Int J Ayu Pharm Chem
ISSN 2350-0204 www.ijapc.com
ORIGINAL RESEARCH ARTICLE
July 10
th
2022 Volume 17, Issue 1 Page 109
Vardhamana Pippali Rasayana in Post Covid
Bronchitis- A Case Study
Author: Pooja Abhani
1
Co Authors: Mandip Goyal
2
1,2
Department of Kayachikitsa , ITRA Jamnagar, Gujarat, India
INTRODUCTION
COVID – 19 disease caused by SARS-CoV-2
Coronavirus is relatively a new disease, with
fresh information being known on a dynamic
basis about the natural history of the disease,
especially in terms of post-recovery events.
SARS-CoV- 2 has resulted in a global pandemic
and an unprecedented public health crisis. It has
infected more than 410,565,868 people
worldwide till 14 February 2022
1
. Clinical
features of COVID 19 vary from a mild
asymptomatic state to a severe state with
respiratory dysfunction, thrombotic
complications, and multi organ failure
2
. After
ABSTRACT
Introduction:
After acute COVID-19 illness, recovered patients may continue to report a wide variety of signs and
symptoms like fatigue, body ache, cough, sore throat, difficulty in breathing, etc. A 43 years old male patient
reported to OPD of ITRA Hospital, Jamnagar on 16
th
July 2021. He had tested positive for COVID 19
infection on 6
th
May 2021. Since then he had been suffering from sore throat, recurrent upper respiratory
tract infection, coughing with whitish expectorant, dyspnea, myalgia, and memory impairment. He had tried
various types of treatment but could not get relief. Due to multiple system involvement, such cases need a
holistic approach for follow-up care and the well-being of post COVID recovering patients.
Materials & Methods:
This case was treated with Vardhamana Pippali Rasayana with milk for 28 day. Total 1000 Pippli given to
the patient during course.
Result :
The patient got relief in all the symptoms. In X-RAY reports, the patient had bronchitis changes before
treatment. Patient had also improved his quality of life. After completing the treatment patient had a normal
X-ray.
Conclusion :
In Post Covid Syndrome, there is vitiation of Vata and Kapha Dosha. Pippali has an antibiotic, antiviral,
immunomodulatory effect and is one of the best Rasayana (Rejuvenate) for Pranavaha Srotas (respiratory
system), hence treating with higher doses of Pippali for a longer period provided significant relief in the case
of post covid syndrome.
Key Words Post Covid Syndrome, Vardhamana Pippali Rasayana, Bronchitis
Received 13
th
April 22 Accepted 10
th
June-22 Published 10
th
July 2022
Int J Ayu Pharm Chem
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ORIGINAL RESEARCH ARTICLE
July 10
th
2022 Volume 17, Issue 1 Page 110
acute COVID-19 illness, recovered patients may
continue to report a wide variety of signs and
symptoms including fatigue, body ache, cough,
sore throat, difficulty in breathing, etc. A large
degree of uncertainty remains regarding disease
progression; however, individuals with pre-
existing chronic cardiac, respiratory, and
metabolic diseases are at risk of developing a
greater disease
3
. Recent literature suggests the
emergence of a novel syndrome known as ‘long
COVID/post-COVID- 19 syndrome’, a term used
to describe a diverse set of symptoms that persist
after a diagnosed COVID-19 infection
4
. National
Institute for Health and Care Excellence (NICE)
guidelines effectively define and clarify the
terminology that can be used to describe the
condition. ‘Post-COVID- 19 syndrome’ is
defined as the persistence of symptoms beyond
12 weeks from the date of onset. These are not
explained by an alternative diagnosis. Ongoing
symptomatic COVID-19 is defined as signs and
symptoms that persist between 4 and 12 weeks
from the onset of the infection. The term ‘long
COVID’ includes both ongoing symptomatic
COVID-19 (4–12 weeks) and post COVID- 19
syndrome (>12 weeks)
5
.
In this case, patient had persistent bronchitis after
the COVID-19 infection and had recurrent upper
respiratory tract infection which was temporary
relieved by modern medicine. This patient was
treated with Vardhamaan Pippali Rasayana in
Ksheerpaka form for 28 days. Vardhamana
Pippali Rasayana is the formulation in which
total one thousand Pippali are administered in 28
days. Pippali has been reported to possess
immunomodulatory, antioxidant, and
antimicrobial activity also. Further, the use of
Pippali as a bioavailability enhancer has
immensely increased its importance in the field
of Ayurveda and modern science. The Rasayana
use in the form of Vardhamana Pippali is
immunity promoting and is indicated in fever,
chronic coughing, spleen enlargement, sustains
age, and promotes intellect
6
.
