“A LITERARY STUDY OF MANSAVAHA SROTAS MOOLASTHANA AS

MENTIONED IN SUSHRUTA SAMHITA WITH SPECIAL REFERENCE TO

MODERN ANATOMY”

BY

DR. PRADNYA BHARAT PATIL MD Scholar

Dissertation submitted to the

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA,

BANGALORE.

In partial fulfillment of the requirements for the degree of

AYURVEDA VACHASPATI

In

RACHANA SHAREERA

Under The Guidance of

Dr. RAHUL NITINALIAS RUGE MD (Ayu)

Associate Professor

Department of PG studies in Rachana Shareera

LATTHE EDUCATION SOCIETY'S

ACHARYA DESHABUSHAN AYURVEDIC MEDICAL COLLEGE

AND HOSPITAL, BEDHIKIHAL DIST- BELAGAVI

2017-2020

LIST OF ABBRAVATIONS USED

AÉ.U. ÌS AÉrÉÑuÉåïSè UWûxrÉ ÌSmÉÏMüÉç

Q. ÌlÉ. xÇÉ QûsWûlÉ ÌlÉoÇÉkÉç xÇÉaÉëWû

xÉÑ zÉÉ xÉÑ́ ÉÑiÉ zÉÉUÏUxjÉÉlÉ

ACL Anterior Crucial Ligament

ACL Anterior cruciate ligament

ASV AntiSnake Venom

DNA Deoxy Ribose Nucleic Acid

HIV Human Immunodeficiency virus

MCL Medial collateral ligament

mm millimeter

PCL Posterior cruciate ligament

PET Poly Ethylene Terephthalate

TB Tuberculosis

UV Ultra Violet

UVR Ultra Violet Radiation

UCL Ulnar collateral ligament

WSR with Special Reference

LIST OF TABLES

Sr.no Tables Page no

1

Type of skin,modern name,pramana

&adhishtana for disease

17

2

Types of tvaca according to different

tikakaras

18

3

Showing the comparison of thickness of

Tvaca according to Sushruta and

Dalhana

19

4

Tvaca and panchamahabhoot relation

24

5

Correlation of Ayurvedokta Tvaca Stara

with Modern sciences

27

6

Special Features of the Different Layers

of Epidermis

77

7

Cause and color of skin

80

LIST OF FIGURES

Sr no Figures Pages

1 Ligament 30

2 Articular ligament 32

3 Cricothyroid ligament 34

4 Periodontal ligament 35

5 Suspensory ligament of lens 35

6 Phrenoesophageal ligament 36

7 Suspensory ligament of breast 37

8 Anterior sacroiliac ligament 38

9 Posterior sacroiliac ligament 38

10 Sacrotuberous ligament 39

11 Sacrospinous ligament 39

12 Inferior pubic ligament 40

13 Superior pubic ligament 41

14 Suspensory ligament of penis 41

15 Anterior cruciate ligament 42

16 Lateral collateral ligament 43

17 Posterior cruciate ligament 44

18 Medial collateral ligament 45

19 Patellar ligament 45

20 Palmer radio carpal ligament 46

21 Dorsal radio carpal ligament 47

22 Ulnar collateral ligament 48

23 Radial collateral ligament 49

24 Peritoneal ligament 50

25 Flexor retinaculum 51

26 Extensor retinaculum 52

27 Lateral retinaculum 55

28 Medial patellar retinaculum 56

29 Keratinocyte 60

30 Melanocyte 61

31 Langerhans cell 62

32 Markel cell 63

33 Stratum basale 64

34 Stratum spinosum 65

35 Stratum granulosum 66

36 Stratum lucidum 67

37 Stratum corneum 68

38 Papilary layer 71

39 Reticular layer 72

40 Cross section of skin 75

41 Cross section of skin- Thick & thin skin

76

ABSTRACT

Ayurveda is a science which requires a lot of research to establish its

authenticity along with modern medical science. The first step in this is to define the

terms mentioned in Ayurvedic classics, especially the basic terms. The science cannot

be implemented methodically as long as the terms are not properly understood.

Rachana shareera is the subject which deals with a lot of anatomical terms and

defining these terms are important for application of the science. Snayu and tvaca is a

term which is explained elaborately in classical texts but yet it is unable to point out

exact structure related with it in human body. During this study, the references related

to the Snayu and tvacaare collected and tried to explain as a structure form. Literally

the term Snayu means to bind. It is explained as a structure which helps in binding the

joints and helps the body in weight bearing. Structurally it has been described

something similar to a fibrous in nature. Tvaca helps to regulate body temperature, &

permits the sensation of touch, heat &cold. Knowledge of snayu & tvaca is very

important for physicians as well as surgeons who are dealing with surgical removal of

foreign bodies.

