Asthi dhatu

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.(SAT-B.436)

Contributors

Section/Chapter/topic	Sharira / Dhatu / Asthi Dhatu
Authors	Anagha S.1, Deole Y.S.
Reviewed by	Basisht G.1
Affiliations	1Charak Samhita Research, Training and Development Centre, I.P.G.T.& R.A., Jamnagar 2
Correspondence email:	carakasamhita@gmail.com
Date of first publication:	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”. It denotes a bone or the kernel of a fruit.

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 Sthana5/21-22]

Synonyms

1. Kikasam: round structures

2. Kulyam: tubularor 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 (panchabhautikasanghatana) 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).

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 of asthi dhatu

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.

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 (asthivahasrotas)

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]

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.

Anatomical network (asthijala)

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 (asthisanghata)

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 (asthimarma)

There are eight vital points formed from bones (asthimarma). [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.

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.

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.

Probable connection in Ayurvedic view of asthi dhatu and conventional views of bone tissue:

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.

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. 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.

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).

• 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 done

1.Alpesh Joshi(2004) : A clinical study on the role of matrabasti and shamana yoga in the management of sandhivata (osteoarthritis), Department of Kayachikitsa, IPGT &RA Jamnagar.

2.Mayuri Shah (2006):A comparative study of matrabasti and some indigenous compound drug in the management of sandhigatavata (osteoarthritis), Department of Kayachikitsa, IPGT &RA Jamnagar.

3.Md. Babul akter(2006) : Clinical study on sandhigatavata with special reference to osteoarthritis and its management by panchatiktaghritaguggulu, Department of Kayachikitsa, IPGT &RA Jamnagar.

4.Dhaval M Dholakiya(2012) : A clinical study on sandhigatavata (osteoarthritis) and its management with dashmoolaghrita and nirgundi tail, Department of Kayachikitsa, IPGT &RA Jamnagar.

5.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, IPGT &RA Jamnagar.

6.Praveen Kumar KC (2005):Effect of vachadiupanaha and vachadighana-vati in sandhigata-vataw.s.r. to osteoarthritis, department of Panchakarma, IPGT &RA Jamnagar.

7.Jayadipkumar P Shah(2008): Effect of tiktakshirabasti and patrapindasweda in the management of cervical spondylosis (asthigatavata), Department of Panchakarma, IPGT &RA 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, IPGT &RA Jamnagar.

9.Saurabh R Bhuva(2012) : A comparative study of matrabasti and brimhanasnehana by asthishrinkhalaghrita in the management of asthi-majjakshayaw.s.r. to osteopenia / osteoporosis, Department of Panchakarma, IPGT &RA 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, IPGT &RA Jamnagar.

More information

VividhashitapitiyaAdhyaya, GrahaniChikitsa

External links

Bone, Human skeleton, Artificial bone, Joint replacement

Abbreviations

• SAT = Standard Ayurveda Terminology
• Cha. = Charak
• Su. = Sushruta
• Ka. = Kashyapa
• Sha. =Sharangadhara
• Sa. = Samhita