According to WHO, Coronavirus disease COVID-19 (U07.1) is an infectious disease caused by a newly discovered coronavirus. As on 1^st July 2021, 181 million cases have been confirmed. among them 3.93 million confirmed deaths¹. Because of its high spreading nature and unavailability of proper treatment makes it more fatal. During this pandemic anxiety and distress has increased due to fear of infection and isolation norms². Stress of it is responsible for production of different anxiety disorders such as Generalized anxiety disorder (GAD), Phobia or Panic-anxiety disorder, Obsessive-compulsive disorder (OCD), Post traumatic stress disorders (PTSD) etc.  Currently Post Covid-19 (U09.9) anxiety is emerging problem in whole medical faculty. Anxiety medications results in dependency, leading to further health deprivation and are economically unaffordable. In such circumstances people are in search of safe, affordable, easily available medication.

     Chittodvega, a Manasika vikara³ can be co-related with anxiety, which is caused by vitiation of Rajas and Tamas and people with Alpa Satva are more prone to it⁴. Ayurveda has mentioned Daivavyapashraya chikitsa as one among the Trividha Chikitsa for the treatment of  disease whose  the exact cause is  not known, Homa and Mantra are important among them⁵. Agnihotra Homa refers to any ritual of making offering into a consecrated fire^6,7 and Mantra means the Vedic Hymns. They are chanted during the course of Homa vidhi. In Agnihotra homa we are using medicinal herbs that contain many psychotropic volatile oils⁸. During respiration these medicinal volatile oils enters in the respiratory system through nasal route and directly gets absorbed by nasal mucosa, lung cells in systemic circulation and start their action on body and mind⁹. In Ayurvedic science, nasal route is the best way to administer medicine in psycho-somatic disorders¹⁰. Thus, medicated fumes emitted from Homa acts as anxiolytic. 

     It is scientifically proven that chanting of Mantra facilitates the property and potency of medicinal fumes¹¹. Chanting of ‘Gayatri Mantra’ in rhythmic way activates every cell and enhances natural healing mechanism, by producing positive vibrations in body¹². It normalizes the neurotransmitters like GABA, Serotonin, Adrenaline, Dopamine etc. Regular chanting of it creates soothing effect on nervous system, relaxes muscle and reduces stress and anxiety. So, both the ‘Agnihotra Homa’ and ‘Gayatri Mantra’ has been taken as study to manage Post COVID-19 anxiety.

OBJECTIVE OF THE STUDY

To Study the Combined effect of Agnihotra Homa and Gayatri Mantra in Post Covid-19 Anxiety.

 STUDY DESIGN:

a)    Type of study: Open label Single arm Prospective clinical study

b)    Sampling method: Convenience sampling

c)    Test: pretest and post test

d)    Sample size: 30 subjects

e)    Treatment duration: 7 days

SOURCE OF DRUG – Agnihotra Homa materials will be obtained from SDM Pharmacy Udupi GMP Certified pharmacy and will be authenticated from Department of Dravyaguna, SDM college of Ayurveda and Hospital, Hassan.

B) DIAGNOSTIC CRITERIA–

The patients presenting anxiety as major symptom in Post Covid-19 (U09.9) Anxiety disorder, will be subjected to detailed clinical history and physical examination. The following criteria of ICD-10-CM will be taken into consideration to the final diagnosis.

Post covid-19 Anxiety disorder episode is considered when at least two of Physiological arousal domain and minimum of two Autonomic arousal domain with significant sleep disturbance. Grading of symptoms will be done during the clinical study.

A.    Psychological arousal- fearful anticipation, irritability, anger, restlessness

B.    Autonomic arousal- excessive sweating, tachycardia, dyspnea, dry mouth

C.    Sleep disturbance

D.    Subjects fulfilling COVID-19 Anxiety Scale²³ (CAS), scoring ≥ 9.

C) INCLUSION CRITERIA:

a.     Subjects in between age of 21– 60 years

b.     Post Covid-19 subjects of either gender irrespective of caste, creed, occupation, religion and socioeconomic status

c.     Post Covid-19 subjects who are willing to participate and ready to sign the informed consent form

d.     Subjects with Mild – Moderate Covid-19 Anxiety, CAS scoring ≥ 9.

D) EXCLUSION CRITERIA:

a.     Subjects with known case of Brain and Spinal cord injury/ surgery.

b.     Subjects with Intervertebral disk prolapse, Spondylitis etc.

c.     Subjects with known case of Chronic obstructive pulmonary disease (COPD).

d.     Subjects who are sensitive to smoke allergens.

e.     Menstruating women.

ASSESMENT CRITERIA:

Subjects will be assessed on 0^th day (before treatment) and 8^th day (after treatment) Each item of the CAS is rated on a 5-point scale, from 0 (not at all) to 4 (nearly every day), based on experiences over the past two weeks. This scaling format is consistent with the DSM-5’s cross-cutting symptom measure. A CAS total score ≥ 9 indicates probable dysfunctional coronavirus-related anxiety. Elevated scores on a particular item or a high total scale score (≥ 9) may indicate problematic symptoms for the individual that might warrant further assessment and/or treatment. Clinical judgement should guide the interpretation of the CAS results.