Status of evidence on efficacy and safety of Indian traditional medicine (Ayush) for COVID-19: a qualitative review and evidence map synthesis.

backgroundThe novel coronavirus (COVID-19), caused by SARS-CoV-2, was first reported in Wuhan, China, in December 2019. Its rapid spread, high mutation rate, and challenges in containment led the WHO to declare it a global pandemic on March 11, 2020. Traditional medicine played a supportive role during the COVID-19 pandemic by offering immune-boosting and symptom-relieving remedies, especially in regions with limited access to conventional healthcare. Several countries, including India, have integrated traditional therapies with modern treatment protocols to enhance patient outcomes and reduce disease burden.

objectivesThis review aims to critically synthesize the existing evidence on the efficacy and safety of Ayush interventions in the management of COVID-19 in India. It seeks to qualitatively analyze published literature and clinical trial data, and to develop an evidence map categorizing interventions by type and associated clinical outcomes.

methodsA comprehensive literature search was conducted across seven electronic databases, including the National Repository on R&D Initiatives of the Ministry of Ayush, WHO COVID-19 dashboard for clinical trials, AYUSH Research Portal, PubMed, Cochrane Library, WHO ICTRP, and CTRI. Studies published between 2019 and June 2024 were considered. A total of 3626 records were identified (2572 from indexed databases and 1054 from trial registries). After removing 640 duplicates, 2986 studies were screened for title and abstract. Following exclusion of 802 records, full-text assessment was performed on the remaining studies. After screening, 304 studies were included in the final review (178 Ayurveda, 22 Siddha, 31 Homeopathy, 22 Unani, and 51 Yoga). Risk of bias was assessed using the ROB 2 and ROBINS-I tools. Data extraction and collation were performed in accordance with the PRISMA guidelines. The study protocol was registered in PROSPERO.

resultsA total of 304 studies were included, comprising 58 (19.1%) prophylaxis studies, 151 (49.7%) treatment studies, and 17 (5.6%) post-COVID rehabilitation studies across different Ayush systems. Ayurveda accounted for the largest proportion of publications (n = 178), followed by Yoga (n = 51). Among the randomized controlled trials, approximately half were assessed as having low-to-moderate risk of bias, whereas the remaining studies exhibited high or unclear risk of bias, primarily due to inadequate reporting of randomization procedures, allocation concealment, and blinding. Considerable methodological variability was observed across studies, including differences in intervention type, duration, outcome measures, and quality assessment scores.

conclusionWhile there is significant data on Ayush and COVID-19, current studies vary too widely to be definitive. Future research must prioritize rigorous scientific standards if these systems are to be effectively integrated into public health responses.