CASE PRESENTATION
A previously healthy 43-year-old male was
diagnosed with COVID-19 in May 2021. He
initially presented with fever, cough, myalgia,
anosmia, and dyspnea symptoms and tested
positive for COVID 19 infection. He was
hospitalized for 15 days of which he was kept on
oxygen for 10 days. Even after taking complete
treatment for COVID 19, he continued to
experience persistent symptoms of sore throat,
sneezing, coughing, fatigue, malaise, and
myalgia. He also experienced back pain, chest
tightness, and persistent dyspnea and had anxiety
after COVID 19 infection. The symptoms
appeared to fluctuate unpredictably over the
weeks with no aggravating or alleviating factors
identified. Other than COVID 19, he had no
significant another medical history. No
significant drug history was found.
Over the subsequent few weeks, he was unable
to do his daily activity and was unable to resume
his professional work. Furthermore, the patient
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experienced a number of multifaceted cognitive
symptoms including a reduction in concentration,
poor memory, ‘non-specific head buzzing’,
worsening anxiety, and brain fog.
Musculoskeletal symptoms included myalgia,
arthralgia, generalized body ache, and flatulence
in the abdomen.
INVESTIGATIONS
He underwent a number of investigations,
including blood tests, ECG, and chest X-rays.
Blood tests showed normal full blood count
(haemoglobin14.2 gm %, white cell count 10240
/cu mm, platelets 294×109/L), liver function test
(alanine aminotransferase 23 U/L, alkaline
phosphatase 17 U/L), ESR 40 mm/hr., s. lipid
profile was slightly elevated ( Cholesterol 189
mg/dL, S. Triglyceride 217 mg/dL, S.LDL
Cholesterol 109.2 mg/ dL, S.VLDL- Cholesterol
43.4 mg/dL ). S. uric acid was also slightly
increased 7.61mg/dL. S. calcium level was
mildly decreased by 9.58 mg/dL. Urine analysis
showed no abnormality in routine and
microscopic examination. ECG was within the
normal limit.
X-ray showed changes of bronchitis
in the lung field.
TREATMENT
Patient was given Mridu Virechana with 40 ml
Erandasneha with lukewarm milk on 1
st
day of
the treatment. After that Pippali Churna was
given in Vardhamana Matra for 28 days. Total
250 gm Pippali (1000 Pippali ) Churna was
given to the patient for 4 weeks in the increasing
dose as mentioned in the Table no. 1.
Table 1 Vardhamana Pippali Rasayana (1 Pippali =
250mg)
Day
Total
Pippali
Total dose of
Pippali / day in gm
Quantity
of milk
1
5
1.25 gm
10 ml
2
10
2.5gm
20 ml
3
15
3.75gm
30 ml
4
20
5 gm
40 ml
5
25
6.25 gm
50 ml
6
30
7.5gm
60 ml
7
35
8.75 gm
70 ml
8
40
10 gm
80 ml
9
45
11.25gm
90 ml
10
50
12.5gm
100 ml
11
50
12.5gm
100 ml
12
50
12.5gm
100 ml
13
50
12.5gm
100 ml
14
50
12.5gm
100 ml
15
50
12.5gm
100 ml
16
50
12.5gm
100 ml
17
50
12.5gm
100 ml
18
50
12.5gm
100 ml
19
50
12.5gm
100 ml
20
50
12.5gm
100 ml
21
45
11.25 gm
90 ml
22
40
10 gm
80 ml
23
35
8.75 gm
70 ml
24
30
7.5gm
60 ml
25
25
6.25gm
50 ml
26
20
5 gm
40 ml
27
15
3.75 gm
30 ml
28
10
2.5 gm
20 ml
29
5
1.25 gm
10 ml
TOT
AL
1000
250 gm
In the table, no 1 dose of Pippali and quantity of
milk has been mentioned to make Pippali
Ksheerpaka as per Ksheerpaka Vidhi
7
. During the
treatment, if the patient was unable to take
Ksheerpaka in gross quantity he was asked to
take Pippali Ksheerpaka in a divided dose.
The patient was advised to take milk and rice
during the four weeks of intervention or to take
light meals without spice and was asked to avoid
excessive salt, sour, and fermented food articles
during the full course.
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OUTCOME AND FOLLOW-UP
The patient in this case study presented with a
variety of symptoms. After completing the course
of four weeks, he got relief in the symptoms like
fatigue, generalized weakness, coughing,
sneezing, myalgia, arthralgia, and dyspnea.
There were changes of bronchitis chest X-ray
before treatment but after completing the course,
no such changes of bronchitis were found. The
difference in Biochemical and Hematological
investigation of BT and AT is shown in Tables 2
& 3.
Table 2 Difference in hematological investigation before and after treatment (BT- before treatment & AT- after treatment)
B.T.
A.T.
Unit
Investigations
B.T.
A.T.
Unit
14.2
15.2
Gms%
D.L.C.
