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A study on the concept of Upadhatu in Samhitas with applied aspect to Artavadusti …

A study on the concept of Upadhatu in Samhitas with applied aspect to Artavadusti
Vaishali Shinde, 2004, Gujarat Ayurved University, Jamnagar

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  • 1. 1 INTRODUCTION Human creature has emerged as a very specialized species in theprocess of evolution. Ayurveda is a practical science that deals withphysiological and pathological status of human mortal. Ancient seers ofAyurveda have classified the elements of the body under three fundamentalcomponents Dosa, Dhatu and Mala. For the existence of mortal, twoelementary requirements are there, one that form anatomical configurationand second which continue physiological provenance. Among formermentioned element Dosa and Mala are the principal physiological entities.These two elements are not structural one and stable too. The basicstructural architectures of the body are formed by Dhatus. They are moststable constituents of the body. Dhatu form the substratum, which bear andnourish other constituents of the body and its concomitant conjugation isresponsible for the existence and continuation of human mortal. They act asrecipient for all the functions taking place in the body. Though the basic elements are categorized under these three groupsbut some elements are left which are not defined. Ancient seers found itdifficult to attribute their functions to former one. Thus further definedspecialized groups of elements termed as Upadhatu. Grammaticalunderstanding of the term shows that Upadhatu consist of two parts prefixUpa and the word Dhatu. Prefix Upa is suggestive of proximity and closeresemblance to the term Dhatu. So in nutshell, it could be said thatUpadhatu is derivative of Dhatu and has some resemblance in terms ofstructure, function and nature. They are important physiological units andradically engaged to design the structural architecture of the mortal. Dhatu form the Basic architecture of the body, they are not accomplished toexecute the functions of body without the support of Upadhatus. Upadhatu furnish abridge between these fundamental entities. This Bridge is also obligatory to ensue
  • 2. 2all the physiological functions. Their function commences since evolvement ofmortal itself. Upadhatus are also involved in emergence of diseases and theknowledge is necessary to understand the pathological conditions. Though theyexhibit a pivotal role in existence of life their knowledge is confined & enfolded inSutras. The methodology of Science is to say things contained in short guidelines. Annotators have tried to unroll the Sutras. They have given a majorcontribution to flourish this source of knowledge. There after the responsibilitycomes on the shoulders of intellectuals of science to explicate this knowledge thuscontributing to make it available for all other followers for application. The ultimatemotto of the science is to achieve Health of mortal. Hence it is necessary toexplicate the knowledge of Upadhatus.Previous Research Work - Following works have been carried out till date i.e.(1) Upadhatu Viniscaya - Vaidya S.P; 1970, Jamnagar.(2) Stanya Upadhatu Ka Sharir Kriyatmaka Adhyayana - Meena D. 1998 (N.I.A. Jaipura)(3) Manasapesi Sharira Ke Sandarbha Me Twaka Upadhatu Ka Prayogika Adhyayana - Singh K. N. 1997, (N. I. A. Jaipur). Many objects remain untouched in these works. Hence considering the necessity of enrolling the knowledge regarding theUpadhatu, the problem has been selected for the study. A Series of research works should be carried out to explore this field.Keeping this in mind, to step further in this direction, the work was planned, toacquire the knowledge regarding basic concept of Upadhatu. The mammalian hierarchy specifies the possibility of initiation of life fromwomb. Raja & Stanya are Stri Visista Upadhatus. This is first attempt to practicallyassess the Upadhatu. Considering the time period available for the study & the
  • 3. 3availability of the subject under concern discipline, Raja seemed to be mostassessible Upadhatu. The comprehensive study has been done on Upadhatu Raja; itsPrakrtatva & Vikrtatva. The conflicting statements are reviewed regarding thisUpadhatu. Majority of the revered seers has adduced that it is Upadhatu of Rasa butfew referred it to Rakta Dhatu. Acarya Sarngadhara & Bhavamisra have distinctlyquoted that it is Upadhatu of Rakta. Considering all, to judge the hypothesis (towhich Dhatu the Upadhatu Raja belongs) and to support conceptual study, appliedstudy has been undertaken with respect to Artavadusti (Rajodusti) for assessment ofUpadhatu Raja.Aims and Objectives: -(1) To Study in detail the Concept of Upadhatu.(2) To Study in detail the Concept of Upadhatu Raja.(3) To resolve the constroversy regarding Upadhatu Raja.(4) Assessment of Prakrtatva & Vikrtatva of Raja.(5) To evaluate therapeutically (Upasayanupasayabhayam) the proximity of Raja with Rasa & Rakta Dhatu.Plan of Study:The present work was designed in two parts(I) Conceptual study(II) Clinical study(I) Conceptual Study- For conceptual part of the study Ayurvedic Classics likeBrhattrayi, Laghuttrayi and other Sangraha Granthas, Journals, Research papers,Modern Texts, etc has been referred. Various fundamentals of Ayurveda areconcerned with these Upadhatus, a light is also shed on these points. The opinions ofvarious Acaryas regarding the concept of Upadhatu Raja is put froth in a systemicway which provides a scientific background to resolve the controversy regarding thisUpadhatu.
  • 4. 4(II) Clinical Study: Ayurveda is a practical Science. Hence fundamentals should be tested onpractical background. For the practicg60al assessment of Upadhatu Raja & to find out its relation with Rasa & Rakta Dhatuclinical study was designed. Upadhatu shows specific relation with Dhatus. They derive theirnourishment after the action of concern Dhatvagni. Status of Upadhatu dependsupon the status of Dhatvagni with which it is related. This Principle of Dhatvagni has been applied for practical assessment.Attyartava condition of Asrgdara has been selected for the study. Prasadana Dravyas distinctly act on concern Dhatvagni. Thus they improvedeteriorated status of Upadhatu. Drugs have been selected on the basic of thisPrasadana principle of Cikitsa. To see the specific relation of Raja with Rasa & Rakta Dhatu, two Groupswere made viz. - (1) Rasaprasadana Group (A) (2) Raktaprasadana Group (B)The observations and results are elaborated in this section.(III) Discussion and Conclusion: Rational behind the fundamentals stated in the conceptual part and the dataobtained from the clinical study has been discussed and important conclusuions aredrawn on these basis.(IV) Summary: The work is summarized at the end.(V) Addenda: This section includes the bibliography and proforma of the clinical work.
  • 5. 5Historical Review Veda is the most ancient literature of the world from which Ayurveda; thescience of life is known to be separated. In Veda the references of Upadhatus arefound in dispersed manner. The number of Asthi Sandhi and their types i.e. Cala andAcala Sandhi are quoted in Rgveda. Ayurveda is said as Upaveda of Atharvaveda.The following references are found in Atharvaveda- The structure of Sandhi and their specific position in the body is quoted."Hira" word is used for Sira; their number is mentioned to be Sahasra. Lohitavarnaword is used for Suksma Sira. References of Twak are found in relation withKustha. "Carma" word is used for Twak. Snayu are also quoted. The references ofRajovahi Nadya are found. Vasa is quoted by the name of Vapa. In MantraSamhita of Kausika Sutra the treatment of Attyartava is mentioned with the help ofMantra. Rajovahi Nadya are mentioned by the name of Lohitavasa.Samhita Kala: - Caraka Samhita was the first who had elucidated Upadhatus collectively inone Sutra. Susruta has given the description of the Upadhatu components separatelybut not as a unit. Astanga Sangrahakara has mentioned these components underPrasadaja elements.Madhya Kala; - Commentator Cakrapani and Dalhana have elaborately explained theUpadhatu concept. Acarya Sarngadhara has introduced a modified unit of Upadhatu.Modern Era-The Ayurvedic scholars like P.S. Variyara, Dr. C. Dwarkanatha, and RanajitaraiDesai have tried to explain these Upadhatus.
  • 6. 6CONCEPT OF UPADHATU(I) EVOLVEMENT OF UPDADHATU: In order to develop the precise concept of Upadhatu availablereferences from the classics are compiled as follows. Acarya Caraka while describing the nutrition of body elements definesa separate group of elements, but has not entitled them. Further whileanalyzing this unit commentator Cakrapani entitled them as Upadhatu.These seven components are Stanya, Rakta (indicative of Raja), Kandara,Sira, Vasa, Twak and Snayu. Cakrapani has also quoted the opinion ofAcarya Bhoja in this regard. Bhoja has mentioned only five components ofthis unit, which are Sira, Snayu, Raja, Stanya and Twak. He hasnomenclated this unit as Upadhatu. Acarya Susruta has not mentioned these components collectively andalso not used the term Upadhatu. While describing the functions of Dosa,Dhatu and Mala revered seer has mentioned Raja and Stanya. Along withthese two components, "Garbha" is mentioned under this unit. CommentatorDalhana has termed these three as Upadhatus. Among the remainingcomponents except Vasa all are mentioned under Vatavyadhi Nidana andCikitsa. In Sutrasthana while explaining the nourishment of Dhatus insuccessive manner Acarya Susruta has used the term "Prajayate" (S.Su.14/10). Elucidating this term revered Dalhana shed a light on Upadhatus.Here commentator has enlisted the same components as stated by AcaryaCaraka and further added Sandhi to the list. He has nomenclated this unit asUpadhatu, Gayadasas commentary on Susruta Samhita is available onNidanasthana only, and while annotating on Nidanasthanas first chapter hehas mentioned the Sloka regarding Upadhatus - "Rasat Raktam Tatha Stanyam Asrjah Kandara Sirah| " Mamsat Vasa Twacah Sat Ca Medasah Snayu Sambhavah ||".[S. Ni.1/25-29, Nyayacandrica]
  • 7. 7He had modified the first part of Sutra as mentioned above. He has notmentioned Sandhi. Here he remarked that originally this Sloka belongs tofifteenth chapter of Sutrasthana. He further opines that when "Dharana"Karma of Dhatu is expected, "Dhatu" term should not be restricted to onlySaptadhatu but Mala and Upadhatu are also to be considered along withthem. In this regard he has clearly used the term Upadhatu. Further references from the classics are mentioned wherecommentators have interpreted the "Dhatu" term in Sloka for Upadhatus andMalas along with Sapta Dhatu.(1) "Dosa Dhatvagni Samatam... |" [S. Ni. 1/18]In the above verses "Dhatu" term is interpreted for Upadhatu and Mala,along with Sapta Dhatu.(2) "Sama Dosah Samagnisca Sama Dhatu Mala Kriyah |" [S. Su. 15/41]In the above context Dalhana has interpreted the "Dhatu" term forUpadhatus along with Sapta Dhatu. In Uttaratantra, Acarya Susruta hasmentioned the Dhatu and Upadhatus related with Netra. (S. U.1/19)Revered Oracle of next era Astanga Sangrahakara has not used the termUpadhatu. While explaining the Dhatu metabolism, revered Acarya hasmentioned the components as a "Prasadaja Part" but not nomenclated themas Upadhatu. Revered Acarya adds Sandhi in these Prasadaja entities forthe first time, which is accepted by Dalhana as mentioned previously. In thiscontext they have not mentioned Raja and Stanya (A.S. 6/45). Acarya hasconsidered these two entities separately while elucidating the "AnjaliPramana" of body elements. (A.S.Sa.5/93). Revered oracle Laghu Vagbhatahas not mentioned these components collectively anywhere and also notused the term "Upadhatu". Commentators of Astanga Sangraha andAstanga Hrdaya have not nomenclated these components as Upadhatus. Further the seer of medieval period Sarngadhara, stands differentlywhile enlisting this unit of Upadhatu. Revered oracle has enlisted Stanya,
  • 8. 8Raja, Vasa, Sweda, Danta, Kesa, and Oja as unit of Upadhatu. (SA. Pr.5/16-18). He has clearly mentioned them as "Sapta Upadhatavah." (SA. Pr.5/1). Further the oracle of next era, Bhavamisra, has accepted the opinion ofSarngadhara. There are some references available in Bhavaprakasa, whichshows similarity with Caraka and Susruta schools of thoughts also. Theauthor of Yogatarangini has also accepted the Sarngadhara school ofthoughts. Review of the Classics.Century Names of Revered Mentioned the Upadhatus Used the term Acaryas Collectively as a Unit "Upadhatu" Yes No Yes No 4-6 th Caraka + + 4-6th Susruta + + 4-6 th Vrddha Vagbhata As a Prasadaja + elements 4-6 th Laghu Vagbhata + + 11 th Bhoja + + 11 th Gayadasa + + 11 th Cakrapani + + 12th Dalhana + + 13th Indu, Arundatta, + + Hemadri 14 th Sarngadhara Modified Unit + 16 th Bhavaprakasa + 17 th Yogatarangini +
  • 9. 9 Bhoja has mentioned only five components as Upadhatu. AcaryaCaraka has elucidated seven components as Upadhatu. AstangaSangrahakara adds Sandhi to the list. Commentator Dalhana accepted itand thus the number of the Upadhatu becomes eight. The author ofmedieval period Sarngadhara comprehends Sweda, Danta, Kesa and Ojaunder Upadhatu. Upadhatus quoted by AcaryasNames of Revered Names of the Upadhatus No. Acaryas Mentioned Bhoja Stanya, Raja, Sira, Twak 5 Snayu.Caraka; Gayadasa; Stanya, Raja, Kandara, Sira, 7 Cakrapani Vasa, Twak, Snayu.Vrddha Vagbhata; Stanya, Raja, Kandara, Sira, 8 Dalhana Vasa, Twak, Snayu, Sandhi Sarngadhara; Stanya, Raja, Vasa, Sweda, 7 Bhavamisra; Danta, Kesa, Oja. Trimalla Bhatta (Y.T.)
  • 10. 10 Upadhatus accepted by Acaryas Newly introduced by Total Sarngadhara Name of Stanya Raja Kandara Sira Vasa Twak Snayu Sandhi Sweda Danta Kesa Oja Acarya Caraka + + + + + + + + - - - - 7 Gayadasa + + + + + + + + - - - - 7 Cakrapani + + + + + + + + - - - - 7 Bhoja + + - + - + + - - - - - 5 Astanga + + + + + + + + - - - - 8Sangrahakara. Dalhana + + + + + + + + - - - - 8Sarngadhara + + - - + - - - + + + + 7 Bhavamisra + + - - + - - - + + + + 7 (II) ETYMOLOGY: One has to apply the grammatical understanding of the term to derive the indepth meaning of the word. The word Upadhatu consists of two parts i.e. Prefix "Upa" and the word "Dhatu". (I) DHATU: Vyutpatti: "Dha Sitanigamati Iti Tun Unam | Sarira Dharaka Vastuni |" [SKD - 1/70]. The word Dhatu is derived from the root "Dha" which means to support and nourish. "Dhiyate Sarvam Asmin Iti |" [SKD] Everything existing is supported by this or because they bear and support, they are termed as Dhatu.
  • 11. 11Nirukti: a) "Dadayati Sarira Samvardhakan Iti Dhatu |" (SKD)Which supports the growth of the body is termed as Dhatu. b) "Ete Sapta Swayam Sthitva Dehan Dadhati Yan Nrnam |" [SKD - IInd/790]Dhatus are stable constituents, the basic elements of the body, which makethe body exist.(II) Upa: "Upa Pradi Vimsati Upasargantargata Upasaraga Visesah |"[Ayurvediya Sabdakosa]Upa" is a prefix attached to the word "Dhatu". Prefix changes the meaning ofthe word with which it is acting. The literary meaning of "Upa" is:"Anugatini | Anukampa | Adhikyam | Hinah | Samipyam |"Towards, near to, by the side of, resemblance, nearness, with the idea ofsubordination and inferiority. [M.W.Dic.](III) Upadhatu-Vyutpatti: "Pu Upamitah Dhatubhih |" [SSTMN] "Pradhana Dhatusadrsesu |"That shows close resemblance towards Dhatu.Nirukti: 1. "Dhatubhava Te Upadhatavah |"Upadhatus are evolved from Dhatus. 2. "Dhatu Samipe Bhava Upadhatavah |" [SA.Pr. 5/1 - Dipika]Upadhatu are produced along with Dhatus. 3. "Dhatubyah Ca Upajayante Tasmat Ta Upadhatavah |" [S.Su.14/10-Bhanumati]
  • 12. 12Those, which are derivatives of Dhatus, produced at complementary,subsidiary level, are known as Upadhatus. 4. "Dhatoh Upadanabhutat Jato Anya Dhatuh |"[C.Ci.17/17-Cakra]"Upadana" means Samavayi Karana (immediate cause). Dhatu are theimmediate cause of Upadhatu. 5. "Upagatah Vaikrtyam Prapto Dhatu Upadhatuh |" [SA.Pr. 5/17-18; Gudhartha Dipika]Vitiated state of Dhatu is termed as Upadhatu.(III) CHARACTERS OF UPADHATU : Classics have explained the concept of Upadhatu in correlation withDhatu. Upadhatu are derived from Dhatus. Acarya Caraka has explainedtheir specific correlation in the following verse: "Rasat Stanyam Tato Raktam Asrjah Kandarah Sirah | Mamsat Vasa Twacah Sat Ca Medasah Snayu Sambhavah | " [C. Ci. 15/17] Dhatu Related Upadhatus Rasa Stanya, Raja Rakta Kandara, Sira Mamsa Vasa, Twak Meda Snayu, Sandhi (Dalhana)First four Dhatus are related with Upadhatus. Revered annotator Dalhana inSutrasthana elucidates the rational behind this. "Vivista Karyantara Utpada Darsanartham |" [S.Su. 14/10 - Dalhana]In the context of nourishment of Dhatus, Acarya Susruta has specified theterm "Prajayate" for first four Upadhatus only. "Rasat Raktam Tato Mamsam Mamsat Medah Prajayate |" [S. Su.14/10]
  • 13. 13Annotator Dalhana has elucidated that to specify the distinct function ofthese Dhatus the term "Prajayate" is used for them. Further he opines thatwe cannot deduce the cause behind this, the only logic is "Swabhava."The features of these Upadhatus are as follows:1) Produced at Complementary level: - "Dhatubhyah Ca Upajayante |" [Bhoja]Upadhatus are produced from Dhatu metabolism, but they are produced atsubsidiary level, secondary level. The word "Upajayante" suggests that theyare byproduct of Dhatu metabolism.2) Gativivarjita: - "Jayanta Eva, Param Na Janayanti |" [C.Ci. 15/17, Cakra]Commenting on the above verse of Bhoja, revered Cakrapani furtherenlightens the view that they are not having the property to producesuccessive elements. "Dhatvantara Aposanat ....... Upadhatu Sabdena Uccante |" [C.Ci.15/17-Cakra]Cakrapani has stated that since they do not have the property of nourishingthe Dhatus, they are termed as Upadhatus.They have no fate to get transformed into further components. Acarya Bhojahas referred this character of Upadhatu as "Gativivarjita".Commentator Sivadasa Sen further confines the meaning of this term as"Atra Gativivarjita Iti Anena Dhatvantara Posanadya Gatih Nisidhyate |" [S.Su.14/10 -Sivadasa Sen]He explained that Upadhatu do not have any fate to nourish successiveDhatu. In the context of Dhatus their Gativarjitva is proved.3) Sarira Posakatva: - Annotator Cakrapani specifies that though Upadhatudo not nourish Dhatu, but they do nourish other components of the body.
  • 14. 14 To understand the precise concept of Upadhatus, their role in bodyphysiology it is necessary to know the characters of Dhatus on the basis ofwhich Upadhatus are described in classics. Characters of Dhatu Characters of Upadhatu1. Dhatvantara Posakatva: Dhatvantara Aposakatva: Dhatu nourishes Successive Dhatu. Upadhatu do not nourish successive Dhatu or Upadhatu.2. Gativivarjita - This property is not found is Dhatu. Upadhatu possesses Gativivarjitva in relation with Dhatu.3. Dhatu Sneha Parampara: - Dhatu nourishes successive as well as Such type of inter-relation is not present former Dhatu. They are connected to in Upadhatus. each other through nourishing pool.4. Sarira Posakatva: - It is present in Dhatus. It is present in Upadhatus too.5. Sarira Dharanatva: - Dhatus bear the body elements. In Upadhatus this function is supportive to Dhatus.6. Dhatu functions right from conception Some Upadhatus (Raja & Stanya) & continue through out the life. functions for specific time period only.7. Some Dhatu (i.e.Sukra) produces alike Upadhatus do not have reproductive body elements. It is having capacity. Function of Raja & Stanya is reproductive capacity. supportive to reproduction.8. Dhatus do not act as Mala Bhava for Some (Raja & Stanya) of them are Body. Only Sukra is ejaculated from excretory in nature & act as Mala
  • 15. 15 the body by means of specific function Bhava for the body if not expelled after of reproduction. specific time period.(IV) MODIFIED CONCEPT OF SARNGADHARA :Svatantra Siddhanta of Acarya Sarngadhara regarding the concept ofUpadhatu: -Eminent oracle Sarngadhara has not accepted the opinion of the formerAcaryas. He introduced a modified unit of Upadhatu. "Stanyam Rajasca Narinam Kale Bhavati Gacchati |" Suddha Mamsabhavah Snehah Sa Vasa Parikirtitah | Swedo Dantah Tatha Kesah Tathaiva Ojasca Saptamam | Iti Dhatubhava Jneya Ete Saptopadhatavah |" [SA. Pr. 5/16-18]Sarngadhara has asserted Stanya, Raja, Vasa, Sweda, Danta, Kesa, andOja as Upadhatu.Acarya Bhavamisra concurred with the opinion of Sarngadhara. "Stanyam Rajo Vasa Swedo Dantah Kesah Tathaiva Ca | Oja ca Sapta Dhatunam Kramat Saptopadhatavah ||" [BH. Pu. 3/212]According to this school of thoughts, Dhatus are related with Upadhatus infollowing manner: - Modified Unit of Upadhatu of Acarya Sarngadhara Related Upadhatu Dhatu Accepted Upadhatus as Newly introduced Excluded previously mentioned Upadhatus Upadhatus Rasa Stanya - Raja Rakta - Raja Kandara, Sira Mamsa Vasa - Twak.
  • 16. 16 Meda - Sweda Snayu, Sandhi Asthi - Danta - Majja - Kesa - Sukra - Oja -As compared to Caraka, Sarngadhara schools are having separate views onfollowing points:Acarya Sarngadhara has not mentioned Kandara, Sira, Twak, Snayu, andSandhi. Instead of these he appendaged Sweda, Danta, Kesa and Oja to thelist of Upadhatu. All the seven Dhatus are mentioned in relation withUpadhatus.Acquiring the knowledge of newly introduced Upadhatus: -1) Sweda - Acarya Caraka and Susruta has referred it under "Dhatu Mala" ofthe body. Sweda is derived from Mala portion of the Meda Dhatu. AcaryaSarngadhara and Bhavamisra have mentioned it under Upadhatu and DhatuMalas too. (SA.Pr. 5/15; BH. Pu. 3/209)ii) Danta - Ancient seer has not mentioned Danta under "Dhatu Mala."All body elements are categorized under Prasadaja or Mala entities.Commentator Cakrapani has explained in this context that Danta receives itsnutrition from Mala portion of Asthi Dhatu. Danta are included in Asthi byAcarya Caraka. Acarya Susruta has termed it as "Rucakasthi". Susruta hasnot referred Danta under "Dhatu Mala".iii) Kesa - Acarya Caraka and Astanga Sangrahakara have included Kesaunder Dhatu Mala. Acarya Sarngadhara mentioned it as an Upadhatu ofMajja.iv) Oja - It is elixir of all the Dhatus starting from Rasa to Sukra.(C.Su. 17/75, S. Su. 15/19 - Dalhana; A.H.Su. 11/37 - Arundatta;A.S.Su. 19/28; C.Su. 17/17 - Cakra; C.Su. 28/4 - Cakra)
  • 17. 17Annotator Cakrapani has quoted few anonymous statements in this regard.Some are of the view that Oja is a specialized form of Sukra since it doesentnourishe the mind. Some opine it as eighth number of Dhatu. In this contextone anonymous statement supports the view of Sarngadhara to consider theOja as Upadhatu. Rational behind this is explained that like other Dhatusthough it sustains the body but does not nourish it. Acarya Bhavamisra inthis context states this entity as essence of all the Dhatus.(BH.Pu.3/101). Cakrapani while commenting on Upadhatus narrated hisopinion that Oja should not be considered as Dhatu or Upadhatu. It cannotbe separated from Dhatus, as it is elixir of them. (C.Ci. 15/17 - Cakra). While commenting on Upadhatu, author of Gudhartha Dipika,Kasirama Vaidya has elucidated his opinion. He raised a question regardingthe Upadhatu of Rasa and Rakta in males. During this discussion he opinesthat when improperly metamorphosed Rasa Dhatu come out of the body it iscalled as Upadhatu of Rasa. Due to vitiation of Pitta, augmented Rakta whengoes upward it is to be named as Upadhatu of Rakta. Further he has given ameaning of Upadhatu as"Upagatah Vaikrtyam Prapto Dhatuh Upadhatuh |" [SA.Pr. 5/17-18]According to his opinion vitiated form of Dhatu is to be termed as Upadhatu.(V) PHYSIOLOGY OF UPADHATU FORMATION: Dhatu metabolism is a nourished pool of all the body constituents.Through this pool all elements including Upadhatus derive their nourishment. Revered seer Caraka explains metabolism process behind this.Upadhatu are sustained being fed by their nourishing factor. Food afterdigestion takes two forms viz. the Prasadaja (essence) and the Kitta.Depending upon their nourishment from Prasadaja or the Kitta, the tissueelements of the body are described of two types, the pure once"Prasadakhya" and waste product "Malakya". From Prasadaja portion all the
  • 18. 18Dhatus are formed in progressive order. Upadhatu are also nourished fromthis Prasadaja part. Ahara Rasa when goes to the abodes of one Dhatu after the action ofSrotasagni it is transformed into two parts Prasadaja and Kitta. Prasadajaportion is further divided into two parts. The main portion of it providesnourishment to that Dhatu and the subtle portion (Suksma Bhaga) is meantto provide nourishment to two elements, by its further division. The majorportion of it goes to the site of next Dhatu and the subtle of it providesnourishment to the Upadhatu. Third waste portion nourishes the Mala of therespective Dhatu. In this way from the Prasadaja part of Ahara RasaUpadhatus derive their nourishment in progressive order. Sthula portion Prasadaja Sthula portion Successive Dhatvagni Portion (major) DhatuAhara Suksma Suksma portionRasa Mala portion Srotasa of (subtle) Upadhatu portion Dhatu In this way when Ahara Rasa comes to the abodes of Rasa Dhatu, bythe action of Rasadhatvagni it get metamorphosed, divided into two parts,the Prasadaja portion and the Mala portion. The Prasadaja part againdivided into two parts Sthula Bhaga and Suksma Bhaga. Sthula portion of itsupplies nourishment to the Rasa Dhatu and Suksma portion of it againdivided into parts. The major portion of it goes to the abodes of Rakta Dhatuand subtle part provides nourishment to Stanya and RAJA(?).In the same manner the subsequent Upadhatus are derived from theirrespective Dhatus.
  • 19. 19Diagrammatic representation of Nourishment of Upadhatu: -
  • 20. 20 The process of Dhatu metabolism goes on incessantly like thepassage of time (Kalavat Anavasthitatva). If all the Dhatvagnis, Vayu andSrotasas are unimpeded they play a pivot role in continuation of Dhatumetabolism. These components are closely related with Upadhatus too.(1) Importance of Vayu: - (I) Illumination (Sandhuksana): "Dhatvagni Samatam |" [S.Ni. 1/10]Vayu is responsible to maintain the normal status of Dhatvagnis. "Agni Sahayavan |" [S. Ni. 1/16 - Dalhana]Vayu is called as "Agnisakha" by the classics. It illuminates the Dhatvagnis. (ii) Separation (Vivecana):Vayu is responsible for appropriate allocation of nutritional material to everyelement of the body.(iii) Conveyance (Gati): "Dhatugatih Samah |" "Rasadinam Posyam Dhatum Prati Gamanam |"Nutritional need of each element is transported to its abode by the action ofVayu. Upadhatu receives their specific nutrients from Rasadi Dhatus andwhich are conveyed to them by the action of Vayu.(2) Importance of Srotasa:Srotasa play an important role in Dhatu metabolism. They are channels oftransportation and transformation. "Parinam Apadyamananam Dhatunam Abhivahini Bhavanti AyanaEarthen |" [C.Vi. 5/3]"Parinam Apadyamana" means Dhatus, which are under the process oftransformation from their previous status. Srotasa convey such Dhatus fromthe abodes of previous Dhatu to successive one.
  • 21. 21The former Dhatu nourishes successive one for this purpose transformationis necessary which supervene at the level of Srotasa. The transformingnutrients are conveyed through these channels.All the structural entities are having their separate channels of transportation.Tissue elements are situated in different parts of the body so each of themshould have separate Srotasa to carry their particular nourishment.One canal cannot irrigate trees situated in different places. The Sameprinciple is applied to the nourishment of body elements. After separation ofnutrients of Upadhatus, Srotasa are necessary to convey the nutrients torespective Upadhatus.Classics have not clearly mentioned the Srotasa for all the Upadhatus.Acarya Susruta has mentioned Stanyavaha and Artavavaha Srotasa inrespective context. One principle is stated by revered oracle Cakrapani tounderstand the knowledge about unexplained Srotasa."Jnanavanto Hi Anena Lingen Anuktam Api Sroto Anumiyate |" [C.Vi. 5/6-7 -Cakra]This supports the view that Srotasas of Upadhatus are also present. "Bhava Hi Na Antarena Srotasa Abhinirvartante |" [C.Vi. 5/3]For every transformation the Srotasas are required. Any substanceundergoes metamorphic changes within the Srotasa. "Srotah Karaniko Hi Dhatunam Prayo Raktadinam Uttara DhatuPosaka Bhaga Parinamo Bhavati |" [C. Vi. 5/3 - Cakra]In the above reference commentator Cakrapani specifically enumerated thatmetamorphosis phenomenon distinctly supervenes at Srotasa level. Thissuggests that Agni is particularly concerned with Dhatu metabolism andresides at Srotasa.(3) Importance of Dhatvagni & Bhutagni: -Dhatvagni plays a principle role in the formation of Upadhatus. Status ofDhatvagni inevitably affects status of Upadhatu. Transformation process of
  • 22. 22Upadhatus is elucidated upto the level of Dhatvagnis only. Furthertransformation is not explained anywhere in the classics.Commentator Cakrapani states evidence of Upadhatu Agni. "Yani Agnyantarani Upadhatu Maladigatani Tani Api AvaruddhaniBhutagnisu Eva |" [C.Ci. 15/30-39; Cakra]Agni, which resides at Upadhatu and Mala, is a type of Bhutagni. Knowingthe role of Bhutagni explained by Acaryas could assess its function."Bhutagni Vyapara" is explained at following levels of metabolism:1) Initially their role is mentioned after the action of Jatharagni, whichsupervenes in the Kostha. Bhutagni reside inside the particles of substancesitself. Jatharagni illuminates them. "Jatharagni Paka" results in thebreakdown of food into five distinct physico-chemical groups of substanceshaving dominance of each Mahabhuta. They are further acted upon by eachBhutagni, leads to radical changes in its qualities termed as "VilaksanaGuna." Thus substances are ready for process of Dhatvagni, whichsupervene at various Dhatu level. There mentioned seven Dhatvagnis atdifferent levels. Dhatus are present in two forms i.e. Posaka and Posya.The terminology is used by Cakrapani to explain the Dhatu metabolism. Theformer nourishes later. The action of Dhatvagni forms two types of materialsubstances viz. Prasadaja and Mala as explained before. Further at Dhatu level, Bhutagni works in the similar manner as theywork at Jatharagni level. Bhutagni are also present at Upadhatu and Malalevel as stated by Cakrapani. Thus after the action of Dhatvagni thePrasadaja portion which nourishes Dhatu and Upadhatu, and the Kittaportion which nourishes Mala, further subjected to action of Bhutagni, wherethe changes in the radical qualities takes place. In this way these substancesare refined at every level of Agni. The final Bhautika molecular configurationof each nutrient, which is homologous with Posya element, supervenes onlyafter the action of Bhutagni. The newly formed compounds, which are results
  • 23. 23of metabolic reactions performed by Dhatvagni and finally configured byBhutagni, are utilized for two purposes. 1. For newer growth of elements 2. To compensate the wear and tear of the already working cells.At the level of Upadhatu, after the action of Bhutagni no further residue isformed. The Upadhatu are the final product of metabolism. They do notnourish successive Dhatu or Upadhatu. They are finalized forms. "SnehaDhatu Parampara" which manifests at Dhatu level cannot be observed incase of Upadhatus. They are motionless, final products of Dhatumetabolism.(VI) UTPATTI (EMERGENCE) OF UPADHATU:Sarirasthana of classics have illustrated this subject in "GarbhavakrantiSarira" and "Garbhavyakarana Sarira." In this regard ancient seers haveexplained that: "Trutiye Masi Sarvendriyani Sarvanga Avayavasca YaugapadyenaAbhinirvartante" | [S. Sa. 3/15]Emergence of all the body constituents takes place at embryological stage. "Raktadayo Hi Garbhat Prabhuti Eva Utpanna...I" [C. Ci. 15/16-Cakra]While commenting on the verse regarding the nourishment of Dhatu,Cakrapani has clearly mentioned that all the Dhatus manifest duringgestational period itself. Their further nourishment is achieved by Dhatumetabolism. Further while explaining the nourishment of Upadhatus fromDhatus he has very clearly stated that "Posana Krama" (way ofnourishment) of Dhatus is described in this context. Their emergencesupervenes at gestational period itself.Acarya Laghu Vagbhata has clearly explained the emergence of Upadhatuin "Garbhavakranti" Sarira as follows.
