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Introduction

Ayurveda is an ancient science of life. It has two aims, one deal with the preventive way that is to safe guard the health of the healthy individuals and another is the curative way that is to treat the disease [1]. Ayurveda explains that human body is made up of Dosha, Dhatu, and Mala [2]. The main function of Dhatus is Dharana and Poshana of the Sharira. [3] Asthi Dhatu is fifth among seven Dhatus. The Asthi is known as kernel of whole body as it provides structural shape and support. Function of Asthi Dhatu is compared with the hard core of bark of the tree, [4] without Asthi human body would have just been an amorphous bolus of soft tissue. Hence, Asthi Dhatu can precisely be termed as the framework on which man can stand tall. Any upheaval in equilibrium of Dhatus leads to disease. Ayurveda comprises many concepts are important to understand pathogenesis of disease and adaptation of treatment. Acharya Vagbhata has contributed the unique concepts Ashraya- Ashrayi Bhava to elaborate the inter-dependency of Dosha and Dhatu, as Vata resides in Asthi Dhatu & Sweda, Rakta resides in Pitta, and other Dathu & Mala resides in Kapha in intimate relation. [5] Doshas are only and direct responsible factors for genesis of disease. Even though there are exogenous and endogenous etiological factors in pathogenesis, Ayurveda suggests that any cause leads to vitiation of Dosha in the first place and then next events start for generation of disease. According to principle of Ashraya - Ashrayi Bhava, Asthi Dhatu is the seat of Vata Dosha. Asthi and Vata are inversely proportional to each other regarding Vriddhi and Kshaya. Vriddhi of Vata Dosha leads to Kshaya of Asthi Dhatu. Asthi Kshaya is a condition in which there in kshaya of Asthi Dahtu. It is state where the functional capacity of Asthi is compromised due to decrease in its Guna, Karma and structure of Asthi. We find many people today suffering from bone disorders which has hampered their living. It is necessary to understand the relationship between Asthi Dhatu and Vata Dosha.

AIM AND OBJECTIVES: To evaluate literary data available on Ashraya-Ashrayi Bhava w.s.r. to Asthikshaya janya Vata Vriddhi. 

STUDY TYPE: - Conceptual literary search.

MATERIALS AND METHODS: -

Ayurvedic texts mainly Charak Samhita, Sushrut Samhita, Ashtang Hridaya, Ashtang Sangraha, Shabda Kalpa Dhruma and their commentaries, websites and articles related to the topic were reviewed to collect the literary material:

LITERARY REVIEW

• Explanation of word Asthikshaya

The word Asthikshaya is composed of two words Asthi and Kshaya. The word Asthi is derived from the root 'As'+'kthin' meaning "To stay" or in the sense of "stability".[6] The definitions of Asthi are 'asyate kshipyateyat', 'asyateiti asthi', mamsabhyantarasthah-sharirastha Sapta dhatvantargata dhatuvisheshaha [7] That which is present in its own state for a long time is called Asthi. Acharya Sushruta mentions that twacha, mamsa etc. tissue get destroyed soon (after death), but Asthi persists in its own state for a long time. Hence, it is called as the sara of the Sharira. Similarly, the definitions of Kshaya are 'kshiyate anena iti kshaya' kriya kshayakaratwat tu Kshaya ityucyatebudhaihi, 'kshaya Vyadhi Visheshana'.[8] That which decrease is called as Kshaya or the kriya which cause the decrease either qualitatively or quantitatively is known as Kshaya and it is a Vyadhi Vishesha.  So, the combine meaning of Asthikshaya is decrease in bone tissue.

Ayurveda concept about Asthi Dhatu utpatti and Poshana: - 

Formation of Asthi Dhatu takes place in the early embryonic stage i.e., in garbhavastha and after birth; it is nourished by Ahararasa just like any other Dhatu. Precursar of Asthi Dhatu (Poshak Asthi) is formed at the time of formation of Medo Dhatu. Asthidhatvagni transforms nutrients of Asthi present in Ahararasa in Asthivahastrotas into poshya Asthi Dhatu and Mala of Asthi Dhatu i.e., kesh, Loma, and smashru, updhatu (Danta) and the formation of poshak majja Dhatu [9]. There are innumerous products which nourish Asthi Dhatu, like Godhuma, Go-dugdha, Go-Ghrita, etc. which are snigdha in quality. Ruksha, kathin products are also termed as Asthi dhatu Poshak, but these poshakansa are carried to poshak Asthi Dhatu with the help of snigdha attribute of Meda Dhatu. 

Panchabhautik Composition of Asthi Dhatu: - Prithvi and Vayu mahabhoot are predominant [10] Akash-porous cavity inside bone, Vayu - flow of blood, nutrients etc, Agni - conversion of cartilage into bone, Jala-bone marrow, Prithvi - constitution of bone. 

