Prakriti analysis of COVID 19 patients:

An observational study
Dr. Sujata Rajan3, Dr. Yogita Munjal2, Dr. Manoj Shamkuwar4, Dr. Nitin Jindal4, Dr. Kiran
Nimabalkar5, Dr. R. K. Manchanda1, Dr. Ankur Kr. Tanwar2, Dr. Shazi Arazzum2, Dr Mahender
Kumar2, Dr. Neha Parmar2, Dr. Nisha Garg2, Dr. Manisha Yadav2, Dr. Jaganath Verma2, Dr. Indu
Sharma2

1. Director AYUSH, Government of NCT of Delhi.

2. Deputy Director AYUSH, Government of NCT of Delhi.
3. Dept. of Physiology, A. & U. Tibbia College & Hospital, New Delhi.
4. Dept. of Panchkarma, A. & U. Tibbia College & Hospital, New Delhi.
5. Dept. of Agada Tantra, A. & U. Tibbia College & Hospital, New Delhi.

ABSTRACT:
Rationale & Objective: The concept of Prakriti is unique to Ayurveda, which is used for
deciding the preventive and curative strategy to be adopted in the treatment of patients. It is the
total of anatomical, physiological, and psychological domains of an individual. The diseases
often manifest by susceptibility that depends upon Prakriti of individuals. COVID 19 is a new
disease, where the status of the susceptibility of its victim in terms of Prakriti is not known. This
study has been undertaken to determine the Prakriti of COVID 19 positive patients. Method:
The validated instrument CCRAS Prakriti assessment scale has been applied to the COVID 19
positive patients admitted between 16 May 2020 to 10 June 2020 at COVID hospital. Result:
Data of 117 patients aged between 10 to 80 years has been analyzed. The ratio of male-female
patients was 1.8:1. Most patients belonged to Vata-Kapha Prakriti (27%). Individuals with their
Prakriti found in order of frequency were Pitta-Kapha (21%), Kapha (20%), Vata (13%), Vata-
Pitta (11%), Sama (4%) and Pitta (3%). Conclusion: Patients with Vata-Kapha, Pitta-Kapha
and Kapha dominant are more prone to develop COVID 19. The treatment strategies can be
accordingly decided in respect of each patient.

Keywords: Prakriti, COVID 19, Dosha, Vulnerability.

INTRODUCTION
Background
Prakriti is a prime concept of Ayurveda that determines the constitution of an individual in terms
of physical, physiological, and psychological characteristics and is the key element behind the
diagnosis, prognosis, and treatment of an illness. Prakriti of an individual is decided by an inbred
specific relative proportion of the tri-dosha that is the building blocks of the body(1). Doshas
control all major pathophysiological functions including, immunity, metabolism, growth, and
development. It comprises three entities, namely, Vata, Pitta, and Kapha that are often
interconnected with each other and are responsible for the internal and external functions of the
human body to maintain homeostasis(2). The proportions of these doshas at the time of
conception determine the Prakriti or constitution and Individual heterogeneity can be defined by
the relative proportion of dosha(3) which varies from person to person to an extent that everyone
is unique.

There are seven different types of Prakriti manifested by different combinations of the three
doshas attributing to specific characteristics and are well described in the ancient literature viz.,
Charaka Samhita, Sushruta Samhita, AshtangaHridaya, etc. (4-8). These are Vata, Pitta,
Kapha, Vata-Pitta, Vata-Kapha, Pitta-Kapha, and Vata-Pitta-Kapha.

