Charak Samhita - User contributions [en]

Shukra dhatu

2020-07-05T17:01:43Z

Anagha:

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [A.S. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su. Sa. Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [A. Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*S. = Sangraha
*Hr. = Hrudaya

=== References from [[Charak Samhita]] ===

The list of references for shukra dhatu in Charak Samhita can be seen [[Media:Shukradhatu-reference_list.pdf|here.]]

==References==

File:Shukradhatu-reference list.pdf

2020-07-05T17:00:15Z

Anagha:

Majja dhatu

2020-07-05T16:58:38Z

Anagha:

Majja literally means the marrow. Majja dhatu is the body component similar to bone marrow, the soft organic material that fills the cavities of the bones.(SAT-B.443)<ref>Available from http//namstp.ayush.gov.in/#/sat accessed on 05/06/2020</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Majja Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 =June 16, 2020
}}

==Etymology and derivation==

It is derived from the Sanskrit dhatu “majjan” meaning that which is sunken, or seated within, which denotes the marrow of bones and flesh, pith of plants etc.<ref>Monier Williams (1899), A Sanskrit–English Dictionary, new edition, Oxford At the Clarendon Press, OCLC 458052227.</ref>

==Synonyms ==

*'''Asthija / Asthisambhava''' : derived from bones ([[asthi dhatu]])

*'''Asthisneha''' : special type of fat found inside bones

*'''Asthisara/Asthiteja''' : the essence of [[asthi]]

*'''Dehasara''' : the essence of body

*'''Shukrakara''': that which produce [[shukra]]

==Meanings in different contexts ==

*In physiology, the word denotes structural and functional components mainly of bone marrow.

*In the contexts of drugs, the word majja is used to denote the pulp, fleshy parts of fruits.Ex. Pulp of Indian jujube (kola)[Cha. Sa. [[Chikitsa Sthana]] 20/29]

*It is included as an animal product(jangama dravya).[Cha. Sa. [[Sutra Sthana]] 1/68] and considered as one among the four unctuous substances(maha sneha) for therapeutic purposes. [Cha. Sa. [[Sutra Sthana]] 1/86]

== Panchabhautika constitution and properties ==

There is a predominance of [[jala mahabhuta]] in majja dhatu. It possesses unctuous(snigdha) and soft (mridu) properties.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.323</ref>

==Formation and metabolism of majja dhatu ==

During metabolism, [[vata dosha]] produces hollowness inside the [[asthi dhatu]]. These hollow cavities are filled by adipose tissue([[meda dhatu]]). The adipose tissue in hollow cavities of bones is known as [[majja dhatu]] (bone marrow).[Cha. Sa. [[Chikitsa Sthana]] 15/31-33]

== Metabolic byproducts and waste products(Upadhatu and mala) ==

Sharangadhara considered hairs (kesha) as metabolic byproduct of majja dhatu. [Sha.Sa. Purva Khanda chapter 5]

Unctuousness in eyes, skin and stools (akshi-twacha-vit sneha) are metabolic waste of majja dhatu. [Cha.Sa. [[Chikitsa Sthana]] 15/20]

== Quantity of majja dhatu in body ==

The total quantity of majja is one anjali. One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person-specific. [Cha. Sa. [[Sharira Sthana]] 8/15]

== Time span ==

The majja dhatu is formed on 6th day from nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]

Sushruta opines that the majja dhatu is formed in a time span of 15075 kala (twenty-five days). [Su. Sa. Sutra Sthana 14/14]

==Characteristics of majja sara (best quality of bone marrow)==

The persons having superior quality of majja dhatu are endowed with soft body parts, strong, unctuous complexion, and sweet voice. They have prominent (sthula), long (dirgha) and rounded joints. [Cha. Sa. [[Vimana Sthana]] 8/108]

==Anatomical and physiological aspects ==

===Brain ===

Brain (mastulunga) is a part of majja dhatu present inside the skull (mastak majja). It is present in the form of half-melted clarified butter (ardha vilina ghrita)[Su. Sa. Sutra Sthana 23/12, Dalhana]

===Channels of transportation and transformation of Majja dhatu (Majjavaha srotas)===

The channels of transportation and transformation of [[meda dhatu]] originate from bones and joints. [Cha. Sa. [[Vimana Sthana]] 5/8].

There are various structures related to majja dhatu. These can be included in the system. The structures are as described below.

=== Layer of majja (Majjadhara Kala) ===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of adipose tissue (Medodharakala)present inside the long bones is known as majja. Though there are no direct references illustrating the layer of bone marrow(majjadharakala) in the classical texts, it can be observed as the thin layer of tissue called endosteum. This is the lining in the bone cavity that separates bone cells and bone marrow.

===Types of bone marrow===

There are two types of bone marrow viz. red bone marrow and yellow bone marrow.

In yellow bone marrow, there is an abundance of fat cells with less amount of blood-forming tissue. In early childhood, red bone marrow is predominantly observed. In adult life, the fatty bone marrow retains the essential reticular structure of the hemopoietic tissue. It is capable of turning into red bone marrow under suitable stimulus like starvation.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.143</ref>

In red bone marrow, there are phagocytic endothelial cells. It is full of erythrocytes in different stages of formation and immensely vascular consisting of arteries, veins, and rich plexus of sinusoid.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.144</ref>

==Function==

The functions of majja dhatu are providing unctuousness(snehana), strength(bala), filling of bone cavity (asthi poorana) and nourishment of its successor [[shukra dhatu]] (shukra pushti). [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

===Causes of vitiation===
The channels of transportation and transformation of majja dhatu are afflicted due to the following causes[Cha. Sa. [[Vimana Sthana]] 5/18]

====Dietary causes====

Excess and frequent consumption of incompatible food (viruddha ahara)

====Exogenous causes ====

*crushing injury

*excessive discharge causing pressure

*trauma

*compression

=== Abnormal states ===

The increase or decrease in quality and/or quantity of majja dhatu can lead to various abnormal conditions. These states can be assessed by the following clinical features.

==== Signs of decrease ====

*atrophy of bone tissues

*weakness/giddiness

*lightness of bones (porosity of bones or decreased bone density)

*susceptibility to vata dominant disorders / frequent vata disorders

*depletion of semen formation

*pain in joints

*cutting pain in bones

*constant dull pain and emptiness of bones

*dimness of vision

[Cha. Sa. [[Sutra Sthana]] 17/68], [Su. Sa. Sutra Sthana 15/9], [A. Hr. Sutra Sthana 11/19]

==== Signs of increase ====

*heaviness in eyes

*heaviness in entire body

*formation of carbuncles/ with broad base on joints/synapses which are difficult to cure
[Su. Sa. Sutra Sthana 15/14], [A. Hr. Sutra Sthana 11/11]

===Clinical features of vitiation of channels of transport and transformation of majja dhatu===

*Pain in the joints, giddiness, unconsciousness, blackouts and deep-rooted abscess in joints are caused due to vitiation of channels of transport and transformation of majja dhatu. [Cha. Sa. [[Sutra Sthana]] 28/17-18].

===Role of majja dhatu as vitiated factor in disease===

Majja dhatu is involved in the pathogenesis of the following diseases

*Urinary disease including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/7]

*Diseases due to vitiation of vata [Cha. Sa. [[Chikitsa Sthana]] 28/73]

*Abscess (vidradhi)[Su. Sa. Nidana Sthana 9/34]

*When the vitiated doshas afflict bone marrow (majja dhatu), the quaternary fever (chaturthaka jwara) is manifested. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*When the vitiated doshas are located in the majja dhatu then the following signs and symptoms appear hiccups, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*Majja is mentioned as one among the eight locations of wounds (vrana), and the other sites being skin, blood vessels, flesh, bone, ligament, vital parts, and viscera. [Cha. Sa. [[Chikitsa Sthana]] 25/26]

*When vitiated [[vata]] is located in bones ([[asthi]]) and marrow(majja), it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/ 33]

*When the [[vata]] is occluded in the marrow, there will be stretching and stiffening of the trunk and extremities, excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). [Cha. Sa. [[Chikitsa Sthana]] 28/ 67-68]

===Prognosis===

*If the vitiated doshas are located in majja dhatu in the case of jwara, it is difficult to treat.[Cha. Sa. [[Chikitsa Sthana]] 3/83]

*A type of abscess (vidradhi) in bone marrow(majjaparipaka vidradhi)has a bad prognosis. Surgical intervention. (shastra sadhya) is needed to treat it. [Su. Sa. Nidana Sthana 9/38]

==Importance in the preservation of health and prevention ==

*Majja dhatu is specifically important for providing strength to bones and nourishment to reproductive tissues.

*Longevity, strength, learning ability, wealth, understanding, progeny, and social respect depend upon superior quality of majja dhatu. [Cha. Sa.[[ Vimana Sthana]] 8/108]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The diseases of vitiation of Majja dhatu shall be treated with food and medicines having sweet and bitter taste. Exercise and body purification treatments in proper dose and time are also indicated. [Cha. Sa. [[Sutra Sthana]] 28/28]

*When the doshas causing fever (jwara) are located in bone tissue ([[asthi dhatu]]) and marrow(majja dhatu), un-unctuous enema (niruha [[basti]]) and unctuous enema (anuvasana [[basti]]) are indicated. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

*The diseases due to aggravation of [[vata dosha]] are treated with medicated ghee, oil, muscle fat, and bone marrow obtained from animal bones. This is done either by oral administration or by external applications like massage or enema. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

===Internal administration of animal bone marrow(majja) for therapeutic oleation===

====Indications====

*Animal bone marrow(majja) is used for therapeutic purposes to improve strength, semen ([[shukra]]),nutrient fluid ([[rasa]]), [[kapha dosha]], adipose tissue ([[meda]]) and bone marrow (majja) itself. It especially strengthens bones and useful for oleation. [Cha. Sa. [[Sutra Sthana]] 13/17]

==== Suitable conditions ====

Animal bone marrow (majja) is administered in those persons with strong digestive power; those who can tolerate excessive physical exertion; who often eat excess food, unctuous fatty substances; who suffer from [[vata]] disorders, and have hard bowel movement(habitual constipation). [Cha. Sa. [[Sutra Sthana]] 13/50-51] The most suitable season for consuming marrow is spring. [Cha. Sa. [[Sutra Sthana]] 13/18]

== Contemporary approach ==

Majja dhatu can be referred to as bone marrow tissue in contemporary physiology. The following information is available<ref>Available from https//en.wikipedia.org/wiki/Bone_marrow accessed on 05/06/2020</ref> and can be referred to further understand the concept of majja dhatu.

===Form and site===

Bone marrow is a semi-solid tissue found within the spongy or cancellous portions of bones.<ref> C., Farhi, Diane (2009). Pathology of bone marrow and blood cells (2nd ed.). Philadelphia Wolters Kluwer Health/Lippincott William & Wilkins. ISBN 9780781770934. OCLC 191807944.</ref>

=== Composition ===
It is composed of hematopoietic cells, marrow adipose tissue, and supportive stromal cells.

=== Quantity ===
Bone marrow comprises approximately 5% of total body mass in healthy adult humans.<ref>Hindorf, C.; Glatting, G.; Chiesa, C.; Lindén, O.; Flux, G. (2010). "EANM Dosimetry Committee guidelines for bone marrow and whole-body dosimetry". Eur J Nucl Med Mol Imaging. 37 (6) 1238–1250. doi10.1007/s00259-010-1422-4. PMID 20411259.</ref>

===Functions===

Bone marrow is the primary site of new blood cell production or hematopoiesis.<ref>Arikan, Hüseyin; Çiçek, Kerim (2014). "Haematology of amphibians and reptiles a review" (PDF). North-Western Journal of Zoology. 10 190–209</ref> Human marrow produces approximately 500 billion blood cells per day, which join the systemic circulation via permeable vasculature sinusoids within the medullary cavity.<ref>Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1) 82–96. Bibcode2016NYASA1370...82B. doi10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419</ref> All types of hematopoietic cells, including both myeloid and lymphoid lineages, are created in the bone marrow; however, lymphoid cells must migrate to other lymphoid organs (e.g. thymus) in order to complete maturation.

==== Mesenchymal stem cells ====

The bone marrow stroma contains mesenchymal stem cells (MSCs).<ref>Raphael Rubin & David S. Strayer (2007). Rubin's Pathology Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 90. ISBN 978-0-7817-9516-6.</ref> These are also known as marrow stromal cells. These are multipotent stem cells that can differentiate into a variety of cell types. MSCs have been shown to differentiate, in vitro or in vivo, into osteoblasts, chondrocytes, myocytes, marrow adipocytes and beta-pancreatic islets cells.

===Investigation techniques===

===Imaging===

CT imaging is useful for assessing the marrow cavity of bones, although with low sensitivity and specificity.
MRI is more sensitive and specific for assessing bone composition. MRI enables assessment of the average molecular composition of soft tissues, and thus provides information regarding the relative fat content of marrow.

===Pathological studies===

Histopathological studies of bone marrow are carried out by obtaining samples of bone marrow via biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, anemia, and pancytopenia.

===Donation and transplantation===

Bone marrow transplants can be conducted to treat severe diseases of the bone marrow, including certain forms of cancer such as leukemia. Additionally, bone marrow stem cells have been successfully transformed into functional neural cells,<ref>Antibody Transforms Stem Cells Directly Into Brain Cells". Science Daily. 22 April 2013. Retrieved 24 April 2013.</ref> and can also potentially be used to treat illnesses such as inflammatory bowel disease.<ref>Research Supports Promise of Cell Therapy for Bowel Disease". Wake Forest Baptist Medical Center. 28 February 2013. Retrieved 5 March 2013</ref>

==Current researches ==

*Replacement of red hematopoietic bone marrow with yellow adipocyte-rich marrow is a conserved physiological process among mammals. Several important molecular characteristics of bone marrow adipose tissue (BMAT) are distinct from the classical depots of white and brown fat tissue. This depot of fat has recently emerged as an active part of the bone marrow niche that exerts paracrine and endocrine functions thereby controlling osteogenesis and hematopoiesis.<ref>Ambrosi TH, Schulz TJ ,The emerging role of bone marrow adipose tissue in bone health and dysfunction,J Mol Med (Berl). 2017 Dec;95(12)1291-1301. doi 10.1007/s00109-017-1604-7. Epub 2017 Nov 3</ref>

*Bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential of differentiation and they secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref>Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2)134-45. doi 10.15283/ijsc.2015.8.2.134</ref>

*In a clinical study, it is observed that majja basti (therapeutic enema with bone marrow) along with oral intake of asthi shrinkhala(Cissus quadrangularis) shows encouraging results in the management of osteoporosis (asthi-majjakshaya) and it also improves the general health of the patients.<ref>Ajay K. Gupta et al, Effect of Majja Basti (therapeutic enema) and Asthi Shrinkhala (Cissus quadrangularis) in the management ofOsteoporosis (Asthi-Majjakshaya),AYU , Jan-Mar 2012 , Vol 33 ,Issue 1,pg.110-113</ref>

=== Further scope of research ===

Bone marrow is used in therapeutics as food and administration through enema. Studies are needed to evaluate the effect of oral and per rectal administration of animal bone marrow (majja basti) in the management of diseases of bone marrow. It can open a new window in the treatment of severe diseases like leukemia.

=== List of theses done ===

#Ajay K Gupta (2010): Effect of majja basti&asthi shrinkhala in the management of osteoporosis w.s.r. to asthi-majja kshaya-A clinical study, department of panchakarma, IPGT &RA, Jamnagar.
#Saurabh R Bhuva(2012): A Comparative Study of Matra Basti and Brimhana Snehana by Asthishrinkhala Ghrita in the management of Asthi-Majja Kshaya w.s.r. to Osteopenia / Osteoporosis, department of panchakarma, IPGT &RA, Jamnagar.

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Shukra dhatu]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*H. = Hrudaya

=== References from [[Charak Samhita]] ===

The list of references for majja dhatu in Charak Samhita can be seen [[Media:Majja_dhatu-reference_list.pdf|here.]]

== References ==

File:Majja dhatu-reference list.pdf

2020-07-05T16:57:08Z

Anagha:

Asthi dhatu

2020-07-05T16:55:46Z

Anagha:

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa. Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su.Sa.Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha. Sa. [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

1.Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

2.Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

3.Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

4.Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

5.Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

6.Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

7.Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

8.Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

9.Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

10.Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita

=== References from [[Charak Samhita]] ===

The list of references for asthi dhatu in Charak Samhita can be seen [[Media:Asthi_dhatu-_reference_list.pdf|here.]]

==References==

File:Asthi dhatu- reference list.pdf

2020-07-05T16:54:34Z

Anagha:

Meda dhatu

2020-07-05T16:53:14Z

Anagha:

Meda dhatu is the body component which indicates fat in general and adipose tissue in particular.<ref>Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020 </ref> Its important function is to oleate or lubricate (snehana). <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.435)

It is present in two forms:

#Fixed or bounded form is observed as stored fats in adipocytes.
#The free form is observed as circulating lipids like lipoproteins or free fatty acids.<ref>Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Meda Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.,
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 4, 2020
}}

==Etymology, derivation and meanings==

The word "meda" is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness.

The literary meanings of word meda are as follows:<ref>Sanskriti Jha and Srujan Jha. Amarkosha.</ref>

1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibers, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them.

In physiology, its proper seat is said to be the abdomen.

2. Morbid or unnatural obesity.

3. In general, obesity or fat in the body is denoted by the word meda.<ref>
Monier-Williams Sanskrit-English Dictionary, 1899, [Cologne record ID = 167817] [Printed book page 832 , 3], https://www.sanskrit-lexicon.unikoeln.de/scans/MWScan/2014/web/webtc/indexcaller.php</ref>

==Panchabhautika constitution and properties==

Meda dhatu has dominance of [[prithvi]], [[jala]] and [[agni mahabhuta]].

It possesses properties like unctuousness (snigdha) and heaviness(guru).<ref>Bhavaprakasha, purva khanda, Garbhaprakarana 207</ref>

== Physiological aspects ==

=== Formation and metabolism ===

Meda dhatu is formed from the unctuous portion of [[mamsa dhatu]] by action of factors responsible for metabolism of meda(medadhatvagni).[Cha. Sa [[Chikitsa Sthana]] 15/29-30]

There are two forms of meda dhatu in body:

1. '''Structural component (poshya meda dhatu):''' It is the form,that is stored in the layer of meda (medodhara kala). It is also called fixed or stored fat(baddha medas). This portion is located mainly in the omentum. This form is responsible for the nutrition of meda dhatu itself in case of starvation.

2. '''Circulating component (poshaka meda dhatu):''' This form is circulated with nutrient fluid or plasma ([[rasa dhatu]]) and blood([[rakta]]). It is free and unbound (abaddha medas). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.[[Nidana Sthana]] 4/7]

===Metabolic by-products and waste products (Upadhatu and mala)===

During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. [[Chikitsa Sthana]] 15/17]. Sweat and sebum are formed during this process as waste products (mala). [Cha.Sa. [[Chikitsa Sthana]] 15/18].

=== Quantity ===

The total quantity of meda dhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. [[Sharira Sthana]] 7/15]

=== Time span ===

The meda dhatu is formed on the 4th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]

=== Characteristics of best quality of adipose tissue (meda sara )===

The person endowed with best quality of meda dhatu has significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.[[Vimana Sthana]] 8/106]

=== Channels of transportation and transformation of meda dhatu (medovaha srotas)===

The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. [[Vimana Sthana]] 5/8]

Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. Sharira Sthana 9/12].

Vagbhata added [[mamsa dhatu]] to the origin with kidneys (vrikka).[A.S.Sharira Sthana 6/26]

Considering the above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment.

The following structures can be considered as components of the transportation and transformation system of meda dhatu.

=== Layer of meda dhatu (medodhara kala)===

It is the layer of fat present in the abdominal cavity, small bones and long bones. In the abdominal cavity, it is present in the form of visceral fats.
Meda dhatu present in the long and big bones is known as marrow ([[majja]]).That present inside the small bones is termed as red marrow (sarakta meda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. Sharira Sthana 4/13]

===Role of meda dhatu in embryonic development===

During embryo-genesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism([[agni]])that makes them elastic and smooth. Ligaments(snayu) are formed after the strong action of factors responsible for metabolism([[agni]]) that makes them hard. [Su. Sa. Sharira Sthana 4/29-30]

The kidneys (vrikka) are formed from the unification of the essence of blood tissue([[rakta dhatu]])and adipose tissue (meda dhatu).The testis(vrishana) are formed from the unification of the essence of adipose tissue (meda dhatu),muscle tissue ([[mamsa dhatu]]), blood tissue ([[rakta dhatu]]) and [[kapha dosha]]. [Su. Sa. Sharira Sthana 4/31]

== Functions ==

Meda dhatu is responsible for functions of lubrication(sneha), sweating (sweda), stability (dridhatwam), and nourishment of bone tissue([[asthi]]pushti). [Su. Sa. Sutra Sthana 15/5]

== Importance in diagnosis ==

===Causes of vitiation===

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by the sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food, and alcoholic drinks. [Cha. Sa. [[Vimana Sthana]] 5/16]

=== Abnormal states ===
The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Decrease of meda dhatu ====

Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. [[Sutra Sthana]] 17/66], [Su. Sa. Sutra Sthana 15/9]

====Increase of meda dhatu====
The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation ===

*Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. [[Sutra Sthana]] 28/15]

*The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.[[Chikitsa Sthana]] 6/13-14]

*The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.[[Sutra Sthana]] 21/3]

*When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.Sharira Sthana 9/12]

=== Role of meda dhatu as vitiated factor in diseases ===

Meda dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/8]
*vitiligo (Shwitra) [Cha. Sa. [[Chikitsa Sthana]] 7/174]
*swelling (Shotha) [Cha. Sa. [[Chikitsa Sthana]] 12/94]
*Anaemia(Pandu)[Cha.Sa. [[Chikitsa Sthana]] 16/6]
*Disorders of thigh and hip (Urusthambha) [Cha. Sa. [[Chikitsa Sthana]] 27/14]
*Obesity (Sthaulya)[Cha. Sa. [[Sutra Sthana]] 21/5-8]
*Vitiated dosha located in the channels of transport of medadhatu (medovahasrotas)cause quaternary fever (chaturthaka jwara).[Cha. Sa. [[Chikitsa Sthana]] 3/66]
*The clinical features of fever due to vitiation of meda dhatu by [[pitta dosha]] (medadhatugata jwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. [[Chikitsa Sthana]] 3/79].
*When vitiated vata is located in [[mamsa]] and meda dhatu, it manifests by producing symptoms like heaviness of the body, pricking pain, and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. [[Chikitsa Sthana]] 28/32].
*When the [[vata]] is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. [[Chikitsa Sthana]] 28/66].
*Obesity (Sthaulya) is defined as an excessive increase of meda and [[mamsa dhatu]] in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. [[Sutra Sthana]] 21/5-9].

== Importance of concept in the preservation of health and prevention ==

Meda dhatu provides unctuousness to all body components. Unctuousness is the essential property of the essence of all seven [[dhatu]] ([[ojas]]). It is related to vitality and immunity of the body. [Cha.Sa. [[Chikitsa Sthana]] 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.[[Sutra Sthana]] 22/11] These are important in various physiological processes and functions of the body.

==Management ==
*Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.[[Sutra Sthana]]22]

The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. [[Sutra Sthana]] 21/21-22]
*Food and drinks that alleviate vata dosha and reduce kapha dosha and meda dhatu (fat),
*Therapeutic enema processed with drugs of sharply acting, dry and hot properties,
*Dry powder massage (udwartana),
*Use of guduchi (Tinospora cordifolia Miers), musta (Cyperusrotundus Linn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belerica Roxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey.
*The condition of fever due to pitta dosha in [[mamsa dhatu]] and meda dhatu is managed by therapeutic purgation ([[virechana]]) and fasting (upavasa). [Cha. Sa. [[Chikitsa Sthana]] 3/316].
*The treatment measures for vata located in meda dhatu are therapeutic purgation ([[virechana]]), evacuative enema([[basti]]) and palliative measures(shamana). [Cha. Sa. [[Chikitsa Sthana]] 28/93].

== Contemporary approach ==
*In conventional physiology, the concept of meda dhatu is perceived in view of adipose tissue, fats, and lipids. <ref>Vandana Verma, Sonam Agrawal, & Sangeeta Gehlot. (2020). Exploration of Ayurveda blueprint on clinical physiology of Meda (adipose tissue) and Majja Dhatu (bone marrow) in context to obesity. International Journal of Research in Pharmaceutical Sciences, 11(1), 358-367. https://doi.org/10.26452/ijrps.v11i1.1830</ref> Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Origin and formation ===

Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.<ref>Available from https://embryology.med.unsw.edu.au/embryology/index.php/Adipose_Tissue_Development cited on 18/05/2020</ref>
Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy.<ref>Birbrair A, Zhang T, Wang ZM, Messi ML, Enikolopov GN, Mintz A, Delbono O (August 2013). "Role of pericytes in skeletal muscle regeneration and fat accumulation". Stem Cells and Development. 22 (16): 2298–314. doi:10.1089/scd.2012.0647. PMC 3730538. PMID 23517218</ref> Adipocytes are derived from mesenchymal stem cells through adipogenesis.

There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.<ref name=abc>Available from https://en.wikipedia.org/wiki/Adipocyte#cite_note-Birbrair_2298%E2%80%932314-1</ref> The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.

The third but poorly understood marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cells expand in states of low bone density but additionally expands in the setting of obesity.<ref>Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J (August 2017). "Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice". Journal of Bone and Mineral Research. 32 (8): 1692–1702. doi:10.1002/jbmr.3159. PMC 5550355. PMID 28436105</ref>

=== Embryonic development ===

Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle, or bone. The fibroblast are preadipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6

=== Quantity and measurement ===

The total weight of fat in an average human adult measures about 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show a fourfold increase in size before dividing and increasing the absolute number of fat cells present.<ref>Robert P (2001). Fat: fighting the obesity epidemic. Oxford [Oxfordshire]: Oxford University Press. pp. 68. ISBN 978-0-19-511853-7</ref>

=== Functions ===

==== Storage of fat ====

The fat is stored in the body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.<ref>KAvailable from https://en.wikipedia.org/wiki/Adipocyte#cite_note-:0-3 cited on 18/05/2020</ref>

==== Generation of heat ====

The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.<ref name=abc/>

==== Adaptation ====

The fat cells tend to increase in size to store more fat in case needed. This expansion of fat mass leads to obesity.

=== Investigations ===

The levels of meda dhatu can be investigated through various assessment parameters like:

#Body mass index
#Waist: hip ratio
#Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
#Estimation of total cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
#Serum insulin

=== Role of adipocytes in causing obesity and diabetes ===

From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation of meda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha).

This patho-physiology can be linked as follows:

Excess nutrition leads to the expansion of fat mass and an increase in the size of adipocytes (hypertrophy).<ref>Bluher M (June 2009). "Adipose tissue dysfunction in obesity". Experimental and Clinical Endocrinology & Diabetes. 117 (6): 241–50. doi:10.1055/s-0029-1192044. PMID 19358089</ref> This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance.<ref>Kahn SE, Hull RL, Utzschneider KM (December 2006). "Mechanisms linking obesity to insulin resistance and type 2 diabetes". Nature. 444 (7121): 840-6. doi:10.1038/nature05482. PMID 17167471</ref> Insulin plays a major role in fat production in adipocytes, synthesis of unsaturated fatty acids, and stimulating lipogenesis. It also plays a role in the uptake of glucose by muscles.<ref>Kahn BB, Flier JS (August 2000). "Obesity and insulin resistance". The Journal of Clinical Investigation. 106 (4): 473–81. doi:10.1172/JCI10842. PMC 380258. PMID 10953022</ref> The malfunctioning of insulin in turn leads to diabetes.

== Current researches ==

An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individuals showed significantly positive relationship with values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high-density lipoproteins), comparatively low values of LDL (low-density lipoproteins), and serum cholesterol.<ref>Najneen M. Bhaldar et al,An Observational Study of Medadhatu Sarata w.s.r. to Lipid Profile, International Journal of Research & Review , Vol.5; Issue: 10; October 2018</ref>

===List of theses ===

Very few research works have been carried out on fundamental approach towards the concept of meda dhatu.

Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and the effect of Ayurveda therapies in their management.

Hyperlipidemia and dyslipidemia are two other disorders related to meda dhatu.

1. Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar

2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar

4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.

6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar.

7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With Medoghna Rasayana Vati, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effect Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of Triphaladi Vati and Shilajitwadi Vati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.

12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, I.P.G.T. & R.A., Jamnagar.

13. Yogesh K Patil (2010) : A Comparative Study of Nyagrodhadi Vati and Gokshuradi Guggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

14.Falguni S Patel (2010) :A Clinical Study of Tryushnadhya Lauha Vati in the Management of Sthaulya w.s.r. to Obesity, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

16.Kanwar S Singh(2011) : Study on Apathyanimittaja Prameha (Type 2 Diabetes) and its Management with Saptarangyadi Ghana vati (A Clinico-Experimental study), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in Apathya Nimittaja Prameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

19.Chitra Devi Sharma (2013) : Comparative Study of Asanadi yoga Vati and Shilajitwadi Vati in the management of Madhumeha w.s.r. to Diabetes mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

20.MalivadShila (2014) : A Comparative Study of Vidangadi Lauh and Triphaladi Vati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

21.Jatin M Vyas (2014) : A Comparative Study of Bilvadi Panchmool Ghana vati and Navaka Guggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,I.P.G.T. & R. A., Jamnagar.

22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadi guggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

23. Bhushan Bhav Ram Prakash Niranjan (2014) : Management of Apathyanimittaja Prameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[Snehadhyaya]], [[Langhanabrimhaniya Adhyaya]], [[Ashtauninditiya Adhyaya]], [[Santarpaniya Adhyaya]]
[[ Grahani Chikitsa]],[[Prameha Nidana]],[[Prameha Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

==External links ==

[[Adipocyte]], [[fat cells]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*S. = Sangraha

=== References from [[Charak Samhita]] ===

The list of references for meda dhatu in Charak Samhita can be seen [[Media:Meda_dhatu-_reference_list.pdf|here.]]

==References==

File:Meda dhatu- reference list.pdf

2020-07-05T16:51:50Z

Anagha:

Rakta dhatu

2020-07-05T16:51:05Z

Anagha: /* References from Charak Samhita */

Rakta dhatu is a body component similar to blood tissue. Its important function is to give life or maintain vitality(jivana). Body fluid (rasa dhatu) after acquiring ‘red’ color is termed as “rakta”(blood).<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.429)

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Rakta Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.
|label3 = Reviewer
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 18, 2020
}}
==Etymology and derivation==

The word ‘Rakta’ is derived from Sanskrit root “ranj”, meaning–to dye or colour, to affect or move, to excite/glad/charm/delight.<ref>Monier Williams (1899), “रक्त”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 0861.</ref>
==Synonyms ==
Shonita, rudhira, asrik, astra,lohita,kshataja

*'''Shonita''': The term is derived from ‘shona’ meaning red color. The term is also applied to denote the female genetic prototype.<ref>Available from https://www.wisdomlib.org/definition/shonita</ref>

*'''Rudhira''': The term is derived from root ‘rudh’ meaning to stop or hold. The blood tissue sustains the life of human beings, hence it is called ‘rudhira’’. [Su. Sam. Sutra Sthana 14/39]

*'''Lohita''': The term indicates the coppery red color of blood. [Su. Sa. Sutra Sthana 14/5]

*'''Asrik/Asra''': The term is derived from Sanskrit root ‘ashukshepane, srijvisarge'. It means to get ejected or expelled out. This synonym is used in the context of excessive bleeding. E.g.menorrhagia(asrigdara), bleeding disorders(asrapitta/raktapitta)

*'''Kshataja''': It means that which originates from trauma (kshata) or wound/ulcer (vrana).

==Meanings in different contexts ==

In different contexts, the word rakta denotes blood tissue (rakta dhatu), menstrual blood (raja or [[artava]]), ovum (shonita or streebeeja), red color, metals like copper, indulgence in some passion or desire.

Life begins with the unification of live sperm(shukra) and live ovum (shonita). The word ‘shonita’ denotes ‘fertile ovum’ whenever it is used in context of conception. [Cha. Sa. [[Sharira Sthana]] 3/3]

Otherwise, in general physiology, shonita denotes blood tissue (rakta dhatu).
The term ‘jeevarakta’ denotes fresh blood. [Su. Sa. Sutra Sthana 14/8]

==Panchabhautika constitution and properties: ==

The Rakta dhatu is constituted with the dominance of [[agni mahabhuta]] and all other [[mahabhuta]]. It possesses properties like peculiar smell (vistrata), liquidity(dravata), red color(raga), pulsation(spandanam) and lightness to get circulated (laghuta) due to [[Prithvi]],[[ jala]],[[teja]], [[vayu]] and [[akasha mahabhuta]] are spectively. [Su.Sa. Sutra Sthana 14/9]

Rakta dhatu is neither too hot nor too cold(anushna-sheeta), sweet (madhura), unctuous (snigdha), red(rakta), heavy(guru), with peculiar smell (vistra).It can get affected by the same substances that provoke [[pitta dosha]].[Su. Sa. Sutra Sthana 21/17]

==Formation and metabolism of rakta dhatu==

*The rakta dhatu is formed from its predecessor [[rasa dhatu]]. The nourishing portion of [[rasa dhatu]] and constituents of nutrient fluid (ahara rasa) are transformed into rakta dhatu by action of ranjakapitta (type of [[pitta]] responsible for colour pigments). [Cha. Sa. [[Chikitsa Sthana]] 15/28] This process takes place in liver and spleen.[Su.Sa.Sutra Sthana 14/4-5]

*The pure blood is formed as per the suitable conditions at the place of living, season, and adaptation. [Cha. Sa. [[Sutra Sthana]] 24/3]

===Location:===
As per contemporary theories, in the early stages of embryogenesis, blood formation (hematopoiesis) occurs in blood islands. These are aggregates of blood cells in the yolk sac. As development progresses, blood formation occurs in the spleen, liver, and lymph nodes. These are the primary site until the first three months of gestation. In the seventh month of gestation, after the development of bone marrow, it eventually becomes the major site of formation of most of the blood cells for the entire organism.<ref>Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1): 82–96. Bibcode:2016NYASA1370...82B. doi:10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419.</ref> Hematopoietic stem cells (HSCs) in the bone marrow give rise to all of the different mature blood cell types and tissues. In children, hematopoiesis occurs in the marrow of the long bones such as the femur and tibia. In adults, it occurs mainly in the pelvis, cranium, vertebrae, and sternum.<ref>Fernández KS, de Alarcón PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>
Sushruta highlighted the presence of adipose tissue ([[meda dhatu]]) in the medulla of bone. The adipose tissue ([[meda dhatu]]) present in long and big bones is known as marrow ([[majja]]). That present inside the small bones is termed as red marrow (saraktameda). [Su. Sa. Sharira Sthana 4/13]

This unctuous portion in the bone marrow can be linked to the formation of blood as per current views.

