Table of Contents  
Year : 2020  |  Volume : 52  |  Issue : 2  |  Page : 70-75

Integrated approach of yoga and naturopathy alongside conventional care: A need of the hour healthcare strategy in the management of COVID-19 in India – An overview

Director, Indian Academy for Scientific Writing and Research, Pune, Maharashtra, India

Date of Submission19-May-2020
Date of Decision10-Aug-2020
Date of Acceptance19-Oct-2020
Date of Web Publication23-Dec-2020

Correspondence Address:
Pradeep M. K Nair
Indian Academy for Scientific Writing and Research, A-1102, Shanti Elixir, Pune - 411 036, Maharashtra
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DOI: 10.4103/ym.ym_11_20

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The coronavirus disease (COVID-19) disease has shaken the health-care system globally. It has become a global public health emergency for which scientists and physicians are trying to find an answer. This pandemic at present has no answer, as conventional medicine is trying to put their best foot forward by using hydrochloroquinone. Clinical trials are underway to find the efficacy of hydrochloroquinone or to develop any other possible immunization in COVID-19, which leaves us in an uncertain situation. Treating the existing condition remains a challenge in one side whilst containing the spread of this disease remains another challenge. Though nations across the globe have declared lock-downs to prevent community transmission, this is insufficient, looking at the magnitude of the disease. Host friendly interventions from traditional medicine focused on improving immunity and offering mental strength to cope with this pandemic are the need of the hour. Yoga and Naturopathy, a holistic system of medicine under the ministry of AYUSH operates by adapting the principle of salutogenesis can be easily integrated into the existing standard of care in prevention and management. This paper discusses about the possibility and necessity of integrating yoga and naturopathy interventions like fasting, diet therapy, hydrotherapy, sunbath, and yoga therapy based on its evidence in the management of COVID-19.

Keywords: COVID-19, fasting, hydrotherapy, integrative medicine, naturopathy, yoga

How to cite this article:
Nair PM. Integrated approach of yoga and naturopathy alongside conventional care: A need of the hour healthcare strategy in the management of COVID-19 in India – An overview. Yoga Mimamsa 2020;52:70-5

How to cite this URL:
Nair PM. Integrated approach of yoga and naturopathy alongside conventional care: A need of the hour healthcare strategy in the management of COVID-19 in India – An overview. Yoga Mimamsa [serial online] 2020 [cited 2021 Sep 24];52:70-5. Available from:

  Introduction Top

The coronavirus disease (COVID-19) outbreak is a major health crisis and the human threat that has struck us in the current times, highly burdening the healthcare systems world over and leading to a global standstill. The coronavirus mainly targets the respiratory system, which was initially identified in patients admitted with a primary diagnosis of Pneumonia of unknown etiolgy (Bogoch et al., 2020). Considering the far-flung and gravity of the detrimental effects caused by COVID-19, World Health Organization (WHO) has declared this as a global public health emergency (World Health Organization, 2020). The health care providers are now faced with a dual challenge: one is to curb the progression of the disease in diagnosed patients and the other is to advocate preventive measures to keep a check on the surge of new cases. At this point of time, we are unsure about the sufficiency of currently available treatment approaches and also uncertain about how this deadly virus can be contained (Taccone et al., 2020). Conventional medicine is presently addressing the critical care cases; however, there is a large amount of work that needs to be done in terms of preventing newer cases as well as reducing the amount of suffering in the existing patients.

At the moment, we are unsure about the whereabouts and natural reservoir of the novel corona virus, it is thought to be a zoonotic virus as these viruses are identical with bat corona virus (Perlman, 2020). According to the previous reports, COVID-19 has a mean incubation of 5.2 days and exhibits non-specific symptoms of fever, cough, fatigue, which further involves multiple systems. The disease prognosis of the disease is poor in almost 39% of the patients who shift from a mild stage of breathlessness to acute respiratory distress syndrome and to stage finally requires mechanical ventilation (Huang et al., 2020; Li et al., 2020). Though we have managed to reduce the mortality rate from 15% to 3% globally, it still needs a lot of work to bring this virus under control and re-establish normalcy (Wu et al., 2020). Since the transmission is through droplets, the chance of human to human transmission is very high in densely populated countries like India.

