CLINICAL EVALUATION OF ASTHI DHATU अस्थी

धातू – By Dr. Shilpa Yerme

 SYNONYMS

 . Kikasam: round structures

 2. Kulyam: tubular or canal like structure
 3. Svadayitam: animals like dogs like it
 4. Medasteja: essence of Medadhatu (adipose tissue)
 5. Sara: extract of body which remains even after
death
 6. Majjakrit: which produces the Majja dhatu

 7. Dehadharakam: which maintains body frame

(skeleton) and bears body weight
 9. Karkaram: rough
Meaning of Asthi
 In physiology, the word denotes structural and functional components
mainly of osseous or bone tissue.
 jangamadravya) --It is a substance of animal origin ( [Cha.
Sa. Su. 1/69]
 In the contexts of some pharmaceutical preparations, seedless fruits
(ansathi) are to be used. Hence it denotes seeds or kernel of fruits.
E.g. seedless fruit of Embelica officinalis (Amalaki) [Cha.
Sa. Chi.1/1/58]
 In the dietary preparation of meat soup (vesavara) bones should be
removed. (nirasthi) [Cha. Sa. Su. 27/ 269]
 There are five types of bones in human body. [Su .Sa Sharira Sthana
5/20]
 1.Flat bones (kapala)
 Knee (Janu), jaghana(pelvic), shoulder(amsa),
 Cheek(ganda),palate(talu),temples(shankha),skull(shiras)
 2.Teeth(ruchaka)
 Teeth
 3.Cartilages(taruna)
 Nose(Ghrana), Ear(karna), Neck(griva),orbit of the
eye(akshikosha)
 4.curved/Annular bones(valaya)
 Ribs(Parshuka), vertebrae (prushthakasheruka)
 5.Tubular bones (nalaka)
 All other long bones
STRUCTURES RELATED WITH ASTHI DHATU