The liver acts as the major blood reservoir. It stores about 450 milliliters or almost 10 percent of the body's total blood volume. This capacity can increase up to 1 litre in certain cases due to the expanding capacity of the liver. It synthesizes some proteins including coagulation factors I (fibrinogen), II (prothrombin), V, VII, VIII, IX, X, XI, XII, XIII, as well as protein C, protein S and antithrombin. All of these play important roles in blood physiology. Moreover, the liver is a major site of production for thrombopoietin, a glycoprotein hormone that regulates the production of platelets by the bone marrow. The liver plays a major role in glucose, protein, and lipids present in the blood. It also purifies and protects blood from harmful toxins, metabolites, and heavy metals.<ref>Available from https://en.wikipedia.org/wiki/Liver accessed on 15/06/2020</ref>

Thus, bone marrow is the site of formation of blood cells; whereas the liver is the major site in maturation of blood cells and maintaining the physiological status of blood tissue.

==Metabolic byproducts and waste products (Upadhatu and mala):==

During the process of metabolism and formation of rakta dhatu, tendons(kandara) and veins(sira) are formed as the metabolic byproducts(upadhatu).[Cha. Sa.[[Chikitsa Sthana]] 15/17]. Sharangadhara opines menstrual blood([[artava]]) as the metabolic by-product.
[Sha. Sa. Purva khanda chapter 5]

Various pigments and acidic secretions are formed as waste during this process. These are termed as malarupa [[pitta]].[Cha.Sa. Sutra Sthana 15/5]

===Quantity of Rakta:===
The quantity of rakta is eight anjali. One Anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person specific.[Cha. Sa. [[Sharira Sthana]] 8/15]

===Timespan:===
Rakta dhatu is formed in a time span of 6030 kala (ten days). [Su. Sa. Sutra Sthana 14/14]

==Characteristics of pure blood==
The color of pure blood is like golden red, firefly, red lotus, lac-resinous material(laksha), and fruit of Gunja (Abrusprecatorius Linn.). [Cha. Sa. [[Sutra Sthana]] 24/22]

The person with pure blood has glowing complexion, well-functioning sense organs, and a cheerful state of mind. His digestion and natural urges are normal. He is endowed with happiness, satiety, and strength. [Cha. Sa. [[Sutra Sthana]] 24/24].

===Characteristics of best quality of blood tissue (raktasara ): ===

The characteristics of the essence of rakta dhatu can be observed on ears, eyes, face, tongue, nose, lips, palms, soles, nails, forehead and genitals. These body parts are unctuous, red, beautiful and shining. The persons are endowed with happiness, sharp intellect, magnanimity, tenderness, moderate strength, lack of endurance, and intolerance to heat.[ Cha. Sa. [[Vimana Sthana]] 8/104]

==Physiological aspects: ==
===Channels of transportation and transformation of rakta dhatu (raktavahasrotas):===
The channels of transportation and transformation of rakta dhatu (raktavahasrotasa) originates from liver and spleen.[Cha. Sa. [[Vimana Sthana]] 5/8]The blood components are formed in the liver and spleen. It is circulated through blood vessels like arteries (dhamani). [Su. Sa. Sharira Sthana 9/12]. Considering the important role of bone marrow in the formation of blood cells, it can be included as an additional site in channels of transportation and transformation of rakta dhatu (raktavhasrotas).

There are various other structures related to rakta dhatu. These can be included in the channels of transportation and transformation.
===Layer of blood tissue (raktadharakala):===
Kala is the layer in outer coverings of the body observed in sagittal section. The layer of formation of blood tissue (raktadhara kala) is second beneath the layer of skin and muscles (mamsadhara kala). It is made of blood vessels connected with the liver and spleen. [Su. Sa. Sharira Sthana 4/10]

==Functions:==
===General physiological functions:===
Giving life and sustaining vitality (Jeevana), enhancing complexion(varna prasadana), nourishing successor muscle tissue and other components ([[mamsa dhatu]] poshana) are the main functions of rakta dhatu. [Su. Sa. Sutra Sthana 15/5] The vitality depends on blood. [Cha. Sa.[[Sutra Sthana]] 24/4]

===Role of rakta in the formation of body organs:===
During embryogenesis, various organs are developed from dhatu by action of factors responsible for digestion and metabolism(agni).

The following table shows details of the role of rakta dhatu in the formation of body organs.
{| class="wikitable"
|-
! Sr.no. !!Body organ !! Factors responsible for its formation
|-
| 1. || Liver || Shonita(pure blood)
|-
| 2. || Speen || Shonita(pure blood)
|-
| 3. || Lungs || Shonitaphena(froth in pure blood)
|-
| 4. || Appendix || Shoinitakitta(waste in formation of pure blood)
|-
| 5. || Intestine, anus and urinary bladder || Asrija + shelshmaprasad acted upon by pitta and vayu(essence of blood and kaphadosha)
|-
| 6. || Tongue || Kapha + shonita + mamsasara(essence of kapha, blood and muscles)
|-
| 7. || Kidneys || Rakta + meda prasada (essence of blood and muscles)
|-
| 8. || Testis || Mamsa + asrik + kapha + medaprasada(essence of muslces, blood, kapha and adipose tissue)
|-
| 9. || Heart || Shonita + kaphaprasada (essence of blood and kapha)
|}
[Su. Sa. Sharira Sthana 4/25-31]

*Rakta is one among the ten seats of vitality(dashapranayatanani). [Su. Sa. Sharira Sthana 7/9]
*Rakta is the primary site of [[pitta dosha]]. [Cha. Sa. [[Sutra Sthana]] 20/8]

==Importance in diagnosis ==
===Causes of vitiation===
The formation of blood is affected by following factors:

'''Dietary causes''':

*Habitual intake of spoiled or unsuitable food and/or liquids

*overeating

*acidic or pungent liquor and other similar drinks

*too much salty, alkaline substances

*sour and pungent food

*Dolichosbiflorus Linn. (kulatha)

*Phaseolus mungo Linn. (masha)

*Dolichos lablab Linn. (nishpava)

*Sesamum indicum Linn. oil (tila taila)

*Randiauliginosa DC.(pindalu)

*radish and all green (leafy) vegetables

*meat of aquatic and marshy animals, burrowing animals and those that snatch birds

*excessive intake of curd

*sour whey (curd-water), vinegars and other sour fermented liquids

*consuming decomposed, putrid food with opposite properties

*indigestion

*taking meal during indigestion

'''Lifestyle factors:'''

*excessive sleeping during the day especially after taking liquids, unctuous and heavy food

*excessive anger

*excessive exposure to the sun and the wind

*suppression of the natural urges like vomiting

*avoidance of blood-letting in prescribed time (autumn)

*too much exertion

*injury

*heat

'''Environmental factors:'''

Due to natural conditions in autumn season. [Cha. Sa. [[Sutra Sthana]] 24/5-10]

The channels of transportation and transformation of blood (raktavahasrotas) is affected due to the following causes:

Excess consumption of pungent and spicy food and drinks that cause burning sensation, unctuous, hot and liquid food, exposure to sun-heat, or fire. [Cha. Sa. [[Vimana Sthana]] 5/14].

===Abnormal states===

The physician should diagnose the quantitative and qualitative imbalance of rakta by observing various features manifested due to decrease(kshaya) and increase(vridhi).

===Clinical features of decrease:===

*Symptoms of decrease of rakta are roughness of skin, cracks, dullness, and dryness of skin.[Cha. Sa. [[Sutra Sthana]] 17/65]. In addition, craving for sour food, liking for cold substances, looseness of blood vessels is also observed.[Su. Sa. Sutra Sthana 15/9].

===Clinical features of increase:===

*Reddish discolouration of eyes and other body parts and fullness of veins are considered as the signs of increase of rakta dhatu. [Su. Sa. Sutra Sthana 15/10].

===Disorders due to blood vitiation:===

'''Following disorders are caused by blood vitiation:'''

Stomatitis, redness in eyes, foul smell in nose and mouth, gulma (abdominal lump), gingivitis (upakusha), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, vatarakta, discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, extreme debility, anorexia, headache, burning sensation after meals, bitter and sour eructation, physical and mental exhaustion, excessive anger, state of confusion, saline taste in mouth, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc.

The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by impure blood. [Cha. Sa. [[Sutra Sthana]] 24/11-17]

===Clinical features of vitiation of channels of transportation and transformation of blood (raktavahasrotasa):===

'''Following clinical conditions are observed due to affection of channels of transportation and transformation of blood:
'''

Skin diseases (kushtha), erysipelas (visarpa), furuncles (pidaka), bleeding disorders(raktapitta), asrigdara(menorrhagia), inflammation of anus, penis, oral cavity, splenic disorders (pliha), abdominal lump (gulma), abscess (vidradhi), blue mole (nilika), jaundice (kamala), freckles/blemish (vyanga), portwine mark (piplu), black mole of the size of sesame seed (tilakalaka), ringworm (dadru), dermatitis (charmadala), leukoderma (shvitra), scabies (pama), urticaria (kotha), and circular erythema (asra mandala).[Cha. Sa. [[Sutra Sthana]] 28/11-13]

===Role of rakta dhatu as vitiated factor in disease:===

Rakta plays a major role in the pathogenesis of the following diseases:

*Bleeding disorders(raktapitta) [Cha.Sa.[[Chikitsa Sthana]] 4/7-9]

*Disease due to vata and rakta (vatarakta) [Cha. Sa. [[Chikitsa Sthana]] 29/10]

*erysipelas(visarpa) [Cha. Sa. Sutra Sthana 18/23] [Cha. Sa. [[Chikitsa Sthana]] 21/15]

*Intoxication(mada), syncope (moorcha), coma(sanyasa) [Cha. Sa. [[Sutra Sthana]] 24/25] skin diseases(kushtha) [Cha. Sa.[[Nidana Sthana]] 5/3]

*Obstinate urinary disorders including diabetes(prameha) [Cha. Sa.[[Nidana Sthana]] 4/7]

Subtypes of some diseases indicate the major role of rakta in their pathogenesis:

*Obstinate urinary disorders (raktameha) [Cha. Sa. [[Nidana Sthana]] 4/32]

*Micro-organisms originating in blood (shonitajaKrimi)[Cha.Sa.[[Vimana Sthana]] 7/11]

*Abdominal lump due to blood (raktagulma)[Cha. Sa. [[Chikitsa Sthana]] 5/18]

*Diarrhoea with blood (raktatisara)[Cha. Sa.[[Chikitsa Sthana]] 19/70]

*Abscess with blood (raktavidradhi) [Su. Sam. Nidana Sthana 9/14,26]

*In case of fever (jwara), when the vitiated [[dosha]] are located in the rakta dhatu, following clinical features are observed: Increase in body temperature, eruptions, thirst, frequent spitting mixed with blood burning sensation, discoloration, giddiness, intoxication, and incoherent speech. [Cha. Sa. [[Chikitsa Sthana]] 3/77]

*In fever (jwara) caused by trauma(abhighata),vitiated vata affects predominantly rakta (blood). This leads to clinical features like discomfort, swelling, discoloration, and pain.[Cha. Sa. [[Chikitsa Sthana]] 3/114].

*In all other exogenous causative injuries like poison (visha) etc, rakta dhatu is predominantly affected. In such cases, it has both diagnostic and therapeutic importance.

==Importance in preservation of health and prevention ==
The pure blood provides the individual with strength, complexion, happiness, and life. [Cha. Sa. [[Sutra Sthana]] 28/4].

It is the fundamental source of vitality and life. [Su. Sam. Sutra Sthana 14/44]

==Principles of management of diseases of rakta dhatu==

*The principles of management for disorders of rakta are mentioned as below [Cha. Sa.[[Sutra Sthana]] 24/18].

If there is excessive vitiation of rakta dhatu, then purification procedures are indicated. This includes therapeutic purgation ([[virechana]]) and bloodletting ([[rakta mokshana]]) after considering the strength of the patient.

In the case of mild to moderate severity of disease and in patients with low strength, pacification therapies (shamana) is indicated. This includes therapeutic fasting (upavasa) and management on the lines of bleeding disorders (raktapitta).

*In case of fever (jwara), the dosha located in rakta dhatu are treated with pouring of medicated liquids (seka) and ointment application (pradeha).[Cha. Sa. [[Chikitsa Sthana]] 3/316].

*In case of poisoning, the spread of toxins is arrested by applying cooling external application (pradeha and alepa) and poring medicated liquids (seka). [Cha. Sa. [[Chikitsa Sthana ]]23/42-43] It shows pacifying actions on vitiated rakta and [[pitta]]. [Su. Sa. Sutra Sthana 18/3]

===Best herbs in management (agryasamgraha):===
Some food items and herbs have excellent action on blood as follows: [Cha. Sa. [[Sutra Sthana]] 25/40].
{| class="wikitable"
|-
! Name !!Pharmacological effect
|-
|Goat milk (ajaksheera) || Pacifying raktapitta (bleeding disorders) (raktapittaprashamana)
|-
|Ananta (Hemidesmus indicus R.B.)or Indian sarsaparilla ||Astringent effect, pacifying raktapitta (Sangrahikaraktapittaprashamana)
|-
|Pollens of utpala (Nymphaca alba Linn.), kumuda (a variety of utpala) and padma (Nelumbo nucifera gaertn.) or pollen of blue and white water lilies || Astringent effect, alleviating raktapitta (sangrahikaraktapittaprashamana)
|-
|Bark of kutaja (Holarrhenaantidyscenterica wall.) or kurchi bark || Among astringent and desiccant of kapha, pitta and the blood (shlesma pitta raktasangrahikopsosananam).
|-
|Fruit of kashmari (Gmelina arboria) or fruit of white teak || Causing haemostasis and curing raktapitta (Raktasangrahikaraktapittaprashamana)
|-
|Guduchi (Tinosporacordifoliamiers) or amrita || Act as astringent, curative of vata, promotes digestion, curative of vitiation of kapha and blood (sangrahikavataharadipaniyashleshmashonitavibandhaprashamana).
|-
| Priyangu [Callicarpa macrophylla Vahi.] or the perfumed cherry || Alleviate the plethoric condition of blood and pitta (shonitapittatiyogaprashamana)
|}

===Physiological effect of various tastes on blood: ===
The substances with predominant tastes (rasa) produce physiological effects on rakta dhatu as shown below.[Cha. Sa. [[Sutra Sthana]] 26/43]
{| class="wikitable"
|-
! Rasa (taste) !!Effect
|-
| Sour(amla rasa) || Vitiates blood (raktam dushayati)
|-
| Salty(lavana rasa) || Increases volume(raktam vardhayati)
|-
| Pungent (katurasa ) || Breaks the blood clots/anti-coagulant (shonitasanghatam bhinatti)
|-
|Bitter (tiktarasa)|| Depletes the quantity of blood by absorbing fluid portion(raktam shoshayati)
|-
|Astringent(kashaya rasa)|| Pacifies vitiated blood (Raktaprashamana)
|}

The above factors are used in diagnosis as well as treatment.

E.g. Sour substances are known to vitiate blood, hence the patients with disorders due to vitiation of blood are advised to avoid sour substance. Instead, they are advised to consume bitter and astringent substances. The substances with pungent taste can be used to prevent coagulation.

==Contemporary approach ==
In contemporary physiology, red coloured fraction of blood is considered as rakta dhatu. The colourless fluid (plasma) is considered as rasa dhatu. Thus, rasa and rakta together form “blood”. The red fraction or red blood corpuscles are referred to as rakta dhatu in this article.
===Composition:===
Blood is a complex liquid tissue composed of different types of cells. The plasma which represents the matrix of this tissue constitutes over 55% of it. Formed elements that are suspended in the liquid matrix constitute over 45% of blood, these comprise of erythrocytes,leukocytes, and platelets.<ref name=dwaraka>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.343</ref> The characteristic color of blood is due to the erythrocytes present in it. These cells are formed in the red born marrow and they survive for about 80 days in circulation and then disintegrate. Their debris is removed from the blood by liver and spleen.<ref name=dwaraka></ref> Ranjaka pitta which gives color to rakta may be considered as the ayurvedic analogue of the red cobalt linked enzyme B12 present in the liver.<ref> Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.330</ref>

===Color: ===
The red color in blood is due to hemochrome present in the protein (hemoglobin). This is responsible for oxygen transport. Different groups of organisms use different proteins.

===Quantity:===
Blood accounts for 7% of the human body weight. The average adult has a blood volume of roughly 5 litres.
===Functions: ===
The blood has an important role in the physiology of the cardiovascular system and lymphatic system.

It carries important functions as below:

*Supply of oxygen to tissues (bound to hemoglobin, which is carried in red cells)

*Supply of nutrients such as glucose, amino acids, and fatty acids (dissolved in the blood or bound to plasma proteins (e.g., blood lipids)

*Removal of waste such as carbon dioxide, urea, and lactic acid

*Immunological functions, including circulation of white blood cells, and detection of foreign material by antibodies

*Coagulation, the response to a broken blood vessel, the conversion of blood from a liquid to a semisolid gel to stop bleeding

*Messenger functions, including the transport of hormones and the signaling of tissue damage

*Regulation of core body temperature

*Hydraulic functions

==Current researches ==
Hematopoietic stem cell transplantation (HSCT) is a curative modality for a wide variety of hematologic disorders. Early survival after HSCT is dependent on the occurrence of hepatic, cardiac, and pulmonary complications.<ref>Kim BK, Chung KW, Sun HS, Suh JG, Min WS, Kang CS, et al. Liver disease during the first post-transplant year in bone marrow transplantation recipients: retrospective study. Bone Marrow Transplant. 2000;26:193–7</ref> This depicts the role of blood as origin in the formation of these organs during embryonic life as mentioned above. More research on this topic can open new avenues in the field of tissue engineering.
===Future scope of research:===
Considering views about the physiology of blood formation and maturation, the role of adipose tissue in marrow (saraktameda and [[majja]]), its connection with liver and spleen need to be explored. This can open a new window in the treatment of diseases due to blood vitiation like skin diseases and bleeding disorders.

===List of theses done===
1. Mohanti Krishna (2000): Critical study on Sroto-Vigyaneeyam in Bruht-trayi w.s.r. to RaktavahaStroto-Dushti and its management, Dept of Basic Principles, IPGT&RA, Jamnagar.

2. Kulkarni Mayur P (2003): Concept of Dhatu-PradoshajaVikaras in Brihattrayee with the principle of management in Rakta-PradoshajaVikaras, Dept of Basic Principles, IPGT&RA, Jamnagar.

3. Shinde Vaishali S (2004): A study on the concept of Upadhatu in Samhitas with applied aspect to Artava-Dushti, Dept of Basic Principles, IPGT&RA, Jamnagar.

4. Kailash Chandra (2006): Applied concept of Kala and Svabhava and their role in Shonita Dusti, Dept of Basic Principles, IPGT&RA, Jamnagar.

5. Anil Avhad(2015): Applied study of Srotasa and Srotomula w.s.r to Raktavaha Srotodushti and its management.

==More information ==
===Related Chapters===
[[ Vidhishonitiya Adhyaya]] ,[[ Vividhashitapitiya Adhyaya]],[[ Grahani Chikitsa]]

Shonitavarnaniya Adhyaya[Su. Sam. Sutra Sthana 14]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

=== External links ===
[[Blood]]

=== Abbreviations ===
*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita

=== References from [[Charak Samhita]] ===

The list of references for rakta dhatu in Charak Samhita can be seen [[Media:Rakta_dhatu-reference_list.pdf|here.]]

==References==

Mamsa dhatu

2020-07-05T16:50:00Z

Anagha:

Mamsa literally means flesh or meat. "Mamsa dhatu" is a body component that denotes flesh and includes muscular tissue. Its important function is to cover body (lepana). It provides protective and structural covering above the skeleton. (SAT-B.433)<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>

As the name suggests, it is a bulky tissue and denotes the status of nutrition. Due to its solid-state, it provides proper size, shape and dimension to the body.

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Mamsa Dhatu

|label2 = Authors
|data2 = Anagha S.1, Deole Y.S.1, Shilawant A.2

|label3 = Reviewed by
|data3 = Basisht G.1

|label4 = Affiliations
|data4 = 1[[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar 2 Department of Kriya Sharir, G.J.Patel Institute of Ayurvedic Studies and Research, New Vallabh Vidyanagar, Anand, Gujarat, India

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = May 21, 2020
}}
== Meaning of term "Mamsa"==

=== Etymology and derivation ===

The word is derived from Sanskrit root called “Mans” meaning flesh or meat.<ref> Monier Williams (1899), “mamsa”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 805</ref> Mamsa dhatu is the component which enhances body mass, covers body parts, takes part in movements of joints and various parts of body.<ref>Jha Srujan. Amarkosha online application</ref>

=== Synonyms ===

'''Pishita''': Found to be separated in single fibers (Vibhakta in Peshi svaroopa)

'''Kravya''': Looks aggressive, fearful just be seeing it (Kuyate anena iti kravyam)

'''Palala''': Wrapped throughout body and having functional potential. (Kriya samarthyavaan)

'''Amisha''' : Creates greed to achieve it or have it.

'''Tarasa''' : Which is responsible for strength within the body (Bala)

'''Rakta teja, Raktodbhava''': Originated and developed from previous [[Rakta dhatu]]

'''Medaskrut''' : Involved in origin and development of next [[dhatu]] – [[Medas]]

=== Meanings in different contexts ===

* In physiology, the word denotes structural and functional components mainly of muscle tissue.

* In the classification of dietary articles, a separate group named class of meats ("mamsa varga") is described. It includes properties of meat of various animals and birds recommended for specific dietary and therapeutic purposes.[Cha. Sa. [[Sutra Sthana]] 27/35-87/]

* A dietary preparation of meat soup("mamsarasa – Veshavara") is best for nourishing the body.[Cha. Sa. [[Sutra Sthana]] 25/40]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

*[[Vayu]], [[jala]] and [[agni mahabhuta]] play major role in the formation of "mamsa". [Cha. Sa. [[Chikitsa Sthana]] 15/29] After formation, it has predominance of [[prithvi mahabhuta]].

*The physical properties of "mamsa dhatu" are bulkiness (sthula), stable (sthira), heavy (guru), rough (khara), hard (kathina) and smooth (shlakshna).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322</ref>

*The physiological properties of flesh after digestion are: moderately cold (na ati sheeta), heavy to digest (na ati guru), and unctuous (na ati snigdha). [Cha.Sa.[[Sutra Sthana]] 27/61]

== Metabolism and Development ==

The mamsa dhatu is formed from its predecessor blood ([[rakta dhatu]]). The nourishing portion of blood ([[rakta dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into mamsa dhatu by action of factors responsible for its metabolism (mamsa dhatvagni),[[ vayu]], [[jala]] and [[tejas mahabhuta]]. [Cha. Sa. [[Chikitsa Sthana]] 15/29]

It gets solid fleshy bulk due to [[prithvi mahabhuta]]. During embryogenesis, bone component ([[asthi dhatu]]) and muscle component (mamsa dhatu) are developed from reproductive tissue ([[shukra]]). This muscle component is differentiated later into ligaments (snayu) during fetal development. [ Ka. Sa. Sharira Sthana 2/2]

The development of mamsa dhatu is enhanced by anabolism in the fifth month of gestation.[Cha. Sa. [[Sharira Sthana]] 4/21]

=== Formation of skin during embryogenesis ===

Seven layers of skin are formed during embryogenesis. The layer holding mamsa dhatu (Mamsadhara) is the seventh and innermost layer. It is estimated to have thickness of 1 to 3 mm or two vrihi(grains of paddy). [One vrihi = 0.5 to 1.5 mm] This layer is affected in diseases like bhagandara(fistula), vidradhi(abscess) and arsha(hemorrhoids). [Su. Sa. Sharira Sthana 4/8]

This layer can be observed as a deeper reticular layer of dermis.<ref>Kuldeep KumarA Critical Study Of Tvak In The View Of Modern Science Ayurpub.com Mar-Apr 2018 Vol III, Issue 2 available from http://ayurpub.com/wp-content/uploads/2018/04/844-849.pdf</ref>

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of mamsa dhatu, muscle fat (vasa) and six layers of skin (tvacha) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. [[Chikitsa Sthana]] 15/17] Sharangadhara considered muscle fat (vasa) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Various secretions accumulated as wastes in external openings of ear and nostrils are waste products of metabolism of mamsa dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity of mamsa dhatu ===

The quantity of the unctuous part of muscles or muscle fat (vasa) is three [[anjali]](personified measurement unit). One Anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together.[Cha.Sa. [[Sharira Sthana]] 7/15]

The structural component of mamsa dhatu is responsible for the compactness of the body and covers the skeleton properly with muscles and ligaments. There are 900 snayu (ligaments) and 400 muscles(peshi). [Cha.Sa.[[Sharira Sthana]] 7/14] In addition, Sushruta described 100 muscles and thus enumerated them as 500 in male body and 520 in female body.[Su.Sa. Sharira Sthana 5/37-39]

=== Time span ===

The mamsa dhatu is formed on 3rd day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the mamsa dhatu is formed in a time span of 6030 kala (ten days). [Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality or essence (mamsa Sara) ==

The persons having essence of mamsa dhatu have their temples (shankha), forehead (lalata), nape (krikatika), eyes (akshi), cheek (ganda), jaws (hanu), neck (griva), shoulder (skandha), abdomen (udara), axillae (kaksha), chest (vaksha), hands (pani), feet (pada)and joints (sandhi) well developed with firm, heavy and good looking muscles. This essence indicates forbearance, restraint, and lack of greed, wealth, knowledge, happiness, simplicity, health, strength and longevity.[Cha.Sa. [[Vimana Sthana]] 8/105]

== Anatomical and physiological structures ==

The mamsa dhatu is present in various forms as below:

=== Channels for transportation and transformation of mamsa dhatu (Mamsavaha srotas) ===

This has its roots in ligaments (snayu) and skin (twak). [Cha. Sa. [[Vimana Sthana]] 5/8]

In addition, the major arterial trunks (raktavahi dhamani) also serve the purpose of transport. [Su. Sa. Sharira Sthana 9/12]

There are various other anatomical structures related to mamsa dhatu. These can be included in the system. The structures are as described below:

=== Layer of muscles (Mamsadhara kala) ===

[[Kala]] is the layer in outer coverings of body observed in sagittal section. Mamsadhara kala is the first covering with a network of sira (veins), snayu (ligaments), dhamani(artery) in it. [Su. Sa. Sharira Sthana 4/10] It is present in the form of a covering of an organ and also carries physiological functions. Ex. Myocardium of Heart

It is a membrane that separates two organs or structures. Ex. Membrane of the gastrointestinal tract that separates it from visceral organs.

=== Muscles (Mamsa peshi) ===

The well differentiated compact form of flesh (mamsa) is called as muscle(peshi). It is created by division of flesh by [[vayu]] and [[pitta]]. [Su.Sa. Sharira Sthana 4/28]

There are 500 muscles in males and 520 muscles in female body. These muscles cover and provide strength to anatomical structures formed by veins, ligaments, bones, and joints. [Su.Sa. Sharira Sthana 5/37-39] Currently, most sources state that there are over 650 named skeletal muscles in the human body<ref>Poole, RM, ed. (1986). The Incredible Machine. Washington, DC: National Geographic Society. pp. 307–311. ISBN 978-0-87044-621-4. Available from https://en.wikipedia.org/wiki/Muscle#cite_note-Poole_1986-14 cited on 23/05/2020</ref>,<ref>Available from https://en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body cited on 23/05/2020 </ref> although some figures go up to as many as 840.

The flesh of muscle (mamsa peshi), veins (sira) and ligaments (snayu) are attached to bones to form anatomical structure.[Su.Sa.Sharira Sthana 5/23]

Assessment of bulk of muscles is useful for nutritional status assessment by Anthropometry.

=== Anatomical network (Mamsa jala) ===

There are four types of network-like structures (jala) in body. Muscle network (mamsa jala) is the first one among them, the others being that of veins (sira) , ligaments (snayu) and bones (asthi). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Cords (Mamsa rajju) ===

There are four major cord-like structures attached to the vertebral column. The muscles are weaved and attached to these cords. [Su. Sa. Sharira Sthana 5/14].

=== Tendons (Kandara) ===

The large ligaments are termed as ‘kandara’. There are 16 kandara in body. [Su.Sa. Sharira Sthana 5/11]

=== Vital points (Mamsa marma) ===

There are eleven vital points formed from muscle (mamsa marma). These are four talahridaya (vital point in middle of palms and soles), four indrabasti (vital point in middle of forearms and upper part of calf region), guda (vital point in anus), and two stanarohita(vital point in upper part of breast nipples). If these marma are injured, then it can affect vitality of the individual. [Su. Sa. Sharira Sthana 6/7]

== Functions ==

Covering and protection (Lepana) is the main function of mamsa dhatu. Providing strength to the body and nourishment to its successor adipose tissue (meda dhatu) are additional functions. [Su. Sa. Sutra Sthana 15/5]. It provides support for various movements and protection to the inner organs too.

Mamsa dhatu is also inevitably involved in sustaining the strength of the body (bala) due to which there is inculcation of potential to perform physical activities.

== Assessment ==

Normal functions of mamsa dhatu are assessed by examination of different muscle actions such as – flexion (akunchana), extension (prasarana), abduction (utkshepana), adduction (apakshepana) and circumduction (chakra gati). Vyana vata is responsible for carrying out this function. [Cha.Sa.[[Chikitsa Sthana]] 28/9]

Mamsa dhatu is known for its pure quality of stability (sthirata). which is manifested by a sort of tension or tautness in a group of muscles and this is seen as – Muscle tone. Any deviation in this may be elicited as – Hypotonia or Hypertonia.

The proportion of mamsa dhatu can easily be assessed by observation of muscle mass. The qualitative assessment can be done based on the physical properties mentioned above.

== Importance in diagnosis ==

Mamsa is one of the ten vital seats (dashapranayatana). [Cha. Sa. [[Sharira Sthana]] 7/9]. Thus it is directly responsible for the vitality of an individual.

Any vitiation or direct injury to the channels of transportation and transformation of mamsa dhatu (mamsavaha strotas) can lead to death. [Su.Sha.Sharir Sthana 9/12]

=== Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of mamsa dhatu (mamsavaha srotasa). [Cha. Sa. [[Vimana Sthana]] 5/15]

==== Dietary causes ====

* Excessive consumption of food that increases secretions and causes obstruction (abhishyandi), bulkiness, heaviness after digestion

==== Lifestyle causes ====

* Day time sleep

==== Action of different rasa(tastes) on mamsadhatu ====

The consumption of dietary article with predominant tastes shows physiological and pathogenic actions on mamsa dhatu as below. [Cha. Sa. [[Sutra Sthana]] 26/43]

{| class="wikitable"
|-
! Rasa !!Action on mamsa dhatu
|-
| Sweet (madhura)-proportionate use || Promotes growth (mamsa vardhana)
|-
| Sour (amla)-excess use || Causes inflammation (mamsam vidahati)
|-
| Salty(lavana)- excess use || Causes sloughing (mamsam kushnati)
|-
| Pungent (katu)-excess use || Scraping (mamsam vilikhati), reduces bulk of muscles
|-
| Bitter (tikta)-excess use || Absorbs moisture (mamsam shoshayati), reduces the elasticity of muscles
|}

=== Abnormal states ===

The increase or decrease in quality and/or quantity of mamsa dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

===== Signs of decrease =====

* Decrease in circumference and skinfold thickness of hips, neck and belly due to loss of the muscle mass
* wasting of buttocks, cheeks, penis, thighs, chest, axillae, calves
* Dryness
* Pricking pain
* Debility
* Fatigue
* Decreased tone of blood vessels especially in the arterial walls [Cha. Sa. [[Sutra Sthana]] 17/65]

===== Signs of increase =====

* Increase in circumference and skinfold thickness of buttocks, cheeks, lips, penis, thighs, arms and calves
* Heaviness of the body
* Extra muscular growth or Hypertrophied musculature [Su.Sa.Sutra Sthana 15/9,24]
* The increase can be easily classified into two classes viz. Hypertrophy (increase in size) & Hyperplasia (increase in number of cells).

