Dhumapana

The word ‘dhuma’ (also spelled as dhooma) means smoke and ‘pana’ means to consume. Thus, the word ‘dhumapana’ means taking smoke inside. In ancient times, dhumapana was a part of daily regimen (dinacharya); wherein a specific procedure is adopted for the smoke inhalation through nose and exhaled through mouth, with help of a medicated wick (varti) containing herbs. However, currently this practice has been limited as an ayurveda treatment procedure in management of certain conditions. Ayurvedic dhumapana is generally misunderstood with the dhumrapana, the basic difference between both is that in Ayurvedic dhumapana, smoke inhalation of medicated herbs is done via nose and exhalation from mouth. While dhumrapana is mainly via mouth and exhalation through nosemouth or both as hukkah, bidi, cigarette, cigar etc.. This smoke inhalation is injurious to health and can lead to eye disorders, respiratory diseases and other complications. Dhumapana (medicated smoking) can be used for prevention and treatment of the diseases in upper clavicular region (urdhvajatrugataroga). This chapter deals with the description of dhumapana.

Contributors

Section/Chapter/topic	Concepts& Practices /Dhumapana
Authors	Bhojani M. K. 1, Jain Rahul1,Singh Priti 2 Deole Y.S.3
Reviewer & Editor	Basisht G.4
Affiliations	1 Department of Sharir Kriya, All India Institute of Ayurveda, New Delhi, India 2Department of Swasthavritta, All India Institute of Ayurveda, New Delhi, India 3Department of Kayachikitsa, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Gujarat, India 4 Rheumatologist, Orlando, Florida, U.S.A.
Correspondence emails	meera.samhita@aiia.gov.in, carakasamhita@gmail.com
Publisher	Charak Samhita Research, Training and Development Centre, I.T.R.A., Jamnagar, India
Date of publication:	June 16, 2023
DOI	10.47468/CSNE.2023.e01.s09.141

Etymology

Dhumpapana word is made up of two words- “dhuma” means smoke and “Pana” means to consume (drink or inhale). So, dhumapana means inhalation of medicated dhuma for treatment as well as prevention of different diseases.

Synonyms

• Dhumra

Types of dhumapana

Acharya Charak [Ch.Sa.SutraSthana, 5/58]	Acharya Sushrut [Su.Sa.ChikitsaSthana40/4]	Acharya Vagbhat [A.Hri. SutraSthana 21/2]	Acharya Sharangdhara [A.Sa. Sutra Sthana,30]
Prayogika or shamana (for preventing/pacifying diseases) Vairechanika (purgative/ cleansing) Snaihika (lubricating)	Prayogika or Shamana (for preventing diseases) Vairechanika (purgative) Snaihika (lubricating) Kashaghna (antitussive) Vamaniya (vomit inducing)	Snigdhadhuma (lubricating passages) Madhyamadhuma (Medium) TikshnaDhuma (Strong or Purifying)	Shamanadhuma (balancing) Brimhanadhuma (nourishing) Rechanadhuma (Purgative) Kasahara dhuma (Antitussive) Vamana dhuma (Vomit inducing)

1. Prayorika or shamana dhumapana (preventing or pacifying diseases)
   Prayogika dhumapana is advised for healthy individuals for preservation of health and prevention of vata-kapha dominant diseases in supraclavicular region.
2. Snaihikadhumapana (lubricating)
   Snaihikadhumapana is done with unctuous substance and intended for oleation purpose.
3. Vairechanikadhumapana (cleansing)
   Vairechanikadhumapana is done with substance having cleansing properties with an intention to remove the aggravated dosha in supraclavicular region.

Time and frequency

Prayogika	Snaihika	Vairechaanika
Two times a day	Once a day till lacrimation in eyes starts	Three to four times per day
Acc. to acharya Charak, there are eight specific times when it can be done [Ch.Sa.SutraSthana5/58] Snatva (After bathing) Bhuktva (After eating) Samulikhya (After vomiting) Kshutva (After sneezing) Dantanighrishya (After brushing teeth) Navanante (After nasya) Anjanante (After applying anjana) Nidrante (After waking up) Acc. To Acharya Sushrut four specific times to do[Su.Sa. Chikitsa Sthana 40/13] After brushing teeth After bathing After consuming food After any surgical procedure	Acc. to acharya Sushrut [Su.Sa.Chikitsa Sthana, 40/13] After evacuation of urine and faeces After sneezing After laughing After coitus After anger	Acc. to acharya Sushrut [Su.Sa.Chikitsa Sthana, 40/13] After bathing After day sleep (divashayan) After vomiting

Preparation of medicated wick for smoking (dhumavarti)