  • 24. 24 "Sastame Masi Snayu Sira Twak Bala…. Utpatti |" [A. H. Sa. 1/51]Revered seer has stated that during sixth month of gestational periodemergence of Snayu, Sira and Twak takes place. The characters, which arepresent since birth, are termed as "Nitya Bhava." All the Dhatus andUpadhatus are termed as "Nitya Bhava" of the body. Upadhatu Raja andStanya are exceptions for this, since they emerge few years after birth andalso not continue through out the life. Such entities are known as "AnityaBhava".STUDY OF SPECIFIC UPADHATUS(I) Upadhatu Raja & Stanya: Raja & Stanya are present only in females. They are derived by means ofspecific function attributed to female physiology i.e. reproduction. They are calledas Upadhatus because they derive their nourishment from Prasadaja portion ofDhatus. Both the entities are present in liquid state. Raja nourishes developingembryo during gestational period and Stanya nourishes infant for specific period oftime. These two entities are functional one. These two entities are excretory in nature. After certain period they are to beexpelled from the body, otherwise they function as Mala and will be pathological forbody. UPADHATU - STANYA Every product comes into existence for its specific function to beperformed by it only. During pregnancy developing embryo receivesnourishment through feto-maternal nourishing pool (placenta). Afterparturition that pool vanishes. Then after the maternal circulation is avertedtowards breast, where the essence part of Rasa transformed into Stanya which
  • 25. 25provide nourishment to the neonate still his digestive system will developedto digest the outside food material.UTPATTI OF UPADHATU STANYA: Rasat Stanyam ...... | [C. Ci. 15/27] There is no controversy about the formation of Stanya. All the Acaryashave narrated its formation from the essence part of Rasa. Ahara Rasa when metamorphosed by Rasavaha Srotasagni gettransformed into three parts:1) Sthula Amsa (gross portion) is used for the maintenance and growth of the Rasa Dhatu.2) Suksma Amsa (subtle portion) meant for the genesis of the next Dhatu i.e. Rakta.3) Mala Amsa (waste portion) which is meant for the genesis of waste products of that Dhatu i.e. Kapha. In puerperient woman the some part of Suksma Amsa is used forformation of Upadhatu Stanya. In Stanyavaha Srotasa it is metamorphosed to Stanya by the action oflocal Agni.(figure) Upto what limit the lactation should continue? Great sages have statedthat upto to dentition the lactation should continue in children."Atha Enam Jata Dasanam Kramaso Apanayet Stanat |" [A. S. U. 1/39]. After eruption of teeth, gradual weaning should be done and breastmilk should be supplemented with semisolid food. Dentition is the indication of development of digestive system alongwith improved status of Agni. Agni is now capable to digest light and
  • 26. 26anabolic cereals. As the infant grows, requirement of the Dhatus increases.Developing Dhatus need additional nourishment than they receive it from thebreast milk. More over his needs and requirements are higher as far as thenourishment from breast milk is concerned. Therefore it is wise to switch overon cereals after six months of age. Acarya Susruta has also mentioned the period to start thesupplementary food as sixth month."Sanmasat Ca Enam Annam Prasayeta Laghu |" [S. Su. 10/54]. During the age of childhood the "Ksirapa-Avastha" is mentioned forone year. It means that upto six months all nutritional requirements should bemet by breast milk. After six months breast milk should be supplemented withsemisolid, light foods.CHARACTERS OF NORMAL BREAST MILK:A test for untainted milk: When poured over a pot of water, it gets mixed up with the waterhomogenously (neither float, nor sinks) then it is said to be endowed withnatural qualities. The white colour of breast milk similes with colour of Conch shell. It should have natural colour, smell, taste and touch. It should not be very cold or very hot; it should suit the bodytemperature of child. It should be clear (free from impurities), thin, frothless, and shredless. It should be sweet in taste and astringent as a secondary taste.
  • 27. 27 Such type of pure milk imparts health, growth and strength of thechild. Kasyapa has given emphasis on resultant that is the qualities acquiredby the child due to consumption of pure milk. Such type of milk impartsunobstructed growth of different body parts, strength to body organs,longevity as well as good health to the child and does not show any type ofabnormality in child and mother. The great seer Harita has also narrated the qualities of breast milk, as itis supportive to increase the Satva, Bala and complexion of a child. Milk is having similar properties to that of Oja; so it is conductive inthe promotion of Oja. Thus milk is an elixir per excellence. Milk is invigorating (Jivaniyam) in action. Human milk is wholesome, invigorating and possesses nourishingproperty. Eye pains also get revealed due to breast milk. Bhavamisra quotes it as Laghu, Sita and Sara. It possesses AgniDipana property. It alleviates Vata and Pitta Dosa. It instantaneously nourishes the Sukra Dhatu. It is Param Vajikara i.e. aphrodisiac in action. It is also having Vayasthapana, Sandhanakara, Rasayana, andAyusyakara properties.Milk Ejection factors: "Siranam Hrdayasthanam Vivrtatvat Prasutitah | Trtiye Anhi Caturthe Va Strinam Stanyam Pravartate ||" [A. S. U. 1/11] After delivery Dhamanies of the cardiac region get dilated thus on thirdor fourth day ejection of milk starts.
  • 28. 28 Revered seer Harita opined that due to force used during bearing downefforts by the parturient woman, the Srotasas get cleared leading to milkejection. Acarya Susruta enumerates that the touch, sight, remembrance andenfolding the child are the factors which account for milk ejection. Uninterrupted affection for the child is the countable factor for theproper flow of the milk. In this regard Susruta has enumerated the analogues factors betweenStanya and Sukra. Stanya just like Sukra is not seen even when the body is cut andbecause of being present throughout the body, Stanya is described as similarto Sukra. The factors account for the ejection of milk similes with those ofSukra.MODERN COUNTERPART:MAMMARY GLANDS: Mammary glands are much modified sudoriferous glands. They are ingrowths from ectoderm, which forms their ducts and alveoli, supported byvascularised connective tissue derived from the mesenchyme. In females ducts and secretary elements undergo extensivedevelopment during puberty and pregnancy. The mammary glands contains:1) Glandular tissue of tubulo- alveolar type2) Fibrous tissue connecting its lobes3) Inter lobar adipose tissue.
  • 29. 29 Subcutaneous tissue encloses the gland, sending in many septa tosupport its lobules. From the covering fascia fibrous processes extend to theskin and the papilla, as suspensory ligaments (of Cooper).Alveoli are functional units of milk formation. They are lined by a layer oflow columnar cells lines. External to these is a layer of elongated mayo-epithelial cells like smooth muscle, and outside this again a basementmembrane. Two layers of cubical cells, the main ducts, near their surfaceopening, line the ducts and acquire a stratified epithelium. Mammary structurevaries with age, pregnancy and lactation. After puberty both the ductal systemand the supporting adipose tissue grows much faster due to increasedsecretion of estrogen. The ducts develop branches whose ends form potentialalveoli.LACTATION:Synthesis and secretion from the breast alveoli:-Though some secretary activity is evident during pregnancy and acceleratedfollowing delivery, actually milk secretion starts on third or fourth postpartumday. Mammary glands free from the effect of estrogen and progesteroneproduction begin its milk secretary activity in previously fully developedmammary glands. The secretary activity is enhanced directly or indirectly bygrowth hormone, thyroxin, glucocorticoids and insulin.Ejection of Milk:-Discharge of milk from the mammary glands depend on the suction forceexerted by the baby during suckling and contractile mechanism acting alongwith, which expresses the milk from the alveoli into the ducts. Impulses fromthe nipple to supra-optic nucleus further along the hypothalamo-pituitary axisto the posterior pituitary. Oxitocin, liberated from posterior pituitary. Inaddition to oxytocic effect produces contraction of the myoepithelial cells of
  • 30. 30the alveoli and the ducts containing the milk. Through this reflex the milk isforced down into the ampulla of the lactiferous ducts. Now the baby can suckit.Maintenance of lactation: - Copious milk secretion and the maintenance of effective andcontinuous lactation depend on suckling. Along with removal of milk fromthe ampulla it causes release of prolactine. Prolactine is the most importantgalactopoietic hormone from posterior pituitary. Basal prolactine levels arenot elevated, but periodic surge of prolactine release induce lactogenesis.Important Role of Suckling:- It evokes milk ejection and is involved in the maintenance andaugmentation of lactation because it promotes release of oxytocin andprolactine both. Milk production can continue for several years if the mothercontinues to be suckled but the rate of secretion normally decreased rathermarkedly by seven to nine months.Breast Feeding: It achieves correct balanced diet and immunological protection. Breastfeeding plays an important role in the social evolution of the family and thehuman way of life. The composition of milk itself has become ideally adaptedto the need of each mammalian species. The composition of breast milkchanges with the age of the child. Upto first five days of postpartum breast milk is known as colostrum. It is having low energy content but much higher lactoferin (humeral factor) and antibody content than mature milk. It is rich in protein and Vitamin A, sodium and chloride content. It has laxative action on the body because of large fat globules. Colostrum is an important vehicle for transfer of immunoglobulins from mother to child. It contains
  • 31. 31 secretary IgA, IgG, IgM antibodies which act on lumen of the neonates gut to protect against infection. This presents an important defense mechanism for the newborn whose own immune system is not yet fully developed. The breast milk secreted during six to fifteen days is termed as transitional milk. The concentration of the antibodies continues to be high in the milk, which is secreted during this period. It protects the newborn against infections. Mature milk is secreted from the fifteen day postpartum. Slow changes in the composition of mature milk continue throughout lactation. It has been observed that in mothers who deliver prematurely the concentration of antibodies continues to be high longer than in mothers who deliver full term babies. This may provide additional protection to the vulnerable premature infant. There are other differences also in the composition of premature milk as compared to term milk, the significance of which is not understood. It is tempting to believe that changes in the composition of breast milkwith the age and maturity of the infant are related to the changing nutritionalrequirements of the infant. The composition of breast milk differs from onespecies to another.The qualities of human milk:- High count of lymphocytes, neutrophils and macrophages confer non-specific as well as specific immunity. Lactoferrin is an iron binding protein,which competes with iron-demanding bacteria for iron available in thegastrointestinal tract thereby reducing the growth of bacteria. Theconcentration of these lactoferrin is much higher in humans than that of
  • 32. 32animal milk. The antibacterial enzyme, lysosome is 3000 times higher inhuman milk than in cows milk.Digestive Property: Casein present in human milk is more easily digested thanthat in cows milk. The presence of folate and cobalamin binding proteins inhuman milk suggests that these proteins assist the absorption of thecorresponding vitamins. The higher concentration of lactose in human milkpromotes calcium absorption. Several lipases most important of which is thebile salt stimulated lipase (BSSL). Milk lipases assist the endogenous lipase inlipid digestion, which is an important function because lipid digestion is poorin the new born, specially the preterm newborn.Growth Factors: Breast milk has been found to have several growth promoting factorssuch as epidermal growth factor (EGF), insulin and somatomedin-C.Contraception: Lactational amenorrhoea due to high prolactine level keeps FSH andLH suppressed. It may last from three months to three years, but it is highlyvariable and does not last for the full duration of breast feeding in every case. The study of Upadhatu Raja, controversy regarding Raja as Upadhatu and itsPrakrtatva is furnished in a separate Capter.KANDARAEtymology:1. Vyutpatti - "Kadi + Aran Tapa Ca |" [SKD]2. Nirukti - "Mahatyah Snayavah Proktah Kandarah |" [BH. Pu. 51]Synonyms: Mahasnayu, Mahanadi. [SKD - IInd]Mahasnayu are termed as Kandara. Annotator Cakrapani named it as Sthula Snayu.Commentator of Sarngadhara quotes it as Mahanadya.Revered Cakrapani whilecommenting on Susruta Samhita quotes it as Sthula Sira. "Vrttastu Kandara Sarva Vijneya Kusalaih Iha |" [S. Sa. 5/30-31]
  • 33. 33While explaining the types of Snayu revered seer Susruta has defined this entity.He has stated that Vrtta Snayu are to be considered as Kandara. Vrtta means roundstructure. (S.E.Dic.)Utpatti : As Kandara are known as a type of Snayu, hence their emergence analoguswith Snayu. They are emerged from Sneha of Medodhatu, which is conveyed by Vayuand by the action of Agni, results into Kandara. After accommplishment, the further nourishment of Kandara is derived fromRakta Dhatu."Snayu Kandarayoh Ca Abheda Eva |" [S. Ni. 1/25-29 Nyacandrica] Nyayacandrikakara (commentator of Susruta Samhita) while commenting onthe Snayugatavata Laksana narrated that these symptoms are also to be considered incase of Kandaragata Vata Laksanas. He further narrated the reason that, since SthulaSnayu is named as Kandara, the symptoms of Vata will be common in bothconditions.Characters : Kandara is Vrtta (round in shape), Sthula (Gross structure), Sthira (Stable)and Murtimad (i.e.specific form). This indicates Prthvi Mahabhuta dominance in thisentity. It is stout, condensed and tough structure. It is placed in Madhyama RogaMarga.Position: "Asthi Sandhi Asritah |" [C. Su. 11/48] Acarya Caraka States that they are placed where the bonding between joints ofbones is required. Acharya Susruta has enumerated sixteen Kandara in the body. Outof them four are placed in both Pada and four each in Hasta, Griva and Prstharespectively.Functions of Kandara : "Prasarana Acuncanayoh Anganam Kandara Matah |" [SA.Pr. 5/39].
  • 34. 34 Acarya Sarngadhara opines that Kandara is responsible for endurment ofvarious movements. It supports to bear the body weight. It provides strength to thelocal architecture. It bounds the articulating structures.Tendons : Tendons are integral part of muscles being largely made up of collagenfibres. Their vascular supply is sparse hence appear white. Taking the form of cordsor straps, they are round, oval or elongate in section. They consist of fascicles ofcollagen fibres. Tendones are strongly attached to bones, not only via their periostea but alsooften by tendon fasciculi which may penetrate deeply into cortical osseous tissue. At the sites of tendinal attachment there is often a plate of whitefibrocartilage. The tensile strength of tendons is similar to that of bone. Tendons are slightly elastic and some contractile energy is stored in themwhen muscles contract. They also exhibit viscosity. Certain vaian wing tendons are highly elastic and have complex,ultrastructural interactions between their collagen and elastic fibres. The metabolic rate of tendons is very low. Repair involves the initialproliferation of connective tissue cells associated with collagen fibres followed byinterstitial deposition of new fibres.Kandara are involved in the pathogenesis of following diseases :Khanja, Grdhrasi, Pangu, Viswaci. They actively participate in the Samprapti stageof these diseases.SIRAEtymology :Vyutpatti- "Senoti | Sin Bandhane | Bahulam Anyatrapi |" [A.K.]Nirukti - "Sr Sarati Asmin Anena l" [A. K.] "Saranat Sira |" [C. Su. 30/12]Saranam means flowing, moving, proceeding, going. [S. E. Dic.]
  • 35. 35Various Annotators have interpreted this word in following way.1. "Saranat Gamahat |" [Jyotiscandra Saraswati] This refers that something is flowing through this or the entity itself travelsfrom one part to another.2. "Rasadinam Gamanat Sira Iti Uccyante |" [Gangadhara] This shows the specificity of material flowing through this i.e. Rasadi.3. "Saranam Mrdugatya Calanam Iti |" [Gananatha Sen] It shows characters of flow, i.e. smooth, rhythmic.4. "Saranat Desantara gamanat .......|" [Cakrapani] It indicates condition of material from one part to another.5. "Sarva Sarira Visarpanam Asam ........... |" [Jyotiscandra Saraswati]It indicates that branches of Sira are spread all over the body.Through these channels Rasadi elements are flowing from one place to another.Utpatti- The Great seer Susruta has specified the accomplishment of Sira inGarbhavyakarana Sariraas- "Medasah Sneham Adaya Sira Snayutvam Apnuyat | Siranam Tu Mrduh Pakah Snayunam Ca Tatah Kharah |" [S. Sa. 4/29]The function of Vayu is mentioned as- "Sarvasarira Dhatu Vyuhakarah (Racanakarah) |" [C. Su.12/8]Vayu is responsible for structural configuration and placement of various organs inthe body. This spurred Vayu by receiving Sneha of Meda converts them into Siraand Snayu. Though the Upadana Karana for both the structure is same, finalconfiguration differs due to action of Agni. During transformation when the actionof Agni is for short duration, Mrdu Paka results in formation of Sira.Vaidya Hariprapanna Sarma has elucidated the reason behind this Mrdu Paka-"Atra Mrdu Paka Bhavati Nirantara Rasa Sambhrtatvat |" [S. Sa. 4/29 -Pathabheda].Due to continuous contact of Rasa, Sira are Mrdu in nature.Nourishment of Upadhatu Sira - "Asrjah Kandarah Sirah |" [C. Ci. 15/17]
  • 36. 36They receive their nourishment from Rakta Dhatu. Rakta Dhara Kala essentiallyfound in Sira, Yakrta and Pliha, which are mentioned as principal sites of Rakta.Kala are nourishing in nature.Mulasthana of Sira -There are different opinions regarding the origin of Sira.1) Acarya Susruta has mentioned that Sira are having their origin at Nabhi.2) Treatise of Caraka has not mentioned the origin of Sira. In the context of Hrdayaand transportation of Oja they have narrated a term Arthedasa Mahamula. Variouscommentators of Caraka interpose it differently-A) According to Cakrapani this is the explanation of Dhamani.B) Gangadhara opines it as Dasa Sira.C) Acarya Jyotiscandra Saraswati has mentioned them as Sira and narrated theirorigin from Hrdaya.D) "Dasamula Sira Hrdaya Prati Braddha |" [A.S. Sa 6/2].Astanga Sangrahakara has stated that Sira are having their origin from Hrdaya.E) Laghu Vagbhata opines the same as Sangrahakara.F) "Hrdayat Sampratayante Siranam Dasa Matarah |"The statement of Vrddha Jivakiya Tantra also supports the Vagbhata.Principal Sira: - The Great oracle Susruta has mentioned that there are forty principal Sira present in the body. Vrddha and Laghu Vagbhata refer them as Ten major Sira.The author of current era have tried to resolve this controversy-During gestational period maternal circulation is received through "Garbha NabhiNadi", which is attached to the umbilicus of the fetus so it is obvious that channels,which are media of transportation of nourishing material to the body parts, shouldhave their origin at the Nabhi. After birth infant is independent of this maternalcirculation. Hence during further development, Sira resume their origin fromHrdaya.
  • 37. 37Acarya Jyotiscandra Saraswati opines that these Ten Sira originate from Hrdayathis statement does not interrogate fundamental origin of all the Siras at NabhiSthana. E.g. Twigs of a tree develop from stem. Roots of a tree traverse deep intosoil spread and draw up nutrition, which nourishes all part of a tree. In the samemanner Sira procures nutritional material from Ahara Rasa and further it istransported to different parts of the body. He further opines that after dissection onecould observe only Two Sira originated from Hrdaya. At the distance of fourAnguli they are divided into each of five branches, thus becomes Ten. These TenSiras are stated as "Dasa Matrka Sira".Division of Sira: -Principal Sira are further divided into four types as Vatavaha Sira, Pittavaha SiraKaphavaha Sira and Raktavaha Sira. Further each of the four types of Sira arebranched into 175 Sira.Vrddha Vagbhata has clearly explained that Vatavaha Sira conveys Rakta havingVata Dosa predominance. It means that division is based on predominance of Dosa.Acarya Jyotiscandra Saraswati Opines-"Tah Khalu Sarire Raktasya Caturvidhyat Caturvidha Bhavanti |” [C.Sa.7/2 Comm.]Depending on the dominance of either Dosa in Rakta, which is flowing all over thebody, Sira are classified into four types.Characters of the Siras -These are the channels for conveyance of Rakta. Internal surface is havingRaktadhara Kala. Sira are Mrdu in nature. They are having Cala (unsteady) property.They are mentioned under Pitrja Bhava. Depending upon the predominance of DosaSira are having Aruna, Nila, and Gaura Varna. Laxity or sturdiness of the wall ofSira is depending upon the quantity of Rakta traversing through it. Hence duringRaktaksaya condition Sira Saithilya is observed. Sira possess constrictor anddilatory property.
  • 38. 38Sira differs according to their thickness (diameter) some are large while others aresmall. They spread all over the body just like small and minute lamina arising fromthe central core of life."Tatra Yad Susiram Viviktam Sarvam Tat Akasiyam |"Sira is a type of "Akasiya" Racana. (Hollow Structure)Various anatomical structures are correlated with Sira: -Authors of the present era opine their different views regarding this entity.P.S. Variyara - Sira means Vein.Gananatha Sen - Nila Sira are Veins and these are the actual Sira.Pandita Gangadhara Sastri - Vataja Sira are Sympathetic nerve fibers.Ghanekara - Vatavaha and Raktavaha Sira are Arteries. Pittavaha Sira are veins.Kaphaja Sira are to be taken as lymphatics. Sira never to be considered as Nerves.Modern Counterpart:Blood vessels form a closed system of tubes that carries blood away from the heart,transport it to the tissues of the body and then return it to the heart.Arteries are vessels that carry blood from the heart to the tissues. Large elasticarteries leave the heart and divide into medium sized muscular arteries that branchout into the various regions of the body. Medium sized arteries then divide intosmall arteries, which in turn divide into still smaller arteries called Arterioles. As thearterioles enter a tissue, they branch into countless microscopic vessels calledCapillaries. Substances are exchanged between the blood and body tissues throughthe walls of capillaries. Before leaving the tissue, groups of capillaries unite to formsmall veins called Venules. These in turn, merge to form progressively larger bloodvessels called Veins. Veins then convey blood from the tissues back to the heart.Because blood vessels require oxygen & nutrients just like other tissues of the bodylarge blood vessels especially also have their own blood vessels, called vasavasorum.Lymphatic vessels begin as closed-ended vessels called lymphatic capillaries inspace between cells, Just as blood capillaries converge to form Venules and Veins,
  • 39. 39lymphatic capillaries unite to form larger tubes called lymphatic vessels. Lymphaticvessels resemble veins in structure but have thinner walls and more valves.Functions of various Sira: -1) Upsnihyate Anugruhyate-Upsnihyate Iti: a) "Pustim Niyate Tarunanam Sariram |" b) "Vrddhanam Sariraparinamat Ten Snehena Sariram Yapyate |"Anugrhyate Iti: a)"Paripalyate |"Dalhana has elucidated that in adult age Sira brings about Upacaya of bodyelements, while in old age they do only Yapana Karma. "Siram Sakalam Ca Etat Sirabhih Posyate Sada |" [BH. Pu. 3/224].Garden or green field is made wet by water carrying big or small channels.Similarly the Siras supply nutrition to the body and help in sustainance of life.2) Siranam Prana Adharatvam -Nabhi is concerned with Prana. Like spokes arising from center of a wheel Sirasurrounds Nabhi from all sides. Hence Sira provide substratum for the functions ofPrana.3) Sira lies at the site of Marma and supply nutrition to Snayu, Asthi, Mamsa, andSandhi and thus maintains the body.4) Functions of Each type of Sira -a) Vatavaha Sira - "Kriyanam Apratighatam Amoham Buddhi Karmanam |" [S.Sa.7/9] [" Kriyanam Iti 1) Kayariyanam 2) Vak Kriyanam-Dalhana]In normal state Vatavaha Sira performs all physical functions along with voluntaryand involuntary action.The word Buddhi Karma is related with five sense organs and mind. Intellect playsimportant role for taking decision in the normal state. Vatavaha Sira performs all thefunctions of Buddhi.2) Pittavaha Sira - "Bhrajisnutam Annarucim Agnidiptim Arogatam | Samsarpat Swah Sirah Pittam Kuryat |" [S Sa. 7/10].
  • 40. 40Pittavaha Sira bring luster to the body, produces urge for food. It increases appetite,maintains normal health and does other normal functions concerned with it.3) Kaphavaha Sira- "Sneham Angesu Sandhinam Sthairyam Balam Udirnatam |" [S. Sa. 7/13]Kaphavaha Sira causes lubrications to the various parts of the body and producesfirmness in the joints. It also improves the strength & does all the functions allottedto it.4) Raktavaha Sira - "Dhatunam Puranam Varnam Sparsajnanam Asamsayam |" [S. Sa. 7/15]The Raktavaha Sira nourishes the Dhatu, improves the complexion, causes a definiteperception of Sparsa (touch) and does other characteristic functions in the body.Sira Viddha Laksana: - "Siragatah Sadyah Chinnasu Sirasu Raktatipravrttih |" [S. Su. 22/8]Sira provide substratum for transportation of "Jiva Rakta." So any type of injury toSira may be fatal. From the injured Sira abundant quantity of blood flows out.Various diseases manifest due to vitiation of Vata. Upadhatu Vasa "Suddha Mamsasya Yah Snehah Sa Vasa Parikirtitah | "[S.Sa 4/13] Vasa is a type of Sneha distinctly present in muscles.Etymology:1. Vyutpatti- "Vasati, Vaste Va |"[A.K]2. Nirukti- a)Vasa Nivase- "Vasati Sarire Visesatah Mamse Iti Vasa |"It resides in the abodes of Mamsa Dhatu.b) Vasa Acchadane- "Accadayati Sariram Mamsam Udaradikam Va Iti Vasa |"It mantles the Mamsa Dhatu.Utpatti - "Vasa Mamsa Niryasah |" [S.Su.23/12]Vasa is derived from essence of Mamsa Dhatu. It is nothing but the extract ofMamsa Dhatu.
  • 41. 41There are three types of Sneha located at various places in the body. They are Majja,Meda and Vasa.1. Majja- It is a type of Sneha, which is placed in bones. Revered author GananathaSen has mentioned its two types 1. Pitta Majja 2. Rakta Majja.2. Meda- "Sandra Sarpitulyah Sneha Dhatuh Sarirasya |” [PS. Pr. page-10]Viscid, Sarpitulya (resembles with clarified butter) Sneha, which is mainly placed inbetween, layers of abdomen and in subcutaneous tissues.3. Vasa- "Vasa Nama Tanu Medorupam Suddha Mamsa Snehah |" A.S.Su.6/106]Vasa is a dilute form of Meda.Vasa show close resemblance with Meda. Vasa is mentioned as a synonym of Meda. "Ati Guru Snigdham Bala Karya Ati Brhanam |"[BH. Pu.3/49]These are the characters of Meda, which shows close resemblance with Vasa. Bothare lubricating substances. They provide strength to other substances. They nourishother structures of the body."Tasya Medasya Anupravesah Tulya Upadanatwat |" [PS.Pr.10]Both Vasa and Meda are derived from essence part of Mamsa Dhatu. According tosome authors these two entities are one and the same. "Medasah Tapyamanasya Sneho Va Kirtita Vasa |" [BH. Pu.3/31]Bhavaprakasa opines that Sneha of Meda Dhatu is also termed as Vasa.Characters of Upadhatu Vasa-Due to Apya Mahabhuta Dominance Vasa possesses the properties likeDrava (liquid), Sandra (viscid), Manda (sluggish), Snigdha (unctuous),Mrdu (soft /mushy), Picchla (sticky).Kapha Dosa resides at Vasa. Pramana of Vasa has three Anjali in normal person.The measurement described here pertains to the ideal standard.Functions of Vasa-1. Snehana- Vasa is a lubricant for the body tissues.2. Varnya- It adds complexion.3. Brmhana-It nourishes other tissue of the body.4. Balya- It strengthens the tissues.
  • 42. 425. It alleviates the Vata Dosa.Vasa is described as a type of animal Sneha. The characters of Vasa Sneha asdescribed by classics similitude with Majja. Along with above mentioned propertiesit is aphrodisiac in nature. It causes augmentation of Pitta and Kapha. Theirpotencies via hot or coldness are to be determined according to the nature of theanimal from which they are collected.Modern Counterpart: - Adipocytes (fat cells) - When occurring singly the cells are oval or sphericalin shape but when mutually compressed they are polygonal. Each cell consists of aperipheral rim of cytoplasm, in which the nucleus is embedded, surrounding a singlelarge central globule of fat. Many microfilaments are also seen around the lipidvacuole as well as some endoplasmic reticulum Fat cells are specially & exclusivelyconcerned with the storage & perhaps the synthesis of fat. The fat first appearing asisolated small globules, which later coalesce to form a single large droplet. Thesespecific cells have a well defined distribution within the body. One of the content ofthe muscle is fat cells. Adipose tissue- A few fat cells occur in loose connective tissue in most partsof the body. However in adipose tissue these occur in great abundance and constitutethe principal component.
  • 43. 43 TwakEtymology:Vyutpatti - "Twak+ Paksa Tap |" [SKD II Page-7]Nirukti - "Tvacati Samvrnnoti Meda Sonitadikam Sarvasariram |" [SKD] "Twacati | Twaca Samvarane | Yadva Tanoti| Tanyate Va | Tanu Vistare| Tenoteranacca Vah| [A.K. 223/62]Synonyms - Chavi, Chadani, Asrgdhara, Tattika, Carma, Kwalli.[A.K.;Sabdaratnavali]Utpatti:- When the fertilization takes place, the fetus develops very rapidly throughthe process of transformation. Each and every molecule is involved in this process.The formation of seven layers of the skin exhibit in the similar manner as thedifferent layer of the skim on the surface of boiled milk occurs. "Asrjah Pacyamanasya Ksirasya Iva Santanikaha Sat twaco Bhavanti |"[A.S.Sa. 5/24] Vrddha Vagbhata has asserted that Rakta Dhatu plays principle role inmanifestation of skin."Raktasya Swo Usmah Pacyamanat.....|"(Indu). Whilecommenting on above verse Indu has elucidated that metamorphosis of Rakta by itsown Usma (Agni) results in accomplishment of all the layers of skin.Skin is mentioned as Upadhatu of Mamsa by all the seers exceptSarngadhara.Annotator of Sarngadhara Samhita has explicated Twak as "MamsaMala." "Mamsasya Sarah Sad Twacah |" [A.S. Sa. 6/29; C.Ci. 15/17] Nourishment of the skin is achieved through essence of Mamsa Dhatu. Mamsa Pesi covers Sira, Snayu and Asthi, Sandhi etc organs of the body.Similarly skin mantles the whole body. Accadana Karma of Skin is identical with Mamsa Dhatu.Layers of Skin
  • 44. 44 Great seer Caraka has defined the six layers of skin as follows -1) Udakadhara - The external layer of the skin is known as Udakadhara. "Udakam Dharayati Iti Udhakadhara |" OR "Udakena Ghriyatel"This layer hold up the Udaka and provide substratum for its functioning. "Sarvasariracaram Bahya Twak Bibharti |" [C. Sa. 7/15]While circulating all over the body Udaka also nourishes the skin and resides at itsexternal layer. Here it is known as Lasika. Lasika is one of the seats of Pitta. Pittaresiding at this layer is termed as Bhrajaka Pitta, which adds the complexion to theskin. Moisture of the skin is maintained due to this layer.2) Asrgdhara:- "Dharayati Asram |" [A.K.] "Na Raktam Bahih Syandyate|" [ A.S.Sa 5/26-Indu]The second layer of the skin is known as Asrgdhara.It provide substratum for Rakta Dhatu.3) Third layer - It is the site for the manifestation of Sidhma and Kilasa. This layer of the skin is the place where the vitiated Dosa give rise to Kilasaand Sidhma.4) Froth layer - The fourth layer is the site for the manifestation of Dadru and Kustha.5) Fifth layer - It is the site for the manifestation of Alaji and Vidradhi.