=== Clinical features of vitiation of channels of transport and transformation of mamsa dhatu ===

* Granuloma or polyps (adhimamsa), tumorous growth or myoma (arbuda), piles, skin tags, warts (kila), uvulitis(galashaluka), galashundika (tonsillitis), gangrene(putimamsa), boils(alaji), goiter(ganda), cervical lymphadenitis(gandamala), and inflammation of epiglottis (upajihvika).[Cha.Sa. [[Sutra Sthana]] 28/13-15]

* Injury to channels of transport and transformation of mamsa dhatu lead to swelling (shwayathu), wasting (mamsashosha), aneurism (siragranthi) and death. [Su.Sa. Sharir Sthana 9/12]

* Burning sensation inside the body, thirst, unconsciousness, weakness, diarrhea, foul smell from the body, and convulsive movements of the limbs are the features manifested in fever due to pitta dosha lodged in mamsa dhatu (mamsagata jwara). [Cha. Sa. [[Chikitsa Sthana]] 3/78]

=== Role of mamsa dhatu as a vitiating factor in diseases ===

Mamsa dhatu is involved as the vitiating tissue (dushya) in the pathogenesis of various diseases as listed below:

* Obstinate urinary diseases including diabetes due to obstructive pathogenesis (avruta madhumeha) [Cha. Sa. Sutra Sthana 17/79]

* Diabetic carbuncles(prameha pidaka) [Cha. Sa. [[Sutra Sthana]] 17/82]

*Swelling (shotha) [Cha. Sa. [[Sutra Sthana]] 18/7]

*Obstinate urinary disorders(prameha) [Cha. Sa. [[Nidana Sthana]] 4/8]

*Skin disorders (kushtha)[Cha. Sa. [[Nidana Sthana]] 5/3]

*Wasting diseases (shosha)[Cha. Sa. [[Nidana Sthana]] 6/8]

*Nodule (granthi) [Cha. Sa. [[Chikitsa Sthana]] 12/81]

*Hemorrhoids (arsha)[Cha. Sa. [[Chikitsa Sthana]] 14/5]

*Jaundice (kamala)[Cha. Sa. [[Chikitsa Sthana]] 16/34]

*Erysipelas(visarpa) [Cha. Sa. [[Chikitsa Sthana]] 21/15]

*Abcess (vidradhi)[Su.Sa. Nidana Sthana 9/4]

*Tertiary fever (tritiyaka jwara) [Cha. Sa. [[Chikitsa Sthana]] 3/66]

*Retention of moisture (mamsakleda) and inflammation of muscles (mamsadaha) are included among the 40 disorders due to pitta. [Cha. Sa. [[Sutra Sthana]] 20/16]

*When vitiated [[vata]] is located in muscles and fat, it manifests as the heaviness of the body, pricking pain and as if beaten by a strong rod, severe pain, and fatigue. [Cha. Sa. [[Chikitsa Sthana]] 28/32]

*When [[vata]] [[dosha]] is occluded by vitiation of mamsa dhatu, it causes hard, discolored boils, swellings, horripilation and tingling. [Cha. Sa. [[Chikitsa Sthana]] 28/64]

*The discharge (srava) from ulcer (vrana) situated in muscle tissue resembles ghee. It is thick, white and slimy. [Su. Sa. Sutra Sthana 22/8]

*If a foreign body gets lodged in mamsa, it produces the symptoms like increased swelling, the appearance of new growth in the path of foreign body, intolerance on pressure, sucking pain and formation of pus. [Su. Sa. Sutra Sthana 26/10]

*Suturing is indicated in non-inflammatory ulcers penetrated up to muscles without any other complications. [Su. Sa. Chikitsa Sthana 1/45]

=== Importance in prognosis ===

* Diminution of muscle mass (as in cachexia) is considered as a bad prognostic feature. [Su. Sa. Sutra Sthana 32/5], [Su. Sa. Sutra Sthana 33/5,18,25]

* Ulcer (Vrana) is easily curable when situated in mamsa. [Cha. Sa. [[Chikitsa Sthana]] 25/36]

*From the prognostic aspect, fever due to vitiation of mamsa dhatu (mamsagata jwara) is curable. [Cha. Sa. [[Chikitsa Sthana]] 3/83]

*In case of fracture, if the inflammation of muscle tissue is noticed, it is difficult to cure. [Su. Sa. Chikitsa Sthana 3/69]

*Formation of muscular sprout like structure on the surgical site is considered as a sign of improper surgical management. [Su. Sa. Sutra Sthana 5/15]

== Importance in the preservation of health and prevention ==

* Proper musculature (samhanana) is one of the assessment parameters of health. Physical strength directly depends upon musculature.[Cha.Sa.[[Vimana Sthana]] 8/116]

* A person with a balanced proportion of muscles and compactness of the body and firmness in sense organs is not affected by diseases. Such people can tolerate hunger, thirst, the heat of the sun, cold and physical exercise. Their digestion, assimilation of food, and muscle metabolism are in a state of equilibrium. [Cha. Sa. [[Sutra Sthana]] 21/19].

* The qualitative and quantitative decrease in mamsa dhatu is directly related to diminution of strength (bala kshaya) [Su. Sa. Sutra Sthana 28/20] and vitality (oja kshaya)[Su. Sa. Sutra Sthana 15/24]. Thus, the nutrition of mamsa dhatu is related to strength and immunity of a person.

== Principles of management of diseases ==

==== Therapeutic and conservative management ====

* The disorders of mamsa dhatu should be treated with purification [[shodhana]], surgery (shastra) , application of alkali (kshara) and cauterization (agni karma) [Cha. Sa. [[Sutra Sthana]] 28/26]

*In fever (jwara) affecting mamsa and [[meda dhatu]], therapeutic purgation ([[virechana]]) and fasting ([[upavasa]]) should be done. [Cha. Sa. [[Chikitsa Sthana]] 3/316]

*When [[vata]] gets occluded by mamsa and [[meda dhatu]], purgation, evacuative enema and palliative measures should be administered. [Cha. Sa. [[Chikitsa Sthana]] 28/93]

*The poisonous effects on mamsa dhatu are treated with roots of khadira (Acacia catechu), nimba (Azadiracta indica) and kutaja (Holarrhena antidysentrica) mixed with honey and water. [Cha. Sa. [[Chikitsa Sthana]] 23/187]

* Enema therapy (Yapana [[ basti]]) is indicated for promoting semen ([[shukra]]) and muscular growth (mamsa) of a person, indulging excessive sexual intercourse. [Cha. Sa. [[Siddhi Sthana]] 8/21]

*The effect of unctuous enema (anuvasana basti) is observed in terms of unctuousness in mamsa dhatu and [[meda dhatu]] on the sixth day. [Su. Sa. Chikitsa Sthana 37/73]

*Meat (mamsa) is considered as the best measure for nourishing (brimhana) and habitual use of meat soup of carnivorous animal is the best remedy for curing gastrointestinal disorders (grahani) or curing of assimilation disorders, consumption and piles. [Cha. Sa. [[Sutra Sthana]] 25/40]

*The patient of emaciation due to trauma is advised to take the decoction of the meat of a carnivorous animal sizzled with ghee and added with pippali (piper longum) and honey. This helps in promoting muscle tissues and blood. [Cha. Sa. [[Chikitsa Sthana]] 11/30]

*In the management of poisoning due to substances of plant and the mineral origin and snake bite, the use of flesh with fresh blood is used to keep on the incision made at the vertex region of the person. [Su. Sa. Chikitsa Sthana 2 /43, Su. Sa. Chikitsa Sthana 3 /24]

==== Surgical Management ====

*In muscular parts, the depth of surgical incision should be equal to the size of 1 yava(barley). [Su. Sa. Sharira Sthana 8/9].

*Pincers/forceps (Sandamsha yantra) are used to pull foreign bodies lodged in muscles (mamsa). [Su. Sa. Sharira Sthana 7/11].

* Tempering of instruments should be done using water, for splitting, cutting and tearing of muscles. [Su. Sa. Sharira Sthana 8/12].

* For thermal cautery (agni karma), a piece of black stone(jambavoshtha), and rods of other metals are used for diseases of mamsa. [Su. Sa. Sharira Sthana 12/4].

==== Dietary management ====

Dietary causative factors shall be avoided in case of increased mamsa dhatu and consumed in case of decreased mamsa dhatu. Mamsa dhatu is increased predominantly with the consumption of meat. [Cha. Sa. [[Sharira Sthana]] 6/10]

==== Lifestyle management ====
Daytime sleep shall be avoided in case of increased mamsa dhatu and is advised in case of its decrease.

===== [[Vyayama]] (specific physical exercise) =====

Specific physical exercise is intended towards bringing stability (in body) and an increase in strength. It can decrease the morbidities and improve the functions of [[agni]]. [Cha.Sa. [[Sutra Sthana]] 7/31] Current researches recognized exercise as a primary strategy to control hyperglycaemic disorders, also it induces a coordinated immune-neuro-endocrine response that acutely modulates cardiovascular, respiratory, and muscle functions and the immune response to exercise are widely dependent on the intensity and volume.<ref>Ana E Von Ah Morano et al, The Role of Glucose Homeostasis on Immune Function in Response to Exercise: The Impact of Low or Higher Energetic Conditions, Journal of Cellular Physiology ; Vol 235, No 4, Apr 2020 ; PP: 3169-3188</ref>

== Contemporary approach and current researches ==

Mamsa dhatu is observed in view of muscular tissue in conventional physiology.

=== Types ===

The muscles in the human body are categorized into three main categories:

# Skeletal muscles
# Smooth muscles
# Cardiac muscles

About 40 percent of the human body is made up of skeletal muscle, and perhaps another 10 percent is smooth and cardiac muscle.<ref>
Guyton A.C., Hall J.E. Contraction of Skeletal muscle. In: Guyton A.C., Hall J.E., editors. Textbook Of Medical Physiology. 11th ed. Philadelphia, PA : Saunders/Elsevier; 2011. pp. 72-74 </ref>

Smooth muscle is composed of far smaller fibers – usually 1 to 5 micrometers in diameter and only 20 to 500 micrometers in length.
In contrast, skeletal muscle fibers are as much as 30 times greater in diameter and a hundred times longer.

The fundamental principles of contraction are almost the same in skeletal muscles and smooth muscles. However the structural arrangement is different in both groups.<ref> Guyton A.C., Hall J.E. Contraction & Excitation of Smooth muscle. In: Guyton A.C., Hall J.E., editors. Textbook of Medical Physiology. 11th ed. Philadelphia, PA : Saunders/Elsevier; 2011. pp. 92-99</ref>

These can be referred to as various types and shapes of peshi and snayu described above.

=== Composition of muscles ===

Skeletal muscle is formed by 75% of water and 25% of solids. Solids are 20% of proteins and 5% of organic substances other than proteins and inorganic substances.

Myoglobin is a protein present in sarcoplasm. It is also called myohemoglobin. Its function is similar to that of hemoglobin, that is, to carry oxygen. It is a conjugated protein with a molecular weight of 17,000.<ref>Essentials of Medical Physiology – Sembulingam – Chapter 29 – Structure of Skeletal muscle</ref>

The components can be referred to as basic pancha bhautika constituents of mamsa dhatu.

=== Origin and development ===

==== Stem cells ====

Myoblasts are embryonic progenitor cells having the capability to differentiate into muscle cells. The fusion of these myoblasts is specially confined only with the skeletal muscle cells. Cells unable to differentiate are pulled back within sarcolemma and endomysium and called as – satellite cells.

In normal and undamaged muscle, these satellite cells are quiescent and do not involve in cell division. But just after facing mechanical strain, proliferates as skeletal myoblasts prior to undergoing differentiation.

Myoblasts are later differentiated and terminated into the last category of – Myocytes. These are long, elongated tubular embedded with specific property within them.

This can be referred to in view of sthayi or poshya part of mamsa dhatu.

==== Embryonic development of muscles ====

Muscle tissue committed cell line – myocytes are originated from the myoblasts under the influence of concerned factor fibroblast growth factor, calcium ions. It is mesodermal in origin basically from pluripotent embryonic stem cells later undergoing differentiation process committed towards myocyte cell lineage.

Initially the myoblasts fuse with each other attaining tubular and multi-nucleated form. Later on these are specialized as per location, control, and final appearances.

==== Myogenesis in a nutshell ====

The steps involved in myogenesis can be described as below.

#Myoblasts proliferate under the influence of the Fibroblast growth factor and form Myotubes.
# Division of myoblasts is regulated by the adequate presence of Fibroblast growth factor.
# The myotubes are fused together under the influence of calcium ions resulting in Myogenesis.
# Myogenesis is enhanced and regulated by Myocyte enhance factor & steroids.
# Serum response factor & androgen receptor is responsible for expression for striated actin genes.

=== Functions of muscles ===

About half of the physical and chemical metabolic processes take place in muscle tissue, and at least three fourth of the total metabolism is due to muscle activity during severe exercise.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.248</ref> The muscle proteins called actin and myosin combine to form a complex and highly viscous colloid called actomyosin. But the contraction of muscles is considered truly as a molecular phenomenon.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.250</ref>

=== Diagnostic investigation methods ===

==== I. Radiological investigation ====

'''1. Scanning electron microscopy (SEM)'''

* '''Purpose''':

*Obtain 2D and 3D images of skeletal muscle

*Quantification of morphological measure of microvasculature based on segmented RBC

*RBC spacing within the muscle tissue – 3D distance mapping

*Tissue oxygenation

'''2. Muscle ultrasound'''

* '''Purpose''' :

* Non-invasive technique for assessment of muscular dystrophies & skeletal muscle disorders in the pediatric population.

==== II. Culture tests ====

* Muscle mass biopsy

==== III. Electro-diagnostic techniques====

'''1. Electromyography (EMG)'''

*'''Purpose:'''

*Electro-diagnostic technique for evaluating and recording the electrical activity produced by skeletal muscles.

*Assessment of the health status of Nerves and Muscles.

'''2.Muscle magnetic resonance imaging (MMRI)'''

'''Purpose:'''

*Evaluation of deep muscles inherited myopathies

*It also provides information about the best sites of muscle biopsy.

==== IV. Hematological & Serological investigation ====

#Creatine Kinase (CK) or Creatine Phosphokinase (CPK)–Myopathies
#Aldolase – Identifies the weakness of the muscle.
#Erythrocyte sedimentation rate (ESR) – Used to measure or assess inflammation of muscles.
#Antibody evaluation for specific diseases – Ex. Anti-Acetylcholine (Ach) antibodies & Anti-Muscle specific kinase (MUSK) antibodies in Myasthenia Gravis

==== V. Genetics ====

'''Exome sequencing'''

'''Purpose:'''

* Identification of genetic variations at base-pair resolution throughout the human genome which targets the proportion of DNA that codes proteins for capturing and sequencing.

=== Pathological conditions ===

==== Hemorrhagic changes in muscles ====

A well-known but so far poorly understood condition is the focal red changes in muscle, often referred to as haemorrhages. Such changes are characterized by muscle necrosis, haemorrhages, and acute inflammation. In situ hybridization(ISH) studies on IgM showed few to moderate amounts of B-cells in red focal changes. Trends in the RT-qPCR showed up-regulation of genes related to innate immunity in the red changes, whereas genes related to adaptive immunity were upregulated in the melanized changes. An important result was the significant down-regulation of the anti-inflammatory cytokine IL10 in all red changes.<ref>Havard Bjorgen et al,Immunopathological characterization of red focal changes in Atlantic salmon (Salmo salar) white muscle, Veterinary Immunology and Immunopathology Volume 222, April 2020, 110035,https://doi.org/10.1016/j.vetimm.2020.110035</ref>

===List of theses ===

1. Pritesh A Dave(2007): A pilot study on sports medicine in ayurveda w.s.r. To sarira bala vrddhi, Department of Basic principles, I P G T & R A , Jamnagar

== More information ==
=== Related chapters ===

[[Vividhashitapitiya Adhyaya]], [[Sroto Vimana]], [[Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

=== External links ===

[https://en.wikipedia.org/wiki/Muscle Muscle], [https://en.wikipedia.org/wiki/Human_musculoskeletal_system Human musculoskeletal system],
[https://en.wikipedia.org/wiki/Muscle_contraction Muscle physiology], [https://en.wikipedia.org/wiki/List_of_skeletal_muscles_of_the_human_body List of skeletal muscles of the human_body]

=== Abbreviations ===
*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita

=== References from [[Charak Samhita]] ===

The list of references for mamsa dhatu in Charak Samhita can be seen [[Media:Mamsa_dhatu-_reference_list.pdf|here.]]

== References ==

File:Mamsa dhatu- reference list.pdf

2020-07-05T16:48:23Z

Anagha:

File:Rakta dhatu-reference list.pdf

2020-07-05T16:41:42Z

Anagha:

Rakta dhatu

2020-07-05T16:40:32Z

Anagha:

Rakta dhatu is a body component similar to blood tissue. Its important function is to give life or maintain vitality(jivana). Body fluid (rasa dhatu) after acquiring ‘red’ color is termed as “rakta”(blood).<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.429)

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Rakta Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.
|label3 = Reviewer
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 18, 2020
}}
==Etymology and derivation==

The word ‘Rakta’ is derived from Sanskrit root “ranj”, meaning–to dye or colour, to affect or move, to excite/glad/charm/delight.<ref>Monier Williams (1899), “रक्त”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 0861.</ref>
==Synonyms ==
Shonita, rudhira, asrik, astra,lohita,kshataja

*'''Shonita''': The term is derived from ‘shona’ meaning red color. The term is also applied to denote the female genetic prototype.<ref>Available from https://www.wisdomlib.org/definition/shonita</ref>

*'''Rudhira''': The term is derived from root ‘rudh’ meaning to stop or hold. The blood tissue sustains the life of human beings, hence it is called ‘rudhira’’. [Su. Sam. Sutra Sthana 14/39]

*'''Lohita''': The term indicates the coppery red color of blood. [Su. Sa. Sutra Sthana 14/5]

*'''Asrik/Asra''': The term is derived from Sanskrit root ‘ashukshepane, srijvisarge'. It means to get ejected or expelled out. This synonym is used in the context of excessive bleeding. E.g.menorrhagia(asrigdara), bleeding disorders(asrapitta/raktapitta)

*'''Kshataja''': It means that which originates from trauma (kshata) or wound/ulcer (vrana).

==Meanings in different contexts ==

In different contexts, the word rakta denotes blood tissue (rakta dhatu), menstrual blood (raja or [[artava]]), ovum (shonita or streebeeja), red color, metals like copper, indulgence in some passion or desire.

Life begins with the unification of live sperm(shukra) and live ovum (shonita). The word ‘shonita’ denotes ‘fertile ovum’ whenever it is used in context of conception. [Cha. Sa. [[Sharira Sthana]] 3/3]

Otherwise, in general physiology, shonita denotes blood tissue (rakta dhatu).
The term ‘jeevarakta’ denotes fresh blood. [Su. Sa. Sutra Sthana 14/8]

==Panchabhautika constitution and properties: ==

The Rakta dhatu is constituted with the dominance of [[agni mahabhuta]] and all other [[mahabhuta]]. It possesses properties like peculiar smell (vistrata), liquidity(dravata), red color(raga), pulsation(spandanam) and lightness to get circulated (laghuta) due to [[Prithvi]],[[ jala]],[[teja]], [[vayu]] and [[akasha mahabhuta]] are spectively. [Su.Sa. Sutra Sthana 14/9]

Rakta dhatu is neither too hot nor too cold(anushna-sheeta), sweet (madhura), unctuous (snigdha), red(rakta), heavy(guru), with peculiar smell (vistra).It can get affected by the same substances that provoke [[pitta dosha]].[Su. Sa. Sutra Sthana 21/17]

==Formation and metabolism of rakta dhatu==

*The rakta dhatu is formed from its predecessor [[rasa dhatu]]. The nourishing portion of [[rasa dhatu]] and constituents of nutrient fluid (ahara rasa) are transformed into rakta dhatu by action of ranjakapitta (type of [[pitta]] responsible for colour pigments). [Cha. Sa. [[Chikitsa Sthana]] 15/28] This process takes place in liver and spleen.[Su.Sa.Sutra Sthana 14/4-5]

*The pure blood is formed as per the suitable conditions at the place of living, season, and adaptation. [Cha. Sa. [[Sutra Sthana]] 24/3]

===Location:===
As per contemporary theories, in the early stages of embryogenesis, blood formation (hematopoiesis) occurs in blood islands. These are aggregates of blood cells in the yolk sac. As development progresses, blood formation occurs in the spleen, liver, and lymph nodes. These are the primary site until the first three months of gestation. In the seventh month of gestation, after the development of bone marrow, it eventually becomes the major site of formation of most of the blood cells for the entire organism.<ref>Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1): 82–96. Bibcode:2016NYASA1370...82B. doi:10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419.</ref> Hematopoietic stem cells (HSCs) in the bone marrow give rise to all of the different mature blood cell types and tissues. In children, hematopoiesis occurs in the marrow of the long bones such as the femur and tibia. In adults, it occurs mainly in the pelvis, cranium, vertebrae, and sternum.<ref>Fernández KS, de Alarcón PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>
Sushruta highlighted the presence of adipose tissue ([[meda dhatu]]) in the medulla of bone. The adipose tissue ([[meda dhatu]]) present in long and big bones is known as marrow ([[majja]]). That present inside the small bones is termed as red marrow (saraktameda). [Su. Sa. Sharira Sthana 4/13]

This unctuous portion in the bone marrow can be linked to the formation of blood as per current views.

The liver acts as the major blood reservoir. It stores about 450 milliliters or almost 10 percent of the body's total blood volume. This capacity can increase up to 1 litre in certain cases due to the expanding capacity of the liver. It synthesizes some proteins including coagulation factors I (fibrinogen), II (prothrombin), V, VII, VIII, IX, X, XI, XII, XIII, as well as protein C, protein S and antithrombin. All of these play important roles in blood physiology. Moreover, the liver is a major site of production for thrombopoietin, a glycoprotein hormone that regulates the production of platelets by the bone marrow. The liver plays a major role in glucose, protein, and lipids present in the blood. It also purifies and protects blood from harmful toxins, metabolites, and heavy metals.<ref>Available from https://en.wikipedia.org/wiki/Liver accessed on 15/06/2020</ref>

Thus, bone marrow is the site of formation of blood cells; whereas the liver is the major site in maturation of blood cells and maintaining the physiological status of blood tissue.

==Metabolic byproducts and waste products (Upadhatu and mala):==

During the process of metabolism and formation of rakta dhatu, tendons(kandara) and veins(sira) are formed as the metabolic byproducts(upadhatu).[Cha. Sa.[[Chikitsa Sthana]] 15/17]. Sharangadhara opines menstrual blood([[artava]]) as the metabolic by-product.
[Sha. Sa. Purva khanda chapter 5]

Various pigments and acidic secretions are formed as waste during this process. These are termed as malarupa [[pitta]].[Cha.Sa. Sutra Sthana 15/5]

===Quantity of Rakta:===
The quantity of rakta is eight anjali. One Anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person specific.[Cha. Sa. [[Sharira Sthana]] 8/15]

===Timespan:===
Rakta dhatu is formed in a time span of 6030 kala (ten days). [Su. Sa. Sutra Sthana 14/14]

==Characteristics of pure blood==
The color of pure blood is like golden red, firefly, red lotus, lac-resinous material(laksha), and fruit of Gunja (Abrusprecatorius Linn.). [Cha. Sa. [[Sutra Sthana]] 24/22]

The person with pure blood has glowing complexion, well-functioning sense organs, and a cheerful state of mind. His digestion and natural urges are normal. He is endowed with happiness, satiety, and strength. [Cha. Sa. [[Sutra Sthana]] 24/24].

===Characteristics of best quality of blood tissue (raktasara ): ===

The characteristics of the essence of rakta dhatu can be observed on ears, eyes, face, tongue, nose, lips, palms, soles, nails, forehead and genitals. These body parts are unctuous, red, beautiful and shining. The persons are endowed with happiness, sharp intellect, magnanimity, tenderness, moderate strength, lack of endurance, and intolerance to heat.[ Cha. Sa. [[Vimana Sthana]] 8/104]

==Physiological aspects: ==
===Channels of transportation and transformation of rakta dhatu (raktavahasrotas):===
The channels of transportation and transformation of rakta dhatu (raktavahasrotasa) originates from liver and spleen.[Cha. Sa. [[Vimana Sthana]] 5/8]The blood components are formed in the liver and spleen. It is circulated through blood vessels like arteries (dhamani). [Su. Sa. Sharira Sthana 9/12]. Considering the important role of bone marrow in the formation of blood cells, it can be included as an additional site in channels of transportation and transformation of rakta dhatu (raktavhasrotas).

There are various other structures related to rakta dhatu. These can be included in the channels of transportation and transformation.
===Layer of blood tissue (raktadharakala):===
Kala is the layer in outer coverings of the body observed in sagittal section. The layer of formation of blood tissue (raktadhara kala) is second beneath the layer of skin and muscles (mamsadhara kala). It is made of blood vessels connected with the liver and spleen. [Su. Sa. Sharira Sthana 4/10]

==Functions:==
===General physiological functions:===
Giving life and sustaining vitality (Jeevana), enhancing complexion(varna prasadana), nourishing successor muscle tissue and other components ([[mamsa dhatu]] poshana) are the main functions of rakta dhatu. [Su. Sa. Sutra Sthana 15/5] The vitality depends on blood. [Cha. Sa.[[Sutra Sthana]] 24/4]

===Role of rakta in the formation of body organs:===
During embryogenesis, various organs are developed from dhatu by action of factors responsible for digestion and metabolism(agni).

The following table shows details of the role of rakta dhatu in the formation of body organs.
{| class="wikitable"
|-
! Sr.no. !!Body organ !! Factors responsible for its formation
|-
| 1. || Liver || Shonita(pure blood)
|-
| 2. || Speen || Shonita(pure blood)
|-
| 3. || Lungs || Shonitaphena(froth in pure blood)
|-
| 4. || Appendix || Shoinitakitta(waste in formation of pure blood)
|-
| 5. || Intestine, anus and urinary bladder || Asrija + shelshmaprasad acted upon by pitta and vayu(essence of blood and kaphadosha)
|-
| 6. || Tongue || Kapha + shonita + mamsasara(essence of kapha, blood and muscles)
|-
| 7. || Kidneys || Rakta + meda prasada (essence of blood and muscles)
|-
| 8. || Testis || Mamsa + asrik + kapha + medaprasada(essence of muslces, blood, kapha and adipose tissue)
|-
| 9. || Heart || Shonita + kaphaprasada (essence of blood and kapha)
|}
[Su. Sa. Sharira Sthana 4/25-31]

*Rakta is one among the ten seats of vitality(dashapranayatanani). [Su. Sa. Sharira Sthana 7/9]
*Rakta is the primary site of [[pitta dosha]]. [Cha. Sa. [[Sutra Sthana]] 20/8]

==Importance in diagnosis ==
===Causes of vitiation===
The formation of blood is affected by following factors:

'''Dietary causes''':

*Habitual intake of spoiled or unsuitable food and/or liquids

*overeating

*acidic or pungent liquor and other similar drinks

*too much salty, alkaline substances

*sour and pungent food

*Dolichosbiflorus Linn. (kulatha)

*Phaseolus mungo Linn. (masha)

*Dolichos lablab Linn. (nishpava)

*Sesamum indicum Linn. oil (tila taila)

*Randiauliginosa DC.(pindalu)

*radish and all green (leafy) vegetables

*meat of aquatic and marshy animals, burrowing animals and those that snatch birds

*excessive intake of curd

*sour whey (curd-water), vinegars and other sour fermented liquids

*consuming decomposed, putrid food with opposite properties

*indigestion

*taking meal during indigestion

'''Lifestyle factors:'''

*excessive sleeping during the day especially after taking liquids, unctuous and heavy food

*excessive anger

*excessive exposure to the sun and the wind

*suppression of the natural urges like vomiting

*avoidance of blood-letting in prescribed time (autumn)

*too much exertion

*injury

*heat

'''Environmental factors:'''

Due to natural conditions in autumn season. [Cha. Sa. [[Sutra Sthana]] 24/5-10]

The channels of transportation and transformation of blood (raktavahasrotas) is affected due to the following causes:

Excess consumption of pungent and spicy food and drinks that cause burning sensation, unctuous, hot and liquid food, exposure to sun-heat, or fire. [Cha. Sa. [[Vimana Sthana]] 5/14].

===Abnormal states===

The physician should diagnose the quantitative and qualitative imbalance of rakta by observing various features manifested due to decrease(kshaya) and increase(vridhi).

===Clinical features of decrease:===

*Symptoms of decrease of rakta are roughness of skin, cracks, dullness, and dryness of skin.[Cha. Sa. [[Sutra Sthana]] 17/65]. In addition, craving for sour food, liking for cold substances, looseness of blood vessels is also observed.[Su. Sa. Sutra Sthana 15/9].

===Clinical features of increase:===

*Reddish discolouration of eyes and other body parts and fullness of veins are considered as the signs of increase of rakta dhatu. [Su. Sa. Sutra Sthana 15/10].

===Disorders due to blood vitiation:===

'''Following disorders are caused by blood vitiation:'''

Stomatitis, redness in eyes, foul smell in nose and mouth, gulma (abdominal lump), gingivitis (upakusha), erysipelas, bleeding disorder, sleepiness, abscess, hematuria, menorrhagia, vatarakta, discoloration of skin, loss of digestive power, thirst, heaviness in body, pyrexia, extreme debility, anorexia, headache, burning sensation after meals, bitter and sour eructation, physical and mental exhaustion, excessive anger, state of confusion, saline taste in mouth, sweating, fetid odor in body, narcosis, tremors, decreased voice, drowsiness, excessive sleep and feeling of darkness, itching, pustules, patches, boils, leprosy, thick skin, etc.

The diseases, which, in spite of being curable, are not alleviated after treatment with any of six therapies like cold-hot, unctuous-rough etc. should be considered as caused by impure blood. [Cha. Sa. [[Sutra Sthana]] 24/11-17]

===Clinical features of vitiation of channels of transportation and transformation of blood (raktavahasrotasa):===

'''Following clinical conditions are observed due to affection of channels of transportation and transformation of blood:
'''

Skin diseases (kushtha), erysipelas (visarpa), furuncles (pidaka), bleeding disorders(raktapitta), asrigdara(menorrhagia), inflammation of anus, penis, oral cavity, splenic disorders (pliha), abdominal lump (gulma), abscess (vidradhi), blue mole (nilika), jaundice (kamala), freckles/blemish (vyanga), portwine mark (piplu), black mole of the size of sesame seed (tilakalaka), ringworm (dadru), dermatitis (charmadala), leukoderma (shvitra), scabies (pama), urticaria (kotha), and circular erythema (asra mandala).[Cha. Sa. [[Sutra Sthana]] 28/11-13]

===Role of rakta dhatu as vitiated factor in disease:===

Rakta plays a major role in the pathogenesis of the following diseases:

*Bleeding disorders(raktapitta) [Cha.Sa.[[Chikitsa Sthana]] 4/7-9]

*Disease due to vata and rakta (vatarakta) [Cha. Sa. [[Chikitsa Sthana]] 29/10]

*erysipelas(visarpa) [Cha. Sa. Sutra Sthana 18/23] [Cha. Sa. [[Chikitsa Sthana]] 21/15]

*Intoxication(mada), syncope (moorcha), coma(sanyasa) [Cha. Sa. [[Sutra Sthana]] 24/25] skin diseases(kushtha) [Cha. Sa.[[Nidana Sthana]] 5/3]

*Obstinate urinary disorders including diabetes(prameha) [Cha. Sa.[[Nidana Sthana]] 4/7]

Subtypes of some diseases indicate the major role of rakta in their pathogenesis:

*Obstinate urinary disorders (raktameha) [Cha. Sa. [[Nidana Sthana]] 4/32]

*Micro-organisms originating in blood (shonitajaKrimi)[Cha.Sa.[[Vimana Sthana]] 7/11]

*Abdominal lump due to blood (raktagulma)[Cha. Sa. [[Chikitsa Sthana]] 5/18]

*Diarrhoea with blood (raktatisara)[Cha. Sa.[[Chikitsa Sthana]] 19/70]

*Abscess with blood (raktavidradhi) [Su. Sam. Nidana Sthana 9/14,26]

*In case of fever (jwara), when the vitiated [[dosha]] are located in the rakta dhatu, following clinical features are observed: Increase in body temperature, eruptions, thirst, frequent spitting mixed with blood burning sensation, discoloration, giddiness, intoxication, and incoherent speech. [Cha. Sa. [[Chikitsa Sthana]] 3/77]

*In fever (jwara) caused by trauma(abhighata),vitiated vata affects predominantly rakta (blood). This leads to clinical features like discomfort, swelling, discoloration, and pain.[Cha. Sa. [[Chikitsa Sthana]] 3/114].

*In all other exogenous causative injuries like poison (visha) etc, rakta dhatu is predominantly affected. In such cases, it has both diagnostic and therapeutic importance.

==Importance in preservation of health and prevention ==
The pure blood provides the individual with strength, complexion, happiness, and life. [Cha. Sa. [[Sutra Sthana]] 28/4].

It is the fundamental source of vitality and life. [Su. Sam. Sutra Sthana 14/44]

==Principles of management of diseases of rakta dhatu==

*The principles of management for disorders of rakta are mentioned as below [Cha. Sa.[[Sutra Sthana]] 24/18].

If there is excessive vitiation of rakta dhatu, then purification procedures are indicated. This includes therapeutic purgation ([[virechana]]) and bloodletting ([[rakta mokshana]]) after considering the strength of the patient.