Singh Hina at el. have shown distinct clustering of SARS-CoV-2 across the globe through their
various research papers. The virus exhibits very high transmissibility based on the aggregation
propensity of the spike protein in the Wuhan and other isolates of SARS-CoV-2(9, 10). Whole-
genome analyses of the Indian isolates and their comparison with global isolates can provide a
better understanding of the disease etiopathogenesis as well as the type of intervention used.
Whole-genome diversity analysis of 3968 global clinical isolates, including 25 isolates
sequenced in India was done and the presence of functionally distinct isolates in the Indian
population raises concerns for better assessment of the evolution of SARS-CoV-2 in India (11).
It is very well documented that severe symptoms like breathlessness are not manifested in every
COVID 19 patient. Why some of the COVID 19 infected patients are sensitive to breathlessness
and sore throat while some are asymptomatic, the reason is not clear (12)

The issues of thousands of clinical isolates of COVID 19 which mutate itself give prominence to
the concept of personalized medicine. A personalized therapeutic approach called Prakriti which
differentiates every individual is the key to the modern era of diseases. Among the different
Prakriti types, sama Prakriti individuals are less susceptible to diseases, and the rest of others
are mostly like to suffer. Vata prakriti people are more prone to get affected due to vataja
disorders or neurological disorders. Similarly, Pitta Prakriti persons are more prone to pittaja
disorders or inflammatory disorders, and Kapha Prakriti person more vulnerable to kaphaja
diseases or respiratory illness during their life(6, 13, 14).
The Prakriti determination has a significant role to play in the preventive and therapeutic aspects
of an individual. The information received from Prakriti assessment can be successfully applied
in diagnosis, prognosis, and treatment (for assessing the appropriate drug, its dose, diet, and
lifestyle modifications). Even Ayurveda emphasizes daily and seasonal regimens to be adopted
for the promotive aspect of health according to Prakriti.

In contrast to the present study, Prakriti assessment may determine the possible identification of
vulnerable individuals towards Sars-Cov-2 within the human population and may intensify the
discovery of efficacious therapies and preventive measures concerning Prakriti.

OBJECTIVE
To identify the Prakriti profile of COVID 19 patients and their correlation with the disease
manifestation.

METHODS
Study design
One hundred seventeen patients, irrespective of gender and religion, were randomly selected in
this observational study of COVID 19 positive patients from 16 May to 10 June 2020 to explore
the Prakriti vulnerability towards COVID 19 infection. The inclusion criteria for the study were
(i) Any person aged between 10 to 80 years; and (ii) Confirmed diagnosis of COVID 19. The
only two criteria for exclusion from the study were (i) non-cooperation during the Prakriti
assessment; and (ii) people whose age fell outside the age limits of the inclusion criteria, i.e., any
person of age less than 10 years or more than 80 years.

Setting
The present study was conducted at Ayurvedic and Unani Tibbia College and Hospital, Karol
Bagh, a designated COVID health center by the Department of Health and Family Welfare,
Govt. of NCT of Delhi for the isolation and treatment of COVID 19 positive through AYUSH
branch of the medical field. A patient case report form (CRF) was used for case taking, based on
the WHO standardized format for COVID 19, and a Validated assessment scale was used for the
Prakriti assessment of participants. Data processing and statistical analysis were done by trained
Ayurveda physicians.
Variables
WHO case report form, Demographic and clinical data of COVID 19 positive patients along with
Validated Prakriti assessment scale by CCRAS are the parameters for this observational study.

Data Sources
We obtained data from the dedicated COVID health center under Govt. of NCT of Delhi.
Primary data for the study are drawn from two sources: (i) WHO standardized CRF which has all
the essential information about the clinical records, past and present history as well as the
outcome of the treatment(s) prescribed; and (ii) a validated Prakriti assessment scale by CCRAS
for assessing the Prakriti of individuals through interview and personal examination.

Statistical Methods
The demographic and Prakriti of the study participants were tabulated using Microsoft excel.
The categorical variables were presented as frequency and percentage. The mean of the
observation was assessed on age, gender, BMI, religion, Socio-economic status, addiction
history, marital status, dietary habits.

RESULTS
A total of 117 study participants for the observational study were included. Out of which 01
study participant was excluded due to non-cooperation for Prakriti assessment and 01 was
excluded due to age below 10 year. Data of 115 patients were taken and analyzed the distribution
of signs and symptoms in different Prakriti individuals.

Subjects Characteristics
The demographic data of subjects are shown in Table 02. Gender, age, dietary pattern, and
socioeconomic status is shown in association with COVID 19 infections in the present study.