 (Asthi jala)
 There are four types of network-like
structures (jala) in body including, bone
network (asthijala).The others are muscles
(mamsa), veins (sira) and ligaments (snayu).
There are four such networks formed from
each of these types. They are present in wrist
and ankle joints and interlinked together.[Su.
Sa. Sha. 5/12].
 Confluence of bones (asthi sanghata)
 confluences are places where many bones present. The
confluences of bones are fourteen in number. They include
ankle(gulpha), knee(janu), and groin(vankshana ) in lower limbs
and their counter parts wrist(manibandha), elbow(kurpara) and
axilla(kaksha) in upper limbs on each side. One is in the lower
back(trika) and the other on the skull(shira) [Su. Sa. Sh. 5/16]
 Vital points (asthi marma)
eight vital points formed from bones (asthi marma). [Su. Sa. S]
 katikataruna(vital spots on both sides of the vertebral column
above and near the pelvic crest),
 nitamba (vital points above the two pelvic bones meeting the
flank),
 amsaphalaka (vital points on scapula- one on each side of the
vertebral column in the upper back region) and
 shankha(vital spots on each side between the outer end of the
 When the vitiated doshas affects bone tissue(asthi dhatu), the
tertiary fever (tritiyakajwara)is manifested.
 In fever, when the dosha are located in bone tissue
(asthigatajwara) , they cause diarrhea, vomiting, pain in the
bones, production of kujana (a sort of cooing sound),
convulsive movement of the body. [Cha. /80]
 vrana- Bone tissue is one of the eight locations of wounds
(vrana). The other sites are skin, blood vessels, flesh, fat,
ligament, vital parts and viscera.
 When vitiated vata is located in bones and marrow, it leads to
splitting pain of bones and joints, arthralgia, loss of muscle
strength, insomnia, and continuous pain. [Cha. Sa. Chi . 28/33]
 When the vata is occluded by the osseous tissue, the patient
likes hot touch (local sudation) and pressing. He has splitting
pain and feels as though his body is being pricked with needles.
[Cha. Sa
 Tridosh dushti and Asthi dhatu –
1. Vata- vitiation leads to weak or fragile bones that become osteoporotic
and fracture easily.
2.Pitta- vitiation leads to bone infections (ostoemyelitis) and inflammation.
3.Kapha- vitiation leads to excessively thick, dense bones. Other diseases of
the bones are more complicated.
4.Osteoarthritis - Vata-Kapha combined in which Vata (age, motion and
stress) is responsible for provoking growth in an irregular fashion leading to
bone spurs.
5.Rheumatoid arthritis- Sannipatika condition in which Vata pushes Kapha
to cause irregular bone growth. Vata increases effect of Pitta causing
inflammation and bone destruction. Ama is also present.
6.Osteoblastic bone cancer- is a Sannipatika condition in which Vata pushes
Kapha (bone growth) and increases effect of Agni within the affected tissue
creating a high metabolic state for growth.
7. Osteoclastic bone cancer- has a dual Dosha pathology in which Vata
combines with Pitta resulting in a high metabolic state that destroys bone
tissue.
Evaluation of Asthi Dhatu
 EVALUATING THE ASTHI DHATU - BY
NORMAL FUNCTIONS
 Asthi Dhatu - through medical testing, it is
necessary to assess the Asthi Dhatu via the
Upadhatus and Malas of its production.
 by examining the hair, nails and teeth the one can
infer the state of the Asthi Dhatu.
 When the Asthi Dhatu is deficient, hair density
becomes scant. Hair loss may be distributed
throughout the scalp or in patches. In addition,
nails become thin and break easily. The teeth will
appear crooked or become darker (gray) than
usual. These findings may indicate deficiency due to
 Asthi Dhatu is in excess, hair density is fuller.
 the nails are thick and the teeth large, straight and white.
These are the signs of Kapha vitiation within the Asthi
Dhatu.
 However, these findings are more difficult to assess as
Kapha Prakruti will also exhibit these same findings. Thus,
secondary signs of Kapha vitiation should also be observed
mandgni and the mind such as stubbornness.
 When these findings are present in addition to dense hair,
thick nails and white teeth it can be assumed that Kapha has
entered the Asthi Dhatu.
 When Pitta has entered the Asthi Dhatu, the teeth and nails
will become a pale shade of yellow and the hair will lose its
color and turn gray. Over time, the nails will become weaker
and the hair may fall out as deficiency sets in due to burn
out.
 IMPORTANCE OF DHATU PRADOSHAJA
VIKARAS Dalhana mentioned the reason
behind explaining the Dhatu Pradosaja
Vikara separately, these are-
 1. Chikitsa Vishesa Vijnanartha
 2. Sukhasadhyatvadi Karma Bodhartham
 Chakrapani also mentioned that vaidya should
refer always dhatudushti also to cure diseases.
 व्यायामाद अतिसंक्षोभात अतिविघट्टनात वातलाना

 1.Ativyayama: Ativyayama means excessive Sharira Ayasa

Janaka Karma.
 2.Atisankshobha: Atisankshobha means Abhighata
(Yogindranath Sen). It means injury or excessive jerk or
violence or commotion.
 3Ativigattana: Ativighattana means Atichaalana
(Yogindranath Sen). It means excessive movements or
separated or loosened or shaking.
 4.Vatala Ahara and Vihara Sevana: Vata Guna Samana Ahara
and Vihara Sevana. Vatala Ahara: Ruksha – Sheeta- Laghu
Guna Pradhana Ahara Sevana, Alpa Matra Ahara Sevana,
Mudga, Masoora, Vaartaaka, Kalinga, Harenuka etc. Vatala
Vihara: Ativyavaya, Ati Jagarana, Krodha, Bhaya,
Vegadharana, Abhighata, Upavasa, Shoka
 मेद मज्जा वात अस्थी पुरीष हेतू
 संप्राप्ती
 Agni Dushti

 Jatharagni Bhutagni (Mandya) Dhatwagni

 (Mandya) (Parthiva, Tejasa & Vayavyagni) (Asthyagni)

