A critical Review of Dhoopan Karma in Ayurveda and Dhoopana of an Ayurvedic Herbomineral formulation Yavasarshapadi churna in context of Sterilization.

Dr. Kiran P. Mendhekar¹*, Dr. Yogesh B. Shinde², Dr. Shrikant V. Kashikar³,

Dr. Sanjeev R. Yadav⁴

¹Assistant Professor, Department of Shalyatantra, Dr. D. Y. Patil college of Ayurved and Research Centre, Pimpri, Dr. D.Y. Patil Vidyapeeth (Deemed to be ) Pune-18, Maharashtra, India.

²Associate Professor, Department of Swasthavritta and Yoga, Dr. D. Y. Patil Ayurved College and

Research Centre, Pimpri, Pune 18.

³H.O.D. Ayurved Medical College, Nalasopara.

⁴Prof. & Dean, DR. G. D. Pol Foundation’s, Y.M.T. college of Ayurved and PG Institue

Kharghar, Navi Mumbai.

*Corresponding Author E-mail: doctor.kiran.mendhekar@gmail.com, yogesh.ayurved@gmail.com, kashikar_shrikant@rediffmail.com, drsanjeevyadav22@gmail.com

ABSTRACT:

Dhoopana Karma is classical remedy mentioned in various Ayurvedic scriptures to maintain disease free and hygienic environment in the world. As per Ayurvedic scriptures Dhoopana is indicated for Rakshoghna Karma which means killing of disease producing microorganisms. Hence, it plays key role in prevention and cure of various infectious diseases.A similar process called fumigation is one of best and fastest method to maintain asepsis, antisepsis in wards and operation theatres of hospitals.Additionally, this study comprises critical literary review of herbomineral formulation named Yavasarshapadi Choorna which is indicated in form of incense for Dhoopana karma. It is indicated in Ayurvedic scripture Charaka Samhita in chapter Jatisutriya Sharir Adhyaya of Sharir Sthana. It was reviewed in context of sterilization activity to maintain asepsis and antisepsis. Specifically, it is indicated for fumigation of cloths and belongings of post-natal period of Women and that of the New born, Drug preparation room, New born care room, Surgical Procedure roommodern surgery, traditional operation theatre sterilization was done by formalin gas fumigation over many decades which is found to have carcinogenic effect over human lives.Ayurvedic modality named Dhoopana was undertaken in current study as it is a safe and healthy alternative for sterilization.It overcomes harmful effects caused by modern sterilization method i.e. Formalin gas fumigation which is need of an hour. The Analytical study of antimicrobial and antifungal effect of various Ayurvedic Dhoopana Dravyas is the need of the hour along with preclinical and clinical study to verify Sterilization activity of various Ayurvedic Dhoopana Dravyas.

KEYWORDS: Ayurveda Dhoopana, Dhoopana Karma, Yavasarshpadi Choorna Dhoopana, Herbomineral Formulation, Formalin Gas Fumigation, Visankramana, Sterilization.

INTRODUCTION:

Shalya Tantra i.e. Ayurvedic Surgery is an integral branch of Ayurveda which specifically explores the principles and practices of surgical management of various diseases. It also focuses on the importance of Purvakarma, Pradhan Karma, and Paschat Karma of Shastra Karma like pre-operative, intraoperative and post-operative care mentioned in modern Surgery.In Shalyatantra, Dhoopana karma i.e. fumigation a type of sterilization of environment i.e. wards, operation theatres, instruments, linen etc. can be done to avoid the nosocomial infections in the Indoor patients.¹ Shalya Tantra imposes the clinical necessity of disinfection of Shalya karma Mandir i.e. Operation Theatre to maintain aseptic environment around the patient. Acharya Charaka has indicated that Dhoopana should be done for Arishtagara (intensive care unit) Vastra, shayya, Asanadi of Bala (cloths, bed and other equipment of children) to avoid Neonatal sepsis.² Scriptures on Shalya Tantra of Ayurveda have explained the aspects like origin of Dhoopana, types of Dhoopana, ways of collection of the Dhoopan drugs, methods of Dhoopana and its Rakshoghna Karma in various diseases. Various Ayurvedic herbomineral formulations are prescribed in scriptures on Shalya Tantra to maintain the asepsis and prevent sepsis in the Vranitagaraa i.e. OPD, IPD wards and procedure room. Sushrutacharya is well-known as father and originator of ancient Surgery. As the foremost references regarding the Dhoopana were found in Sushruta Samhita, he is also called as the originator of aseptic surgery. He mentioned the Dhoopana Karma of Shalya Karma Mandir before surgery in Vranitopasaniya Adhyyaya.³ This gives better exposition of references of aseptic surgery in Ayurveda. According to Acharya Sushruta the patients in whom there is break in continuity of tissues should always be protected from dangerous and invisible creatures (Nishachara)⁴. According to Acharya Sushruta the powerfully virulent and harmful organisms, to whom flesh and blood is very dear, invade the patient’s tissues through the portals of entry of ulcers and wounds and this creates infections⁵ And Goghrita is specially indicated in many of the kushtha Vikaras i.e. such pathological conditions of Skin.⁶ When flies come in contact with wound they drop the invisible organisms on the wound which flourish on it and develops a severely painful condition.⁷ While explaining Bhagna Chikitsa i.e. Ayurvedic Orthopedics, Acharya Sushruta quotes that a surgeon should make efforts so that, in compound fracture, infection does not supervene as the suppuration of muscles, ligaments, vessels and nerves leads to great difficulty in fracture healing and may lead to various complications.⁸ According to Acharya Sushruta, the surgical instruments should be used only after having been heated in the fire. Dalhana commentator on Sushruta Samhita has further explained this principle as by saying that in using unheated instruments there is a risk of contamination, suppuration of incised wound.⁹ The earlier references of the Micro-organisms could be correlated with the references from Kashyapa Samhita. Acharya Kashyapa has stated that when Rakshasas troubled the children of Rushis, they (Rushis) offered prayers to Agni-Devata i.e. Fire God who was pleased with the offerings and prayers and gave Dhoopana a dravyas to Rushi munis and asked to use them to get rid of Rakshas, Bhoota and Pishacha. Gratified with the blessings of Agni-Devata all Rushis choose Kashyapa Muni to receive Dhoopana as he was known for his social welfare.¹⁰

Hence, Acharya Kashyapa says Agni is the God of Dhoopana. Sthavara (Immobile or Plant Kingdom) and Jangama (Animal Kingdom) are two Ashraya-Sthanas (Origin) of Dhoopana. In Kashyapa Samhita Vrudha Jivaka has described Dhoopana in a separate chapter named Dhoopana Aadhyaya in Kalpa-sthana. Here he has quoted 40 Dhoopana a kalpas i.e. Fumigation formulations.¹⁰ Some of the medicinal herbs are repeatedly mentioned in Dhoopana for their Rakshoghna Karma I.e. Sterilization activity amongst various Ayurvedic Dhoopana formulations. Namely Sarshapa is been described 14 times. Vacha has been mentioned 10 times, Hingu 4 times, Laksha 3 times, Guggulu 2 times, Jatamansi 2 times, Yava once and Choraka only once.¹⁰ Acharya Kashyapa has categorized Dhoopana into 3 types as Dhoopa, Anudhoopa and Pratidhoopa. Acharya Kashyapa further explores that Dhoopana Dravyas should be collected by a Vaidya personally from Agneya (Igneous) and Uttara (North) Disha (directions) on Pushya Nakshatra (an auspicious day of every month as per Indian Hindu calendar). After performing the ritual duties of prayers and offerings, four clean and tidy Paricharicas (nurses) should powder and store Dhoopana Dravyas at a safe place and use it as and when necessary. If required, it could be used immediately. Such Dhoopa will definitely provide a Ayurvedic Rakshoghna remedy for Dhoopana. Dhoopana a karma in this way should be repeated again and again to avoid recurrence of infections totally.¹⁰ Amongst the 40 Dhoopa yoga mentioned, only 32 Dhoopa yoga are seen in the currently present manuscript of Kashyapa Samhita and only 30 of them are in complete verse.¹⁰ As Ghrita (cow ghee) finds its place in all 30 of them compared to Taila and Majja it could be said that Ghrita is an essential component for combustion of Dhoopa dravyas. This may be due the medicinal properties of Ghrita i.e Rasayana (rejuvenation), Vajikara (Aphrodisiac) Sanskara Anuvartana (alterations in the property of a substance by certain procedures), Sarvasneha Uttama (best in unctuous lipids), Agni Deepana (Enhancing Metabolic Fire), and is Rasa (primary body fluids), Shukra (semen), Oja (Immunity) Heetakar i.e. conductive to them. Additionally, Ghrita is explained to have many properties and actions like vitalizing, rejuvenating (Rasayana), Vrishya (Aphrodisiac), Deerghayushyakara (promoter of long life) and Shuddhikar i.e. removes toxic substances from the body.^10,6,12 References from Sushruta Samhita, Dalhana Commentary and Kashyapa-Samhita suggest that Dhoopana in Vranitagara is effective to avoid infections.¹⁰ Acharya Sushruta has further clarified the fact that one should not sneeze, laugh or yawn without covering the mouth. This was to prevent airborne bacterial infections form the organisms coming from nose or mouth.¹¹ As in Tuberculosis patients, one should cover mouth with mask to avoid airborne infection. No one is permitted to enter the modern procedure room without a cap and mask for the same reasons. In this context Acharya Charak has further mentioned a formulation named Yavasarshapadi Choorna Dhoopana.