In the case of mild to moderate severity of disease and in patients with low strength, pacification therapies (shamana) is indicated. This includes therapeutic fasting (upavasa) and management on the lines of bleeding disorders (raktapitta).

*In case of fever (jwara), the dosha located in rakta dhatu are treated with pouring of medicated liquids (seka) and ointment application (pradeha).[Cha. Sa. [[Chikitsa Sthana]] 3/316].

*In case of poisoning, the spread of toxins is arrested by applying cooling external application (pradeha and alepa) and poring medicated liquids (seka). [Cha. Sa. [[Chikitsa Sthana ]]23/42-43] It shows pacifying actions on vitiated rakta and [[pitta]]. [Su. Sa. Sutra Sthana 18/3]

===Best herbs in management (agryasamgraha):===
Some food items and herbs have excellent action on blood as follows: [Cha. Sa. [[Sutra Sthana]] 25/40].
{| class="wikitable"
|-
! Name !!Pharmacological effect
|-
|Goat milk (ajaksheera) || Pacifying raktapitta (bleeding disorders) (raktapittaprashamana)
|-
|Ananta (Hemidesmus indicus R.B.)or Indian sarsaparilla ||Astringent effect, pacifying raktapitta (Sangrahikaraktapittaprashamana)
|-
|Pollens of utpala (Nymphaca alba Linn.), kumuda (a variety of utpala) and padma (Nelumbo nucifera gaertn.) or pollen of blue and white water lilies || Astringent effect, alleviating raktapitta (sangrahikaraktapittaprashamana)
|-
|Bark of kutaja (Holarrhenaantidyscenterica wall.) or kurchi bark || Among astringent and desiccant of kapha, pitta and the blood (shlesma pitta raktasangrahikopsosananam).
|-
|Fruit of kashmari (Gmelina arboria) or fruit of white teak || Causing haemostasis and curing raktapitta (Raktasangrahikaraktapittaprashamana)
|-
|Guduchi (Tinosporacordifoliamiers) or amrita || Act as astringent, curative of vata, promotes digestion, curative of vitiation of kapha and blood (sangrahikavataharadipaniyashleshmashonitavibandhaprashamana).
|-
| Priyangu [Callicarpa macrophylla Vahi.] or the perfumed cherry || Alleviate the plethoric condition of blood and pitta (shonitapittatiyogaprashamana)
|}

===Physiological effect of various tastes on blood: ===
The substances with predominant tastes (rasa) produce physiological effects on rakta dhatu as shown below.[Cha. Sa. [[Sutra Sthana]] 26/43]
{| class="wikitable"
|-
! Rasa (taste) !!Effect
|-
| Sour(amla rasa) || Vitiates blood (raktam dushayati)
|-
| Salty(lavana rasa) || Increases volume(raktam vardhayati)
|-
| Pungent (katurasa ) || Breaks the blood clots/anti-coagulant (shonitasanghatam bhinatti)
|-
|Bitter (tiktarasa)|| Depletes the quantity of blood by absorbing fluid portion(raktam shoshayati)
|-
|Astringent(kashaya rasa)|| Pacifies vitiated blood (Raktaprashamana)
|}

The above factors are used in diagnosis as well as treatment.

E.g. Sour substances are known to vitiate blood, hence the patients with disorders due to vitiation of blood are advised to avoid sour substance. Instead, they are advised to consume bitter and astringent substances. The substances with pungent taste can be used to prevent coagulation.

==Contemporary approach ==
In contemporary physiology, red coloured fraction of blood is considered as rakta dhatu. The colourless fluid (plasma) is considered as rasa dhatu. Thus, rasa and rakta together form “blood”. The red fraction or red blood corpuscles are referred to as rakta dhatu in this article.
===Composition:===
Blood is a complex liquid tissue composed of different types of cells. The plasma which represents the matrix of this tissue constitutes over 55% of it. Formed elements that are suspended in the liquid matrix constitute over 45% of blood, these comprise of erythrocytes,leukocytes, and platelets.<ref name=dwaraka>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.343</ref> The characteristic color of blood is due to the erythrocytes present in it. These cells are formed in the red born marrow and they survive for about 80 days in circulation and then disintegrate. Their debris is removed from the blood by liver and spleen.<ref name=dwaraka></ref> Ranjaka pitta which gives color to rakta may be considered as the ayurvedic analogue of the red cobalt linked enzyme B12 present in the liver.<ref> Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.330</ref>

===Color: ===
The red color in blood is due to hemochrome present in the protein (hemoglobin). This is responsible for oxygen transport. Different groups of organisms use different proteins.

===Quantity:===
Blood accounts for 7% of the human body weight. The average adult has a blood volume of roughly 5 litres.
===Functions: ===
The blood has an important role in the physiology of the cardiovascular system and lymphatic system.

It carries important functions as below:

*Supply of oxygen to tissues (bound to hemoglobin, which is carried in red cells)

*Supply of nutrients such as glucose, amino acids, and fatty acids (dissolved in the blood or bound to plasma proteins (e.g., blood lipids)

*Removal of waste such as carbon dioxide, urea, and lactic acid

*Immunological functions, including circulation of white blood cells, and detection of foreign material by antibodies

*Coagulation, the response to a broken blood vessel, the conversion of blood from a liquid to a semisolid gel to stop bleeding

*Messenger functions, including the transport of hormones and the signaling of tissue damage

*Regulation of core body temperature

*Hydraulic functions

==Current researches ==
Hematopoietic stem cell transplantation (HSCT) is a curative modality for a wide variety of hematologic disorders. Early survival after HSCT is dependent on the occurrence of hepatic, cardiac, and pulmonary complications.<ref>Kim BK, Chung KW, Sun HS, Suh JG, Min WS, Kang CS, et al. Liver disease during the first post-transplant year in bone marrow transplantation recipients: retrospective study. Bone Marrow Transplant. 2000;26:193–7</ref> This depicts the role of blood as origin in the formation of these organs during embryonic life as mentioned above. More research on this topic can open new avenues in the field of tissue engineering.
===Future scope of research:===
Considering views about the physiology of blood formation and maturation, the role of adipose tissue in marrow (saraktameda and [[majja]]), its connection with liver and spleen need to be explored. This can open a new window in the treatment of diseases due to blood vitiation like skin diseases and bleeding disorders.

===List of theses done===
1. Mohanti Krishna (2000): Critical study on Sroto-Vigyaneeyam in Bruht-trayi w.s.r. to RaktavahaStroto-Dushti and its management, Dept of Basic Principles, IPGT&RA, Jamnagar.

2. Kulkarni Mayur P (2003): Concept of Dhatu-PradoshajaVikaras in Brihattrayee with the principle of management in Rakta-PradoshajaVikaras, Dept of Basic Principles, IPGT&RA, Jamnagar.

3. Shinde Vaishali S (2004): A study on the concept of Upadhatu in Samhitas with applied aspect to Artava-Dushti, Dept of Basic Principles, IPGT&RA, Jamnagar.

4. Kailash Chandra (2006): Applied concept of Kala and Svabhava and their role in Shonita Dusti, Dept of Basic Principles, IPGT&RA, Jamnagar.

5. Anil Avhad(2015): Applied study of Srotasa and Srotomula w.s.r to Raktavaha Srotodushti and its management.

==More information ==
===Related Chapters===
[[ Vidhishonitiya Adhyaya]] ,[[ Vividhashitapitiya Adhyaya]],[[ Grahani Chikitsa]]

Shonitavarnaniya Adhyaya[Su. Sam. Sutra Sthana 14]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

=== External links ===
[[Blood]]

=== Abbreviations ===
*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita

=== References from [[Charak Samhita]] ===

The list of references for rasa dhatu in Charak Samhita can be seen [[Media:Rakta_dhatu-reference_list.pdf|here.]]

==References==

Shukra dhatu

2020-07-03T05:24:20Z

Anagha: /* References from Charak Samhita */

Majja dhatu

2020-07-03T05:23:50Z

Anagha: /* References from Charak Samhita */

Asthi dhatu

2020-07-03T05:23:22Z

Anagha: /* References from Charak Samhita */

Meda dhatu

2020-07-03T05:22:55Z

Anagha: /* References from Charak Samhita */

Mamsa dhatu

2020-07-03T05:22:15Z

Anagha: /* References from Charak Samhita */

Rakta dhatu

2020-07-03T05:21:30Z

Anagha: /* References from Charak Samhita */

Shukra dhatu

2020-06-28T15:28:31Z

Anagha: /* Prognosis */

Shukra dhatu

2020-06-28T15:25:19Z

Anagha: /* Abbreviations */

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [A.S. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su Sa Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [A. Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*S. = Sangraha
*Hr. = Hrudaya

=== References from [[Charak Samhita]] ===

The list of references for shukra dhatu in Charak Samhita can be seen here.

==References==

Shukra dhatu

2020-06-28T15:24:40Z

Anagha: /* More information */

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [A.S. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su Sa Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [A. Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*S. = Sangraha
*Hr. = Hrudaya

==References==

Shukra dhatu

2020-06-28T15:24:22Z

Anagha: /* More information */

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [A.S. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su Sa Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [A. Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*S. = Sangraha
*Hr. = Hrudaya

==References==

Shukra dhatu

2020-06-28T15:21:42Z

Anagha: /* Prognosis */

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [A.S. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su Sa Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [A. Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Shukra dhatu

2020-06-28T15:21:15Z

Anagha: /* Signs of increase */

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [A.S. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su Sa Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [Ash Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Shukra dhatu

2020-06-28T15:18:07Z

Anagha: /* Principles of management */

Shukra literally means semen virile, sperm, lucid, clear.<ref>Available from https://spokensanskrit.org/index.php?tran_input=zukra&direct=se&script=hk&link=yes&mode=3 accessed on 16/06/2020</ref> In human physiology, Shukra dhatu is a body component having reproductive capacity. It is generally equated with semen (SAT-B.445).<ref>Available from http://namstp.ayush.gov.in/#/sat accessed on 16/06/2020</ref>

Shukra dhatu is described to be of two forms in Ayurveda textbooks:
#The one that is ejaculated during the process of mating, which is responsible for fertilization of ovum and thus embryogenesis. This is semen in males.
#The one that is formed from predecessor the tissue that fills the bony cavities([[majja dhatu]]). This in turn circulates all over the body both in males and females.

Reproduction is the function of this second form of shukra too. Therefore, on careful examination, it seems that the first form of shukra stands for the semen in general and for sperms in particular; and, the second form of shukra stands for hypothalamic-pituitary-gonadal axis of hormones that circulate all over the body.<ref>Patwardhan Kishor. 2018 [[Grahani Chikitsa]] Adhyaya available from http://www.carakasamhitaonline.com/mediawiki-1.32.1/index.php?title=Grahani_Chikitsa#Vidhi_Vimarsha_.28Applied_Inferences_.29 accessed on 08/06/2020 </ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Shukra Dhatu

|label2 = Authors
|data2 = Anagha S.,Deole Y.S.
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 16, 2020
}}

==Etymology and derivation ==

It is derived from the Sanskrit root-word “shuch” meaning brightness, clearness, light, flame, glow, heat etc. <ref>Monier Williams (1899), “शुच्”, in A Sanskrit–English Dictionary, new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 1081.</ref>

The term is used to denote any clear liquid, juice, the essence of anything, semen virile, seed of animals (male and female), and sperm.<ref>Jha Srujan. Amarkosha online application</ref>

==Synonyms ==

*'''Pumstvam / Paurusham''': denoting masculinity

*'''Retas''': that which flows (denoting seminal fluid)

*'''Beejam''': denoting the germ element/origin/ source/cause

*'''Veeryam''': denoting the power/potency /valor/heroism

*'''Teja''': showing the essential nature or essence of tissues

*'''Indriyam''': bodily virile power or power of the sense

*'''Annavikara''': originated from the nutrient fluid (ahara rasa)

*'''Majjarasa''': derived from the essence of bone marrow([[majja dhatu]])

==Meanings in different contexts==

*It refers to “male genetic prototype”-one of the factors, which is responsible for the formation of the embryo ([[garbha]])[Cha. Sa.[[Sharira Sthana]] 2/4]

*It is one of the factors responsible for the basic constitution ([[prakriti]]) of an individual.[Cha. Sa. [[Vimana Sthana]] 8/95], [Su. Sa. Sharira Sthana 4/6].

*Shukra is known as the most important (pradhana [[dhatu]])[Cha. Sa. [[Chikitsa Sthana]] 30/184] and seed like component (beejarupa [[dhatu]]) [Cha. Sa. [[Sharira Sthana]] 4/7,10]

*In the context of reproduction, the term shukra denotes the semen only. [Cha. Sa. [[Chikitsa Sthana]] 30/146]

*Shukra/shukla refers to white colour and the iris of the eye and some morbid afflictions/ diseases of the iris are also known by the term shukra.[Su. Sa Uttara Tantra 1/36]

== Panchabhautika constitution and properties ==

Shukra is constituted by four elements-[[vayu]], [[agni]], [[prithvi]] and [[jala]](four [[mahabhuta]]) in equal proportion. It is originated from six basic tastes. [Cha.Sa.[[Sharira Sthana]] 2/4]

The pure virile semen (shukra)is unctuous (snigdha), viscous (ghana), slimy (picchila), sweet (madhura). It does not cause a burning sensation in genital tract (avidahi). It looks like white crystal quartz (shukla).[Cha. Sa.[[Chikitsa Sthana]] 30/146]

== Formation and metabolism of shukra dhatu ==

During metabolism, the unctuous part of predecessor [[majja dhatu]] is transformed into shukra dhatu. The marrow is present in bones. Minute pores are created by the action of [[vayu]] and [[akasha mahabhuta]] on bones. The shukra dhatu oozes out from these minute pores after action of factors responsible for the metabolism of shukra dhatu (shukra dhatu agni). This process is like water oozing out of new mud pot, shukra also oozes out of these pores. It is then circulated all over the body through channels of transportation of shukra dhatu(shukravahasrotas).[Cha. Sa.[[Chikitsa Sthana]] 15/32-33] Thus, shukra dhatu is present all over body.

The second form is present in testicles (vrushana). After maturation, at the time of sexual excitation or urge of ejaculation (vega), the semen (shukra) is discharged through urethra. This process happens just like ghee is melted by heat.
[Cha. Sa.[[Chikitsa Sthana]] 15/34-35].

=== Metabolic byproducts (Upadhatu) ===
[[Ojas]] is considered as the metabolic byproduct (upadhatu) of shukra.[Sha. Sa. Purva khanda chapter 5]
Other scholars opine that as shukra is the essence of all [[dhatu]], there is no metabolic byproduct or waste formed during its formation.

=== Quantity of shukra dhatu in body===

The total quantity of shukra is mentioned as half anjali. [Cha. Sa. [[Sharira Sthana]] 7/15] Anjali is a personified measurement unit.

=== Time span ===

Shukra is formed on the seventh day by the transformation of nutrient fluid (ahara rasa).
The aphrodisiac food and medicines (vrishya) can enhance the formation of shukra in a shorter time. [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]
Sushruta opines that shukra dhatu is formed in a time span of one month. (18090 kala≈30days).[Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality of reproductive tissue(shukra sara) ==

The persons endowed with the essence of shukra dhatu are gentle (saumya), having charming appearance (saumyaprekshina), beautiful eyes as if filled with milk (kshirapurnalochana) and immensely exhilarated (praharshabahula). Their teeth are unctuous, rounded, firm, even and compact. They have prominent buttocks (large pelvic girdle). They have pleasant, unctuous complexion and voice. They are brilliant. They are liked by women for enjoyment, are strong and endowed with happiness, leisure, health, wealth, honor, and progeny. [Cha. Sa. [[Vimana Sthana]] 8/109]

== Forms of shukradhatu in body ==

The shukra dhatu is present in various forms as below:

===Channels of transportation transformation of shukra dhatu (shukravahasrotas)===

The Channels of transportation and transformation of shukra dhatu (shukravahasrotas) has its roots in testicles and penis. [Cha. Sa. [[Vimana Sthana]] 5/8] Sushruta opines that they originate from breast and testicles. There are two vessels to carry Shukra dhatu. [Su. Sa. Sharira Sthana 9/12]
There are various other anatomical structures related to shukra dhatu. These can be included in the transport and transformation system of shukra dhatu (shukravaha srotas).

The structures are as described below:

=== Layer of shukra (shukradhara kala):===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of shukra is the innermost layer that is present in the entire body. Shukra dhatu is distributed all over the body in the same manner that the fat in the milk and juice in the sugar cane plant are distributed. [Cha Sa [[Chikitsa Sthana]] 2/46],[Su. Sa. Sharira Sthana 4/20]

Some scholars opine that shukradhara kala can be observed as the seminiferous tubules of the testes.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.349</ref>

The mucous membranes of the testes, seminiferous tubules, epididymis, vas deferens and prostate in the male and that of the vagina, uterus, uterine tubes and ovaries in females can be considered as shukradhara kala.

=== Vessels carrying shukra dhatu (shukravahini dhamani) ===
Two pairs of vessels carrying shukra dhatu (shukravahini dhamani) are listed as channels for transportation. [Su. Sa. Sharira Sthana 9/12] Two more vessels are present for production of semen (shukra)and two are for ejaculation.[Su. Sa.Sharira Sthana 9/7]

====Ejaculation====

The semen (shukra) passes through the ducts situated about 4 cm (two angula) on either side (vas deferens)and just below the neck of the bladder. It is finally ejaculated through urethra. [Su. Sa.Sharira Sthana 4/22]

== Functions of shukra dhatu ==

Shukra bestows courage, ejaculation, lust, strength of the body, pleasure, love, and affection. The main function of shukra is reproduction and embryogenesis. [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

Shukra is one among the ten seats of vitality (dashapranayatanani) [Cha. Sa. [[Sharira Sthana]] 7/9] Thus extreme depletion of its quality and quantity may lead to death.

===Causes of vitiation===

The following are the causative factors for the vitiation of channels for transport and transformation of shukra dhatu.[Cha. Sa. [[Vimana Sthana]] 5/19]

==== Dietary causes ====
Consumption of incompatible food, excessive consumption of dry, bitter, astringent, salty, sour, hot food.

==== Psychological causes ====

Anxiety, distress, distrust, apprehension, rage, exorcism.

==== Causes related to coitus ====

Excess intercourse, untimely coitus, coitus other than in vagina, or complete abstinence from it(suppression of discharge of semen), unaware of female desire, untimely ejaculation etc.

==== Other causes ====

Excess exercise, senility, improper usage of surgical instruments, alkali (kshara), heat or cautery (agni), emaciation due to other diseases, repression of natural urges, injury, morbidity causing vitiation of dhatus, doshas individually or collectively reaching reproductive system (retovahasrotas) leads to acute disorders of the shukra (semen). [Cha. Sa. [[Chikitsa Sthana]] 30/139]

=== Abnormal states ===

The increase or decrease in quality and/or quantity of shukra dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*Debility
*Dryness of mouth
*Pallor
*Asthenia
*Fatigue/giddiness
*Impotency
*Pain in penis and testes
*Delayed ejaculation, absence of ejaculation
*Scanty semen, Semen mixed with blood
*Burning sensation in penis

[Cha. Sa. [[Sutra Sthana]] 17/69], [Su. Sa. Sutra Sthana 15/9], [Ash. Sa. Sutra Sthana 19/9]

==== Signs of increase ====

*Seminal calculi
*Excessive production of semenor hyperspermia
*Excessive libido

[Su. Sa. Sutra Sthana 15/14], [Ash. Sa. Sutra Sthana 19/6]

===Clinical features of vitiation of channels of transport and transformation of shukra dhatu (shukravahasrotas) ===

*Due to vitiation of channels of transportation and transformation of shukra dhatu (shukravahasrotas), the person becomes sexually impotent, with lack of libido, and infertile. The spouse is also affected by diseases. There are chances of no conception or frequent abortions. The progeny, if borne, is sick, impotent, and short-lived with congenital abnormalities. Thus, abnormalities of shukra dhatu result in misery for the individual as well as his family.[Cha. Sa. [[Sutra Sthana]] 28/18-19]

*Injury to the shukravahasrotas leads to impotence, delayed ejaculation, and semen mixed with blood.[Su. Sa. Sharira Sthana 9/12]

== Role of shukra dhatu as vitiated factor in diseases ==

Shukra dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes(prameha) [Cha. Sa. [[Nidana Sthana]] 4/7]

*Emaciation including tuberculosis (shosha) [Cha. Sa. [[Nidana Sthana]] 6/8]

*Emaciation due to trauma (kshata-ksheena)) [Cha. Sa. [[Chikitsa Sthana]] 11/12].

*When vitiated [[vata dosha]] affects semen, it causes premature ejaculation or absence of ejaculation. In females, it can cause dysmenorrhoea, oligomenorrhoea, or amenorrhoea. In pregnancy, it leads to preterm or delayed labor. It may also cause congenital deformities in the fetus. [Cha. Sa. [[Chikitsa Sthana]] 28/34].

*If the vata is occluded in semen, it results in ejaculation or premature ejaculation or sterility. [Cha. Sa. [[Chikitsa Sthana]] 28/68].

*In case of fever (jwara), vitiated dosha located in the shukra dhatu cause untimely ejaculation and destruction of shukra. This results in decreased vitality with [[vayu]], [[agni]], and soma components of the subtle body. It is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/82]

=== Characteristics of vitiated semen (shukradushti) ===

The vitiated semen is frothy(phenilam), less viscous (tanu), dry with less fluid (ruksha), discolored(vivarnam), putrid(puti), slimy (pichhilam ), afflicted with other dhatus and precipitant. [Cha. Sa. [[Chikitsa Sthana]] 30/139-140].

==== Dosha specific features ====

The shukra dhatu affected by [[dosha]] and specific cause show respective characteristics as given below:
{| class="wikitable"
|-
| '''Cause/factor of vitiation''' || '''Characteristic features'''
|-
| [[Vata dosha]] || frothy, slender, dry, scanty, discomforting ejaculation, infertile
|-
| [[Pitta dosha]] || bluish or yellow discoloration,putrid odor, ejaculation with burning sensation
|-
| [[Kapha dosha]] ||extremely slimy and obstructs channel of semen (ejaculatory duct)
|-
| Excessive coitus/ injury || semen with blood
|-
|Suppression of sexual urge || ejaculate painfully with increased viscosity.
|}

Sushruta and Vagbhata described eight types of vitiated shukra as below:
Affected by [[vata dosha]], [[pitta dosha]], [[kapha dosha]], that having cadaveric smell(kunapagandhi), having clots/coagulated mass(granthi), foul smelling, pus like(puti-puya), decreased quantity(kshina), mixed with urine(mutraretas) and feces (purisha).[Su. Sa.Sharira Sthana 2/3]

=== Abnormalities of Semen ===

Currently, the microscopic study of semen is done as the “seminal analysis”. The abnormalities in semen are observed as below:

*'''Aspermia''': absence of semen

*'''Azoospermia''': absence of sperm

*'''Hypospermia''': low semen volume

*'''Hyperspermia''': high semen volume

*'''Oligozoospermia''': Very low sperm count

*'''Asthenozoospermia''': poor sperm motility

*'''Teratozoospermia''': sperm carry more morphological defects than usual

*'''Necrozoospermia''': all sperm in the ejaculate are dead

*'''Leucospermia''': a high level of white blood cells in semen.

== Prognosis ==

* In case of fever, if the vitiated dosha are affecting shukra dhatu, then it is incurable. [Cha. Sa. [[Chikitsa Sthana]] 3/83].

*The vitiation of shukra by vata, pitta, kapha dosha are curable. The semen with cadaveric smell(kunapagandhi), having clots/coagulated mass (granthi), foul-smelling, pus-like(puti-puya), decreased quantity (kshina) are difficult to cure. The semen mixed with urine(mutra) and faeces (purisha)are incurable. [Su Sa Sharira Sthana 2/4]

Vagbhata opines that all conditions are difficult to cure except the ones mixed with urine and feces, which is incurable. [Ash Hr. Sharira Sthana 1/11]

== Importance of concept in the preservation of health and prevention ==

Aphrodisiac therapies (vajikarana) produces lineage of progeny, quick sexual stimulation, enables one to perform sexual act with the women uninterruptedly and promote corpulence and infallible and indestructible semen. [Cha. Sa. [[Chikitsa Sthana]] 1/1/9-10] This is one of the most important measures to promote sexual health and prevent diseases.

== Principles of management ==

*If the semen is affected, virility enhancing food and drinks which promote strength and semen are beneficial. Therapeutic purgation ([[virechana]]) is indicated in the case of obstruction in the passage of semen.[Cha. Sa. [[Chikitsa Sthana]] 28/94]

* Aphrodisiac therapies (vajikarana) is beneficial in the case of diseases of semen. The medicines pacifying bleeding disorders (raktapittahara) and those indicated in the management of disorders of the female genital tract (yoni vyapat) are prescribed in vitiation of shukra dhatu. Jeevaneeyaghritam, chyavanaprasha and shilajatu are specially indicated to treat diseases of virile semen. [Cha. Sa. [[Chikitsa Sthana]] 30/146-148]

*Ghee(sarpi), milk(payas), meat soup (mamsarasa), shali rice, barley (yava), shashtika rice, and especially therapeutic enema ([[basti karma]]) are advised in the disorders of semen.[Cha. Sa. [[Chikitsa Sthana]] 30/152]

The following table shows specific therapies for treating disorders of shukra dhatu by vitiated dosha.
{| class="wikitable"
|-
|'''Type of vitiation''' || '''Treatment'''
|-
| [[Vata]] || evacuation and unctuous enema (niruha and anuvasana)
|-
| [[Pitta]] || rasayana formulations indicated in abhayaamalakeeya chapter
|-
| [[Kapha]] || pippali,guduchi, loha, triphala, bhallataka rasayana
|}

== Contemporary approach ==

In the contemporary approach, the body components related to reproduction are considered under purview of shukra dhatu. Thus, the male and female reproductive systems, their anatomical and physiological aspects are observed under shukra dhatu. The disorders of semen are described mainly in this article. The disorders of female genital tract and menstruation are described in separate contexts with reference to [[Yonivyapat Chikitsa]].

=== Seminogram ===

The semen analysis also called seminogram or spermiogram which evaluates certain characteristics of semen and the sperm contained therein.

There are many parameters obtained through a spermiogram, the most frequently studied are:

*'''Liquefaction''': After the ejaculation, the sperm sample is coagulated and needs to be liquefied in order to perform any tests. In normal conditions, the sperm is totally liquefied in 60 minutes after the ejaculation.

*'''Viscosity''': When the semen sample is highly viscous, it may be a sign of a prostatic dysfunction.

*'''Volume''': The normal volume of an ejaculate sample after 3 or 5 days of sexual abstinence is 1.5 ml approximately. Lower volumes might suggest hypospermia.

*'''Color''': Sperm is usually opalescent white, lightly yellow. When the color is altered, it is recommended to study possible causes.

*'''pH''': Values should be greater than 7.1. Lower values might be a sign of azoospermia (lack of spermatozoa) or chronic inflammatory processes.

*'''Sperm concentration''': Normal values are around 15 million per ml ejaculated or 39 million per complete semen sample. When these values are lower it could indicate oligozoospermia.

*'''Motility''': The percentage of motile spermatozoa and progressively motile is analyzed. The progressive motility value should be over 32%, on the contrary, it might indicate astenozoospermia.

*'''Vitality''': The percentage of vital spermatozoa must be over 58%. Lower values could indicate astenoozoospermia.

*'''Morphology''': There might be 4% or more normal spermatozoa in an usual spermiogram. Lower percentage of normal sperms and high percentage of morphologically abnormal sperms could indicate teratozoospermia.

*'''Leukocytes''': When the leukocyte concentration is over 1 million per ml of sample it might indicate an infection (leukocytosis).

*'''Antisperm Antibodies or Mar test''': The number of spermatozoa with adherent particles or cells is reflected. More than 50% spermatozoa clustered together suggests an immunological problem.

== Current researches ==

Ayurveda text describe the formation of shukra dhatu from majja dhatu. Current research shows that bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential for differentiation. They secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref> Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2):134-45. doi: 10.15283/ijsc.2015.8.2.134</ref>

===List of theses ===

The following research works are done to study the efficacy of various formulation in enhancing virility and treating disorders of vitiation of shukra dhatu.

#Raja Reddy G.(1999): A comparative pharmaco-therapeutic study of erandamula and kapikacchu bija with special reference to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar
# Mangalasseri Prakash (2002): A clinical study of shukragata-vata w.s.r. to premature ejaculation and its management with akarakarabhadi yoga and yapana basti, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Girish K J (2002): Role of shukrasodhana-janana yoga in the management of ksheena-shukra, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Kulakarni Hrishikesh(2004): A pharmaco-therapeutic study on putranjeevaka (drypetes roxburghii wall.) w.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Joshi Kalpesh (2005): Comparative study with mashadi vati and amalaki-bhavit shilajitu in the management of ksheena-shukra (oligospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Basil Cardozo (2006): A clinical study on psycho-somatic management of shukravrita vata (premature ejaculation) with rasayana yoga and shirodhara, department of Kayachikitsa, IPGT &RA, Jamnagar.
#Shiromani Mishra (2008): A pharmaco-therapeutic study on kushmanda [benincasahispida (thunb.) cong.] beejaw.s.r. to vrishya karma, department of Dravyaguna, IPGT &RA, Jamnagar.
#Vinish Kumar Gupta (2009): The role of akarakarabhadi yoga in the management of kshipramunchan of shukragata vata w.s.r. to premature ejaculation (p.e.), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Jitesh C Padariya (2010): Effect of pushpadhanva-rasa and swayamgupta ikshurak beejachoorna on kshinashukra(oligozoospermia), department of Kayachikitsa, IPGT &RA, Jamnagar.
#Rajiv G Amal (2011): The role of gokshuradi yoga in the management of klaibya w.s.r. to erectile dysfunction, department of Kayachikitsa, IPGT &RA, Jamnagar
# Prasad Kulkarni (2012): A clinical study on shukragatavata w.s.r. premature ejaculation and its management by stambhanakarak yoga, department of Kayachikitsa, IPGT &RA, Jamnagar

==More information ==

===Related Chapters===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Asthi dhatu

2020-06-27T05:48:07Z

Anagha: /* References from Charak Samhita */

Asthi dhatu

2020-06-27T05:47:35Z

Anagha: /* External links */

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa. Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su.Sa.Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha. Sa. [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

1.Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

2.Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

3.Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

4.Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

5.Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

6.Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

7.Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

8.Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

9.Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

10.Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita

=== References from [[Charak Samhita]] ===

The list of references for meda dhatu in Charak Samhita can be seen here.

==References==

Asthi dhatu

2020-06-27T05:45:47Z

Anagha: /* Abbreviations */

Asthi dhatu

2020-06-27T05:39:25Z

Anagha: /* List of theses */

Asthi dhatu

2020-06-27T05:38:26Z

Anagha: /* Abbreviations */

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa. Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su.Sa.Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha. Sa. [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

#Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*Hr. = Hrudaya

==References==

Asthi dhatu

2020-06-27T05:36:36Z

Anagha: /* More information */

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa. Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su.Sa.Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha. Sa. [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

#Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Meda dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Asthi dhatu

2020-06-27T05:33:28Z

Anagha: /* Role of asthi dhatu as a vitiating factor in diseases */

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa. Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su.Sa.Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha. Sa. [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

#Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Asthi dhatu

2020-06-27T05:04:12Z

Anagha: /* Metabolism and Development */

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa. Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su.Sa.Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha Sa [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha Sa [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

#Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Asthi dhatu

2020-06-27T04:57:35Z

Anagha: /* Definition */

Asthi literally means bone or that entity which stays or doesn’t get destroyed easily. Asthi dhatu is a body component similar to bone (osseous) tissue. Its important function is to hold body frame (dharana). It provides stability to the body and forms skeleton.<ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.436)
{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Asthi Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 = June 2, 2020
}}

== Definition and meaning of term "Asthi"==

=== Etymology and derivation ===

The word Asthi is a combination of two Sanskrit words "as” and “kthin”. They together give the meaning “stability”.<ref>Jha Srujan. Shabdakalpadruma online application</ref> It denotes a bone or the kernel of a fruit.<ref>Monier Williams (1899), “अस्थि”, in A Sanskrit–English Dictionary,new edition, Oxford: At the Clarendon Press, OCLC 458052227, page 122.</ref>

=== Definition ===
Asthi is a body component which stays for a longer time (asyate) and which takes part in movements (kshipyate) with muscles. It is also termed as the extract (sara) of the body which remains even after the destruction of all other body components. [Su.Sa.Sharira Sthana 5/21-22]

=== Synonyms ===

1. '''Kikasam''': round structures

2. '''Kulyam''': tubular or canal like structure

3. '''Svadayitam''': animals like dogs like it

4. '''Medasteja''': essence of Medadhatu (adipose tissue)

5. '''Sara''': extract of body which remains even after death

6. '''Majjakrit''': which produces the [[Majja dhatu]]

7. '''Dehadharakam''': which maintains body frame (skeleton) and bears body weight

9. '''Karkaram''': rough

=== Meanings in different contexts===

*In physiology, the word denotes structural and functional components mainly of osseous or bone tissue.
*It is a substance of animal origin (jangamadravya) [Cha. Sa. [[Sutra Sthana]] 1/69]
*In the contexts of some pharmaceutical preparations, seedless fruits (ansathi) are to be used. Hence it denotes seeds or kernel of fruits. E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha. Sa. [[Chikitsa Sthana]] 1/1/58]
*In the dietary preparation of meat soup (vesavara) bones should be removed. (nirasthi) [Cha. Sa. [[Sutra Sthana]] 27/ 269]

== Fundamental constitution (panchabhautika sanghatana) and properties ==

Fundamental constitution of asthi dhatu shows predominance of [[Prithvi mahabhuta]].

