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INSIGHT ON RAKSHA KARMA

WITH STERILIZATION

BY
DR NISHA SHARMA
Ist YEAR PG STUDIES
DEPT OF SHALYATANTRA

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 CONTENTS
✓ INTRODUCTION
✓RAKSHA KARMA
✓ DIFFERENT METHODS OF RAKSHA KARMA
✓STERILIZATION
✓METHODS OF STERILIZATION
✓ STERILIZATION OF THE OPERATION THEATRE
✓ DISCUSSION
✓CONCLUSION

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 INTRODUCTION
Raksha karma or Nirjantukarana can be correlated with the term
sterilization.
The process by which any living organism present on a material is
completely destroyed or terminated is called sterilization.
The effective use of disinfection and sterilization procedures is
important in preventing healthcare associated infections.
Raksha karma as mentioned as a Shashti upakrama by Acharya
Sushruta.

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In Ayurveda the term Krimi is used in broader sence, it includes
micro and macroorganism covering wide range of infection and
infestation. To get prevention from krimi, rakshogna vidhi is
explained in our classics

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What is Raksha Karma?

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Raksha Karma
✓ It is one of the Shashti upakrama as mentioned by Acharya
Sushruta,
✓Raksha karma for instruments has been mentioned in our
classics.
✓In classics the term raksha karma has been explained in different
contexts like raksha karma for nilamakshika, krimi, rakshasa,
,nishachara which attributes to micro and macro-organisms which
has been explained below as:

✓According to Su. Su .5/18 – Dalhana tika

न केवलं व्रणं धूपयेत् शयनाद्यपप व्रणदौर्गन्ध्यापर्मार्थं
नीलमपिकापदपरिहािार्थं च; अन्यर्था नीलमपिकोपसपगणाद्व्रणे
पिमयः पतन्ति||

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▪ According to Su. Su.19/28- Dalhana tika:

मपिकापदभ्यो [२] िािसापदभ्यश्च ििार्थं धूपमाह- …

▪ According to Su.Chi.1/133

पनशाचिे भ्यो िक्ष्यस्तु पनत्यमेव ितातुिः |

ििापवधानैरुपिष्टैयगमैः सपनयमैस्तर्था | |
 Krimighna dravyas: Su.Su.19/29
Chatra Jatila
Shatavirya Bhramacharini
Atichatra Lakshmi
Sahasravirya Atiguha
Langali Vacha
Sidhartaka

So here Sushruta has mentioned Raksha karma from Rakshasa,

Makshika and nishachara.

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Different Methods of Raksha Karma

Agni
Pariseka
tapana

Mantras,
Dhoopana
homa
Raksha
Karma
 Dhoopana
✓ Dhoopana is one of the measure of raksha karma.
✓ It is one among the Shashti upakrama.
✓ Acharya Sushruta has mentioned dhoopana as a raksha vidhi for
vranitagara, sutikagara, kumaragara, for atura, as a krimighna by
using certain dhoopana dravyas or rakshoghna dravyas such as:

Dhoopana dravyas according to Acharya Sushruta:

ततोर्ुग्गुल्वर्ु रुसर्गिसवचार्ौिसर्गपचूणैलगवणपनम्बपत्रपवपमश्रैिाज्ययुक्तैधूगपये
त् || (Su.Su.5/18)
✓Dhoopana is not only given for vrana ropana but it is also
used for vranitagara, sutikagara,kumaragara, purification of
air.
✓ Vranitagara: सर्गपारिष्टपत्राभ्यां सपपगर्ा लवणेन च |
पििह्नः काियेद्धूपं दशिात्रमतन्तितः ||
Su.Su.19/28
✓Vrana: Dhoopana dravyas are sarshapa, agru, guggulu,
goura sarshapa etc are used to fumigate the vrana.
✓ Sutikagara: Acharya Sushruta has mentioned doopana
with sarshapa, ghrita guggulu , bilwa etc i.e rakshoghna
dravyas are used to fumigate the sutikagara.
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✓ For kumaragara : Ch.Sha.8/59
Rakshoghna dravyas like guggulu,vacha, kushta,sarshapa etc are
used to fumigate the kumaragara.
According to Su.Sha.10/23: Acharya Sushruta says peelu, badari,
nimba, parushaka etc rakshoghna dravyas are used to fumigate the
kumaragara.
✓ Purification air:( Su.ka,3/17)
लािाहरिद्रापतपवर्ाभयाब्दहिे णुकैलादलविकुष्ठम् |