1. Prayogika dhumapana [Cha.Sa. Sutra Sthana 5/20-24]
   Materials: Harenuka (Aconitum novoluridum), Priyangu (Callicarpa macrophylla), Prithvika (Ammonum subulatum), Keshar (Crocus sativus), Nakha (Helix aspera), Hriver (Pavonia odorata), Chandan (Santalum album), Patra (Cinnamomum tamala), Twak (Cinnamomum zeylanicum), Ela (Elettaria cardamomum), Usheera (Vetiveria zizaniodes), Padmaka (Prunus cerasoides), Dhyamaka (Cymbopogon martini), Madhuka (Madhuca longifolia), Janmansi (Nardostachys jatamansi), Guggulu (Commiphora mukul), Agaru (Aquilaria agallocha), Sharkara, Nyagrodha (Ficus bengalensis), Udumbara (Ficus glomerata), Ashvattha (Ficus religiosa), Plaksha (Ficus virens), Lodhra (Symplocos racemose), Vanya (Dioscorea bulbifera), Sarjarasa (Vateria indica), Musta (Cyprus rotundus), Shaileya (Parmelia perlata), Utpala, Shreeveshtaka (Pinus roxburghii), Shallaki (Boswellia serrata), Sthauneyaka (Taxus baccata).
   Method
   
   • Make paste of above-mentioned drugs by grinding and adding water.
   • Stick that paste on a shareshika (pipe like structure) such that it’s width should be more in centre and narrow at the ends.
   • Pramana (measurements): angushtha pramana (thickness of thumb)
   • Length: Twelve angula (measurement by fingers approx.21.12 cm). (Acc. to acharya Charak) and eight angula (measurement by fingers approx. 14.08 cm) (Acc. to acharya Sushrut)
   • Dry that varti (wick) in shade and then remove it from shareshika (pipe like structure).
2. Snaihika dhumapana [Cha. Sa. Sutra Sthana 5/25]
   Materials: Vasa (fat), ghrita (clarified butter), Madhuchhishta (beeswax), Jeevaniya gana drugs (Jeevaka- Malaxis acuminate, Rishabhaka- Manilkara hexandra, Meda- Polygonatum cirrhifolium, Mahameda- Polygonatum verticilatum, Kakoli- Fritillaria roylei, Ksheerkakoli- Roscoea purpurea, Mudgaparni- Phaseolus trilobus, Mashaparni- Teramnus labialis, Jeevanti- Leptadenia reticulata, Madhuka- Glycyrrhiza glabra)
   Method
   
   • Mix the jeevaniya gana dravya with vasa, ghrita and madhuchhishta (beeswax)
3. Vairechanika dhumapana
   Materials: Aparajita (Clitoria ternatea), Jyotishmati (Celastrus paniculatus), Hartal, Manah-shila, Gandha agaru (Aquiularia agallocha), Patra(Cinnamomum tamala) etc.
   Method
   
   • Prepare the dhumavarti as mentioned above in prayogika dhumapana
4. Dhumanetra (nozzle for the smoking)
   Material- Should be made of the same material as bastinetra (Suvarna- gold, silver, ranga-tin, lead, copper, bronze etc).
   Structure-
   • It should have 3 kosha (curves).
   • Base should have a hole of angushtha pramana (.).
   • Upper part should also have a hole of kolasthi pramana (..).

Acc. to acharya Sushruta dimensions for dhumavarti is described:

Prayogika	Snaihika	Vairechanika	Kasaghna and vamaniya
Pramana- kanishthika anguli (breadth with little finger) 48 angula (84.48cm) length 36 angula (63.36) length (Acc. To Acharya Charak)	32 angula (56.32 cm) length	24 angula (42.24 cm) length	16 angula (28.16 cm) length

