E-ISSN:2456-3110

Review Article

Vankshana Sandhi

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Sandhi Sharir in Ayurveda and applied anatomy in Vankshana Sandhi - A Review Article

Paikra S1*, Chaturvedi G2, Dwivedi S3
DOI:10.21760/jaims.9.7.27

1* Sarita Paikra, Post Graduate Scholar, Department of Rachana Sharira, Govt Ayurvedic College, Raipur, Chhattisgarh, India.

2 GR Chaturvedi, Professor and Principal, Department of Rachana Sharira, Govt Ayurvedic College, Raipur, Chhattisgarh, India.

3 Sushil Dwivedi, Reader and HOD, Department of Rachana Sharira, Govt Ayurvedic College, Raipur, Chhattisgarh, India.

The Sandhi is essential for locomotion and various movements of body. Injury to these structures may lead to many complications and even up with morbidity. Vankshan Sandhi is a type of Ulukhal Sandhi is present at iliac region and it is multiaxial joint. The structure of this joint is made to give stability to human body. The movement of body is possible only due to the joints. it is very important to know the structure as well as its function of the Sandhi. Vankshan Sandhi is one of the major weights bearing joint in the body and strong secure & stable joint. It is subjected to repetitive high stresses during daily activities. it is a synovial ball and socket joint. The joint is surrounded by a large complex musculature, capsule and ligaments. The hip joint is most commonly affected by various diseases and structural degeneration. In this article Sandhi Sharir in a Ayurveda and applied anatomy in Vankshana Sandhi.

Keywords: Sandhi, Vankshan Sandhi, Hip joint, Applied anatomy

Corresponding Author How to Cite this Article To Browse
Sarita Paikra, Post Graduate Scholar, Department of Rachana Sharira, Govt Ayurvedic College, Raipur, Chhattisgarh, India.
Email: 		Paikra S, Chaturvedi G, Dwivedi S, Sandhi Sharir in Ayurveda and applied anatomy in Vankshana Sandhi - A Review Article. J Ayu Int Med Sci. 2024;9(7):175-178.
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https://jaims.in/jaims/article/view/3567

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-13 2024-05-24 2024-06-04 2024-06-14 2024-06-24
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 11.33

© 2024by Paikra S, Chaturvedi G, Dwivedi Sand Published by Maharshi Charaka Ayurveda Organization. This is an Open Access article licensed under a Creative Commons Attribution 4.0 International License https://creativecommons.org/licenses/by/4.0/ unported [CC BY 4.0].

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Sarita P et al. Sandhi Sharir in Ayurveda and applied anatomy in Vankshana Sandhi

Introduction

Ayurveda is the most ancient science of medicine in the world. It is considered as the intimate part of Athraveda. In ancient text of Ayurveda like Sushruta Samhita, Charaka Samhita and Ashtang Sangraha the knowledge of is Sharir Sthan important for the treatment of human being. In Ayurvedic classics like Charaka Samhita, Sushruta Samhita etc. a huge knowledge regarding Shareer, Nidana and Chikitsa are available.

Materials and Methods

Samhitas of Ayurveda, Modern Anatomy books, Research paper from journals and relevant internet site were availed.

Ayurvedic Review

According to Aacharya Sushruta only Asthi Sandhi should be taken into account where as other Sandhi of Snayu. Peshi and Sira are innumerable and should be excluded while counting.[1]

Classification of Sandhi

Main classification is of two types.

Kriyanusar (based on Kriya)

The Sandhis are two types, Chal (Cheshtayukta Sandhi) diarthrosis. Achal (Sthira Sandhi) synarthrosis the Sandhis which are situated in the Shakhas, Kati, and Hanu, are Cheshtayukta Sandhi while all the remaining Sandhi comes under the Sthira in nature, the Cheshtayukta Sandhis are further classified into two types based on their extent of movement. They are Bahu Chala (freely movable) Alpachala (slightly movable). The Sandhi of Shakhas, Kaksha and Vankshan Sandhi are of Bahuchala variety and the Sandhi of Griva, Prushtha etc. are Alpachala variety.[2]

Rachananusar Sandhi (based on Rachana)

Based on the structure Aacharya Sushruta had described 8 types of Sandhi. Thay are Kora, Ulukhal, Samudga, Pratara, Tunnasevani, Vayastunda, Mandala and Shankhavarta.[3]

Vankshan Sandhi

According to Acharya Sushrut Ulukhal Sandhis are Kaksha, Vankshan, & Dasana Sandhi.[4]

According to Acharya Gannath Sen in Pratyaksha Shariram the description related to Vankshan Sandhi is explained in 2nd chapter of Sandhi Visheshvigyaniya Adhyaya as follows.

