E-ISSN:2456-3110

Review Article

Shleshmadhara Kala

Journal of Ayurveda and Integrated Medical Sciences

2024 Volume 9 Number 7 JULY
Publisherwww.maharshicharaka.in

Conceptual study of Shleshmadhara Kala w.s.r to Synovial Membrane and its Applied Aspect - A Review

Milmile SK1*, Urmale RR2
DOI:10.21760/jaims.9.7.22

1* Sharada K Milmile, Assistant Professor, Department of Rachna Shareer, Jupiter Ayurveda Medical College, Nagpur, Maharashtra, India.

2 Rajesh R Urmale, Professor, Department of Rasashastra and Bhaishajya Kalpana, Government Ayurved College, Nagpur, Maharashtra, India.

Anatomy is the science that deals with study of the different structures of human body. Kala Sharir is one of the important concepts of Ayurveda anatomy which is mainly about the layers or membranes of the body. Kala is the term stated by Acharya Sushruta in relevance of sheath or beholding membrane of internal organs. Among the Sapta Kalas, Shleshmadhara Kala is fourth important Kala which is described by Acharaya Sushruta and other Acharyas. It is present specially in all the Sandhi. It could be correlate with the Synovial membrane of the joint as per modern Anatomy. Aim of this study is to determine the applied aspect of Shleshmadhara Kala. Objectives of this study are to compare the anatomical structure of Shleshmadhara Kala according modern anatomy and to evaluate the Doshic involvement in various ailments like Osteoarthritis, Rheumatoid arthritis and gout etc. in Shleshmadhara Kala. To fulfill such aim and objectives we have reviewed all the Ayurvedic classics, related literature and modern anatomy literature.

Keywords: Shleshmadhara Kala, Synovial membrane, Sushrutachrya, Kala Sharir

Corresponding Author How to Cite this Article To Browse
Sharada K Milmile, Assistant Professor, Department of Rachna Shareer, Jupiter Ayurveda Medical College, Nagpur, Maharashtra, India.
Email: 		Milmile SK, Urmale RR, Conceptual study of Shleshmadhara Kala w.s.r to Synovial Membrane and its Applied Aspect - A Review. J Ayu Int Med Sci. 2024;9(7):152-155.
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https://jaims.in/jaims/article/view/3603

Manuscript Received Review Round 1 Review Round 2 Review Round 3 Accepted
2024-05-17 2024-05-25 2024-06-03 2024-06-13 2024-06-23
Conflict of Interest Funding Ethical Approval Plagiarism X-checker Note
None Nil Yes 12.22

© 2024by Milmile SK, Urmale RRand 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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Introduction

Kala Sharir is one of the important aspects of Ayurvedic Sharir Rachna Vijnyana which mainly deals with the layers and membranes which covers various organs and tissues of the body. Kala is the term stated in Ayurveda for various purposes including unit of time and membrane etc., with respect to anatomical view it can be correlated with membranous structure. Kala is a unique concept explained by Acharaya Sushruta in “Garbhavyakarana Sharir Adhyaya.” Sushrutachrya defined the Kala as separator between Dhatu (tissues) & its Ashaya (organ or viscera), here Ashaya described as cavity that holds Dhatus.[1]

During foetal development, Kleda or moisture present in between the Dhatu and its Ashaya, reacting to its own heat gets converted into Kala.[2] Kala Swaroop (structure) described by Acharaya are the body parts covered by Snayus, enveloped Jarayu and smeared with Kapha.[3]

As per modern science it can be correlated with mucous membranes and epithelium. Therefore, Kala is membrane which protected by Snayus and secrets mucous; thus, Snayu and Shleshma are considered as components of Kala. The first Kala is known as Mamsadhara, the second is Raktadhara, the third is Medodhara Kala, the fourth is Shleshmadhara Kala, the fifth is Purishdhara Kala, the sixth is Pittadhara Kala and the seventh is Shukradhara Kala, thus the seven Kala. [4]

A basic structure of Sandhi is described as union of Asthi (bony surfaces), presence of Shleshmadhara Kala (synovial membrane) and Shleshak Kapha (synovial fluid). Joint diseases as mentioned in modern science can be classified in to inflammatory or non- inflammatory (degenerative) diseases.

According to Ayurveda diseases have to be justified as Sama or Nirama condition. Here an attempt is made to understand involvement of different Doshas in these inflammatory and non- inflammatory joint diseases in respect of Shleshmadhara Kala, it will evaluate the different Sandhigat Vyadhi, by compiling the existing evidences.

Aim and Objective

Aim of this study is to determine the applied aspect of Shleshmadhara Kala.

Objectives of this study are to compare the anatomical structure of Shleshmadhara Kala with the Synovial membrane according modern anatomy and to evaluate the Doshic involvement in various ailments like OA, RA and gout etc. with respect to Shleshmadhara Kala.

Materials and Methods

From various classical texts Bruhatrayi like Charaka Samhita, Sushruta Samhita, Ashtanga Samgraha, Ashtanga Hrudaya and Laghutrayi like Madhav Nidan, Sharangadhara Samhita etc and evidence based resources as scientific journals, books and data based information from various texts.