Asthi Dhara Kala: According to Dalhana, Purishdharakala and Asthidharakala are the same. [11]

Functional similarities between these two can be understood as -Both are the sites of Vata Dosha. Purish Vikriti and Agnivikriti for eg. Malavishtabha, Grahani etc. are relatively common in katishula, Sandhi sula and Asthi-shula. Basti chikitsa is the line of treatment of Asthi disorders and root of administration of Basti is Pakvashaya.

Asthi Dhatu Guna and Karma: Asthi is guru (Heavy), khara (rough), kathina (hard), sthula (bulkiness), sthira (stable) and murtimad [12]. Its function is deha dharana (provides structrual framework to the body), Majja pushti (nutrition to bone marrow) and is the seat of vata. [13] 

Asthi Kshaya Lakshanas : Asthi Kshaya symptoms mentioned in Different samhita are – Asthi shoola, kesha-loma-nakha-smashru-danta Vikara and paata (disorders of hair, nails, teeth) sandhi shaithilya, rukshta Asthi toda, srama (feeling tiredness without work). [14,15,16]

Nidanas for Asthi Pradoshaya Vikaras: -Two types of Nidanas i.e., Samanya and Vishesa Nidana are described in Samhita which are follows: - 

Samanya Nidhaana [17] 

1. Dosha Guna Sama Ahara and Vihara 

2. Dhatu Viguna Ahara and Vihara 

3. Ritu Viguna Ahara and Vihara 

Vishesa Nidhana [18]

- In Charak Samhita some specific Nidanas are mentioned for Asthi Pradoshaja vikaras like

- Ativayama 

- Atisankshobha 

- Ativighattana 

- Vatala Ahara and Vihara 

These above-mentioned Nidana leads to Agni Dushtu and is the cause of production of abnormal Asthi Dhatu. In such conditions if the patient continues the intake of causative factors [Nidana Sevana], there will be excessive vitiation of Doshas as they have been already vitiated earlier. These excessive vitiated Doshas when lodges in Asthi Dhatu, the manifestation of asthi pradosaja Vikara takes place at various site in the body according to Sthana dusti or khavaigunya.

• Mental factors and kala (age factor) also play a vital role in the pathogenesis of Asthikshaya.

 Thus, there is no single pathogenesis mechanism leading to Asthikshaya.

Vata Dosha

 

Definition: - The word Vata is derived from 'VA' Dhatu which indicates Gati any movement or Gandha smell. So, the element in the body which performs all the movement is termed as Vata.

Panchabhautikatwa: -   Vayu and Akash

Synonyms: - Maruta, Anil, Pavana, Sameerana, Prabhanjana, Matarishwa, Sadagati, Shwasana.

Sthana: - The main site or seat or the location of the Vata Dosha is Pakvashaya. It is the place where normal Vata Dosha is originated after the completion of digestion.

Pakvashaya: This is the last part of intestine, in Pakvashaya region Vata dosha is generated during the last stage of digestion that is katu Awasthapaka.

Kati:    It is the waist region in the body. It is made up of union of many bones.

Sakthi: Thighs are also a location of Vata. 

Shrotra: Vata Dosha is also located in ears as well as in srotraendriya.

Asthi: Asthi means bones. These are parthiva in nature. But these are porous internally. This porosity is filled or packed by Majjadhatu.

Sparshanendriya: This is the skin or Twak which covers the whole body as well as different organs. 

Vata Guna: Chala, Ruksha, Laghu, Sheeta, Khara, Sookshma, Parush, Vishada [21]

Vata Prokopa Karana: Vyayam (Excessive Excercise) Apatarpana (Fasting in excess) Prapatana (fall, injury) Bhanga (fractures) Kshaya (Depletion of tissues), Jaagarat (awaking) Veganam cha Vidharant (Suppression of natural body urges) Atisuchi (Excessive Administration of cleansing procedurs like Panchakarma) Shaityadi (Excessive consumption of cold foods and activities Traasaat (fear) Ruksha (Excessive consumption of dry foods, kshobha (irritation), kashaya (Excessive consumption of astringent foods), Tikta (Excessive consumption of bitter foods), katu (Excessive consumption of pungent foods), Vari-ghanagame (cloudy and rainy season) Parinate anne (After the digestion of food.) Aparahne - Evening [22, 23]. Because of above mentioned factors, the aggravated Vayu, while filling up the channels of circulation which are empty or have become weak in quality because of the lack of unctuousness etc. produces different kinds of ailments affecting the whole body or a part of body.

Lakshanas of Vata Vriddhi: Symptoms of Vata Vriddhi are roughness in speech (Vakparushya), emaciation, (karshya), karshnya (Black discoloration), Gatrasphurana (twitching in body) ushna kamita (desire for warm food and drink) Nidranasha (loss of sleep), Alpabaltwam (decrease in strength), Gadhavarchastwan (Hard stool) Aatopa (gurguling sound), Adhmana (distension of Abdomen), kampa (tremors), Asthi-shula (pain in bones), Dinya (Depressed), Bhaya (fear), Shoka etc. [24,25]

Ashraya Ashrayi Bhava

Relationship between Dhatus and Doshas -

As Acharya Vagbhata mention Ashrya Ashrayi Bhava of Vata Dosha and Asthi Dhatu. According to this principle all Dhatus gives Ashraya to Doshas.