MATERIAL AND METHODS:

In this Literary critical study, various Ayurvedic scriptures and Modern Books, and Journals were studied and reviewed critically in the view of exploring the Sterilization activity of various Ayurvedic Dhoopana Dravyas.

As per the reference from Charak Samhita, Yavasarshapadi Choorna has 14 different drugs which could be taken in equal amount to each other and burnt with equal quantity of Goghruta (Cow Ghee). This combination of Dhoopana is mentioned for the Dhoopana of Vastras (CLothes) and Vranitagra^1,13,14 By using these Dhoopana dravyas, the clothes and Vranitagara must be fumigated to kill various diseases causing microorganisms.

Additionally, this study comprises a critical literary review of a herbomineral formulation named Yavasarshapadi Choorna which is indicated in the form of dhoop i.e. incense or resin for Dhoopana a karma. It is indicated in Ayurvedic scripture Charaka Samhita in the chapter Jatisutriya Sharir Adhyaya of Sharir Sthana. It was reviewed in the context of sterilization activity to maintain asepsis and antisepsis. Specifically, it is indicated for the Dhoopana i.e. fumigation of cloths and belongings of sutika i.e. post-natal period of Women and that of the New born,¹³ Bheshajaagar (drug preparation room), Kumaraagar (newborn care room), Vranitaagar (Surgical Procedure room)¹⁷

1.1 Table showing Comparative Properties of various Dhoopana Dravyas in Yavasarshapadi Choorna¹⁸

Sr. No.	Name	L.N and Family	Rasa	Guna	Virya
1	Yava	Hordeum vulgare linn. Poaceae	Madhur kashay	Mrudu, ruksha	Sheeta
2	Sarshapa	Brassica compestrisl. Czem.-	Katu, tikta	Snigdha, ushna	Ushna
3	Atasi	Linum ussitassimum linn.	Madhur, tikta,	Guru, snigdha	Ushna
4	Hingu	Ferla asafoetida	Katu	Tikshna, laghu,snigdha	Ushna
5	Guggulu	Commiphora mukul	Tikta	Laghu, ruksha, vishada picchila	Ushna
6	Vacha	Acorus calamus linn.	Katu ,tikta	Laghu, tikshan	Ushna
7	Chorpushpi	Angelica glauca edgew	Katu, tikta	Laghu, tikshna	Ushna
8	Bramhi ¹⁵	Bacoppa monnieri linn	Tikta, kashay	Laghu	Sheeta
9	Shwetadurva	Cynodone ductylon linn.	Tikta madhura, kashay	Laghu	Sheeta
10	Jatamansi ¹⁶	Nordostachys jatamansi	Tikta kshay madhura	Ruksha, laghu,	Sheeta
11	Kutaki	Picrorhiza kurroa	Katu ,tikta	Laghu	Ushna
12	Go ghrit	Butyrum depratu	Madhura	Snigdha, guru	Sheeta
13	Plankasha	Phylum-arthropoda	Order-hemipetra	Sub order- Homopetra	Genus laccefera
14	Sarpanirmok	-	-	-	-

