Review on Role of Dhoopan in the prevention of airborne infections (COVID-19)

Renu Bharat Rathi; Bharat Jagdish Rathi; Roshna S. Bhutada; Devyani Dasar; Rakesh Khatana

doi:https://doi.org/10.26452/ijrps.v11iSPL1.2706

Review on Role of Dhoopan in the prevention of airborne infections (COVID-19)

Renu Bharat Rathi ✉ ¹ , Bharat Jagdish Rathi ¹ , Roshna S. Bhutada ¹ , Devyani Dasar ¹ , Rakesh Khatana ¹

1 Department of Kaumarbhritya, Mahatma Gandhi Ayurveda College, Hospital & Research Centre, Salod, Wardha, Datta Meghe Institute of Medical Sciences(DU), Nagpur, Maharashtra, India, 9373703816

Abstract

Dhoopan is a procedure in which fumes or smoke produced from defined drug formulations are inhaled/exposed by patients for the therapeutic relief or externally as a cleanser to the environment. There is a significant risk of spread of airborne infections with hospital-acquired infections and to mitigate Dhoopan is safe and effective to prevent such infections. The aim and objectives were to review and re-publicize the efficacy of Dhoopan in the prevention of diseases with the published data and Ayurveda compendium. The literature has been searched from database like Pubmed, Google Scholar, Scopus, Dhara online, other database and Ayurveda compendia from1980 to 2020. Dhoopan is an ancient method of sterilization for Vranitagar (vran/wound healing), Sutikagar, Kumaragar, etc. with preventive as well as curative efficacy. Smoke can be facilitated to expose or inhale in various diseases such as cough, coryza, piles, epilepsy, insanity, Asthma and wounds. The content of Dhoop are herbs, animal products (skin, hair, bones, horn, etc.) and minerals, described in Ayurveda compendia are potent anti-microbial, anti-fungal and antiviral action. Since time immemorial, sages used to clean the environment by Homa-havanadi rituals. However, due to the lacking scientific validation, these Dhoop methods are not popular, which bring attention to research opportunities and understand its safety and efficacy to prevent airborne infections. Dhoopakalpas are beneficial in dealing with airborne infection because of antioxidant and anti-microbial activity with safe, economical and eco-friendly potential. Thus, it can be publicized in the prevention of COVID 19 like a pandemic situation as an adjuvant.

Keywords

Airborne infections, antimicrobial, antiviral, antifungal action, COVID 19, Dhoop, Dhoopankalpa, hospital acquired infections

Introduction

Ayurveda is a life science; it has given more emphasis on prevention of diseases than therapeutic cure. Ayurveda is an applied philosophy, while modern science is the applied study. To combat with the COVID-19 like pandemic, several measures and medicines are mentioned in Ayurveda. Use of culinary herbs, spices like turmeric and herbal tea with ginger may protect from the COVID-19 menace effectively (Rathi, Rathi, & Khobragade, 2020). Dhoopan means fumigation, which is one of the measures of prevention (Byrns & Fuller, 2011). The decontamination of an enclosed environment is an essential consideration for the control of pathogens. Chemical

Table 1: Dhoopana Dravyasin Charaka Samhita

Sr.No.	Name & Reference	Therapeutic indication	Ingrednts
1	DhoopanaDravya Sha. 8/61	Disinfecting clothes, bed, environment	Sarshap, Atasi, Hinga, Guggulu, Vacha, Chor- pushpi, Brahmi, Duba, Jatamansi, Ashok, Kutki, snake molt
2	Chi. 3/269	Sheeta Jwara	Agaru
3	Chi. 3/307	Vishama Jwara	Guggulu, Neem, Vacha, Kustha, Haritaki, Sarshap, Yava & Ghee
4	Chi. 10/38	Apasmara	Pippali, SaindhavaLavana, Chitraka, Hingu, Vanshapatri, Kakoli, Sarshap, Kakanasha, Bakayana, Chandana, bones and nails of dog. Levigation-urine of goat in Pushya Nakshatra
5	Chi. 23/98	Vishato remove toxins from clothes, bed and rooms.	Peacock feathers, Bagulabones, Sarshap & Chandana
6	Sarvavinashaka Dhooma Chi. 23/99	To eliminate all kinds of Vishas	Tagara, Kushtha, Bhujakpati Shira, Shirisha & Ghee