N %
56.8
68.6
%
10240
6290
/cu mm
L %
36.1
25.1
%
4.41 (L)
4.74
mill/c.mm
E %
0.6(L)
0.5(L)
%
40(H)
20(H)
mm/hr
M %
6.3(H)
5.6
%
61.44
31.45
/Ul
B %
0.2
0.2
%
294000
276000
/cu mm
Table 3 Difference in hematological investigation BT & AT
Investigations
B.T.
A.T.
Unit
R.B.S.
115
122
mg/dL
Serum Cholesterol
189
159
mg/dL
Serum Triglycerides
217(H)
157
mg/dL
HDL Cholesterol
36.4
34.4
mg/dL
LDL
109.2(H)
93.2
mg/dL
VLDL
43.4(H)
31.4
mg/dL
Blood Urea
14
34
mg/dL
Serum Creatinine
1.01
1.22
mg/dL
Serum uric acid
7.61
7.05
mg/dL
Aminotransferase
ALT (SGPT)
23
21
IU/L
AST (SGOT)
17
15
IU/L
There was a significant difference seen in ESR as
compared to before treatment reports. Also, there
was a decrease in serum triglyceride and LDL,
and VLDL (Table -3). After completing the
treatment chest X-ray report was also normal.
Significant changes in Post-COVID Functional
Scale were also found as depicted in Table No.
04
Table 4 Post-COVID Functional Scale
8
PCFS
Score
BT
AT
FU
I have no limitations in my everyday life and no symptoms, pain, depression
or anxiety related to the infection.
0
0
0
I have negligible limitations in my everyday life as I can perform all usual
duties/ activities, although I still have persistent symptoms, pain, depression or
anxiety.
1
I suffer from limitations in my everyday life as I occasionally need to avoid or
reduce usual duties/activities or need to spread these over time due to
symptoms, pain, depression or anxiety. I am, however, able to perform all
activities without any assistance.
2
I suffer from limitations in my everyday life as I am not able to perform all
usual duties/ activities due to symptoms, pain, depression or anxiety. I am,
however, able to take care of myself without any assistance.
3
3
I suffer from severe limitations in my everyday life: I am not able to take care
of myself and therefore I am dependent on nursing care and/or assistance from
another person due to symptoms, pain, depression or anxiety.
4
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Timeline
Sr.
no
Complains
Treatment given
Days
Purpose
1.
a. Sore throat++
b. Sneezing ++
c. Coughing yellowish-white
expectorant throughout day
+++
d. Fatigue+++
e. Myalgia ++
f. Back pain ++,
g. Chest tightness++,
h. Persistent dyspnea +++
i. Anxiety +
Erandtaila 40 ml
On 1
st
day
Koshtha
Shuddhi for
flush out
residual
infection of
Covid 19
2.
As above
1
st
week of
Vardhamana Pippali
Rasayana
For the next 7 days
increasing dose started
at 1.25 gm and
increased to 1.25 gm
On the 8
th
day 8.75 gm
3.
a. Sore throat 0,
b. Sneezing 0
c. Coughing yellowish-white
expectorant throughout day
++
d. Fatigue ++
e. Myalgia +
f. Back pain 0,
g. Chest tightness +,
h. Persistent dyspnea ++
i. Anxiety +
2
nd
week of
Vardhamana Pippali
Rasayana
Stable dose of
Vardhamana Pippali
Rasayana 12 gm for 7
days given in the
divided dose
4.
a. Coughing +
b. Fatigue +
c. Myalgia 0
d. Chest tightness 0 ,
e. Persistent dyspnea ++
f. Anxiety 0
3
rd
week of
Vardhamana Pippali
Rasayana
Stable dose of
Vardhamana Pippali
Rasayana 12 gm for 7
days given in the
divided dose
5.
a. Occasionally Coughing white
expectorant +
b. Fatigue +
c. Myalgia 0
d. Chest tightness 0 ,
e. Persistent dyspnea ++
f. Anxiety 0
4
th
week of
Vardhamana Pippali
Rasayana
Tapering dose of
Vardhamana Pippali
Rasayana decreased by
1.25 gm each day for 7
days
6.
a. Coughing +
b. Fatigue +
c. Myalgia 0
d. Chest tightness 0,
e. Dyspnea 0
f. Anxiety 0
Follow up
-
DISCUSSION
After 15 days of the treatment, it was observed
that there was 100 % relief in the symptoms of
sore throat, sneezing, and chest pain. Also, the
symptom of fatigue was improved. And after 4
weeks of treatment, all symptoms were relieved.