Drugs for preparing dhumavarti

S.No.	Dhumpana	Drugs
1.	Snigdha or mridu (soft or lubricating) [A.Hr. Sutra Sthana 21/13]	Agaru (Aquilaria agllocha), Guggulu (Commiphora mukul), Nagarmotha (Cyprus rotundus), Thuner (Taxus wallichiana), Shaileya (Parmelia perlata), Jatamansi (Nardostachys jatamansi), Khas (Chrysopogon zizanioides), Netrabala (Pavonia odorata), Dalchini c, Renuka (Vitex negundo), Yastimadhu (Glycyrrhiza glabra) Bilwa (Aegle marmelos) majja, Elvaluka (Prunus cerasus), Shreeveshtaka (Pinus roxburghii), Sarjarasa (Vateria indica), Dhyamka (Cymbopogon schoenanthus), Shallaki (Boswellia serrata), Kumkum (Mallotus philippensis), Masha (Vigna mungo), Yava (Hordeum vulgare), Kunduru (Coccinia grandis), Tila (Sesamum indicum), Sneha (Oil), Meda (fat), Majja, Vasa (fat), Ghrita (Clarified butter)
2.	Madhyama or Shamana (moderate or pacifying) [A.Hr. Sutra Sthana 21/16]	Shallaki (Boswellia serrata), Laksha (Laccifer lacca), Prithvika (Ammonum subutalum), Kamal (Nelumbo nucifera), Utpala (Nymphea alba), Nyagrodha (Ficus bengalensis), Udumbara (Ficus glomerata), Ashvatha (Ficus religiosa), Plaksha (Ficus virens), Lodhra (Symplocos racemose), Twaka (Boswellia serrata), Sita, Yashtimadhu (Glycyrrhiza glabra), Padmaka (Prunus cerasoides), Manjishtha (Rubia cordifolia), Kushtha (Saussurea lappa), Tagara (Valeriana wallichii)
3.	Teekshna (strong or cleansing) [A.Hr. Sutra Sthana 21/17]	Jyotishmati (Celastrus paniculatus), Haridra Curcuma longa), Dashamool (Bilwa- Aegle marmelos, Agnimantha- Premna mucronate, Shyonaka- Oroxylum indicum, Patala- Stereospermum suaveolens, Gambhari- Gmelina arborea, Brihati- Solanum indicum, Kantakari- Solanum xanthocarpum,  Gokshura- Tribulus terrestris, Shalaparrni- Desmodium gangeticum, Prishnaparni- Uraria pictta), Manah-shila, Hartal, Laksha (Laccifer lacca), Apamarga (Achyranthes aspera), Triphala (Amalaki- Phyllanthus emblilca, Vibhitaki- Terminalia bellerica, Haritaki- Terminalia cheebula), Gandha dravya (aromatics), Shirovirechana gana (nasal errhines)

Indications

Dhumapana is indicated in following diseases:

Shiro gaurav (heaviness in head) Shira shoola (headache) Peenasa (commong cold) Ardhavabhedaka (migraine) Karna shoola (earache) Akshi shola (ocular pain) Kasa (cough) Hikka (hiccups) Shwasa (asthma) Galagraha (sour throat) Danta-daurbalya (weakness in gums) Shrotra-strava (ear discharge) Ghrana- strava (nasal discharge) Akshi-strava (lacrimal discharge) Pootighrana (foul smell from nose) Aasayagandha (foul smell in mouth) Danta-shoola (pain in teeth) Arochaka (anorexia)

Hanugraha (stiffness in jaw) Manyagraha (stiffness in Neck) Kandu (itching) Krimi (worm infestation) Mukha-panduta (pale face) Shleshma-Praseka (secretion from mouth) Vaiswarya (change in voice) Galshundi (uvulitis) Upjihvika (ranula) Khalitya (alopecia) Pinjaratva (white hair) Kesha-patana (hairfall) Kshavathu (sneezing) Atitandra (reduced acuity of perception) Buddhhimoha (delusion) Murcha (dizziness) Atinidra (hypersomnia)

Dhumapana provides strength to organs in shiras (head), kesha (hairs), akshi (eyes), karna (ears), swara (voice), and throat.

Unfit for dhumapana

1. Those are having following diseases should avoid taking dhumapana [Su.Sa. Chikitsa Sthana 40/11]

   Shoka (grief) Shrama (fatigue) Bhaya (fear) Krodha (anger) Visha (toxins) Raktapitta (bleeding disorder) Mada (intoxication) Murchha (unconsciousness) Daha (burning sensation in body) Pipasa (thirst) Urdhva vata Panduroga (anemia)

   Talushosha (dryness in palate) Chhardi (vomiting) Shiro-abhighata (Traumatic head injury) Udgara (belching) Langhana Timir (myopia) Prameha (diabetes) Udar (ascites) Adhmana (constipation) Kshata-ksheena (wasting/ Emaciation) Urah-kshata (tuberculosis)

2. Unfit for dhumapana: vrudhha (old age), balaka (children), garbhini (pregnant women), durbala (weak), after virechana (after purgation) and niruha basti (enema with decoction), ratri-jagrana (waking during night time), people having alpa kapha in body.
3. Unfit after consuming: madhu (honey), ghrita (clarified butter), dadhi (curd), dugdha (milk), matsya (fish), madya (fermented drink), yavagu (gruels)

Procedure for dhumapana

• Person should sit in a comfortable posture and breath normally.
• Place the dhumavarti in dhumanetra and ignite it.
• Then the person should inhale the smoke come out from the dhumavarti through one nostril.
• Exhale the same through mouth.
• In one round three puffs should be taken.
• Do the same procedure through another nostril.
• Inhalation of smoke can be done by nostril or mouth but exhalation should only be done through mouth.