 Amarasa Improper Conversion of Increased

Decreased
 Utpatti Vijatiya Panchabhautika Increased Asthi
Decreased Asthi Dhatwagni
 Dravya into Sajatiya Apachaya Upachaya
 Margavarana
 Panchabhautika Dravya
 Vata prakopa
 Lack of poshana
 to Asthi Dhatu Vyaya (Resorption) Utpatti (Formation) क्षय
 .
 १.Asthi bheda – च.asht
 2 Asthi toda - सु. अष्टांग
 3 Ruja -- हारित
 4 Asthi shula च सु.
 5 Kesha vikara & paata – च अष्टांग
 6 Loma/Roma vikara and paata - च अष्टांग
 7 Nakha vikara & paata - च, सु, अष्टांग
 8 Smashru vikara - च
 ९. dantvikar - च. सु. अष्टांग
 १० .Shrama - च.
 11 Sandhi shaithilya - च.
 12 Rukshata - सु. अष्टांग
 13 Parushya - अष्टांग
 14 Asthi baddha - अष्टांग
 15 Mamsabhilasha - अष्टांग
 16 Anga bhanga - हारित
 17 Ati manda cheshta - हारित
 18 Bala kshaya – सु.
 19 Meda kshaya – च. हारित
 20 Viryasya mandya (Utsaha Hani) - हारित
 21 Vikampana - हारित
 22 Vamana - हारित
 23 Visangnata - हारित
 24 Shosha - हारित
 25 Kathorata हारित
 26. khalitya palitya kunakha
Asthi Vriddhi Abnormal growth of bones and teeth
are signs of Asthivriddhi. These conditions can
be equated with Hyperostosis, Osteoporosis (any
degree of skeletal fragility increases the risk of
fracture), Calcaneal spur, Diaphyseal Aclasis
and Flurosis.
Phakka Roga - If an infant is unable to walk at the
age of one year, condition is known as Phakka
Roga. Clinical features of this disease are similar
to features of Rickets.
 Calcium Bone, liver, intestine kidney Serum - Colorimetric
 02 Total alkaline phosphatase Bone, liver, intestine,
 (total ALP) kidney, placenta Serum Colorimetric
 03 Bone specific alkaline Bone Serum Colorimetric,
 phosphatase (BALP) electrophoretic,
 precipitation,
 IRMA, EIA
 04 Osteocalcin Bone, platelets Serum - RIA, ELISA
 05 Carboxy-terminal propeptide Bone, soft tissue, skin Serum RIA,
ELISA
 of type-I procollagen (PICP)
 06 Amino- terminal propeptide Bone, soft tissue, skin Serum RIA,
ELISA
 of type-I procollagen (PINP
 Women, men, and osteoporosis
 Women are more likely than men to develop osteoporosis. This is
because women generally have smaller, thinner bones than men
have and because women can lose bone tissue rapidly in the first 4
to 8 years after menopause because of the sharp decline in
production of the hormone estrogens. Produced by the ovaries,
estrogens has been shown to have a protective effect on bone.
Women usually go through menopause between age 45 and 55.
After menopause, bone loss in women greatly exceeds that in men.
However, by age 65, women and men tend to lose bone tissue at the
same rate. Although men do not undergo the equivalent of
menopause, production of the male hormone testosterone may
decrease, and this can lead to increased bone loss and a greater risk
of developing osteoporosis.
 osteropoiesis
 Etiological factors for Osteoporosis:
 Osteoporosis is one of the common condition aging is main reason ,
in women, additional losses related to natural menopause. This
condition is called as the ‘Primary Osteoporosis’. Osteoporosis that
is caused or
 by other disorders or medication exposures is referred to as
‘Secondary Osteoporosis’.
 of Primary Osteoporosis causes- follows Advanced age, history of
fracture in adult, history of low body mass index (BMI) <19,
female gender,
 menopause/andropause, surgical menopause (radical
 hysterectomy or oophorectomy in early age), low calcium
 diet, magnesium and vitamin-D deficiency, smoking or