  • 45. 456) Sixth layer: - This is the innermost layer of the skin. The excision of which causestrembling, person may enter into darkness (gets fainting) like a blind man. Arumsika(boils of joints), which is having thick root manifestes at this layer. These areextremely difficult for treatment. Vrddha Vagbhata has named this sixth layer asPranadhara. It is related with underlying Mamsa Dhatu. It holds the Prana. These arethe six layesr of the skin, which covers the entire human body. Acarya Susruta in the context of Garbhavyakarana Sarira illustrates theseven layers of skin along with their measurements.1) Avabhasini - The first outer layer of the skin is called Avabhasini. It reflects all the colors.At the level of this layer five shades come into the light. The thickness of this layeris described as 1/18th of Vrihi. This layer is described as the seat of Sidhma andPadmakantaka (Type of Ksudra Kustha).2) Lohita - The second layer is known as Lohita. Its thickness is described as 1/16th ofthe thickness of the Vrihi. It is the seat of Tilakalaka, Nyaccha and Vyanga (Typesof Ksudra Kustha).3) Sweta - The third layer of the skin measures 1/12th of the thickness of Vrihi. It is thesite of Carmadala, Ajagalli and Masaka (Ksudra Kustha).4) Tamra - Fourth layer of the skin named Tamra measures 1/18th of the thickness ofVrihi. Different types of Kilasa & Kustha manifests in this layer.5) Vedini - This fifth layer of the skin measures 1/5th of the thickness of Vrihi. It isdescribed as the seat of Kustha and Visarpa.
  • 46. 466) Rohini - The sixth layer is labelled as Rohini. It is equal to the thickness of Vrihi.The Granthi, Apaci, Arbuda, Slipada and Galaganda types of diseases takes place inthis layer.7) Mamsadhara - The seventh layer named as Mamsadhara has double the thickness of Vrihiand it is a seat of Bhagandara, Vrana and Arsa. Sarngadhara has named this layer of skin as Sthula Twak. These measurements as mentioned above are specially found in fleshy partsof the body and not in the fore head or smaller parts like fingers. Dalhana states differently regarding the thicking of this layers. According to him Vrihi should be taken as Yava. Parinaha (circumference)of each Vrihi is to be divided into twenty parts. Among these 18 parts are to beconsidered, for 1st layer. So the thickness of first layer of skin will be 18/20 Yavaand not 1/18 Vrihi. According to this consideration the total thickness of the skinwill be 5.95 Yava. On the basis of opinion of Susruta the total thickness of the skinis 3.53 Vrihi.Characters of Skin -Skin is described as Sthula (Gross), Sthira (Stable) and Murtimad (having specificform). Due to this properties skin is having Prthvi Mahabhuta dominance.It also possesses Mrdu (Soft), Snigdha (Luster) Guna, which indicate presence ofApya Mahabhuta.Sparsana property (tactile sensation) of it is indicative of Vayu Mahabhuta. Skin is a Matrja Avayava. Sarata of Rakta Dhatu is characterized byunctuousness, red colour, and beautiful dazzling appearance of the ears, eyes, face,
  • 47. 47tongue, nose, and lips, sole of the hands and feet, nails, forehead. These allcharacters are observed on skin. It comes under Bahya Roga Marga. It is narrated as Mulasthana (origin) ofMamsavaha Srotasa. Lomakupa that are the Mulasthana of Swedavaha Srotasa opens on skin.Mala of Majja Dhatu maintains the unctuousness of the skin.Relation with Dosa:- Bhrajaka Pitta is mainly related with skin. Luster, Colour, reflected shadowof the skin these characters are attributed by Bhrajaka Pitta. Skin is the mainplatform for various functions of Vayu.Functions of Skin-1) Skin covers the whole body, thus protect it from various foreign materials.2) Indriya Adhisthana - It is important sense organ. It pervades all the sense organs.No sensation can occur without a sense of touch. All the five kinds of sensationscould be received through tactile sensation only.3) "Bhumih Srotasam Ca Swedavahanam |"[PS. Pr. Page-56]. The conveyance of perspiration (Sweda) occurs through Swedavaha Srotasa,which opens on skin. Hence it is an important organ of excretion for Sweda Mala. Through the mechanism of perspiration it also regulates the temperature ofthe body. So it is an important organ for heat regulation.Microscopic structure of SkinThe Epidermis -
  • 48. 48It is composed of Keratinized stratified squamous epithelium. In this tissue there iscontinuous replacement of cells. Keratinocyte cells are in constant replacement.There also include melanocytes, phagocytic langerhans cells, and Merkel cells.Number of strata represents different stages in Keratinocyte maturation.1) Stratum Basale (Stratum germinativum) - It includes single layer of cells, whichlies in contact with basal lamina. Division of a population of stem cells formsKeratinocytes in this layer. The basal cells have many cytoskeletal filamentsincluding actin microfilaments & Keratin filament bundles Melanin granules arealso present in many of these cells.2) Stratum Spinosum - Contain more mature Keratinocytes several layers deep,Internally the cells possess large numbers of Keratin filament bundles, because thecells are anchored together in this way the stratum provides much tensile strengthand coherence to the surface of the integument. Many cells are attached todesmosomes at the cell surface.3)Stratum Granulosm - Ultrastructurally these cells contains Keratin filamentbundles enclosed or enmeshed by the irregular masses of densely stainingKeratohyalin granules.4) Stratum Lucidum - Only found in thick glubrous skin closely resembles tostratum corneum.5) Stratum Corneum - Consists of closely packed layers of flattened, dead Keratin.The cells of this layer, corneocytes are quite large. Basement Membrane ofEpidermis consists of lamina lucida and lamina densa.Dermis-Providess considerable strength to skin by virtue of the numbers & arrangement ofits collagen fibers and has elastic recoil. It provides compartment for blood vessels,lymphatics, Nerves & defensive cells and so is vital to the survival of the epidermisand to much of the skins physiology.1) Papillary Layer -It includes housing rich networks of sensory nerve endings andblood vessels. Superficial surface is marked by numerous papillae that interdigitatewith recesses in the base of epidermis and form the dermo-epidermal junction. At
  • 49. 49their interface lying under each epidermal ridges are two longitudinal rows ofpapillae one on either side of the midline through which sweat ducts pass within theepidermal rete pegs.2) Reticular layer- Its bundles of collagen fibers are thicker than those in thepapillary layer and interface with them and with each other to form strong threedimensional lattices.Blood supply - Blood enter the skin through small arteries penetrating the reticularlayer from its deep aspect. Sheet like plexus is form in both dermis and superficialfascia.Would Healing - When skin is injured dermis responds by repair while epidermisresponds by regeneration. The collective response of the skin to injury is termed aswound healing.SnayuEtymology:Vyutpatti: "Sa + Bahulakat Un |"Nirukti: 1)" Snati Sna Sauce |" "Anga Pratyanga Sandhibandhanah Upayah Snayoh |" [A.K. Page-224/60] 2) "Snati Sudhyati Doso Anaya Sna Un | Sarirasthe Vayuvahi NadiBhede |" [SSTMN]Synonyms: Vasnasa, Snasa, Snayu, Snava. [Abhidhana Cintamani] In Ayurvedic classics mostly Snayu word is used. At one place VrddhaVagbhata has used the word Snava.Utpatti:
  • 50. 50 Vrddha Vagbhata has mentioned that accomplishment of Snayu takes placeat sixth month of gestational period. According to Madhukosakara emergence ofSnayu takes place at seventh month of gestational period. With the help of Vayu,Sneha of Meda gets transformed into Snayu by the process of Agni. The KharaPaka of Agni is responsible for conversion of Meda to Snayu. Acarya Kasyapaopines differently regarding the Utpatti of Snayu. According to him Snayu is derivedfrom Asthi & Mamsa Dhatu. Nourishment of Snayu is derived from essence part ofMeda Dhatu."Sukrat Asthi Asthito Mamsam Ubhabyam Snayavah Smartah |" [KA. Sa. page-70;Asamanagotriya].Characters of Upadhatu Snayu: "Snayu Iti Sanakara Upadhatu Visesah Yen Dhanusi Nahyante |" [S. Su 25/21 - Dalhana]."Sana" means hemp. Appearance of Snayu resembles with hempen string. It ismentioned under Pitrja Bhava. It is a Prthvi dominating structure hence possessesSthula (Corpulent), Sthira (stable), Murtimad (having specific form), Guru (heavy),Khara (rough) and Kathina (hard) Gunas. It is solid, dense, tough, strong and rigid innature. It contributes to the anatomical configuration of Marma. It is mentionedunder Madhyama Roga Marga. It forms the Mulasthana (origin) of MamsavahaSrotasa. Concealed Snayu reveals longevity of life.Classics have described Nine hundred Snayu. These are of four types:1) Pratana 2) Vrtta 3) Prthu 4) SusiraThese words indicate the specific structure of Snayu.1) Pratana Snayu: - "Pratanavattyo means Bisa Mrnala Sadrusah |"[BH. Pu.3/258]Pratana means Vistrtah; Pratana means Tendril, ramifying or Branching.Pratana Snayu is found in extremities and all joints.2) Vrtta Snayu: - Vrtta Snayu is called as Kandara. These are described in previouschapter of Kandara.3) Susira Snayu: - Susira means pours or perforated, having whole.This type of Snayu is found at the distal ends of Aamasaya, Pakvasaya and Basti.
  • 51. 514) Prthu Snayu: - "Prthu Iti Mahati Sthula |” [SKD]Prthu means wide, expansive. This type of Snayu is present in the Parsva, Urah, andPrsta and at Sira.Anatomical Structures resembling with Snayu: - The strong bonding of the joints is achieved through forms of regularconnective tissue. This includes those highly fibrous tissues with fibers regularlyorientated either to form sheet such as fasciae and aponeurosis or thicker bundles asligaments and tendons. The direction of the fibers within such structures is related tothe stress, which they undergo but there is considerable interweaving of fibrousbundles, even within tendons, which increases their structural stability andresilience. Regular connective tissue is predominantly collagenous but in someligaments elastic components also occur, as in the ligaments flava of the vertebrallaminae and in the vocal folds. Some elastin is also present between the collagenlamellae of many other ligaments and fasciae. In other sites, the collagen fibers mayform precise geometrical patterns.I) Ligaments: - Pratana Snayu resembles with ligaments. Ligaments provide strengthto the joints. There present fibrous capsule. The capsule usually has localthickenings of parallel capsular ligaments (which are nothing but the bundles ofcollagen fibers. Accessory ligaments are separate from capsules and may be extracapsular or intracapsular in position. All ligaments although yielding little to tensionare pliant and do not resist normal actions, being designed to check excessive orabnormal movements. All ligaments are slightly elastic. Due to tension in ligamentsthe movement of the joints is limited (controlled).II) Aponeurosis: - Pratana Snayu resembles with Aponeurosis. These are sheets ofwhite compacted collagen fibres attached directly or indirectly to skeletal musclesand distributing their contractile forces to fasciae, other muscles, cartilage or bone.Sometime a whole attachment is aponeurotic. Elsewhere aponeurosis provides largeaxillary attachment areas for muscle fibres. Some major aponeurosis interlace atlinear decussations or raphes.
  • 52. 52III) The Sphincters or Valves placed at various junctions of alimentary and atBladder neck resembles with the description of Susira Snayu.1) Pyloric Sphincter - is a muscular ring formed by a marked thickening of thecircular gastric muscle, some longitudinal fibers also interlacing with it.2) Cardiac Sphincter - Formed from the circular films of the gastric wall.3) Ileocaecal valve - Consisting of two flaps projecting into the lumen of largeintestine. In the distended, fixed Caecum the flaps are semi lunar. At the end theflaps coalesce, continuing as narrow membranous ridges, the frenula of the valve.Circular and longitudinal muscle layers of the terminal ileum continue in the valveto form a sphincter. The margin of the ileocaecal valve is a reduplication of theintestinal mucosa and circular muscle.Longitudinal fibers are partly reduplicated as they enter the valve. The valve notonly prevents reflux from the caecum to the ileum but is probably also a sphincterregulating the passage of ileal contents into the caecum.4) Anal Sphincters -At the anorectal junction, the rectal circular muscle is thickened as nonstriatedsphincter ani internus. The sphincter ani externus surrounds the whole anal canal. Itis usually consisting of three parts, all composed of skeletal muscle. Muscle tone inboth internal and external sphincters keeps the Canal and anus closed.5) Bladder Sphincter:-Bladder neck - The non striated muscles of this region distinct from that whichcomprises the detrusor proper. The arrangement differs in male and female.Male - The non striated muscles form a complete circular collar extend distally tosurround the preprostatic portion of the urethra. These fibres are termed as internal,proximal and preprostatic urethral sphincter.Female - the female bladder neck also consists of non striated muscle. But infemales they do not possess a smooth muscle sphincter at the bladder neck since themuscle fasciculi extend obliquely or longitudinally into the urethral wall and notform circular orientation. It is unlikely that the active contraction of this region playsa significant part in the maintenance of female urinary continence.
  • 53. 53Functions of the Snayu:- "Snayavo Bandhanani Syuh Dehe Mamsasthi Medasam |" [SA.Pr.5/36; BH.Pu.3/258-259]Snayu bound the various structures of the body. Mamsa, Asthi, Meda are fastenedby the Snayu. It supports the above structures. "Asthi Samyogah Tatra Upanibaddhah Ca Snayuh |" [C. Su. 11/48]Due to contiguous support of Snayu all the joints of the body are able to sustain thebody weight. Just like a boat made upof firmly joined wooden planks, which bearthe weight of many persons in water, Snayu execute crucial role to bear the bodyweight.Injury to the Asthi, Mamsa Pesi, Sira & Sandhi do not cause as much disability as aninjury to the Snayu. Great oracle Susruta has described the Snayu Viddha Laksanasas shortening, debility of body parts, inability to perform their actions, severeexcruciating pain. Wound healing after a long time should be understood as causeddue to cut or injury to the Snayu. SandhiEtymology-Vyutpatti- "Sam + Dha + Lyut |" [A.K.] "Sandhanam | Upasarge Ghoh Kih |"[A. K. page-340]Nirukti- “Sandhiyate Yasyam Iti |" "Sanyoge Asthidvaya Samyogasthane |" [SSTMN]Definition- "Sandhayah Ca Anga Sandhanat Dehe Prokta Kaphanvita |" [SA.Pr.5/37] Articulation points of two or many structures are termed as Sandhi. Sandhi, mentioned as the Upadhatu of Meda Dhatu. "Medasah Sarah |" [A.S. Sa 6/29]. Sandhi derives their nourishment from essence part of Meda Dhatu.
  • 54. 54 Classics have given emphasis on the joints of bones. Acarya Susruta hasstated that though the joints between Mamsapesi, Snayu and Sira are present butsince they are innumerable hence not practical to describe them.Vrddha Vagbhata has mentioned these joints as Sahasradwaya (two thousand).Acarya Susruta has described two hundred and ten joints of bones. Acarya Kasyapahas mentioned this number as three hundred and eight one.According to Caraka the number of joints is two hundred.On the basis of their movement Acarya have mentioned two types Asthi Sandhinamely Cestavanta (movable) & Sthira (immovable). Movable joints are found in Sakha (extremity), Hanvasthi (mandible) andSroni (hip). The rest of the joints are known as immovable joints.On the basis of their anatomical structure they are further divided into eight types.1. Kora Sandhi. 2. Ulukhala Sandhi. 3. Samudga Sandhi. 4. Pratana Sandhi5. Tunnasevani Sandhi. 6. Vayasatunda sandhi.7. Mandala Sandhi.8. Sankhavarta Sandhi.Relation with Dosa: 1. Vayu: - Various movements at Sandhi are carried out with the help of Vyana Vayu. 2. Kapha: - Kapha Dosa plays an important role in smooth functioning of Sandhi. Slesaka Kapha is present at Sandhi. “Sandhistha Slesma Sarva Sandhi Samslesat Sarva Sandhi AnugrahamKaroti |" [S.Su.21/14] “Samslesana means Sandhibandhanam Karoti |" [S.Su. 15/4, Dalhana]Slesma provides the lubrication to joints. Lubrication, which is given by Sneha ofMeda, Kapha Dosa follows the same path. Features of Sandhi:
  • 55. 55Sandhi are covered by Mamsapesi. They mantle the joints. Concealed joints are thetoken of their excellence. Deeply located joints Sira, Snayu indicate the long span oflife. They are considered in Madhyama Roga Marga.They are mentioned as the Mulasthana of Majjavaha Srotasa.Functions of Sandhi: -All types of movements are performed due to presence of thin articulating entity.This structural architecture helps to do all the activities of body. They participate inanatomical derivation of Marma.Any type of injury to Sandhi causes great debility. Great seer Susruta has explainedsandhi Viddha Laksanas. When the joint, either movable or immoveable are injuredthere will be great swelling, very severe pain, loss of strength of the joints, splittingpain, edema and loss of function of the joints.Modern Counterpart:Functionally the joints are classified into three types take into account the degree ofmovement they permit.1. Synarthrosis- It is an immovable joint.2. Amphiarthrosis- It is a slightly movable joint.3. Diarthrosis- It is a freely movable joint.Concentrating on Diarthrosis- Diarthrosis have a variety of shapes and permitseveral different types of movements.General structure of Diarthrosis- There present synovial space, which separates the articulating, bones. Articulating cartilage covers the surfaces of the articulating bones but doesnot bind the bones together. It reduces friction at the joint. Articular capsule encloses the synovial cavity and unites the articulatingbones. It is composed of two layers. The outer layer is called the fibrous capsuleusually consist of dense irregular connective tissue. Its great tensile strength resistsdislocation. The fibers of some fibrous capsule are arranged in parallel bundle & arethere for highly adapted to resist recurrent strain. Such bundles of fibers are calledligaments (ligare-to bind) the strength of such ligaments is one of the principal
  • 56. 56factors in holding bone to bone. A synovial membrane forms the inner layer of thearticular capsule. The synovial membrane is composed of variable amount ofadipose tissue and areolar connective tissue with elastic fibers. It secretes synovialfluid. This fluid, which fills the synovial cavity, has several functions. It lubricates &reduces friction in the joint. It also supplies nutrients to joints and removesmetabolic wastes from the chondocytes of the articular cartilage. It also consists ofhyaluronic acid and an interstitial fluid formed from blood plasma. The amount offluid varies according to the size of the joint. Many Diarthrotic joints also containaccessory ligaments. Some joints contain articular dica. IMPORTANCE OF UPADHATU Role of Upadhatus in Marma Sarira "Marayanti Iti Marmani l" [S. Su. 6/1-Dalhana]These are such anatomical locations in the body, which are vital in the sense that anyinjury to these parts is painful, cripple the local functions or even lead to suddendeath of the individual. Prana is a vital energy necessarily sustains activity of livingbeing. Marmas are important anatomical locations where the Prana resides.Out of twelve elements of Prana, three Dosa, three Manasa Guna and Bhutatmathese seven Prana reside at Marma. Physical matrix having suitable Upadhatu andDhatu serve as a favourable platform for the functioning of these elementsThe treatise of Acarya Susruta defined Marma as the meeting point of Mamsa,Asthi, Sira, Snayu and Sandhi.There are total 107 Marma in the body. On the basis of predominant physicalcomponent they are classified into five categories as:1. Sira Marma 2. Snayu Marma. 3. Sandhi Marma 4. Asthi Marma 5. MamsaMarma.Out of these five entities three are none else than Upadhatu. .Out of 107 Marma the anatomical configuration of 55 Marma are designed byUpadhatu. Out of 88 Marma the physical matrix of 41 Marma are mainly attributedby Sira. Upadhatu Snayu participates predominantly in the structural configuration
  • 57. 57of 27 Marma. Upadhatu Sandhi forms the anatomical structure of 20 Marma. Therest are attributed to Dhatu.On the basis of vulnerability Marma are further divided into five types.Highlighting the status of Upadhatu in this condition: - Out of 41 Sira Marma (14) (0)Sadhyapranahara Rujakara (10) (16) Kalantara Vaikalyakara Pranahara (1) Visalyaghna Out of 27 Snayu Marma (1) (4)Sadhyapranahara Rujakara (4) (16) Kalantara Vaikalyakara Pranahara (2) Visalyaghna Out of 20 Sandhi Marma (1) (4)Sadhyapranahara Rujakara (5) (10) Kalantara Vaikalyakara Pranahara (0) VisalyaghnaAbove Figures reveals that:1. For most of the Sadyapranahara Marma the platform is furnished by UpadhatuSira.
  • 58. 582. Most of the Vaikalyakara Marma are designed by Upadhatu Snayu, Sandhi andSira. Any type of injury or insuts to these Marma results in the deformity of therelated body parts. These magnify the pivot role of Upadhatu in the construction ofMarma and so for the survival of life.Relation of Dosa with UpadhatuBy studying all the Upadhatus their observed specific relationship of Dosa withUpadhatus.Vata principally resides at Kandara, Sira, Snayu and Sandhi to performvarious function of the body. Pitta Dosa mainly resides at Raja. Twak is the seate ofVata and Pitta Dosa. Kapha Dosa resides at Stanya and Vasa. Dosa Related Upadhatu Vata Kandara, Sira, Snayu, Sandhi, Twak [S. Ni. 1/25-29 Nyacandrica] Pitta Raja Twak Kapha Stanya VasaIMPORTANCE OF UPADHATUS IN PATHOGENESIS: In the pathogenesis of diseases the Upadhatus references are foundin a very specific manner. The diseases of Raja and Stanya are restricted tofemale physiology. Among the rest Upadhatus, except Twak and Vasa all four Upadhatus(i.e. Sira, Snayu, Kandara and Sandhi) may be categorized under onegroup. "Sira Snayu Sandhinam Asrayabhutanam Asrita Vataroga Avasarah |"Snayu Kandarayoh Abhedah| [S. Ni. / 25-29 Nyacandrica]All the Vatavyadhi manifests by residing at one of the above-mentionedUpadhatu level. Acarya Caraka has specifically illustrated the diseases,
  • 59. 59which supervene at these Upadhatus after the description of DhatuPradosaja Vikara. Stambha, Sankoca, Khalli, Granthi, Sphurana, Supti arethe diseases which manifest at Sira, Snayu and Kandara. Upadhatu Disease Status Raja, Stanya Concern with female physiology. Kandara, Sira, Distinctly related with Vatavyadhi & Snayu, Sandhi involved in chronic stage of other diseases. Sira Conveyance of Dosa to the place of "Kha Vaigunya", thus involved in pathogenesis of many diseases Vasa Distinctly involved in Prameha. One of the Dusya of Prameha. Twak Many underlying pathological conditions manifest on skinRelation with Rogamarga:Great oracle Caraka has elucidated Trividha Gati of Dosa as they move inKostha, Sakha and Marmasthi Sandhi. (C.Su. 17/113). These are three paths of diseases in the body in which diseasesmanifest and process. Among these three Roga Marga, Vasa and Twak areincluded in Bahya Roga Marga, on the contrary Sandhi (joints of Bones),Sira, Snayu and Kandara these four Upadhatus are included in MadhyamaRoga Marga. Upadhatu Rogamarga Raja, Stanya Bahya Kandara, Sira, Madhyama Snayu, Sandhi Sira
  • 60. 60 Vasa Bahya Twak Bahya.The diseases are classified according to their prognosis."Gambhiram Marmasthi Sandhi Samsritam |" [C. Su. 10/18]The diseases of Madhyama Roga Marga determine the palliability of diseaseand they are having bad prognosis. This indicates the severity of thediseases, manifest at these Upadhatus.UPADHATU RAJA:I). Introduction: - On the earth the animal kingdom is divided into four species. Amongthese the human being comes under viviparous type of species. The speciestake their specific forms depending on the contact of the causative factors ofthe fetus with the womb of a specific species. A human being is considered to be a causative factor for the productionof another human being simply because a fetus is composed of theconglomeration of various factors which produces a human form. "Dhrvam Caturnam Sanidhyat Garbhah Syat Vidhipurvakah | Rtu Ksetrambu Bijanam Samugryat Ankuro Yatha |" (S.Su. 2/33) These are the fundamental requirements of conception. Equatinggermination of a seed with achievement of conception Acarya Susruta hasmentioned that Rtu (Period of conception), Ksetra (Female reproductivesystem) and Ambu (nourishing substances) assemble together for
  • 61. 61reproduction of a progeny. Thus these factors will help only when they comecollectively to help fertilization. Among above mentioned factors Rtu, Ambu,Ksetra and a part of Bija (ovum) these three and half factors are attributed byfemale only. This shows the important role of female in reproduction.As mentioned by Acarya Caraka - "Apatyanam Mulam Naryah Param Nrnam |" [C.Ci. 30/5]The following things support the above statement –Addition Anatomical Structures: - There are nine external openings (Bahirmukha Srotasa) in male. Inaddition to these, in females there are three extra openings viz. two are at thebreast and one for the Raja in the lower part of the body i.e. vaginal orifice. In addition to Seven Asayas, females are having Garbhasaya as theeightth one. Acarya Sarngadhara added two Stanyasaya to this list. Femaleshave twenty extra Pesies (muscles). Ten Pesies are found in the breast.Remaining ten Pesies are related with uterus and concerned structures.Acarya Susruta has mentioned two extra Artavavaha Srotasas related withfemale anatomy. These anatomical structures are further constructive inprocreation. Age of a human being represents the state of his body dependingupon the length of the times that has been passed since birth.In females, reproductive function is observed for a specific period of timeonly. So it is mandatory to know the specific epoches of woman’s life. Beforedealing with subject it is necessary to study the stages of life according todevelopment.Epoches of life : . Life span is broadly divided into three stages - I) Balyavastha (Childhood)
  • 62. 62 II) Madhyamavastha(Adult age) III) Vrddhavastha (Old age)(I) Balyavastha: It lasts upto sixteen years in which various organs of the body are notwell developed. During this span the Dhatus are immature, hair on axilla andface are not grown, body is soft, strength is also not completely achieved. Thespan is dominated by Kapha. Acarya Caraka stretches it upto thirty yearsconsidering the attainment of fully maturity of Dhatus and stability of man.(II) Madhyamavastha: During this stage energy, strength, working capacity, memory and allthe Dhatus are fully developed and mature, psychology is stable. There is nodecline in the quality of Dhatus. The span is dominated by Pitta. AcaryaCaraka and Vagbhata keep the limit of this span up to sixty years, whileSusruta, Kasyapa and Harita upto seventy years.Vrddhi Yauvana Sampurnatva Aparihani- 30yrs 40yrs 60yrs [A.S.Sa. 8/24]20yrs 30yrs 40yr 70yrs [S.Su. 35/29] According to constitution, Ahara and Vihara early or late changesoccur.(III) Old age: It starts after 60/70 years, in which gradual diminution in the qualitiesof Dhatus occur and there is dominancy of Vata Dosa. Thus it is understood that according to age, the status of the Dhatuschanges and they attain complete maturity at adult age. Preceding descriptionrelates to both sex.b). Epoches of women’s life: - Now considering the specific epoches of woman’s life
  • 63. 63Bala Taruna Adhirudha VrddhaUpto 16 yrs. upto 32yrs. upto 50 yrs. after 50yrs. [BH. Pu. 5/281-282]Bala Mugdha Praudha PragalbhaUpto 5/12 yrs. upto 11/19 yrs. upto 20 yrs. upto 31 yrs. [HA.Pr. 5/13-14] This difference might be due to individual variations. In between 24-37 years of age, she is called as Madhyaga, which is the elite period of her life. The specific life span of female deals with her reproductive capacity,which maintains parity. Up to 10 years she assumes general development ofall body organs. After this period the development of secondary sexcharacters commences. Between 12 and 16 years production of Upadhatucommences and after menarche within three to four years she becomescapable to conceive. Period of 16-40 years is the foremost period ofreproduction in female physiology, after 40-50yrs. premenopasual symptomsbecome evident. In the middle age Dhatus are in complete mature state or tends to bemature. In this period Artava Upadhatu starts functioning and continue for aspecific time period only. When Dhatus are in decline state Raja stopsfunctioning. Middle age (Madhyamavastha) of a female life is indicative ofreproductive state.Rational put froth by Various Acaryas: - Acarya Caraka explains important principle acting behind thisphenomenon. It explains the rational behind the Utpatti of Raja, its action forspecific time period, reason behind the restricted function of Raja to femalephysiology. The senses and the organs of the fetus are simultaneously manifestedexcept those that are manifested only after birth. For example, teeth,secondary sexual characteristics like beard and breast, signs of puberty like
  • 64. 64production of semen and ovum, and such other traits are developed later. Thisis the normalcy and anything other than this is abnormal. In fetus some characters are permanent and some are temporary. Thepermanent characteristics determine the masculine, feminine or neutralcharacter of the fetus. The characteristic features, which determine its maleand female sex, are either of spiritual or material nature. Materialcharacteristics are derived from sperm and ovum. Even though the seeds for secondary sexual characters like breasts andbeard are already present in the fetus. Due to the specific nature of the seeds,the organs manifest in later stage. This is on the analogy of the seed of cornsthrown on the ground, which sprouts only when a congenial atmosphere in theform of proper season etc. is available. Natural manifestations are not conditioned by any factor. Heaviness oflower limbs, intolerance, slackness, softness, presence of uterus and ovary andother characteristics features are of material (Bhautika) origin and are causedby the dominance of material factor (i.e.ovum) in the conception.This principle explains the reason why Upadhatu Rajas is related with femalephysiology and rational behind its function for a specific time period only.Other rationales put forth by Acaryas -: As in developing and aged plants flower and fruits do not come up, asin bud and decaying flowers or fruits the fragrance is not explicit, similarly infemales Raja (menstrual blood) and Stanya (milk) before twelve years andafter fifty years of age are not visible. Susruta has indicated that “Yoni Abhivrddhi” and slow accumulationof Raja causes its appearance in Yuvavastha. Bhavamisra has specified the Upacaya Rupa Vrddhi as the causativefactor for the Raja Utpatti. Upacaya means slow accumulation of the Raja inthe Garbhasaya.