Discussion

The body parts covered by Snayus, enveloped by Jarayu and smeared with Kapha are called Kalas. As per modern science it can be correlated with mucous membranes and epithelium. Kala separates hollow or lumen of Organ from its lining tissue, therefore mucous membranes of the hollow Organs can be considered as Kala. It is interposed structure between the Dhatu and its Ashaya.

Shleshmadhara Kala is layers which holds mucous, present in all bony joints. It has been compared like the lubricant (oil) in a wheel axis which permits the wheel to move round in a free manner. Similarly, the Shleshma secreted by the Shleshmadhara Kala allow all bony joints to move freely on their respective axis.[5] The Synovial membrane is a specialized connective tissue that lines the inner surface of capsules of synovial joints and tendon sheath. This synovial membrane is lubricated with synovial fluid secreted by it. The term synovium refers to the soft tissue lining the movable joints throughout the body. Synovial lining secretes synovial fluid that lubricates and nourishes synovial joints.[6]

The basic structure of Sandhi is described in short in classical texts. Structure of Sandhi is not elaborated in detail by Sushrutachrya. A basic structure of Sandhi is described as union of Asthi (bony surfaces), presence of Shleshmadhara Kala (synovial membrane) and Shleshak Kapha (synovial fluid). Modern science reveals the basic structure of synovial joint as consisting of synovial cavity, articular cartilage, fibrous articular Capsule, synovial membrane and ligaments.


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There are two types of Sandhi, Chal (movable) and Achal (immovable).[7] The joints of extremities, temporomandibular joint and joints of waist are movable and rest all are immovable. According to Sushrutachrya joints are of eight types namely Kor, Udukhal, Samudga, Tunnasevani, Vayastunda, Mandal, Shankhavarta.[8] According to modern science joints are classified into three basic types as fibrous, cartilaginous and synovial joints depending on the material composing the joint and presence or absence of a cavity in the joint.[9]

Joint diseases as mentioned in Ayurveda or modern science can be classified into inflammatory or non- inflammatory (degenerative) diseases. Ayurveda mentioned the diseases in which joints are affected mainly includes Sandhigat Vata, Asthimajjagata Vata, Amavata, Vatarakta, Abhyantar Phiranga, Kroshtuk Shirsha, Vatakantak. Amongst these in first five diseases all the joints are involved whereas in last two diseases knee joint and ankle joint are involved respectively.

Modern science distinguished the joint diseases into two principal categories inflammatory diseases having inflammation as a Principal set of signs or symptoms. Rheumatoid arthritis, bursitis, infective arthritis is the examples of inflammatory joint diseases. Traumatic joint diseases, degenerative joint diseases likely Osteo arthritis, congenital abnormalities are the example of non-Inflammatory diseases.[10]

According to Acharya Charak cardinal sign of Sandhigat Vat are painful movement of joint especially large joint, inflammation and tenderness.[11] In this disease degeneration occurs in large joints due to geriatric changes or obstructive pathogenesis. Similarly in osteoarthritis usually degeneration in synovial membrane and in cartilage occurs, which leads to painful joint movement and inflammatory joint condition.

In Asthimajjagat Vata Vyadhi continuous pain especially in small joints and bones are found.[12] In such condition Vata dosha extensively aggravates with Pitta and Kapha Doshas and affects Asthi and Majja Dhatu. Such kind of situation are seen in Avascular necrosis of hip joint.[13]

According to Madhavnidan when Ama affects site of Shleshma with vitiated Vata it causes Amavata. Amashaya, Sandhi, Shirah Pradesh etc are the chief sites of Shleshma.

Out of it Sthula Sandhi which are commonly affect in Amavata. Shotha and Vrushchika Danshavata Vedana are cardinal sign which found in Amavata.[14] In advance stage of Rheumatic arthritis synovitis, pannus formation, cartilage and bone erosion occurs which leads to joint space narrowing.[15]

As per Acharya Charak in Gambhir Vatarakta Shotha, Kathinya, Daha and Sandhivakrata are found. Some times which lead to deformity also.[16] In such conditions Shleshmadharakala also get inflamed and become hard. Similarly in Gouty arthritis due to deposition of urate crystals in joint tissue causes acute inflammation, restricted joint movement and tophy formation.

When symptoms reside in the skin and muscle the condition known as Uttan Vatarakta. On the other hand, symptoms spread to all the tissue and manifested sever pain in the joints, swelling, having ulcers is the Gambhir Vatarakta which very much resembles to Psoriatic arthritis.[17]

Here we are discussed about the diseases Sandhigat Vata, Asthimajjagata Vata, Amavata, Vatarakta and Kroshtuk Sheersh. This can be compared with Osteoarthritis, AVN hip joint, Rheumatoid arthritis and Psoriatic Arthritis and Pseudogaut respectively. After comparing the symptoms, it is observed that Sandhishul (joint pain) and Sandhishoth (inflammation) is seen in almost all joint diseases.