Public health emergencies like COVID-19 may also induce severe mental stress due to various factors surrounding the disease like isolation, confusion, insecurity, economic loss and so on (Pfefferbaum & North, 2020). In addition to the public health safety measures like social distancing, frequent handwashing, etc., integration and utilization of holistic health care systems alongside the standard care to provide natural and indigenous health measures prove to be of immense importance and need of the hour. Yoga and Naturopathy as a system of medicine has its philosophy rooted in an approach which focuses at the human body in its entirety rather on than targeting the external pathogens. The basic philosophy of naturopathy is that, the body has its own healing capacity, which needs to be augmented by host-friendly treatment measures (Nair & Nanda, 2014; Fleming & Gutknecht, 2010). Naturopathy modalities are based on the five great elements (Panchamahabhootas), that support the body in the promotion of health and well-being. These modalities comprise fasting, diet therapy, hydrotherapy, heliotherapy, chromotherapy etc. Yoga, on the other hand, is a mind-body system which has a unique potential to handle the emotional insufficiencies, strengthens the mind and body, and promotes healing (Collins, 1998). Yoga and Naturopathy consider illness as a course of disturbance to the health process by external agents like poor dietary habits, stress, or chronic exposure to toxic substances (Fleming & Gutknecht, 2010).

Having a host-friendly treatment approach is extremely vital while dealing with such pandemics as the health impact is not limited to the physical body alone but has major inflictions on other dimensions of health as well. This article focuses on stressing the need for integrating yoga and Naturopathy in the preventive and prophylactic measures of COVID-19 as it can enhance the quality of care and prognosis. Further, in the article, the evidence behind various modalities that can be advocated in the preventive approach is discussed.

  Host Immunity and COVID-19 Top

Yoga and Naturopathy, as a system of medicine, operates on the principle of salutogenesis - that embraces the concept of health than focusing on the disease (Lindström & Eriksson, 2005).

Acquiring good natural immunity through a healthy lifestyle is the key factor in preventing infections. Standard physician manuals on Naturopathy and yoga also resonate with the same concept of building a strong immunity in order to render the bodily environment unfavorable for pathogens to thrive in (Satyalakshmi, 2017). The immune system mediates the potential defense against invasive pathogens directly or indirectly through the involvement of molecular and cellular inflammatory processes (National Research Council (US) Committee on Research Opportunities in Biology., 1989). Invigorating the bodily processes to exhibit optimum immunity may act as a basic preventive strategy against COVID-19.

Yoga and Naturopathy therapies advocated for COVID-19 are based on the holistic approach as it can complement the existing strategy for prevention and/or management.

  Fasting Therapy Top

There is mounting evidence on therapeutic fasting, i.e., wilful abstinence from the intake of any solid food for a stipulated period (Wilhelmi De Toledo et al., 2013). Intermittent fasting as short as from dawn to sunset has shown to up-regulate key proteins of DNA repair and the immune system (Mindikoglu et al., 2020). Time-restricted feeding has shown to reset the circadian rhythm, (Stokkan, Yamazaki, Tei, Sakaki, & Menaker, 2001),which is regarded as the key mechanism in treating immune system dysfunction (Mindikoglu et al., 2020). Further, fasting has a respiratory system-specific anti-inflammatory effect by delimitating NLRP3 inflammasome and Th2 cell activation and by reducing the airway epithelial cell cytokine production (Han et al., 2018). These changes owing to prolonged fasting can work as a preventive and prophylactic strategy in COVID-19. Fasting is known to elate the physical and emotional well-being as well, which substantiates its definitive use in a highly compromising pandemic like COVID-19 (De Toledo, Grundler, Bergouignan, Drinda, & Michalsen, 2019)Though COVID-19 affects all age groups, the elderly population is said to be more vulnerable, as the mortality rates are seen to be high in this group (Liu, Chen, Lin, & Han, 2020). Fasting confers a greater deal of benefits in the elderly population by providing resistance to stress, which in turn bolsters mental and physical performance. Further, the periodic metabolic switch during the fasting churns the systemic and cellular immune response to elicit disease resistance (Anton et al., 2018; De Cabo & Mattson, 2019). Cui et al. demonstrated that deviated/compromised metabolic stages like diabetes, obesity can increase the host susceptibility to viral infection (Cui, et al., 2017). Altering cellular metabolism can be utilized as a potential way to prevent viral infections in the host, as viruses are not capable of replicating by themselves. This is mainly because of their inability to extract energy from nutrients by themselves and is highly depended on host's metabolism (Passalacqua, Purdy, & Wobus, 2019). Thus slowing down metabolism through intermittent fasting can definitely be introduced as a preventive strategy in COVID-19.