पियङ् र्ुकां चाप्यनले पनधाय धूमापनलौ चापप पवशोधयेत||

✓ Purification of water:
तद्यर्था- कतकर्ोमेदकपिसग्रन्तिशैवालमूलवस्त्रापण मुक्तामपणश्चेपत||
(Su.Su.45/17)
अनेन दु न्दु पभं पलम्पेत् पताकां तोिणापन च |
श्रवणािशगनात् स्पशाग त् पवर्ात् [१] सम्प्रपतमु च्यते ||४|| Su.ka.6/4

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Parisheka
✓ It is one among the Shashti upakrama. (Su.Chi.1/17)
✓ Acharaya Sushruta has mentioned parisheka as a raksha
karma by parisheka of ghrita, madhu, taila, gomutra and
kwatha, to prevent the vrana from nilamakshika, krimi
formation.
✓ These dravyas act as anti- bacterial, anti- fungal activity.
✓As madhu has and act as anti- bacterial activity.
( https://www.ncbi.nlm.nih.gov.articles)
Agni tapta

✓AGNI TAPTA SHASTRA

▪ अपितप्तेन शस्त्रेण पिन्द्यात्, अन्यर्था अतप्तशस्त्रच्छे दने पाकभयं
स्यात् || Su.Chi.2/46 – dalhana Teeka:
Here, Acharya Sushruta says that incision is taken after
proper heating of Shastra, otherwise paka takes place ( pus
formation).
 1. Kshara

PAYANAS 2. Udaka

3. Taila (Su.Su.8/12)

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❖Kshara payana : After red hot, the instruments should
dipped in kshara udaka and later used for asthi chedana
karma.
❖Udaka payana: Red hot instruments should dipped in
boiled water and used for mamsa chedana, bhedana.
❖ Taila payana: Red hot instruments should dipped in taila
and used for snayu chedana, shiro bhedana.
✓As Acharya sushruta says payanas are having tikshana gunas so
after agni tapta when the instruments are subjected for payanas ,it
will retained its sterilized quality of instruments.
✓ Shastra kosha:
तेर्ां पनशानार्थं श्लक्ष्णपशला मार्वणाग ; धािासं्ापनार्थं [१]
शाल्मलीफलकपमपत [२] ||१३|| Su.su8/13

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 Mantras, Homa
✓ Rakshartha mantras is also one of the measure of raksha karma.
✓ Mantra means constant repetition, or which is recited out loudly or
silently.
✓ Acharya Sushruta he has mentioned raksha karma mantra in order
to prevent the spreading of diseases, for the purification of air ,water,
to prevent from nishacharis, rakshasa etc ( Su.Su.5/19-33)
उदकुम्भाच्चापो र्ृहीत्वा िोियन् ििाकमग कुयाग त्; तिक्ष्यामः -
कृत्यानां िपतघातार्थं तर्था ििोभयस्य च |
ििाकमग करिष्यापम ब्रह्मा तदनुमन्यताम् ……….
Su.Su.5/19-33
✓ Mantra chikitsa , which is inherentancient vedic tradition
used in Ayurveda as a means of treating the diseases.
✓ Mantra chikitsa is said to be have a profused effect on the
soul and relief all forms of sufferings.
✓ In the same way homa also plays an important role in raksha
karma by creating positive vibes as shanti homa and all etc..