Sandhigat Vata show a unique symptoms called Atop (crepitus). But in Amavata the severity of pain is high and it shift from one joint to other. Only in Vatarakta pain begins from smaller joints whereas in rest larger joints affected first. Vata Dosha is the main vitiated dosha in all the joint diseases. In Amavata it is associated with Ama and in Vatarakta it is associated with Pitta and Rakta.[18]

Kroshtuksheersha is an acute joint condition which specially affects knee joint. It can be correlate with Pseudogout. In this acute arthritic attack extreme pain, swelling and stiffness in joints found.

Pathophysiology caused by breakdown of calcium pyrophosphate crystals, an insoluble calcium salt, from bone that has been accumulated in ligaments and joint spaces especially in knee joint. Similarly, in ayurvedic pathogenesis it is caused by vitiation of Vata Dosha due to Kshaya of Shleshma property of Shleshmadhara Kala.[19]


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Conclusion

Shleshmadhara Kala or synovial membrane plays an important role in all movable joints. Disease in which Shleshmadhara Kala is affected by Vata Dosha only leads to degenerative changes in the joints and mobility of the joint gets affected. Whereas Vata Dosha aggravated with the Pitta or Rakta Dosha in inflammatory joint diseases causes pain and inflammation in the synovial membrane. Third condition where Vata Dosha is aggravated with Kapha or Ama, Pain and restricted joint movement are predominant sign. In such condition Shleshmadhara Kala get inflamed which causes severe pain.

References

1. Ghanekar, Dr Bhaskar Govind Ayurveda Rahasya Deepika Hindi Commentary on Sushruta Samhita Sharir Sthanam, Meherchand Lachmandas Publications New Delhi 2013, page no. 108.

2. Trivedi Raghuvir Prasad, SarvangaSundari Vyakhya Ashtanga Samgraha Sharir Sthanam, Baidyanath Ayurveda Bhavan Private Limited,1989, page no. 115.

3. Ghanekar, Dr Bhaskar Govind Ayurveda Rahasya Deepika Hindi Commentary on Sushruta Samhita Sharir Sthanam, Meherchand Lachmandas Publications New Delhi 2013, page no. 108.

4. Ghanekar, Dr Bhaskar Govind Ayurveda Rahasya Deepika Hindi Commentary on Sushruta Samhita Sharir Sthanam, Meherchand Lachmandas Publications New Delhi 2013, page no. 108.

5. Ghanekar, Dr Bhaskar Govind Ayurveda Rahasya Deepika Hindi Commentary on Sushruta Samhita Sharir Sthanam, Meherchand Lachmandas Publications New Delhi 2013, page no. 108.

6. Peter L. Williams, Gray’s anatomy Churchill livingstone 38th edition 1999, page no 497.

7. Shastri Ambikadatta Ayurveda Tatva Sandipani Hindi Commentary on Sushruta Samhita part 1, Chaukhamba Sanskrit Sansthan 2007, page no. 45.

8. Shastri Ambikadatta Ayurveda Tatva Sandipani Hindi Commentary on Sushruta Samhita part 1, Chaukhamba Sanskrit Sansthan 2007, page no. 46.

9. Anne MR Agur & Arthur F. Dalley, Grants Atlas of Anatomy, 13th Edition, page no. 39.

10. Sadhale Varsha, Budruk Pramod, A review of Joint diseases, NJRS, vol 7, issue 3, June 2019, eISSN 2320-7379.

11. Shastri Kashinath Dr., Vidyotini Commentary on Charak Samhita Part II Chaukhamba Bharati Academy, 1996, page no. 783.

12. Shastri Kashinath Dr. Vidyotini Commentary on Charak Samhita Part II Chaukhamba Bharati Academy, 1996, page no. 782.

13. Dash G, Dinesh Patil et al; Ayurvedic management of Asthimajjagat Vata w.s.r. AVN of head of femur – a case study; IJAM, vol 14 (3), 2023, ISSN 0976-5921.

14. Upadhyaya Yadunandan, Madhukosh hindi Commentary on Madhavnidan, Chaukhamba Sanskrit Sansthan, page no. 462, 463.

15. Sir Stanley Davidson; The Principles of practise of medicine; E & S livingstone ltd, Edinburge, 5th edition 1960.

16. Shastri Kashinath Dr. Vidyotini Commentary on Charak Samhita Part II Chaukhamba Bharati Academy, 1996, page no. 822.

17. Sudarshan Kaveri R. N., Nutan Mahato et al; ayurvedic management of psoriatic arthritis- a case study; Kerla Journal of Ayurveda; vol 1(1), 14-19, 2022, ISSN 2583-8555.

18. Sadhale Varsha, Budruk Pramod, A review of Joint diseases, NJRS, vol 7, issue 3, June 2019, eISSN 2320-7379.

19. Uttamram Yadav, management of Pseudogout (Kroshtuksheersha) through herbal medicine: a case report; J-ISM, vol 11, issue 2, apr- June 2023, ISSN-2455-5029.


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