Table 1: Demographic details of study participants

Sl. No. Characteristics Percentage
Male 65%(75)
01 Gender
Female 35%(40)
02 Religion Hindu 98.2%
 Muslim 1.8%
10-20 year 20%(23)
21-30 year 25%(29)
31-40 year 24%(28)
03 Age 41-50 year 17%(19)
51-60 year 8%(9)
61-70 year 3%(4)
71-80 year 3%(3)
Married 65.2% (75)
04 Marital Status
Unmarried 34.8% (40)
Veg 34% (39)
05 Diet
Mix 66% (76)
Smoking 4.3%
Alcohol 11.3%
06 Addiction Tobacco 5.2%
Tea or Coffee 10.6%
None 69.8%
Upto 5 lakh/annum 89.5%
5-8 lakh/annum 8.7%
07 Social-Economic status
8 to 10 lakh/annum 0.8%
More than 10 lakh/annum 0.8%
Illiterate 9.5%
Up to primary 13%
08 Education Up to middle 19.1%
Up to intermediate 32.2%
Graduation or Post Graduation 26.1%
<18.5 15.6%
18.5-24.9 59.1%
09 BMI 25-29.9 18.3%
30-39.9 7%
>40 00

Prakriti assessment:
The subjects had completed the Prakriti assessment scale by CCRAS. The present study showed
that Vata-Kapha Prakriti (Vata–Kapha Dosha dominant constitution) Pitta Kapha Prakriti
(Pitta–Kapha Dosha dominant constitution) and Kapha Prakriti (Kapha dosha dominant
constitution) was the predominant Prakriti among the COVID 19 positive patients whose data
was analysed.

Table 2: Prakriti of COVID 19 patients

Sl. No. Prakriti Percentage

01 Vata 13%
02 Pitta 3%
 03 Kapha 20%
04 Vata-Kapha 27%
05 Vata-Pitta 11%
06 Pitta-Kapha 21%
07 Sama 4%

Prakriti and COVID 19 Symptoms association:

The data of the present study showed an association between Dosha predominance and
symptoms of COVID 19 patients. The details of all clinical symptoms according to Prakriti are
conscripted in Table 03.

Table 3: Symptoms profile of admitted patients’ perceptive to Prakriti

Sl. No. Symptom Prakriti Percentage

01 Breathlessness Vata Nil
Pitta 0.8%
Kapha 6.2%
Vata-Pitta 2.6%
Vata- Kapha 5.3%
Pitta-Kapha 5.3%
Sama Nil
02 Fever Vata 3.5%
Pitta 0.8%
Kapha 7.9%
Vata-Pitta 1.7%
Vata- Kapha 8.8%
Pitta-Kapha 8.8%
Sama Nil
03 Cough Vata 4.4%
Pitta 0.8%
Kapha 12.4%
Vata-Pitta 3.5%
Vata- Kapha 15%
Pitta-Kapha 11.5%
Sama Nil
04 Chest pain Vata-Pitta 1.7%
Vata- Kapha 0.8%
Kapha 1.7%
05 Sore throat Vata 2.6%
Pitta 1.7%
Kapha 2.6%
Vata-Pitta 1.7%
Vata- Kapha 5.3%
 Pitta-Kapha 7.1%
Sama Nil
06 Cold Kapha 0.8%
Vata-Pitta 0.8%
07 Headache Kapha 0.8%
Vata-Pitta 0.8%
Vata-Kapha 2.6%
08 Vomiting Vata 0.8%
Kapha 0.8%
Pitta-Kapha 0.8%
09 Loss of smell/taste Vata-Kapha 0.8%
Vata- Pitta 1.7%
10 Weakness Vata 1.7%
Pitta Nil
Kapha 0.8%
Vata-Pitta 0.8%
Vata- Kapha 1.7%
Pitta-Kapha 4.4%
Sama 0.8%
11 Myalgia Vata-Kapha 0.8%
12 Abdominal Pain Pitta-Kapha 0.8%
13 Loose motion Vata-Kapha 0.8%
14 No complaints Vata 6.2%
Pitta 0.8%
Kapha 2.6%
Vata-Pitta 2.6%
Vata- Kapha 8%
Pitta-Kapha 3.5%
Sama 3.5%