‘Long COVID’ is a complex, multifactorial
illness that describes the residual effects of the
acute COVID-19 infection. While thousands of
patients experienced ‘mild’ COVID-19
symptoms not requiring hospital admission, a
large proportion is collectively suffering from
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post-COVID- 19 sequelae. These symptoms were
not commonly acknowledged within healthcare
policymaking during the start of the pandemic
but have emerged as tremendous challenges for
clinicians and the healthcare system. The causes
of post covid syndrome are under study,
however, the main hypotheses include a
persisting chronic inflammatory process, an
autoimmune phenomenon, or even a hormonal
imbalance as a consequence of an alteration in
the hypothalamic-pituitary-adrenal axis
9
. In this
line, COVID-19 patients at 3–6 months of
convalescence may exhibit high levels of CD27+
IgD+ B cells (which have been associated with
autoimmune diseases such as multiple
sclerosis)
10
, CD8+ T cells, as well as elevated
Th17 cytokines, thus favoring a
hyperinflammatory milieu. In addition, patients
showed B cell impaired response given by IL-
6/IL-10 imbalance
11
production of Th1. From
Ayurveda point of view, there will be Dhatu-
Kshaya & Agnimandya Avastha in Post-COVID
19 condition.
Pippali is a potent rejuvenate herb that has strong
anti-viral, anti-bacterial, and anti-fungal
properties, along with the anti-inflammatory
activity. The drug has also been reported to be
the antagonist in respiratory depression. Pippali
is an ultimate remedy for all sorts of Kapha
aggravating disorders like asthma, bronchitis,
COPD, cough, and cold symptoms and also helps
in removing phlegm deposits from the respiratory
tract. Alcoholic extract of the fruits of Piper
longum and its component piperine have shown
effective immunomodulatory and antitumor
activity in cell-line and animal experiments
12
.
Studies show anti-allergic, anti-histaminic, mast
cell stabilizer, anti-spasmodic,
immunomodulator, anti-inflammatory &
antioxidant effects of Pippali. The
neuroprotective effect of dichloromethane
extraction from piper nigrum and piper longum
13
has also been reported. Piperine possesses
thyrogenic activity, thus modulating
apolipoprotein levels and insulin resistance in
HFD-fed rats, opening a new view in the
management of dyslipidemia by dietary
supplementation with nutrients
14
. Pippali has
been reported to possess immunomodulatory,
antioxidant, and antimicrobial activity also.
Further, the use of Pippali as a bioavailability
enhancer has immensely increased its importance
in the field of Ayurveda and modern science also.
Pippali has a multi-dimensional role in various
systems of the body and cures many diseases
effectively, in a quick time, just as the steroid
dose
15
. The Rasayana use of Pippali
Vardhamana is bulk promoting, beneficial for
voice and life span, alleviates spleen
enlargement, sustains age, and promotes
intellect
16
.
The role of Rasayana therapy with recent
advancements can be adjusted in terms of
immunomodulatory, cytoprotective, geno
protective, adaptogenic, stress reliever actions,
etc. Vardhamana Pippali Rasayana in which
Pippali is used in a total number of one thousand
in 28 days by gradually increasing and tapering
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doses is more effective because it can be
administered in its maximum doses without any
discomfort to the patient
17
. Thus, Vardhamana
Pippali Rasayana aims at increasing and
enriching the quality of the tissues or Dhatus
with the active components of the herb or
compound. This strengthens them structurally
and functionally.
CONCLUSION
In this case study, it is found that oral
administration of Vardhamana Pippali Rasayana
therapy has potency in reversing the condition
and improving the quality of life of the post-
COVID patient. It’s possible as per the principle
of Naimaittika Rasayana which is administered
after Koshtha Shuddhi in chronic disease. Pippali
Rasayana through Vata-Kapha pacifying,
Srotoshodhana and Kapha Nissarana properties
had made the pathway clear for proper circulation
of Vata thus relieving the respiratory signs and
symptoms. It has properties that are essential for
the removal of toxins and purifying internal
channels, thus the administration of Pippali in
Vardhamana dosage suppressed the
inflammation associated as a part of Post
COVID.
Take Away Lessons
Approach for Ayurvedic management in post
covid syndrome helped to raise faith in Ayurveda
which is necessary for future inventions. Further
study on big sample size should be done to
evaluate the efficacy of Vardhamaana Pippali
Rasayana in Post Covid Syndrome.
Clinician Outcome: After treatment of 1 month,
it was found that the patient improved at a
dramatic pace. No recurrence of URTI upper
respiratory tract infection was found after 6
months and CBC, Lipid Profile, and RFT were
within normal limits which are shown in tables
no 2 & 3 along with normal chest X-ray.
Patient Outcome: The patient was satisfied with
improvement in quality of life after COVID 19
infection complaints with no dyspnea on
excretion, generalized weakness, fatigue. His
PCFS was also decreased to 3 to 0 as mentioned
in table no 4.
Patient consent details:
Prior consent has been taken before enrolled
patient in study. All the investigation report
attach with the case report.
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ORIGINAL RESEARCH ARTICLE
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Lipoprotein Profiles In Hyperlipidemic
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