Table 2: Dhoopkalpa in Charak Samhita on Urdhvajatrugatvyadhis

Name of Kalp	Herbal dravyas	Jangam/ Animal products	Minerals	Indication	Action
Manashiladi Dhoom	Palash, Ajmoda, Shunthi, Vanshlochana	Cow ghee	Manashila	Kasa/cough	Kasahar, antibacterial, antioxidant,
Nav pratishyaya har Dhoop	Yava	Ghrit	--	Nav pratishyaya	Antimicrobial
Shirashoolahar	Erandmool, Jatamansi, Agaru, guggul, Chandan	Ghrit	---	Headache	antibacterial, antioxidant, antifungal, aromatic, anti-inflammatory

Dhoopankalp described in Sushrut Samhita as shown in Table 2

Table 3: Dhoopana Dravyasin Sushruta Samhita

Sr.No.	Name & Reference	Therapeutic indication	Ingredients
1	Su. 19/28	Fumigation of Vranagara Twice a day for ten days	Sarshap, Neem, Ghee & Lavana
2	Dhoopana Dravya Su. 36/22	Vrana Dhoopana	Shreevestaka, Sarjarasa, Sarala, Devdaru & Salaradigana
3	Ka. 3/17	Air purification	Laksha, Haridra, Ativisa, Abhaya, Musta, Harenuka, Ela, Tagara, Kustha & Priyangu
4	Chi. 1/80	Wounds of Vataja Dosha, pain and discharge	Kshauma, Yava, Ghee & Dhoopana Dravyas (Shrivestaka, Sarjarasa)
5	Utta.28/6	Skanda Graha	Snake molt, hairs of camel, goat, sheep and cow, Vacha, Gunja, Sarshap & Ghee
6	Utta.39/262	Vishama Jwara with chills	Leather and hairs of goat, sheep,Vacha, Kustha, Guggulu, Neem & honey
7	Utta.39/262	Vishama Jwara	Excreta of cat
8	Utta.50/19	Hikka Pratisedha	Sarjarasa & Manashila, Ghee, Horn, leather & hairs of cow
9	Utta.32/6	Putana Graha Pratisedha	Devdaru, Vacha, Hingu, Kustha, Girikarnika, Kadamba, Ela, Harenu & Ghee

Dhoopankalp described in Ashtanga Sangraha by Vagbhat as shown in Table 4

Table 4: Dhoopana Dravyasin Ashtanga Sangraha

Sr.No.	Name & Reference	Therapeutic indication (Purpose)	Ingredients
1	Jatwadi Dhoopa Su. 8/91	Vishaghna destroys poison of animal & vegetable origin witchcraft, magic does not have any effect	Jatu, Sarjarasa, Ushira, Sarshap, Patra, Valaka, Vella, Aruskara, Pura & Arjuna
2	Chi. 2/45	Visham Jwara	Agaru
3	Aparajita Dhoopa Chi. 2/67	Jwara	Guggulu, Neem, Vacha, Kustha, Haritaki, Sarshap, Yava & Ghee
4	Chi. 2/68	Sarva Jwara	Sahadeva, Vacha, Bhadra & Nakuli
5	Utta. 1/17	Balaupchara (Shanti karma)	Guggulu, Agaru, Sarjarasa, Vacha, Sarshap, Hingu, Lavana, Neem & Ghee
6	Sarvagraha DhoopaUtta. 4/3	Sarva Graha	Puti, Dashanga, Sarshap, Vacha, Bhallataka, Dipyaka, Kustha, Ghee and Sarshap, Nimba, Ashwagandha, Vacha, Bhurjapatra & Ghee
7	Utta. 6/9	Sheetaputana Graha Chikitsa	Excreta of Gridha, owl, Ajagandha, Nirmoka & Nimba
8	Utta.6/11	Mukhamanditika Graha Chikitsa	Yava, Kustha, Sarjarasa
9	Karpasthyadi Dhoopana Utta. 8/10	Skanda, Unmada, Pisacha, Rakshyas, Sura	Karpasasthi, Mayur, Patra, Brihati, Nirmalya, Madan, Twaka, Wanshi, VrishaDansha, Vita, Tusha, Vacha, Kasha, Nirmochan, Nagendra Beeja, Shringa, Hingu & Maricha
10	Utta. 6/10	Andhaputana Graha Chikitsa	Rakshoghna, Bhallataka, Sarjarasa & Madhu
11	Utta. 43/56	Raksha Vidhana	Gomaya & Agaru
12	Agardhooma Utta.46/15	Aakhuvisha	Manjistha, Rajani & Lavana