Clinical features of proper dhumapana [Cha.Sa. Sutra Sthana 5/37]

• Purity and lightness in chest region (hrudaya),throat (kantha) and all sense organs (indriya), lightness in head and supra clavicular region (urdhvajatru).
• Elimination of kapha and vata dosha.

Clinical features of less dhumapana [Su.Sa. Chikitsa Sthana 40/12]

• Unclear voice
• Kapha in kantha (throat)
• Heaviness and stiffness in head
• Unclear oral cavity

Clinical features of excess dhumapana

Acc. to acharya Sushrut [Su.Sa.Chikitsa Sthana 40/17]	Acc. to acharya Charak [Ch.Sa.Sutra Sthana 5/38-39]
Talushosha (dryness of palate)   Galashosha (dryness of throat) Daha (burning sensation in body) Pipasa (thirst) Murchha (unconsciousness) Bhrama (delusion) Mada (intoxication) Karna-kshveda (tinnitus) Drishti-roga (eye diseases) Nasa-roga (nasal diseases) Daurbalya (weakness)	Badhirya (deafness) Aandhya (blindness) Mukatva (unable to talk) Raktapitta (bleeding disorder) Shiro-bhrama (delusion)

Clinical features of dhumapana at improper time [Su. Sa. Chikitsa Sthana 40/12]

• Bhrama (delusion)
• Murchha (unconsciousness)
• Shiroruja (headache)
• Ghrana (nose), shrotra (ear), jihva (tongue) diseases.

Dhumapana indicated as treatment for various diseases

1. Vairechanika dhumapana is prescribed in the treatment of krimi (worm infestation), kushtha (Skin diseases), kilasa (Vitiligo). [Cha. Sa. Chikitsa Sthana 7/ 49]
2. In unmada chikitsa, if the patient is having peenasa (paranasal sinusitis) and mukhapraseka (excessive salivation), then the vairechanika dhumapana or dhumapana prepared with shweta (Clitoria ternatea) etc, drugs with hngu (Ferula aesfoetida) should be used. [Cha. Sa. Chikitsa Sthana 9/73]
3. Vataja pratishyaya (allergic rhinitis): Saunf (Foeniculum vulgare), Twak (Cinnamomum zeylanicum), Bala (Sida cordifolia), Shyonaka (Oroxylum indicum), Erand (Ricinus communis) moola, Aragwadha (Cassia fistula), paste (kalka) of these drugs should be added with madhuchhishta (Beeswax), vasa (fat) and ghrita (clarified butter), and prepared dhumavarti should be used. [Cha. Sa. Chiikitsa Sthana 30/ 136]
4. Naveen pratishyaya (rhinitis): Dhumavarti made of yava (Hordeum vulgare) saktu and ghrita (clarified butter) should be used for dhumapana. [Cha.Sa. Chikitsa Sthana 30/137]
5. Kaphaja pratishyaya (rhinitis): Dhumavarti made up of pungent (katu) rasa dravya should be used. [Cha.Sa. Chikitsa Sthana 30/ 151]
6. Shiriroga (diseases of head): Dhumavarti prepared from Erandamoola (Ricinus communis), Jatamansi (Nardostachys jatamansi), Kshauma, Guggulu (Commiphora mukul), Agaru (Aquilaria agallocha), Chandana (Santalum album) should be used. [Cha.Sa. Chikitsa Sthana 30/ 182]

Contemporary approach

Mode of action

The dhumapana, when ignited releases the volatile substances in the nostrils, which are absorbed resulting in vasodilatation and stimulation of surrounding nerves of nasopharynx and the olfactory nerve. This stimulates the endocrine system and nervous system also. Same way when these volatile substances are inhaled and reach lungs, it leads to a soothing effect and eases the difficulty of breathing because of their bronchodilator effect.

Previous research works

1. Dhumapana: An effective Ayurvedic herbal smoking technique for prevention and treatment of COVID-19 like diseases: In this article, a description of ayurveda procedure dhumapana and its customized preparation method with basic ingredients are described for first-aid treatment of respiratory diseases like COVID-19 and for prevention as well.
2. Effect of Haridra (turmeric) dhumapana and swasakuthara rasa in tamaka shvasa: A comparative trial
3. The effect of dhumapana therapy in comparative study of Haridra (turmeric) dhumapana and Behada dhumavarti in the preventive management of tamaka shwasa.

The above-mentioned works have described the concepts and benefits of dhumapana and its effects in treatment of infectious as well as non-infectious diseases. Mainly, it is found useful in the diseases pertaining to head and neck - urdhwajatrugata roga (diseases manifested above the clavicle).

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