Keywords- Snayu, tvaca, Sharir Rachana, fibrous structure.

1

1. INTRODUCTION

The Ayurveda is an ancient medical system that originates in india more than

five thousand years ago. It is considered as upveda of Atharvaveda. The term

Ayurveda is derived from the Sanskrit word Ayu which stands for the integrated

relation of body, sense, mind and the soul. Veda means science .This science is

concerned with life and hence called science of life. Shareera rachana is important

characteristic feature and compact the total science of biology.

Shareera Rachana is one of the basic subjects for the principles of

Ayurveda. It deals with the structure of a human body, its applied aspects & clinical

importance. Most of the structural entities explained in our Samhita are very difficult

to understand. It is very important to interpret the anatomical terms with reference to

the Samhita. There is a lacuna in this interpretation. Tvaca and Snayu Shareera is one

of such area which needs much more research.

Human anatomy (shareera rachana) is an important for allied health

sciences. It is one of the fundamental subject to the health science. The ayurvedic life

science is also based on the human anatomy and physiology (rachana & kriya),

without the knowledge of shareera rachana and kriya, the physician cannot become

perfect in the profession. So the ancient acharyas like Sushruta, Charaka and

Vagbhata were given importance to the knowledge of rachana shareera. The acharya

sushruta was mentioned in the shareerasthana of sushruta samhita, other acharyas are

also explained about the human anatomy in their samhitas.

2

Sushruta shareera sthana has great anatomical importance, therefore it

is said that, Shareera sthana of Sushrut Samhita is best. Strotas formulation takes

place in intrauterine life with appropriate Agni and differentiation takes place, Vayu is

responsible in generation of strotas. This process of differentiation of fertilized zygote

arises many strotas in which body entities take their origin. The term strotas means a

channel. It is derived from the root" susravane" meaning to exude, to ooze, to filter.

Strotas is unique concept of Ayurveda. According to Ayurveda the whole body is

made up of Srotas. The number of Srotas is as many as the number of cells, tissues

and organs put together. This explains that every human cell is possibly a Strotas.

The internal transport system of the body represented by strotamsi, has given a place

of fundamental importance in Ayurveda both in health and disease. Two types of

vyadhies are mentioned. When mamsavaha strotas get vitiated then some diseases

occur these are Aadhimamsa, Arbuda, Arsha, Adhijivha, Upakush, Galashundika,

Aalji, Galaganda, Gandamala, Arsha is mentioned in Mamsadoshaj vikar by Acharya

Sushruta. Srotas are channels of circulations. These channels carry the dhatus

undergoing transformation to their destination. Tissue elements are situated in

different parts of the body and each of them has channels to carry their particular

nourishment.

Mamsavaha Strotas have two roots viz. Snayu, tvaca .symptoms of

damage or injury of mansavaha strotas are shwayathu, mamsashosha and siragranthi

can occurs. Tvaca and snayu are moolasthana of mansavaha strotas. Tvaca as

diagnostic tool in clinical aspects & tvaca serving as prognostic tool. All In Ayurveda

snayu refers to the ligaments. The anatomical study of ligaments is known as

3

desmology. Muscular channels, which originate in the ligaments, tendons, and skin,

supply nutrients to all over the body. Impairment of these channels is due to regular

intake of heavy, greasy foods, excessive sleep, sleeping after meals, and sedentary

lifestyle. The symptoms of vitiation are usually benign tumors produced by the

muscular system, tonsillitis a swollen uvula, hemorrhoids, and swelling of the thyroid

glands and adenoids. The emotional symptoms are lack of mental clarity and nervous

tension.

The study of human anatomy is very much vital for preventive and

curative aspect. Sushrutacharya explains three moolsthana of mansavaha strotas but in

this we are going to study only two moolasthana i.e. tvaca and snayu. Knowledge of

snayu & tvaca is very important for physicians as well as surgeons who are dealing

with surgical removal of foreign bodies. Nowadays because of stressful life, food

habits the necessity of ayurveda principles play an important role for the benefit and

welfare of peoples, so the main purpose of ayurveda is the prevention of disease by

following the various majors and promotion of life.

