A National Web Conference on Integrated Siddha Approach in Clinical Practice and Research on COVID-19 Pandemic (ISACC)- Tirupati, December 2020

Siddha Clinical Research Unit (SCRU) Tirupati, working under the Central Council for Research in Siddha (CCRS), Ministry of AYUSH, Govt. of India, conducted a National Web conference titled “Integrated Siddha Approach in Clinical Practice and Research on COVID-19 Pandemic (ISACC)” on 23rd Dec 2020, as a part of the fourth Pre-Siddha Day observance. Totally, 256 participants from Siddha colleges and various institutes of CCRS attended the Web conference and 9 eminent Speakers share their knowledge at the conference. The Technical session was separated by three panels, (i)Siddha Standalone and Integrative Clinical trials on COVID-19, (ii)Siddha Preventive and Prophylactic Measures on COVID-19, (iii)Experiences in Siddha Integrative Clinical Practice on COVID-19. The take home message of the conference insisted upon the three facts the need for more clinical trials , need for increased experience sharing platforms for Siddha medical system and finally that Siddha standalone as well as integration for COVID-19 management gave significant outcome in both preventive and promotive healthcare. Central Council for Research in Siddha (CCRS), Ministry of AYUSH, Govt. of India and Directorate of Indian Medicine and Homeopathy (DIM&H), Government of Tamil Nadu, contributed a lot in Research and services in COVID-19 pandemic. *Author for correspondence JOURNAL OF NATURAL REMEDIES DOI: 10.18311/jnr/2021/27282 Article Received on: 09.03.2021 Accepted on: 22.05.2021 Revised on: 22.05.2021


Introduction
Siddha Clinical Research Unit (SCRU) Tirupati, working under the Central Council for Research in Siddha (CCRS), Ministry of AYUSH, Govt. of India, conducted a National Web conference titled "Integrated Siddha Approach in Clinical Practice and Research on COVID-19 Pandemic (ISACC)" on 23 rd Dec 2020, as a part of the fourth Pre-Siddha Day observance. Totally, 256 participants from Siddha colleges and various institutes of CCRS attended the Web conference and 9 eminent Speakers shared their knowledge at the conference.
The COVID-19 pandemic is considered a lifethreatening disease due to the lack of appropriate drug or vaccine till December 2020, which has caused the world to turn towards traditional medicine. Traditional medicine in India such as Siddha, Ayurveda, and Yoga played a critical role in COVID-19 pandemic management. This web conference is aimed to highlight synopsis and explore the Siddha drugs used as well as to rationalize its scientific evidence to the globe. The event began with the Inaugural Address by Prof. Dr