In Shroniphalaka by the articulation of Vankshanodukhala with Urvasthimunda covered by Tarunasthivalaya forms Ulukhala Sandhi. This Sandhi is surrounded by Mahati Shleshmadhara Kala and covered by Mahasnayukosha. This Mahasnayukosha is attached around Vankshanodukhala, Urvasthigreeva and Shikharantaral Rekha.

This movable and strong Sandhi is secured by surrounding Peshi. Inside the Mahasnayukosha there is a strong Snayurajju known as Vankshanasandhyantariya (ligamentum teres) which is attached cavity of Vankshanodukhala to Garta on the Urvasthimunda.[5] The acetabulum articulates with the head of the femur to form the hip joint.[6] Hip joint ball and socket variety of synovial joint.

Applied anatomy of Vankshan Sandhi

Sandhi Viddha Lakshan

Acharya Sushrut explained Sandhi Viddha Lakshan in Sutra Sthan 25 chapter i.e., Ashtaviddha Shashtra Karmiya Adhyaya. Injury of Chal and Achal Sandhi lead to Shophativriddhi, Ruja, Balakshaya, Parvabheda, and Shopha.[8]

Sandhigata Vata

According to Acharya Charak, Vaat Dosha and Asthi Dhatu are interrelated i.e., Ashryashrayee Bhava. So, the Vaatprakopaka Hetu also leads to the Dushti of the Asthi. When the vitiated Vaat associated with other factors like trauma, age related factors etc.

affecting Asthi and Sandhi, takes the shelter of affected Sandhi causing diseases of Sandhis or joints. When aggravated Vaat Dosha take shelter of the affected Sandhi it produces Sandhigata Vaat Lakshana. The Vaat located in the joints is provoked; there occurs Shotha like air filled bladder in touch and pain during Prasharan and Aakunchan of limbs.[9]

As per Acharya Sushrut Vaat situated in Sandhis causes loss of functions of Sandhis along with Shool and Swelling. In Sandhigata Vata the aggravated Vata Dosha damages the Sandhi and causes Shool and swelling in the joints.[10]


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Sandhi Mukta Samanya Lakshan

Incapability of extension, flexion, movement, circumduction and rotation (immobility, considered in respect of the natural movements of the joint), of the dislocated limb, which becomes extremely painful and cannot bear the least touch. These are said to be the general symptoms of a dislocation.[11]

Sandhi Mukta Vishesh Lakshan

Acharya Sushrut divided Sandhi Mukta Vishesh Lakshan into six types such as

  • Utpishta: specific symptoms are Shopha on both the sides of Asthi Sandhi and different kinds of Vedana appear especially at night.
  • Vishlishta: Alpa Shopha, Satat Vedana and
  • Vivartita: Sandhiparshvagamanam, Vishama Angata and
  • Avakshipta: Sandhivishlesh with
  • Atikshipta: the term Atikshipta means when two or more Asthi is forming the Sandhi is moved apart with
  • Tiryakshipta:only one Asthi of the Asthi Sandhi is displaced to a side and produces Vedana.[12]

Samanya Chikitsa

Bhagna Sthapana in Sandhi

Aanchana: Traction / pulling forward

Pidana:Pressing down the bone

Sankshepa: flexion / contraction / bringing together

Bandhana: bandaging[13]

Alepa: Lepa prepared with powder of Manjishta, Madhuka, Rakta Chandana, mixed in Shatadhouta Ghrta is to be used. Lepa is applied prior to Bandaging. Lepa helps to reduce inflammation, improves circulation, brings union of joint and strengthens ligaments.

Aspiration of the hip joint can be done by passing a needle from a point 5cm below the anterior superior iliac spine, upwards, backwards and medially.

It can also be done from the side by passing the needle from the posterior edge of the greater trochanter, upwards and medially, parallel with the neck of the femur.[14]

Discussion

Acharya Sushrut has referred Vankshan Sandhi as a major joint of Adhah Shakha (lower extremities). On the basis of Gati or Chesta, Acharya Sushrut and Acharya Sharangdhar have divided Sandhi into two types i.e., Chestavanta and Sthira Sandhi. According to the Rachna, Sandhi is divided into eight types i.e., Kora, Ulukhal, Samudga, Pratara, Tunnasevani, Vayastunda, Mandala, and Shankhavarta. Acharya Gannath Sen depicts that Ulukhal Sandhi are of two types, Sthir namely Dashan along with their Mool and Chestavant such as Kaksha and Vankshan. Vankshan Sandhi is referred to as Shroniphalaka by the articulation of Vankshanodukhala with Urvasthimunda covered by Tarunasthivalaya thus forming an Ulukhala type of Sandhi and ultimately Vankshan Sandhi.