 tobacco , alcoholism, lack of exercise (Sedentary life style),
astronauts (living in low gravity areas).
 Some of the causes of secondary Osteoporosis
, premature menopause,
 osteogenesis imperfect, anorexia nervosa/bulimia,
 androgen insensitivity, Turner’s and Kleinfelter’s
 syndrome, diabetes mellitus, hyperparathyroidism (1
 Cushing’s syndrome, gastrectomy & celiac disease,
 malabsorption, Protein Calorie Malnutrition (PCM),
 Rheumatoid arthritis etc.
 1. Failure to achieve optimal peak bone mass. This is
 largely genetically determined,
 affected by lifestyle, particularly calcium
 intake and physical activity during skeletal growth.
 2. Increased bone resorption -- has been reported in most
 Osteoporotic patients. Estrogen deficiency is a major
 especially after menopause, and
 apparently in men as well. Calcium and vitamin-D
 deficiency and reduced calcium absorption . Endocrine abnormalities
(e.g. primary hyper parathyroidism or hyper thyroidism etc.),
 3. Inadequate bone formation. This may be due to
 complete loss of skeletal elements by excessive
 resorption,
 Pain in the bones and joints
 is the main symptom of Asthi kshaya.
Generally, when dhatu is affected its
upadhatu and mala is also affected;
 hence dental deformity/fall, falling of; hair,
body hair,
 moustache and nail deformity are seen in
Asthi kshaya
Investigation – x-ray,MRI,
BONE MINERAL STUDY
 Symptoms
 of Osteoporosis include: 1) Pain (due to fractures), 2)
 Tenderness, 3) General debility, 4) Muscular weakness,
 5) Abdominal distension, 6) Insomnia, 7) Loss of appetite,
 8) Osteo-arthritis, 9) Constipation and ileus and 10)
 Kyphosis and Scoliosis.
 The gradings for assessing pain,
 tenderness and general debility have been mentioned in
 previous works43 but, for the assessment of hair fall,
 dental deformity/fall and nail deformitiy the following
 gradings have been developed.
 Investigator’s gradings to assess hairfall, dental
 deformity/fall and nail deformity (Sanjay Kadlimatti,
 Chandola H. M. 2009) :
 1. Hair fall :
 Grade 0 - No hair fall
 Grade 1 - Hair fall once in the morning while washing /
 combing
 Grade 2 - Hair fall on every time of combing
 Grade 3 - Hair fall even without combing & raised
 hairline in the frontal region (mild baldness)
 Grade 4 - Visible or significant baldness in frontal /
 vertex region (caput).
 2. Dental deformity/fall :
 Grade 0 - No dental deformity
 Grade 1 - Occasional dental pain with dental caries or
 loosening of at least one tooth.
 Grade 2 - Dental pain that don’t responds to analgesics
 along with caries / loosening / loss of 2-4 teeth.
 Grade 3 - Loosening / loss of 4-8 teeth.
 3. Nail deformity :
 Grade 0 - No Nakha Vikara (nail deformity)
 Grade 1 - Mild loss of natural texture & elasticity of
 nails
 Grade 2 - Moderate loss of natural texture &
elasticity
 of nails
 Grade 3 - Visible brittleness of nails
 Diagnosis : Compar
 osteomalasia - . pain muscle weakness common symptoms. Ca
phosphorous def. only in adults – women commonly
Osteoporosis – brittleness, porous nature increase leading to
fractures. Vit. D def.
rickets – in children's prior to epiphyseal fusion - vit.D. def. leads to
growth retardation .
 Arthritis - general term that describes
inflammation in joints.
 Osteoarthritis - is the most common type of a
When the smooth cushion between bones
(cartilage) breaks down, joints can get painful,
swollen and hard to move.
 Osteomyelitis (OM) -is an infection of bone.
