Charak Samhita

Majja dhatu

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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)[1]

Contributors
Section/Chapter/topic Sharira / Dhatu / Mamsa Dhatu
Authors Anagha S.1, Deole Y.S.1, Shilawant A.2
Reviewed by Basisht G.1
Affiliations 1Charak 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
Correspondence email: carakasamhita@gmail.com
Date of first publication: June 10, 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.[2]

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 a 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.[3]

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. [Sharangadhara Sam. PurvaKhanda 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.[4]

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.[5]

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[6] 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.[7]

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.[8]

Functions

Bone marrow is the primary site of new blood cell production or hematopoiesis.[9] Human marrow produces approximately 500 billion blood cells per day, which join the systemic circulation via permeable vasculature sinusoids within the medullary cavity.[10] 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).[11] 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,[12] and can also potentially be used to treat illnesses such as inflammatory bowel disease.[13]

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.[14]

• 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.[15]

• 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.[16]

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

1. 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.

2. 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

  1. ↑ Available from http//namstp.ayush.gov.in/#/sat accessed on 05/06/2020
  2. ↑ Monier Williams (1899), A Sanskrit–English Dictionary, new edition, Oxford At the Clarendon Press, OCLC 458052227.
  3. ↑ Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.323
  4. ↑ Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.143
  5. ↑ Dwarkanath C. Introduction to Kayachikitsa. Chaukhambha Orientalia. Varanasi; 1996. Third edition.pg.144
  6. ↑ Available from https//en.wikipedia.org/wiki/Bone_marrow accessed on 05/06/2020
  7. ↑ C., Farhi, Diane (2009). Pathology of bone marrow and blood cells (2nd ed.). Philadelphia Wolters Kluwer Health/Lippincott William & Wilkins. ISBN 9780781770934. OCLC 191807944.
  8. ↑ 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.
  9. ↑ Arikan, Hüseyin; Çiçek, Kerim (2014). "Haematology of amphibians and reptiles a review" (PDF). North-Western Journal of Zoology. 10 190–209
  10. ↑ 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
  11. ↑ Raphael Rubin & David S. Strayer (2007). Rubin's Pathology Clinicopathologic Foundations of Medicine. Lippincott Williams & Wilkins. p. 90. ISBN 978-0-7817-9516-6.
  12. ↑ Antibody Transforms Stem Cells Directly Into Brain Cells". Science Daily. 22 April 2013. Retrieved 24 April 2013.
  13. ↑ Research Supports Promise of Cell Therapy for Bowel Disease". Wake Forest Baptist Medical Center. 28 February 2013. Retrieved 5 March 2013
  14. ↑ 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
  15. ↑ 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
  16. ↑ 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
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