DISCUSSION:
We reported the clinical characteristics and Prakriti of 117 patients admitted to a COVID 19
dedicated health care center. Compared to previously published reports, the age group which
contracted the most from infection was lower (20-50 years)(15-17). The patient mix was skewed
in favour of male patients with the male patients outnumbering the females by almost twice the
number. People with dietary habits of mixed diet as compared to a vegetarian diet were found
more infected due to COVID 19.
The disease prevalence is more in lower socio-economic groups having low income (less than
₹.5 lakh/annum) as compared to middle or upper socio-economic groups, likely due to lack of
proper precautionary measures against COVID 19 as a result of factors like low nutrient
dietary pattern and living in crowded places, which essentially means that compared to
the middle or high-income group, the low-income group is more vulnerable to
communicable diseases (18). Most of the patients observed belong to a Healthy BMI group as
compared to obese or overweight group.
The present study shows the predominance of Vata-Kapha, Pitta-Kapha, and Kapha dominant
Prakriti in COVID 19 positive patients. Majority of the patients of COVID 19 are asymptomatic
or mildly symptomatic. Most of the patients who showed symptoms of breathlessness, cough,
sore throat and fever belong to Vata-Kapha Prakriti. The clinical signs and symptoms of COVID
19 like cough, breathlessness, sore throat, and fever are mainly due to the deterioration of lung
parenchyma due to the virus(19, 20). Ayurveda scriptures described that the combined vitiation
of Vata and Kapha is the cause of jwara (fever)(21), the clinical features which are considered as
signs and symptoms of the initial phase of COVID 19. It is also described that disease prognosis
depends upon the etiological factors, Dushya (substratum of pathology i.e. dhatu), causative
dosha, dosha of physical constitution, the period of onset, and the place of habitat(22). So Vata-
Kapha constitution is more vulnerable towards Vata-Kapha jwara. The present study showed
that an individual having Vata -Kapha dosha predominance in their constitution have more
severe and discernible symptoms of the disease as compared to the other doshas. The importance
of body constitution lies in the fact that they are prone to be vitiated by respective dosha(s) and
the disease when they occur, tend to be severe (23).
The main findings can be summarized as follows:
i) Vata-Kapha Prakriti may be associated with COVID 19 infections and showed
the symptoms of cough, fever, breathlessness, and sore throat more as compared
to other Prakriti.
ii) Male and younger population are at an increased risk of infection of COVID 19 in
India.
iii) Low-income group of the socio-economic strata is more prone to COVID 19.
This study may provide baseline values for different signs and symptoms of SARS-Cov-2 within
dominant Prakriti and could be used for understanding Prakriti based susceptibility, disease
manifestation, etiology, disease prognosis, and improving the treatment modalities as per
Prakriti.
LIMITATION OF THE STUDY
The limitation of the present study is that we have not assessed any biological markers to
measure Prakriti based disease susceptibility.

CONCLUSION
The present observational study showed that the maximum number of patients who had been
hospitalized with COVID 19 had Vata-Kapha, Pitta-Kapha, and Kapha dominant Prakriti and
had symptoms of respiratory illness like cough, fever, breathlessness, and sore throat.

ACKNOWLEDGMENT
We thank Dr. Mohammad Idris for technical support and motivation during the work. We would
also like to thank all the clinical and paramedical staffs of the hospital and Special thanks to P.G.
Dept. of Physiology for their support in this context.

AUTHOR CONTRIBUTION
This study was conducted under the guidance of Dr. Raj K. Manchanda and he made a critical
analysis of the manuscript. Dr. Sujata Rajan designed the study as well as drafted the manuscript.
Dr. Yogita Munjal reviewed the manuscript. All the other authors participated in data collection.

FINANCIAL SUPPORT
The study was undertaken at an institute that receives funds from Govt. of NCT of Delhi for its
activities.

CONFLICT OF INTEREST
There was no conflict of interest in conducting the study.
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