  • 65. 65In Bhela Samhita the reason behind the Utpatti of Raja is elucidated as "DhatuParipurnatva."According to Dalhana purification process is the cause of Raja Utpatti. In Brhat Jatikam it is explained that the menstrual phenomenon is caused bythe influence of Candra and Mangala Grahas. According to Modern Science the gonadotrophic harmones and ovariansteroidal hormones are the causative factors for the menstrual blood. These are thereasons elucidated by classics regarding the Utpatti of Raja for specific time period.Formation of Upadhatu Raja:Different opinions of Acaryas and Controversies regarding its formation: -There are many references regarding the formation of Raja.In fifteenth chapter of Caraka Cikitsasthana, Acarya Caraka dealt withnourishment of Upadhatus from respective Dhatus. "Rasat Stanyam Tato Raktam ... |"[C.Ci. 15/17]In the context he elucidated that from essence part of Rasa, Stanya and Rakta(which is suggestive of Raja i.e. menstrual blood) are formed. Instead of theword "Tato" commentator Gangadhara used the word Striyah as –"Rasat Stanyam Striyah Raktam |"In this context he opines that in pregnant women the essence of food (AharaRasa) is divided into three parts.1. One portion provides nourishment to the developing embryo.2. Second portion nourishes Stanya (breast milk).3. The remaining one gets transformed into Rakta Dhatu.This is the case in pregnant women. In non-pregnant women there is no suchdivision of Rasa and hence Rasa directly metamorphoses to Rakta. In this wayMamsadi Dhatus are nourished in progressive order. When the Suksma partcomes to Sukra Dhatu, due to the action of Sukra Dhatvagni major portion ofit metamorphoses to Artava Raktam and remaining small portion converts toSukra Dhatu. In this way Artava Rakta is formed after one month. When the
  • 66. 66Artava Rakta of previous month is excreted from the body the female isknown as Rtumati. This phenomenon is restricted to female physiology. Acarya Susruta illustrates the formation of Raja while explaining thedetails about Sonita (Rakta Dhatu). Posaka Rasa (essence of food) whencomes to the origin of Raktavaha Srotasa i.e. liver where it is acted upon byRanjakagni and metamorphoses to Rakta Dhatu. (S.Su.14/6). When the part ofthis Rakta comes to uterus, it is named as Raja. Here it shows the relationbetween Rakta and Raja. Dalhana states that the Rakta, which comes out ofthe uterus during Rtukala, is named as Raja. While commenting on thenourishment of Dhatus, Dalhana opines that just like Rakta Dhatu, Stanya andRakta Samjnaka Raja Upadhatu also nourished from the essence part of Rasa. Artava acquires its Ranjakatva along with Rakta (on seventh day). Thechannels, which traverse Raja, are very minute (Suksma), it procures all itscharacters after reaching to Garbhasaya, which happens at the end of themonth, that’s why Susruta used the term “Masena Artavam Bhavati”. He hasmentioned this Raja as Bija Rakta. Further in the same chapter Susruta hasmentioned the time required for the metamorphosis of Rasa into Sukra andArtava (S.Su.14/14). Further he has stated that this Raja comes to Garbhasayato receive male Sukra. Thus here Upadhatu concept and Stri Bija concept isintermingled. Commenting on this Cakrapani has opined that the above verseis related with formation of Raja and not with Stri Sukra. According toDalhana (in this context) the word Artava is indicative of Stri Sukra and notof Raja. Formation of Raja takes place after seven days along with Rakta. Theword Bhavati is for accumulation as well as revelation. Two Dhamanies transports Raja to Garbhasaya for a period of one month. It assumes slight black colour and specific Odor and brought downwards to vaginal orifice by Vayu for excretion. "Ubhabhyam Api Ca Etat Rasa Prasadatmakam l”[A.S.Sa. 5/93]
  • 67. 67 While explaining the Pramana (quantity) of Raja and Stanya, AstangaSangrahakara clearly mentioned that both these entities are derived from theessence of Rasa. In the first chapter of Sarirasthana, Sangrahakara states that Raktaitself comes to uterus and get accumulated for a period of one month then it isexcreted for three days as Artava. Here “Artava" word is used for Raja.Commentary of Indu: "Raktam Eva Sarvasya Dhatutvena Jayate |Tadeva Visistam Sad Artavam Iti Auh |"[A. S. Sa. 1/9]Rakta comes to Garbhasaya, accumulates for a period of month and expulsionof this cumulated Rakta to the exterior for three days is termed as Artava.There are two Dhamanies (channel) for the transportation of Rakta to uterus.Here also the process is quite confusing and difficult to understand whetherArtava should be considered as Upadhatu Raja or Stri Bija because this versehas come in the context of explanation of Stri Bija but the descriptionsimilitudes with Raja. In this context commentator Indu has explained thatthis Raja, which is visual to exterior is “Upalaksanatmaka” of that Artavawhich is not visual and also indicates the characters of Bija Artava. "Masi Masi Rajah Strinam Rasajam Sravati Tryaham |" [A.H.Sa. 1/7] Laghu Vagbhata has supported the opinion of Caraka. He opines thesame as Caraka stated previously. Arundatta opines that this Raja is formedfrom Ahara Rasa and not from Rasa Dhatu. In this context he mentioned thesetwo entities differently. In third chapter of Sarirasthana when he deals withthe nourishment of the Dhatu, he states them indifferent. Homogenousmixture of Rasa Dhatu and Ahara Rasa is now called as ‘Dhatu Rasa, whichfurther transforms to Rakta Dhatu."Rasat ....... Dhaturasat Ahara Rasena Sah Ekatam Apannat Raktam Prajayate|"[A.H.Sa. 3/62]
  • 68. 68Here, he clarifies that all the Dhatus including Rasa Dhatu derives theirnourishment from nutritive Rasa only.One of the commentators of Astanga Hrdaya, Sivadasa Sen in the samecontext of nourishment of Dhatus, states the difference between Rasa Dhatuand Ahara Rasa. Ahara Rasa, which nourishes all the Dhatus including RasaDhatu, is termed as "Posaka".Rasa Dhatu, which is nourished by Ahara Rasa, is a stable entity like otherSthayi Dhatus and is termed as Posya.Hrdaya (heart) is the site of Posya Rasa and Dhamanies are the site for PosakaAhara Rasa. But one cannot differentiate these two entities on the basis ofsite, Agni etc points. So, in the verse-"Rasat Raktam…|" [A.H.Sa. 3/62]Rasa means combination of Posya and Posaka Rasa.“Masena Upacitam Raktam Dhamanibhyam Tat Artavam |”[A. H. Sa. 1/22]Commenting on this verse Arunadatta has stated that Rakta Dhatu, whichreceives nourishment from the Ahara Rasa, carried through Dhamanies toGarbhasaya (uterus), where it is accumulated continuously for one month.That Rakta which comes out through vagina (Yonimukha) is termed asArtava. Here Artava word is used for Raja. In Kasyapa Samhita we get two contradictory statements in this regard.First statement is in Sutrasthana- Lehadhyaya. In this context the way ofdistribution of Ahara Rasa is mentioned in pregnant women.One part of it nourishes Stanya.One part provides nutrition to developing embryo and the remaining portionis used to nourish all the Dhatus.Second sutra has been stated during the explanation of "Raktagulmaviniscayain Khilasthana. In this context it has been mentioned that Sonita (RaktaDhatu) is responsible for nourishment of embryo, Stanya and all the tissueelements.
  • 69. 69 Sarngadhara has mentioned seven Upadhatus with respect to eachDhatu. Raja is mentioned as Upadhatu of Rakta. Bhavamisra has mentioned two conflicting statements in this regard.He opines-"Rasat Eva Rajah Strinam Masi Masi Tryaham Sravet |" [BH.Pu.3. 3/204]Raja is derived from Rasa. Here on the basis of Adhikarana Tantrayukti,Rasa is to be taken as Ahara Rasa. Subsequently while explaining theformation of Upadhatu from Dhatus revered seer has stated that the Raja isderived from Rakta Dhatu.Here it is clearly mentioned that Raja is Upadhatuof Rasa. (BH. Pu. 3/212)These are the different statements of various Acaryas regarding the formationof Raja. There are two main entities viz. Upadhatu Raja and Stri Bija Artava(ovum) related with female reproductive system. One is responsible forfertilization and other is for nourishment. The same nomenclature has beenadapted by the classics to explain these two entities. So it is difficult at someplaces to make out the difference between these two entities.The previous statements regarding the formation of Upadhatu Raja results inmaking a controversy whether it is the Upadhatu of Rasa or Rakta. Charactersof Raja show close resemblance with Rakta Dhatu.An attempt is made toresolve this controversy.Characters of Rakta Dhatu and its physiological Functions- "Sa Khalu Apyo Raso Yakrta Plihanau Prapya Ragam Upaiti |" [S. Su. 4/4] Rasa Dhatu when comes to the abodes of Yakrta it is acted upon byRanjakagni and gets transformed into Rakta. This Agni is responsible for itsRanjakatva (colour).It is having following characters:(1) Snigdha - unctuous
  • 70. 70(2)Guru- This property can be interpreted as Wt/vol>1, it means that Raktapossess specific gravity greater than water.(3) Cala - flowing (here the word ala also indicates the liquidity of Rakta.)(4) Swadu - Sweet to taste.(5) Pramana- Classics have described Anjali as the unit for measuring theliquid substances of the body. Pramana of Rakta Dhatu is mentioned as eightAnjali.(6) Varna- The colour of Rakta Dhatu is compared with the colors of othersubstances. Pure Rakta Dhatu can be likened to gold (purified with fire), firefly (Indragopa), red lotus, Laksa, fruit of Gunja (Abrus precatorius. Linn),blood of Rabbit and Sheep by various Acaryas.(7) Staining property of cloth - Revered commentator Dalhana narrates in thisregard as - "Vastradilagnam Sat Praksalyamanam Api Na Vivarnatam Yati |" [S.Su.14/22-Dalhana]The blood stained cloth gets easily washed and becomes stainless.(8) Gandha - Rakta Dhatu is having typical Visra Gandha.(9) Agneya Property – "Anusnasitam.... Raktam |" [S. Su.21/17] Anusnasitam Iti Sadharana -(Dalhana)Rakta Dhatu possesses Anusnasita property (i.e. not very hot, not very cold oftemperature). Due to this Character "Amla-Sita Prarthana" (wish to have coldand sour substances) is the symptom in Raktaksaya condition.(10) Relation with Pitta- "Prakrtam Tu Na Pitta Hetoh Utpadhyate l" [S.Su.14/5, Bhanumati]The vitiating factors for Pitta and Rakta are same but in normal condition thefactors required for the production of Rakta, not simile with those required inPittaksaya condition. "Tat Pitta Slesmalaih Prayo Dusyate |" [A.H. Su. 27/12]
  • 71. 71The excess amount of Pitta and Kapha Dosa vitiating Ahara causesaugmentation of Rakta.Function of Rakta Dhatu:(1) Jivana- The important function of Rakta Dhatu is Jivana."Raktam Jivasya Adharam Uttamam |"[BH. Pu. 3/139] "Jivanam Iti Prananuvartanam Karoti |" (Dalhana)It means that Prana, which is necessary for continuation of life, is circulatingall over the body through Rakta Dhatu. It is the media for conveyance ofPrana.(2) Varna Prasadana - Rakta Dhatu adds complexion / luster to the skin.(3) Mamsa Pusti- Rakta Dhatu provides nourishment to the subsequentMamsa Dhatu.Characters and Functions of Rasa Dhatu: - While dealing with the controversy it is essential to focus on thecharacters of Rasa Dhatu. Rasa Dhatu is having following characters (a)Sita-Cooling property (b) Snigdha- unctuous (c) Drava- liquid nature . [BH.Pu. 3/137]. ss(d)Pramana - Rasa is having Dasa Anjali Pramana in normalcondition.Functions of Rasa Dhatu:(a) Prinana: "Prinana Iti Tustim Karoti l"[S Su.15/15-Dalhana]"Dhatun Sarvan Ayam Rasah Pusyati |" [BH. Pu .3/137] It provides nourishment to all Dhatus and other body elements. This is the single entity through which every element of the bodyreceives nutrition.(b) Sariravrtti - It brings about various activities of the body.
  • 72. 72(c) Sarira Vrddhi - Growth and development of all body parts.(d) Prananubandha – It nourishes the Prana.Nutritional requirement of the Dhatus varies as per the age of individuals andthe size of the body.At various stages of life the function of Rasa Dhatu varies to some extent.(1) Tarpayati - throughout the life.(2) Vardhayati - during childhood when Dhatus are in developing,growing stage, they are in immature state. Rasa Dhatu by providingnourishment brings out the growth of the body.(3) Dharayati - During adult stage when Dhatu resumes their maturity, thefurther maintenance of these body tissues is achieved by the function of RasaDhatu.(4) Yapayati - due to derangement of Dhatu in old age, Rasa Dhatu enoughto support all of them.Hence it is stated that - "Vrddhanam Isat Prinano Bhavati -Jivanamatram Karoti |" [S.Su.14/19, Dalhana]The nourishing function is very much reduced at old age.IV) Synonyms of Raja: -Artava, Sonita, Asrk, Rakta, Lohita, Rudhira, Puspa, Asra.1. Artava: - "Rtuh Asya Praptah, An Yadva Rtuh Eva |" [SKD - 186] "Rtau Bhavam Artavam |" The word is mainly used for Stri Bija formed during Rtukala. Rarely italso comes to define the Upadhatu Raja. Rtu- It is indicative of specific time period. Bhavam- Occurrence.Raja is the substance, which manifests during specific time.The word is used for both Stri Bija and Upadhatu Raja.
  • 73. 732. Sonita: - "Sona Varne+ Ktah | Sona Varnacca He Raktibhavah |" [SSTMN]It indicates mainly the specific colour of that substance for which it is used.In Brhattrayi "Sonita" word is rarely used for Upadhatu Raja.In the classics it is used for Stri Bija and Rakta Dhatu.3. Asrk / Asra: - "Asyate Asu Ksepane | Na Srjati Va | Srja Visarge |"[A.K.223/64]"Asyate Ksipyate Itastato Nadibhih As Rji Va |"Ksepana means throwing, dispatching. [S-E Dic.]The substance, which is dispatching all over the body, termed as Asrka. Asrkaword is used for Upadhatu Raja, Stri Bija and Rakta.4. Rakta: - " Rajyate Sma | Ranja Rage |" [A.K. 223/64]The substance that has acquired redness through Ranjana process.The word principally indicates the Rakta Dhatu but also used in the context ofUpadhatu Raja and Stri Bija.5. Lohita: - " Rohati | Ruhyate Va | "[A.K. 223/64]It is mainly used for Rakta Dhatu and at few places for Upadhatu Raja and forStri Bija.6. Rudhira: - "Runaddhi | Rudhyate Va | Rudhira Avarane| " [A.K. 223/64] Runaddhi means to hold up. [S.E Dic.]In Caraka Samhita, while explaining the Raktagulma Cikitsa, Acarya Carakahas used only this word for obstructed menstrual blood. It also comes incontext of Stri Bija.7. Puspa: - " Pusyate | Puspa Vikasane |" [A.K. 210/21] "Alankarika" word.
  • 74. 74Puspa is indicative of future fruit. In the same way Raja is indicative ofMaturity of womans reproductive system. It is used for Upadhatu Raja andStri Bija.8. Raja: - " Rajanam | Rajyate Anena Va | Ranja Rage |" [A.K. 438/231] " Rajyate Anena Yonyadi Iti Rajah |" [BH. Pu. 3]It is used for both Upadhatu Raja and Stri Bija.Thus all the synonyms of Rakta Dhatu also come under description ofUpadhatu Raja.(4) To study the Prakrtatva of Raja - Menstruation is indicative of maturation stage of female physiology. Raja is the product of menstruation. It is one of the Upadhatusrestricted its purpose to female physiology. Menarche starts at the age of twelve years and continues upto fiftyyears of age. It is visible that between sixteen and forty years. Female is havingmaximum reproductive capacity. Every month Raja is conveyed through two Rajovahi Dhamanies toGarbhasaya. It accumulates there for a period of month and then by action ofApana Vayu it is excreted from the body.(I) Rtucakra (Menstrual Cycle) All Acaryas have considered intermenstrual period as one month. On the basis of available data the entire period of one month is dividedin to three stages as-a) Raja Srava Kala (Duration of menstruation)b) Rtukala (Period of ovulation)c) Rtu Vyatita Kala (Post ovulatory period)
  • 75. 75a) Raja Srava Kala There are different opinions regarding the duration of menstruation. Rajasrava Kala Opinion of Acaryas 3 Days Vrddha & Laghu Vagbhata, Bhavamisra & Susruta. 5 Days Caraka 7 Days Harita, Bhela.Revered seer Vrddha Vagbhata, Laghu Vagbhata, Bhavamisra and Susrutastates it as three days. Acarya Caraka mentioned it as five days.Revered seers Harita and Bhela mentioned the duration as seven days. During this period the stuff accumulated in the uterus during theprevious period of fertility is eliminated. The Raja, which is accumulated inthe uterus after Rtukala, is termed as "Purana Rajas". This accumulated Rajais eliminated from the uterus during Rajakala. (Ca Sa. 4/7, Chakra) This period is prohibited for cohabitation because it is inauspiciousduring this period fertilization cannot take place by the sperm. It will throwout just like a floating substance, which goes in the reverse direction in thewater current.Susruta has mentioned two parts of Dhamanies, out of which one reachs toUterus, which traverses Raja to uterus and another excretes it to exterior.Rtukala: -"Rtusca Nisiktasya Bijasya Phala Prasava Anugunah Kalah |" [A. S. Sa. 1/9 Indu] It is mainly related with Bija (Artava) .This is most fertile period of themonth.
  • 76. 76 Rtukala Opinion of Acaryas 12 days Caraka, Susruta Vrddha (Starts from 4th day of cessation of menstruation Vagbhata, Laghu Vagbhata, Kasyapa. 16 days Bhavamisra, Harita, Videha(Starts from 1st day of menstruation)Caraka mentions this period as twelve days. Revered seers Susruta, VrddhaVagbhata, Laghu Vagbhata and Kasyapa have supported this conceptregarding the number of days of Rtukala. Rtukala starts after cessation ofmenstruation and continues for twelve days.Bhavaprakasa mentioned it as sixteen days from the onset of menstruationthus Rajakala also included in it.The treatise of Harita and Videha has also mentioned it as sixteen days On the basis of Varna Paddhati (different castes) the further divisionof Rtukala is illustrated by Kasyapa and Bhavamisra.Varna Paddhati Kasyapa Samhita BhavaprakasaBrahmana 12 days 12 NightsKsatriya 11 days 10 NightsVaisya 10 days 8 NightsOthers / Ksudra 9 days 6 Nights [BH.Pu. 3/2] [KA. Sa. Jatisutriya -5] The Yoni (external Os of uterus) closes after Rtukala like a lotusflower closes at the end of the day so the sperm fails to enter the uterus.Therefore it is thought that the chances of conception are very rare after theperiod of Rtukala. If Yoni, Garbhasaya and Artava are in good condition (healthyreproductive system and ovum) Rtukala may continue for entire month.
  • 77. 77With Rtukala inception previous menstrual cycle overs and another becomesset in. The Bija Artava, which comes up and settles in the Garbhasaya duringRtukala, is termed as Suddha Sonita (i.e.Stri Bija). Dalhana clarifies about this controversy that when sixteen days ofRtukala is considered, it should be counted from the first day of the onset ofmenses, and if it is counted as twelve days, it should be counted from fourthday of the menses, first three and last day of constriction of Yoni should beexcluded from this. Laghu Vagbhata states that on eleventh and nineteenth day the coitus isstrictly prohibited since it results in eunuch. Susruta has mentioned the prohibition on thirteenth day. At one placein Sarirasthana, Acarya Caraka has illustrated the specific act to procreate ason of desired qualities. In this regard he has advised the abstinence for firsteight days then suggested a process named "Putrayasti Yajna" and thensuggested cohabitation for eight successive nights. In this way in successive days of Rtukala progeny will have maximumqualities. Artava Bija of the Rtukala is said to be fresh (Nava) and stable. Itshould be settled (Avasthita) and if not, fertilization fails.C) Rtuvyatita Kala: - The period after the constriction of the Yoni (external os of uterus)upto next menstruation is termed as Rtuvyatita Kala. The term is not clearlymentioned by the classics. The Raja, which is accumulated over this period oftime, is called as "Purana Rajas""Purana Iti Rtukala Atikrama Samcite |" [C. Sa. 4/7 Cakra]Menstruation cycle ends with evacuation of this "Purana Raja. Thus itexplains monthly physiological process related with Upadhatu Raja.Characters of Upadhatu Raja: -1. Varna: - The colour of menstrual blood is compared with substances ofuniverse on the basis of their analogous nature. The example elucidated by
  • 78. 78classics while considering the colour of Raja similitude with those explainedpreviously in the context of Rakta Dhatu.2. Quantity: -Some Acaryas have stated the quantity of Raja on the basis ofAnjali Pramana as four Anjali. Anjali Pramana of Raja seems to be muchscientific because each woman has different size of Anjali from the other oneand amount of Raja Srava measured by her own Anjali is a better parameterwhich indicates the healthy condition of her physiology. If it is increased ordecreased than four Anjali is considered to be deviation from normalphysiology." Naivati Bahu Natyalpam Artavam Suddham Adiset |" [C. Ci. 30/225] Acarya Caraka has not mentioned any fixed quantity of Raja. Thequantity should not be very excess or less. The quantity of menstrual bloodvaries according to Desa, Kala, Ahara, Vihara, and Prakrti etc. The quantity,which is normal for one woman, may be abnormal for another one. According to modern science the average total loss is estimated toabout 60 ml. ranging from 30 to 180 ml (from 1 to 6 ounces). Average – 35 ml, ranging from 5-60 ml- (Dawn) Average loss of iron was found as 12 mg. The loss widely varies and becomes greater in women living in warmclimate than those living in cold climate.3. Staining property: - The untainted menstrual blood does not stain the clothafter washing.4. Gandha: - It should be devoid of any type of odour. According toHiranyaksa, Artava is having peculiar odour like Madhugandhi. The discharge has a characteristic odour caused partly by bacterialaction and degeneration and partly by accompanying secretions of sebaceousand apocrine glands of vulva.5. Agneya property: -"Artava Sonitam Tu Agneyam |" [S. Su. 14/7]
  • 79. 79 Direct reference of Agneya character of Raja is not mentioned inclassics. But both Stri Bija and Raja are having same Yoni (Upadana Karana),so Raja also possesses the same Agneya character. Due to Agneya characterof Raja, habitual use of substances having homologous quality results intoincrease in the Upadhatu quantitatively within normal limits. Due to Agneyacharacter of Raja during Rajaksaya Cikitsa, the diet prescribed are oil, Masa(black grain), flesh that increases the Pitta and Kapha and finally Raja.Menstrual blood should be devoid of sliminess, pain and any type of burningsensation.III) Composition of the menstrual blood (Raja): - One half to three fourth of the discharge is blood.Remaining constituents are as follows: Cervical mucus, fragments of endometrial tissue containingmacrophages, histocytes, mast cells, bacteria, desquamated vaginalepithelium, estrogen level five times greater than that of circulating blood,Cholesterol, estrogen, variety of lipids, prostaglandins PGE2 & PGF2,anticoagulant substance likes fibrinogen. Menstrual blood is rich in calcium.It also contains monotoxin named as euglobulin debatably termed menstrualtoxin. Only menstruating endometrium is having toxic character. Progesteronesensitized endometrium is more toxic. Smith and Smith identify it aseuglobulin, catabolite formed or released by the disintegrating endometriumfollowing the withdrawal of hormonal support. Euglobuline is havingpyrogenic and fibrinolytic properties.(5) Modern Counterpart: -I) The Anatomy of Genital Organs: For the knowledge of physiology first step is to have the knowledge ofanatomy.
  • 80. 80 Anatomy of the organs, which are directly concern with the topic, areexplained here.THE UTERUS:Position: The normal position is one of the antiversion and antiflexion. The walls of the uterus are about 1.25 cm thick. It is divided into - 1. Body of corpus 2. Isthmuss 3. Cervix1.Body of corpus: Further divided into fundus and the body proper. The superiolateral angles of the body, where the uterine tube isattached, named as cornu of the uterus.2. Isthmus: It is a constricted part measuring about 0.5 cm situated between thebody and the cervix. It is limited above by the anatomical internal os andbelow by histological internal os.3. Cervix: This is the lowermost part of the uterus lies between histologicalinternal OS and external OS. It measure about 2.5 cm in length and diameter.It is divided in two parts- 1. Supra vaginal part 2. Part lying within the vaginaCavity: - Cavity of uterine body is triangular. Normal length of the uterinecavity including cervical canal is 6-7 cm.STRUCTURES: It is a hollow seromuscular structure lined with mucous membranewithout any submucous layer.The layers are as follows (outside inwards)-
  • 81. 81I) Peritoneum: It is the serous coat, intimately adherent to the underlying muscle.(II) Myometrium: It consists of plain muscle tissue and fibrous tissue in varyingproportions at different periods of life.It consists of three layers (outside inwards): -1. Outer longitudinal layer - called pace maker of the uterus.2. Middle interlacking - Forms the main bulk of the uterine wall. Alsocalled vascular layer because the muscle fibers from figures of eight aroundblood vessels.3. Inner thin circular layer - Chiefly developed at the tubal ostia and theinternal os.(III) Mucous layer (endometrium): Rests directly on the muscle without the intervening sub mucous layer. It measures 1-6 mm in thickness in the various phases of the menstrualcycle.The structures are as follows:(i) Epithelial lining: (a) Of the surface and (b) Of the glands(a) The surface epithelium consists of single layer of low columnar cellsresting on a basement membrane but ciliated.(b) The glands are the growth of the surface epithelium and are simple tubulartype lined with the same type of epithelium but non-ciliated Electronmicroscope of surface epithelium shows two types of epithelial cells - 1. Secretary with microvilli 2. 5-15% intervening ciliated cells.(ii) Stroma or supporting tissue is composed of three types of cells as follows.
  • 82. 821. Stellate connective tissue cells with branching fibrils, which unite with those of adjacent cells to form a supporting reticular network.2. Stroma cells are embryonic mesenchymal cells and assume various shapes and sizes viz. elliptical round or fusiform. They fill up spaces of the reticular network and undergo changes under harmonic stimuli.3. Lymphocytes and polymorphonuclear leukocytes are also present.(iii) Blood and lymph vessels are also present along with nerve ending. Endometrium is divided into two layers.1) Stratum basalis (Basal layer)2) Stratum functionalis (Functional layer)Basal zone: It is about 1/3rd of the total depth of the endometrium and lies incontact with myometrium. In this part stromal cells are compactly placed. Thezone is uninfluenced by hormone and as such no cyclic changes are observed.The regeneration of all the components occurs from this zone.Functional zone: It is under the influence of estrogen and progesterone.THE CERVIX:1. Serous layer - Covers only the post surface of the supra vaginal cervix.2. Muscle layer - It is mainly a fibrous and elastic tissue structure mixed with involuntary muscle, arranged spirally.3. Mucous layer -a) Endocervix: It lines the cervical canal. A single layer of tall mucified secretary columnar cells lines the surface epithelium with basal nuclei and surface microvilli and intervening a few ciliated epithelial cells. The basement membrane is thin and continuous. The glands are of tubular branching type and are lined with non-ciliated secretary columnar epithelium. Endocervix shows branching folds like that of a tree on both anterior and posterior walls; this mucous pattern is called arbor vitae.
  • 83. 83b) Squamous epithelium: It covers the portio vaginalis upto cervicovaginal junction.Transitional epithelial zone: At the external OS, epithelia, lining abruptly changes from columnar toSquamous epithelium.BLOOD SUPPLY:Arterial supply: The arterial supply is from the uterine artery one on each side. Theartery arises from the anterior division of the internal iliac. The other sources are ovarian and vaginal arteries to which the uterinearteries anatomies.The Course of Uterine Artery: - Uterine artery originates from anterior division of internal iliac artery(either in common trunk with obliterate hypogastric artery or rarely asseparate vessel) From uterine artery – Segmental Arcuate Arteries are given anteriorlyand posteriorly in the outer third of myometrium. Multiple Radial Branches arises perpendicular from arcuate arteriesand runs spirally to supply deeper myometrium and ends at myoendometrialjunction into:(1) Spiral Endometrial Arteries – It run to superficial endometrium to end in capillary plexus to anastomosis with Venus lakes. It supplies middle and superficial part of endometrium. These are named as " Arteries of Menstrual Bleeding."(2) Basal endometrial arteries supplying basal portion of endometrium.Lymphatics of the Uterus:(i) Intrinsic lymph drainage
  • 84. 84 (1) The endometrial plexus(2) Subserous lymphatic plexus(ii) Extrinsic lymph drainage: From the uterine corpus into the following three groups of lymph nodes (1) Para aortic lymph nodes (2) Superficial inguinal group (3) External iliac group. From the cervix into the following types of lymph nodes: (i) External iliac group. (ii) Obturator group (iii) Paracervical node (iv) Internal iliac group (v) Sacral groupLymph from all the above groups of lymph nodes drains into the commoniliac and para aortic groups of lymph nodes. Free anastomosis exists between the lymphatic of the uterus, fallopiantube, ovary, vagina, vulva, and also with those of adjacent pelvic organs.Veins: These channels corresponds to the arterial course and drain intointernal iliac veins.Nerve supply: Sympathetic components are from T5 and T6 (motor) and T10 to L1spinal segments (sensory) The parasympathetic system is represented on either side by the pelvicnerve consist of both motor and sensory fibers from S2, S3, S4. It also has the power of rhythmic contraction independent of extrinsicnerve supply.The Ovary:
  • 85. 85 The ovaries are paired sex glands or gonads in female, which areconcerned with:(1) Germ cell maturation, storage and its release(2) Steroid genesis.Structures: Single layer of germinal epithelium covers the ovary. The substance of the gland consists of outer cortex and inner medulla.Cortex: It consists of stromal cells, which are thickened beneath the germinalepithelium to form tunica albuginea. The follicular structures called thefunctional units of the ovary presents in various phases of their development.Medulla: It consists of loose connective tissue, few unstripped muscles, bloodvessels and nerves.Blood supply is from the ovarian artery - branch of the abdominal aorta.II) Role of Endocrines: -Role of Endocrines in Development of Female Reproductive System andRegulation of Menstrual Cycle: -.Harmones secreted by hypothalamus, anterior pituitary gland and ovariescontrol the principal events.1) Hypothalamus: With the onset of puberty the negative feed back effect of estrogen onhypothalamus is gradually lost. GnRH pulses from hypothalamus results ingonadotrophin secretion. Hormones secreted by hypothalamus which control the secretion ofother glands are:(1) GHRH (Growth hormone releasing hormone) stimulates the release ofhuman growth hormone.
  • 86. 86(2) GnRH (gonadotrophin releasing hormone) stimulates the release andsynthesis of both LH and FSH hormone from anterior pituitary and alsomaintains the synthesis of these harmones. It plays an important role in the neuroendocrine regulation.2) Pituitary Hormones:Anterior pituitary -(1) FSH - Follicle stimulating hormone is transported from the anteriorpituitary gland to ovaries. There it initiates the development of follicles eachmonth after puberty.(2) Luteinizing hormone (LH) Together with FSH stimulates secretion of estrogen by ovarian cellsand brings about the release of secondary oocyte by the ovary; it alsostimulates formation of the corpus luteum in the ovary and the secretion ofprogesterone by the corpus luteum.3) Thyroid Hormones: Under the action of TSH, secreted by hypothalamus, thyroid glandsproduce tyroxine (T4) and triiodothyronine (T3) these hormones bring aboutgrowth and development. Due to thyroid hyperfunction ovarian failure occursdue to hypofunction estrogen are produced low.(4) Gonadotrophin Hormones: The ovaries produce female sex hormones called estrogen andprogesterone.(5) Adrenal Cortex: Estrogen and progesterone is secreted in smallamount.HORMONAL REGULATION: The uterine and ovarian cycle are controlled by gonadotrophinreleasing hormone (GnRH) from the hypothalamus. GnRH stimulates therelease of follicle stimulating hormone (FSH) and luetinizing hormone (LH)from anterior pituitary gland. FSH stimulates the initial secretion of estrogens
  • 87. 87by growing follicles. LH stimulates the further development of ovarianfollicles and their full secretion of estrogen, brings about ovulation, promotesformation of the corpus luteum, and stimulates the production of estrogen,progesterone, relaxin and inhibin by the corpus luteum. Estrogen is present principally in three forms Beta (B) estradiol,estrone and estriol.Function of Estrogen - It is very important hormone, which govern the female reproductivesystem.(1) They promote the development and maintenance of femalereproductive structures, secondary sex characteristics and the breast.(2) They help to control fluid and electrolyte balance. The total physiological effect of estrogen can be seen in conversion ofa girl into a woman with sexual maturity.(1) Genital Effect - Estrogen develop ovaries and make them sensitized togonadotrophins, estrogen develops secondary sex organs as vulva, vagina,uterus and fallopian tubes. Estrogen cause these developed genital organs tofunction cyclically for reproduction.(2) Effect on Secondary Sex Characteristics: Estrogen causes fatdeposition in breasts, development of stromal breast tissue, nipple and areola.Along with adrenal androgen it develop faminine pubic and axillary hair.Estrogen develops feminine adiposity and figure. Estrogens maintain all thesecondary sex characteristics.(3) General Effects: - Ovulation Inhibition - Estrogen inhibits ovulation through negativefeed back control on FSH and LH. Vascular Effect - It causes capillary vasodilatation particularly in theendomerial capillary bed.