*The physical properties of "asthi dhatu" are heaviness (guru), roughness (khara), hardness (kathina), bulkiness (sthula), static (sthira), with a definite physical form (murtimanta).<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.322-3</ref>

== Metabolism and Development ==

The asthi dhatu is formed from its predecessor adipose tissue ([[meda dhatu]]). The nourishing portion of adipose tissue ([[meda dhatu]]) and constituents of nutrient fluid (ahara rasa) are transformed into asthi dhatu by action of factors responsible for its metabolism (asthi dhatvagni). [[Agni mahabhuta]] and [[vayu mahabhuta]] play a major role in the solidification and roughness of asthi by acting upon [[Prithvi mahabhuta]] components of adipose tissue ([[meda dhatu]]).[Cha. Sa. [[Chikitsa Sthana]] 15/30]

Porosity in bones are due to actions of [[vayu]] and [[akasha]] mahabhuta. [Cha. Sa. [[Chikitsa Sthana]] 15/30]

=== Metabolic byproducts and waste products (Upadhatu and mala) ===

During the process of metabolism and development of asthi dhatu, nails (nakha) are formed as the metabolic byproducts (upadhatu). [Su. Sa. Sutra Sthana 46/529] Sharangadhara considered teeth (danta) only as metabolic byproduct.[Sha. Sa. Purva khanda chapter 5]

Scalp hair (kesha) and body hair(loma) are waste products of metabolism of asthi dhatu. [Cha.Sa. [[Sutra Sthana]] 15/18]

=== Quantity and measurement ===

There are total 360 well-formed asthi in human body. [Cha. Sa.[[Sharira Sthana]] 7/6].
Sushruta opines the total number as 300. [Su.Sa Sharira Sthana 5/18]

Currently, most sources state that there are total 270 bones in human body at the time of birth. Many bones fuse together and the count comes to 206 separate bones. This number does not include small sesamoid bones. <ref>Steele, D. Gentry; Claud A. Bramblett (1988). The Anatomy and Biology of the Human Skeleton. Texas A&M University Press. p. 4. ISBN 978-0-89096-300-5 Available from https://en.wikipedia.org/wiki/Bone#cite_note-1 cited on28/05/2020.</ref><ref>Mammal anatomy : an illustrated guide. New York: Marshall Cavendish. 2010. p. 129. ISBN 9780761478829. Available from https://en.wikipedia.org/wiki/Human_skeleton#cite_note-1 cited on 28/05/2020.</ref>

The reason behind the difference in counting has been well discussed in [[Sharira Sankhya Sharira]] chapter of [[Sharira Sthana]].

=== Time span ===

The asthi dhatu is formed on 5th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the asthi dhatu is formed in a time span of 12060 kala (twenty days). [Su. Sa. Sutra Sthana 14/14]

== Characteristics of best quality or essence (asthisara) ==
The persons with essence of asthi dhatu have prominent heels (parshni), ankles (gulpha), knee joint (janu), elbows (aratni), collarbones (jatru), chin (chibuka), head (shira), flanks (parshva) and joints and also bones and teeth.
Such persons are highly enthusiastic, active, enduring, having strong and firm body as well as longevity.[Cha.Sa. [[Vimana Sthana]] 8/107]

== Anatomical and physiological structures ==

The asthi dhatu is present in various forms as below.

=== Channels for transportation and transformation of asthi dhatu (asthivaha srotas) ===

The channels originate from predecessor meda dhatu and buttocks (jaghana). [Cha. Sa. [[Vimana Sthana]] 5/8]
There are various other anatomical structures related to asthi dhatu. These can be included in the system. The structures are as described below.

=== Layer of bone tissue (Asthidhara kala) ===

Kala is the layer in outer coverings of body observed in sagittal section. Some scholars opine that the inner layer of large intestine that holds fecal matter (purishadhara kala) has relation with the layer of bone tissue (asthidhara kala).
The layer of adipose tissue (medodhara kala) is present in small bones(anu asthi) where it is known as red fat (saraktameda). The layer inside long bones is known as [[majja]] (marrow). [Su.Sa.Sharira Sthana 4/13].

=== Bones (asthi) ===

The well differentiated compact form of osseous tissue (asthi) is bone.

===Types of bones ===

There are five types of bones in human body. [Su .Sa Sharira Sthana 5/20]

{| class="wikitable"
|-
!Sl.No: !!Type !!Site
|-
|1. || Flat bones (kapala)||Knee (Janu), jaghana(pelvic), shoulder(amsa),
Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
|-
|2. || Teeth(ruchaka) || Teeth
|-
|3. || Cartilages(taruna) || Nose(Ghrana), Ear(karna), Neck(griva),orbit of the eye(akshikosha)
|-
|4. || curved/Annular bones(valaya) || Ribs(Parshuka), vertebrae (prushthakasheruka)
|-
|5. || Tubular bones (nalaka) || All other long bones
|}

The contemporary anatomical views also categorize bones under five categories like long bones, short bones, flat bones, sesamoid bones, and irregular bones.<ref>Available from https://en.wikipedia.org/wiki/Bone#Types cited on 29/05/2020</ref>

=== Anatomical network (asthi jala) ===

There are four types of network-like structures (jala) in body including, bone network (asthijala).The others are muscles (mamsa), veins (sira) and ligaments (snayu). There are four such networks formed from each of these types. They are present in wrist and ankle joints and interlinked together.[Su. Sa. Sharira Sthana 5/12].

=== Confluence of bones (asthi sanghata)===

The places where many bones are present is called confluences. The confluences of bones are fourteen in number. They include ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs and their counter parts wrist(manibandha), elbow(kurpara) and axilla(kaksha) in upper limbs on each side. One is in the lower back(trika) and the other on the skull(shira) [Su. Sa. Sharira Sthana 5/16]

=== Vital points (asthi marma) ===

There are eight vital points formed from bones (asthi marma). [Su. Sa. Sharira Sthana 6/4]

These are katikataruna(vital spots on both sides of the vertebral column above and near the pelvic crest), nitamba(vital points above the two pelvic bones meeting the flank), amsaphalaka (vital points on scapula- one on each side of the vertebral column in the upper back region) and shankha(vital spots on each side between the outer end of the brow and the ear)[Su.Sa.Sharira Sthana 6/7]

== Functions ==

The important function of asthi dhatu is providing structure and support to the body. It also nourishes the successor bone marrow tissue ([[majja dhatu]]).[Su. Sa. Sutra Sthana 15/5]

In addition, contemporary physiology states that bone tissue carries out the following functions too.

=== Mechanical ===
*Protection : It protect internal organs
*Movement: facilitate movement
*Hearing: Facilitate hearing through sound transduction

===Synthesis ===

The cancellous part of the bone contains bone marrow. It produces blood cells including red blood cells, platelets and white blood cells. This process is called as hematopoiesis.<ref>Fernández, KS; de Alarcón, PA (December 2013). "Development of the hematopoietic system and disorders of hematopoiesis that present during infancy and early childhood". Pediatric Clinics of North America. 60 (6): 1273–89. doi:10.1016/j.pcl.2013.08.002. PMID 24237971</ref>

=== Metabolism ===

The bone tissue regulates acid-base balance, stores calcium, and fat cells. It acts as an endocrine organ by controlling the phosphate metabolism. It release fibroblast growth factor – 23 (FGF-23), which acts on kidneys to reduce phosphate reabsorption. The bone cells also release a hormone called osteocalcin. This contributes to the regulation of blood sugar (glucose) and fat deposition. Osteocalcin increases both insulin secretion and sensitivity, in addition to boosting the number of insulin-producing cells and reducing stores of fat.<ref> Lee, Na Kyung; et al. (10 August 2007). "Endocrine Regulation of Energy Metabolism by the Skeleton". Cell. 130 (3): 456–469. doi:10.1016/j.cell.2007.05.047. PMC 2013746. PMID 17693256</ref>

== Importance in diagnosis ==

===Causes of vitiation ===

The following are causative factors for the vitiation of channels for transport and transformation of asthi dhatu (asthivahasrotasa). [Cha. Sa. [[Vimana Sthana]] 5/17]

==== Dietary causes ====

* Excessive consumption of food that aggravates vatadosha in body. This includes the dietary items which possess properties like light to digest (laghu), dry(ruksha), cold(sheeta), rough(khara), highly penetrating or subtle (sukshma), mobile(chala).

==== Lifestyle causes ====

* Excessive physical exercise
*Excessive jerks to the body or jerky movements
*Excessive pressure on bones.

===Abnormal states===

The increase or decrease in quality and/or quantity of asthi dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Signs of decrease ====

*loss of scalp and body-hair, beard, nails and teeth
*fatigue
*loose joints
*pain in bones
*dryness
*breaking of teeth and nails
[Cha. Sa. [[Sutra Sthana]] 17/67], [Su. Sa. Sutra Sthana 15/9]

==== Signs of increase ====

* extra tooth and bony growth [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation of channels of transport and transformation on asthi dhatu ===

The features of the vitiation of asthi dhatu are visible on teeth(danta), hairs(kesha) and nails(nakha). These are extra growth of bones(adhyasthi) and teeth(adhidanta), splitting(bheda) and severe pain in teeth and bones(shula), discoloration(vivarnata), abnormalities of body hair(kesha), nail(nakha) and beard(shmashru). [Cha. Sa. [[Sutra Sthana]] 28/16]

==== Fracture of bone ====

*Constant and severe pain
*Discomfort in any posture or position
*Thirst
*Weakness
*Swelling [Su. Sa. Sutra Sthana 25/39]

==== Signs of foreign body piercing bones ====

*Different kinds of pain and swelling

==== Signs of foreign body in bone cavity ====

* Sense of fullness in the bones
*constant pricking pain
* profound horripilation. [Su. Sa. Sutra Sthana 26/10]

=== Role of asthi dhatu as a vitiating factor in diseases ===

*When the vitiated doshas afflict bone tissue(asthi dhatu), the tertiary fever (tritiyakajwara)is manifested. [Cha. Sa.[[Chikitsa Sthana]] 3/64]

*In fever, when the dosha are located in bone tissue (asthigatajwara) , they cause diarrhea, vomiting, pain in the bones, production of kujana (a sort of cooing sound), convulsive movement of the body. [Cha. Sa.[[Chikitsa Sthana]] 3/80]

*Bone tissue is one of the eight locations of wounds (vrana). The other sites are skin, blood vessels, flesh, fat, ligament, vital parts and viscera. [Cha. Sa.[[Chikitsa Sthana]] 25/26]

*When vitiated vata is located in bones and marrow, it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia, and continuous pain. [Cha Sa [[Chikitsa Sthana]] 28/33]

*When the vata is occluded by the osseous tissue, the patient likes hot touch (local sudation) and pressing. He has splitting pain and feels as though his body is being pricked with needles. [Cha Sa [[Chikitsa Sthana]] 28/66]

*When the wound(vrana) is deep to affect bones due to different types of injuries or destruction by the aggravated doshas, it looks like an oyster shell. There is discharge(srava) mixed with marrow and blood.[Su. Sa. Sutra Sthana 22/8]

=== Importance in prognosis ===

*The fever (jwara) in which doshas are located in the bone tissue (asthi dhatu) is difficult to treat.[Cha Sa [[Chikitsa Sthana]] 3/83]

*Among the types of fractures, those broken into multiple pieces(churnita), moved to the other side(chhinna), entire bone is broken into pieces without any tissue remaining (atipatita) and piece of bone pierces into the marrow(majjanugata) are difficult to cure. [Su. Sa. Nidana Sthana 15/11]

== Importance in preservation of health and prevention ==

Bone tissue (asthi dhatu) is considered as the essence of body tissue which remains even after destruction of all other tissues. [Su. Sa. Sharira Sthana 5/21-22]

The enthusiasm, endurance, strength, body structure, firmness, and longevity depend upon quality of asthi dhatu. [Cha. Sa. [[Vimana Sthana]] 8/107]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The disorders of asthi dhatu are treated with [[panchakarma]], especially enema prepared with bitter drugs, milk, and ghee(tiktaksheerabasti).[Cha. Sa. [[Sutra Sthana]] 28/27]

*When a foreign body is concealed in bone, the patient should be treated with oleation (snehana), fomentation(swedana) and then the bones should be tied with bandage(bandha) tightly or squeezed hard. [ Su. Sa. Sutra Sthana 26/12]

*The qualitative and quantitative decrease in bone tissue is managed by the supplements having similar properties. E.g. the calcinated powder of eggshell (kukkutandatwakbhasma), calcinated powder of goat bones (ajasthibhasma), coral (pravalbhasma).

=== Surgical management ===

*A type of surgical instrument with crossed blades (swastika yantra)was used to remove foreign bodies from bone tissues. [Su.Sa. Sutra Sthana 7/10]

*Details management of fractures is described in a separate chapter “bhagna chikitsita” by Sushruta. [Su.Sa.Chikitsa Sthana 3]

*Many remarkable advances in the surgical management of disorders of bones have been observed including the artificial bone grafting, total joint replacement.

== Contemporary approach and current researches ==

Asthi dhatu is observed in view of bone or osseous tissue in conventional physiology. Bone is the dense and hard connective tissue. Its hardness is due to the deposition of inorganic salts like calcium phosphate and calcium sulphate in an organic matrix. There are three types of bone cells – osteoblast, osteocyte and osteoclast.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue ===
{| class="wikitable"
|-
|Sr.No. || Concept of Asthi dhatu ||Bone tissue
|-
|1. || Role of [[Prithvi mahabhuta]] in asthi dhatu || Minerals including inorganic salts like calcium phosphate and calcium sulphate make the matrix more dense
|-
|2. || Role of adipose tissue (meda dhatu) || Marrow adipose tissue (MAT) is stored in bones.
|-
|3. || Composition of Asthi dhatu || Support cells, namely, osteoblasts and osteocytes ;
Remodeling cells, namely, osteoclasts ;Non-mineral matrix of collagen and noncollagenous proteins called osteoid, with inorganic mineral salts deposited within matrix
|-
|4. || Factors responsible for transformation and metabolism of bone (asthi dhatu agni) || Factors responsible for skeletal metabolism:
Calcitropichormones, Parathyroid hormone (PTH), Calcitonin (CT), Vitamin D [1,25(OH 2)D], PTHrP, other hormones, gonadal and adrenal steroids, Thyroid hormones, Growth factors and cytokines
|-
|5. || Formation of asthi dhatu || Processes of bone formation, bone resorption and remodeling
|-
| 6.|| Nutrition, growth and development (poshana) || The factors responsible for skeletal metabolism are responsible for longitudinal and radial growth of boneuptothe age of skeletal maturity (18 to 25 years)
|-
|7.|| Disorders of channels of transport and transformation on asthi dhatu – extra growth of bones || osteoma, osteoid osteoma, osteochondroma, osteoblastoma, enchondroma, giant cell tumor of bone, aneurysmal bone cyst, leukemia
|}

=== Assessment and investigations ===

==== Radiological investigations ====

*X ray, Ultrasound, CT scan and MRI scan are methods used for scanning structural abnormalities, fractures of bones.

*Nuclear imaging technique ‘Bone scan’ is used to detect the bone cancers.

*Dual Energy X-ray Absorptiometry (DEXA) scan is used to measure bone mineral density. It is used to diagnose osteopenia and osteoporosis.

== Current researches ==

Growth factors produced by stem cells aid in the bone repair process. Current researches investigated the ability of encapsulated rat adipose‐derived stem cells (rASCs) treated with osteogenic media (OM) to produce growth factors, and determined the optimal combination of OM components that will lead to the production of both osteogenic and angiogenic factors. The results demonstrate that microencapsulated stem cells were able to produce vascular endothelial growth factor (VEGF), fibroblast growth factor‐2, and bone morphogenetic protein‐2 (BMP2) necessary for bone regeneration.<ref>Shirae K. Leslie et al,Production of osteogenic and angiogenic factors by microencapsulated adipose stem cells varies with culture conditions,Journal of Biomedical Materials Research Part B: Applied Biomaterial ; Vol 108, No 5, Jul 2020 ; PP: 1857-1867</ref>

=== Bone tissue engineering ===

*The successful regeneration of bone tissue to replace areas of bone loss in large defects or at load-bearing sites remains a significant clinical challenge. Over the past few decades, major progress is achieved in the field of bone tissue engineering to provide alternative therapies, particularly through approaches that are at the interface of biology and engineering.<ref>Li JJ, Ebied M, Xu J, Zreiqat H. Current Approaches to Bone Tissue Engineering: The Interface between Biology and Engineering. Adv Healthc Mater. 2018;7(6):e1701061. doi:10.1002/adhm.201701061</ref> The major components of bone tissue engineering are the scaffold, cells, and growth factors. The recent advancements in developing scaffolds that can mimic the natural extracellular matrix of bone using two main fabrication techniques, electrospinning and thermally-induced phase separation, and incorporating bone-like minerals, such as hydroxyapatite, composite nanofibrous scaffolds can improve cell adhesion, stem cell differentiation, and tissue formation.<ref>Holzwarth, J. M., & Ma, P. X. (2011). Biomimetic nanofibrous scaffolds for bone tissue engineering. Biomaterials, 32(36), 9622–9629. https://doi.org/10.1016/j.biomaterials.2011.09.009</ref>

=== Scope of further research ===
Osteoarthritis (OA) is a degenerative joint disorder, represents failure of the diarthrodial (movable, synovial-lined) joint. OA of knee joint comes under the inflammatory group which is almost identical to sandhigatavata described in Ayurveda with respect to etiology, pathology, and clinical features. Agnikarma (therapeutic heat burn)is an observed effective nonpharmacological, para surgical procedure for pain management in SandhigataVata (OA of knee joint).<ref>Jethava NG, Dudhamal TS, Gupta SK. Role of Agnikarma in Sandhigata Vata (osteoarthritis of knee joint). Ayu. 2015;36(1):23‐28. doi:10.4103/0974-8520.169017</ref> <ref>Sharma A, Shalini TV, Sriranjini SJ, Venkatesh BA. Management strategies for Janu Sandhigata Vata vis-a-vis osteoartheritis of knee: A narrative review. Ayu. 2016;37(1):11‐17. doi:10.4103/ayu.AYU_24_16</ref>

* The role of enema therapy in various disorders of bone tissue is an important topic of research. Many researches are carried out in this area as listed below. However precise studies are required to be done for the effect of enema therapy at various levels of bone metabolism and factors responsible for growth.

=== List of theses ===

#Patel Kalapi B (2001) : A clinical study on the development of subtype of abhyanga with reference to its role in the management of griva-hundana (cervical spondylosis) , Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Alpesh Joshi(2004) : A clinical study on the role of matra basti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Praveen Kumar KC (2005):Effect of vachadi upanaha and vachadi ghana-vati in sandhigata-vata w.s.r. to osteoarthritis, department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Mayuri Shah (2006):A comparative study of matra basti and some indigenous compound drug in the management of sandhigata vata (osteoarthritis), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Md. Babul akter(2006) : Clinical study on sandhigata vata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Dhaval M Dholakiya(2012) : A clinical study on sandhigata vata (osteoarthritis) and its management with dashmoola ghrita and nirgundi tail, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

#Jayadipkumar P Shah(2008): Effect of tikta kshira basti and patra pinda sweda in the management of cervical spondylosis (asthigata vata), Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Ajay K Gupta (2010):Effect of majjabasti&asthishrinkhala in the management of osteoporosis w.s.r. to asthi-majjakshaya-a clinical study, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Saurabh R Bhuva(2012) : A comparative study of matra basti and brimhana snehana by asthishrinkhala ghrita in the management of asthi-majjakshaya w.s.r. to osteopenia / osteoporosis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

#Chugh Deepa Surender Pal (2014): A comparative study of shwadanshtradibasti and chitrakadighrita in management of sandhivata with special reference to osteoarthritis, Department of Panchakarma, I.P.G.T. & R.A., Jamnagar.

== More information ==

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

== External links ==

[[Bone]], [[Human skeleton]], [[Artificial bone]], [[Joint replacement]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Majja dhatu

2020-06-27T04:55:42Z

Anagha: /* Abbreviations */

Majja dhatu

2020-06-27T04:54:15Z

Anagha: /* Related articles */

Majja dhatu

2020-06-27T04:53:59Z

Anagha: /* Related Chapters */

Majja literally means the marrow. Majja dhatu is the body component similar to bone marrow, the soft organic material that fills the cavities of the bones.(SAT-B.443)<ref>Available from http//namstp.ayush.gov.in/#/sat accessed on 05/06/2020</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Majja Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 =June 16, 2020
}}

==Etymology and derivation==

It is derived from the Sanskrit dhatu “majjan” meaning that which is sunken, or seated within, which denotes the marrow of bones and flesh, pith of plants etc.<ref>Monier Williams (1899), A Sanskrit–English Dictionary, new edition, Oxford At the Clarendon Press, OCLC 458052227.</ref>

==Synonyms ==

*'''Asthija / Asthisambhava''' : derived from bones ([[asthi dhatu]])

*'''Asthisneha''' : special type of fat found inside bones

*'''Asthisara/Asthiteja''' : the essence of [[asthi]]

*'''Dehasara''' : the essence of body

*'''Shukrakara''': that which produce [[shukra]]

==Meanings in different contexts ==

*In physiology, the word denotes structural and functional components mainly of bone marrow.

*In the contexts of drugs, the word majja is used to denote the pulp, fleshy parts of fruits.Ex. Pulp of Indian jujube (kola)[Cha. Sa. [[Chikitsa Sthana]] 20/29]

*It is included as an animal product(jangama dravya).[Cha. Sa. [[Sutra Sthana]] 1/68] and considered as one among the four unctuous substances(maha sneha) for therapeutic purposes. [Cha. Sa. [[Sutra Sthana]] 1/86]

== Panchabhautika constitution and properties ==

There is a predominance of [[jala mahabhuta]] in majja dhatu. It possesses unctuous(snigdha) and soft (mridu) properties.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.323</ref>

==Formation and metabolism of majja dhatu ==

During metabolism, [[vata dosha]] produces hollowness inside the [[asthi dhatu]]. These hollow cavities are filled by adipose tissue([[meda dhatu]]). The adipose tissue in hollow cavities of bones is known as [[majja dhatu]] (bone marrow).[Cha. Sa. [[Chikitsa Sthana]] 15/31-33]

== Metabolic byproducts and waste products(Upadhatu and mala) ==

Sharangadhara considered hairs (kesha) as metabolic byproduct of majja dhatu. [Sha.Sa. Purva Khanda chapter 5]

Unctuousness in eyes, skin and stools (akshi-twacha-vit sneha) are metabolic waste of majja dhatu. [Cha.Sa. [[Chikitsa Sthana]] 15/20]

== Quantity of majja dhatu in body ==

The total quantity of majja is one anjali. One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person-specific. [Cha. Sa. [[Sharira Sthana]] 8/15]

== Time span ==

The majja dhatu is formed on 6th day from nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]

Sushruta opines that the majja dhatu is formed in a time span of 15075 kala (twenty-five days). [Su. Sa. Sutra Sthana 14/14]

==Characteristics of majja sara (best quality of bone marrow)==

The persons having superior quality of majja dhatu are endowed with soft body parts, strong, unctuous complexion, and sweet voice. They have prominent (sthula), long (dirgha) and rounded joints. [Cha. Sa. [[Vimana Sthana]] 8/108]

==Anatomical and physiological aspects ==

===Brain ===

Brain (mastulunga) is a part of majja dhatu present inside the skull (mastak majja). It is present in the form of half-melted clarified butter (ardha vilina ghrita)[Su. Sa. Sutra Sthana 23/12, Dalhana]

===Channels of transportation and transformation of Majja dhatu (Majjavaha srotas)===

The channels of transportation and transformation of [[meda dhatu]] originate from bones and joints. [Cha. Sa. [[Vimana Sthana]] 5/8].

There are various structures related to majja dhatu. These can be included in the system. The structures are as described below.

=== Layer of majja (Majjadhara Kala) ===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of adipose tissue (Medodharakala)present inside the long bones is known as majja. Though there are no direct references illustrating the layer of bone marrow(majjadharakala) in the classical texts, it can be observed as the thin layer of tissue called endosteum. This is the lining in the bone cavity that separates bone cells and bone marrow.

===Types of bone marrow===

There are two types of bone marrow viz. red bone marrow and yellow bone marrow.

In yellow bone marrow, there is an abundance of fat cells with less amount of blood-forming tissue. In early childhood, red bone marrow is predominantly observed. In adult life, the fatty bone marrow retains the essential reticular structure of the hemopoietic tissue. It is capable of turning into red bone marrow under suitable stimulus like starvation.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.143</ref>

In red bone marrow, there are phagocytic endothelial cells. It is full of erythrocytes in different stages of formation and immensely vascular consisting of arteries, veins, and rich plexus of sinusoid.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.144</ref>

==Function==

The functions of majja dhatu are providing unctuousness(snehana), strength(bala), filling of bone cavity (asthi poorana) and nourishment of its successor [[shukra dhatu]] (shukra pushti). [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

===Causes of vitiation===
The channels of transportation and transformation of majja dhatu are afflicted due to the following causes[Cha. Sa. [[Vimana Sthana]] 5/18]

====Dietary causes====

Excess and frequent consumption of incompatible food (viruddha ahara)

====Exogenous causes ====

*crushing injury

*excessive discharge causing pressure

*trauma

*compression

=== Abnormal states ===

The increase or decrease in quality and/or quantity of majja dhatu can lead to various abnormal conditions. These states can be assessed by the following clinical features.

==== Signs of decrease ====

*atrophy of bone tissues

*weakness/giddiness

*lightness of bones (porosity of bones or decreased bone density)

*susceptibility to vata dominant disorders / frequent vata disorders

*depletion of semen formation

*pain in joints

*cutting pain in bones

*constant dull pain and emptiness of bones

*dimness of vision

[Cha. Sa. [[Sutra Sthana]] 17/68], [Su. Sa. Sutra Sthana 15/9], [A. Hr. Sutra Sthana 11/19]

==== Signs of increase ====

*heaviness in eyes

*heaviness in entire body

*formation of carbuncles/ with broad base on joints/synapses which are difficult to cure
[Su. Sa. Sutra Sthana 15/14], [A. Hr. Sutra Sthana 11/11]

===Clinical features of vitiation of channels of transport and transformation of majja dhatu===

*Pain in the joints, giddiness, unconsciousness, blackouts and deep-rooted abscess in joints are caused due to vitiation of channels of transport and transformation of majja dhatu. [Cha. Sa. [[Sutra Sthana]] 28/17-18].

===Role of majja dhatu as vitiated factor in disease===

Majja dhatu is involved in the pathogenesis of the following diseases

*Urinary disease including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/7]

*Diseases due to vitiation of vata [Cha. Sa. [[Chikitsa Sthana]] 28/73]

*Abscess (vidradhi)[Su. Sa. Nidana Sthana 9/34]

*When the vitiated doshas afflict bone marrow (majja dhatu), the quaternary fever (chaturthaka jwara) is manifested. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*When the vitiated doshas are located in the majja dhatu then the following signs and symptoms appear hiccups, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*Majja is mentioned as one among the eight locations of wounds (vrana), and the other sites being skin, blood vessels, flesh, bone, ligament, vital parts, and viscera. [Cha. Sa. [[Chikitsa Sthana]] 25/26]

*When vitiated [[vata]] is located in bones ([[asthi]]) and marrow(majja), it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/ 33]

*When the [[vata]] is occluded in the marrow, there will be stretching and stiffening of the trunk and extremities, excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). [Cha. Sa. [[Chikitsa Sthana]] 28/ 67-68]

===Prognosis===

*If the vitiated doshas are located in majja dhatu in the case of jwara, it is difficult to treat.[Cha. Sa. [[Chikitsa Sthana]] 3/83]

*A type of abscess (vidradhi) in bone marrow(majjaparipaka vidradhi)has a bad prognosis. Surgical intervention. (shastra sadhya) is needed to treat it. [Su. Sa. Nidana Sthana 9/38]

==Importance in the preservation of health and prevention ==

*Majja dhatu is specifically important for providing strength to bones and nourishment to reproductive tissues.

*Longevity, strength, learning ability, wealth, understanding, progeny, and social respect depend upon superior quality of majja dhatu. [Cha. Sa.[[ Vimana Sthana]] 8/108]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The diseases of vitiation of Majja dhatu shall be treated with food and medicines having sweet and bitter taste. Exercise and body purification treatments in proper dose and time are also indicated. [Cha. Sa. [[Sutra Sthana]] 28/28]

*When the doshas causing fever (jwara) are located in bone tissue ([[asthi dhatu]]) and marrow(majja dhatu), un-unctuous enema (niruha [[basti]]) and unctuous enema (anuvasana [[basti]]) are indicated. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

*The diseases due to aggravation of [[vata dosha]] are treated with medicated ghee, oil, muscle fat, and bone marrow obtained from animal bones. This is done either by oral administration or by external applications like massage or enema. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

===Internal administration of animal bone marrow(majja) for therapeutic oleation===

====Indications====

*Animal bone marrow(majja) is used for therapeutic purposes to improve strength, semen ([[shukra]]),nutrient fluid ([[rasa]]), [[kapha dosha]], adipose tissue ([[meda]]) and bone marrow (majja) itself. It especially strengthens bones and useful for oleation. [Cha. Sa. [[Sutra Sthana]] 13/17]

==== Suitable conditions ====

Animal bone marrow (majja) is administered in those persons with strong digestive power; those who can tolerate excessive physical exertion; who often eat excess food, unctuous fatty substances; who suffer from [[vata]] disorders, and have hard bowel movement(habitual constipation). [Cha. Sa. [[Sutra Sthana]] 13/50-51] The most suitable season for consuming marrow is spring. [Cha. Sa. [[Sutra Sthana]] 13/18]

== Contemporary approach ==

Majja dhatu can be referred to as bone marrow tissue in contemporary physiology. The following information is available<ref>Available from https//en.wikipedia.org/wiki/Bone_marrow accessed on 05/06/2020</ref> and can be referred to further understand the concept of majja dhatu.

===Form and site===

Bone marrow is a semi-solid tissue found within the spongy or cancellous portions of bones.<ref> C., Farhi, Diane (2009). Pathology of bone marrow and blood cells (2nd ed.). Philadelphia Wolters Kluwer Health/Lippincott William & Wilkins. ISBN 9780781770934. OCLC 191807944.</ref>

=== Composition ===
It is composed of hematopoietic cells, marrow adipose tissue, and supportive stromal cells.

=== Quantity ===
Bone marrow comprises approximately 5% of total body mass in healthy adult humans.<ref>Hindorf, C.; Glatting, G.; Chiesa, C.; Lindén, O.; Flux, G. (2010). "EANM Dosimetry Committee guidelines for bone marrow and whole-body dosimetry". Eur J Nucl Med Mol Imaging. 37 (6) 1238–1250. doi10.1007/s00259-010-1422-4. PMID 20411259.</ref>

===Functions===

Bone marrow is the primary site of new blood cell production or hematopoiesis.<ref>Arikan, Hüseyin; Çiçek, Kerim (2014). "Haematology of amphibians and reptiles a review" (PDF). North-Western Journal of Zoology. 10 190–209</ref> Human marrow produces approximately 500 billion blood cells per day, which join the systemic circulation via permeable vasculature sinusoids within the medullary cavity.<ref>Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1) 82–96. Bibcode2016NYASA1370...82B. doi10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419</ref> All types of hematopoietic cells, including both myeloid and lymphoid lineages, are created in the bone marrow; however, lymphoid cells must migrate to other lymphoid organs (e.g. thymus) in order to complete maturation.

==== Mesenchymal stem cells ====

The bone marrow stroma contains mesenchymal stem cells (MSCs).<ref>Raphael Rubin & David S. Strayer (2007). Rubin's Pathology Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 90. ISBN 978-0-7817-9516-6.</ref> These are also known as marrow stromal cells. These are multipotent stem cells that can differentiate into a variety of cell types. MSCs have been shown to differentiate, in vitro or in vivo, into osteoblasts, chondrocytes, myocytes, marrow adipocytes and beta-pancreatic islets cells.

===Investigation techniques===

===Imaging===

CT imaging is useful for assessing the marrow cavity of bones, although with low sensitivity and specificity.
MRI is more sensitive and specific for assessing bone composition. MRI enables assessment of the average molecular composition of soft tissues, and thus provides information regarding the relative fat content of marrow.

===Pathological studies===

Histopathological studies of bone marrow are carried out by obtaining samples of bone marrow via biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, anemia, and pancytopenia.