Table 5: Popular Dhoopdravyas but not included in Samhitas

Name of Kalp , Ref.	Indication	Action
Tulsi- (Prabhu, Rengaramanujam, Joice, & P, 2009)	Respiratory ailments	Olianic acid-Anti-flu, immune-modulatory
Nilgiri (Chaieb et al., 2007)	Respiratory ailments	Alpha-terpinol against E.coli, S.aureus
Menthol	Respiratory ailments	Menthol, menthone: Against C.albicans
Lavang oil (Briozzo, Núncez, Chirife, Herszage, & D'aquino, 1989)	Respiratory ailments	Eugenol- Larvicidal agent (combat dengue) Antimicrobial, antiviral, anti-cancerous
Camphor- (Wang et al., 2019)	Respiratory ailments	Linalool: Antimicrobial, Krimighna, Tridoshhara, Biofuel

fumigation with costly technology has many toxic effects (Bhinde & Joshi, 2015). Ayurveda recommends fumigation as a method of sterilization with economic, readily available, safe and ecofriendly aromatic substances which not only provide physical, and mental health but also purify and sanitize environment to kill microbes. It is a therapeutic procedure for various human diseases, including microbial infections, vector-borne, airborne viruses and psychological disorders (Vishnuprasad, Pradeep, Cho, Gangadharan, & Han, 2013). However, it has not gained much attention as a prospective field with multiple research opportunities. Fumigation is an age-old method of sterilization since time immemorable. There are few examples mentioned in Kashyap Samhita, Dhupkalpadhyaya for the use as Rakshoghna in treatment of Jwara, Vishamjwara, Dushtavrana, insanity, obstructed labour, newborn care and retention of placenta. Ayurveda has mentioned the concept of Janapadodhwasa, refers to the situation where there is extensive damage to the environment and lives. Epidemics and outbreaks of highly infectious diseases have shattered humanity many times up till now.

Airborne infections are commonest one, originate respiratory ailments. COVID 19 is one of the viral respiratory problems, created pandemic with death toll crosses over 1 lakh across the globe (CDC.gov, 2020). These spreads from droplets, aerosol and fomite by affected patient’s cough, sneeze, sputum or nasal discharge and easily contaminate the environment. Airborne infections can quickly spread in masses through breathing and inhalation of microbes (World Health Organization, 2011). Therefore, there is a need to sterile the area by disinfectant solution or fumigation. There are a plethora of microbes everywhere in the environment. Hence, it is a protocol to fumigate operation theatre prior surgery to prevent hospital-acquired infections (HAI) It needs to be carried out as per the established protocol and guidelines to ensure patient safety (Rutala & Weber, 2008). Recently, Dhoopan is seldom used as a fumigation method. Therefore, this review study aimed to review and re-publicize the benefits of Dhoopan and to evaluate the efficacy of various Dhoopkalpas for fumigation purposeas Rakshoghna (anti-microbial/sterile) with safe and instant action to prevent airborne infections.

Materials and Methods

The literature has been searched from database like Pubmed, Scopus, Dhara online, etc. and Ayurveda abstracts from 1980 to 2020. Dhoopanyog has been gathered with ingredients, indications and summarized them.

Observations and Results

There are many common drugs such as Guggulu, (Rout, Acharya, Mishra, & Sahoo, 2012) Sarja/Loban, Arishtak/Neem, Rason peel (Münchberg, Anwar, Mecklenburg, & Jacob, 2007), Haridra (Teow, Liew, Ali, Khoo, & Peh, 2016), Sarshapa (Braithwaite, Vuuren, & Viljoen, 2008), cow dung cakes (Rajeswari, Poongothai, & Hemalatha, 2016), Ghee (Zope, Harit, Pawar, & Hande, 2017), Hingu (Lad & Palekar, 2016), Vidanga (Kaur & Arora, 2009), Yava (Prabhu et al., 2009)Aparajita (Akram et al., 2018), Vacha (Kumar, 2016), Devdaru (Zeng & He, 2012), Daruharidra, Bilva (Ganapathy & Karpagam, 2016), Lakh, Atasi, Bramhi, Jatamansi, Sarpanirmok/skin of snake etc. Almost all the Dhoopa ingredients have an action of deodorant, antiseptic, antipyretic, anti-inflammatory, analgesic, Rakshoghna/Vishhar (anti-microbial) etc. by spreading pleasant aroma to fill in the air (Tambekar & Dahikar, 2010). The action of these drugs has been proven the efficacy for maintenance of health as well as prevention of diseases as they are anti-microbial (Anantkumar & Shekokar, 2013; Bhatwalkar, Shukla, Srivastava, Mondal, & Anupam, 2019). Their bifurcation has been done as per Samhita (Charak, Sushrut, Ashtang Hridaya and Sangraha), diseases, indications and confirmed action with references as shown in Table 1, Table 2, Table 3 and Table 4.