  Diet Therapy Top

Experiences gathered from outbreaks in the past advocate that there is a need for expanding the public health activities beyond clinical management (Gamage & Kravolic, 2009). Maintaining optimum nutrition is one such strategy to be inculcated, as nutrition is not only associated with physical health but also mental health (Hislop et al., 2006). Naturopathy and yoga advocate good nutrition for maintaining a high level of immunity. Food is considered as medicine in naturopathy and there exists a significant relationship between poor nutritional status and infections (Chandra & Kumari, 1994). Compromised immunity can make individuals vulnerable for contagions. Various micronutrients like Vitamin C, Vitamin E and Vitamin D have a major role to play in optimizing the host immune functions. Daily intake of 90 mg of Vitamin C offers protection against infections by phagocytic accumulation and generation of reactive oxygen species (Carr & Maggini, 2017). Similarly, Vitamin E is also known to enhance T cell activation that enhances humoral responses that makes it a critical micronutrient in enhancing immune function (Lee & Han, 2018). The recommended daily allowance of Vitamin E is 15 milligrams a day. Further, Vitamin D is another highly recognized micronutrient that upscale human immunity. Though the major source of this vitamin is sunlight, studies suggest 6%–47% of Vitamin D comes from dietary supplements (Calvo & Whiting, 2005; Prietl, Treiber, Pieber, & Amrein, 2013). A naturopathic dietary prescription that includes fresh vegetable salads, fruits, fruit juices, dry fruits, sprouts, coconut milk, dry chapatti with cooked vegetables, and soups has been shown to improve the immune status even in-highly immune compromised disease condition such as Acquired Immuno-deficiency Syndrome (AIDS) (Joseph, Nair, Nanda, 2015). This should be prescribed in the right proportion as per the recommended dietary standards and considering the local availability. Moreover, nutrition is considered as one of (Naja & Hamadeh, 2020) the indicators of resilience amidst destabilization, especially in public health emergencies like COVID-19. Thus integrating diet therapy as a preventive and prophylactic measure can enhance the standard of care to multi-fold levels.

  Sun Bath Top

Sun bath or heliotherapy is one of the major treatment modalities in naturopathy. Sunlight is the best-known source of Vitamin D, the “sun shine vitamin” (Mead, 2008). Vitamin D is reckoned to be involved in the functioning of more than 1000 different genes in the body that govern various functions. Besides this 1,25-dihydroxyvitamin D3 (1,25[OH]D), the active form of Vitamin D is responsible for calcium metabolism and immune system functioning (Mead, 2008). The function of Vitamin D as an immunomodulator is reckoned after the discovery of nuclear Vitamin D receptors and hydroxylase enzymes by immune cells (Hughes & Norton, 2009). The effect of Vitamin D as an anti-bacterial and anti-viral agent has been studied in case of tuberculosis and influenza respectively (Nursyam, Amin, & Rumende, 2006; Hansdottir, Monick, Hinde, Lovan, Look, & Hunninghake, 2008).

The ability of Vitamin D to up-regulate the microbial peptides and production of cathelicidin is the rate-limiting factor that determines the anti-viral activity of Vitamin D (Cannell et al., 2006). There are many population studies on Vitamin D and its effect on lung function, which is suggestive of using sunbath as a means to mitigate respiratory systems inflammation and infections. It is estimated that we need a serum concentration of >30 ng/l of Vitamin D to achieve desired normal physiological activities (Laaksi et al., 2007). Further, we may need to supplement at least 800–1000 IU (20–25 μg) Vitamin D per day if there is inadequate sun exposure (Holick & Chen, 2008). Therefore, 10–15 min of sun exposure everyday between 11 am and 4 pm is warranted as a preventive and prophylactic strategy against COVID-19.