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 मन्त्रैश्चायुवेदपवपहतैः || Su.Chi.1/133- Dalhana teeka
✓In our classics role of mantras, homa has been explained under
various vyadhis such as jwara- mryutunjaye mantra will be
chanted to get rid from jwara.
✓ Thus, Mantras , homas has a role raksha vidhana either in roga,
swastha

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 STERILIZATION

❖ The process by which any living organism present on a

material is completely destroyed or terminated is called
sterilization.
❖ It is freeing an article by removing or killing all bacteria,
spores, fungi and viruses.
 Terms used in sterilization

❖ DISINFECTION
The destruction or removal of all pathogenic organisms
capable of giving rise to infection.
It is killing of all bacteria, fungi and viruses but not spores.
❖ ANTISEPSIS
The term is used to indicate the prevention of infection,
usually by inhibiting the growth of bacteria in wounds or
tissues.
It is inhibition of growth of microorganisms
This done by the antiseptics.
❖ GERMICIDES
Those which able to kill bacteria
❖ASEPSIS
Asepsis means organisms are prevented to access the patient or individual.
Methods of sterilization

Sterilization

Chemical
method

Physical Mechanical
method method
 Boiling
Moist Heat
Autoclave
Physical
Method
Flaming

Dry Heat Incineration

Hot Air Oven

Radiation

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 PHYSICAL METHOD
DRY HEAT STERILIZATION - Adequate heat is most certain
and rapid method of sterilization as it causes hydrolysis and
breakdown of bacterial proteins. Higher temperatures, produce rapid
sterilization. Dry heat is used for sterilizing glasswares etc. This is
not suitable for sterilizing culture media, rubber connections, fabrics
eg. Masks, Towels etc.
Dry heat can be done by - Flaming
- Incineration
- Hot air ovens
Flaming
✓ This is a method of passing the article over a Bunsen flame
✓ Heating the instrument over the fire till they becomes red hot.
USES : -By flaming method these materials like spatulas,
inoculating loops or wires and point of forceps can be sterilized
Incineration

❖ It is a process that involves the combustion of organic

substances contained in waste materials.
❖Materials : contained cloth, animal carcasses and
pathological material . PVC, POLYTHENE can be sterilized
by this method..
Hot Air Oven
✓Hot air are electrical devices used in sterilization.
✓ The oven uses dry heat to sterilize articles.
✓Generally, they can be operated from 50 to 300 C ( 122 to 572 F ) .
✓ There is a thermostat controlling the temperature.
✓ This is the most widely used method of sterilization by dry heat.
USES: Hot air oven used in the sterilization of :
- Glassware - Dusting powders
- Sharp instruments
- Swabs
- Forceps
 PRECAUTIONS:
❖Glass wares should be dry.
❖ Oven should not be over loaded.
❖Articles are to be arranged in a manner to allow free circular of
air.
❖ Door of the oven should be opened after it cools down (2 hrs).

Temperature (c) Holding time (in min)

160 45
170 18
180 7.5
190 1.5
ADVANTAGES & DISADVANTAGES :

❖ They do not require water and there is not much

pressure build up within the oven, unlike an
autoclave, making them safer to work within the oven
❖ Suitable to be use in a laboratory environment.
❖ They are much smaller than autoclaves but can still
be as effective.
❖ As they use dry heat instead of moist heat, some
organisms like prions, may not be killed by them
every time.
MOIST HEAT STERILIZATION:
a) Boiling: Kills vegetative forms of bacterial pathogens.
Boing at 100C is a common method for disinfecting instruments
but it is not adequate as many spores withstand this temperature.

Advantages: 1. It is a simple method.

2. It is economical.
Disadvantages: 1. Certain bacteria, viruses and spores are
resistant to boiling.
2. This method cannot be used for sterilizing
sharp instruments which are damaged by heat and moisture.
 Steam under pressure i.e. Autoclave : Steam is the most effective
b)

moist heat sterilization technique.

AUTOCLAVE: It is the most common method used for
sterilizing surgical instruments. It accomplishes sterilization
dependably without damaging to most of the instruments.
✓ The steam is used in the autoclave for the following reasons:
▪ When the steam is held in a closed container, it is compressed
and the temperature rises above the boiling point.
▪ The steam is able to penetrate porous materials rapidly.
USES: For sterilization of:
✓ Surgical instruments
✓ Syringes & needles
✓Linen including gowms
✓Masks
✓ Swabs
✓ Flasks
✓ Glasswares
✓ Pippettes
STERILIZATION BY RADIATION :

Non-ionizing radiation :1. Infrared rays used for rapid mass

sterilization of prepacked items such as Syringe, Catheters
2. UV (sunlight) -Direct sunlight has germicidal
activity.
- Used for disinfecting enclosed area such as enteryways,
operation theatres and labs.
Ionizing radiation : 1. Gamma rays used for plastic syringes,
swabs, catheters, suture materials, and surgical instruments
2. X-rays used for sterilizing syringes,
swabs, catheters.