  • 88. 88 Nervous System - Estrogen controls female hypothalamus making it towork cyclically.Physiological Functions of Progesterone:(1) Genital Effect: It inhibits uterine contractibility. In case of pregnancyensues in uterus, progesterone act as pregnancy hormone making the uterusquiescent to run the pregnancy.(2) It promotes tubal secretion helping transport of zygote.(3) It promotes development of lobules and alveoli in the breast preparingthem for lactation.(4) General Effect: (a) Progesterone inhibits LH surge by negative feed backmechanism. (b) It increases basal body temperature acting on hypothalamus.Effect of Gonadotrophin Hormones on Menstrual Cycle: -(1) Proliferative Phase- Oestradiol from ovarian follicles causesproliferative changes in uterine endometrium.(2) Secretary Phase - Act synergistically with estrogen, progesteronecauses secretary changes in endometrium to receive fertilized ovum forembedding.(3) Menstrual Phase - degeneration of corpus luteum causes withdrawal ofestrogen and progesterone leads to menstruation.III) Physiology of Menstruation: - Menstruation itself represents failure of fertilization, a missedconception. It is the dismantling and shedding of an endometrium elaboratelyprepared for the reception and housing of a fertilized ovum. Immediatelythereafter, the reconstruction of the endometrium, once more in anticipationof fertilization, begins a new. This process is interrupted only when
  • 89. 89fertilization occurs and goes on throughout the reproductive life of thewoman. The menstrual cycle is divided into three phases(2) Stage of regeneration(2) Menstruating phase(3) The proliferative phase / Preovulatory phase / Estrogen phase(4) Secretary phase / Progesterone phase / Post ovulatory phaseStage of Regeneration: Estrogen in turn produces re-growth of the endometrium. Regenerationstarts even before the menstruation ceases and is completed 2-3 days after theend of menstruation. The glands and the stromal cells are regenerated fromthe remnants left in the basal zone. The glands are lined by the cubicalepithelium and lie parallel to the surface. The stromal ground substance re-expands the apical cell surface contains microvilli and some ciliated cells arepresent.Stage of Proliferation: During this stage endometrium attains a thickness of 3.5 mm.In the beginning the endometrial glands are narrow tabular widely scattered inthe stroma and lined by moderately low columnar epithelial cells withirregularly located nuclei. Surface epithelium resembles that of the glands.The stroma is dense and contains small number of lymphocytes amongst thelarge population of mensenchymally derived cells. Mitosis is very active, inrelatively dense stroma, small blood vessels run obliquely from basal layertowards surface, where they form loose capillary network. Glands becomedistinctly tortuous. The lining epithelium becomes tall columnar. Histochemically the epithelium is shown to contain large amount ofribonucleoprotein, alkaline phsophatase, signifying the production andutilization of protein.
  • 90. 90Secretary Phase (Premenstrual Phase): Estrogen continues the process of endometrial proliferation, though asmaller degree and the progesterone produces the differentiative alternationscharacterizing this phase of the endometrial cycle. In early secretary phase glycogen masses (known incorrectly as"subnuclear vacuoles") appear in the basal cytoplasm of epithelial cells liningthe gland, where they are often associated with lipid nuclei thus displacedtowards the center of the cells. Giant mitochondria appear and are associatedwith semi rough endoplasmic reticulum. A notable increase in polarization ofthe gland cells occurs with Golgi apparatus and secretary vesiclesaccumulating in the supra nuclear cytoplasm. By the mid secretary phase the endometrium may be up to 6 mm deep. The basal epithelial glycogen mass is progressively transferred to theapical cytoplasm nucleus return to the cell base. The Golgi apparatus becomes dilated and the secretions includingglycogen, mucin and other glycoproteins are released from the glandularepithelium in to the lumen, increase in volume of gland lumens. In the early secretary phase the packing density of the residentmesenchymal cells increases. In mid secretary phase the notable edema appears with a correspondingdecrease in the density of collagen fibres at the same time the endoplasmicreticulum and Golgi apparatus become more prominent and there is evidencefor new synthesis of collagen as well as endocytosis and degradation. Since the glands become more voluminous and their walls folded uponthemselves so that tuft like processes project into the lumen this givesglandular wall saw toothed appearance. The well developed secretary type of endometrium present mostphenomenal constructive change in the two functional layers of mucosa.(1) The superficial Compacta layer: represent a thin zone, composed of the (1) Neck of the traversing uterine glands,
  • 91. 91 (2) Engorged Venules (3) Large polyhedral stroma cells with abundant cytoplasm andlarge round nuclei. This closely resembles the decidua cells of pregnancy.(2) Middle layer is spongiosa, which is composed of (1) Dilated tortuous glands (2) Thin arterioles (3) Narrow bridges of decidua like stroma cells.(3) Nonfunctional layer: (1) Contains the inactive fundi of the glands (2) Almost unchanged in structure. Lymphocytes appear in the endometrium in increasing number. Progressive increase in vascularization occurs in all three layers of theendometrium during this phase. So that numerous wide vessels appear in thestroma. During the week preceding menstruation, the uterus becomes soft andslightly larger because of actual growth of the muscle cells. During proliferative, early and midsecretory phases of the cycle, thebone marrow derived cells present in the endometrium are mainlymacrophages and classic T cells, with very few B cells. In late secretaryphase, an unusual, large granular lymphocyte population is recruited to thetissue and is found mainly in the stromal compartment. If fertilization fails due to withdrawal of hormonal influence thefollowing changes occur in the endometrium.(1) Collapse of the secretion filled glands.(2) Leukocyte infiltration.(3) Considerable thinning of the two superficial layers of the endometrium, because of loss of tissue fluid and decrease of blood flow.Menstrual Phase:
  • 92. 92 Disintegration and exfoliation of the two functional layers of theendometrium i.e. stratum compactum and stratum spongiosum takes place inthis phase. Embracing approximately three fourths of the uterine lining.Outwardly this phase is marked by a discharge of blood with necroticepithelial and stromal debris from the uterus through the vagina(IV) Mechanism of Menstruation: The increased coiling of the spiral arterioles that results from theshrinkage of the endometrium creates circulatory stasis, leading to furthertissue ischemia. This is followed by a profound vasoconstriction of spiralarterioles supplying the two functional layers, causing, focal necrosis of theirwall and of the surrounding tissues. The necrotic process opens blood vesselsand bleeding ensues. Escape blood form haematoma beneath the surface epithelium, whichraise it. Blood and necrotic endometrium then begin to appear in the uterinelumen. Shedding starts at the surface and extends into the deeper layers. Menstrual blood from the endometrium clots in the uterine cavity by itsthromboplastic property. The clots are dissolved by the fibrinolysins releasedfrom the endometrium. Fibrin degradation products there fore circulates inincreased amount during menstruation. Though it is proved that the menstruation is based solely uponhormonic withdrawal and regards the spiral arterial system as an essential partof the mechanism, all investigators accept the important role of local stimulus.The following factors are taken in to consideration in these regards.Unknown endometrial bleeding factor:(1) According to Markee, it seems to be a vasoconstrictor of great potency, selectively acting on the coiled spiral arterioles.(2) Contractile elements surrounding the anastomotic vessels.(3) Inadequate lymphatic drainage: Endometric lymphatic channels are suggested to inadequate to provide a ready mechanism for the removal
  • 93. 93 of the protein catabolite formed following withdrawal of metabolic support of the endometrium.(3) The unknown local bleeding factor may be the menstrual toxin euglobulin, the catabolite formed or released by the disintegrating endometrium following withdrawal of hormonal support. It also shows pyrogenic and fibrinolytic properties. The circulating blood of women shows protective pseudoglobulin during menstruation.(4) Role of Prostaglandins: Prostaglandins produced in the endometrium in the late luteal and menstrual phases, coinciding with the fall in blood and local progesterone level. PGE2 and PGI2 (prostaglandin) have vasodilating activity.(6) FUNCTIONS OF UPADHATU RAJA - Artava plays a very important role in reproduction, which is essentialfor continuation of the species.(1) It is responsible for "Ksetrikarana Prakriya" "Narinam Rajasi Ca Upacayamane Sanaih Sanaih Stana Garbhasaya Yonibhih Abhivrddhih Bhavati |" [S. Su. 12/15 C.H. Sen Calcutta Prakasana -Pathabheda] Menarche age is mentioned as twelve years. On the contrary theconceptual period starts from sixteen years of age. The mid period is essentialfor complete maturity of reproductive system and organs related. Theaccumulated Raja plays substantial role to provide nourishment to theseorgans. This process is termed as "Ksetrikarana" of Stri Sarira. Raja helps toprepare the body to receive the embryo.(2) Nutritive function of Artava -Microscopic picture of the secretary endometrium closely resembles withearly decidua.a) The postovulatory endometrium contains acid phosphatases, malic andsuccinic dehydrogenases, cytochrome oxidase and adenosine triphosphatase
  • 94. 94with large amount of glycogen and fat presumably to supply nutrition for thefertilized ovum.b) The amount of Glycogen per 100 GM of endometrium is variously estimatedat 0.25 to 0.65 GM.c) The postovulatory constructive changes in the endometrium already described occur in preparation for the reception and maintainance of a fertilized ovum.(3) Every month it provides basis for the developing embryo. If fertilization occurs, due to developing embryo Rajovaha Srotasa get obstructed. Part of accumulated Raja ascends upward, help in formation of placenta.(4) The secretary endometrium of pregnancy now called as decidua of the pregnancy. It takes part in formation of placenta. It provides good nidus for the implantation of the blastocyst. Previously mentioned nutritive secretary endometrium afterfertilization provides nutrition to the early stages of growing ovum by its richnutritive contains. The blastocyst derives nourishment from tubal and uterinesecretions, subsequently, during the process of embedding, from productsstemming from the lysed uterine tissue. Then following period of about two weeks during which the embryonicdisc is dependent on the nourishment obtained from the fluid, which fill thecavity of the amnion, the coelom and the yolk sac. These fluids containmaterial absorbed by the trophoblast from the lysed uterine tissues andextravasated maternal blood, selectively modified perhaps as they passthrough the cellular walls of these various cavities. Thus endometrium isnutritive and supportive to developing embryo. This explains the nutritive roleof Upadhatu Raja for fetus. In this way the "Garbhakrtatva" of Upadhatu Rajais proved.
  • 95. 95 Dalhana has narrated that the Rajasrava (menstrual flow) is veryimportant to save women from many diseases like Prameha etc. In otherwords it could be said that it is one type of purification process for femalesand by which genital track of female gets purified.
  • 96. 96"Vikaro Dhatu Vaisamyam, Samyam Prakritih Ucyate|" [C.Su. 9/4 -Cakra]Equilibrium of Dhatus is Prakrti that is health. Any disturbance in theequilibrium of Dhatus constitutes Vikara that is disease.The term Dhatu comprises Tridosa, Saptadhatu and Upadhatu. Anydeficiency or excess in the normal quantity of Dhatus causes Vikara.The moment there is any increase or decrease in Dhatus, it is bound toproduce a disease with symptoms excessive or deficient as the case may be."Swadhatu Vaisamya Nimittah Sarve Vikara Vata Pitta KaphatNativartante |" [C.Su.19/5]No endogenous disease caused by disturbance of equilibrium of Dhatus canoccur without the vitiation of Vata, Pitta and Kapha."Ksinah Jahati Swa Lingam |" [C.Su. 9/4]Dosa, in deficient condition cannot produce Vikara.So in most of the cases vitiated Dosa further vitiates Dhatus, which causesmanifestation of disease."Atipravrtti Laksanam Artavasya Vikrti – Asrgdaratva Nama Uchyate |"[S. Sa. 2 Dalhana]1. Vaisamya of the Dhatus as well as of Upadhatus is of two types i.e. Vrddhiand Ksaya. Concentrating on Vrddhirupa Vikrtavastha of Artava.
  • 97. 972. Atipravrtti (excessive excretion) of Artava is indicative of augmented stateof Artava.3. Increased vitiated status of Upadhatu Artava, the Dosa DusyaSammurcchana behind it and the associated symptoms are explained underthe heading of Asrgdara.Literary review of Asrgdara and its modern counterpartAcarya Caraka described Asrgdara as synonymous with Pradara.[C. Ci. 130/204]Susruta refers to it in the context of Sukra Sonita Dusti.Sarngadhara termed it as Raktapradara. Astanga Samgraha, Cakrapaniconsider the Raktayoni as synonym of Asrgdara.While explaining the Cikitsa of Raktayoni, Caraka at few places used theword Asrgdara synonymous with Raktayoni. Asrgdara is mentioned as one ofthe complications of Yonirogas. It is one of the symptoms of Pittavrta Apana.Kasyapa and Caraka have mentioned it under the Raktaja Vyadhi.1] Pradara =>In the word Pradara ‘Pra’ is a prefix indicating the excessiveness or “intensityof “Prakarsana” or “Utkrstatama Bhava” along with Dhatu“Dr – Vidarane – Daranam l” of which it is comprised."Daranam" means cleaving, breaking, flowing. [S.E. Dic.]
  • 98. 98A phenomenon in which there is an excessive or intensive flow of blood fromvaginal orifice. “Dara” word is indicative of wear and tear phenomenongoing on in the bodyThe great seer Caraka elucidates –"Rajah Pradiryate Yasmat Pradarah Ten Sa Smrtah |" [C. Ci. 30/209]Excessive excretion of Raja is termed as Pradara.Commenting on above verse Cakrapani has narrated that“Pradiryate Iti Vistarito Bhavati Iti Pradarah |” [C. Ci. 30/204 – 209 Cakra]"Vistara" means extended, expanded. [S.E.Dic.]At this point the stress has been laid on the prolonged process ofmenstruation. The bounce and bouts of the vitiated blood oozing out throughthe vaginal orifice are defined by the word “Pradara”.Asrgdara =>Asrgdara is made up of two words Asrk and DaraAsrk --- “Asu Ksepane” [A.K. page 223/64]Ksepana means throwing or sending or dispatching. [S.E. Dic.]“Asyate Ksipyate Hrdayena Cakravat Parivrtya Nikhile Dehe Iti Asra |”Asrk is that which resides and accumulates in the Hrdaya to circulate swiftlyall over the body.Cakrapani elucidates that  “ Asrk Diryate Yasmin Iti Asrgdara|” [C. Ci. 30/204 – 209, Cakra]
  • 99. 99This is the condition in which the Rajo Rakta (menstrual blood) flowsabundantly from the uterus. “Artava Atipravrttitvena Asrgdarah|” [SA.Pr. 7/146 Dipika]Due to excessive flow of Artava, it is termed as Asrgdara.Bhavaprakasa States that  “Asra Diryate Cavyate Asmin Iti Asrgdara |” [BH. U. 68/2]Excretion of the vitiated Raja in bulk quantity through the vaginal tract isknown as Asrgdara.Susruta illustrates in this regard"Tadeva Atiprasangena Pravrttam Anrtau Api Asrgdaram Vijaniyat |" [S. Sa.2/18]The term Atiprasangena means-1. "Atipracuryena" – Excess in quantity2. "Dirghakalanubandhena Ca- For long duration [Dalhana]Excessive and/or prolonged menstruation during menstrual period or evenduring intermenstrual period is known as Asrgdara.Astanga Sangrahakara opines the same in this regard.According to annotator Dalhana, scanty menstruation for short durationduring intermenstrual period also considered as Asrgdara.Modern medicine has described the above condition under three mainheadings as follows: -
  • 100. 100Polymenorrhoea - This means too frequent menstruation at regular intervalsof two weeks but less than three weeks. Such cyclical bleeding can be normalin amount but when heavy, is known as epimenorrhagia.Metrorrhagia - This is intermenstrual irregular uterine bleeding.Menorrhagia - Excessive menstrual loss in amount or duration or bothcausing more than 80 ml blood loss is menorrhagia. Considering the definitions elucidated by various Acaryas, generalclinical features and the given pathogenesis, Asrgdara appears to beanalogous with menorrhagia.For the complete knowledge of disease it is essential to know the “NidanaPancaka”Nidana [Etiology] For the proper understanding, the Nidanas are broadly classified under thefollowing headings.Aharaja Hetu [Dietetic factors] All the factors mentioned below will cause the disease if they are consumedin excess amount.Acarya Caraka -Lavana (Salty), Amla (Sour), Guru (heavy), Katu (hot), Vidahi (producingburning sensation) and Snigdha (Unctuous substances), Mamsa (meat ofdomestic, aquatic and fatty animals), Krsara (olio made with rice and pulses),
  • 101. 101Payasa (rice cooked with milk and sweetened), Dadhi (curd), Sukta (vinegar)Mastu (curd water) and Sura (wine).Acarya Madhava-Viruddhasana (Incompatible diet), Adhyasana, Ajirnasana (eating before theprevious meal digests), Atikarsana (emaciation).Viharaja Hetu (Habitual irregularities): -Madhava-Ati Maithuna (excessive coitus), Ati Yanasevana (riding), Ati Margagamana(walking), Ati Bharavahana (weight lifting), Diva Swapa (day sleeping).Manasa Hetu (Psychic factors): -Madhava-Soka (grief).Anya Hetu (Mysterious factors): -Madhava-Garbhapata (abortion), Abhighata (trauma).‘Nidana Parivarjana’ forms the basis of the management and hence a closeand detailed probing of etiological factors is necessary.Intake of wholesome and unwholesome diet plays an important role in themaintenance of health and production of diseases respectively.Excess use of Amla Rasa will result in liquification of Kapha, aggravation ofPitta and vitiation of Rakta.
  • 102. 102Amla Rasa possesses Agni & Prthvi Mahabhuta Dominance.Excess intake of Lavana causes vitiation of Pitta, aggravation of Rakta andDarana.Jala and Agni Mahabhuta dominance is present in Lavana Rasa. Excess use ofKatu causes emaciation, vitiation of Pitta and Vata and aggravation of Rakta.Agni and Vayu Mahabhuta is present predominantly in Katu Rasa.Guru and Snigdha substances result in vitiation of Kapha with Rakta Dhatu.Dadhi vitiates Rakta, Kapha and Pitta.Vidahi substances aggravate Pitta and Rakta.Excessive consumption of aquatic and fatty type of meat results in vitiation ofRakta, Kapha and Pitta.Krsara and Payasa vitiate Kapha Dosa.Sukta, Mastu and Sura vitiate Rakta and Pitta Dosa.Viruddhasana causes vitiation of Vata, Pitta and Kapha Dosa, Agnimandya,Ama formation.Adhyasana and Ajirnasana aggravate all the three Dosas and are responsiblefor formation of Ama and causes Agnimandya.According to Caraka, Guru, Suska (dry) and Vidahi type of diet is alsoresponsible for formation of Ama and hence Agnimandya.Emactiation results in vitiation of Vata Dosa. On the basis of Guna Samanyathe Pitta Dosa vitiating factors, augment the Rakta and Artava.Now looking toward habitual irregularities 
  • 103. 103Excessive coitus causes vitiation of Apana Vayu, Vyana Vayu and results inDhatu Ksaya condition. It is also responsible for pelvic congestion.Vayu is responsible for all types of Gati or movements in the body.The excess movements like Atiyanasevena and Atigamana cause vitiation of(Vyana Vayu and Apana Vayu) respectively by Karma Samanya.Ati Bharavahana causes vitiation of Vata Dosa.Diva Swapa results in augmentation of KaphaRole of Manasika Nidana –"Kama Soka Bhayat Vayuh |" [C.Ci. 3/115]Soka causes vitiation of Vata Dosa. In modern science it has been shown by(one scientist) Wolf that all mucosae react to emotion in the same way theendometrium also. The emotional disturbances result into vasodilatation andhyperemia, which causes the profuse bleeding.Other Direct Causes Abortion followed by improper involution and increased endometrial area orincomplete abortion with retained bits of placenta / fetus results in excessivebleeding.Samprapti (Pathogenesis) Samprapti is the process of the manifestation of the disease. It deals with asto how Dosa – Dusya Sammurcchana occurs. This is the course of diseaseright from the affliction (due the etiological factors) till its manifestation. A
  • 104. 104good understanding of it is essential for early diagnosis, prognosis and foradopting preventive and curative measures.Samprapti Ghataka: -Dosa - Vata – Vyana, Apana Pitta – Ranjaka and Pacaka Kapha – Present as Anubandhita DosaDusya - Rasa, Rakta, ArtavaAgni - Jatharagni, Upadhatvagni, Rasagni, RaktagniSrotasa - Rasavaha, Raktavaha, ArtavavahaSrotodusti Prakara - Ati Pravrtti, VimargagamanaRogamarga - AbhyantaraAdhisthana - Artavavaha Srotasa, Rajovahi Sira, GarbhasayaVitiated Vyana Vayu is responsible for conduction of excessive amount ofblood to Rajovahi Sira (uterine vessels).Apana Vayu is responsible for intensive excretion of uterine product andSthanika Kha Vaignya.Vitiated Pitta due to Drava, Sara and Usna Guna further augments thequantity of Rakta and also vitiates the Rakta and Artava due to GunaSamanya.Vitiated Kapha along with Pitta responsible for vitiation of Rakta.
  • 105. 105Vitiating factors of Kapha similes with those of Rasa results in augmentationof Rasa. Since Artava is produced from essence part of Rasa, impure Rasacauses impure production of Artava.The process is explained as under:Caraka The particular etiological factors provoke Vata Dosa to augment in itsquantity.Due to specific Nidanas Rakta get vitiated along with Pitta Dosa.Some times Kapha followed by Pitta augments the Rakta.Then increased quantity of Rakta is driven by vitiated Vata through RajovahiSira enters the Garbhasaya (uterus).In the uterus vitiated and augmented Rakta gets mixed with Artava and thusincreases immediately the amount of Raja.Thus results in excessive flow of uterine blood causing Asrgdara.While elucidating the process, Acarya Caraka has used the word “RasabhavatVimantah |" [C. Ci. 30/208]Commenting on this verse Gangadhara says –“Rasabhavat Vimanata Bhavati Iti Swamanat Vivrddhamanata Bhavati |” [C.Ci. 30/208 - Gangadhara ].Since Artava is formed from the essence part of Rasa, so in the physiologicalstate it is present and formed in specific normal amount. In the presentpathological condition it is vitiated and augmented, hence the quantitatively
  • 106. 106increased status of Artava and its relation with Rasa Dhatu is indicated byAcarya Caraka.There is one more condition of Asrgdara elucidated by Acarya Caraka inCikitsasthana with reference to Avrtatva of Vata Dosa.“Lingam Pittavrte Apane Rajasah Ca Atipravartanam |” [C. Ci. 28/230]“Apane Pitta Samyukte Daha Ausne Syat Asrgdarah |” [S.Ni. 1/37]Vitiated Pitta obstructs the Prakrta Gati of Vata, which further causes thevitiation of Apana Vayu. This vitiated Apana results in to manifestation ofAsrgdara.Acarya Caraka has mentioned two basic causes of Vitiation of Vata Dosa. 1. Due to obstruction to the flow of Vata Dosa. 2. Deterioration of Dhatu.Third cause is due to its own etiological factors.In the first Samprapti, it is vitiated due to its own etiological factors and in thelatter one due to obstruction in its way. Vata plays important role in thepathogenesis of Asrgdara.
  • 107. 107 Nidana Ahara Vihara Manasika Anya Vitiation of Pitta Vitiation of Vyana Vayu Vitiation & Vayu carries Augmentation of vitiated Rakta Rakta through Rajovaha Sira to Gabhasaya Sthanika Vitiation & Augmentation ofApana Dusti Artava + mixed with Rakta Further immediate Augmentation of Artava Profuse Menstrual Bleeding Asrgdara (Pradara)
  • 108. 108Laksana (clinical features of asrgdara) - The Dosa, Dusya Sammurcchanaresults in manifestation of characteristic signs and symptoms.Lakshanas of the Asrgdara are grouped into three: - 1. Pratyatma Laksanas [Cardinal symptoms] 2. Samanya Lakshanas [General symptoms] 3. Visesa Lakshanas [Specific characters]1) Cardinal Symptoms: -Caraka has explained only symptom i.e. presence of excessive bleedingduring menstruation.According to Susruta profuse and/or prolonged menstruation during menstrualand/or intermenstrual period and different from the features of normalmenstrual blood is known as Asrgdara.2) General Features “Asrgdaro Bhavet Sarvah Sangamardah Savedanah |”[S. Sa. 2/19; BH. Ci. 68/2]“Artavam Angamardam Atipravrttim Daurgandhyam Ca |”[S.Su. 15/16]Associated symptoms along with excessive flow are: - 1. Angamarda (Bodyache/ Malaise) – Bodyache is due to obstruction to the passage of Vayu by increased Artava. 2. Vedana (pain) – “Vatadrte Nasti Ruja |” Pain is an important sign of presence of Vata Dosa.
  • 109. 109 3. Daurgandhya (foul smell)Dalhana has explained that this foul smell in menstrual blood is due topresence of Pitta Dosa.Visesa LaksanasClinical features of specific types of Asrgdara: -On the basis of dominance of specific Dosas involved in the pathogenesisAsrgdara is further classified as: 1. Vataja Asrgdara 2. Pittaja Asrgdara 3. Kaphaja Asrgdara 4. Sannipataja Asrgdara1. Vataja Asrgdara Characters of the menstrual blood  1. Phenila (frothy) 2. Tanu (thin) 3. Ruksa (ununctous) 4. Syava (dark brown / dusky) 5. Aruna (reddish) 6. Resembling with the colour of water of Palasa flower. 7. With pain or without painAssociated symptoms 
  • 110. 110Vitiated Vata Dosa produces severe pain in sacral, groin and cardiac regions,flanks, back and pelvis.1. Phenila (frothy) If some air is passed through any liquid, it creates bubbles or foam. In thesame way, when Vata Dosa vitiates Artava, it will naturally be froth.2. Tanu (thin) It indicates the decreased concentration of menstrual blood.Increased Vata Dosa decreases Slesma (the concentration is present due toSlesma). Vata decreases Slesma means a decrease in concentration andincrease in the thinness of the blood.3. Ruksa (ununctous)  Menstrual blood with vitiated Vata shows absenceof unctuousness, which is one of the characteristics of Slesma.Susruta and Vrddha Vagbhata have not classified the disease on the basis ofDosika predominance.According to commentator Dalhana the Dosika predominance of menstrualflow is to be judged by " Atidesa Tantrayukti" Characters of vitiated Rakta onthe basis of Dosa predominance is illustrated in Sutrasthana. These are to beconsidered while diagnosing the Dosika predominance elucidated inSutrasthana. These are to be considered while diagnosing the Dosikapredominance of menstrual blood.
  • 111. 111Susruta and Vagbhata have added that this Raja does not clot, Accha (limpid),flows quickly has after taste as Kasaya (astringent), smells like iron and iscold. Pittaja Asrgdara: - 1. Characters of menstrual blood 2. Nila (blue) 3. Pita (yellow) 4. Usna (hot) 5. Asweta (blackish) 6. Continuous discharge 7. Repeatedly and with painThe great oracle Susruta and Vagbhata added that blood vitiated with Pittaresembles with, water mixed with smoke or Rasanjana or Cows urine, greencolour, fishy smell, being bitter in taste and is not liked by flies does notcoagulate and if put in water it spreads all of a sudden evenly and all round.Dalhana explains that green, blue and blackish colours of blood are indicativeof Sama Pitta and yellow colour is indicative of Nirama Pitta.Associated symptoms: -Daha (Burning sensation), Raga (redness of the skin), Trsa (thirst), Moha(delusion), Jwara (fever), Bhrama (giddiness).
  • 112. 112The Nila, Pita and Syava colours of Raja are difficult to explain but may beindicative of a severe inflammatory condition of the genital tract andreproductive system.Kaphaja Asrgdara Character of menstrual blood  1. Picchila (sticky) 2. Pandura Varna (pale) 3. Guru (heavy) 4. Snigdha (unctuous) 5. Sita (cold) 6. Mixed with Slesma 7. Ghana (thick) 8. With mild painThe great seers Susruta and Vrddha Vagbhata added that Kapha dominatingmenstrual blood resembles with, water mixed with red ochre and flower ofKovidara, is excreted very slowly, get clotted like muscle, Lavana in taste andsmells like Vasa.Madhavakara and Bhavamisra have mentioned that in Tridosaja Asrgdara theexcreted blood resembles with honey, Ghrta and Haritala in colour,similitudes bone marrow and has putrid smell. This is incurable.
  • 113. 113Associated Symptoms Chardi (vomiting), Arocaka (anorexia), Hrllasa (nausea), Swasa and Kasa arethe symptoms present.Sannipataja Asrgdara-In this type the clinical features of all the three Dosas are present.When a severely ill and anemic woman consumes diet capable of aggravatingall the three Dosas then her excessively aggravated Vayu withholds Kapha,which is already burnt due to fire of Pitta shows following characters ofblood:1. Foul smelling (Durgandhi)2. Picchila (sticky/viscous)3. Pita (yellow)Acarya Susruta adds that the blood similes Kanji in colour. According toVagbhata it is like bronze, dirty and foul smelling.Associated Symptoms The woman suffers from Trsna, Daha, Jwara, Daurbalya and Ksinarakta(condition of anemia) is incurable.Sadhyasadhyatva (Prognosis)-Sanninpataja Asrgdara is Asadhya.Acarya Harita says that a woman having continuous bleeding, suffering fromfever and having very short menstrual period is incurable.
  • 114. 114Upadrava (complications): -"Tasyatiprvrttau Daurbalyam Bhramo Murccha Daha Pralapa PandutvamTandra Rogasca Vatajah |"[S.Sa. 2/19-20]Susruta Samhita, Madhava Nidana and Bhavaprakasa have mentionedweakness, giddiness, mental confusion, feeling of darkness, dyspnoea, thirst,burning sensation, deterioration, anemia, drowsiness, convulsions anddisorders of Vata as the complications.Acarya Caraka and Vagbhata have mentioned Pradara as Nija Hetu of Sotha.Continuous and excessive loss of blood for a long time causes deterioration ofall the Dhatus, weakness and loss of body resistance (Vyadhiksamatva).“Tesam Ksayavrddhi Sonita Nimitte |” [S. Su.14/21] "Tesam Iti Dhatunam |" ... [Dalhana]Bhrama, Murcha, Tama, Tandra, these symptoms are due to cerebral hypoxiaresulting from the reduced oxygen carrying capacity of the blood. Trsnaresults due to loss of fluids from the body and also increased Usna Guna ofPitta.Rasa and Rakta Dhatu Ksaya causes Panduta (pallor).The Usna Guna of the vitiated Pitta causes Daha.Continuous loss of blood causes vitiation of Vata Dosa and this vitiated VataDosa in turn results in Pralapa (delirium) and other diseases of Vata Dosa.
  • 115. 115Thus it can be said that all the Upadravas of Asrgdara are due to theRaktaksaya, Pitta Prakopa and Vata Prakopa.Vyavacchedaka Nidana (Differential diagnosis): -Clinical features of one disease may mimic the other. It is essential toconfirm the diagnosis by differentiating the disease from other similar ones.Asrgdara must be differentiated from the following diseases:1. Adhoga Raktapitta2. Pittala Yoni3. Rakta Yoni4. Yoni Arsa1. Asrgdara and Adhoga Raktapitta:In both the disorders bleeding occurs from genital organs, however there aremany other symptoms, which differ from each other are as follows – Asrgdara Adhoga Raktapitta Vata Dosa plays an important role Pitta Dosa is dominating in1 in the pathogenesis. pathogenesis. Premonitory signs and symptoms Premonitory signs and symptoms2 are not mentioned. are mentioned. Per Rectal / Urethral bleeding can3 Only per vaginal bleeding is found. be found.
  • 116. 116 Bleeding occurs due to separation Bleeding does not occur due to4 of endometrium. separation of endometrium. Specific time limitation is5 mentioned i.e. menarche to No specific time limitation. menopause. Types are mentioned according to Types are according to orifices6. predominance of Dosas. through which bleeding occurs.2. Asrgdara and Raktayoni:Per vaginal excessive bleeding is found in both the diseases. According tosome Acaryas and commentators, Rakta yoni and Asrgdara are one whileothers claim them to be separate entities. Cakrapani opines that Asrgdara isan elaboration of Rakta yoni. Asrgdara Rakta yoni1 Yoni Dusti is not mentioned. Yoni Dusti is present. Bija Dusti and Daiva factors are not Etiological factors include Bija2 present. Dusti, Daiva etc.