===Donation and transplantation===

Bone marrow transplants can be conducted to treat severe diseases of the bone marrow, including certain forms of cancer such as leukemia. Additionally, bone marrow stem cells have been successfully transformed into functional neural cells,<ref>Antibody Transforms Stem Cells Directly Into Brain Cells". Science Daily. 22 April 2013. Retrieved 24 April 2013.</ref> and can also potentially be used to treat illnesses such as inflammatory bowel disease.<ref>Research Supports Promise of Cell Therapy for Bowel Disease". Wake Forest Baptist Medical Center. 28 February 2013. Retrieved 5 March 2013</ref>

==Current researches ==

*Replacement of red hematopoietic bone marrow with yellow adipocyte-rich marrow is a conserved physiological process among mammals. Several important molecular characteristics of bone marrow adipose tissue (BMAT) are distinct from the classical depots of white and brown fat tissue. This depot of fat has recently emerged as an active part of the bone marrow niche that exerts paracrine and endocrine functions thereby controlling osteogenesis and hematopoiesis.<ref>Ambrosi TH, Schulz TJ ,The emerging role of bone marrow adipose tissue in bone health and dysfunction,J Mol Med (Berl). 2017 Dec;95(12)1291-1301. doi 10.1007/s00109-017-1604-7. Epub 2017 Nov 3</ref>

*Bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential of differentiation and they secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref>Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2)134-45. doi 10.15283/ijsc.2015.8.2.134</ref>

*In a clinical study, it is observed that majja basti (therapeutic enema with bone marrow) along with oral intake of asthi shrinkhala(Cissus quadrangularis) shows encouraging results in the management of osteoporosis (asthi-majjakshaya) and it also improves the general health of the patients.<ref>Ajay K. Gupta et al, Effect of Majja Basti (therapeutic enema) and Asthi Shrinkhala (Cissus quadrangularis) in the management ofOsteoporosis (Asthi-Majjakshaya),AYU , Jan-Mar 2012 , Vol 33 ,Issue 1,pg.110-113</ref>

=== Further scope of research ===

Bone marrow is used in therapeutics as food and administration through enema. Studies are needed to evaluate the effect of oral and per rectal administration of animal bone marrow (majja basti) in the management of diseases of bone marrow. It can open a new window in the treatment of severe diseases like leukemia.

=== List of theses done ===

#Ajay K Gupta (2010): Effect of majja basti&asthi shrinkhala in the management of osteoporosis w.s.r. to asthi-majja kshaya-A clinical study, department of panchakarma, IPGT &RA, Jamnagar.
#Saurabh R Bhuva(2012): A Comparative Study of Matra Basti and Brimhana Snehana by Asthishrinkhala Ghrita in the management of Asthi-Majja Kshaya w.s.r. to Osteopenia / Osteoporosis, department of panchakarma, IPGT &RA, Jamnagar.

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

**[[Meda dhatu]]

*[[Asthi dhatu]]

*[[Shukra dhatu]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*H. = Hrudaya

== References ==

Majja dhatu

2020-06-27T04:52:23Z

Anagha: /* Abbreviations */

Majja literally means the marrow. Majja dhatu is the body component similar to bone marrow, the soft organic material that fills the cavities of the bones.(SAT-B.443)<ref>Available from http//namstp.ayush.gov.in/#/sat accessed on 05/06/2020</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Majja Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 =June 16, 2020
}}

==Etymology and derivation==

It is derived from the Sanskrit dhatu “majjan” meaning that which is sunken, or seated within, which denotes the marrow of bones and flesh, pith of plants etc.<ref>Monier Williams (1899), A Sanskrit–English Dictionary, new edition, Oxford At the Clarendon Press, OCLC 458052227.</ref>

==Synonyms ==

*'''Asthija / Asthisambhava''' : derived from bones ([[asthi dhatu]])

*'''Asthisneha''' : special type of fat found inside bones

*'''Asthisara/Asthiteja''' : the essence of [[asthi]]

*'''Dehasara''' : the essence of body

*'''Shukrakara''': that which produce [[shukra]]

==Meanings in different contexts ==

*In physiology, the word denotes structural and functional components mainly of bone marrow.

*In the contexts of drugs, the word majja is used to denote the pulp, fleshy parts of fruits.Ex. Pulp of Indian jujube (kola)[Cha. Sa. [[Chikitsa Sthana]] 20/29]

*It is included as an animal product(jangama dravya).[Cha. Sa. [[Sutra Sthana]] 1/68] and considered as one among the four unctuous substances(maha sneha) for therapeutic purposes. [Cha. Sa. [[Sutra Sthana]] 1/86]

== Panchabhautika constitution and properties ==

There is a predominance of [[jala mahabhuta]] in majja dhatu. It possesses unctuous(snigdha) and soft (mridu) properties.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.323</ref>

==Formation and metabolism of majja dhatu ==

During metabolism, [[vata dosha]] produces hollowness inside the [[asthi dhatu]]. These hollow cavities are filled by adipose tissue([[meda dhatu]]). The adipose tissue in hollow cavities of bones is known as [[majja dhatu]] (bone marrow).[Cha. Sa. [[Chikitsa Sthana]] 15/31-33]

== Metabolic byproducts and waste products(Upadhatu and mala) ==

Sharangadhara considered hairs (kesha) as metabolic byproduct of majja dhatu. [Sha.Sa. Purva Khanda chapter 5]

Unctuousness in eyes, skin and stools (akshi-twacha-vit sneha) are metabolic waste of majja dhatu. [Cha.Sa. [[Chikitsa Sthana]] 15/20]

== Quantity of majja dhatu in body ==

The total quantity of majja is one anjali. One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person-specific. [Cha. Sa. [[Sharira Sthana]] 8/15]

== Time span ==

The majja dhatu is formed on 6th day from nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]

Sushruta opines that the majja dhatu is formed in a time span of 15075 kala (twenty-five days). [Su. Sa. Sutra Sthana 14/14]

==Characteristics of majja sara (best quality of bone marrow)==

The persons having superior quality of majja dhatu are endowed with soft body parts, strong, unctuous complexion, and sweet voice. They have prominent (sthula), long (dirgha) and rounded joints. [Cha. Sa. [[Vimana Sthana]] 8/108]

==Anatomical and physiological aspects ==

===Brain ===

Brain (mastulunga) is a part of majja dhatu present inside the skull (mastak majja). It is present in the form of half-melted clarified butter (ardha vilina ghrita)[Su. Sa. Sutra Sthana 23/12, Dalhana]

===Channels of transportation and transformation of Majja dhatu (Majjavaha srotas)===

The channels of transportation and transformation of [[meda dhatu]] originate from bones and joints. [Cha. Sa. [[Vimana Sthana]] 5/8].

There are various structures related to majja dhatu. These can be included in the system. The structures are as described below.

=== Layer of majja (Majjadhara Kala) ===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of adipose tissue (Medodharakala)present inside the long bones is known as majja. Though there are no direct references illustrating the layer of bone marrow(majjadharakala) in the classical texts, it can be observed as the thin layer of tissue called endosteum. This is the lining in the bone cavity that separates bone cells and bone marrow.

===Types of bone marrow===

There are two types of bone marrow viz. red bone marrow and yellow bone marrow.

In yellow bone marrow, there is an abundance of fat cells with less amount of blood-forming tissue. In early childhood, red bone marrow is predominantly observed. In adult life, the fatty bone marrow retains the essential reticular structure of the hemopoietic tissue. It is capable of turning into red bone marrow under suitable stimulus like starvation.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.143</ref>

In red bone marrow, there are phagocytic endothelial cells. It is full of erythrocytes in different stages of formation and immensely vascular consisting of arteries, veins, and rich plexus of sinusoid.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.144</ref>

==Function==

The functions of majja dhatu are providing unctuousness(snehana), strength(bala), filling of bone cavity (asthi poorana) and nourishment of its successor [[shukra dhatu]] (shukra pushti). [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

===Causes of vitiation===
The channels of transportation and transformation of majja dhatu are afflicted due to the following causes[Cha. Sa. [[Vimana Sthana]] 5/18]

====Dietary causes====

Excess and frequent consumption of incompatible food (viruddha ahara)

====Exogenous causes ====

*crushing injury

*excessive discharge causing pressure

*trauma

*compression

=== Abnormal states ===

The increase or decrease in quality and/or quantity of majja dhatu can lead to various abnormal conditions. These states can be assessed by the following clinical features.

==== Signs of decrease ====

*atrophy of bone tissues

*weakness/giddiness

*lightness of bones (porosity of bones or decreased bone density)

*susceptibility to vata dominant disorders / frequent vata disorders

*depletion of semen formation

*pain in joints

*cutting pain in bones

*constant dull pain and emptiness of bones

*dimness of vision

[Cha. Sa. [[Sutra Sthana]] 17/68], [Su. Sa. Sutra Sthana 15/9], [A. Hr. Sutra Sthana 11/19]

==== Signs of increase ====

*heaviness in eyes

*heaviness in entire body

*formation of carbuncles/ with broad base on joints/synapses which are difficult to cure
[Su. Sa. Sutra Sthana 15/14], [A. Hr. Sutra Sthana 11/11]

===Clinical features of vitiation of channels of transport and transformation of majja dhatu===

*Pain in the joints, giddiness, unconsciousness, blackouts and deep-rooted abscess in joints are caused due to vitiation of channels of transport and transformation of majja dhatu. [Cha. Sa. [[Sutra Sthana]] 28/17-18].

===Role of majja dhatu as vitiated factor in disease===

Majja dhatu is involved in the pathogenesis of the following diseases

*Urinary disease including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/7]

*Diseases due to vitiation of vata [Cha. Sa. [[Chikitsa Sthana]] 28/73]

*Abscess (vidradhi)[Su. Sa. Nidana Sthana 9/34]

*When the vitiated doshas afflict bone marrow (majja dhatu), the quaternary fever (chaturthaka jwara) is manifested. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*When the vitiated doshas are located in the majja dhatu then the following signs and symptoms appear hiccups, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*Majja is mentioned as one among the eight locations of wounds (vrana), and the other sites being skin, blood vessels, flesh, bone, ligament, vital parts, and viscera. [Cha. Sa. [[Chikitsa Sthana]] 25/26]

*When vitiated [[vata]] is located in bones ([[asthi]]) and marrow(majja), it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/ 33]

*When the [[vata]] is occluded in the marrow, there will be stretching and stiffening of the trunk and extremities, excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). [Cha. Sa. [[Chikitsa Sthana]] 28/ 67-68]

===Prognosis===

*If the vitiated doshas are located in majja dhatu in the case of jwara, it is difficult to treat.[Cha. Sa. [[Chikitsa Sthana]] 3/83]

*A type of abscess (vidradhi) in bone marrow(majjaparipaka vidradhi)has a bad prognosis. Surgical intervention. (shastra sadhya) is needed to treat it. [Su. Sa. Nidana Sthana 9/38]

==Importance in the preservation of health and prevention ==

*Majja dhatu is specifically important for providing strength to bones and nourishment to reproductive tissues.

*Longevity, strength, learning ability, wealth, understanding, progeny, and social respect depend upon superior quality of majja dhatu. [Cha. Sa.[[ Vimana Sthana]] 8/108]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The diseases of vitiation of Majja dhatu shall be treated with food and medicines having sweet and bitter taste. Exercise and body purification treatments in proper dose and time are also indicated. [Cha. Sa. [[Sutra Sthana]] 28/28]

*When the doshas causing fever (jwara) are located in bone tissue ([[asthi dhatu]]) and marrow(majja dhatu), un-unctuous enema (niruha [[basti]]) and unctuous enema (anuvasana [[basti]]) are indicated. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

*The diseases due to aggravation of [[vata dosha]] are treated with medicated ghee, oil, muscle fat, and bone marrow obtained from animal bones. This is done either by oral administration or by external applications like massage or enema. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

===Internal administration of animal bone marrow(majja) for therapeutic oleation===

====Indications====

*Animal bone marrow(majja) is used for therapeutic purposes to improve strength, semen ([[shukra]]),nutrient fluid ([[rasa]]), [[kapha dosha]], adipose tissue ([[meda]]) and bone marrow (majja) itself. It especially strengthens bones and useful for oleation. [Cha. Sa. [[Sutra Sthana]] 13/17]

==== Suitable conditions ====

Animal bone marrow (majja) is administered in those persons with strong digestive power; those who can tolerate excessive physical exertion; who often eat excess food, unctuous fatty substances; who suffer from [[vata]] disorders, and have hard bowel movement(habitual constipation). [Cha. Sa. [[Sutra Sthana]] 13/50-51] The most suitable season for consuming marrow is spring. [Cha. Sa. [[Sutra Sthana]] 13/18]

== Contemporary approach ==

Majja dhatu can be referred to as bone marrow tissue in contemporary physiology. The following information is available<ref>Available from https//en.wikipedia.org/wiki/Bone_marrow accessed on 05/06/2020</ref> and can be referred to further understand the concept of majja dhatu.

===Form and site===

Bone marrow is a semi-solid tissue found within the spongy or cancellous portions of bones.<ref> C., Farhi, Diane (2009). Pathology of bone marrow and blood cells (2nd ed.). Philadelphia Wolters Kluwer Health/Lippincott William & Wilkins. ISBN 9780781770934. OCLC 191807944.</ref>

=== Composition ===
It is composed of hematopoietic cells, marrow adipose tissue, and supportive stromal cells.

=== Quantity ===
Bone marrow comprises approximately 5% of total body mass in healthy adult humans.<ref>Hindorf, C.; Glatting, G.; Chiesa, C.; Lindén, O.; Flux, G. (2010). "EANM Dosimetry Committee guidelines for bone marrow and whole-body dosimetry". Eur J Nucl Med Mol Imaging. 37 (6) 1238–1250. doi10.1007/s00259-010-1422-4. PMID 20411259.</ref>

===Functions===

Bone marrow is the primary site of new blood cell production or hematopoiesis.<ref>Arikan, Hüseyin; Çiçek, Kerim (2014). "Haematology of amphibians and reptiles a review" (PDF). North-Western Journal of Zoology. 10 190–209</ref> Human marrow produces approximately 500 billion blood cells per day, which join the systemic circulation via permeable vasculature sinusoids within the medullary cavity.<ref>Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1) 82–96. Bibcode2016NYASA1370...82B. doi10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419</ref> All types of hematopoietic cells, including both myeloid and lymphoid lineages, are created in the bone marrow; however, lymphoid cells must migrate to other lymphoid organs (e.g. thymus) in order to complete maturation.

==== Mesenchymal stem cells ====

The bone marrow stroma contains mesenchymal stem cells (MSCs).<ref>Raphael Rubin & David S. Strayer (2007). Rubin's Pathology Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 90. ISBN 978-0-7817-9516-6.</ref> These are also known as marrow stromal cells. These are multipotent stem cells that can differentiate into a variety of cell types. MSCs have been shown to differentiate, in vitro or in vivo, into osteoblasts, chondrocytes, myocytes, marrow adipocytes and beta-pancreatic islets cells.

===Investigation techniques===

===Imaging===

CT imaging is useful for assessing the marrow cavity of bones, although with low sensitivity and specificity.
MRI is more sensitive and specific for assessing bone composition. MRI enables assessment of the average molecular composition of soft tissues, and thus provides information regarding the relative fat content of marrow.

===Pathological studies===

Histopathological studies of bone marrow are carried out by obtaining samples of bone marrow via biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, anemia, and pancytopenia.

===Donation and transplantation===

Bone marrow transplants can be conducted to treat severe diseases of the bone marrow, including certain forms of cancer such as leukemia. Additionally, bone marrow stem cells have been successfully transformed into functional neural cells,<ref>Antibody Transforms Stem Cells Directly Into Brain Cells". Science Daily. 22 April 2013. Retrieved 24 April 2013.</ref> and can also potentially be used to treat illnesses such as inflammatory bowel disease.<ref>Research Supports Promise of Cell Therapy for Bowel Disease". Wake Forest Baptist Medical Center. 28 February 2013. Retrieved 5 March 2013</ref>

==Current researches ==

*Replacement of red hematopoietic bone marrow with yellow adipocyte-rich marrow is a conserved physiological process among mammals. Several important molecular characteristics of bone marrow adipose tissue (BMAT) are distinct from the classical depots of white and brown fat tissue. This depot of fat has recently emerged as an active part of the bone marrow niche that exerts paracrine and endocrine functions thereby controlling osteogenesis and hematopoiesis.<ref>Ambrosi TH, Schulz TJ ,The emerging role of bone marrow adipose tissue in bone health and dysfunction,J Mol Med (Berl). 2017 Dec;95(12)1291-1301. doi 10.1007/s00109-017-1604-7. Epub 2017 Nov 3</ref>

*Bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential of differentiation and they secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref>Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2)134-45. doi 10.15283/ijsc.2015.8.2.134</ref>

*In a clinical study, it is observed that majja basti (therapeutic enema with bone marrow) along with oral intake of asthi shrinkhala(Cissus quadrangularis) shows encouraging results in the management of osteoporosis (asthi-majjakshaya) and it also improves the general health of the patients.<ref>Ajay K. Gupta et al, Effect of Majja Basti (therapeutic enema) and Asthi Shrinkhala (Cissus quadrangularis) in the management ofOsteoporosis (Asthi-Majjakshaya),AYU , Jan-Mar 2012 , Vol 33 ,Issue 1,pg.110-113</ref>

=== Further scope of research ===

Bone marrow is used in therapeutics as food and administration through enema. Studies are needed to evaluate the effect of oral and per rectal administration of animal bone marrow (majja basti) in the management of diseases of bone marrow. It can open a new window in the treatment of severe diseases like leukemia.

=== List of theses done ===

#Ajay K Gupta (2010): Effect of majja basti&asthi shrinkhala in the management of osteoporosis w.s.r. to asthi-majja kshaya-A clinical study, department of panchakarma, IPGT &RA, Jamnagar.
#Saurabh R Bhuva(2012): A Comparative Study of Matra Basti and Brimhana Snehana by Asthishrinkhala Ghrita in the management of Asthi-Majja Kshaya w.s.r. to Osteopenia / Osteoporosis, department of panchakarma, IPGT &RA, Jamnagar.

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita
*A. = Ashtanga
*H. = Hrudaya

== References ==

Majja dhatu

2020-06-27T04:48:12Z

Anagha: /* Metabolic byproducts and waste products(Upadhatu and mala) */

Majja literally means the marrow. Majja dhatu is the body component similar to bone marrow, the soft organic material that fills the cavities of the bones.(SAT-B.443)<ref>Available from http//namstp.ayush.gov.in/#/sat accessed on 05/06/2020</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Majja Dhatu

|label2 = Authors
|data2 = Anagha S., Deole Y.S.

|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliations
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of first publication:
|data6 =June 16, 2020
}}

==Etymology and derivation==

It is derived from the Sanskrit dhatu “majjan” meaning that which is sunken, or seated within, which denotes the marrow of bones and flesh, pith of plants etc.<ref>Monier Williams (1899), A Sanskrit–English Dictionary, new edition, Oxford At the Clarendon Press, OCLC 458052227.</ref>

==Synonyms ==

*'''Asthija / Asthisambhava''' : derived from bones ([[asthi dhatu]])

*'''Asthisneha''' : special type of fat found inside bones

*'''Asthisara/Asthiteja''' : the essence of [[asthi]]

*'''Dehasara''' : the essence of body

*'''Shukrakara''': that which produce [[shukra]]

==Meanings in different contexts ==

*In physiology, the word denotes structural and functional components mainly of bone marrow.

*In the contexts of drugs, the word majja is used to denote the pulp, fleshy parts of fruits.Ex. Pulp of Indian jujube (kola)[Cha. Sa. [[Chikitsa Sthana]] 20/29]

*It is included as an animal product(jangama dravya).[Cha. Sa. [[Sutra Sthana]] 1/68] and considered as one among the four unctuous substances(maha sneha) for therapeutic purposes. [Cha. Sa. [[Sutra Sthana]] 1/86]

== Panchabhautika constitution and properties ==

There is a predominance of [[jala mahabhuta]] in majja dhatu. It possesses unctuous(snigdha) and soft (mridu) properties.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.323</ref>

==Formation and metabolism of majja dhatu ==

During metabolism, [[vata dosha]] produces hollowness inside the [[asthi dhatu]]. These hollow cavities are filled by adipose tissue([[meda dhatu]]). The adipose tissue in hollow cavities of bones is known as [[majja dhatu]] (bone marrow).[Cha. Sa. [[Chikitsa Sthana]] 15/31-33]

== Metabolic byproducts and waste products(Upadhatu and mala) ==

Sharangadhara considered hairs (kesha) as metabolic byproduct of majja dhatu. [Sha.Sa. Purva Khanda chapter 5]

Unctuousness in eyes, skin and stools (akshi-twacha-vit sneha) are metabolic waste of majja dhatu. [Cha.Sa. [[Chikitsa Sthana]] 15/20]

== Quantity of majja dhatu in body ==

The total quantity of majja is one anjali. One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. This measurement is person-specific. [Cha. Sa. [[Sharira Sthana]] 8/15]

== Time span ==

The majja dhatu is formed on 6th day from nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21]

Sushruta opines that the majja dhatu is formed in a time span of 15075 kala (twenty-five days). [Su. Sa. Sutra Sthana 14/14]

==Characteristics of majja sara (best quality of bone marrow)==

The persons having superior quality of majja dhatu are endowed with soft body parts, strong, unctuous complexion, and sweet voice. They have prominent (sthula), long (dirgha) and rounded joints. [Cha. Sa. [[Vimana Sthana]] 8/108]

==Anatomical and physiological aspects ==

===Brain ===

Brain (mastulunga) is a part of majja dhatu present inside the skull (mastak majja). It is present in the form of half-melted clarified butter (ardha vilina ghrita)[Su. Sa. Sutra Sthana 23/12, Dalhana]

===Channels of transportation and transformation of Majja dhatu (Majjavaha srotas)===

The channels of transportation and transformation of [[meda dhatu]] originate from bones and joints. [Cha. Sa. [[Vimana Sthana]] 5/8].

There are various structures related to majja dhatu. These can be included in the system. The structures are as described below.

=== Layer of majja (Majjadhara Kala) ===

Kala is the layer in outer coverings of the body observed in sagittal section. The layer of adipose tissue (Medodharakala)present inside the long bones is known as majja. Though there are no direct references illustrating the layer of bone marrow(majjadharakala) in the classical texts, it can be observed as the thin layer of tissue called endosteum. This is the lining in the bone cavity that separates bone cells and bone marrow.

===Types of bone marrow===

There are two types of bone marrow viz. red bone marrow and yellow bone marrow.

In yellow bone marrow, there is an abundance of fat cells with less amount of blood-forming tissue. In early childhood, red bone marrow is predominantly observed. In adult life, the fatty bone marrow retains the essential reticular structure of the hemopoietic tissue. It is capable of turning into red bone marrow under suitable stimulus like starvation.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.143</ref>

In red bone marrow, there are phagocytic endothelial cells. It is full of erythrocytes in different stages of formation and immensely vascular consisting of arteries, veins, and rich plexus of sinusoid.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.144</ref>

==Function==

The functions of majja dhatu are providing unctuousness(snehana), strength(bala), filling of bone cavity (asthi poorana) and nourishment of its successor [[shukra dhatu]] (shukra pushti). [Su. Sa. Sutra Sthana 15/5]

==Importance in diagnosis ==

===Causes of vitiation===
The channels of transportation and transformation of majja dhatu are afflicted due to the following causes[Cha. Sa. [[Vimana Sthana]] 5/18]

====Dietary causes====

Excess and frequent consumption of incompatible food (viruddha ahara)

====Exogenous causes ====

*crushing injury

*excessive discharge causing pressure

*trauma

*compression

=== Abnormal states ===

The increase or decrease in quality and/or quantity of majja dhatu can lead to various abnormal conditions. These states can be assessed by the following clinical features.

==== Signs of decrease ====

*atrophy of bone tissues

*weakness/giddiness

*lightness of bones (porosity of bones or decreased bone density)

*susceptibility to vata dominant disorders / frequent vata disorders

*depletion of semen formation

*pain in joints

*cutting pain in bones

*constant dull pain and emptiness of bones

*dimness of vision

[Cha. Sa. [[Sutra Sthana]] 17/68], [Su. Sa. Sutra Sthana 15/9], [A. Hr. Sutra Sthana 11/19]

==== Signs of increase ====

*heaviness in eyes

*heaviness in entire body

*formation of carbuncles/ with broad base on joints/synapses which are difficult to cure
[Su. Sa. Sutra Sthana 15/14], [A. Hr. Sutra Sthana 11/11]

===Clinical features of vitiation of channels of transport and transformation of majja dhatu===

*Pain in the joints, giddiness, unconsciousness, blackouts and deep-rooted abscess in joints are caused due to vitiation of channels of transport and transformation of majja dhatu. [Cha. Sa. [[Sutra Sthana]] 28/17-18].

===Role of majja dhatu as vitiated factor in disease===

Majja dhatu is involved in the pathogenesis of the following diseases

*Urinary disease including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/7]

*Diseases due to vitiation of vata [Cha. Sa. [[Chikitsa Sthana]] 28/73]

*Abscess (vidradhi)[Su. Sa. Nidana Sthana 9/34]

*When the vitiated doshas afflict bone marrow (majja dhatu), the quaternary fever (chaturthaka jwara) is manifested. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*When the vitiated doshas are located in the majja dhatu then the following signs and symptoms appear hiccups, bronchitis, cough, feeling of entering into darkness frequently, cutting pain in the vital organs (marmas), feeling of cold externally and internal burning sensation. [Cha. Sa. [[Chikitsa Sthana]] 3/64]

*Majja is mentioned as one among the eight locations of wounds (vrana), and the other sites being skin, blood vessels, flesh, bone, ligament, vital parts, and viscera. [Cha. Sa. [[Chikitsa Sthana]] 25/26]

*When vitiated [[vata]] is located in bones ([[asthi]]) and marrow(majja), it leads to splitting pain of bones and joints, arthralgia, loss of muscle strength, insomnia and continuous pain. [Cha. Sa. [[Chikitsa Sthana]] 28/ 33]

*When the [[vata]] is occluded in the marrow, there will be stretching and stiffening of the trunk and extremities, excess yawning, twisting and colicky pain. The patient gets relief on pressing with the hand (gentle massage). [Cha. Sa. [[Chikitsa Sthana]] 28/ 67-68]

===Prognosis===

*If the vitiated doshas are located in majja dhatu in the case of jwara, it is difficult to treat.[Cha. Sa. [[Chikitsa Sthana]] 3/83]

*A type of abscess (vidradhi) in bone marrow(majjaparipaka vidradhi)has a bad prognosis. Surgical intervention. (shastra sadhya) is needed to treat it. [Su. Sa. Nidana Sthana 9/38]

==Importance in the preservation of health and prevention ==

*Majja dhatu is specifically important for providing strength to bones and nourishment to reproductive tissues.

*Longevity, strength, learning ability, wealth, understanding, progeny, and social respect depend upon superior quality of majja dhatu. [Cha. Sa.[[ Vimana Sthana]] 8/108]

== Principles of management of diseases ==

=== Therapeutic and conservative management ===

*The diseases of vitiation of Majja dhatu shall be treated with food and medicines having sweet and bitter taste. Exercise and body purification treatments in proper dose and time are also indicated. [Cha. Sa. [[Sutra Sthana]] 28/28]

*When the doshas causing fever (jwara) are located in bone tissue ([[asthi dhatu]]) and marrow(majja dhatu), un-unctuous enema (niruha [[basti]]) and unctuous enema (anuvasana [[basti]]) are indicated. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

*The diseases due to aggravation of [[vata dosha]] are treated with medicated ghee, oil, muscle fat, and bone marrow obtained from animal bones. This is done either by oral administration or by external applications like massage or enema. [Cha. Sa. [[Chikitsa Sthana]] 3/317]

===Internal administration of animal bone marrow(majja) for therapeutic oleation===

====Indications====

*Animal bone marrow(majja) is used for therapeutic purposes to improve strength, semen ([[shukra]]),nutrient fluid ([[rasa]]), [[kapha dosha]], adipose tissue ([[meda]]) and bone marrow (majja) itself. It especially strengthens bones and useful for oleation. [Cha. Sa. [[Sutra Sthana]] 13/17]

==== Suitable conditions ====

Animal bone marrow (majja) is administered in those persons with strong digestive power; those who can tolerate excessive physical exertion; who often eat excess food, unctuous fatty substances; who suffer from [[vata]] disorders, and have hard bowel movement(habitual constipation). [Cha. Sa. [[Sutra Sthana]] 13/50-51] The most suitable season for consuming marrow is spring. [Cha. Sa. [[Sutra Sthana]] 13/18]

== Contemporary approach ==

Majja dhatu can be referred to as bone marrow tissue in contemporary physiology. The following information is available<ref>Available from https//en.wikipedia.org/wiki/Bone_marrow accessed on 05/06/2020</ref> and can be referred to further understand the concept of majja dhatu.

===Form and site===

Bone marrow is a semi-solid tissue found within the spongy or cancellous portions of bones.<ref> C., Farhi, Diane (2009). Pathology of bone marrow and blood cells (2nd ed.). Philadelphia Wolters Kluwer Health/Lippincott William & Wilkins. ISBN 9780781770934. OCLC 191807944.</ref>

=== Composition ===
It is composed of hematopoietic cells, marrow adipose tissue, and supportive stromal cells.

=== Quantity ===
Bone marrow comprises approximately 5% of total body mass in healthy adult humans.<ref>Hindorf, C.; Glatting, G.; Chiesa, C.; Lindén, O.; Flux, G. (2010). "EANM Dosimetry Committee guidelines for bone marrow and whole-body dosimetry". Eur J Nucl Med Mol Imaging. 37 (6) 1238–1250. doi10.1007/s00259-010-1422-4. PMID 20411259.</ref>

===Functions===

Bone marrow is the primary site of new blood cell production or hematopoiesis.<ref>Arikan, Hüseyin; Çiçek, Kerim (2014). "Haematology of amphibians and reptiles a review" (PDF). North-Western Journal of Zoology. 10 190–209</ref> Human marrow produces approximately 500 billion blood cells per day, which join the systemic circulation via permeable vasculature sinusoids within the medullary cavity.<ref>Birbrair, Alexander; Frenette, Paul S. (1 March 2016). "Niche heterogeneity in the bone marrow". Annals of the New York Academy of Sciences. 1370 (1) 82–96. Bibcode2016NYASA1370...82B. doi10.1111/nyas.13016. ISSN 1749-6632. PMC 4938003. PMID 27015419</ref> All types of hematopoietic cells, including both myeloid and lymphoid lineages, are created in the bone marrow; however, lymphoid cells must migrate to other lymphoid organs (e.g. thymus) in order to complete maturation.

==== Mesenchymal stem cells ====

The bone marrow stroma contains mesenchymal stem cells (MSCs).<ref>Raphael Rubin & David S. Strayer (2007). Rubin's Pathology Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 90. ISBN 978-0-7817-9516-6.</ref> These are also known as marrow stromal cells. These are multipotent stem cells that can differentiate into a variety of cell types. MSCs have been shown to differentiate, in vitro or in vivo, into osteoblasts, chondrocytes, myocytes, marrow adipocytes and beta-pancreatic islets cells.

===Investigation techniques===

===Imaging===

CT imaging is useful for assessing the marrow cavity of bones, although with low sensitivity and specificity.
MRI is more sensitive and specific for assessing bone composition. MRI enables assessment of the average molecular composition of soft tissues, and thus provides information regarding the relative fat content of marrow.

===Pathological studies===

Histopathological studies of bone marrow are carried out by obtaining samples of bone marrow via biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a number of conditions, including leukemia, multiple myeloma, anemia, and pancytopenia.

===Donation and transplantation===

Bone marrow transplants can be conducted to treat severe diseases of the bone marrow, including certain forms of cancer such as leukemia. Additionally, bone marrow stem cells have been successfully transformed into functional neural cells,<ref>Antibody Transforms Stem Cells Directly Into Brain Cells". Science Daily. 22 April 2013. Retrieved 24 April 2013.</ref> and can also potentially be used to treat illnesses such as inflammatory bowel disease.<ref>Research Supports Promise of Cell Therapy for Bowel Disease". Wake Forest Baptist Medical Center. 28 February 2013. Retrieved 5 March 2013</ref>

==Current researches ==

*Replacement of red hematopoietic bone marrow with yellow adipocyte-rich marrow is a conserved physiological process among mammals. Several important molecular characteristics of bone marrow adipose tissue (BMAT) are distinct from the classical depots of white and brown fat tissue. This depot of fat has recently emerged as an active part of the bone marrow niche that exerts paracrine and endocrine functions thereby controlling osteogenesis and hematopoiesis.<ref>Ambrosi TH, Schulz TJ ,The emerging role of bone marrow adipose tissue in bone health and dysfunction,J Mol Med (Berl). 2017 Dec;95(12)1291-1301. doi 10.1007/s00109-017-1604-7. Epub 2017 Nov 3</ref>

*Bone marrow-derived mesenchymal stem cells (BM-MSCs) have the potential of differentiation and they secrete anti-inflammatory cytokines and growth factors which make them appropriate for cell therapy. A study conducted to evaluate the healing effect of BM-MSCs transplantation on germinal cells showed that the transplanted BM-MSCs could successfully induce spermatogenesis in seminiferous tubules of azoospermic hamster. Therefore, BM-MSCs can be an attractive candidate in cell transplantation of azoospermia.<ref>Tamadon A et al, Induction of Spermatogenesis by Bone Marrow-derived Mesenchymal Stem Cells in Busulfan-induced Azoospermia in Hamster,Int J Stem Cells. 2015 Nov;8(2)134-45. doi 10.15283/ijsc.2015.8.2.134</ref>

*In a clinical study, it is observed that majja basti (therapeutic enema with bone marrow) along with oral intake of asthi shrinkhala(Cissus quadrangularis) shows encouraging results in the management of osteoporosis (asthi-majjakshaya) and it also improves the general health of the patients.<ref>Ajay K. Gupta et al, Effect of Majja Basti (therapeutic enema) and Asthi Shrinkhala (Cissus quadrangularis) in the management ofOsteoporosis (Asthi-Majjakshaya),AYU , Jan-Mar 2012 , Vol 33 ,Issue 1,pg.110-113</ref>

=== Further scope of research ===

Bone marrow is used in therapeutics as food and administration through enema. Studies are needed to evaluate the effect of oral and per rectal administration of animal bone marrow (majja basti) in the management of diseases of bone marrow. It can open a new window in the treatment of severe diseases like leukemia.