This Vankshan Sandhi is clearly defined as having Vankshanodukhala as an articulating surface while the other surface is shaped like a Urvasthimunda and attaches to it. Hence Ulukhala Sandhi may be considered as ball and socket variety of synovial joint and gomphosis variety of fibrous joint. The similarity between ball and socket and gomphosis is in their shape, both having a socket like articular surface with another surface fitting into it.

Discussion on applied anatomy

In Sadhigatavata, Acharya explained that due to Hetu there is vitiation of Vata which is located at Sandhigata and it can be correlated osteoarthritis. Arthritis the joint space is reduced or sclerotic changes of articular bone or osteophyte formation is occurred. Clinically symptoms are paining constant pain in groin region and limitations of movement. Acharya Sushruta classified many types of joint dislocations and suggested correct joint reduction. Even though hip dislocation is a rare type of dislocation, once it occurs it has severe effect on the affected limb and chances of complication is highest.

Acharya Sushruta did not specifically mention the hip joint, but it is understandable that it falls under Ulukhala Sandhi because it has characteristics that are similar to those of a ball & socket joint. The concept of Samanya and Visesha Lakshana of Sandhi Mukta by Acharya describe different degrees of displacements that are comparable to types descriptions of dislocations found in modern texts.


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Sarita P et al. Sandhi Sharir in Ayurveda and applied anatomy in Vankshana Sandhi

Acharya mentioned Vislishta Sandhi Mukta, which can be considered as hip joint instability, Avakshipta, which is an anterior dislocation in which the joint is displaced downward, Atikshipta, which is a posterior dislocation of the hip, and Triyakshipta, which is a subluxation. Utpishta or Vislishta Sandhi Mukta should not be reduced, according to Acharya Sushruta. Therefore Sheeta Pariseka and Pradeha should be carried out. Vedana and Pradeha should be carried out. Vedana and Sopha Harana. Similarly, even now, ice packing is done for reduction of pain and swelling is suggested. ancient methods of placing a joint back to normal position like Anchana, Peedana Vartana, Sankshepa are retention maneuvers.

Conclusion

The Vankshan Sandhi which is Chestavanta and comes under Ulukhal Sandhi is very much similar to concept of modern science which considers hip joint as a movable and ball and socket type of synovial joint. Sandhigata Vata can be correlated osteoarthritis. Amongst several type of Sandhi Mukta, Vivartita can be correlated to the anteroposterior dislocation of a joint, which resembles to the anterior and posterior dislocation of the Vankshan Sandhi and Avakshipta type of Sandhimukta can be correlated to the downward displacement of a joint, which resembles to the central dislocation of the Vankshan Sandhi. Various types of hip dislocation can be understood clearly with the types and Lakshana of Sandhi Mukta mentioned by Acharya Sushruta. As a result, the treatment’s mention is unchanged from what Acharya Sushruta mentioned. After reduction, Bahyachikitsa, which are suitable for joint stability, can be given, such as Seka and Abhyanga, to strengthen the joint. Shamana Oushadhis can be used to relieve pain and swelling. It may be suggested to take the Pathya Apathya that Acharya Sushruta suggested in order to quickly regain joint stability. Therefore, it is crucial to comprehend the idea presented by Acharyas in order for a doctor to successfully treat the condition.

References

1. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 Sharir Sthan 5/33

2. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 Sharir Sthan 5/26

3. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 Sharir Sthan 5/23

4. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 Sharir Sthan 5/32

5. Pratyaksha Shariram, shri Gannath Sen-sharm-sarshwati virichita, page no. 146

6. Chaurasia’s BD Human anatomy 6th edition CbS Publishers 2013-page no.6

7. Chaurasia’s BD Human anatomy 6th edition CbS Publishers 2013-page no.136

8. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 sutra sthan 25/38

9. Charka Samhita,Charka Chandrika hindi Vyakhya,edited by Brahmanand Tripathi,Chaukhamba Surbharati Prakashan,edition. 2017 chikitsa sthan 28/37

10. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 nidan sthan 1/28

11. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 nidan sthan 15/5

12. Sushruta Samhita, Ayurved-Tattva-Sandipika with Hindi Vyakhya, edited by Ambika Dutta Shastri, Chaukhambha publications, Edition.2018 nidan sthan 15/7

13. Sushruta Vaidya Jadv ji Trikam ji Acharya, ed, Sushruta Samhita, Nibandha Samgraha commentary of Shri Dalhanacharya and Nyayachandrika panjika of shri Gayadasacharya choukamba, chapter 3.

14. Chaurasia’s BD Human anatomy 6th edition CbS Publishers 2013-page no.150


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