  • 117. 117 Vata Dosa is important in3 Pitta predominates in pathogenesis. pathogenesis. Specific time boundaries are4 No specific time limitations. mentioned.3. Asrgdara and Pittala Yonivyapada Pittala Yonivyapada bears more similarity to Paittika Asrgdara. Thedifferentiating sign and symptoms are as follows: Asrgdara Pittala Yonivyapada Predominance of augmented and1 Predominance of Vata Dosa. vitiated Pitta Dosa. Such causes, which produce Specific cause like suppression of2 Sthanika Avrtatva, are not urges of sneezing and eructation mentioned. during coitus is mentioned. Mainly Pitta Dosa is vitiating factor Etiological factors include Tridosa3 and along with Paittika constitution as vitiating causes. is mentioned. Sthanika Asaya Dusti is not4 Sthanika Asaya Dusti is important. mentioned.Asrgdara and Pittavrtta Apana: -
  • 118. 118"Tapccha Guda Medhrayoh |" [C.Ci.28/229]Caraka has described Avrtatva condition in Vatavyadhi. But it may alsoassociate with symptoms like deep yellow colour of urine and stool, heat inanus and penis. Modern ReviewMenorrhagia The term menorrhagia literally means to burst forth every month.(In Greek: mene means the moon; ‘rhegnymi’ means to burst froth)Definition :The entity in which the menstrual cycle is unaltered but the duration andquantity of the menstrual loss are increased is called menorrhagia.Menorrhagia Causes (Etiology) Menorrhagia can be due to varied causes and could be classified as:Primary or essential cause: - Dysfunctional uterine bleeding (DUB), whichpossesses non-demonstrable pathology.Secondary Causes 1) General or constitutional- Heart disease  Leukemia Chronic nephritis.  Emotional disturbances Vitamin B deficiency  Prolonged taking of drug Hepatic dysfunction (anticoagulants) Blood disorders  Acute Pyrexia
  • 119. 2 Over work  Vitamin C deficiency Changes in environment  Increased fragility of the red blood Nervous disorders cells. Blood dyscrasiasLocal causes The organic changes of the pelvic organs that cause bleeding in the non-pregnant women are either neoplastic or inflammatory. Fibroid in uterus.  Uterine malformation (e.g. Carcinoma of the cervix Bicornis) Carcinoma of the endometrium  I.U.C.D. Pelvic inflammation  Acute gonorrheal infection (Salpingooophritis)  Abortion Chronic endometritis  Uterine sub involution Pelvic endometriosis  A submucous leomyoma Adenomyosis  Fixed retroversion of uterus Chorolate cyst of the ovary  Endometrial hyperplasia Ovarian tumor  Uterine myomata.Endocrinal disorders  Obesity  Ovarian dysfunction Myxoedema  Over activity of ovary
  • 120. 2 Hypothyroidism  Cirrhosis of liver Hypothalamic  Hyperoestrogenism pituitary diseases  Taking of oral contraceptives These are the important etiological factors, which causes menorrhagia. In absence of any organic cause (systemic, haematological or pelvic)most women with menorrhagia are diagnosed as cases of dysfunctionaluterine bleeding (DUB).[Reference- Bnnar Joh - Sheppard Brian- Treatment of menorrhagia duringmenstruation … BMJ 1996: 313: 579 -582]Dysfunctional uterine bleeding or DUB is abnormal uterine bleeding in theabsence of demonstrable organic pathology to account for it.It includes menorrhagia, metrorrhagia, menometrorrhagia, polymenorrhoeaand amenorrhoea followed by profuse bleeding.Menorrhagia is the commonest and account for 34% of all DUB cases inIndian study by Pilli et al 2002.[Ref- Ganga S. Pilli et al, Dysfunctional uterine bleeding (study of 100 cases)of Obst. and Gynae. of India, Volume 52, No.3. May/June 2002, Pg 87 - 89]It is of two types: Ovulatory and Anovulatory1. Ovulatory  Functional menorrhagia.Two varieties are found:1. Irregular shedding of the endometrium  Desquamation is continued for avariable period with simultaneous failure of regeneration of endometrium.
  • 121. 2Possible theories are:I) Incomplete withdrawal of LH even on twenty sixth day of menstrual cycle-Incomplete atrophy of corpus luteum - Persistent secretion of progesterone.II) Persistent LH  Inhibition of FSH – suppresses ripening of the follicle inthe next cycle – less estrogen – less regeneration.Endometrium of 7th day after menstruation reveals a mixture of secretary andproliferative endometrium.2. Irregular ripening of the endometrium  Poor formation and inadequatefunction of corpus luteum, secretion of both estrogen and progesterone isinadequate to support the endometrial growth.Endometrial study prior to or soon after spotting reveals patchy area ofsecretary changes admit proliferative endometrium.2. Anovulatory More likely associated with menorrhagia close to menarche or menopause.Due to anovulation – absence of growth limiting progesterone – endometrialgrowth is under the influence of estrogen throughout the cycle. Thuswithdrawal of estrogen due to negative feedback action of FSH, theendometrial shedding continues for a long time.Anovulation is especially common in adolescent.Up to 80% of menstrual cycles are anovulatory in the first year after mearche.Cycles become ovulatory an average of 20 months after menarche.
  • 122. 3Current research shows that local endometrial aberrations act as majorcontributing factors to essential menorrhagia.Abnormal local endometrial factors: -*Abnormality Prostaglandin synthesis, with greater endometrial concentrationof the vasodilator PGs (PGE2 & PGI2)*Greater fibrinolytic activity*Poor angiogenesis*Vascular factorCareful history taking and thorough examination of all the systems arenecessary for the diagnosis purpose.Clinical examination Proper history of onset of menstruation, its duration and the amount ofbleeding and its characters are closely noted.The bimanual examination of the uterus for the judgment of hyperplasia of theuterus or any other conditions such as uterine polyps, carcinoma etc. shouldbe done.Investigations  1. Complete blood count, haematocrit, bleeding time, coagulation time, and plasma fibrinogen should be done to exclude coagulation defects. 2. Pelvic ultra sound  Routine pelvic ultrasound along with Trans vaginal sonography is useful mainly in the identification of anatomic
  • 123. 4 abnormalities such as fibroids, polyps abnormal endometrial pattern and assessing endometrial thickness.3. Hysteroscopy  Hysteroscopy with biopsy allows visualization of the endometrial cavity. Indications – 1. Where ultra sound is abnormal and 2. Patients attending in the late secretary phase of the cycle where ultrasound may be inconclusive.4. Endometrial sampling and Biopsy  it is indicated when ultrasound and hysteroscopy shows abnormal findings, history of prolonged exposure to unopposed estrogen (anovulatory DUB)5. Dilation and Curettage (D&C)  According to the RCOG guidelines, D&C is not therapeutic in cases of heavy menstrual bleeding.
  • 124. 5 DRUG REVIEW Revered seers of Ayurveda expounded the immortal and sacredscience of life consisting of three principles viz. etiology (Hetu)symptomatology (Linga) and knowledge of drugs as a means to wellbeing par excellence to healthy and diseased. Drug is integral componentof this Trisutri Ayurveda. There is no drug in the universe, which is saidto be of no use. Substances endowed fully with their natural potenciesand qualities, used in an appropriate manner for specified purposes willdefinitely become effective. Dhatusamya, the motto of treatment inAyurveda is achieved by proper use of drug. The aim of the present study is to assess the efficacy of Rasaprasadana drugs and Raktaprasadana drugs on Upadhatu Raja.BASIS FOR SELECTION OF DRUGS - Drugs prescribed for Rasa Pradosaja Vyadhi, Rakta PradosajaVyadhi and Rajodusti Cikitsa were listed in three groups. Theoverlapping drugs of first two groups were excluded. Further the drugs,which are having their action on Raja and come under Rasadusti Cikitsaonly, were selected in Rasaprasadana group. In the same mannerRaktaprasadana drugs were selected.The drugs are as follows:Group A - Rasaprasadana Drugs -(1) Satavari (2) Ativisa (3) Brhati (4) GuduciGroup B - Raktaprasadana Drugs -(1) Sariva (2) Manjistha (3) Raktacandana (4) LodhraFORMULATION OF DRUGS:
  • 125. 6 Ghanavati Kalpana was selected for administration of drugs. Itwas prepared in the pharmacy of Gujarat Ayurveda University byclassical method.METHOD OF PREPARATION OF GHANAVATI: Drugs 1 part + Water 16 times of it 1 part of drugs and 16 times of water were subjected to Agni,when it reduced to ¼, decoction was extracted from the drugs and then aclear decoction again subjected to Agni till it became solidified to formtablets. In this way Ghanavati was prepared.Details of Individual Drugs:I. Rasaprasadana Drugs: -1.SATAVARIBotanical Name : Asparagous racemosusEnglish Name : Wild AsparagusNatural order : LiliaceaeSynonyms: Atirasa, Bahumula, Narayani, Satamula, Bhiru, Satavirya, SatamuliClassificationCaraka Samhita: Balya, Vayasthapana, Prajasthapana, Sukrajanana, MadhuraskandhaSusruta Samhita: Vidarigandhadi, KantakaPancamula, Pitta SamanaPart used: Tuberous RootPharmacotherapeutics: Rasa : Madhura, Tikta Guna : Guru, Snigdha Virya : Sita Vipaka : Madhura Dosaghnata : Vata-Pitta Samaka
  • 126. 7 Karma : Dipana, Anulomana, Garbhaposaka, Stanyajanana, SukralaChemical Constituents : Plant contains 4 saponins viz. Shatavarin I to IV. Sarasapogenin,glycosides of quercetin, hyperoside in flowers and fruits, disogenin,quercetin 3 glucuronide in leaves. Sitosterol and Stigmasterol along withtheir glucosides, asparagamineA and disaccharide. Active ingredient is20% saponins (Satavarins).Pharmacological Activities: Antiallergic, antidysenteric, antifungal, antispasmodic, antibacterialantiabortifacient (Shatavarin I) gastric sedative, antioxytocic (ShatavarinIV), antiviral, diuretic, galactagogue, antiamoebic, hyperglycaemic,phagocytic, hypotensive, anticoagulant immunomodulatory activity. Thesaponins in doses of 20 ug to 500ug ml produce a specific blockade ofsyntocinon (oxytocin) induced contraction of rat. It is a natural source ofestrogen. It has invigorating action on the ovaries and the matrix. It alsoblocks the uterine spontaneous motility.It is a natural source of estrogen. It has invigorating action on the ovariesand the matrix. It increases weight of mammary glands, develops lubo-alveolar tissues, increases milk secretion, action is attributed to a directaction of mammary glands and through pituitary adrenal axis bystimulating secretion of prolactine and ACTH.Action and Uses: The roots are oleaginous, cooling, appetizer, aphrodisiac, stomachic,and tonic. Roots are useful in dysentery, tumors, and inflammations,useful in kidney and liver diseases. The roots are diuretic. Satavari tonesup muscles, growth promotion, anabolic property, and checks accessoryacid secretions. Satavari acts on female reproductive organs. It has
  • 127. 8specific antispasmodic activity on uterus. Its efficacy is evaluated in-patients suffering from duodenal ulcer.2. ATIVISABotanical name : Aconitum heterophyllumEnglish Name : Crow footNatural order : RanunculaceaeSynonyms : Suklakanda, Bhangura, Ghunavallabha, Syamakanda, SisubhaisajyaClassificationCaraka Samhita : Arsoghna, LekhaniyaSusruta Samhita : Pippalyadi, Vacadi, MustadiPart used : RootPharmacotherapeutics : Guna : Laghu, Ruksa Rasa : Tikta, Katu Virya : Usna Vipaka : Katu Dosaghnata : Tridosa SamakaKarma: " Dhatu Malan Visosayati Ca | " Grahi, Vrsya, Balya, Sarira Saithilyanasaka, Stanyasuddhikara,Sothaghna, Amapacana, Krmighna.Chemical Constituents : 5 Diterpene alkaloids viz. (1) Palmatisin (2) Vakognavine (3) Vakatisine (4) Vakatisinine (5) Vakati. It also contains atisin, atisinine, heteratisin, histisine, heterophylisine, heterophylline, heterophyllidine, atidine,
  • 128. 9 hetidine, benzol heteratisine, F-dihydroatisine, atesinol.Pharmacological activity: Immunomodulation, anti inflammatory, cholagogue. The wholeaqueous extract of the root induces marked hypertension apparentlythough an action on the sympathetic nervous system. It is antidiabetic inaction.Action and Uses : The roots are bitter tonic, hot, stomachic, and digestive. It alleviatesdysentry and bilious complaints. It is used as tonic in periodic andintermittent fever. It strengthens the body in plethoric conditions. It isconsidered as astringent and used in dyspepsia, vomiting, cough. Rootsare effective in irritability of stomach and abdominal pains.3. BRHATIBotanical Name : Solanum indicumEnglish name : Indian SunplantNatural order : SolanaceaeSynonyms : Vartaki, Sinhika, Visada, Duspradharsa, Mahostri, Simhi, KsudrabhantakiClassification Caraka Samhita : Kanthya, Hikkanigrahana, Sothahara, Angamardaprasamana Susruta Samhita : Brhatyadi, LaghupancamulaPart used : Whole plant, Fruit, Seeds, RootPharmacotherapeutics : Rasa : Tikta, Katu Guna : Laghu, Ruksa, Tiksna Virya : Usna
  • 129. 10 Vipaka : Katu Dosaghnata : Kapha Vataghna Karma : Dipana, Pacana, Grahi, Sothahara, Mutrala, Krmighna Seeds are Garbhasaya Sankocaka and Vajikara.Chemical Constituents : Solenin, Solenidin. Fruits and leaves contain glycoalkaloid andSolasonine. Roots, leaves and fruits contain Solanin. Fruit containprotolytic enzyme, similar to pancreatic trypsin.Pharmacological Activity : Brhati possesses antibacterial, diuretic activity. Chloroform solubleand insoluble fraction of ethanol extract showed cytotoxicity to colon,nesopharynx, uterine cervix, hepatoma, glioma, melanoma cells(anticancer). It increases levels of prostaglandins E & F in theendometrium. It increases 17 oxysteroids excretion in urine. The extractof whole plant influences blood pressure. They have an effect on humanepidermal carcinoma of the nasopharynx in tissue culture and foundvirus leukaemia (solid) in the mice.Action and Uses : Brhati possess astringent, cardiotonic and digestive property. Itremoves apathy towards food. Regulates excretion of waste productsfrom the body. It is used in anorexia, skin diseases, fever, dyspnoea, colic,cough, and dyspepsia. Roots are carminative and expectorant. They arebeneficial in chronic fever, flatulence. They relieve pain arising fromdifficult parturition. Brhati works against worm infestation also dissolvesulcer. It promotes menstruation. It is useful in painful menstruation.4. GUDUCIBotanical Name : Tinospora cordifolia
  • 130. 11English name : TinosporaNatural order : MenispermaceaeSynonyms : Amrtavalli, Chinnodbhava, Rasayani, Visalya, Vayastha, Vatsadani, TantrikaClassification : Caraka Samhita : Vayasthapana, Dahaprasamana, Trsnanigrahana, Stanyasodhana, Trptighna, Snehopaga Susruta Samhita : Guducyadi, Patoladi, Aragvadhadi, Kakolyadi, Vallipancamula.Parts used : Root, Stem, LeafPharmacotherapeutics : Rasa : Tikta, Kasaya Guna : Laghu, Snigdha Virya : Usna Vipaka : Madhura Dosaghnata : Tridosasamaka Karma : Dipana, Pacana, Krmighna, Jwaraghna,StanyasuddhikaraChemical Constituents: Gilion glucoside, giloinin, gelesterol, berberine, tinosporine, palmarin,B.sitosterol, cordifolide, columbin, tinosporol, unosporin, cordifolon,tembetarine, tetra hydrofuran.Pharmacological Activity: Hypoglycaemic, antihyperglycaemic, CNS depressant, antibacterial,antimicrobial, antipyretic, antiarthritic, antiallergic, hepatoprotective,analgesic, immunostimulant, antineoplastic, adaptogenic, antioxidant,
  • 131. 12hypotensive, diuretic. It stimulates Nitric oxide activity both in vitro andin vivo. The active constituent in the drug was also found to inhibit invitro the growth of mycobacterium tuberculosis. The drug has favorableeffect on the endogenous insulin secretion, glucose uptake and inhibitionof peripheral glucose release.Action and Uses: The stem is bitter, appetizer, stomachic. It is used in chronic fever,vomiting, diabetes, and vaginal and urethral discharge. It improvesimmune system and body resistance to infections. It is also used inimpotency and fractures. It promotes regeneration of the tissue. Extractjuice is used in menstrual disorders. In heavy menstruation, bleedingafter abortion or after delivery leaf juice or root decoction is used. In heavy bleeding with palpable uterine tumor stem decoction is used. It is excellent natural analgesic for all types of pain, possess one fifthof the analgesic effect of sodium salicylate. It relieves pelvic pains, backaches and legcramps in dysmenorrhoea. II. RAKTAPRASADANA VATI1. SARIVABotanical Name : Hemidesmus indicusEnglish Name : Indian SarsaparilaNatural order : AsclepiadaceaeSynonyms : Gopavalli, Sphota, Krsodari, Utpala, AnantaClassification :
  • 132. 13 Caraka Samhita : Stanyasodhana, Purisasangrahaniya Jwarahara, Dahaprasamana, Madhura Skandha. Susruta Samhita : Sarivadi,Vidarigandhadi, Vallipancamula Parts used : Root bark and Root leafPharmacotherapeutics : Rasa : Madhura, Tikta Guna : Guru, Snigdha Virya : Sita Vipaka : Madhura Dosaghnata : Tridosa Samaka Karma : Dipana, Pacana, Stambhaka, Rakta Sodhaka, Garbhasayasodhaka, Mutravirajaniya, Jwaraghna.Chemical constituents : Major constituent - P methoxy Salicyclic aldehyde, 2 hydroxy 4 methoxybenzaldehyde, pytosterols, triterpenes, saponin, resin acid, tannins, fatty acids,glycosides, 16 dehydropregnenolone, a new pregnan ester diglycoside.Pharmacological activity : Bacteriostatic, anticancer, antiviral, antilithic, hypotensive, antifungal,antibacterial, anti inflammatory, antispasmodic.Action & Uses: It is liquefying & diuretic, It is alexiteric, anthelmintic, demulcent,emollient, invigorating, rejuvenating. It is effective in dyspepsia, anorexia, remedyfor gonorrhea, rheumatoid arthritis, quote and diseases caused by mercurypoisoning.Useful in constitutional debility and kidney troubles, useful in the fractures of bones.Ether extract of roots exerts some inhibitory effect on the growth of Escherichia coli. It cares diseases of blood, colic piles, and ulcer. The bark is much used in uterineaffections. Useful in menorrhagia, dysmenorrhea, menstrual cramp, uterine fibroids.It is considered as a uterine sedative and tonic.
  • 133. 142.ManjisthaBotanical Name : Rubia CordifoliaEnglish Name : Indian MaddarNatural Order : RubiaceaeSynonyms : Yojanavallika, Samanga, Vikasa, Tamravalli,Raktayastika, Raktapuspi.Classification : Caraka Samhita : Varnya, Visaghna, Jwarahara. Susruta, Samhita : Priyangwadi, Pittasamana. Part used : RootPharmacotherapeatics : Rasa : Tikta, Kasaya, Madhura Guna : Guru, Ruksa Virya : Usna Vipaka : KatuDosaghnata : Kapha Pitta SamakaKarma : Dipana, Pacana, Krmighna, Sonitasthapana, Sothaghna, Vranaropaka,Vedanasthapaka, Garbhasayottejaka, Artavajanana, Stanyasodhana.Chemical Constituents: Free alizarin and its qlucoside, purpurin, xanthopurpurine, manjistin, glucose,sucrose, 1-Hydroxy, 2-methylanthraquineone, Physician, Nordamnacanthal, 1, 4 -Dihydroxy, 6 - Methylanthraquinone. Antitumour cyclic hexapeptides RA -V & RA-VII along with RA-I-IV.Pharmacological Activities: Antioxidant, antibacterial, anticancer, anti-inflammatory, antitumour, antiviral,haemostatic, antilipidic, peroxidative, hypoglycemic, Mollugin showed inhibition ofpassive cutaneous anaphylaxis & protection of mast cells degeneration in rats. It
  • 134. 15exhibits considerable activity against lymphoid leukemia in mice. It inhibitsHepatitis B surface antigen secretion.Dr. Play fair, in a note appended to his translation of the Talif-l Sharifi (p 150) statedthat if taken to the grams several times daily, it powerfully affects the nervous system, inducing temporary delirium, etc. with evident deterioration to the uterine system.Actions & Uses: It is analgesic, anthelmintic, and lactogogue, antipyretic, antidysenteric in action. Used in inflammatory condition of the chest. It cares leucoderma, crisipelas and ulcers. Roots are useful in leucorrhoea, urinary discharges, and scanty lochial discharge after childbirth. It is useful in excessive painful uterine bleeding, postnatal bleeding, diseases of uterus, vagina and blood disorders. Decoction is useful in amenorrhoea. Zulu females take a preparation of the root to hasten the inception of menstruation & in the treatment of over due menses.(4) LODHRABotanical Name : Symplocos racemosaEnglish name : Symplocos barkNatural order : SymplocaceaeSynonyms : Lodhra, Sabaraka, Tilvaka, Sthulavalkala, LaksaprasadanaClassification : Caraka Samhita : Sonitasthapana, Sandhaniya, Purisasangrahaniya, Kasay Skandha Susruta Samhita : Lodhradi, Nyagrodhadi Parts used : Stem barkPharmacotherapeutics :
  • 135. 16 Rasa : Kasaya Guna : Laghu, Ruksa Virya : Sita Vipaka : Katu Dosaghnata : Kapha Pitta Samaka Karma : Grahi, Stambhaka, Sothahara, Vranaropaka, Garbhasaya Sothaghna, used in Raktatisara, and ParavahikaChemical Constituents : Three main alkaloids viz. loturine, loturidine and colloturine. It also containsmonomethyl pelargonidin glycosides (I & II), oxalic acid, phytosterol, 3 monoglucofuranoside of 7-0-methyl leucopelargonidin (bark).Pharmacological activities Antibacterial, anti diarrheal, heart depressant, hypotensive. Bark showedinhibitory effect on the growth of micrococcus pyogenes var. aureus, E. coli andenteric and dysenteric group of organisms. It reduces frequency and intensity of thecontractions in vitro of both pregnant and non-pregnant uteri of some animals. Another fraction from the bark, besides showing action on uteri wasspasmogenic on various parts of the gastrointestinal tract and could be antagonizedby atropine. Symposide and epiafzelechin showed antifibrinolytic activity . Stem bark shows anti inflammatory and hypothermic property. It is supposed topromote the maturation of the uterine tissue.Actions and uses: The bark is acrid, cooling, mild astringent, used in liver complaints. Useful indropsy, elephantiasis, filaria. It promotes resolution of inflammation if masses andexudates and it is supposed to promote the maturation of the uterine tissue inmenorrhagia due to relaxation of uterine tissue. Useful in blood diseases, vaginaldischarge abortions and miscarriages, good for ulcers in the vagina. (N. Med.Plants). In combination with sugar it is recommended in the treatment of menorrhagia dysfunctional uterine bleeding and other uterine disorders.
  • 136. 175. RAKTACANDANABotanical Name : Pterocarpus santalinusEnglish name : Red SandersNatural order : LeguminosaeSynonyms : Raktasara, Pravalaphala, Haricandana, Tamrasara, Raktanga, TilaparnikaClassification Susruta Samhita : Patoladi, Sarivadi, Priyangvadi, Pittaghna Part used : KandaPharmacotherapeutics Rasa : Tikta, Madhura Guna : Guru, Ruksa Virya : Sita Vipaka : Katu Dosabghnata : Kaphapittasamaka Karma : Raktadosahara, Raktapittaghna, SothaghnaChemical Constituents : Three colourless substances viz. pterocarpin, pterostilbene and homopterocarpin.Red colour matter-Santalin and Santalic acid possess quinonoid structure. Desoxy santalin supposed to be a naphtaquinonoid derivative.Pharmacological Activity: Antipyretic, Anthelmintic, Antiperiodic, Antiseptic. It inhibits tumour necrosisfactor alpha production and T cell prolation.Action and Uses : The wood is bitter with a flavour, very cooling, tonic, aphrodisiac, cures diseasesof blood, ulcer, and mental aberrations. It is an antiaging agent.
  • 137. 18 It is used in burning sensation, haemorrhage, and inflammation. It acts as a bloodpurifier expels toxins. Decoction of fruit it used as an astringent tonic in chronicdesentry.DRUG RATIONALEDefinitions:"Prasadaja Iti Nirmalataya | " [ C. Ci. 15/16, Carkra]"Prasadah Iti Sarah |" [S. Sa. 4/31-32, Dalhana]"Prasadana Iti Vaisadyakaram |" [C. Su. 5/16]."Dhatu Prasada Samjnakan Iti Atyartha Suddhena Iva Dhatu Prasada Samjnakena |" [C. Su. 28 - Cakra] Dhatu Prasadana Cikitsa is a type of therapy, which is done by means toachieve good quality of Dhatus. Prasadana Karma supervenes at various level ofDhatu metabolism. Prasadana drugs principally act on Dhatvagni. "Prasadana" termindicates two major functions of these Drugs.(1) Nirmalataya/Vaisadyakaram: - By doing Dosa Pacana (at Dhatu & Upadhatu level) causes Sodhana. Thuspurity of Dhatu & Upadhatu is achieved.(2) Sarataya: A drug causes illumination of Dhatvagni, which further improves genesis ofDhatu. Thus results into good quality of Dhatu. Since Upadhatu are nourished fromSuksma Prasadaja part of Dhatu the quality of formation of Upadhatu also improves. In Avarodhatmaka Samprapti due to Dosa Pacana (Ama Pacana) Srotosuddhiis achieved, thus Dhatu & Upadhatu receive proper nourishment. In Ksayaja Samprapti due to illumination of Dhatvagni, production of Dhatuimproves. Thus Dhatu & Upadhatu receive their proper nourishment. Thus due toPrasadana Dravyas the normal status of Dhatu is achieved which further adds theexcellence of Dhatu & Upadhatu.
  • 138. 19Rasaprasadaja Group : Name of Rasa Virya Vipaka Guna Dosagna Drugs Satavari Madhura, Sita Madhura Guru, Vata, Pitta Tikta Singdha Ativisa Tikta, Katu Usna Katu Ruksa, Vata, Pitta, Laghu Kapha Brhati Katu, Tikta Usna Katu Laghu, Vata, Tiksna Kapha Guduci Tikta Usna Madhura Laghu, Vata, Pitta, Snigdha KaphaPredominancy Tikta Usna Madhura, Laghu Vata, Pitta, Katu KaphaRaktaprasadana Group : Name of Rasa Virya Vipaka Guna Dosaghnata Drugs Sariva Madhura, Sita Madhura Guru, Vata, Pitta, Tikta Singdha Kapha Manjistha Tikta, Usna Katu Guru, Kapha, Kasaya Ruksa Pitta Lodhara Kasaya Sita Katu Laghu, Kapha, Ruksa PittaRaktacandana Tikta, Sita Katu Guru, Kapha, Madhura Ruksa PittaPredominancy Tikta Sita Katu Guru, Kapha, Ruksa Pitta
  • 139. 20 Rasa Pancaka of Rasaprasadana drugs shows that most of the drugs arehaving Tikta Rasa dominance, Usna Virya, Tridosa Samaka property. Due to thisproperty by doing Dosa Pacana they cause alleviation of Dosa, this will results intoDhatu & Upadhatu Sodhana. Further by acting on Dhatvagni also results into excellence of Dhatu &Upadhatu. Rakta Prasadaja Dravyas are having Tikta & Madhura Rasa dominance, SitaVirya & Kapha Pitta Samaka property. These Dravyas act principally on RaktaDhatvagni. Fig.
  • 140. 21AIMS AND OBJECTIVES: The present study has been undertaken with the following aims andobjectives(1) Practical assessment of Upadhatu Raja.(2) To evaluate the efficacy of Rasaprasadana drugs and Rakta Prasadana drugs in Asrgdara.(3) To evaluate therapeutically (Uapasayanupasayabhyam) the proximity of Raja with Rasa and Rakta Dhatu.MATERIAL AND METHOD:Patients: - Individuals attending the OPD & IPD of the Department of Basic Principlesof I.P.G.T. & R.A., Hospital, Jamnagar, fulfilling the criteria was selected forpresent study. The special proforma was prepared mainly on Ayurvedic guidelines.Criteria of Selection:(1) Patients having classical symptoms of Asrgdara (Attyartava) were selected on the basis of following guidelines ( a)The quantity of menstrual bleeding increased. (b)The menstrual cycle unchanged. (c )Associated symptoms of Asrgdara were present in patients (on the basis of Caraka Samhita) In Caraka Samhita, There is no standard criteria of menstrual blood loss has been mentioned. So far as the clinical study is concerned, importance has been given to history and present clinical symptoms. (2) Routine haematological, urine, stool examinations were carried out to assess the effect of therapy and to rule out any pathological condition.
  • 141. 22Criteria of Exclusion:Patients with(a) Any infectious disease(b) Operable organic defect in the female genital tract(c) Lactating mother(d) Patients nearing the menopausal stage(e) Patients using oral / local contraceptives.(f) Patients suffering from Metrorrhagia were excluded from the study.Plan of Study : All the selected patients fulfilling the criteria of selection were randomly divided into two groupsGroup A - Rasaprasadana Vati; GroupB - Raktaprasadana VatiThe details are as follow: - Details Group-A Group-B Drug Rasaprasadana Vati Raktaprasadana Vati Dose (500 mg.) 4 tab twice daily (500mg) 4 tab twice daily Time of administration Apana Kala Apana Kala Anupana Plain water Plain water Number of Patients 7 7 Duration of treatment 2 months 2 months All the pretreatment investigations were repeated after the treatment Diet = All patients were advised similar dietetic restriction.Criteria for Assessment :Symptomatic relief obtained by the treatment given was assessed periodically afterthe commencement of treatment till the completion.The effect of treatment was assessed on the basis of changes in the following point.
  • 142. 23(a) Subjective improvement in cardinal symptoms of Asrgdara(b) Effect on Rasa and Rakta Dhatu symptomatically(c) Routine haematological investigations(d) Number of sanitary pads required for B.T. & A.T. Patients.According to the severity and intensity of the cardinal symptoms of Asrgdara, theywere graded on the basis of scoring pattern.Scoring Pattern:(I) Duration of menstrual bleeding: Duration Score Grade <5 days 0 NIL 6 to 7 days 1 Mild 8 to 9 days 2 Moderate >9 days 3 Severe(II) Assessment of amount of blood loss Amount of blood loss Score Grade 61 to 80 gm 0 NIL 81 to 100 gm 1 Mild 101 to 120 gm 2 Moderate >120gm 3 Severe(III) Pain During Menstrual period (Below umbilicus) No Pain 0 Mild Pain 1 Moderate Pain 2 Severe Pain 3 Pain during menstrual cycle were observed on the basis of verbalmultidimensional scoring system:0 Menstruation is not painful
  • 143. 241 Menstruation is painful but daily activity is not affected, no need of analgesic drug.2. Daily activity affected, needs to take analgesic drug.3. Daily activity inhibited, pain continue after administration of analgesic drug.(IIV)Daurbalya (general weakness) present during menstrual cycle No weakness 0 Mild weakness 1 Weakness is severe but perform routine work 2 Weakness is much severe and cannot 3 perform routine activityAssessment of Amount of Blood loss:Quantity of menstrual blood has been assessed with the help of vaginal pads; before,during and after treatment for three successive cycles.A standard vaginal pads (Stayfree Secure-Regular; gohnson&gohnson)weighing10.25gms each was advised during the menstrual period, starting from thefirst day of menstrual cycle, till its cessation. Weight of soaked pads were measuredon an electrical balance. Thus the total weights of all the pads used in the periodwere measured. The difference of weight between dry and wet pads was calculated.The mean score of this calculation gives us rough idea about the quantity ofmenstrual blood loss.Total effect of Therapy: On the basis of improvement over the signs and symptoms of Asrgdara, thefollowing criteria were evolved to assess the total effect of therapy.1. Cured: 100% relief in symptoms of Asrgdara2. Markedly Improvement: 76-99% relief in symptoms of Asrgdara3. Moderately Improvement: 51-75% relief in symptoms of Asrgdara4. Improved: 26-50% relief in symptoms of Asrgdara
  • 144. 25 5. Unchanged: Less than 25% relief in symptoms of Asrgdara OBSERVATIONS AND RESULTS STATUS OF 20 PATIENTS OF ASRGDARA No. of Patients Groups Total LAMA Completed Registered Rasaprasadana Vati 10 3 7 Raktaprasadana Vati 10 3 7 Total 20 6 14 In the present study, total 20 patients of Asrgdara were registered,Out of which 14 patients completed the course of treatment and 6 patients left thetreatment in between. The data obtained from 20 patients of Asrgdara is presentedbelow. AGE WISE DISTRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Age Group in Years Total (%) A Group B Group Up to 20 2 3 5 25 21 to 30 5 5 10 50 31 to 40 3 2 5 25
  • 145. 26Age: The above table reveals that maximum of 50% patients were belonging to theage group of 21-30 years followed by 25% patients were belonging to 31-40 years ofage group and 25% were up to 20 years of age group.