Continue Table 1.1

Sr. No.	Name	Vipaka	Karma	Part Used	Chemical Composition
1	Yava	katu	Balya, kaphahar, Lekhana, Vrushya	Seed	Flavone glycoside, orientoside, vitexin, orientin, flavone glycoside,
2	Sarshapa	katu	Dhoopana a, vidahi, kaphapittakar, vatahra	Seed	Fixed oil
3	Atasi	katu	Dhoopana, vidahi, kaphapittakar, vatahra		Fixed oil, mucilage, protein
4	Hingu	katu	PachanVK har, bhedaniya	Gum	Gum pipenbutyl propenyl disulphide, astrisulphide,gummosinundecyl-sulphonil acetic acid
5	Guggulu	katu	Brihana, KV hara, rasayan	Niryas(gum)	Volatile oils,guggulusteroneE-Z,Sesaine, camphorene, cambrine-A
6	Vacha	Katu	Medya, KVhara, dipan, lekhaniya	Roots(rizome)	Acolaone ,cis and trans asarone,azuene, calamine,volatile oil eugenol,acoric acid, camphene
7	Chorpushpi	Katu	Hridya, KV hara, sandnyasthapan	Roots	3-butylidene, dihydrophthalide, phthalides, oxypeucedanin
8	Bramhi¹⁵	madhura	Medhya, vishahara, rasayan KPhara	Whole plant	TetulinoroxindiN, oroxindin, 6 methylether of baicalenin=oroxylum, b sistosterol, p coumaric acid, 7 rutinoside
9	Shwetadurva	Madhuar	Varnya, KP hara, parajsthapak	Whole plant	3 chlorpropionic acid
10	Jatamansi¹⁶	Katu	Medya, tridoshhar, balya	Root	Essential oil, resinous material
11	Kutaki	Katu	Dipan bhedan pittahar, jwarahar	Root	D-mannitol, kuticol, apocunin, phenol glucosidespicroside I II III, picrorrhizine
12	Go ghrit	madhura	Tridoshaghna		Triglycerides diglyceridesmonoglyceridesketo acid glyceride, phopholipuds, sterols, Free fatty acids, Vit. A,D,E,K
13	Plankasha	Species lacca	superfamily lassiferidae		Aleuritic acid
14	Sarpanirmok	-	Rakshoghna

Modern Review of Sterilization:

As per the modern science, Hospital Associated Infections (HAI) or Nosocomial infections are the infections which were neither present nor incubating at the time the patient was admitted to health care facility. The organisms come from many possible sources, such as patients’ own resident flora, mouth, gastrointestinal tract, vagina or the skin, the resident microbial flora of health care workers and from other patients on the ward, patient to another one, Contaminated instruments, dressings, needles, etc. used for invasive procedures and in fusions.

The source of most of the hospital epidemics is an infected patient, i.e. patients ccontaminated with pathogenic microorganisms. These microorganisms are often released into the environment in very high numbers, exceeding the minimal infective dose and contaminate other patients who subsequently develop hospital-acquired infections.

Gas Fumigation is the process introduced in the modern science which can be correlated with Ayurvedic Dhoopana karma. Fumigation is the process by which a lethal chemical is released into an enclosed area to eliminate an infestation of pests.^19,20,23,24

Review of Formalin Gas as a Sterilization Agent in Modern Medicine:

1.2 Table showing various Properties of Formalin in the view of Sterilization^21,22

Formalin:

Synonyms	Methyl aldehyde, methylene glycol, methylene oxide, formaldehyde, formal.
Molecular formula	CH₂O
Molar mass	30.03gm mmol^-1., Colorless gas
Density	0.8153gm/cm³(-20℃)
Melting point	-92℃ , -134°f, 181f.
Boiling point	-19℃, -2°f, 254 k
Solubility in water	400gm dm^-3.
Molecular shape	Trigonal planer
Explosive limit	7-73%.
Lethal dose (L.D.)	100mg/kg i.e. 50 ml oral /rats, 35%fatal to death.
Fumigation quantity	0.028m³ approximately 2ml/cu.ft.
Safe level	0.3%
Eye irritation	0.05 to 1% ppm
Nasal Irritation to lungs	1.9 ppm (pulmonary damage)
Fatal dose	35%.
Parts per million (10^-6)	begin to smell at 0.05ppm and highest level= 1ppm
Irritation	0.46 ppm (asthma in child)

Nowadays, old methods of fumigation by formalin has been proven to develop harmful effect on the health care workers as Formalin is a proven carcinogen.^21,22 Hence, Ayurvedic Herbo-mineral compound for fumigation may useful. So, Yavasarshapadi Choorna Dhoopana can be used as a safe substitute for hygienic way of sterilization.

Action of Ayurvedic Drugs used in Dhoopana Karma:

1. 1.The Dhoopana dravyas like Yava, Sarshapa, Atatsi, Hingu, Guggulu, Vacha, Choraka, Brahmi, Kutaki are mentioned to be Krumighna i.e. Anthelminthic in various Samhitas and Nighantus. Goghruta (Cow Ghee) is essential for combustion of these constituents.

2. Sarpanirmok (the shed skin of a snake after molting) mentioned in Kashyap Samhita Dhoop Kalapadhyay 4 times as rakshoghna dravyas (antimicrobial agents).

3. Laksha is mentioned in Kashyap Samhita 2 times as Rakshoghna Dravya.

Probable mode of Action of Various Ingredients in Yavasarshapadi Choorna: Modern Perspective:

1. Dodecane which was found to be present in a drugs belonging to family vulgare from which yava belong,likely to have fungicidal and antimicrobial activity..