Symptoms may include pain in a specific bone
with overlying redness, fever, and weakness
 Ayurvedic Management : Nidana Parivarjana
(Avoidance of etiological factors),
 2) Shodhana (Biopurification),
 3) Shamana (Palliative
 treatment),
 4) Rasayana (Rejuvenation) and 5)
 Pathyapathya (Proper diet).
 1. Avoidance of etiological factors
 2. SHODHAN – TIKTA KSHIR GHRIT BASTI-
 Asthi Taruna Sangnakena Asthnam”. DALHAN
1)Ajasthi bhasma,
2) Asthi bhasma of other animals and
3) Kacchapa prishthasthi bhasma etc. Some other
closely related transformations of similar dravyas are :
1) Pravala bhasma, 2) Pravala pishti, 3) Kukkutanda
twak bhasma, 4) Shankha bhasma, 5) Shukti bhasma,
6) Kapardika bhasma etc.
SAMAN GUNA --
Asthi such as guru (heavy), kathina
(hard), khara (rough), sthula (bulk), sthira (remains for
a long time) and murtimad (having shape) etc. Such drugs are
milk, ghee, bitter substances combined with milk and ghee, black
gram, meat/meat soup, rice and other drugs which possess the
above mentioned properties of Asthi. In addition mentioned the
use of external and internal oleation therapy for the treatment
TAIL- : Kshirabala taila, Chandana bala lakshadi
taila, Dhanvantara taila, Bala guduchyadi taila,
Balashwagandhadi taila, Lakshadi taila, Mahalakshadi
taila, etc.
 Ghee : Pancha tikta guggulu
 ghrita, Patoladi ghrita, Mahatiktaka ghrita, Pancha tiktaka
 ghrita, Tiktaka ghrita,
 Guggulu Kalpa : Various Guggulu formulations
 mentioned in the treatment of fractures and disorders of
 Vata can be given - Mahayogaraja guggulu, Lakshadi
guggulu,
 Yogaraja guggulu etc.
 Kshira paka : Arjuna kshirapaka (Arjuna is
 known to be rich in calcium), Ashwagandha kshira Paka.
 Rasayana : Various Rasayana preparations are
 useful in Asthi kshaya like:
 Chathurtha Triphala Rasayana, Chyavanaprasha
 Rasayana and Shilajatu Rasayana with milk.
 आहार विहार
 Pathya Apathya (Avoid in excess)
 Sweet taste dominant substances; Pungent, bitter,
astringent taste dominant substances; Dry, cold, light,
poros, etc.
 Rice; Black gram; Milk Whey; property predominant
substances; Madya (Alcohol); Shushka Mamsa (Dry meat);
 Butter milk; Butter; Ghee; Shushka Shaka (Dry vegetable);
Excessive eating; Fasting; Heavy exercise;
 Meat soup; Anti Vata oils; Excessive sexual intercourse;
Fighting with stronger person; Day sleep; Night;
 Regular exercise; awakening; Suppression of natural urges;
Medicines like Cortico-steroids
 Exposure to early morning sun rays. etc.); Smoking and
other etiological factors.
Psychology & Asthi Dhatu
 When the asthi dhatu is healthy, there is a healthy
confidence in one’s ideas, decisions, and beliefs. As the
asthi dhatu increases and becomes excessive, the
qualities of the earth element increase and a person
becomes overly attached, obstructive, and stubborn.
 Exercise, Yoga and the Asthi Dhatu
 Exercise increases the asthi agni supporting the
formation of high quality boney tissue. Care should be
taken when exercising however as weakness in the
asthi dhatu makes the bones more likely to fracture.
Thus, when significant weakness is present, the patient
should begin with mild weight bearing exercises.
Walking is a healthy place for most patients to begin.
mes difficult to move or shift directions.
 mediation chanting and
asthi dhatu
 . Attention on the muladhara chakra and its
connection to the earth also supports
building the qualities of the earth element