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 Chemical
Method

Gaseous Disinfectants

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CHEMICAL METHOD
GASEOUS STERILIZATION – Butapropiolactone
1 .

- Ethyleneoxide
-Formaldehyde
✓ These gases are safe and non- inflammable.
✓ Now adays ethylene oxide is widely used in gaseous
sterilization agent in medical sciences.

.
Advantage :
It has penetration power quite useful for sterilizing surgical
instruments such as catheter, needles, disposables.

Disadvantages :
1. Very slow sterilization process.
2. Very costly equipment.
 STERILIZATION BY DISINFECTANTS
✓ It is a germicidal chemical substance used in inanimate objects to kill
most recognized pathogenic microorganisms but not necessarily all
microbes.
✓ These chemical agents are Alcohol, phenol, povidone- iodine
solution,Dettol etc.
Advantage : 1.Widely used in hospitals for materials that cannot
withstand steam sterilization.
2. It is an easy and fast acting method.
Disadvantage : 1. 40-60% humidity in sterilizing chamber.
2.Disinfectants often cannot destroy spores.
 Chemical agents

✓Alcohol – spirit,
✓ Aldehydes – formaldehyde, Glutaraldehyde
✓ Dyes - Aniline dyes, Acridine dyes
✓ Halogens - Iodine
✓ Phenols
✓ Surface active agents – Soaps and Detergents
✓ Metallic salts - Salts of copper,mercury and silver

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 Alcohols
Ethanol /Isopropyl alcohol, spirit are frequently used
No action on spores
Concentration recommended 60-90% in water
Uses
Disinfection of clinical thermometer.
Disinfection of the skin – Venupuncture

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Spirit:
USES: 1. Disinfection of skin before intramuscular and
intravenous injection.
2. Cleaning the stiched wound.
3. Cleaning the skin of the surrounding ulcer or open
wounds.
4. Used along with other disinfectants, such as iodine-
spirit and cetavelon-spirit for painting the parts before operation.

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Povidine-Iodine( Betadine)

✓ Iodine is recognized as an effective and useful germicide.

✓ It is very effective against the microorganisms such as viruses,
bacteria, protozoa, yeast, and fungi.
USES: 1. Used as a local antiseptic and for wound dressing.
2. Used for irrigation of bladder, wound etc.
3. Has Antibiotic action, antiseptic action.

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 Aldehydes

✓ Formaldehyde & Glutaraldehyde are frequently used

✓Formaldehyde is bactericidal, sporicidal & has a lethal
effect on viruses.
✓Glutaraldehyde is effective against Tubercle bacilli,
fungi and viruses
FORMALDEHYDE
✓To preserve anatomical specimens
✓Destroying Anthrax spores in hair and wool
✓10% Formalin+0.5% Sodium tetra borate is used to sterilise
metal instruments
GLUTARALDEHYDE
✓Used to treat corrugated rubber anesthetic tubes,
bronchoscopes, Face masks, Plastic endotracheal tubes, Metal
instruments and polythene tubing
 Dyes

 Aniline dye:

 - Are Brilliant green, Malachite green & Crystal violet

 - Active against Gram positive bacteria
 - No activity against tubercle bacilli
Acridine dyes:

Acridine dyes in use are orange in colour

Effective against Gram positive than Gram negative

Important dyes are Proflavine, Acriflavine,Euflavine

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 Halogens

Iodine in aqueous and alcoholic solution has been used

widely as a skin disinfectant
Actively bactericidal with moderate against spores
Chlorine and its compounds have been used as
disinfectants in water supplies & swimming pools.
 Phenols

Phenols are powerful microbicidal substances

Phenolic derivatives have been widely used as disinfectants for
various purposes in hospitals
Eg: Lysol, cresol
Uses:
Various combinations are used in the control of pyogenic
cocci in surgical & neonatal units in hospitals.
Aqueous solutions are used in treatment of wounds.
Disinfection of sharp instruments.
Metallic salts

✓Salts of silver, copper and mercury are used as

disinfectants.