  • 146. 27 RELIGION WISE DISRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Religion Total (%) A Group B Group Hindu 9 9 18 90 Muslima 1 1 2 10Religion: In the present study maximum number of patients i.e. 90% were fromHindu community, where as 10% patients were from Muslima community OCCUPATION WISE DISTRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Occupation Total (%) A Group B Group House wife 6 5 11 55 Labour worker 2 1 3 15 Service - 1 1 5 Student 2 3 5 25Occupation: The above table portrays that maximum number of 55% patients werehousewives, followed by 25% were students, 15% were laborers, and 5% patientswere serving at places. SOCIO-ECONOMIC STATUS OF 20 PATIENTS OF ASRGDARA Socio-economic No. of Patients status Total (%) A Group B Group Poor class 3 0 3 15 Lower middle class 5 6 11 55 Upper middle class 2 4 6 30
  • 147. 28Socio-economic Status: The above table shows that maximum of 55% patients werebelonging to lower middle class followed by 30% patients of upper middle classand 15% of poor class. MARITAL STATUS OF 20 PATIENTS OF ASRGDARA No. of Patients Marital Status Total (%) A Group B Group Married 7 6 13 65 Unmarried 3 4 7 35Marital Status: In the present study maximum no. of 65% patients were marriedwhere as35% patients were unmarried. DISTRIBUTION OF 20 PATIENTS OF ASRGDARA BASED ON PARITY No. of Patients Parous Condition Total (%) A Group B Group Nulliparous 1 0 1 5 Parous 2 1 3 15 Multiparous 4 5 9 45 Unmarried 3 4 7 35Parous Condition: The above table shows that the maximum of 45% patients weremultiparous.
  • 148. 29 DISTRIBUTION OF 20 PATIENTS OF ASRGDARA BASED ON AGE OF MENARCHE No. of Patients Age of Menarche Total (%) A Group B Group 13 Years 3 2 5 25 14 Years 2 3 5 25 15 Years 5 3 8 40 16 Years 0 2 2 10Age of Menarche: Maximum no. of patients i.e. 40% were belonging to 15 years ofage group, followed by 25% patients in each of 13 & 14 years of age groups. DISTRIBUTION OF 20 PATIENTS ACCORDING TO DEHA PRAKRTI No. of Patients Deha Prakrti Total (%) A Group B Group Vata Pitta 6 8 14 70 Pitta Kapha 1 2 3 15 Vata Kapha 3 0 3 15Deha Prakrti: It is evident from the above table that maximum 70% patients werehaving Vata Pitta Prakrti. SARA WISE DISRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Sara Total (%) A Group B Group Pravara 1 0 1 5 Madhyama 6 6 12 60 Avara 3 4 7 35Sara: The above table reveals that the maximum number of patients i.e.60% hadMadhyama Sara.
  • 149. 30 SAMHANANA WISE DISRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Samhanana Total (%) A Group B Group Pravara 2 0 2 10 Madhyama 4 7 11 55 Avara 4 3 7 35Samhanana: Among 20 patients, Madhyama Samhanana was found in 55%patients, where as 35% patients were of Avara Samhanana. DISTRIBUTION OF 20 PATIENTS OF ASRGDARA ACCORDING TO SATVA PRADHANATA No. of Patients Satva Total (%) A Group B Group Pravara 0 0 0 0 Madhyama 7 7 14 70 Avara 3 3 6 30Satva: The maximum no. 70% patients were of Madhyama Satva; followed by 30%patients were of Avara Satva. PRAMANA WISE DISRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Pramana Total (%) A Group B Group Pravara 2 0 2 10 Madhyama 4 9 13 65 Avara 4 1 5 25Pramana: The maximum number of 65% patients were of Madhyama Pramana.
  • 150. 31 DISTRIBUTION OF 20 PATIENTS OF ASRGDARA ACCORDING TO ABHYAVAHARANA SAKTI No. of Patients Abyavaharana Sakti Total (%) A Group B Group Pravara 0 2 2 10 Madhyama 8 5 13 65 Avara 2 3 5 25Abhyavaharana Sakti: The maximum number of 65% patients were of MadhyamaAbhyavaharana Sakti. DISTRIBUTION OF 20 PATIENTS OF ASRGDARA ACCORDING TO JARANA SAKTI No. of Patients Jarana Sakti Total (%) A Group B Group Pravara 0 0 0 0 Madhyama 9 8 17 85 Avara 1 2 3 15Jarana Sakti : The above observations reveals that maximum number of 85%patients were having Madhyama Jarana Sakti. DISTRIBUTION OF 20 PATIENTS OF ASRGDARA ACCORDING TO VYAYAMA SAKTI No. of Patients Vyayama Total (%) A Group B Group Pravara 2 3 5 25 Madhyama 6 6 12 60 Avara 2 1 3 15Vyayama Sakti: Above observation reveals that maximum 60% patients werehaving Madhyama Vyayama Sakti.
  • 151. 32 SATMYA WISE DISTRIBUTION OF 20 PATIENTS OF ASRGDARA No. of Patients Satmya Total (%) A Group B Group Pravara 1 1 2 10 Madhyama 8 9 17 85 Avara 1 0 1 5Satmya: In this study the maximum 85% patients were having Madhyama Satmya. DISTRIBUTION OF 20 PATIENTS OF ASRGDARA ACCORDING TO VYADHI DESA No. of Patients Vyadhi Desa Total (%) A Group B Group Anupa 0 1 1 5 Jangala 9 8 17 85 Sadharana 1 1 2 10Vyadhi Desa: In the present study maximum numbers of 85% patients werebelonging to Jangala Desa. DISTRIBUTION OF 20 PATIENTS OF ASRGDARA ACCORDING TO DIETARY HABITS No. of Patients Diet Total (%) A Group B Group Vegetarian 5 7 12 60 Mixed 5 3 8 40Diet: 60% patients in the study were taking vegetarian diet, while 40% patients wereaccustomed to non vegetarian diet.
  • 152. 33 DISTRIBUTION OF 20 PATIENTS BASED ON RASA SEVANA HABIT No. of Patients Rasa Sevana Total (%) A Group B Group Madhura 1 2 3 15 Amla 3 5 8 40 Katu 8 7 15 75 Lavana 0 1 1 5Rasa Sevana: The maximum 75% patients were having Katu Rasa dominancy indiet, 40% patients were taking Amla Rasa predominantly. DISTRIBUTIONOF 20 PATIENTS BASED ON AHARAJA NIDANA No. of Patients Aharaja Nidana Total (%) A Group B Group Abhisyandi 3 8 11 55 Vidahi 6 7 13 65 Viruddhanna 1 7 8 40 Harita Saka 5 4 9 45 Paryusitanna 3 2 5 25 Ruksa Ahara 5 0 5 25 Ajirnasana 2 2 4 20Aharaja Nidana: Maximum 65% patients were taking Vidahi Ahara, 55% patientswere consuming Abhisyandi Ahara, 45% patients were having regular Harita SakaSevana. Viruddhasana was recorded in 40% patients.
  • 153. 34 MANASIKA HETU OBSERVED IN 20 PATIENTS OF ASRGDARA No. of Patients Manasika Nidana Total (%) A Group B Group Cinta 8 7 15 75 Krodha 4 2 6 30 Soka 0 1 1 5Manasika Hetu: The Maximum 75% patients were presented with Cinta andKrodha was observed in 30% patients. RASA DUSTI NIDANA OBSERVED IN 20 PATIENTS OF ASRGDARA No. of Patients Rasa Dusti Nidana Total (%) A Group B Group Ati Guru 0 1 1 10 Ati Sita 1 1 2 10 Ati Snigdha 2 1 3 15 Ati Matra 0 1 1 5 Ati Cinta 8 7 15 75Rasa Dusti Nidana: Ati Cinta was observed in maximum number of 75% patients.
  • 154. 35 RAKTA DUSTI NIDANA OBSERVED IN 20 PATIENTS OF ASRGDARA No. of Patients Rakta Dusti Nidana Total (%) A Group B Group Vidahi 5 6 11 55 Ati Tiksna 6 3 9 45 Ati Usna 6 3 9 45 Ati Katu 5 5 10 50 Viruddhanna 3 6 9 45 Dadhi 4 9 13 65 Matsya 2 1 3 15 Ati Amla 4 4 8 40 Ati Snigdha 1 2 3 15 Harita Saka 1 2 3 15 Bhojanottara 4 2 6 30 DivaswapaRakta Dusti Nidana: The maximum 65% patients were having habit of takingDadhi (curd) in regular diet. 50% patients were taking Katu Rasa in excess quantity.45% patients were taking Vidahi, Tiksna, Usna type of diet (each). 45% patientswere taking Viruddhanna more frequently. 40% patients were having habit of takingAmla Rasa frequently.
  • 155. 36 CARDINAL SYMPTOMS OBSERVED IN 20 PATIENTS OF ASRGDARA No. of Patients Cardinal Symptoms Total (%) A Group B Group Ati Pramanena 10 10 20 100 Rajah Srava Angamarda 6 9 15 75 Daurgandhya 9 10 19 95Cardinal Symptoms: In all the 20 Patients Ati Pramanena Rajah Srava wasobserved. Angamarda was found in 75% patients and 95% were presented withDaurgandhya of menstrual bleeding. LOCAL SYMPTOMS FOUND IN 20 PATIENTS OF ASRGDARA No. of Patients Local Symptoms Total (%) A Group B Group Ruja 10 10 20 100 Daha 1 1 2 10 Kandu 0 1 1 5Local Symptoms: In all 20 patients of Asrgdara Ruja was reported, while DahaLaksana was observed in 10% patients.
  • 156. 37 SRAVAGATA LAKSANA OBSERVED IN 20 PATIENTS OF ASRGDARA No. of Patients Sravagata Laksana Total (%) A Group B Group Tanu 2 0 2 10 Picchila 6 6 12 60 Ghanatva 3 3 6 30 Granthibhuta 6 8 14 70 Daurgandhya 7 7 14 70 Varna (a) Aruna 7 3 10 50 (b) Krsna 3 1 4 20 (c) Sonita 1 5 6 30Sravagata Laksana: Maximum each of 70% patients was observed GranthilaRajasrava (clots) and Daurgandhya. Picchila Raja Srava was observed in 60%patients, ArunaVarna Srava was observed in 50% patients.
  • 157. 38 SARVADEHIKA LAKSANA RECORDED IN 20 PATIENTS OF ASRGDARA Sarvadehika No. of Patients Laksana Total (%) A Group B Group Angamarda 8 7 15 75 Pindikodvestana 9 8 17 85 Daurbalya 10 9 19 95 Sirahsula 3 2 5 25 Anidra 2 1 3 15 Mutradaha 1 3 4 20 Bhrama 5 15 10 50 Trsna 3 2 5 25 Ati Sweda Pravrtti 1 4 5 25 Panduta 2 2 4 20 Tamah Pravesa 3 3 6 30 Aruci 5 5 10 50 Alasya 2 2 4 20 Chardi 1 1 2 10 Hrllasa 3 3 6 30Sarvadehika Laksana: Out of 20 patients Daurbalya was found in 95% of patients,Pindikodvestana was seen in 85% patients, 75% patients were observed withAngamarda and Aruci was present in 50% of patients.
  • 158. 39RASA DUSTI LAKSANA RECORDED IN 20 PATIENTS OF ASRGDRA No. of PatientsRasa Dusti Laksana Total (%) A Group B GroupAnna Asrddha 1 2 3 15Aruci 6 6 12 60Avipaka 2 0 2 10Jwara 4 3 7 35Hrllasa 5 1 6 30Angasada 6 5 11 55Tamah Pravesa 2 3 5 25Trpti 1 0 1 5Agnisada 2 3 5 25Alasya 3 3 6 30Atinidra 1 0 1 5Angamarda 5 6 11 55Sabdasahisnuta 5 7 12 60Trsna 3 1 4 20Sramasosa 5 4 9 45Ruksata 4 2 6 30Sunyata 1 0 1 5Kampa 0 2 2 10Hrdrava 2 2 4 20Pandu 2 2 4 20Karsya 3 1 4 20Akala Vali Palita 1 1 2 10Praseka 1 0 1 5
  • 159. 40Rasa Dusti Laksana: Among 20 patients, Sabdasahisnuta was observed in 60%patients, 55% showed Angamarda, 45% patients were complaining of Sramasosa,Ruksata was observed in 30% patients. RAKTA DUSTI LAKSANA OBSERVED IN 20 PATIENTS OF ASRGDARA Rakta Dusti No. of Patients Laksana Total (%) A Group B Group Parusata 1 3 4 20 Sphutita Tvak 4 2 6 30 Twakruksata 4 5 9 45 Amla Sita Prarthana 2 3 5 25 Mukhapaka 2 4 6 30 Pipasa 3 3 6 30 Siroruja 3 2 5 25 Tamasa Darsana 2 3 5 25 Kandu 1 0 1 5 Vivarnata 2 1 3 15 Ati Daurbalya 0 1 1 5 Agni Sada 2 3 5 25 Aruci 6 6 12 60 Sarira Daurgandhya 1 0 1 5 Pidaka 1 3 4 20 Krodhadhikya 0 3 3 15 Vyanga 0 1 1 5 Switra 1 0 1 5 Kustha 0 1 1 5 Amlodgara 1 1 2 10
  • 160. 41 Guru Gatrata 0 1 1 5 Annapana Vidaha 0 1 1 5 Asyagandhita 0 2 2 10 Nidratiyoga 0 1 1 5 Ati Sweda 0 1 1 5 PravartanaRakta Dusti Laksana: In all 45% patients were having Twakruksata. Aruci wasobserved in 45% patients. Each 30% of the patients showed Mukhapaka,Sphutitatvak and Amla Sita Prarthana. INVOLVEMENT OF SROTASA OBSERVED IN 20 PATIENTS OF ASRGADRA No. of Patients Srotasa Involved Total (%) A Group B Group Annavaha Srotasa 5 8 13 65 Udakavaha Srotasa 3 4 7 35 Mamsavaha Srotasa 1 1 2 10 Medovaha Srotasa 2 3 5 25 Asthivaha Srotasa 3 2 5 25 Swedavaha Srotasa 5 4 9 45Srotodusti: The maximum 65% of patients were observed Annavaha SrotodustiLaksanas. Swedavaha Srotodusti Laksanas were present in 45% of patients andUdakavaha Srotodusti Laksanas were observed in 35% patients.Bowel Habit Observed in 20 Patients of Asrgdara Mala No.of patients Total % Pariksa A Group B Group Vibandha 3 3 6 30
  • 161. 42 Vibandha: Among 20 patients of Asrgdara Mala Vibandha were observed in 30% of patients. OBSTETRIC HISTORY RECORDED IN 13 PATIENTS OF ASRGDARA No. of Patients Obstetric History Total (%) A Group B Group Abortion 2 2 4 30Obstetric History: Among 13 married patients, history of abortion was present in30% patients. OBSERVATIONS OF P/V EXAMINATION IN 13 PATIENTS OF ASRGDARA (I) Position of No. of Patients Total (%) Uterus A Group B Group AV AF 5 3 8 61.53 RV RF 3 4 7 53.84Position of Uterus : 53.84% patient of Asrgadara were having retroverted uterus. (II) Tenderness of No. of Patients Uterus Total (%) A Group B Group Present 4 2 6 46.15Tenderness of Uterus: Tenderness of uterus was observed in 46.15%of patients. (III) Mobility of No. of Patients Total (%) Uterus A Group B Group Freely Mobile 7 6 13 100 Fixed 0 0 0 0
  • 162. 43Mobility of Uterus: In P/V examination all 13 married patients were presented withfreely mobile uterus.
  • 163. 44 No. of Patients (IV)Size of Uterus Total (%) A Group B Group Normal 2 3 5 38.46 Bulky 5 3 8 61.53Size of Uterus: During P/V examination 61.53% of patients were having bulkyuterus.OBSERVATION OF P/S EXAMINATION IN 13 PATIENTS OF ASRGDARA No. of Patients (I) White Discharge Total (%) A Group B Group Present 5 3 8 61.53White Discharge: 61.53 % of married patients were having white discharge. No. of Patients (II) Vaginitis Total (%) A Group B Group Present 2 1 3 23.07Vaginitis: Among 13 married patients of Asrgdara Vaginitis was present in 23.07%patients. (III)Cervical No. of Patients Total (%) Erosion A Group B Group Present 3 3 6 46.15Cervical Erosion: Cervical Erosion was observed in 46.15% of married patients.
  • 164. 45
  • 165. 461. Effect of Rasaprasadana Vati on Haematocrit Values of 7 Patients ofAsrgdara Parameters Mean Score % change S.D. () S.E. () t p B.T. A.T. RBC 4.51 4.60 1.96 0.51 0.19 0.46 >0.05 Hb% 10.71 11.0 2.80 1.15 0.43 0.68 >0.05 TLC 7557.14 7785.71 3.02 905.01 341.51 0.66 >0.05 Neutrophil 55.42 58.28 5.14 6.41 2.42 1.17 >0.05 Lymphocyte 38.85 35.85 7.72 7.95 3.0 1.0 >0.05 Eosinophil 4.71 4.57 2.97 3.18 1.20 0.11 >0.05 ESR 150.42 18.57 20.36 7.38 2.75 1.14 >0.05 PCV 33.14 34.57 4.28 4.50 1.69 0.83 >0.05Bleeding Time 2.87 3.07 6.96 0.33 0.13 1.46 >0.05Clotting Time 5.98 6.08 1.67 0.45 0.18 0.54 >0.05 In Rasaprasadana group there was increase in heamoglobin level by 2.80%,which was statistically insignificant (P>0.05). Erythrocyte sedimentation rate (ESR)was increased by 20.36%, which was statistically insignificant (P>0.05). Red Bloodcells (RBC) count was increased by 1.96%, which was statistically insignificant(P>0.05). Total leukocyte count (TLC) was increased by 3.02%, which wasstatistically insignificant (P>0.05). Bleeding time of the patients was increased by6.96%, which was statistically insignificant (P>0.05). Clotting time was increasedby 1.67%, which was also statistically insignificant (P>0.05).
  • 166. 472. Effect of Raktaprasadana Vati on Haematocrit Values of 7 Patients ofAsrgdara. Parameters Mean Score % of S. D. () S.E. () t p B. T. A.T. change RBC 4.40 4.16 5.45 0.34 0.13 1.95 >0.05 Hb% 12.38 11.2 9.53 1.10 0.41 2.88 <0.05 TLC 7614.28 7228.57 5.06 1882.75 710.47 0.54 >0.05 Neutrophil 54.43 52.71 3.14 6.29 2.37 0.72 >0.05 Lymphocyte 41.29 42.43 2.68 7.45 2.81 0.40 >0.05 Eosinophil 4.43 3.85 1.28 5.50 2.08 0.27 >0.05 ESR 14.28 12.0 15.96 4.07 1.54 1.48 >0.05 PCV 37.42 34.28 8.39 2.48 0.93 3.36 <0.05Bleeding Time 2.84 3.14 10.50 0.38 0.14 2.09 >0.05Clotting Time 6.09 6.24 2.29 0.31 0.12 1.18 >0.05Haematocrit Values: - In Raktaprasadana Group, there was a decrease inhaemoglobin level by 9.53%, which was statistically significant (P<0.05).Erythrocyte sedimentation rate (ESR) was reduced by 15.96%, which wasstatistically insignificant (P>0.05). Red blood cells (RBC) count was reduced by5.45%, which was statistically insignificant (P>0.05). Total leukocyte count (TLC)was reduced by 5.06%, which was statistically insignificant (P>0.05). Bleeding timewas increased by 10.50%, which was statistically insignificant (P>0.05). Clottingtime of the patients was increased by 2.29%, which was statistically insignificant(P>0.05).
  • 167. 483. Effect of Rasa Prasadana Drug on the Cardinal Symptoms of 7 Patients ofAsrgdara after Two month. Mean ScoreSr. n Cardinal symptoms A.T. B.T. % S.D. S.E. t pNo. Relief () () 1. 7 Amount of blood loss 1.42 0.14 90.14 0.75 0.28 4.57 < 0.01 2. 7 Duration of Menstrual bleeding 1.85 0.28 84.94 0.78 0.29 5.28 < 0.01 3. 7 Pain (below Umbilical region) 1.85 0.57 69.49 0.48 0.18 6.95 <0.001 4. 6. Daurbalya 1.33 0.5 62.65 0.40 0.16 4.96 < 0.01 Cardinal symptoms : Assessed after two Month. In Rasa Prasadana group of seven patients of Asrgdara, 90.14% relief wasobserved in amount of blood loss, which was highly significant (P<0.01). 84.94%relief was found in duration of menstrual bleeding, which was statistically highlysignificant (P<0.01). Pain was relieved upto 69.49% which was statistically highlysignificant (P<0.001). The relief in Daurbalya was observed upto 62.65% which wasalso highly significant (P<0.01).
  • 168. 494. EFFECT OF RAKTAPRASADANA DRUG ON THE CARDINAL SYMPTOMS OF 7 PATIENTS OF ASRGDARA: AFTER TWOMONTHSr. n Cardinal Symptoms Mean (%) S.D. S.E. t PNo. Score relief () () B.T. A.T. 1. 7 Amount of blood loss 1.86 0.14 92.43 0.75 0.28 6.04 <0.001 2 7 Duration of menstrual 1.43 0.0 100 0.78 0.29 4.82 <0.01 bleeding 3 7 Pain (below umbilical 1.71 0.14 91.81 0.79 0.29 5.26 <0.01 region) 4 7 Daurbalya 2.0 0.71 64.50 0.76 0.28 4.49 <0.01Cardinal Symptoms:In Rakta Prasadana group of 7 patients of Asrgdara, the relief obtained in excessiveblood loss was up to 92.43%, which was statistically highly significant (P<0.001).Menstrual bleeding was relived by 100%, which was statistically highly significant(P<0.01). Pain was relived up to 91.81%, which was statistically highly significant(P<0.001). Daurbalya was reduced up to 64.50%, which was statistically highlysignificant (P<0.01).
  • 169. 505. Over all effect of therapy in each group. Group Mean score % S.D. () S.E. () t p B.T. A.T. Relief Group A 1.61 0.37 76.89% 0.31 0.15 8.11 < 0.01 Group B 1.75 0.25 85.57% 0.18 0.09 16.44 < 0.01Over all effect of Therapy: 85.57% relief was observed in symptoms of Asrgdara in Group B, whileGroup A shows 76.89% relief.
  • 170. 516. Total Effect of Therapy on 14 patients of Asrgdara. Results Group A Group B No. of % No. of % patients patients Cured (100%) 2 28.57 2 28.57 Markedly Improved (76 - 99%) 2 28.57 4 57.14 Moderately Improved (51 - 75%) 2 28.57 1 14.28 Improved (26 - 50%) 1 14.28 0 0 Unchanged (up to 25%) 0 0 0 0 Total effect of therapy reveals that no patient remains unchanged in both thegroups. Each 28.57% patients of both the groups show complete remission. 28.57%& 57.14% patients were markedly improved in Group A & Group B respectively. InGroup A, 28.57% patients shows moderate improvement & 14.28% patients ofGroup B Shows moderate improvement. Group A shows that 14.28% patients weremild improved.
  • 171. 52Discussion: Historical review reveals that though some references are available in Vedicliterature, concept of Upadhatu is not available in particular sense in whichAyurveda comprehends it. In Samhita Kala revered Acarya Caraka mentioned thecomponents of Upadhatu collectively as a unit. This forms a good platform forcommentators to develop this concept. Acarya Bhoja and Gayadasa who belong to11th century, one among the two might have introduced the term Upadhatu for firsttime. The commentators of 11th and 12th century like Cakrapani and Dalhanacontribute significantly to elaborate the Concept. Revered seer of medieval periodSarngadhara introduced new components as Upadhatu, which is accepted by theAcarya of 16th century i.e. Bavamisra. Etymological meaning reveals close resemblance between Dhatu andUpadhatu. There mentioned four Dhatus to which Upadhatu belongs in specificorder. Astanga Sangrahakara adds Sandhi as a Prasadaja entity, which is accepted byDalhana and included it under previous list of Upadhatu. Hence the number becomeseight. Sarngadhara has introduced a new Unit of Upadhatus. He added Sweda,Danta, Kesa and Oja to the list and deduct Sira, Kandara, Twak and Snayu. Among these newly introduced entities Sweda and Kesa are nourished from"Mala" portion of Dhatus. Danta too receive its nourishment form Mala portion ofAsthi Dhatu. Due to tough hard structure of Danta, which resembles with Asthi,might spur Sarngadhara to consider it as Upadhatu of Asthi. Sarngadhara has included Sweda under Mala Bhava and under Upadhatustoo. Since these three are " Mala Posaka" entities of the body, it cannot beincluded under Upadhatus because Upadhatu were nourished by Prasadaja part ofDhatu. Oja is also considered as Upadhatu by Sarngadhara. It is an elixir of all theDhatus hence it is not an Upadhatu entity. Upadhatus are byproduct of Dhatu metabolism. They are produced fromDhatu but at secondary and subsidary level. They have no fate of nourishing further
  • 172. 53Dhatu or Upadhatu. The former Dhatu nourishes successive Dhatus and the reversenourishment is also present at Dhatu level. They are produced in a cyclic manner.The nourishing pool connects all the Dhatus with each other. Such type ofinterrelation is not observed at Upadhatu level. Once they are formed, they do notnourish any former or successive entity. This proves their Gativivarjitatva thoughthey do not nourish Dhatu, but they are an important unit of body. Sarira Posakatvais present in them. Upadhatus are nourished from Prasadaja portion of Dhatus. They receivetheir nourishment from that Suksma Prasadaja portion of Dhatu which providesnourishment to the successive Dhatu. This may be the reason that the structuralconfiguration of Upadhatu show close resemblance with successive Dhatus. Dhatvagni, Vayu and Srotasa plays significant role in proper nourishment ofUpadhatus. Vayu is responsible for conveyance of specific amount of nutrient to theparticular Upadhatu. Srotasa are the channels of transportation and transformation. "ParinamaApadyamana Dhatus" are traversed through Srotasas. Agni is essential for any typeof transformation. So it is concluded that Dhatvagni of each Dhatu resides atSrotasa, which is responsible for Parinamana of Dhatu from one state to another. Dhatvagni are closely related with Upadhatu. Detoriated status of Dhatvagniaffects the normal functions of Upadhatu. To convey the nourishing material to theabodes of Upadhatus Srotasa are necessary. Hence it is stated that Upadhatu are alsohaving their own Srotasa, through which they receive their nutrients. Agni present at Upadhatu level is a type of Bhutagni. This Agni isresponsible for the final configuration of the molecules, which are homologous withUpadhatu. This homologous nourishing portion is used for the development ofUpadhatu or it replaces the former molecules of that Upadhatu to compensate wearand tear phenomenon to of the body. Once the Upadhatu nourishing portion comesto Upadhatu it cannot be circulated to another Dhatu or Upadhatu. They are endproduct of Dhatu metabolism.
  • 173. 54 Emergence of all the Upadhatus except Raja and Stanya takes place duringgestational period only. Raja and Stanya emerge after few years of development andhence they are named as Anitya Bhava of the body. Further each Upadhatu is discussed separately and have tried to give rationalbehind some important fundamentals (related with Upadhatu) stated by classics. Though Kandara is mentioned as a type of Snayu. Besides Meda it is statedas Upadhatu of Rakta. This is because though anatomically it closely related withSnayu at physiological level, the nourishing pool of it is derived differently fromSnayu. Kandara shows other characters like Gativivarjitva, Dhatvantara Aposakatva,which confine its Upadhatutva. In diseased status, the drugs which are acting onRakta Dhatu shows better results in the symptoms of this Upadhatu. Emergence of Sira takes place along with Snayu. Moderate heat for shortduration results in formation of Sira from Meda. Kala possesses nourishing property.Raktadhara Kala, which principally present at inner side of the Sira nourishes it.There is controversy regarding the origin of Sira whether it is from Nabhi or Hrdaya.Considering the views of different Acaryas one can conclude that the descriptiongiven by Susruta indicates its origin at gestational period and those of Vagbhata isrelated with postnatal period. The opinion of Acarya Jyotiscandra Saraswati shouldbe kept in mind while considering the Ayurvediya Sira Sarira. Dosa travels from one place to another through these channels. Sira providesubstratum for all the functions of Dosa. In the bounds of these channels Dosaexhibit many physiological functions. All the sensations are received due to function of Vayu. Raktavaha Siraprovides a platform to convey this knowledge to concern entity. The authors of thepresent era have different opinion regarding this entity. On the basis of presentanatomical knowledge the following structures may be included in Sira. *The Arteries, which are the bigger channels of the body, convey pure blood. *The Veins, which are smaller, returns blood from the different tissues of thebody to the heart.
  • 174. 55 *Capillaries have the property of permeability allow the nutrients to go outof them. *The channels, which convey the lymph to the veins, called Lymphaticchannels. These four structures are to be co-related with Ayurvediya Sira Sarira. Any type of injury to Sira causes loss of Jiva Rakta, which may be fatal. Thisproves their importance in body physiology. Vasa shows close resemblance with Meda Dhatu. Both the structures arenourished from Prasadaja portion of Mamsa Dhatu. According to somecommentators these two entities are one and the same, but Vasa is formed by actionof Mamsa Dhatvagni, on the contrary Meda is formed further after the action ofMedo Dhatvagni. To understand the relation between these two entities, anatomicalstructures of these two are to be studied. It shows that Adipocytes (Vasa) constitutethe principal component of Adipose tissue (Meda), but they are also present in looseconnective tissue and other parts of the body. The statement of Bavamisra is to be considered in this regard. He has statedthat Sneha of Meda also called as Vasa. This is a very practical statement. If Mamsaand Meda put on fire, the extract will be the same and identical in character. ThisSneha is known as Vasa. For the smooth functioning of muscles a lubricating material is placed in theform of Vasa, which alleviates Vata Dosa. Deficiency of this Upadhatu causesdetoriation in the status of Mamsa Dhatu. Rakta Dhatu is involved in embryological development of various organs.This may be the reason that Astanga Sangrahakara has mentioned the emergence ofTwak from Rakta. One could not understand the rational behind the statement ofSarngadhara to consider the Twak under "Mala Bhava". Twak is the Upadhatu of Mamsa. Mamsa provides support to the skin andalso nourishes it. Their functions similitudes with each other. If the skin is damagedthe rejuvenation process starts from most inner layer of the skin which is in closecontact with Mamsa Dhatu. In such conditions administration of MamsavardhakaDravyas (which nourishes Mamsa Dhatu) regain its normal status very rapidly.
