has been more
widespread, 30% of patients testing positive have had anosmia as their major presenting symptom in
otherwise mild cases. This lends strong support to the assumption that Suśrutasaṃhitā was referring to
viral infections in this context.

The Suśrutasaṃhitā also describes the modes of contagion - by repeated physical contact
(gātrasaṃsparśāt), by inhalation (niḥśvāsāt), by eating together (sahabhojanāt), by sitting and sleeping
together (sahaśayyāsanāt), by contact with clothes, garlands and so on (vastramālyānulepanāt) -
प्रसङ्गाद्गात्रसंस्पशार्िन्नश्वासात् सहभोजनात् | सहशय्यासनाच्चािप वस्त्रमाल्यानुलेपनात् ||, कुष्ठं ज्वरश्च शोषश्च नेत्रािभष्यन्द एव च |

औपसिगर् करोगाश्च सङ्क्रामिन्त नरान्नरम् || The importance of social distancing to prevent the spread of epidemic
diseases is hinted at in this ancient medical text. Sthānaparityāga or abandoning the places of human
activity is mentioned by Suśruta as the first and foremost measure in mitigating an epidemic. This reminds
us of the stringent measures like lockdown that we have been forced to enforce in the wake of the
COVID-19 pandemic. The word quarantine means fourty days in Italian and refers to the practice of isolation
to prevent contagion in the middle ages. This practice is said to have been discovered by Avicenna, the
Arab Physician. However, such principles in the mitigation of epidemics are found mentioned in classical
Ayurvedic texts composed centuries before the common era. Quarantine was also practice in the ancient
civilisation of Nepal. nearly a thousand years ago. To contain and prevent the transmission of infectious
diseases it was a standard cultural practice for people to self-isolate themselves after traveling to distant
places. The Newars of ancient Nepal travelled long distances for trade. As they moved about in far off
places and mingled with different types of people, most of them would come back sick with some disease.
In order to prevent such diseases from spreading to the community, it was a custom to self isolate before
returning to their homes. Once they show signs of health, the chief priest would examine them and subject
them to a purificatory ritual before sending them to their homes. The self-quarantine routine was an
important part of Nepali Culture during the Malla Dynasty and was practiced until the last century.

The word kṛmi in sanskrit means that which migrates from one location to the other. This term covers
pathogenic organisms in general, but also includes microbes. One category of kṛmi is minute, without feet
and invisble to the naked eye संस्थानम्- अणवो वृत्ताश्चापादाश्च, सूक्ष्मत्वाच्चैके भवन्त्यदृश्याः।।. The existence of
microbes was clearly documented in classical Ayurvedic texts. It is even more interesting to note that these
organisms were classified into the natural (sahaja) and pathogenic (vaikārika) अन्यत्र सहजेभ्य इत्यनेन
शरीरसहजास्त्ववैकािरकाः िक्रमयो िवं शतेरप्यिधका भवन्तीित दशर्यित|. Cakrapāṇi, the commentator of Carakasaṃhitā says
that the natural organisms and microbes living in the human body have not been counted and this is
perhaps a very early allusion to the human microbiome. Modern studies have confirmed that many herbs
used in Ayurveda against kṛmis (kṛmighna) have anti viral and anti bacterial activity.

It would be pertinent to ask what medical measures Ayurveda has advised to deal with such epidemic
diseases. Interestingly, the Carakasaṃhitā says that we will need highly potent medicines to deal with an
epidemic and that effort has to be taken to collect and process such medicines before the epidemic scales
up. The text advises that as soon as an outbreak is anticipated, people should be administered medicines
that enhance their immunity (rasāyana) चतुष्वर्िप तु दुष्टेषु कालान्तेषु यदा नराः| भेषजेनोपपाद्यन्ते न भवन्त्यातुरास्तदा||१२||

येषां न मृत्युसामान्यं सामान्यं न च कमर्णाम्| कमर् पञ्चिवधं तेषां भेषजं परमुच्यते|| रसायनानां िविधवच्चोपयोगः प्रशस्यते| शस्यते देहवृित्तश्च
भेषजैः पूवर्मुद्धृतैः|| The importance of bolstering one’s immune system to survive an epidemic was emphasised
in ancient times in Ayurveda.

However, Ayurveda informs us that epidemics are not merely diseases that can be handled just by medical
interventions. The texts emphasize that the root cause of an epidemic outbreak is adharma or unsustainable
ways of human thought and action that damage the plant and animal life around us, the environment
around us and the natural resources available on our planet - सवेर्षामप्यिग्नवेश! वाय्वादीनां यद्वै गुण्यमुत्पद्यते तस्य
मूलमधमर्ः, तन्मूलं वाऽसत्कमर् [१] पूवर्कृतं; तयोयोर्िनः प्रज्ञापराध एव।।. From the Ayurvedic point of view, an epidemic
comes with a deep message. The message is that we have to mend our ways and find sustainable ways of
living and a deeper connection with the Universe. As well as practice compassion to other living forms and
even to other human beings and mother earth itself. For this reason, many spiritual practices and
compensatory actions are recommended in the Ayurvedic texts for mitigation of the epidemic apart from
medical measures. तत्र, स्थानपिरत्यागशािन्तकमर्प्रायिश्चत्तमङ्गलजपहोमोपहारेज्याञ्जिलनमस्कारतपोिनयम-
दयादानदीक्षाभ्युपगमदेवताब्राह्मणगुरुपरैभर्िवतव्यम्, एवं साधु भवित || In the aftermath of an epidemic, humans can reflect
and introspect and find ways to restore the lost harmony within their own selves, the people and living
forms around them and the Universe itself. Caraka also mentions that one should protect onself
(guptirātmanaḥ) and relocate to places that are not affected by the disease - सद्धृत्तस्यानुवृित्तश्च प्रशमो गुिप्तरात्मनः||
१५|| िहतं जनपदानां च िशवानामुपसेवनम्|