Summary of the Presentations
Anurag Srivastava, M.D, HOD, Department of Community medicine, Government institute of medical sciences (GIMS), Noida, India, Anurag explained the clinical trial titled "A double blinded Comparative RCT to evaluate the effectiveness of siddha medicines, Kabasura kudineer (KSK) and Nilavembu Kudineer (NVK) along with Standard allopathy treatment in symptomatic COVID-19 patients", which was conducted in Government Institute of Medical Sciences (GIMS) in collaboration with CCRS. He explained the primary objective of the trial as to explore the effectiveness of standard care along with KSK and NVK in the reduction of the viral load in clinical symptoms like fever, Cough, dyspnea. Reduction in the risk of disease progression, duration of hospital stays, exploring the Siddha body constitution of COVID-19 patients, monitoring of ADR/AE are another secondary objective. He explained the selection criteria as mild to moderate COVID-19 positive cases been included in the trial and patients with Chronic Renal Failure, uncontrolled diabetes, severe hypertension and malignancies been excluded from the trial. Further, he explained about the intervention arms, Arm I received Standard Allopathy intervention, placebo decoction alike trial drug, Arm II received Standard Allopathy intervention, NVK, Arm III received Standard Allopathy intervention, KSK. Kannan explained a clinical trial titled "A Prospective, non-randomized, Single-arm interventional study to assess the safety and efficacy of Siddha sasthric Medicine-Fixed Regimen in the prevention of COVID-19 disease progression of asymptomatic and mild category at Siddha COVID Care Centre (SSM-FiRe)", which was conducted in Stanley medical college, Chennai, India in Collaboration with CCRS, DIM&H, The Indian Medical Practitioners Co-operative Pharmacy and stores (IMPCOPS) Ltd. He elaborated the rationale behind the study, also mentioned about the guidelines for Siddha practitioners for COVID-19 management published by CCRS, Ministry of AYUSH. He described the Primary Objective of the trial as preventing the disease progression, in asymptomatic, mild stage COVID patients. The Secondary objective is to determine the safety of the SSM-FiRe drugs, duration of hospital stay, exploring the Siddha body constitution of COVID-19 patients, monitoring of ADR/AE.
He further briefed that in the trial, as the sample size is 60 the selection criteria was that the RT-PCR positive COVID patients were included, COVID-19 positive with Severe symptoms, Patient with Chronic Renal Failure, Uncontrolled diabetes, Hemoglobin 7 and below, were excluded from the trial. He also shared some interesting results of the trial that, out of 60 participants, 50 participants turned negative on the 7 th day, 2 participants turned negative on the 10 th day, 7 participants turned negative on the 14 th day, 1 participant didn't turn negative even after the 14 th day. He said that as per the Siddha text, Aiyam constitution has stronger immunity; Azhal constitution has moderate immunity compared to Vali constitution, which correlated with the trial as 40 were of Azhal constitution, 14 were of Aiyam constitution, 5 were of Vali constitution. He also added that there was no ADR/AE reported throughout the trial.
The second panel discussion of the webinar was Siddha Preventive and Prophylactic Measures on COVID 19 under which the following topics were discussed. The session was chaired by Kannan Muthaiah.

Samraj K M.D(s), Research Officer (Siddha), Scientist-I and In-charge, Siddha Clinical Research Unit (CCRS) Tirupati, Andhra Pradesh.
Samraj explained about the "Role of Siddha medicines in Quarantine Centers /High Risk Population". He reviewed the concept of Preventive and Prophylactic Measures of COVID-19 in Siddha System through a different perspective. He made note of the strategy of the World Health Organization (WHO) and public health officials that insists on good nutrition, reduced stress and optimum physical activities to build general immunity to the public to challenge the COVID 19 pandemic. In his view he opined that boosting the immunity could be complemented preferring over traditional, Phytotherapeutic medicines and non-medicinal practices compared to other means. As said by Samraj, Siddha fundamentals state that Muththodam-Uyirthaadhu Azhal type of body constitution having 3 folds of high immunity status compared with Vali, moderate stressed mind, and moderate level of nutritional absorption from foods. Aiyam type of body constitution have high immunity, strong will power, and good nutritional status. In his presentation he added scientific support to the philosophy of YakkaiIlakkanam quoting the results of a study conducted to assess the immune and nutritional status of quarantine people and COVID-19 positive patients in Tirupati using Siddha Yakkai Ilakkanam (YI) Tool (https://www.siddhayitool.com/). He also explained that the patients in the District COVID Care Center-Tirupati, 43% are found to have Vali type of body constitution, 17% were Azhal and 40% were of Aiyam. Of the quarantined population, 43% of were under Vali, 21.4% were from Azhal and 35.7% were from Aiyam. He concluded that from the above observation, Prevention and prophylactic management in Siddha system is directly related to the nature of the body constitution of a person. So, medicines selected on the basis of individual Yakkai Ilakkanam for COVID-19 could be a better way of Prevention and Prophylactic measure through Siddha System of medicine. Manickavasagam elaborated the "Rationale of Siddha medicine Kabasuram and Kabasura kudineer in COVID-19". Before getting into the topic, he gave a brief introduction about origin, nature of spread of COVID 19, that has affected 28.0 million people and caused 908, 500 deaths until Oct-2020. He explained the common symptoms of COVID 19 and its resemblance with symptoms of Kabasuram that has been quoted in Siddha literatures like Therayar Yamaga Venba, Theran Karisal, Sura Vagadam and Yugi Vaithya Sinthamani. Table 1 shows the details how COVID-19 symptoms could be analogized with Kaba Suram He explained about the scientific studies that were conducted on ingredients of KSK showing Anti Pyretic, Anti-viral, Immuno Modulator, Anti-Microbial, Anti Asthmatic, Antitussive, Expectorant, Astringent, Refrigerant activities. Also, he quoted studies that explored the antiviral activity of KSK specifically against spike proteins of novel coronavirus.