  • 175. 56 There are different opinions regarding the number of layers of the skin. It iswith a view to suit the specific purpose of a part of branch of Ayurveda that theorgans of the body are counted differently. Susruta Samhita is related with surgerywhere as Caraka with internal medicine so the difference in the description ofnumber of layer by these authors is counted. The first two layer described by AcaryaCaraka indicates their normal physiological functions, while others are indicative ofseverity of diseases. The last layer provide substratum for the functions of Prana.The layers described by Acarya Susruta indicates their role in normal physiologicalfunctions of the skin and the site of different diseases manifest at skin layers andtheir prognosis too. Avabhasini, the first layer maintains the temperature of thebody. Bhrajaka Pitta resides at this layer. All types of sensations are receivedthrough fifth layer. In head region the Mamsa Pesi are having their insertion directly on the skin.This may be the reason that Twak is mentioned as a Mulasthana of MamsavahaSrotasa, though it is Upadhatu of Mamsa. Any type of sensation cannot be received without the indulgence of skin. Modern anatomy helps to understand the status of these layers. Sensorynerve endings are situated in papillary layer. The function of this layer similitudewith "Vedini." Snayu are emerged from Meda Dhatu. "Khara Paka" of Agni is responsiblefor conversion of Meda to Snayu. The term ‘Khara Paka’ indicates two differentforms of Agni. 1. Moderate heat for longer duration 2. Intense heat If we see the constitution of Snayu it is very dense, solid, gummy (glutinous)in nature. To procure this quality moderate heat for longer duration is required. Tomaintain the status of the Snayu and to alleviate the Vata Dosa, which resides atSnayu the compensatory mechanism is resorted in the form of lubrication of Meda.Snayu are mentioned as a Mulasthana of Mamsavaha Srotasa, though it is the
  • 176. 57Upadhatu of Meda, which is next to Mamsa Dhatu. Snayu bounds Mamsa Pesi toAsthi, thus they provide a firm base for attachment and bear it. This may be thereason that Snayu are mentioned as a Mulasthana of Mamsavaha Srotasa.Classification of Snayu explained by great seer Susruta is based on the nature ofSnayu. If we compare the structure of Snayus with present modern anatomicalstructures then it is observed that: -1. Pratana Snayu resembles with ligaments. Prthu Snayu similitudes withflattened or ribbon shaped tendons or aponeurosis. They also show closeresemblance with sphincter muscles or valvular bands of muscles. This is theexception where Mamsapesi are named as Snayu by classics. If we consider theSnayu in relation with Kostha, Mesentery is the structure placed in relation withKostha. Their function correlates with Snayu. These entities provide support to theelementary canal. But these are not a Susira type of Snayu. Snayu provide strengthto the joints and other structures of the body, hence any type of injury to thisstructure causes great disability. Sandhi are articulating points of the body. Especially the joints of bones areexplained by Acaryas. Sneha of Medo-Dhatu nourishes them. To understand therelation between these two entities the anatomical structure of Sandhi should bediscussed. Adipose tissue (Meda Dhatu) is involved in composition of synovialmembrane. This synovial membrane secretes fluids, which lubricates & reduces thefriction of the joints. This supports the view that Meda nourishes Sandhi. InMedaksaya condition the symptoms related with Sandhis like Sandhisunyata,Ruksata, Sandhi Sphutana are present which indicate the lack of nourishment due toMedaksaya. Sandhi is also described as a Mulasthana of Majjavaha Srotasa. The rationalbehind this is not understood, but it is observed that Majja Dusti causes Arunsika,which manifests at small joints. This evidences that Sandhis are involved in MajjaDhatu Dusti.
  • 177. 58 Raja & Stanya are Stri Visista Upadhatus. These two are "Anitya Bhavas"because their function is observed for specific time period. They play distinct role inreproduction. On the contrary one can say that they are only attributed to female’sphysiology for the purpose of reproduction. These two Upadhatus show differentcharacters as compare to other Upadhatus, which are as follows:Raja & Stanya Other Upadhatu1. Function is observed only in females 1. Common to both Sex.2. Functions for specific time period only 2. Functions through out the life3. They are having liquid nature 3. These are solid in nature4. Excretory in nature 4. Not evacuated from the body5. Functions like Mala too 5. Not functions like Mala6. Functional entities 6. Principal structural entities7. After some time harmful to body 7. Not harmful to bodyStanya: Stanya has no beneficial role to female body. It is present only in puerperientwoman. It is derived to nourish the infants. Its formation ceases when its need isover that is when infant become independent to digest the external food material. AsRasa Dhatu provide nourishment to all the tissue elements; Stanya provides allnutritional requirements to the fetus for certain period of time.Except Stanya, Raja and Vasa other Upadhatus are stable and stationary. They arestructural entities. Sira Snayu, Sandhi are distinctly involved in the pathogenesis ofVatavyadhi. They come under Madhyama Roga Marga, hence difficult to treat.Due to "Gativivarjitva" the diseases of Upadhatu are difficult to treat. Therapyrequires long duration to treat them. In the pathogenesis of disease Upadhatus are involved in later stage, so theirinvolvement indicate bad prognosis. Artava [Stri Bija] and Raja Upadhatu are two entities concern with femalereproductive system.
  • 178. 59 Stri Bija is responsible for procreation and Upadhatu Raja is responsible fornourishment and sustenance of the developing embryo during gestational period. These two entities are separately mentioned in the classics.1] Rajakala and Rtukala are separately mentioned.2] While describing the Yonivyapada Nidana revered seer Caraka has stated thesetwo entities distinctly. Artava Stri Bija is not a visible entity. Raja and Artava are closely relatedwith each other. Status of one affects the other. Since Artava is not visible, onecannot examine its status independently. By examine the characters of Raja, whichis visible one, status of Artava could be judged. This might be the reason that inclassics wherever the characters of Artava are mentioned they are attributed to Raja.It is also observed in the case of Dusti Laksana of Artava. Regarding the Utpatti of Artava (Stri Bija): - Classics have not clearlymentioned the Utpatti of Artava. The formation of Raja is stated from Rasa alongwith Rakta. Similar nomenclature has been adapted two describe these two entities.Due to this commentators are also confused and opine the contradictory statements.So it is difficult to conclude at few places whether the verse is related with formationof Raja or Artava. The above discussion reveals that Utpatti of Stri Bija Artava is not clearlymentioned in the classics. The status of Artava could be judged by examine thecharacters of Raja. Artava combines with Sukra to form an embryo. Hence it must havereproductive capacity. So its formation may supervene along with Sukra to resumethe reproductive capacity. Raja functions throughout the fertile period of female physiology. Maturityof all the Dhatus is having great significance in manifestation of Raja. There is acontroversy regarding the formation of Raja whether it is Upadhatu of Rasa orRakta. Raja shows close resemblance with Rakta Dhatu.1. Colour: -
  • 179. 60 The examples depicted by Acaryas to understand the colour of the Rajasimilitudes with the examples mentioned to understand the colour of Rakta.2. Staining property of cloth: - In Prakrta condition both the entities do not stain the cloths.3. Both are Pitta Dosa Sthanas.4. Rakta vitiating factors and Raja vitiating factors are same.Important differentiating points are also present in these two entities, which arediscussed here. 1. Raja is Agneya in character, while Rakta is Anusnasita. 2. In normal condition the nourishing substances of these two aredifferent. For "Apyayana" of Artava Pitta and Kapha Vardhaka Ahara is prescribedby Acaryas. The principle behind this is quoted as "Samanena Samanasya Vrddhi."The same principle is applied to Raja. Agneya Dravyas are described in Rajaksayacondition. On the contrary diet, which is not very cold and or hot, is prescribed forApyayana of Rakta Dhatu. In Raktaksaya condition the Amla and Sita type ofDravyas are suggested. By comparing the functions of these two, Raja is having nourishing property,while the important function of Rakta is Jivana. Though Dalhana has stretched the Jivana Karma to Raja also, but theopinion is not much accepted and supported by others.Regarding formation of Raja: - Some verses of the classics explicit that after the action of Ranjakagni thepart of the Rakta Dhatu itself comes to Garbhasaya, where it is termed as Raja.[S.Su. 14/6; A. S. Sa. 1/9 Indu, A.H.Sa. 1/22 Arundatta]Considering these references the formation of the Raja will take place in followingway.
  • 180. 61 Posya Rasa Stanya Rasa Dhatvagni Ahara Rasa Yakrta Rasavaha Srotasa Rakta Posaka Amsa Ranjakagni Kapha RAJA Garbhasaya Rajovaha Srotasa Posya Mala Rakta Dhatu Mamsa Posaka Amsa According to principle of Upadhatu, Upadhatu belongs to that particularDhatu from which it receives its nourishment and this nourishing part separates afterthe action of that particular Dhatvagni. Now by applying this principle to the abovecondition, Raja will become the Upadhatu of Rakta because it is formed by Suksmaportion of Rakta Dhatu after the action of Ranjakagni.Now comparing Raja with Rasa: Rasa provide nourishment to all body constituents. In the same way duringgestational period Raja provide nourishment to developing embryo. Menarche startsat the age of twelve years, but the childbearing period is mentioned after sixteenyears of age. During this mid period the slow accumulation of Raja in theGarbhasaya helps in development of all reproductive organs. It brings aboutApyayana of these organs and prepares the body to receive conceptus. Development and maturation of all the Dhatus is the function of Rasa. Whenit brings about the maturation of all Dhatus then after the extra work is attributed toit (in females) i.e. derivation of Raja Upadhatu. Again when Dhatu are in declinestate they need more nourishment for their sustainance, Rasa does not nourish RajaUpadhatu and again the nourishment is fully concentrated only towards Dhatus.Though the Pitta Vardhaka diet is prescribed for females, it mainly responsible forits expulsion (i.e.Vyaktibhava). Acarya Vagbhata has specified that the female whoregularly consumes buttermilk, milk in diet, Raja functions for a longer duration ascompare to others, Ksayavastha of Raja comes in later stage of life in those women.
  • 181. 62This indicates that nourishment of Rasa Dhatu is responsible for nourishment ofRaja.But these two entities are having very different characteristic nature.Rasa is pacifying in nature (Saumya Bhava), while Raja is having Agneya character.Karya-Karana Siddhanta is applicable here i.e."Parinama Visesat Karana Visadrsam Karyam Bhavati | "[S. Su. 4/7 Bhanumati]As solid substances are changed into fumes due to action of fire, sugarcane juice, avitiating factor of Kapha is changed after formation into wine, which vitiates all thethree Dosa, in the same manner Saumya Rasa Dhatu, takes form of Agneya entityRaja. Parinamana supervene due to crucial role of Agni. All the ancient Acaryasexpect few, have clearly stated that Raja is formed from Rasa Dhatu.In this case the formation process will be like this: Posya Rasa Dhatu Stanya Rasa Dhatvagni Ahara Rasa Rakta Posaka Amsa Raja Mala1. It is formed by action of Rasadhatvagni and it derives its nourishment from that part Suksma Prasadaja of Rasa Dhatu,which further provide nourishment to Rakta Dhatu On the basis of principle of Upadhatu, it reveals that Raja possess all thecharacteristics necessary to mention it as Upadhatu of Rasa.On the basis of this it is concluded that Raja is Upadhatu of Rasa. But question remains, what are those factors which makes its appearancesimile with Rakta, because to acquire the Ranjaktava it should be acted upon byRanjakagni, without it such transformation does not supervene.Harita has explained the changes of Rasa Dhatu while transforming into Rakta. Hehas mentioned the changes in the colour as-Sweta-Kapota-Harita-Haridra-Padma-
  • 182. 63Kimsuka-Alaktaka. It is quoted that Raja is formed along with Rakta Dhatu and itshows resemblance with the colour of Rakta Dhatu the same changes will also takesplace at the level of Raja. Though it is formed along with Rakta it procures all itsCharacters when it comes to Garbhasaya. It accumulates here for a period of month.Agni, Kala, Asaya Prabhava are the major factors responsible for its transformationParinamana is the function of Agni. It is responsible for transformation of Rasa intoRaja. Evidences shows that it should have similar qualities as that of Ranjakagniwhich supervene this transformation to acquire the Ranjakatva. One should recollect that most of the Upadhatus shows close resemblancewith subsequent Dhatus because they are derived from that Suksma Prasadaja part ofDhatu, which provides nourishment to the successive Dhatu. It adds to thereasoning, which indicates the rational of its resemblance with Rakta Dhatu. The second important factor is Kala, though Raja is formed along withRakta after seven days, it needs one month to procure all its characters. Garbhasaya and its Asaya Agni are also responsible in resuming itscharacters because it acquires all its characters after reaching the Garbhasaya. This shows that many factors are responsible for its resemblance with RaktaDhatu. Nourishing principle of Upadhatu and the statements supported by classics,reveal that Raja is Upadhatu of Rakta. During menstrual cycle various stages of Dosa predominance are observed.Vyana Vayu is responsible to provide proper amount of nourishment to Raja. ApanaVayu expels the Raja to the exterior for specific period of time. The normal slightblackish colour of Raja is present due to Apana Vayu. Normal functioning of Raja isvery much depended on the status of Apana Vayu. There are different opinions regarding the duration of menstruation. Prakrtiplays an important role in this regard. Pitta Prakrti female menstruates for longerduration as compare to others. Rtukala is the most fertile period. Condition of Raja affects Rtukala. Duringnormal status of Raja, Rtukala may continue for entire month.
  • 183. 64 Purana Raja has no significance in female’s physiology. Menstruatingendometrium is toxic in nature. Euglobin is the toxin responsible for this. It showsthe " Malarupata" of Raja. At this stage, it should not retain in the body otherwisecause disease.Anatomical structures of reproductive system are very much adaptive to receive theconceptus. According to modern science estrogen has prime role in development ofreproductive system. Constructive changes in the endometrium and its nourishingfunction support the nutritive role of Raja for fetus.Along with nutritive function, accumulated Raja is the nidus to developing embryo.Before the establishment of the feto-maternal pool the accumulated Raja providesnourishing material for the sustainance of embryo.This reveals the "Posana Karma" of Raja. Clinical study has been conducted to support the hypothesis of formation ofUpadhatu Raja, to prove its specific relation with Rasa and Rakta Dhatu. In thepresent context the term “Artavadusti” indicates Dusti of Upadhatu Raja, this“Rajodusti” word is exclusively used in classics. Rajodusti indicates the vitiatedstatus of Upadhatu Raja. Asrgdara is a broadly classified disease, includes various diseased conditionsof menstrual cycle, hence Attyartava condition of it was selected for clinical study. Keeping in mind the principle of Dhatvagni i.e. drugs which act on particularDhatvagni will certainly improve the status of its Upadhatu. The patients ofAsrgdara were treated with Rasaprasadana and Raktaprasadana drugs. Prasadana
  • 184. 65drugs principally improves the status of that Dhatvagni, thus improves the vitiatedstatus of Upadhatu. The Dravyas, which act on Rasa Dhatvagni, will certainly show some effecton Rakta Dhatu and vice a versa, but Dravyas of specific group will show majorrelief in the symptoms of that particular Dhatu. Most of the patients were Hindu. This data is in consistent with thepopulation characteristic of Jamnagar. The incidence of disease was found more in lower middle class females.Due to small data, there may also not have any relation between the social status &the disease. Most of the patients were married. This shows that married women are moreprone to disease. This may be because of excessive and improper sexual indulgence,which will further aggravate the Sthanika Apana Vayu Dusti, which is the principalfactor in the pathogenesis of the disease. Dvidosaja Prakrti is prevalent in today’s society. The maximum patients ofVata-Pitta dominance were found. These two Dosa plays a major role inpathogenesis of disease. Thus signifies the role of Vata-Pitta Prakrti in pathogenesis. Many patients were observed of Madhyama Sara, but Avara Sara patientswere also observed in significant number. Due to involvement of Rasa & RaktaDhatu the Avara Sara Laksanas of these Dhatus were observed which are mentionedunder Dusti Laksana of these Dhatus. Since chronic patients were not taken for the study, most of the patients ofMadhyama Pramana were found. Satva shows no direct relation with disease. In many of the patients Abhyavaharana and Jarana Sakti was foundMadhyama because chronic patients of Asrgdara were not included in the study.Thus it can be said that in early stages of disease the status of Jatharagni is notaffected to a great extent.
  • 185. 66 Most of the patients were belonging to Jangala Desa because patients fromJamnagar were selected for the study, which is a type of Jangala Desa.The study incorporates Nidana of Rajodusti along with Rasa & Rakta Dusti. Manasika Nidana like Cinta & Krodha was also found in maximum numberof patients. Acarya Madhava has distinctly mentioned the role of Manasika Bhava inmanifestation of Asrgdara. Above data supports role of Manasa Bhavas in thepathogenesis of disease. These Nidana also incorporates the vitiation of Rasa Dhatu,which explains the critical role of Manasika Bhava in Rasa Dusti. Significant number of patients were consuming Non-vegetarian dietfrequently, like Mamsa, Matsya etc. Mamsa is having Pitta-Kapha Vardhakaproperty, is prescribed for Apyayana of Raja. But if it is consumed improperly & inexcess amount it may lead to Rajodusti as well as it also vitiates Rakta Dhatu. Most of the patients were consuming Katu, Amla Rasa and Tiksna Gunadominating diet. Vidahi, Abhisyandi, Viruddhanna, Dadhi, Harita Saka Sevana wasobserved in maximum number of patients. These Nidana vitiate Pitta and Kapha,cause deterioration of Agni, vitiate Raja and Rakta too. One point should be notedhere that vitiating factors of Raja & Rakta were observed similar. As discussedpreviously due to resemblance in the characters, the vitiating factors of both theentities are same. Thus above findings support the classical references. The Aharaja Nidana (dietetic factors) which directly vitiate the Rasa Dhatuas mentioned in the classics were not observed but the above mentioned Nidanahampers the status of Jatharagni which results into improper formation of AharaRasa which affect the status of Rasadhatu. All the mentioned Cardinal symptoms of the disease were observed inmaximum number of patients. Ruja was observed in all the patients, with varying degree, which shows theimportant role of Vayu in the manifestation of disease.
  • 186. 67 During diseased condition, normal characters of the Raja get changed. Indiseased status, the menstrual blood was showing Picchila Guna, Granthibhutatva,and Daurgandhya. Aruna and Sonita Varna were observed in maximum number ofpatients. Among the above observed characters, Picchila Guna indicates thedominance of Kapha Dosa. Granthibhuta Raja indicates the excess amount of flowalong with dominance of Vata and Kapha Dosa. Daurgandhya indicates the vitiationof Pitta Dosa. Aruna Varna indicates the dominance of Vata Dosa. Sonita Varnaindicates the Pitta dominancy. Thus the Laksana of all the Dosa were observed in vitiating Raja, whichshows their involvement in the pathogenesis of Asrgdara. Sarvadehika Laksana like Aruci, Angamarda, Pindikodvestana, Daurbalya,Bhrama was observed predominantly. Among the Rasadusti Laksana mentioned inthe classics, Angamarda, Sabdasahisnuta, Aruci, Angasada, Sramasosa & wereobserved in maximum number of patients. Among Rakta Dusti Laksana Twak Ruksata, Mukhapaka, Pipasa, SphutitaTwak, Aruci & Pidaka (on face & Prsta) was observed in maximum number ofpatients. Thus this data shows that both Rasa Dhatu Dusti and Rakta Dhatu DustiLaksanas are observed in cases of Asrgdara. This shows that both are getting vitiatedsimultaneously.The above two charts shows that though direct Nidana of Rasa Dhatu Dusti were notobserved, still their present higher occurrence of Rasadusti Laksanas as compare toRakta Dusti Laksanas. Thus it can be said that Rajodusti Nidana directly affects thestatus of Rasadhatu also. It proves the direct co-relation between these two entities. Along with Rasa and Raktavaha Srotasa, the involvement of Annavaha &Swedavaha Srotasa is also observed in maximum number of patients. Annavaha
  • 187. 68Srotasa involvement indicates the Jatharagni Dusti, which further affects the statusof Rasa. During Kostha Pariksa Vibandha was noted in significant number ofpatients. This shows that vitiated Apana Vayu also affects the normal status ofMala. History of abortion was found in few patients. Due to small number of dataone cannot specify the relation between history of abortion with manifestation ofdisease. Retroverted and bulky uterus, cervical erosions, tenderness of uterus wereobserved in significant number of patients. This shows the deviant status of uterusin this disease and its vulnerability towards the disease. White discharge was observed in many patients, which suggests the Kaphaand Rasa Dhatu Dusti.Investigations: - Haematological investigations show that Haemoglobin is increased inRasaprasadana group (A) but at insignificant level. On the contrary it is reduced inRaktaprasadana group (B) at significant level. RBC count TLC count, Neutrophils are increased in Group A while thesevalues are decreased in Group B. Lymphocyte count was decreased in Group Awhile it was increased in Group B. Eosinophyl count was decreased in both thegroups. These changes are observed statistically insignificant. Bleeding time andclotting time is increased in both the groups, which is statistically insignificant. Thus it could be said that drugs of both the groups are acting on coagulationfactors of blood. This proves that haematological parameter shows better results inRasaprasadana group. While in Raktaprasadana group the results are not so positive. This could be explained on the basis of Dhatvagni Concept.
  • 188. 69 Rasa Prasadana drugs act on Rasadhatvagni thus by restoring the basicfunction (status) of Rasagni it improves the qualitative genesis of Dhatu. Rakta andRaja both receives their nourishment from Suksma Rakta Prasadaja part ofRasadhatu. This genesis supervenes after the action of Rasadhatvagni. So once thestatus of Rasadhatvagni is improved, it certainly improves "Dhatu VyuhanaPrakriya" (Samvardana process) which is achieved by Rasaprasadana drugs. Rakta Prasadana drugs might not have acted on Rasa Dhatvagni, thereforestatus of Rasa Dhatvagni remains unchanged and hence status of basic nourishingpool remains unchanged. Thus Rakta Dhatvagni condition was not improved, sohaematological reports have not showen positive improvement. In Rasaprasadana group the effect of therapy shows highly significant resultson all the Cardinal symptoms (i.e. Amount of blood loss, Duration of menstrualbleeding, pain and Daurbalya) of Asrgdara. In Rakta Prasadana group all the cardinal symptoms shows highly significantresults. By comparing the results of two groups: Symptoms Rasaprasadana Rakta Prasadana Drugs (A) Drugs (B)1. Amount of blood loss 90.14 92.432. Duration of menstruation bleeding 84.94 100.03. Pain 69.49 91.814. Daurbalya 62.65 64.50 The above results implicate that in amount of blood loss complete cure wasobtained in Group - B. It also shows better results in pain as compare to Group - A. By comparing the over all effect of therapy 76.89% relief was observed inRasaprasadana group, while 85.50% relief was observed in Raktaprasadana group. Thus percentage relief was higher in Group - B as compared to Group - A.
  • 189. 70 Total effect of therapy on both groups reveals that in both the groups nopatient remain unchanged, but in Raktaprasadana group more significantimprovement was observed in patients of Asrgdara as compare to Rasaprasadanagroups. Thus one can state that symptomatic relief was observed in both the groups.Raja shows close resemblance with Rakta. Artavavaha Srotasagni similitude withRanjakagni, hence Raktaprasadana drug shows slight better improvement insymptoms of Asrgdara as compare to Rasaprasadana drugs. But if both of these parameters (i.e. symptomatic relief & haematologicalreport) are compared then it is proved that Rasaprasadana drugs are more effectivethan Raktaprasadana drugs. Raktaprasadana drugs only bring symptomatic relief, on the contrary inRasaprasadana drugs Dhatu Vyuhana process is also restored and hence the status ofRakta Dhatu is also improved. This reveals that Rasaprasadana group is moreeffective as compared to Raktaprasadana group.CONCLUSION:1. Acarya Caraka has introduced the Concept of Upadhatu.2. Commentators have contributed significantly to illustrate the Concept.3. Upadhatus are closely related with the Dhatus.4. First four Dhatus exhibit a distinct role in derivation of Upadhatus.5. Upadhatus do not nourish any successive Dhatu, but they nourish other constituents of the body.6. Stanya, Raja, Kandara, Sira, Twak, Vasa, Snayu & Sandhi are the components of Upadhatu Unit.7. Sarngadhara has introduced a modified Unit of Upadhatu. Among newly introduced components Sweda, Kesa and Danta are "Dhatu Mala" while Ojais elixir of Dhatus. Hence these cannot be accepted as Upadhatus.
  • 190. 718. Upadhatus are by product of Dhatu metabolism.9. They are nourished from that Suksma Prasadaja portion of Dhatus, which also nourishes successive Dhatu. Due to this property they show close resemblance with successive Dhatu.10. They are end, finalised products of Dhatu metabolism.11. Dhatvagni, Vayu and Srotasa play a pivotal role in proper nourishment of Dhatu and Upadhatu.12. Upadhatu possesses their distinct Srotasa through which they receive their nourishment.13. Normal functioning of Upadhatu is directly concerned with status of Dhatvagni.14. Bhutagnis are present at Upadhatu level. They supervene final molecular configuration of nutrients homologous to Upadhatus.15. Upadhatus are of two types i.e. structural entities & functional entities.16. Raja and Stanya are functional entities restricted to Stri Sarira. They arederived only by means of nourishment of progeny, play a pivotal role incontinuation of human species. Stanya is Upadhatu of Rasa.17. Kandara, Sira, Snayu, Sandhi and Twak are principally involved to designthe structural architecture of the body.18. Sira is Upadhatu of Rakta. They are channels for conveyance of materialconstituents from one part of the body to other. They provide substratum for variousfunctions of Dosa.19. Sira, Snayu and Sandhi forms physical mortal of Marma.20. Kandara and Snayu show anatomical and functional resemblance. Kandara isUpadhatu of Rakta while Snayu is Upadhatu of Meda.21. Snayu is an important structural entity evolved to bear the body weight.22. Vasa is Upadhatu of Mamsa. It is a lubricating agency placed for smooth functioning of muscles.23 Twak mantles the whole body, it also provides platform for various functionsof Vayu and other Dosa.
  • 191. 7224. Sandhi are Upadhatu of Meda. They are articulating joints of the body. Allthe movements of body are practiced due to presence of this entity.25. Upadhatus have great importance in pathogenesis of disease.26. Kandara, Sira, Snayu and Sandhi are included in Madhyama Roga Marga,which are intricate for treatment.27. Stri Bija - Aratava and Upadhatu Raja are two related entities concerned with female reproductive system. Artava is non visible component hence by assessing the characters and functions of Raja the Status of Artava should be judged.28. Thorough study of the classics reveals that after the action of RasaDhatvagni, Raja is derived from Suksma Prasadaja part of Rasa; hence it isUpadhatu of Rasa.29. Properties of Ranjakagni similitudes with the Agni, present at Artavavaha Srotasa.30. Agni, Kala and Asayaprabhava are the factors responsible for closeresemblance of Raja with Rakta Dhatu. Due to their analogous characters thevitiating factors of both the entities are simile with each other.31. Prasadana Drugs act on its particular Dhatvagni It restores the normal status of Dhatvagni and helps to improve the quality of Dhatus.32. The the practical study reveals that Rajodusti Nidana directly affect the Rasadusti Nidana.In absesce of direct classical Nidana of vitiation of Rasa, greater occurrence of symptoms of Rasadusti elucidates the direct relation of Rasa and Raja.The final results of the clinical study shows that through Rasaprasadana drugs normal status of Upadhatu is achieved and Dhatu Vyuhana process is also restored, thus shows better results as compared to Raktaprasadana drugs. These results support the conceptual conclusion i.e. Raja is nourished from Prasadaja portion of Rasadhatu. So from both (Conceptual and Clinical Study) it is concluded that Raja is Upadhatu of Rasa.
  • 192. 73 Summary After considering a thorough view of Conceptual Study and Applied Study,distinctly undertaken with Upadhatu Raja on patients of Attyartava (condition onAsrgdara) followed by fruitful discussion based on the critical examination offundamental scientific references and data obtained from applied study, conclusionsdrawn from the study it is the time to summarized the whole work: The present study entitled "A study on the Concept of Upadhatu in Samhitaswith Applied Aspect to Artavadusti" was designed in two parts: Conceptual Studyand Clinical Study. Conceptual Study comprises seven subsections with study ofconcept of Upadhatu along with the details of disease and drug, the second part ofthe study deals with Clinical Study, the third part deals with fruitful Discussion andConclusion. The extract of the work is presented as follows: Ayurveda is evolved from Vedic literature. The concept of Upadhatu istraced from ancient literature under Historical review. Though the components of Upadhatu unit were known since ancient years,Acarya Caraka first commenced the terminology. The evolvement of the Conceptover a period of time is studied in the beginning of Conceptual part. To understand the logic behind the derivation of every term, one has to findout its literary meaning. The etymological meaning of the term Upadhatu isdefined further. Upadhatus are mentioned along with Dhatus. They are related with Dhatusin a very specific manner. This co-relation is studied with Characters of Upadhatusdescribed by various annotators. Author of medievel period Sarngadhara has introduced a modified Unit ofUpadhatu. This is studied further as compare to previous Concept of Science &have tried to find out the logic behind this.
  • 193. 74 Physiology of Upadhatu formation is studied. Due emphasis is given toexplicate the important role of Vayu, Srotasa and Agni in the formation ofUpadhatu. Relation of Srotasa with Dhatvagni is sited with new perception. Status ofUpadhatu depends upon the status of Dhatvagnis. Their pivotal role in thephysiology of formation of Upadhatu is also explained. Bhutagni plays an importantrole to derive final Bhautika molecular configuration of components. Their role inUpadhatu formation is dealt with new task. After highlighting the nourishment of Upadhatu their emergence is alsoexplicated further. Some Upadhatus act as a physiological entity. On the contrary others areprincipally involved in anatomical configuration of human mortal. To know the status of Upadhatus in the body each Upadhatu is dealtseparately with its characters, structures, and specific functions. There are many vital structures, which are related with Upadhatus, Marmaare one of them. Upadhatu are principally involved in the formation of physicalmatrix of Marma. The importance of Upadhatu in normal functioning of Marma isstudied. Upadhatus are having specific relation with Dosa. This concept is alsostudied. Upadhatu are involved in emergence of diseases. Their important role inpathogenesis of various diseases is studied, which is also necessary to confine theprognosis of diseases. Further the study is focused particularly on Upadhatu Raja, which is maintopic of Research Work. Different views of the classics related with the formation of Upadhatu arestudied. The hypothesis regarding the controversy whether it is Upadhatu of Rasa orRakta is put forth. Characters & functions of Rasa & Rakta Dhatu, confined withthe subject are highlighted.
  • 194. 75 The Prakrtatva of Raja with its synonyms, characters, physiology, distinctfunctions related with reproduction is also given with its modern view. Thecontroversy is dealt on the basis of Principle of Dhatvagni. To prove the principle practically and to resolve the controversy regarding itsformation, Attyartava condition of Asrgdara was selected for practical study.Etiological factors, its etiopathogenesis, features of Dusta (vitiated) andcontaminated Raja are illustrated under disease review. Acting on related Dhatvagni, Prasadana drugs improves the status ofDhatvagni thus the genesis of Dhatu & the Upadhatu is also improved. On the basisof this principle the Rasa Prasadana and Rakta Prasadana drugs were selected. Two Groups were done viz. 1. Rasaprasadana Group 2. RaktaprasadanaGroup, to assess the specific correlation of Rasa and Rakta Dhatu with UpadhatuRaja. IInd Section is dealt with Clinical Study. The data recorded from 20 patientsof Asrgdara has been given. Criteria for selection of patients, criteria of assessment,observations and effect of therapy are given at end. IIIrd Section comprises data collected, compiled and analysed,comprehensive study of Classics as well as modern literature evaluated critically andthorough discussion is done on the subject. The observations recorded from thepractical study and the results obtained are assessed and discussed. On the basis of logical discussion done on conceptual part & the resultsobtained from practical study, the conclusions are drawn at the end, like Upadhatusare final product of Dhatu metabolism. It is fundamental unit of body havingforemost importance in the continuation of life. Status of Upadhatu depends uponthe status of concern Dhatvagni. Upadhatu Stanya and Raja are functional entitieswhile other Upadhatus are principal structural entities. Raja shows closeresemblance with Rakta Dhatu. It is an Upadhatu of Rasa Dhatu.
  • 195. 76In the available infrastructure there were many limitations for practical study.Sampling weas small and not possible to materialize all the possible parameters ofapplied aspect. The humble efforts are attributed to explicate this fundamental principle ofScience. Whatsoever the honest work has been done comprehend further. It willdefinately contribute to understand the concept of Upadhatu, as depicted by ancientAcaryas. The study will definitely act as a basic platform for further research workson Upadhatu, thus will helpful to add a bit in development of this great science.