=== List of theses done ===

#Ajay K Gupta (2010): Effect of majja basti&asthi shrinkhala in the management of osteoporosis w.s.r. to asthi-majja kshaya-A clinical study, department of panchakarma, IPGT &RA, Jamnagar.
#Saurabh R Bhuva(2012): A Comparative Study of Matra Basti and Brimhana Snehana by Asthishrinkhala Ghrita in the management of Asthi-Majja Kshaya w.s.r. to Osteopenia / Osteoporosis, department of panchakarma, IPGT &RA, Jamnagar.

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[ Grahani Chikitsa]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

== References ==

Meda dhatu

2020-06-26T18:51:30Z

Anagha: /* Abbreviations */

Rakta dhatu

2020-06-26T18:50:31Z

Anagha: /* Abbreviations */

Mamsa dhatu

2020-06-26T18:49:46Z

Anagha: /* Abbreviations */

Meda dhatu

2020-06-26T18:48:29Z

Anagha: /* Abbreviations */

Meda dhatu is the body component which indicates fat in general and adipose tissue in particular.<ref>Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020 </ref> Its important function is to oleate or lubricate (snehana). <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.435)

It is present in two forms:

#Fixed or bounded form is observed as stored fats in adipocytes.
#The free form is observed as circulating lipids like lipoproteins or free fatty acids.<ref>Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Meda Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.,
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 4, 2020
}}

==Etymology, derivation and meanings==

The word "meda" is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness.

The literary meanings of word meda are as follows:<ref>Sanskriti Jha and Srujan Jha. Amarkosha.</ref>

1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibers, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them.

In physiology, its proper seat is said to be the abdomen.

2. Morbid or unnatural obesity.

3. In general, obesity or fat in the body is denoted by the word meda.<ref>
Monier-Williams Sanskrit-English Dictionary, 1899, [Cologne record ID = 167817] [Printed book page 832 , 3], https://www.sanskrit-lexicon.unikoeln.de/scans/MWScan/2014/web/webtc/indexcaller.php</ref>

==Panchabhautika constitution and properties==

Meda dhatu has dominance of [[prithvi]], [[jala]] and [[agni mahabhuta]].

It possesses properties like unctuousness (snigdha) and heaviness(guru).<ref>Bhavaprakasha, purva khanda, Garbhaprakarana 207</ref>

== Physiological aspects ==

=== Formation and metabolism ===

Meda dhatu is formed from the unctuous portion of [[mamsa dhatu]] by action of factors responsible for metabolism of meda(medadhatvagni).[Cha. Sa [[Chikitsa Sthana]] 15/29-30]

There are two forms of meda dhatu in body:

1. '''Structural component (poshya meda dhatu):''' It is the form,that is stored in the layer of meda (medodhara kala). It is also called fixed or stored fat(baddha medas). This portion is located mainly in the omentum. This form is responsible for the nutrition of meda dhatu itself in case of starvation.

2. '''Circulating component (poshaka meda dhatu):''' This form is circulated with nutrient fluid or plasma ([[rasa dhatu]]) and blood([[rakta]]). It is free and unbound (abaddha medas). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.[[Nidana Sthana]] 4/7]

===Metabolic by-products and waste products (Upadhatu and mala)===

During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. [[Chikitsa Sthana]] 15/17]. Sweat and sebum are formed during this process as waste products (mala). [Cha.Sa. [[Chikitsa Sthana]] 15/18].

=== Quantity ===

The total quantity of meda dhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. [[Sharira Sthana]] 7/15]

=== Time span ===

The meda dhatu is formed on the 4th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]

=== Characteristics of best quality of adipose tissue (meda sara )===

The person endowed with best quality of meda dhatu has significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.[[Vimana Sthana]] 8/106]

=== Channels of transportation and transformation of meda dhatu (medovaha srotas)===

The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. [[Vimana Sthana]] 5/8]

Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. Sharira Sthana 9/12].

Vagbhata added [[mamsa dhatu]] to the origin with kidneys (vrikka).[A.S.Sharira Sthana 6/26]

Considering the above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment.

The following structures can be considered as components of the transportation and transformation system of meda dhatu.

=== Layer of meda dhatu (medodhara kala)===

It is the layer of fat present in the abdominal cavity, small bones and long bones. In the abdominal cavity, it is present in the form of visceral fats.
Meda dhatu present in the long and big bones is known as marrow ([[majja]]).That present inside the small bones is termed as red marrow (sarakta meda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. Sharira Sthana 4/13]

===Role of meda dhatu in embryonic development===

During embryo-genesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism([[agni]])that makes them elastic and smooth. Ligaments(snayu) are formed after the strong action of factors responsible for metabolism([[agni]]) that makes them hard. [Su. Sa. Sharira Sthana 4/29-30]

The kidneys (vrikka) are formed from the unification of the essence of blood tissue([[rakta dhatu]])and adipose tissue (meda dhatu).The testis(vrishana) are formed from the unification of the essence of adipose tissue (meda dhatu),muscle tissue ([[mamsa dhatu]]), blood tissue ([[rakta dhatu]]) and [[kapha dosha]]. [Su. Sa. Sharira Sthana 4/31]

== Functions ==

Meda dhatu is responsible for functions of lubrication(sneha), sweating (sweda), stability (dridhatwam), and nourishment of bone tissue([[asthi]]pushti). [Su. Sa. Sutra Sthana 15/5]

== Importance in diagnosis ==

===Causes of vitiation===

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by the sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food, and alcoholic drinks. [Cha. Sa. [[Vimana Sthana]] 5/16]

=== Abnormal states ===
The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Decrease of meda dhatu ====

Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. [[Sutra Sthana]] 17/66], [Su. Sa. Sutra Sthana 15/9]

====Increase of meda dhatu====
The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation ===

*Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. [[Sutra Sthana]] 28/15]

*The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.[[Chikitsa Sthana]] 6/13-14]

*The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.[[Sutra Sthana]] 21/3]

*When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.Sharira Sthana 9/12]

=== Role of meda dhatu as vitiated factor in diseases ===

Meda dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/8]
*vitiligo (Shwitra) [Cha. Sa. [[Chikitsa Sthana]] 7/174]
*swelling (Shotha) [Cha. Sa. [[Chikitsa Sthana]] 12/94]
*Anaemia(Pandu)[Cha.Sa. [[Chikitsa Sthana]] 16/6]
*Disorders of thigh and hip (Urusthambha) [Cha. Sa. [[Chikitsa Sthana]] 27/14]
*Obesity (Sthaulya)[Cha. Sa. [[Sutra Sthana]] 21/5-8]
*Vitiated dosha located in the channels of transport of medadhatu (medovahasrotas)cause quaternary fever (chaturthaka jwara).[Cha. Sa. [[Chikitsa Sthana]] 3/66]
*The clinical features of fever due to vitiation of meda dhatu by [[pitta dosha]] (medadhatugata jwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. [[Chikitsa Sthana]] 3/79].
*When vitiated vata is located in [[mamsa]] and meda dhatu, it manifests by producing symptoms like heaviness of the body, pricking pain, and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. [[Chikitsa Sthana]] 28/32].
*When the [[vata]] is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. [[Chikitsa Sthana]] 28/66].
*Obesity (Sthaulya) is defined as an excessive increase of meda and [[mamsa dhatu]] in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. [[Sutra Sthana]] 21/5-9].

== Importance of concept in the preservation of health and prevention ==

Meda dhatu provides unctuousness to all body components. Unctuousness is the essential property of the essence of all seven [[dhatu]] ([[ojas]]). It is related to vitality and immunity of the body. [Cha.Sa. [[Chikitsa Sthana]] 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.[[Sutra Sthana]] 22/11] These are important in various physiological processes and functions of the body.

==Management ==
*Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.[[Sutra Sthana]]22]

The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. [[Sutra Sthana]] 21/21-22]
*Food and drinks that alleviate vata dosha and reduce kapha dosha and meda dhatu (fat),
*Therapeutic enema processed with drugs of sharply acting, dry and hot properties,
*Dry powder massage (udwartana),
*Use of guduchi (Tinospora cordifolia Miers), musta (Cyperusrotundus Linn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belerica Roxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey.
*The condition of fever due to pitta dosha in [[mamsa dhatu]] and meda dhatu is managed by therapeutic purgation ([[virechana]]) and fasting (upavasa). [Cha. Sa. [[Chikitsa Sthana]] 3/316].
*The treatment measures for vata located in meda dhatu are therapeutic purgation ([[virechana]]), evacuative enema([[basti]]) and palliative measures(shamana). [Cha. Sa. [[Chikitsa Sthana]] 28/93].

== Contemporary approach ==
*In conventional physiology, the concept of meda dhatu is perceived in view of adipose tissue, fats, and lipids. <ref>Vandana Verma, Sonam Agrawal, & Sangeeta Gehlot. (2020). Exploration of Ayurveda blueprint on clinical physiology of Meda (adipose tissue) and Majja Dhatu (bone marrow) in context to obesity. International Journal of Research in Pharmaceutical Sciences, 11(1), 358-367. https://doi.org/10.26452/ijrps.v11i1.1830</ref> Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Origin and formation ===

Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.<ref>Available from https://embryology.med.unsw.edu.au/embryology/index.php/Adipose_Tissue_Development cited on 18/05/2020</ref>
Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy.<ref>Birbrair A, Zhang T, Wang ZM, Messi ML, Enikolopov GN, Mintz A, Delbono O (August 2013). "Role of pericytes in skeletal muscle regeneration and fat accumulation". Stem Cells and Development. 22 (16): 2298–314. doi:10.1089/scd.2012.0647. PMC 3730538. PMID 23517218</ref> Adipocytes are derived from mesenchymal stem cells through adipogenesis.

There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.<ref name=abc>Available from https://en.wikipedia.org/wiki/Adipocyte#cite_note-Birbrair_2298%E2%80%932314-1</ref> The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.

The third but poorly understood marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cells expand in states of low bone density but additionally expands in the setting of obesity.<ref>Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J (August 2017). "Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice". Journal of Bone and Mineral Research. 32 (8): 1692–1702. doi:10.1002/jbmr.3159. PMC 5550355. PMID 28436105</ref>

=== Embryonic development ===

Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle, or bone. The fibroblast are preadipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6

=== Quantity and measurement ===

The total weight of fat in an average human adult measures about 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show a fourfold increase in size before dividing and increasing the absolute number of fat cells present.<ref>Robert P (2001). Fat: fighting the obesity epidemic. Oxford [Oxfordshire]: Oxford University Press. pp. 68. ISBN 978-0-19-511853-7</ref>

=== Functions ===

==== Storage of fat ====

The fat is stored in the body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.<ref>KAvailable from https://en.wikipedia.org/wiki/Adipocyte#cite_note-:0-3 cited on 18/05/2020</ref>

==== Generation of heat ====

The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.<ref name=abc/>

==== Adaptation ====

The fat cells tend to increase in size to store more fat in case needed. This expansion of fat mass leads to obesity.

=== Investigations ===

The levels of meda dhatu can be investigated through various assessment parameters like:

#Body mass index
#Waist: hip ratio
#Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
#Estimation of total cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
#Serum insulin

=== Role of adipocytes in causing obesity and diabetes ===

From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation of meda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha).

This patho-physiology can be linked as follows:

Excess nutrition leads to the expansion of fat mass and an increase in the size of adipocytes (hypertrophy).<ref>Bluher M (June 2009). "Adipose tissue dysfunction in obesity". Experimental and Clinical Endocrinology & Diabetes. 117 (6): 241–50. doi:10.1055/s-0029-1192044. PMID 19358089</ref> This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance.<ref>Kahn SE, Hull RL, Utzschneider KM (December 2006). "Mechanisms linking obesity to insulin resistance and type 2 diabetes". Nature. 444 (7121): 840-6. doi:10.1038/nature05482. PMID 17167471</ref> Insulin plays a major role in fat production in adipocytes, synthesis of unsaturated fatty acids, and stimulating lipogenesis. It also plays a role in the uptake of glucose by muscles.<ref>Kahn BB, Flier JS (August 2000). "Obesity and insulin resistance". The Journal of Clinical Investigation. 106 (4): 473–81. doi:10.1172/JCI10842. PMC 380258. PMID 10953022</ref> The malfunctioning of insulin in turn leads to diabetes.

== Current researches ==

An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individuals showed significantly positive relationship with values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high-density lipoproteins), comparatively low values of LDL (low-density lipoproteins), and serum cholesterol.<ref>Najneen M. Bhaldar et al,An Observational Study of Medadhatu Sarata w.s.r. to Lipid Profile, International Journal of Research & Review , Vol.5; Issue: 10; October 2018</ref>

===List of theses ===

Very few research works have been carried out on fundamental approach towards the concept of meda dhatu.

Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and the effect of Ayurveda therapies in their management.

Hyperlipidemia and dyslipidemia are two other disorders related to meda dhatu.

1. Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar

2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar

4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.

6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar.

7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With Medoghna Rasayana Vati, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effect Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of Triphaladi Vati and Shilajitwadi Vati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.

12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, I.P.G.T. & R.A., Jamnagar.

13. Yogesh K Patil (2010) : A Comparative Study of Nyagrodhadi Vati and Gokshuradi Guggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

14.Falguni S Patel (2010) :A Clinical Study of Tryushnadhya Lauha Vati in the Management of Sthaulya w.s.r. to Obesity, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

16.Kanwar S Singh(2011) : Study on Apathyanimittaja Prameha (Type 2 Diabetes) and its Management with Saptarangyadi Ghana vati (A Clinico-Experimental study), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in Apathya Nimittaja Prameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

19.Chitra Devi Sharma (2013) : Comparative Study of Asanadi yoga Vati and Shilajitwadi Vati in the management of Madhumeha w.s.r. to Diabetes mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

20.MalivadShila (2014) : A Comparative Study of Vidangadi Lauh and Triphaladi Vati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

21.Jatin M Vyas (2014) : A Comparative Study of Bilvadi Panchmool Ghana vati and Navaka Guggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,I.P.G.T. & R. A., Jamnagar.

22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadi guggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

23. Bhushan Bhav Ram Prakash Niranjan (2014) : Management of Apathyanimittaja Prameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[Snehadhyaya]], [[Langhanabrimhaniya Adhyaya]], [[Ashtauninditiya Adhyaya]], [[Santarpaniya Adhyaya]]
[[ Grahani Chikitsa]],[[Prameha Nidana]],[[Prameha Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

==External links ==

[[Adipocyte]], [[fat cells]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Sha. =Sharangadhara
*Sa. = Samhita
*A = Ashtanga
*S = Sangraha

=== References from [[Charak Samhita]] ===

The list of references for meda dhatu in Charak Samhita can be seen here.

==References==

Meda dhatu

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Anagha: /* Abbreviations */

Meda dhatu

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Anagha: /* Abbreviations */

Meda dhatu

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Anagha: /* More information */

Meda dhatu is the body component which indicates fat in general and adipose tissue in particular.<ref>Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020 </ref> Its important function is to oleate or lubricate (snehana). <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.435)

It is present in two forms:

#Fixed or bounded form is observed as stored fats in adipocytes.
#The free form is observed as circulating lipids like lipoproteins or free fatty acids.<ref>Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Meda Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.,
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 4, 2020
}}

==Etymology, derivation and meanings==

The word "meda" is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness.

The literary meanings of word meda are as follows:<ref>Sanskriti Jha and Srujan Jha. Amarkosha.</ref>

1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibers, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them.

In physiology, its proper seat is said to be the abdomen.

2. Morbid or unnatural obesity.

3. In general, obesity or fat in the body is denoted by the word meda.<ref>
Monier-Williams Sanskrit-English Dictionary, 1899, [Cologne record ID = 167817] [Printed book page 832 , 3], https://www.sanskrit-lexicon.unikoeln.de/scans/MWScan/2014/web/webtc/indexcaller.php</ref>

==Panchabhautika constitution and properties==

Meda dhatu has dominance of [[prithvi]], [[jala]] and [[agni mahabhuta]].

It possesses properties like unctuousness (snigdha) and heaviness(guru).<ref>Bhavaprakasha, purva khanda, Garbhaprakarana 207</ref>

== Physiological aspects ==

=== Formation and metabolism ===

Meda dhatu is formed from the unctuous portion of [[mamsa dhatu]] by action of factors responsible for metabolism of meda(medadhatvagni).[Cha. Sa [[Chikitsa Sthana]] 15/29-30]

There are two forms of meda dhatu in body:

1. '''Structural component (poshya meda dhatu):''' It is the form,that is stored in the layer of meda (medodhara kala). It is also called fixed or stored fat(baddha medas). This portion is located mainly in the omentum. This form is responsible for the nutrition of meda dhatu itself in case of starvation.

2. '''Circulating component (poshaka meda dhatu):''' This form is circulated with nutrient fluid or plasma ([[rasa dhatu]]) and blood([[rakta]]). It is free and unbound (abaddha medas). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.[[Nidana Sthana]] 4/7]

===Metabolic by-products and waste products (Upadhatu and mala)===

During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. [[Chikitsa Sthana]] 15/17]. Sweat and sebum are formed during this process as waste products (mala). [Cha.Sa. [[Chikitsa Sthana]] 15/18].

=== Quantity ===

The total quantity of meda dhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. [[Sharira Sthana]] 7/15]

=== Time span ===

The meda dhatu is formed on the 4th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]

=== Characteristics of best quality of adipose tissue (meda sara )===

The person endowed with best quality of meda dhatu has significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.[[Vimana Sthana]] 8/106]

=== Channels of transportation and transformation of meda dhatu (medovaha srotas)===

The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. [[Vimana Sthana]] 5/8]

Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. Sharira Sthana 9/12].

Vagbhata added [[mamsa dhatu]] to the origin with kidneys (vrikka).[A.S.Sharira Sthana 6/26]

Considering the above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment.

The following structures can be considered as components of the transportation and transformation system of meda dhatu.

=== Layer of meda dhatu (medodhara kala)===

It is the layer of fat present in the abdominal cavity, small bones and long bones. In the abdominal cavity, it is present in the form of visceral fats.
Meda dhatu present in the long and big bones is known as marrow ([[majja]]).That present inside the small bones is termed as red marrow (sarakta meda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. Sharira Sthana 4/13]

===Role of meda dhatu in embryonic development===

During embryo-genesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism([[agni]])that makes them elastic and smooth. Ligaments(snayu) are formed after the strong action of factors responsible for metabolism([[agni]]) that makes them hard. [Su. Sa. Sharira Sthana 4/29-30]

The kidneys (vrikka) are formed from the unification of the essence of blood tissue([[rakta dhatu]])and adipose tissue (meda dhatu).The testis(vrishana) are formed from the unification of the essence of adipose tissue (meda dhatu),muscle tissue ([[mamsa dhatu]]), blood tissue ([[rakta dhatu]]) and [[kapha dosha]]. [Su. Sa. Sharira Sthana 4/31]

== Functions ==

Meda dhatu is responsible for functions of lubrication(sneha), sweating (sweda), stability (dridhatwam), and nourishment of bone tissue([[asthi]]pushti). [Su. Sa. Sutra Sthana 15/5]

== Importance in diagnosis ==

===Causes of vitiation===

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by the sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food, and alcoholic drinks. [Cha. Sa. [[Vimana Sthana]] 5/16]

=== Abnormal states ===
The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Decrease of meda dhatu ====

Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. [[Sutra Sthana]] 17/66], [Su. Sa. Sutra Sthana 15/9]

====Increase of meda dhatu====
The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation ===

*Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. [[Sutra Sthana]] 28/15]

*The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.[[Chikitsa Sthana]] 6/13-14]

*The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.[[Sutra Sthana]] 21/3]

*When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.Sharira Sthana 9/12]

=== Role of meda dhatu as vitiated factor in diseases ===

Meda dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/8]
*vitiligo (Shwitra) [Cha. Sa. [[Chikitsa Sthana]] 7/174]
*swelling (Shotha) [Cha. Sa. [[Chikitsa Sthana]] 12/94]
*Anaemia(Pandu)[Cha.Sa. [[Chikitsa Sthana]] 16/6]
*Disorders of thigh and hip (Urusthambha) [Cha. Sa. [[Chikitsa Sthana]] 27/14]
*Obesity (Sthaulya)[Cha. Sa. [[Sutra Sthana]] 21/5-8]
*Vitiated dosha located in the channels of transport of medadhatu (medovahasrotas)cause quaternary fever (chaturthaka jwara).[Cha. Sa. [[Chikitsa Sthana]] 3/66]
*The clinical features of fever due to vitiation of meda dhatu by [[pitta dosha]] (medadhatugata jwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. [[Chikitsa Sthana]] 3/79].
*When vitiated vata is located in [[mamsa]] and meda dhatu, it manifests by producing symptoms like heaviness of the body, pricking pain, and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. [[Chikitsa Sthana]] 28/32].
*When the [[vata]] is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. [[Chikitsa Sthana]] 28/66].
*Obesity (Sthaulya) is defined as an excessive increase of meda and [[mamsa dhatu]] in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. [[Sutra Sthana]] 21/5-9].

== Importance of concept in the preservation of health and prevention ==

Meda dhatu provides unctuousness to all body components. Unctuousness is the essential property of the essence of all seven [[dhatu]] ([[ojas]]). It is related to vitality and immunity of the body. [Cha.Sa. [[Chikitsa Sthana]] 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.[[Sutra Sthana]] 22/11] These are important in various physiological processes and functions of the body.

==Management ==
*Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.[[Sutra Sthana]]22]

The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. [[Sutra Sthana]] 21/21-22]
*Food and drinks that alleviate vata dosha and reduce kapha dosha and meda dhatu (fat),
*Therapeutic enema processed with drugs of sharply acting, dry and hot properties,
*Dry powder massage (udwartana),
*Use of guduchi (Tinospora cordifolia Miers), musta (Cyperusrotundus Linn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belerica Roxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey.
*The condition of fever due to pitta dosha in [[mamsa dhatu]] and meda dhatu is managed by therapeutic purgation ([[virechana]]) and fasting (upavasa). [Cha. Sa. [[Chikitsa Sthana]] 3/316].
*The treatment measures for vata located in meda dhatu are therapeutic purgation ([[virechana]]), evacuative enema([[basti]]) and palliative measures(shamana). [Cha. Sa. [[Chikitsa Sthana]] 28/93].

== Contemporary approach ==
*In conventional physiology, the concept of meda dhatu is perceived in view of adipose tissue, fats, and lipids. <ref>Vandana Verma, Sonam Agrawal, & Sangeeta Gehlot. (2020). Exploration of Ayurveda blueprint on clinical physiology of Meda (adipose tissue) and Majja Dhatu (bone marrow) in context to obesity. International Journal of Research in Pharmaceutical Sciences, 11(1), 358-367. https://doi.org/10.26452/ijrps.v11i1.1830</ref> Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Origin and formation ===

Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.<ref>Available from https://embryology.med.unsw.edu.au/embryology/index.php/Adipose_Tissue_Development cited on 18/05/2020</ref>
Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy.<ref>Birbrair A, Zhang T, Wang ZM, Messi ML, Enikolopov GN, Mintz A, Delbono O (August 2013). "Role of pericytes in skeletal muscle regeneration and fat accumulation". Stem Cells and Development. 22 (16): 2298–314. doi:10.1089/scd.2012.0647. PMC 3730538. PMID 23517218</ref> Adipocytes are derived from mesenchymal stem cells through adipogenesis.

There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.<ref name=abc>Available from https://en.wikipedia.org/wiki/Adipocyte#cite_note-Birbrair_2298%E2%80%932314-1</ref> The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.

The third but poorly understood marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cells expand in states of low bone density but additionally expands in the setting of obesity.<ref>Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J (August 2017). "Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice". Journal of Bone and Mineral Research. 32 (8): 1692–1702. doi:10.1002/jbmr.3159. PMC 5550355. PMID 28436105</ref>

=== Embryonic development ===

Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle, or bone. The fibroblast are preadipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6

=== Quantity and measurement ===

The total weight of fat in an average human adult measures about 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show a fourfold increase in size before dividing and increasing the absolute number of fat cells present.<ref>Robert P (2001). Fat: fighting the obesity epidemic. Oxford [Oxfordshire]: Oxford University Press. pp. 68. ISBN 978-0-19-511853-7</ref>

=== Functions ===

==== Storage of fat ====

The fat is stored in the body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.<ref>KAvailable from https://en.wikipedia.org/wiki/Adipocyte#cite_note-:0-3 cited on 18/05/2020</ref>

==== Generation of heat ====

The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.<ref name=abc/>

==== Adaptation ====

The fat cells tend to increase in size to store more fat in case needed. This expansion of fat mass leads to obesity.

=== Investigations ===

The levels of meda dhatu can be investigated through various assessment parameters like:

#Body mass index
#Waist: hip ratio
#Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
#Estimation of total cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
#Serum insulin

=== Role of adipocytes in causing obesity and diabetes ===

From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation of meda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha).

This patho-physiology can be linked as follows:

Excess nutrition leads to the expansion of fat mass and an increase in the size of adipocytes (hypertrophy).<ref>Bluher M (June 2009). "Adipose tissue dysfunction in obesity". Experimental and Clinical Endocrinology & Diabetes. 117 (6): 241–50. doi:10.1055/s-0029-1192044. PMID 19358089</ref> This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance.<ref>Kahn SE, Hull RL, Utzschneider KM (December 2006). "Mechanisms linking obesity to insulin resistance and type 2 diabetes". Nature. 444 (7121): 840-6. doi:10.1038/nature05482. PMID 17167471</ref> Insulin plays a major role in fat production in adipocytes, synthesis of unsaturated fatty acids, and stimulating lipogenesis. It also plays a role in the uptake of glucose by muscles.<ref>Kahn BB, Flier JS (August 2000). "Obesity and insulin resistance". The Journal of Clinical Investigation. 106 (4): 473–81. doi:10.1172/JCI10842. PMC 380258. PMID 10953022</ref> The malfunctioning of insulin in turn leads to diabetes.

== Current researches ==

An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individuals showed significantly positive relationship with values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high-density lipoproteins), comparatively low values of LDL (low-density lipoproteins), and serum cholesterol.<ref>Najneen M. Bhaldar et al,An Observational Study of Medadhatu Sarata w.s.r. to Lipid Profile, International Journal of Research & Review , Vol.5; Issue: 10; October 2018</ref>

===List of theses ===

Very few research works have been carried out on fundamental approach towards the concept of meda dhatu.

Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and the effect of Ayurveda therapies in their management.

Hyperlipidemia and dyslipidemia are two other disorders related to meda dhatu.

1. Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar

2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar

4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.

6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar.

7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With Medoghna Rasayana Vati, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effect Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of Triphaladi Vati and Shilajitwadi Vati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.

12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, I.P.G.T. & R.A., Jamnagar.

13. Yogesh K Patil (2010) : A Comparative Study of Nyagrodhadi Vati and Gokshuradi Guggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

14.Falguni S Patel (2010) :A Clinical Study of Tryushnadhya Lauha Vati in the Management of Sthaulya w.s.r. to Obesity, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

16.Kanwar S Singh(2011) : Study on Apathyanimittaja Prameha (Type 2 Diabetes) and its Management with Saptarangyadi Ghana vati (A Clinico-Experimental study), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in Apathya Nimittaja Prameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

19.Chitra Devi Sharma (2013) : Comparative Study of Asanadi yoga Vati and Shilajitwadi Vati in the management of Madhumeha w.s.r. to Diabetes mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

20.MalivadShila (2014) : A Comparative Study of Vidangadi Lauh and Triphaladi Vati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

21.Jatin M Vyas (2014) : A Comparative Study of Bilvadi Panchmool Ghana vati and Navaka Guggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,I.P.G.T. & R. A., Jamnagar.

22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadi guggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

23. Bhushan Bhav Ram Prakash Niranjan (2014) : Management of Apathyanimittaja Prameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[Snehadhyaya]], [[Langhanabrimhaniya Adhyaya]], [[Ashtauninditiya Adhyaya]], [[Santarpaniya Adhyaya]]
[[ Grahani Chikitsa]],[[Prameha Nidana]],[[Prameha Chikitsa]]

=== Related articles ===

*[[Dhatu]]

*[[Rasa dhatu]]

*[[Rakta dhatu]]

*[[Mamsa dhatu]]

*[[Asthi dhatu]]

*[[Majja dhatu]]

*[[Shukra dhatu]]

==External links ==

[[Adipocyte]], [[fat cells]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Meda dhatu

2020-06-26T18:43:38Z

Anagha: /* Layer of meda dhatu (medodhara kala) */

Meda dhatu is the body component which indicates fat in general and adipose tissue in particular.<ref>Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020 </ref> Its important function is to oleate or lubricate (snehana). <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.435)

It is present in two forms:

#Fixed or bounded form is observed as stored fats in adipocytes.
#The free form is observed as circulating lipids like lipoproteins or free fatty acids.<ref>Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Meda Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.,
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 4, 2020
}}

==Etymology, derivation and meanings==

The word "meda" is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness.

The literary meanings of word meda are as follows:<ref>Sanskriti Jha and Srujan Jha. Amarkosha.</ref>

1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibers, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them.

In physiology, its proper seat is said to be the abdomen.

2. Morbid or unnatural obesity.

3. In general, obesity or fat in the body is denoted by the word meda.<ref>
Monier-Williams Sanskrit-English Dictionary, 1899, [Cologne record ID = 167817] [Printed book page 832 , 3], https://www.sanskrit-lexicon.unikoeln.de/scans/MWScan/2014/web/webtc/indexcaller.php</ref>

==Panchabhautika constitution and properties==

Meda dhatu has dominance of [[prithvi]], [[jala]] and [[agni mahabhuta]].

It possesses properties like unctuousness (snigdha) and heaviness(guru).<ref>Bhavaprakasha, purva khanda, Garbhaprakarana 207</ref>

== Physiological aspects ==

=== Formation and metabolism ===

Meda dhatu is formed from the unctuous portion of [[mamsa dhatu]] by action of factors responsible for metabolism of meda(medadhatvagni).[Cha. Sa [[Chikitsa Sthana]] 15/29-30]

There are two forms of meda dhatu in body:

1. '''Structural component (poshya meda dhatu):''' It is the form,that is stored in the layer of meda (medodhara kala). It is also called fixed or stored fat(baddha medas). This portion is located mainly in the omentum. This form is responsible for the nutrition of meda dhatu itself in case of starvation.

2. '''Circulating component (poshaka meda dhatu):''' This form is circulated with nutrient fluid or plasma ([[rasa dhatu]]) and blood([[rakta]]). It is free and unbound (abaddha medas). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.[[Nidana Sthana]] 4/7]

===Metabolic by-products and waste products (Upadhatu and mala)===

During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. [[Chikitsa Sthana]] 15/17]. Sweat and sebum are formed during this process as waste products (mala). [Cha.Sa. [[Chikitsa Sthana]] 15/18].

=== Quantity ===

The total quantity of meda dhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. [[Sharira Sthana]] 7/15]

=== Time span ===

The meda dhatu is formed on the 4th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]

=== Characteristics of best quality of adipose tissue (meda sara )===

The person endowed with best quality of meda dhatu has significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.[[Vimana Sthana]] 8/106]

=== Channels of transportation and transformation of meda dhatu (medovaha srotas)===

The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. [[Vimana Sthana]] 5/8]

Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. Sharira Sthana 9/12].

Vagbhata added [[mamsa dhatu]] to the origin with kidneys (vrikka).[A.S.Sharira Sthana 6/26]

Considering the above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment.

The following structures can be considered as components of the transportation and transformation system of meda dhatu.

=== Layer of meda dhatu (medodhara kala)===

It is the layer of fat present in the abdominal cavity, small bones and long bones. In the abdominal cavity, it is present in the form of visceral fats.
Meda dhatu present in the long and big bones is known as marrow ([[majja]]).That present inside the small bones is termed as red marrow (sarakta meda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. Sharira Sthana 4/13]

===Role of meda dhatu in embryonic development===

During embryo-genesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism([[agni]])that makes them elastic and smooth. Ligaments(snayu) are formed after the strong action of factors responsible for metabolism([[agni]]) that makes them hard. [Su. Sa. Sharira Sthana 4/29-30]

The kidneys (vrikka) are formed from the unification of the essence of blood tissue([[rakta dhatu]])and adipose tissue (meda dhatu).The testis(vrishana) are formed from the unification of the essence of adipose tissue (meda dhatu),muscle tissue ([[mamsa dhatu]]), blood tissue ([[rakta dhatu]]) and [[kapha dosha]]. [Su. Sa. Sharira Sthana 4/31]

== Functions ==

Meda dhatu is responsible for functions of lubrication(sneha), sweating (sweda), stability (dridhatwam), and nourishment of bone tissue([[asthi]]pushti). [Su. Sa. Sutra Sthana 15/5]

== Importance in diagnosis ==

===Causes of vitiation===

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by the sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food, and alcoholic drinks. [Cha. Sa. [[Vimana Sthana]] 5/16]

=== Abnormal states ===
The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Decrease of meda dhatu ====

Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. [[Sutra Sthana]] 17/66], [Su. Sa. Sutra Sthana 15/9]

====Increase of meda dhatu====
The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation ===

*Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. [[Sutra Sthana]] 28/15]

*The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.[[Chikitsa Sthana]] 6/13-14]

*The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.[[Sutra Sthana]] 21/3]

*When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.Sharira Sthana 9/12]

=== Role of meda dhatu as vitiated factor in diseases ===

Meda dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/8]
*vitiligo (Shwitra) [Cha. Sa. [[Chikitsa Sthana]] 7/174]
*swelling (Shotha) [Cha. Sa. [[Chikitsa Sthana]] 12/94]
*Anaemia(Pandu)[Cha.Sa. [[Chikitsa Sthana]] 16/6]
*Disorders of thigh and hip (Urusthambha) [Cha. Sa. [[Chikitsa Sthana]] 27/14]
*Obesity (Sthaulya)[Cha. Sa. [[Sutra Sthana]] 21/5-8]
*Vitiated dosha located in the channels of transport of medadhatu (medovahasrotas)cause quaternary fever (chaturthaka jwara).[Cha. Sa. [[Chikitsa Sthana]] 3/66]
*The clinical features of fever due to vitiation of meda dhatu by [[pitta dosha]] (medadhatugata jwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. [[Chikitsa Sthana]] 3/79].
*When vitiated vata is located in [[mamsa]] and meda dhatu, it manifests by producing symptoms like heaviness of the body, pricking pain, and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. [[Chikitsa Sthana]] 28/32].
*When the [[vata]] is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. [[Chikitsa Sthana]] 28/66].
*Obesity (Sthaulya) is defined as an excessive increase of meda and [[mamsa dhatu]] in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. [[Sutra Sthana]] 21/5-9].