  Hydrotherapy Top

Hydrotherapy, the use of water in various temperature, forms and pressure is an integral part of naturopathy (Wardle, 2013). The common modalities of hydrotherapy used in infections are hot water gargling, steam inhalation and Jal neti (nasal cleansing). Hot water sipping or gargling is a traditional practice which is known to alleviate the symptoms of sore throat, cold and flu (Sanu & Eccles, 2008; Sakai et al., 2008; Satomura et al., 2005). Hot water gargling decreases the supervening bronchial symptoms in upper respiratory tract infections (URTIs). Besides this, the gargling of water in the throat is postulated to prevent the multiplication of viruses (Sakai et al., 2008; Satomura et al., 2005) Steam inhalation is another anecdotal hydrotherapeutic practice that improves mucociliary clearance and reduces the air getting trapped in the bronchi (Rea et al., 2010). This helps in improving the respiratory rhythm, which is commonly affected in COVID-19. Further steam inhalation reduces the nasal mucosal temperature and the nasal airway resistance (Olsson & Bende, 1985).

Jal Neti (Cleansing of nostrils by water) is one of the integral parts of yoga kriyas (cleansing proedures), which helps to alleviate and prevent URTI (Meera et al., 2019). Jal neti is utilized to treat all respiratory symptoms like common cold, cough, sinusitis, rhinitis, etc. Jal neti helps in enhancing the circulation and function of the nasal mucosa. Anecdotally, Jal Neti is utilized to treat respiratory diseases like asthma, pneumonia, bronchitis, pulmonary tuberculosis as it clears the nasal canal and improves the oxygen intake and thereby optimizing respiratory functions (Pandey, 2009). Besides its system-specific effects jal neti also helps in reducing anxiety and depression, which makes it a dual-edged therapy that can be integrated in the prevention and management of COVID-19.

  Yoga Top

Yoga philosophy comprehensively explains about the fear of disease and fear of death through Kleshas, raga (attraction) and dvesha (repulsion) are the two kleshas which creates imbalance in the human mind and body (Subash, 2020). Evidence suggest stress as an important factor that catalyzes the pathogenesis of infectious disease in men (Sheridan, Dobbs, Brown, & Zwilling, 1994). Since early twentieth-century yoga is being utilized as a therapeutic measure to offer mental and physical health. It is an integrated practice of postures (asanas), breathing techniques (pranayamas) and meditation (dhyana) along with principles of an ethical lifestyle and mindful living like non-violence (ahimsa), truthfulness (satya) and detachment (pratyahara), which cultivate the body and mind (Büssing, Michalsen, Khalsa, Telles, & Sherman, 2012). COVID-19 outbreak is associated with severe psychological distress, (Bao et al., 2020), which can hamper immunity, thus becoming a possible threat to the public health strategy in containing the further spread of this virus.

Studies that have been published on the mental health issues prevailing around COVID 19 have identified depression, anxiety, and mental trauma as a serious concern among the general public as well as the infected patients (Wang et al., 2020; Li et al., 2020; Rajkumar, 2020). Though exercises are found to be beneficial in improving respiratory functions, (McNamara, Spencer, Dale, Leung, & McKeough, 2018) yoga-based breathing techniques are reported to have more effect in restoring respiratory functions, especially in older adults (Santaella et al., 2011) who are most vulnerable to COVID-19 infection. Besides this, yoga is reckoned to improve physical functions and enhance health-related quality of life compared to both active and inactive controls (Sivaramakrishnan et al., 2019). This necessitates the immediate integration of yoga modalities, which has proven benefits in alleviating depression, anxiety, and post-traumatic stress disorders (Gururaja et al., 2011).

  The Proposed Integrated Approach Top

Yoga and Naturopathy is well recognized and accepted system of medicine in India. In this current period of the extreme health crisis, yoga and naturopathy modalities with their existing evidence base can be effectively integrated into the prophylactic and preventive measures strategized for COVID-19 management. The introduction of holistic therapy may enhance the therapeutic potential of the existing standard of care as well as can possibly offer a better prognosis and reduction in the number of days of stay in the hospital. A schematic representation of the possible integration of yoga and naturopathy in COVID-19 prevention and management is depicted in [Figure 1]. Meanwhile, owing to demand from the general public, a trial involving yoga and Naturopathy interventions are in the pipeline with the Government of Tamilnadu, India (Traditional Medicine's 'Therapeutic Trial' Begins in Tamil Nadu., 2020). Yoga and Naturopathy as a health-care system has substantial overlap with public health (Tripathy, 2015), which makes it an ideal preventive and prophylactic health-care model. Therefore, it is the right time to integrate the best therapeutic measures from all the systems of medicine, in the right proportions, for the prevention, protection, and well-being of humankind from the deadly COVID-19.
Figure 1: Schematic model of prevention and prophylactic strategy and possible outcomes of integration of naturopathy and yoga in COVID-19 care

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