 MEDICOLEGAL ASPECT OF BONE

 Dr yerme

 धातू शरीराची आकृ ती बनवीत असल्याने अस्थीसारतेमध्ये अस्थी विशेष

बलवान असतात .शरीरावरचे प्रधान अस्थी आकाराने मोठे असतात .
 पार्ष्णी heel–पायाची टाच , गुल्फ ankle – घोट्याचा भाग ,
 जानू knee – गुढघा अरत्नी hands –हात
 जत्रू clavical – अक्षकास्थि चिबुक chin –हनुवटी ,शीरhead –
डोके
 पर्व digits–हातापायाच्या बोटाचे संधी , नख ,दंत हे सर्व अवयव
आकाराने मोठे असतात व शरीरावर उठू न दिसतात .शरीराची उंची भरपूर
असते .दात नखे मोठी असतात त्यांना वाढ भरपूर असते .अस्थी पार्थिव व
गुरु असल्याने शरीराचे वजन देखील उत्तम असते .
 अस्थी धातू उत्कृ ष्ट असल्याने अस्थीज भाव अधिक बलवान मोठे
असतात ,उपधातू संबधी देखील लक्षणे आढळून येतात
 , अस्थिच्या वजनामुळे शरीराचे वजन व उंची नजरेत भरण्यासारखी असते .
 महोत्साहाenthusiastic- सदा उत्साही असणारे .सतत न थकता का
चेहरयाची ठेवण मोठी असते त्यामुळे हनुवटी ,नाक ,डोके ,कपाळ मोठे
असते.एकं दर शरीरावरील अस्थी विशेषत: गुढघे ,मनगट,घोट्याचा भाग
स्थूल मोठा असतो .चालताना दाणदाण पावले टाकणारा असा असतो व हा
अस्थी सार व्यक्ती चालताना दुरूनहि ओळखता येतो.
 धडपड करणारा असा असतो ,म्हातारपणात देखील कामात व्यग्र असणारे हे
लोक होत.वय झाले म्हणून काम /उत्साह कमी होत नाही तर तरुणाच्या
सोबत काम करू शकणारे असतात. अस्थी कठीण धातू असल्याने
म्हातारपण येऊन देखील यांची मान कं बर वाकत नाही , कायम ताठ बसणारे
असतात . दात हा अस्थीज भाव असल्याने दात येताना त्रास होत नाही व
दात लवकर पडत देखील नाहीत ,दातांच्या
 तक्रारी सुद्धा कमी असतात. feel 16 at the age of 60.
 के स अस्थीज भाव असल्याने ,के सांच्या तक्रारी कमी असतात ,के स न
गळणारे ,टक्कल न पडणारे असतात .
 क्रियावंत active,energetic –सतत कामात व्यग्र असणारे
असतात , उद्योगप्रिय ,सतत काही ना काही काम करत राहणारे
असतात.स्वस्थ बसत नाहीत .धडपडा स्वभाव
 क्ले शसहा can bear stress ,efforts– क्ले श श्रम भरपूर करू
शकतात .अस्थी पृथ्वीज भाव असल्याने ,चिकाटी भरपूर असते व कष्ट
ताण सहन करू शकतात
 सार स्थिर शरीरा stable strong body–शरीर दृढ बळकट असते
., अस्थिच्या गुरु गुणाने शरीर मजबूत , व वजनामुळे स्थिरता येते .
 आयुष्यमंत longevity – आयुष्य दीर्घ असते .व्याधी क्षमत्व उत्तम
असल्याने आयुष्य भरपूर असते
 महाशीर large head –डोके मोठे असते. डोके अस्थीज भाव
असल्याने मोठे असते .
 एकं दर उंच हाडे मोठी असणारे ,श्रम भरपूर करणारे ,स्थिर मजबूत
शरीराचे सतत कामात मग्न असणारे ,उद्योगप्रिय असे व्यक्तिमत्व
असते .बुद्धीबाबत ग्रंथात वर्णन आढळत नाही . अस्थी धातू सारवान
असल्यास दात लवकर पडत नाहीत ,किरकोळ अपघाताने अस्थिभंग
होत नाही .के श नख दातांचे आरोग्य उत्तम असणारे .कायम ताठ
असणारे ,पाठीचा बाक न येणारे (विशेषतः म्हातारपणात ),टक्कल न
पडणारे ,म्हातारपणात सुद्धा तरुणांच्या बरोबरीने काम करणारे हे लोक
असतात . अस्थी धातू असारतेत अस्थी संधी शूल ,के शांच्या
तक्रारी ,के श गळणे ,नखे दंत तक्रारी ,शारीरिक बल कमी ,अस्थी वक्रता
(बाकयेणे ) ई लक्षणे आढळतात
मानसिक लक्षणे अस्थि
Energetic, enthusiastic, spirited
person
स्थूल चिबुक bony clavicle, chin, अस्थि
shoulder
स्थूल अस्थी heel, ankle, knee, hands अस्थि

 .