Ashraya: - Ashraya (abode) means a residing place on which anything depends.

Ashrayi: - Ashrayi means resting with and depends on or that which takes shelter in abode.

Doshas are the functional components of the body. They are constantly moving from one place of the body to the other coordinating the different life activities. But they too need some place from where they can operate or move around. Doshas have found their places in these Dhatus which forms their Ashrayas. Vata Dosha is predominant in Vayu and Akasha Mahabhoot, whereas Asthi Dhatu is Prithvi and Vayu. Also, Akash Mahabhoot is present in bones in the form of sinuses or cavity [26]. If there is alteration in volume of mahabhoot, it leads to imbalance in mahabhoot constitution of Asthi Dhatu. The drug which causes increase of Ashraya should also affect the increase of Ashrayi. If Kshaya of Dhatu is there then Brihmana is advice. If Dhatu vriddhi is there then langhana is advice. But this principle is inversely proportional in Vata Dosha and Asthi Dhatu [27]. It means that Vriddha Vata has tendency to abide Asthi. But it has no capacity to increase Asthi. On the Contrary Vriddha Vata decrease and deteriorates the Asthi Dhatu and causes Asthi Dhatu Kshaya Janya Roga. Aggravation of Vata is the main factor responsible for Asthi Kshaya. It may follow two patterns one is from margavarana and another is from dhatu kshaya[28].

Discussion

According to Ayurveda, like all tissues of the body, the bones and bone marrow tissues are also formed from [29] –

• The nutritional essence derived from Aahara rasa i.e., nutritional juice.
• From their precursor tissue in the Ayurvedic chronology of formation of tissues i.e., dhatu poshana karma.

The Asthivaha srotas i.e., channels responsible for bone tissue formation lay in fat tissue (Medodhatu) and hip bones (Jaghana). This is because according to Ayurveda chronology, bones are formed by their precursor tissue i.e., fat tissue. The hip bones and the pelvis seem like holding the entire upper skeleton and the lower limb bones. Therefore, they may be considered as roots of bone formation. Thus, bone tissue is formed from ‘the portions of fat tissue that take part in nurturing and formation of the bone tissue’. If there is deficit functioning and reduced strength of medodhatvagni i.e., tissue fire of fat, the bone will be formed inadequately. The weak ‘fat tissue fire’ will not take part in the proper formation of bone. As a result, lot of fat tissue is formed. This leads to deficit formation of all tissues and excessive formation and deposition of fat in the body. This will eventually impact bone formation also. Similarly, accumulation of Ama and many intermediate products of tissue metabolism in fat tissue and other channels occurs.

This also leads to deficit bone formation. This shows that an impairment of fat metabolism and consequent block of bone forming channels leads to deficit formation of bone. This may also lead to formation of weak and immature bone tissue. The bone health will deteriorate. All these events will lead to manifestation of Asthi kshaya. If bone precursors are not formed adequately due to deficit ‘fat tissue fire’, the ‘bone tissue fire i.e., Asthi dhatvagni’ may get exacerbated through chain of formation, as a reflex or feedback mechanism. Vata dosha contributes largely for occurrence of Asthi related diseases because of unique relationship of Vata and Asthi. Asthikshaya is caused mainly due to Vatakara Aahara and Vihara, also decreased intake of nutrients to Asthi dhatu, when left uncontrolled will lead to other complications like danta nakha bhanga, asthi shoola, sandhi shathilya etc and diseases like asthi saushirya (bhagna), asthi vrana etc.

Conclusion

In a condition of normalcy and health, the relationship is favourable (compatible). The Doshas do not harm their own houses i.e., the Dhatus and Malas (Aasharyas or viscera made up of Dhatu). But when the Doshas get vitiated due to many contributing factors like incompatible food, erratic lifestyle, stress, not properly following the dincharya (daily regimen) ritucharya (seasonal regimen), sadvritta and sadachara, geographic and climatic variations etc. They tend to contaminate and vitiate the Dhatus.The Doshas tend to attack the weaker and susceptible Dhatus and damage them. The channels of the transport system in the body will be blocked and damaged, the protective system and immunity of the body fails. The body and mind become susceptible to many diseases. The knowledge of Aashraya and Aashrayi will help us to plan effective treatment protocol.

It includes isolating the morbid Doshas from the Dhatus and flushing them away from the body. Through procedure like Deepana (Enhancers of metabolism) Paachana (digestants), Snehana (oleation) and Swedana (sudation) etc. Hence Concept of Ashraya Ashrayi Bhava helps to understand the relation between important entities of the body like Dosha, Dhatu, Mala and helps in understand the Samprapti and prognosis of the disease.