== Importance of concept in the preservation of health and prevention ==

Meda dhatu provides unctuousness to all body components. Unctuousness is the essential property of the essence of all seven [[dhatu]] ([[ojas]]). It is related to vitality and immunity of the body. [Cha.Sa. [[Chikitsa Sthana]] 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.[[Sutra Sthana]] 22/11] These are important in various physiological processes and functions of the body.

==Management ==
*Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.[[Sutra Sthana]]22]

The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. [[Sutra Sthana]] 21/21-22]
*Food and drinks that alleviate vata dosha and reduce kapha dosha and meda dhatu (fat),
*Therapeutic enema processed with drugs of sharply acting, dry and hot properties,
*Dry powder massage (udwartana),
*Use of guduchi (Tinospora cordifolia Miers), musta (Cyperusrotundus Linn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belerica Roxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey.
*The condition of fever due to pitta dosha in [[mamsa dhatu]] and meda dhatu is managed by therapeutic purgation ([[virechana]]) and fasting (upavasa). [Cha. Sa. [[Chikitsa Sthana]] 3/316].
*The treatment measures for vata located in meda dhatu are therapeutic purgation ([[virechana]]), evacuative enema([[basti]]) and palliative measures(shamana). [Cha. Sa. [[Chikitsa Sthana]] 28/93].

== Contemporary approach ==
*In conventional physiology, the concept of meda dhatu is perceived in view of adipose tissue, fats, and lipids. <ref>Vandana Verma, Sonam Agrawal, & Sangeeta Gehlot. (2020). Exploration of Ayurveda blueprint on clinical physiology of Meda (adipose tissue) and Majja Dhatu (bone marrow) in context to obesity. International Journal of Research in Pharmaceutical Sciences, 11(1), 358-367. https://doi.org/10.26452/ijrps.v11i1.1830</ref> Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Origin and formation ===

Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.<ref>Available from https://embryology.med.unsw.edu.au/embryology/index.php/Adipose_Tissue_Development cited on 18/05/2020</ref>
Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy.<ref>Birbrair A, Zhang T, Wang ZM, Messi ML, Enikolopov GN, Mintz A, Delbono O (August 2013). "Role of pericytes in skeletal muscle regeneration and fat accumulation". Stem Cells and Development. 22 (16): 2298–314. doi:10.1089/scd.2012.0647. PMC 3730538. PMID 23517218</ref> Adipocytes are derived from mesenchymal stem cells through adipogenesis.

There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.<ref name=abc>Available from https://en.wikipedia.org/wiki/Adipocyte#cite_note-Birbrair_2298%E2%80%932314-1</ref> The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.

The third but poorly understood marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cells expand in states of low bone density but additionally expands in the setting of obesity.<ref>Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J (August 2017). "Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice". Journal of Bone and Mineral Research. 32 (8): 1692–1702. doi:10.1002/jbmr.3159. PMC 5550355. PMID 28436105</ref>

=== Embryonic development ===

Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle, or bone. The fibroblast are preadipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6

=== Quantity and measurement ===

The total weight of fat in an average human adult measures about 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show a fourfold increase in size before dividing and increasing the absolute number of fat cells present.<ref>Robert P (2001). Fat: fighting the obesity epidemic. Oxford [Oxfordshire]: Oxford University Press. pp. 68. ISBN 978-0-19-511853-7</ref>

=== Functions ===

==== Storage of fat ====

The fat is stored in the body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.<ref>KAvailable from https://en.wikipedia.org/wiki/Adipocyte#cite_note-:0-3 cited on 18/05/2020</ref>

==== Generation of heat ====

The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.<ref name=abc/>

==== Adaptation ====

The fat cells tend to increase in size to store more fat in case needed. This expansion of fat mass leads to obesity.

=== Investigations ===

The levels of meda dhatu can be investigated through various assessment parameters like:

#Body mass index
#Waist: hip ratio
#Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
#Estimation of total cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
#Serum insulin

=== Role of adipocytes in causing obesity and diabetes ===

From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation of meda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha).

This patho-physiology can be linked as follows:

Excess nutrition leads to the expansion of fat mass and an increase in the size of adipocytes (hypertrophy).<ref>Bluher M (June 2009). "Adipose tissue dysfunction in obesity". Experimental and Clinical Endocrinology & Diabetes. 117 (6): 241–50. doi:10.1055/s-0029-1192044. PMID 19358089</ref> This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance.<ref>Kahn SE, Hull RL, Utzschneider KM (December 2006). "Mechanisms linking obesity to insulin resistance and type 2 diabetes". Nature. 444 (7121): 840-6. doi:10.1038/nature05482. PMID 17167471</ref> Insulin plays a major role in fat production in adipocytes, synthesis of unsaturated fatty acids, and stimulating lipogenesis. It also plays a role in the uptake of glucose by muscles.<ref>Kahn BB, Flier JS (August 2000). "Obesity and insulin resistance". The Journal of Clinical Investigation. 106 (4): 473–81. doi:10.1172/JCI10842. PMC 380258. PMID 10953022</ref> The malfunctioning of insulin in turn leads to diabetes.

== Current researches ==

An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individuals showed significantly positive relationship with values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high-density lipoproteins), comparatively low values of LDL (low-density lipoproteins), and serum cholesterol.<ref>Najneen M. Bhaldar et al,An Observational Study of Medadhatu Sarata w.s.r. to Lipid Profile, International Journal of Research & Review , Vol.5; Issue: 10; October 2018</ref>

===List of theses ===

Very few research works have been carried out on fundamental approach towards the concept of meda dhatu.

Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and the effect of Ayurveda therapies in their management.

Hyperlipidemia and dyslipidemia are two other disorders related to meda dhatu.

1. Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar

2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar

4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.

6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar.

7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With Medoghna Rasayana Vati, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effect Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of Triphaladi Vati and Shilajitwadi Vati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.

12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, I.P.G.T. & R.A., Jamnagar.

13. Yogesh K Patil (2010) : A Comparative Study of Nyagrodhadi Vati and Gokshuradi Guggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

14.Falguni S Patel (2010) :A Clinical Study of Tryushnadhya Lauha Vati in the Management of Sthaulya w.s.r. to Obesity, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

16.Kanwar S Singh(2011) : Study on Apathyanimittaja Prameha (Type 2 Diabetes) and its Management with Saptarangyadi Ghana vati (A Clinico-Experimental study), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in Apathya Nimittaja Prameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

19.Chitra Devi Sharma (2013) : Comparative Study of Asanadi yoga Vati and Shilajitwadi Vati in the management of Madhumeha w.s.r. to Diabetes mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

20.MalivadShila (2014) : A Comparative Study of Vidangadi Lauh and Triphaladi Vati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

21.Jatin M Vyas (2014) : A Comparative Study of Bilvadi Panchmool Ghana vati and Navaka Guggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,I.P.G.T. & R. A., Jamnagar.

22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadi guggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

23. Bhushan Bhav Ram Prakash Niranjan (2014) : Management of Apathyanimittaja Prameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[Snehadhyaya]], [[Langhanabrimhaniya Adhyaya]], [[Ashtauninditiya Adhyaya]], [[Santarpaniya Adhyaya]]
[[ Grahani Chikitsa]],[[Prameha Nidana]],[[Prameha Chikitsa]]

==External links ==

[[Adipocyte]], [[fat cells]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Meda dhatu

2020-06-26T18:43:01Z

Anagha: /* Channels of transportation and transformation of meda dhatu (medovaha srotas) */

Meda dhatu is the body component which indicates fat in general and adipose tissue in particular.<ref>Available from https://ayurvedanetworkbhu.com/physiological-issues-related-to-medo-dhatu-with-special-reference-to-obesity/ cited on 18/05/2020 </ref> Its important function is to oleate or lubricate (snehana). <ref>Available from http://namstp.ayush.gov.in/#/sat</ref>(SAT-B.435)

It is present in two forms:

#Fixed or bounded form is observed as stored fats in adipocytes.
#The free form is observed as circulating lipids like lipoproteins or free fatty acids.<ref>Kishor Patwardhan, ‘Human Physiology in Ayurveda’, Published by Chaukhambha Orientalia, Varanasi (2005) Page No.19</ref>

{{Infobox

|title = Contributors

|label1 = Section/Chapter/topic
|data1 = [[Sharira]] / [[Dhatu]] / Meda Dhatu

|label2 = Authors
|data2 = Deole Y.S.,Anagha S.,
|label3 = Reviewed by
|data3 = Basisht G.

|label4 = Affiliation
|data4 = [[Charak Samhita Research, Training and Development Centre]], I.P.G.T.& R.A., Jamnagar

|label5 = Correspondence email:
|data5 = carakasamhita@gmail.com

|label6 = Date of publication:
|data6 = June 4, 2020
}}

==Etymology, derivation and meanings==

The word "meda" is derived from Sanskrit root medas[meda-asun]. It means to lubricate or oleate or to provide unctuousness.

The literary meanings of word meda are as follows:<ref>Sanskriti Jha and Srujan Jha. Amarkosha.</ref>

1. Marrow; applicable not merely to the marrow of the bones, but more properly, to the serous or adipose secretion that spreads amongst the muscular fibers, and which is considered as performing the same functions to the flesh that the marrow of the bones performs to them.

In physiology, its proper seat is said to be the abdomen.

2. Morbid or unnatural obesity.

3. In general, obesity or fat in the body is denoted by the word meda.<ref>
Monier-Williams Sanskrit-English Dictionary, 1899, [Cologne record ID = 167817] [Printed book page 832 , 3], https://www.sanskrit-lexicon.unikoeln.de/scans/MWScan/2014/web/webtc/indexcaller.php</ref>

==Panchabhautika constitution and properties==

Meda dhatu has dominance of [[prithvi]], [[jala]] and [[agni mahabhuta]].

It possesses properties like unctuousness (snigdha) and heaviness(guru).<ref>Bhavaprakasha, purva khanda, Garbhaprakarana 207</ref>

== Physiological aspects ==

=== Formation and metabolism ===

Meda dhatu is formed from the unctuous portion of [[mamsa dhatu]] by action of factors responsible for metabolism of meda(medadhatvagni).[Cha. Sa [[Chikitsa Sthana]] 15/29-30]

There are two forms of meda dhatu in body:

1. '''Structural component (poshya meda dhatu):''' It is the form,that is stored in the layer of meda (medodhara kala). It is also called fixed or stored fat(baddha medas). This portion is located mainly in the omentum. This form is responsible for the nutrition of meda dhatu itself in case of starvation.

2. '''Circulating component (poshaka meda dhatu):''' This form is circulated with nutrient fluid or plasma ([[rasa dhatu]]) and blood([[rakta]]). It is free and unbound (abaddha medas). This provides lubrication and unctuousness wherever needed. This form is vitiated in the pathogenesis of obstinate urinary disorders including diabetes (prameha) [Cha.Sa.[[Nidana Sthana]] 4/7]

===Metabolic by-products and waste products (Upadhatu and mala)===

During the process of metabolism and formation of meda dhatu, ligaments (snayu) are formed as the metabolic byproducts (upadhatu). [Cha. Sa. [[Chikitsa Sthana]] 15/17]. Sweat and sebum are formed during this process as waste products (mala). [Cha.Sa. [[Chikitsa Sthana]] 15/18].

=== Quantity ===

The total quantity of meda dhatu is two anjali (personified measurement unit). The quantity of vasa is three anjali (personified measurement unit). One anjali is equal to the quantity that can be filled in a space formed from joining one’s palms together. [Cha. Sa. [[Sharira Sthana]] 7/15]

=== Time span ===

The meda dhatu is formed on the 4th day from the nutrient fluid (ahara rasa). [Cha.Sa. [[Chikitsa Sthana]] 15/20-21] However, Sushruta opines that the meda dhatu is formed in fifteen days (a time span of 9045 kala). [Su. Sa. Sutra Sthana 14/14]

=== Characteristics of best quality of adipose tissue (meda sara )===

The person endowed with best quality of meda dhatu has significant unctuousness specifically in complexion, voice, eyes, hair, skin hair, nails, teeth, lips, urine and feces. This indicates wealth, power, happiness, enjoyment, charity, simplicity and delicacy in dealings.[Cha.Sa.[[Vimana Sthana]] 8/106]

=== Channels of transportation and transformation of meda dhatu (medovaha srotas)===

The channels of transportation and transformation of meda dhatu originate from the kidneys(vrikka) and omentum (vapavahana), [Cha. Sa. [[Vimana Sthana]] 5/8]

Sushruta opines that they originated from pelvic region(kati) and kidneys(vrikka).[Su. Sa. Sharira Sthana 9/12].

Vagbhata added [[mamsa dhatu]] to the origin with kidneys (vrikka).[A.S.Sharira Sthana 6/26]

Considering the above opinions, the origin of meda dhatu can be considered in pelvic region, omentum and kidneys. The sites of origin are important for knowing the source of nourishment in diagnosis and treatment.

The following structures can be considered as components of the transportation and transformation system of meda dhatu.

=== Layer of meda dhatu (medodhara kala)===

It is the layer of fat present in the abdominal cavity, small bones and long bones. In the abdominal cavity, it is present in the form of visceral fats.
Meda dhatu present in the long and big bones is known as marrow (majja).That present inside the small bones is termed as red marrow (sarakta meda). The unctuous portion of mamsa dhatu transforms into fat and is known as muscle fat (vasa). [Su. Sa. Sharira Sthana 4/13]

===Role of meda dhatu in embryonic development===

During embryo-genesis, veins (sira) and ligaments (snayu) are formed from the unctuous portion of meda dhatu. The veins are formed after mild action of factors responsible for metabolism([[agni]])that makes them elastic and smooth. Ligaments(snayu) are formed after the strong action of factors responsible for metabolism([[agni]]) that makes them hard. [Su. Sa. Sharira Sthana 4/29-30]

The kidneys (vrikka) are formed from the unification of the essence of blood tissue([[rakta dhatu]])and adipose tissue (meda dhatu).The testis(vrishana) are formed from the unification of the essence of adipose tissue (meda dhatu),muscle tissue ([[mamsa dhatu]]), blood tissue ([[rakta dhatu]]) and [[kapha dosha]]. [Su. Sa. Sharira Sthana 4/31]

== Functions ==

Meda dhatu is responsible for functions of lubrication(sneha), sweating (sweda), stability (dridhatwam), and nourishment of bone tissue([[asthi]]pushti). [Su. Sa. Sutra Sthana 15/5]

== Importance in diagnosis ==

===Causes of vitiation===

The channels of transportation and transformation of meda dhatu (medovahasrotas) are affected by the sedentary lifestyle including lack of physical exercise, daytime sleep, excessive consumption of fatty food, and alcoholic drinks. [Cha. Sa. [[Vimana Sthana]] 5/16]

=== Abnormal states ===
The increase or decrease in quality and/or quantity of meda dhatu can lead to various abnormal conditions. The states can be assessed by the following clinical features.

==== Decrease of meda dhatu ====

Symptoms of decrease of meda dhatu are cracking sound in the joints, lassitude in eyes, exhaustion, decreased abdominal girth or thinning, splenomegaly, feeling of emptiness in joints. dryness and craving for fatty food and meat. [Cha. Sa. [[Sutra Sthana]] 17/66], [Su. Sa. Sutra Sthana 15/9]

====Increase of meda dhatu====
The increase in meda dhatu can be observed by unctuousness of body,increased abdominal girth (abdominal obesity), increased size of flanks,cough, dyspnoeaand bad body odour. [Su. Sa. Sutra Sthana 15/14]

=== Clinical features of vitiation ===

*Premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha)and signs of eight undesirable types of physical constitutions are observed due to vitiation of channels of transportation and transformation of meda dhatu. [Cha. Sa. [[Sutra Sthana]] 28/15]

*The premonitory symptoms of obstinate urinary disorders including diabetes mellitus (prameha) include excess sweating, body odor, flabbiness of the body, desire for constantly lying on the bed, sitting, sleeping and leading an easy life, a feeling as if the cardiac region is covered with extraneous material, exudation of excreta from eyes, tongue and ears, corpulence of the body, excessive growth of hair and nails, liking for cold things, dryness of throat and palate, sweet taste in the mouth, burning sensation in hands and legs and swarming of ants on the urine. [Cha.Sa.[[Chikitsa Sthana]] 6/13-14]

*The signs of eight undesirable physical constitutions include too tall, too short, too hairy, hairless, too dark, too light (complexion), too obese and too lean body statures. [Cha, Sa.[[Sutra Sthana]] 21/3]

*When there is injury to channels of transportation and transformation of meda dhatu(medovahasrotas), the symptoms like excessive sweating, unctuousness of body, dryness of the palate, thick or hard swelling and severe thirst are observed. [Su. Sa.Sharira Sthana 9/12]

=== Role of meda dhatu as vitiated factor in diseases ===

Meda dhatu is involved in the pathogenesis of the following diseases:

*Obstinate urinary diseases including diabetes (Prameha)[Cha. Sa. [[Nidana Sthana]] 4/8]
*vitiligo (Shwitra) [Cha. Sa. [[Chikitsa Sthana]] 7/174]
*swelling (Shotha) [Cha. Sa. [[Chikitsa Sthana]] 12/94]
*Anaemia(Pandu)[Cha.Sa. [[Chikitsa Sthana]] 16/6]
*Disorders of thigh and hip (Urusthambha) [Cha. Sa. [[Chikitsa Sthana]] 27/14]
*Obesity (Sthaulya)[Cha. Sa. [[Sutra Sthana]] 21/5-8]
*Vitiated dosha located in the channels of transport of medadhatu (medovahasrotas)cause quaternary fever (chaturthaka jwara).[Cha. Sa. [[Chikitsa Sthana]] 3/66]
*The clinical features of fever due to vitiation of meda dhatu by [[pitta dosha]] (medadhatugata jwara) are excessive sweating, thirst, incoherent speech, frequent emesis, inability to tolerate own body odor, wet feeling in the body and anorexia. [Cha. Sa. [[Chikitsa Sthana]] 3/79].
*When vitiated vata is located in [[mamsa]] and meda dhatu, it manifests by producing symptoms like heaviness of the body, pricking pain, and as if beaten by a strong rod or fist cuff and painful severe fatigue. [Cha. Sa. [[Chikitsa Sthana]] 28/32].
*When the [[vata]] is occluded in the meda dhatu, it causes movable, smooth, soft, cold swellings in the body, and anorexia. This condition is known as ‘adhyavata’ and is difficult to cure. [Cha. Sa. [[Chikitsa Sthana]] 28/66].
*Obesity (Sthaulya) is defined as an excessive increase of meda and [[mamsa dhatu]] in the regions of buttocks, abdomen, and breasts. This leads to flabby or pendulous appearance the person suffers from deficient metabolism and energy. The pathogenesis of obesity begins with the obstruction of body channels by medas leading to excess deposition of fats. It causes severe diseases resulting in rapid deterioration of life. [Cha. Sa. [[Sutra Sthana]] 21/5-9].

== Importance of concept in the preservation of health and prevention ==

Meda dhatu provides unctuousness to all body components. Unctuousness is the essential property of the essence of all seven [[dhatu]] ([[ojas]]). It is related to vitality and immunity of the body. [Cha.Sa. [[Chikitsa Sthana]] 24/31] The unctuous portion (sneha) carries functions like lubrication, providing moisture, smoothening, unction, fluidity, and ooziness. [Cha.Sa.[[Sutra Sthana]] 22/11] These are important in various physiological processes and functions of the body.

==Management ==
*Nourishing therapy (brimhana) and oleation therapy (snehana) are indicated in conditions of decrease of meda dhatu. Drying therapy (rukshana)and scraping therapy (lekhana) are indicated in conditions of increase in meda dhatu. [Cha.Sa.[[Sutra Sthana]]22]

The management of diseases due to vitiation of medadhatu includes following measures: [Cha. Sa. [[Sutra Sthana]] 21/21-22]
*Food and drinks that alleviate vata dosha and reduce kapha dosha and meda dhatu (fat),
*Therapeutic enema processed with drugs of sharply acting, dry and hot properties,
*Dry powder massage (udwartana),
*Use of guduchi (Tinospora cordifolia Miers), musta (Cyperusrotundus Linn), triphala (combination of Haritaki (Terminalia chebula Linn), bibhitaki(Terminalia belerica Roxb) and amalaki (Emblica officinalis Gaertn)), takrarishta (a fermented medicinal preparation of buttermilk) and honey.
*The condition of fever due to pitta dosha in [[mamsa dhatu]] and meda dhatu is managed by therapeutic purgation ([[virechana]]) and fasting (upavasa). [Cha. Sa. [[Chikitsa Sthana]] 3/316].
*The treatment measures for vata located in meda dhatu are therapeutic purgation ([[virechana]]), evacuative enema([[basti]]) and palliative measures(shamana). [Cha. Sa. [[Chikitsa Sthana]] 28/93].

== Contemporary approach ==
*In conventional physiology, the concept of meda dhatu is perceived in view of adipose tissue, fats, and lipids. <ref>Vandana Verma, Sonam Agrawal, & Sangeeta Gehlot. (2020). Exploration of Ayurveda blueprint on clinical physiology of Meda (adipose tissue) and Majja Dhatu (bone marrow) in context to obesity. International Journal of Research in Pharmaceutical Sciences, 11(1), 358-367. https://doi.org/10.26452/ijrps.v11i1.1830</ref> Fat is found primarily as a continuous layer or as a deposition on membranes such as mesenteries or greater omentum. It is usually found around kidneys helping to hold them in place around the intestine and furrows of the heart. Fat is found in marrows of long bones also.<ref>Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.346</ref>

=== Origin and formation ===

Adipose tissue is a loose connective tissue including adipocytes, fibroblasts, vascular endothelial cells, and some immune cells.<ref>Available from https://embryology.med.unsw.edu.au/embryology/index.php/Adipose_Tissue_Development cited on 18/05/2020</ref>
Adipocytes, or lipocytes or fat cells, primarily compose adipose tissue and store fat as energy.<ref>Birbrair A, Zhang T, Wang ZM, Messi ML, Enikolopov GN, Mintz A, Delbono O (August 2013). "Role of pericytes in skeletal muscle regeneration and fat accumulation". Stem Cells and Development. 22 (16): 2298–314. doi:10.1089/scd.2012.0647. PMC 3730538. PMID 23517218</ref> Adipocytes are derived from mesenchymal stem cells through adipogenesis.

There are two types of adipose tissue, white adipose tissue (WAT) and brown adipose tissue (BAT), which are also known as white and brown fat, respectively, and comprise two types of fat cells.<ref name=abc>Available from https://en.wikipedia.org/wiki/Adipocyte#cite_note-Birbrair_2298%E2%80%932314-1</ref> The WAT carries out functions of storage of fat, whereas BAT is involved in thermogenesis.

The third but poorly understood marrow fat cells (unilocular cells) are also derived from mesenchymal stem cells. These cells expand in states of low bone density but additionally expands in the setting of obesity.<ref>Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J (August 2017). "Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice". Journal of Bone and Mineral Research. 32 (8): 1692–1702. doi:10.1002/jbmr.3159. PMC 5550355. PMID 28436105</ref>

=== Embryonic development ===

Mesenchymal stem cells can differentiate into adipocytes, connective tissue, muscle, or bone. The fibroblast are preadipocytes that can differentiate to form adipocytes. Connective tissues are originated from mesoderm during embryogenesis. The development of adipose tissue starts in 14th week of gestation in buccal pad.6

=== Quantity and measurement ===

The total weight of fat in an average human adult measures about 13.5 kg. There are 30 billion fat cells. In case of excess weight gain, the fat cells show a fourfold increase in size before dividing and increasing the absolute number of fat cells present.<ref>Robert P (2001). Fat: fighting the obesity epidemic. Oxford [Oxfordshire]: Oxford University Press. pp. 68. ISBN 978-0-19-511853-7</ref>

=== Functions ===

==== Storage of fat ====

The fat is stored in the body for energy in case of starvation. The white fat cells store fat in a semi-liquid state. It is composed primarily of triglycerides and cholesteryl ester. White fat cells secrete many proteins acting as adipokines such as resistin, adiponectin, leptin and apelin.<ref>KAvailable from https://en.wikipedia.org/wiki/Adipocyte#cite_note-:0-3 cited on 18/05/2020</ref>

==== Generation of heat ====

The brown color in the brown fat cells comes from the large quantity of mitochondria. Therefore, the brown fat, also known as "baby fat," is used to generate heat.<ref name=abc/>

==== Adaptation ====

The fat cells tend to increase in size to store more fat in case needed. This expansion of fat mass leads to obesity.

=== Investigations ===

The levels of meda dhatu can be investigated through various assessment parameters like:

#Body mass index
#Waist: hip ratio
#Distribution of fat like measurement of visceral fat, muscle fats through body fat monitor
#Estimation of total cholesterol, triglyceride, HDL (high density lipoprotein), LDL (low density lipoprotein) and VLDL Cholesterol (very low-density lipoprotein)
#Serum insulin

=== Role of adipocytes in causing obesity and diabetes ===

From the above description, it is clear that meda dhatu is responsible for obesity (sthaulya)due to excess nourishment. The vitiation of channels of transportation and transformation of meda dhatu(medavahasrotasa) leads to obstinate urinary disorders including diabetes(prameha).

This patho-physiology can be linked as follows:

Excess nutrition leads to the expansion of fat mass and an increase in the size of adipocytes (hypertrophy).<ref>Bluher M (June 2009). "Adipose tissue dysfunction in obesity". Experimental and Clinical Endocrinology & Diabetes. 117 (6): 241–50. doi:10.1055/s-0029-1192044. PMID 19358089</ref> This leads to obesity. In the fat cells of obese individuals, there is increased production of metabolism modulators, such as glycerol, hormones, macrophage stimulating chemokines, and pro-inflammatory cytokines, leading to the development of insulin resistance.<ref>Kahn SE, Hull RL, Utzschneider KM (December 2006). "Mechanisms linking obesity to insulin resistance and type 2 diabetes". Nature. 444 (7121): 840-6. doi:10.1038/nature05482. PMID 17167471</ref> Insulin plays a major role in fat production in adipocytes, synthesis of unsaturated fatty acids, and stimulating lipogenesis. It also plays a role in the uptake of glucose by muscles.<ref>Kahn BB, Flier JS (August 2000). "Obesity and insulin resistance". The Journal of Clinical Investigation. 106 (4): 473–81. doi:10.1172/JCI10842. PMC 380258. PMID 10953022</ref> The malfunctioning of insulin in turn leads to diabetes.

== Current researches ==

An observational study assessing the qualities of excellence of medadhatu(sarata) in 60 individuals showed significantly positive relationship with values of lipids. The data showed that persons showing excellent qualities of meda dhatu have normal to high values of HDL (high-density lipoproteins), comparatively low values of LDL (low-density lipoproteins), and serum cholesterol.<ref>Najneen M. Bhaldar et al,An Observational Study of Medadhatu Sarata w.s.r. to Lipid Profile, International Journal of Research & Review , Vol.5; Issue: 10; October 2018</ref>

===List of theses ===

Very few research works have been carried out on fundamental approach towards the concept of meda dhatu.

Prameha (obstinate urinary disorders including diabetes) and sthaulya (obesity) are two most prevalent disorders observed in society. Hence the clinical research in relation to meda dhatu is mostly focused on these two disorders and the effect of Ayurveda therapies in their management.

Hyperlipidemia and dyslipidemia are two other disorders related to meda dhatu.

1. Upadhyay Vashudev J (2001) : Medo-Dhatvagni ka SthaulyaRogakeSandharbhameinSaidhantikaevamPrayogikaAdhyayana, Department of Basic Principles, IPGT&RA,Jamnagar

2.Savjani Rekha T (2001) :A clinical study on the management of Sthaulya by Pancha-Tikta and Lekhana-Basti, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

3.BuchakeAnand(2002) :An assessment of the activities of RookshaGunaw.s.r. to Sthaulya, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar

4. Parmar Sheetal (2002): The role of Virechana and Triphaladi Ghana-Vati in the management of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

5. GujarathiRitesh A ( 2004) : Conceptual and applied aspects of HrasaHetur-Visheshascha in the context of Sthaulya, Department of Basic Principles, IPGT&RA,Jamnagar.

6. Talathi Sameer (2005) : A study of Saptaparna (Alstoniascholaris) w.s.r. to Sthaulyahara Karma, Department of Dravyaguna, I.P.G.T. & R. A., Jamnagar.

7.Dyuti Dave (2006) : Further Clinical Studies In The Management Of Madhumeha With Medoghna Rasayana Vati, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

8.Umesh Kumar Sapra (2007) : A Clinical Study Of Hyperlipidaemia And The Effect Of Panchatikta Ghana In Its Management-A Double Blind Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

9.Jyoti Kumari (2007) :A Comparative Clinical Study Of NyagrodhadiGhanavati And Virechana Karma In The Management Of Madhumeha (Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

10.Amit Kumar Singh (2007): A comparative study of Vidangadichurna and some indigenous drug in the management of sthaulya (obesity), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

11. Shweta M Khanapurkar (2008) :Comparative Study of the Efficacy of Triphaladi Vati and Shilajitwadi Vati in the Management of Prameha (DM), Department of Kayachikitsa, Akhandanand Ayurveda College, Ahmedabad.

12.Anoop K (2010) :Pharmaco-Therapeutical Evaluation of Anti-Hyperlipidaemic Activity of Vacha (Acorus calamus Linn.) W.S.R. to Sthaulya,Department of Dravyaguna, I.P.G.T. & R.A., Jamnagar.

13. Yogesh K Patil (2010) : A Comparative Study of Nyagrodhadi Vati and Gokshuradi Guggulu in the Management of Madhumeha W.S.R. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R.A., Jamnagar.

14.Falguni S Patel (2010) :A Clinical Study of Tryushnadhya Lauha Vati in the Management of Sthaulya w.s.r. to Obesity, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

15.Manjiri S Ghorpade (2011) : A Comparative Study of Vatsakadi Ghana Vati and Mamajjaka Ghana Vati in the management of Madhumehaw.s.r. to Diabetes Mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

16.Kanwar S Singh(2011) : Study on Apathyanimittaja Prameha (Type 2 Diabetes) and its Management with Saptarangyadi Ghana vati (A Clinico-Experimental study), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

17.Shivam Joshi (2013) :A Comparative clinical study of AsanadiGhanavati and GomutraHaritakiVati in KaphaMedoMargavaranaw.s.r. to Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

18.Ankush Gunjal (2013) : A Clinico-experimental Study on Triphaladi Granules in Apathya Nimittaja Prameha (Type 2 Diabetes mellitus), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

19.Chitra Devi Sharma (2013) : Comparative Study of Asanadi yoga Vati and Shilajitwadi Vati in the management of Madhumeha w.s.r. to Diabetes mellitus, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

20.MalivadShila (2014) : A Comparative Study of Vidangadi Lauh and Triphaladi Vati in the Management of Madhumeha with special reference to Diabetes Mellitus (Type II), Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

21.Jatin M Vyas (2014) : A Comparative Study of Bilvadi Panchmool Ghana vati and Navaka Guggulu in the Management of Sthaulya with special reference to Obesity, Department of Kayachikitsa ,I.P.G.T. & R. A., Jamnagar.

22. PadharBharatkumarChhaganbhai(2014) :A Comparative Clinical Study of Tryoshnadi guggulu and Lasuna in Management of Dyslipidemia, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar.

23. Bhushan Bhav Ram Prakash Niranjan (2014) : Management of Apathyanimittaja Prameha (Type 2 Diabetes mellitus) with Mayaphala (Quercus infectoria Olivier) A Clinio-experimental Study, Department of Kayachikitsa, I.P.G.T. & R. A., Jamnagar

== More information ==

=== Related Chapters ===

[[ Vividhashitapitiya Adhyaya]], [[Snehadhyaya]], [[Langhanabrimhaniya Adhyaya]], [[Ashtauninditiya Adhyaya]], [[Santarpaniya Adhyaya]]
[[ Grahani Chikitsa]],[[Prameha Nidana]],[[Prameha Chikitsa]]

==External links ==

[[Adipocyte]], [[fat cells]]

=== Abbreviations ===

*SAT = Standard Ayurveda Terminology
*Cha. = Charak
*Su. = Sushruta
*Ka. = Kashyapa
*Sha. =Sharangadhara
*Sa. = Samhita

==References==

Rakta dhatu

2020-06-26T18:40:21Z

Anagha: