Doshas And Musculo-Skeletal System

By Dr Raghuram Y.S. MD (Ay) & Dr Manasa, B.A.M.S

The entire journey of human evolution took place on comprehensively aligned and synchronised musculoskeletal system bestowed to him by creation.

Introduction

Our limbs and spine, which are comprised of components of musculoskeletal system, are most sophisticated machinery in creation. Fine movements occurring in them make many activities possible. These movements occur due to uninterrupted articulation between ends of 2 or more bones i.e. bony joints along with help of muscles, ligaments and tendons. A proper synchronisation among these components is very essential for all movements and activities occurring in our body.

Human musculoskeletal system is also called locomotor system or activity system.
Read – Asthi Shareera – Definition, Anatomy, Types Of Bones

Sanskrit verse

Vata and musculoskeletal system

From perspective of definition of Vata – definition of vata points towards relationship of vata dosha and musculoskeletal system.

Vata is defined as ‘that which causes gati and gandhana’.
Here, gati means movement, knowledge or obtaining something.
Gandhana means enthusiasm and interest, response to something, carrying a message, continued effort.
Read – Understand Vata Dosha By Its Functions

Therefore vata can be defined as ‘that which causes movement, enables obtaining knowledge, makes one reflect enthusiasm and interest, respond to stimulus and make continued effort’

Definition explains physical and mental abilities, sensory and motor responses and all activities happening in body as conducted by vata.

Combined meaning of gati and gandhana describes synchronised sensory perception and motor responses.

Movements occur everywhere in body and mainly in musculoskeletal system. These movements like holding things, giving, taking, walking, running, sitting, climbing, swimming and other activities of daily living are carried out by motivation and mobilization caused by vata in joints and tissues of locomotion system.

Vata is representative of air in body. Just like wind mobilizes things from one place to other, vata in body enables the movement of body by causing activities in musculoskeletal system.
Read – Vata Kalakaliya Adhyaya – Charaka Sutrasthana 12

From perspective of importance of vata in body

A reference from Sharngdhara Samhita quotes –

‘Everything in body, including pitta, kapha, excreta and tissues of body are lame. They get carried away to places in body wherever they are pushed, pulled or propelled by action and force of vata.’

When we plug in bone and muscle tissues in above said quote, activities and movements in them are caused by vata. Without motivation of vata these tissues are lame and there will be no movements in them. If there are no movements in bones, joints and muscles, we are lame and there is no locomotion.

From perspective of normal Vata functions

Among many functions of balanced vata explained by Charaka (Cha.Su.12/7) below mentioned aspects explain vata connection with musculoskeletal system.

प्रवर्तकः चेष्टानाम् –
Vata, in a state of balance, is initiator of all psychosomatic activities in body. This includes functions and activities of musculoskeletal system.

सर्व शरीर धातु व्यूहकरः, सन्धानकरः शरीरस्य –
Vata is chief coordinator of different parts of body. It integrates various parts of body, all tissues and aligns their functions. Due to activity of vata, entire body works as a single unit and all functions take place normally in a synchronized way. This rule is applicable for components of musculoskeletal system also. Integrity between bones, joints made of these joints, muscles, ligaments and tendons is maintained by balanced vata. Involvement of vata enables a synchronized function of these components of musculoskeletal system leading to many kinds of movements which define our life activities.

Cheshta – Cheshta means activities. It is one of main functions of vata which is in a state of balance.
Read – Symptoms Of Vata Dosha Increase And Imbalance – Vata Vruddhi Lakshana

From perspective of vata vitiation

a. Pathological manifestation of vitiated Vata i.e. vata prakopa lakshanas showing relationship of vata and musculoskeletal system

Below mentioned pathological manifestations caused by vitiated vata involves damage to one or more of components of musculoskeletal system.

• Visceroptosis – displacement of an organ(s) from their original places
• Dilatation of organs or tissues, expansion beyond their normal limits
• Inertia – stoppage of functioning in some organs or parts of organs
• Dropping of an organ
• Spasm / contractures
• Twisting sensation
• Tremors
• Twitching and ticks
• Rigidity

b. Vata Vyadhi

Vata vyadhi – comprises of set of special and uncommon diseases and syndromes caused by vitiated vata. Most diseases included in this list have involvement of musculoskeletal components. This also establishes relationship of vata with musculoskeletal system from pathological viewpoint.
Read – Vata Disorders (Vatavyadhi): Definition, Causes, Symptoms

i. Definition of vata vyadhi –

‘severely vitiated vata occupies all empty channels of body and causes many diseases afflicting a portion of body or entire body’.

Most diseases afflicting a portion of body or entire body are related to components of musculoskeletal system.

ii. Premonitory symptoms of vatavyadhi

• Contractures of small joints of hands and feet
• Stiffness of joints of body
• Pathological fractures of bones of body
• Pathological dislocation of joints of body
• Lameness, limp
• Tremors of body parts, limbs
• Crookedness of joints of head, nose, eye, neck

Read – Difference Between VataVyadhi And Other Pathological Vata Manifestations

iii. Examples of such musculoskeletal diseases caused by vitiated vata are –

Sarvanga vata – Vata vitiated in entire body causes tremors and shaking in body parts, cracks in joints or splitting pain in joints among many symptoms.

Guda sthita vata – vata aggravated in anus and rectum causes dryness, emaciation and pain in legs, sacral region, legs and hands.

Pakwashaya sthita vata –pain in sacral region is one of symptoms of vata aggravation in colon.

Twak gata vata – pain in inter-phalangeal joints i.e. small joints of hands and feet are one of symptoms of vata aggravation in skin.

Mamsa meda gata vata – presence of throbbing pain in muscles and pain as if beaten with sticks is experienced in vitiated vata afflicting muscles and fat

Majja asthi gata vata – splitting pain in small joints of hand and feet, pain in multiple joints of body, decrease in muscle strength, constant pain in body parts are symptoms of vata aggravation in bone and bone marrow

Snayu gata vata – when vata aggravates in ligaments, it causes twitching, sprains and pain in foot and other joints and diseases afflicting part or whole body, mainly degenerative diseases of joints.

Sandhi gata vata – when vata gets aggravated in joints, it causes destruction and damage to ligaments of joints, pain, swelling and difficulty in movements. This condition is compared to osteoarthritis.

Pittavrita Vyana – When vyana vata functions are disturbed by pitta, it causes involuntary jerking of limbs

Asthi avrita vata – when bone tissue obstructs function of vata, it causes breaking and throbbing pain in body parts.

Majja avrita vata – when bone marrow obstructs functions of vata, it causes crookedness of body, cramps and pain in body parts.

Annavrita vata – when functions of vata are obstructed by pressure of food, it causes severe pain in joints of pelvis, groin, hip and low back.

Pranavrita samana – when functions of samana vata are obstructed by prana vata stiffness and loss of movement of body parts are manifested among many symptoms.

Udanavrita prana – when prana vata functions are blocked by udana vata, destruction of physical activities, strength and color occurs among many symptoms.

Samanavruta vyana – when vyana vata functions are obstructed by samana vata, laxity of body parts and destruction of strength are caused.

Udanavrita vyana – when vyana vata functions are obstructed by udana vata, stiffness of body parts and loss of all activities of body occurs.

Kaphavruta Vyana – when vyana vata functions are obstructed by kapha, it causes severe pain in all bones and joints of body and obstruction of all activities of body.
Read – Avarana Janya Vata Vikara: Vata Disorders Due To Blockage Of Channels

iv. Other conditions –

• Akshepaka – presents with convulsions in body, bowing of body and spine,
• Danda apatanaka – log like stiffness of body
• Dhanustambha – stiffness along with bowing of body is caused due to affliction of ligaments of body by vata
• Pakshavadha – affliction of ligaments, nerves and blood vessels of half portion of body by vitiated vata leads to their dryness leading to laxity of joints on one half (opposite half) of the body and renders that portion of afflicted body motionless and numb. If same mechanism happens in ligaments of entire body, it is called sarvanga roga and if it happens in one part of body it is called ekanga roga. This condition is often compared to paralysis and hemiplegia.
• Ardita – when vitiated vata gets lodged in joints of head, nose, lips, chin, forehead and eye joints and damage them, it causes deviation of face to one side and causes facial paralysis.
• Hanu graham – vitiated vata located in joints of jaw causes stiffness in them causing lock jaw.
• Manyastambha – vata vitiated in muscles and tendons of nape of neck cause stiffness in those parts.
• Gridhrasi – when vata and kapha either individually or in combination gets aggravated in muscles and nerves of butts, pelvis, hips, low back, thigh, knee, legs and feet, they cause stiffness, pain and pulsations in those regions. When vata is predominant it causes severe pain in lower limb, crookedness of limb and pulsating pain in knee, hip and pelvic joints. This condition is compared to sciatica.
• Viswachi and apabahuka – vata getting aggravated in tendons on back of hands and upper limbs causes pain and loss of movements of upper limbs.
• Kroshtu shirshka – severe painful swelling occurs in middle of knee joints due to aggravation of vata and blood in these joints.
• Khanja and Pangu – when vata gets aggravated in pelvis and thighs and cause twitching and tremors of tendons of those regions, it causes khanja i.e. limp and pangu i.e. lameness.
• Vata kantaka – when vata aggravates in foot i.e. ankle joints, it causes pain and difficulty to walk.
• Amsa shosha – vata getting aggravated in scapular region causes dryness of joints of shoulder and shoulder girdle.
• Kampa vata – when vata aggravates in entire body it causes shaking of body. When vata aggravates only in head, it causes shaking of head. Both conditions are called kampa vata. This condition is often compared to Parkinsonism.
• Khalli – vata aggravated in feet, legs, thighs, wrists and ankles causes cramps in those areas.

v. Other systemic non-vatavyadhi diseases involving vata in causation of musculoskeletal disorders

Amavata – often compared to rheumatoid arthritis.

Name itself shows that this musculoskeletal disorder is formed due to involvement of two pathological elements i.e. vitiated vata and ama. Both can cause painful conditions individually. Combination is lethal and produces systemic and gastrointestinal complaints at the beginning stages and musculoskeletal illness in later stages. It presents with –

Vatarakta – often compared to gouty arthritis. Name itself has vata rakta which shows two pathological components which are jointly vitiated in causation of painful joint disorders, i.e. vata and blood. It presents in two forms.

• Uttana Vatarakta
• Gambhira Vatarakta

Vata nanatmaja vyadhi – Nanatmaja Vyadhis of vata are those disorders which are caused due to vitiation of only vata. They are special conditions involving vata and are 80 in number. Here I will enlist only those diseases caused by vata which have musculoskeletal involvement. Full list of Vataja Nanatmaja Vyadhi

Read – Vata Samanya And Nanatmaja Vyadhis (General And Unique Vata Disorders)

vi. From perspective of composition of marma

Among different routes in which diseases are formed, intermediate routes i.e. madhyama roga marga comprises of marmasthi sandhi gata rogas. These diseases occur in

• Marmas – vital parts of the body which are formed by confluence of muscle, blood vessels, tendons, bones and joints of the body. Injury to these spots may either take away life immediately or after long duration or after foreign material is removed from contact of these parts. Injury of some of these parts causes severe pain and some cause deformity and debility.
• Asthi-sandhi – bones and bony joints

It is said that the life element located in these spots of the body which make them delicate and life threatening when they get injured.
Read – Marma Shaareera: Definition, Composition: Vital Points of The Body

Marmas are made up of –

• Soma i.e. kapha
• Maruta i.e. vata
• Teja i.e. Pitta
• Satwa
• Raja
• Tama
• Bhuta i.e. 5 basic elements of creation, Earth, Wind, Water, Fire and Ether
• Atma i.e. Soul

Satwa, Raja and Tama are the forms of ahankara i.e. egoism derived from macrocosm and form basic qualities of mind.

All above said ingredients in composition with Marmas are called Pranas or life elements. When marmas are injured, one or more of these Pranas will be afflicted leading to death or deformity.

This shows relationship between vata, pitta and kapha and structures of musculoskeletal system i.e. bones, muscles and joints which are also vital parts of body.

One of chief marmas i.e. vishalyaghna marmas take away life once foreign body impacted in it is removed. These marmas are predominantly composed of Vayu Guna i.e. qualities of Vayu Mahabhuta / Air element. escape of this Vata following removal of foreign body causes death.

Some references quote deeper tissues formed in later part of chronological formation of tissues i.e. bone, bone marrow and semen are also marmas. Here, vata has its seat in bone tissue which is also a vital structure in body. Thus, vata disturbances can hamper vital nature of bone and cause bone and joint related diseases.
Read – Classification Of Marma Based On Components

From treatment perspective

Use of sesame oil or other medicated herbal oils and treatments given with same are said to be best remedies for vata. Oil and ghee when used for internal consumption and external application have been effective in combating vata disorders.

Medicated oil used in form of massage, stream pouring of oils over body and head, enema and purgation help in combating musculoskeletal disorders caused by vitiation of vata. This shows that musculoskeletal disorders are caused by vitiated vata. This shows that vata is related with musculoskeletal disorders.

Similarly relieving and aggravating factors of vata administered in form of medicines, food and lifestyle activities in order to diagnose vata conditions through upashaya-anupashaya methods also point towards involvement of vata in causation of musculoskeletal disorders.
Read – How To Balance Vata Dosha? Line Of Treatment And Reasoning

From perspective of vata and tissue relationship

Bone is one of the seats of vata. Along with this, pelvis and thighs inclusive of bones and joints of this region are also chief places of vata.

Each dosha has a residence-resident relationship with one or more tissues. Vata is related to bone tissue in this relationship. Bone is an abode and vata is resident. An increase or decrease of vata, impacts in a bad way on bone tissue. Converse is also true.
Read – Ashraya Ashrayi Bhava: Relationship Between Tissues And Doshas

From perspective of vata types

Among sub-types of vata, prana vata and vyana vata are mainly responsible for carrying most activities of the body, including at musculoskeletal department enabling movements. Other sub-types also coordinate and cooperate in functions of these vatas.

Pitta and musculoskeletal system

There is an indirect influence of pitta on musculoskeletal system.

Formation of tendons, blood

From perspective of formation of tendons from blood and influence of pitta on tendons

Siras i.e. blood vessels and veins and kandaras i.e. tendons are sub-tissues of blood tissue. They are formed during transformation of blood into muscle tissue in chronology of tissue formation.
Read – Upadhatus: Sub-Tissues Of The Body

Pitta has a residence-resident relationship with blood tissue. Here blood forms residence and pitta staying in blood forms resident. Thus, blood and pitta have inseparable coexistence. Increase or decrease of pitta imparts pathological influence on blood. In definition and pathogenesis of a disease called rakta-pitta which deals with bleeding disorders, pitta and rakta are said to influence each other by virtue of coexistence and tendency to mutually contaminate each other.

Now, when we match up above said concepts, blood forms tendons and pitta resides in blood. Health, formation, maintenance of tendons depends on health of blood tissue. Thus, blood influences tendons in greater way since it is origin of tendons.

Similarly, pitta residing in blood also influences tendons. Pathological increase of pitta may vitiate blood and influences improper formation of tendons. Similarly, vitiation of pitta in blood can also contaminate and damage tendons leading to many musculoskeletal disorders of pitta origin, mainly of inflammatory type. We should remember that tendons are important members of musculoskeletal system.
Read – Upadhatu Of Rakta: Sira, Kandara – Sub Tissues Of Rakta

From perspective of pitta nanatmaja diseases

Pitta nanatmaja diseases are diseases caused by vitiation of only pitta. They are 40 in number. Among these diseases, few of these special diseases show involvement of pitta in manifestation of musculoskeletal disorders. Example –

• Anga avadaarana – splitting pain in body parts
• Mamsa kleda – decaying of flesh / muscles

From perspective of treatment

Virechana i.e. therapeutic purgation is treatment of choice in pitta disorders.

Many musculoskeletal disorders are also inflammatory in origin, caused by vitiated pitta. This includes diseases like amavata i.e. rheumatoid arthritis, vatarakta i.e. gout, sandhigata vata i.e. osteoarthritis etc. In all these diseases, therapeutic purgation is seen to give good results and cure. These conditions are healed once vitiated pitta is taken care of.

Though paralysis / hemiplegia is not a musculoskeletal disorder in strict terms, muscles and joints are involved i.e. there is musculoskeletal involvement. Therapeutic purgation is said to be one of best treatments for this condition. Purgation administered on backdrop of oleation and sudation is seen to bring good movements in limbs of patients suffering from hemiplegia.

Kapha – musculoskeletal system

Kapha also has its relationship with musculoskeletal system.

From perspective of definition of kapha

Shleshma is synonym of kapha.

Definition of shleshma states – ‘That which binds things together is called shleshma’. From this statement we can understand that kapha forms binding substance and holds all the components of the body together as a single mass.

Apart from water component, kapha also has earth element in it. Both together form cement substance which binds and holds all structures together, including bony joints.
Read – Understand Kapha Dosha By Its Functions

From perspective of kapha types

One among five sub-types of kapha is shleshaka kapha. This kapha is located in bony joints of the body and is responsible for strength and integrity of joints. It holds bones and bony ends together and helps in easy articulation and movements at joints. Balance of vata and shleshaka kapha enables all movements at joints and is responsible for locomotion. Balance of vata and kapha is very important.

If vata increases, kapha decreases. This lessens lubrication of joints and joints are subjected to wear and tear phenomenon. With passage of time increase of vata causes degenerative diseases like osteoarthritis in joints. Similarly, if kapha increases, vata decreases in joints. Consequentially swelling and stiffness of joints occur along with formation and accumulation of exudates and liquid in joints. This leads to restricted movements and heaviness in joints.

From perspective of qualities of kapha

Unctuous and sticky quality of kapha along with unctuous quality of pitta and movement quality of vata enables easy movements in bony joints and enables locomotion in an uninterrupted way.

From perspective of seats of kapha

Among many seats of kapha, parvani i.e. interphalangeal joints of fingers and toes are mentioned.
Read – Kapha Dosha Dominant Places in Our Body

From perspective of functions of balanced kapha

Among functions of normal kapha below mentioned functions explain relationship of kapha with musculoskeletal system.

• Sthiratva – stability of body, stability to joints
• Snigdhatva – lubrication of body, lubrication of joints enabling easy movements and preventing wear and tear
• Sandhi bandha – binds and holds bony joints together
• Kshama – provides immunity and endurance to whole body including musculoskeletal system

Read – Functions Of Doshas In Balance In The Body – Prakrita Dosha Karma

From perspective of residence-resident relationship

Kapha has residence-resident relationship with muscles, fat and bone marrow tissues which form important components of musculoskeletal system. Kapha resides in these tissues in an inseparable coexistence.

From perspective of formation of ligaments and bony joints from fat tissue

Ligaments and bony joints which are important components of musculoskeletal system are formed from fat tissue. They are formed during process of formation of bone tissue from fat tissue in chronology of tissue formation as explained by Ayurveda.

Kapha has residence-resident relationship with fat tissue. Here, fat forms residence and kapha is resident. Kapha is located in fat tissue. Thus, kapha and fat tissue live with an inseparable coexistence.

Increase or decrease of fat tissue will impact formation of ligaments and joints.

Now, when we match up above said concepts, fat tissue forms ligaments and joints and kapha dosha resides in fat tissue. Health, formation, maintenance of ligaments and joints depends on health of fat tissue. Thus, fat influences ligaments and joints in greater way since it is origin of ligaments and joints.

Similarly, kapha residing in fat tissue also influences ligaments and joints. Pathological increase of kapha may vitiate fat tissue and influences improper formation of ligaments and bony joints. Similarly, vitiation of kapha in fat can also contaminate and damage ligaments and joints leading to many musculoskeletal disorders of kapha origin. We should remember that ligaments and joints are important members of musculoskeletal system.

From perspective of kapha nanatmaja diseases

Kapha nanatmaja diseases are diseases caused by vitiation of only kapha. They are 20 in number. Among these diseases, few of these special diseases show involvement of kapha in manifestation of musculoskeletal disorders.

• Guru gaatrataa – heaviness of body, includes heaviness of joints due to accumulation of fluids in joints and soft tissues
• Ati sthoolata – excessive body weight, obesity which creates pressure on joints and bones causing arthritis, example – osteoarthritis

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