✓Act by coagulating proteins

✓Marked bacteriostatic, weak bactericidal and limited

fungicidal activity
 MECHANICAL METHOD

✓ In this method , filtration is used for sterilization.

✓ Filteration through several different types of filters including the
modern membrane filters ( Millipore filters) is an efficient way of
removing larger particles and bacteria from liquids ( e.g human
serum albumin) that cannot be treated by other means.
✓The micro-organism are physically removed by absorption on the
filter medium or by mechanisms.
✓ However this method may not be exactly equivalent to
sterilization of viruses.
✓Small size of bacterias can pass through such filters.
TYPES OF FILTERS: 1. Earthenware candles
2. Asbestos disc filter
3. Sintered glass filter
4. Collodian filter

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 Sterilization of Operation theatre

✓ Surgical site infections are one among the most common

cause of hospital acquired infections.
✓ By maintaining sterile environment in operation theatre we
can control major part of exogenous infections.
✓ Sterilization of ot can be divided into 3 zones: 1. outer zone-
here i.e. enteryway should be sterilized i.e floors should be
cleaned by disinfectants solutions. Fumigation should be given
in ot.
2. Middle zone –
- Here the surgeon should refresh
himself with a bath in doctor’s
room of the operation theatre.
-Should wear clean trousers, vest,
footwear, masks i.e. ot dress which
is kept in ot.
-Surgeon should then clean his hands till elbow using soap.
3. Inner zone- Here preparation to be done by surgeon as: - -
-Surgeon should dry his hands with sterile
towel after washing with soap and again
clean hands, forearms with spirit.
- Wear gown, without touching the outside.
- Then should wear the sterile gloves.
- Then painting, drapping of the part
should be done.

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IMPORTANCE OF STERILIZATION
❖ Prevents the growth of diseases:
✓ In any medical tool/ device used, bacteria comes onto
it. If left unchecked or not disinfected properly, it is
highly likely that bacteria will grow.
❖ Prevents the spread of diseases:
✓ If surgical equipment is not properly sterilized, it can
spread the disease to other patients.
❖ Prevents double surgeries:
✓ If unsterilized equipment is used, it can cause an
infection leading to another surgery later on in order to
remove it. This is costly and can cause many life
threatening complications.
 DISCUSSION
✓For the success of any surgical treatment, sterilization
is of prime importance.
✓Lack of sterilization leads to complications like
infection, impaired wound healing etc.
✓In Sushruta Samhita, methods of sterilization ( Raksha
karma) has been mentioned sporadically under various
diseases and to maintain health.
✓They have explained various methods of sterilization
like: Dhoopana , Parisheka, Agnitaptha and Mantra .,
etc.
➢ Dhoopana method can be correlate to fumigation.

Dhoopana Fumigation

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➢ Parisheka can be correlate to the chemical method of
sterilization.

Parisheka with panchavalkala kwatha Betadine

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✓Acharya Sushruta mentioned Raksha karma in order to
prevent atura from nishachari, makshika and rakshasa, krimi
✓Rakshoghna dravyas which are used in raksha karma are
pocessing anti- bacterial, anti-microbial action.
✓ Agni tapta shasthras can be correlate to the flaming method
i.e. physical method in modern science.
➢ Incineration method which comes under dry heat can be
understood as a kshara.
➢ In classics kshara preparation has been described.
➢ kshara can be understood as incineration in modern
sterilization.

Kshara Incineration

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✓ Rakshartha mantra,homa has also plays an important role as
mentioned Acharya Sushruta where the modern science fails to
explain this concept.
✓After the 59 upkrama the last upkrama is raksha karma explained
by Acharya Sushruta.

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✓Sterilization has major share in Success of surgical
management.
✓In olden days raksha karma concept was explained by our
Acharyas which is now said as sterilization in modern science.

✓Standardization of Ayurvedic sterilizing agents as well as

methods need further research.
✓Role of rakshaartha mantras, homa needs further research.

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