2. Oxirane (oxacyclopropanes) and pthalic acids (pthalides) found in choraka proven as a good fungicide and bactericide.

3. Phenol, 2,4 bis (1,1 dimethylethyl) found in kutaki aslso has d same action.

4. Hexadecane, nonadecane, hexadecanoic acid, methyl ester, Pentadecanoic acid and octadecanoic acid most likely found in drugs belong to the family vulgare.

5. Chlorpropionic acid is most likely found in shweta durva.

6. Linseed oil have antimicrobial activity obtained from seeds of Atasi.

7. Volatile oil from roots of Vacha found to have inhibitory effect on the growth of Mycobacterium tuberculosis.

8. Ethanolic extract of Bacopa monnieri has antibacterial activity seen in more effective in Gram –ve bacteria.

9. Volatile oils from roots of Acorus calamus Linn. inhibited the growth of gram-negative organisms.

10. Volatile oils from gum-resin of Guggulu shows antibacterial activity

Probable Mode of Action of Yavasarshapadi Choorna Dhoopana : ayurvedic perspective:

1. The mode of action of Yavasarshapadi Choorna dhoop is probably due to the potency of various herbs in it along with their Agni Sanskar i.e. Fire Burn on Dhupan Dravya. Dhoopana dravyas have Vayu (Air), Akash (Sky), Agni (Fire) Mahabhootadhikya (dominance amongst Five Vital Elements) and Sukshma Strotogamitva (penetrates up to the cellular level) and its sterilization effects could be ascertained to the combination of these mahabhootas.

2. The sterilization effects of Yavasarshapadi Choorna Dhoopana are probably due the volatile constituents burnt in them. So the sterilization effects the of Yavasarshapadi Choorna Dhoopana could be achieved in almost every corner of the associated environment and at various microbiological levels.

Comparision of Yavasarshpadi Choorna Dhoop with Modern Sterilization Drugs:

1. Availability: Dhoopana drugs are easily available in the local India markets and are used for Dhoopana karma in day to day practice as per Indian tradition.

2. Efficacy: The efficacy of Ayurvedic Dhoopana drugs has not been fully explored till today. Until sufficient Analytical and Efficacy Studies are conducted, the Ayurvedic Dhoopana Karma couldn’t be established as a routine Sterilization practice. The utility of Dhoopana karma in day to day practice as per Indian tradition needs to be validated through scientific researches.

3. Safety: Use of herbomineral formulations for sterilization over synthetically derived chemical compounds will always be safe for health care workers. Dhoopana is practiced since long years in Indian Tradition. All the contents of Dhoopana dravyas are probably safe as there are no documented reports of their side effects yet. So various Ayurvedic Dhoopana dravyas like Yavasarshpadi Choorna must be studied thoroughly for their safety.

CONCLUSION:

1. The modern classic sterilization techniques like formalin gas fumigation are producing health hazards to the health care workers and tend to produce carcinogenic effects on the community. Hence in this scenario, we must study Indian traditional Dhoopana karma for prevention and control of Infections.

2. From the above study it could be concluded that there are many scientific recommendations from various Ayurvedic Scriptures about certain Dhoopana Dravyas for their activities which are similar to Sterilization. For example, a herbomineral formulation like Yavasarshapadi Choorna Dhoop is indicated to be used as an alternative for sterilization of operation theatre, IPD and ward fumigation since it has Krumighna and Rakshoghna property i.e. antimicrobial and antifungal property as per Ayurvedic texts.

The Analytical study of antimicrobial and antifungal effect of various Ayurvedic Dhoopana Dravyas is the need of the hour.

So, we need to do the preclinical and clinical study also to verify the Sterilization activity of various Ayurvedic Dhoopana Dravyas like Yavasarshpadi Choorna Dhoopana.

ACKNOWLEDGEMENT:

I Dr. Kiran Pundlikrao Mendhekar would like to express my appreciation to Dr. Yogesh Shinde sir for his valueble and constructive suggesions during planning of this research work. I convey my sincere gratitude to Dr. Sanjeev Yadav Sir for all possible assistance and mentoring for successful completion of this research work. His willingness to give his time has been very much appreciated. I would like to express my deep gratitude to my guide Dr. S.V. Kashikar sir for the inspiration and guidence about this research work. I wish to thank my parents and husband for their support and encouragement throughout my study.

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Received on 23.10.2020 Modified on 29.11.2020

Research J. Pharm. and Tech 2021; 14(11):6095-6100.

DOI: 10.52711/0974-360X.2021.01059