Concept of DhoopanainKashyapa Samhita

Kashyapa Samhita is a medical text dealing with diseases of newborn and children. Acharya has given a completely separate chapter describing near about 40 Dhupana formulations for newborn, growing child prophylaxis and therapeutics to a diseased child. He also opined that the physician should always possess fumigating material with him at the time of the visit to the patient. The procedure of preparation of fumigation material and their collection in Pusya or MaitrayaNaksatra from southeast or north direction is also described. Acharya has also mentioned chanting hymn at the time of fumigation. He also focused on the anti-microbial potential of Dhupana drugs by indicating them in various GrahaRoga as morphology and fate of Graha mentioned in different Ayurveda texts could be unequivocally interpreted as microscopic pathogenic organisms like virus and bacteria etc. (Zope et al., 2017).

In BhaishjyaRatnavali Out of total 14 Dhoomkalpas, three indicated for fever, 3 for Kasa and remaining for Graha, shool, Arsha, Pilla, Vranaropan. In Ras RatnaSammuchhaya, a total of 8 kalpas mentioned for Kasa, Shwas andGraha. In BharatBhaishajya Ratnakar , many Dhoopkalpas are mentioned for Hikka, Kandu, Krimi, Shoola, Netravikar and Jwar diseases taken from Gadnigraha, VangSen, Yogaratnakar, Bhavprakash and Brihat Nighantu Ratnakar. In Sharangdhar Samhita also fumigation is indicated in ulcer and respiratory ailments in a separate chapter named Dhumrapanvidhi.

Discussion

Many Acharya such as Charak, Sushruta, Vagbhat, Sharangdhar has suggested Dhoopkalpa on Kasa, Shwas, Unmad, Arsha and Vrana. Acharya Kashyap has advised total 40 Dhoopkalpas and dedicated the whole chapter as Dhupakalpadhyay. He emphasized mainly on GrahaharDhoopkalp (out of 40/23kalpa) to kill non visible microbes which causing diseases in children. He added so many animal products such as hair, horn, skin, nails, feathers and bone ash in Dhoomkalpas having anti-microbial properties as animals follow food chain and eat to other small animals carrying some infective residues. Thus, body parts of Vulture like animals are the best source of anti-microbial action (Mendoza et al., 2018). Other eleven kalpas are mentioned to feel pleasant, auspicious, to become attractive, healthy (boost growth and development) and to increase prosperity. Acharya Vagbhat has advocated same Dhoopkalpas as Charak. Ghrit is the common ingredient for all Dhoopkalpas as an excellent binder, facilitates the combustion of herbs by provoking fire with anti-microbial properties (Rathi & Rajput, 2018). Cow dung cakes are also common ingredient but not mentioned in kalpas having potent antibacterial and antiviral properties (Rajeswari et al., 2016). Many drugs which are mentioned in Table 5, not described under Dhoopkalpas in Ayurveda Samhitas but having anti-microbial properties also cited in this review with references.

There are lots of airborne infections, and hospital-acquired diseases with a plethora of micro-organisms in the environment which poses a threat to humans, so it is the need of the hour to find a good alternative to chemical fumigation which is very hazardous to humanity. Some Dhoopkalpas are proven and validated by some studies that they improve the air quality microbiologically (cfu/m³ of air) by assessing microbes pre and post-experiment on Agar plate and swabs. Methicillin-resistant Staphylococcus aureus strains (MRSA 1–3) are the commonest microbes causing HAI or nosocomial infections. (Bhatwalkar et al., 2019) a study has proved to kill these bacteria to a great extent with Dhoop of Rason peels, Loban, Carom seeds/Ajmoda and Curcuma longum. (Braithwaite et al., 2008) and (Yassin & Almouqatea, 2010) study has evaluated the efficacy of herbal fumigation having Devdaru in airborne infections (Bisht, Brindavanam, & Kimothic, 1988; Nautiyal, Chauhan, & Nene, 2007).

In another study but under publication by Rathi Renu et al. on Maheshwar Dhup, it shows significant outcome (p<0.0001) with one-week residual effect when compared with Basilocid to fumigate minor operation theatre and procedure rooms.

Conclusion

Dhoopkalpas are very safe, cheap and environment friendly as compared to other chemical fumigation in the prevention and control of airborne diseases. Thus, it is the need of the hour to explore the potential of Ayurveda herbs with minerals, animal products by research and then propagate Ayurveda Dhoopkalpa to avert COVID19 like epidemic outbreaks in future.

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