Natarajan. S, M.D(s) Research Officer (Siddha), Scientist-I, Head, Department of Clinical Research, Siddha Central Research Institute, Chennai, Tamil Nadu
Natarajan explained the clinical trial titled "The efficacy of Siddha Medicine, KSK compared to Vitamin C and Zinc (CZ) supplementation in the management of asymptomatic COVID-19 cases". He conducted (Randomized Controlled Trial) RCT to know the efficacy of the intervention of KSK in one arm (30 patients) and Vitamin C and Zinc (30 patients) clearly by investigating the viral load of patients involved in that study before and after drug intervention. The intervention was said to be a standalone intervention which indicates one group of patients only received KSK and another group received only Vitamin C and Zinc. The study was registered in Clinical Trial Registry of India (CTRI). Laboratory investigations were recorded only in the Indian Council for Medical Research (ICMR) empaneled laboratory. The study results revealed that the Siddha drug KSK intervention plays a crucial role in decreasing the viral load among COVID-19 asymptomatic patients. This research work was published in an indexed peerreviewed journal, he concluded that though this research finding was conducted in a small number of patients, the identified impact of KSK in decreasing viral load can help us with a lead for conducting further clinical trials. Hospital, Pernambut, Vellore District, Tamil Nadu He elaborated the history and origin of Siddha system of medicine and also explained the role of Siddha medicine in this pandemic. He gave an introduction about the Covid Care Center, exclusively established to provide Siddha treatment to the mild to moderate COVID-19 patients, initiated by the Tamil Nadu government in most of the districts in Tamil Nadu. He explained the functioning of COVID Care Centre (CCC) in Vellore that treated a greater number of COVID-19 positive patients with Siddha medicines, next to Chennai. This center is a model for its unique treatment protocol with Siddha medicines as per the guidelines of AYUSH ministry, Government of India. The District Collector of Vellore took essential steps for a Siddha treatment center with great interest and focused objective.

Sankara Raj P, M.D (s),
He explained the treatment with Siddha medicine was initiated on 10 th July 2020. The patients were treated by Siddha medicine for improving quality of health and to reduce the various signs and symptoms of the COVID-19 disease. Nearly 3000 patients were treated by Siddha With this experience they expanded the distribution of COVID kit to Chennai and Tirunelveli also. In Chennai along with the CCRS more than 870 COVID positive cases were treated.
Also, he explained one case study of a 27 year old Auto driver who met with an accident and had fracture in the wrist joint with ligament injury. Due to his being COVID positive the surgery was postponed, after he was treated with Siddha medicines he turned negative in 5 days. Finally, he concluded his presentation that Integration of Siddha and Biomedicine becomes the boon in this COVID Pandemic period to prevent the spread and reduce the mortality rate.

Conclusion
Dr. Samraj. K, the organizing secretory of this web conference, summarized the speakers' Research and clinical experience on COVID-19 pandemic. This web conference provided three take home information to the participants, which were, 1. Traditional medicines like Siddha medicine needing more clinical trials and experience sharing platforms, which will be crucial for the development of Siddha clinician and Researchers. 2. The significant outcomes were noted in both clinical practice and research of the Siddha standalone as well as integrative management on COVID-19 3. Central Council for Research in Siddha (CCRS), Directorate of Indian Medicine and Homeopathy (DIM&H), Government of Tamil Nadu, contributed a lot in Research and clinical service in COVID-19 pandemic. Finally, the web conference was concluded with the vote of thanks by Dr. S. Radha, Consultant, SCRU, Tirupati.