4

2. OBJECTIVS

AIMS

1) To study the mansavaha strotas moolasthana as per classical texts and modern

anatomy.

OBJECTIVES

1) To elobrate the moolasthana of mansavahastrotas as per sushrutasamhita and

sushrutatikakaras.

2) To determine the action and functions of ligaments and differentiate tendons,

ligaments and muscles.

3) To study the modern anatomy of tvaca(skin) &snayu(ligament) in detail.

5

3. REVIEW OF LITERATURE

1.PREVIOUS WORK DONE

1) Structural study of mansa and rudhira wsr to the effect of vyayam.

2) A critical study of snayu sharer wsr to sushirsnayu.

3) Study of tvaca sharer wsr to vyanga.

4) A critical study of shareera terms snayu, kandara & rajju.

5) Study of Twak Shareer w.s.r to Kitibha Kustha

The literature review broadly divided in two groups mentioned in this topic-

1. Ayurvedic literature

2. Modern literature

1. Ayurvedic literature

We will describe the strotas and symptoms produced when these are injured at their

roots.

Mansavaha strotas(muscular system)-

qÉÉÇxÉuÉWå û²å iÉrÉÉåqÉÑïsÉxlÉÉrÉÑiuÉcÇÉU£üuÉWûɶÉkÉqÉlrÉÉ:

iɧÉÌuÉkÉxrɵÉrÉjÉÑqÉÉÇïxÉzÉÉåwÉ: ÍxÉUÉaÉëljÉrÉÉ qÉUhÉçÇcÉç: xÉÑ zÉÉ 9/12

6

Channels of muscle tissue are two, their roots are snayu (ligaments) and tvaca(skin)

and raktavahi dhamani when these are injured, swelling, emaciation/ wasting of

muscles and death occurs.

MANSAVAHA SROTAS DUSHTI KARANA-

Sevana of abhishyandi padarth.

Eating regularly of guru sthool padarth in excess quantity.

Diwaswap after eating.

MANSAVAHA SROTAS DUSHTI LAKSHANA-

Adhimansa

Arbud

Galshaluk

Galshundikavriddhi

Putimansa

Alaji

Galgand

Gandmala

Upjivika

There are two moolasthana of mansavahastrotas-

1) Snayu ( ligaments)

2) Tvaca ( skin)

7

1) Snayu

Snayu is a structure which performs the function of holding and binding the

various structures of human body like bones, muscles and adipose tissue.

Snayu is used as bow string owing to its strength. Detailed observation of

these structures reveals them as generally fibrous structures which are strong

enough to withstand a certain amount of tension. Observations of Snayuarma

show it as a white, tough structure.

An overall observation of these structures gives an impression that Snayu is a

fibrous structure visible in the body. Aponeurosis, ligament,tendons,

retinaculam, nerve, deep fascia and other fibrous structures in the body.

xlÉÉrÉÑ xÉÇZrÉÉ-

lÉuÉxlÉÉrÉÑzÉiÉÉÌlÉ | iÉÉxÉÉÇ zÉÉZÉÉxÉÑ wÉOûzÉiÉÉÌlÉ,

²å zÉiÉåå ̧ÉÇzÉcrÉ MüÉåwPå, aÉëÏuÉÉÇmÉëirÉÑkuÉçïÇ xÉmiÉÌiÉ xÉÑ.zÉÉ 5/29

Dosha that‘s why called the snayu. The word Snayuis formed from the word

root (Dhatu) Sna. Sna Dhatu when combined with un’ and yuk’ Pratyaya

forms the word Snayu. Snayu(ligaments) are nine hundreds in number of these

six hundred are in sakha (extrimities), two hundred and thirty in the kostha

(trunk) and seventy in griva( neck) and above.

8

Total Snayu–900

Sakha- 600

Kostha- 230

Greeva- 70

Vutpatti of snayu

Sna + una = snayu

Sna word denotes purity. It purifies the. From the unctuous portion of

MedasSnayuare formed.

Snayua rise from Khara Paaka.

Nirukti

Vachaspatya states Snayu as a Strilinga Shabda. The etymology is similar to

Sidhanta Kaumudi. Its function is binding the body.

Synonyms of Snayu

Snayu is said to be a structure which binds the Anga-Pratyanga Sandhi.

Relation between snayu&dhatu-

Snayu is updhatu of meda. From meda snayus are produced.

Snayubhava-

snayu is a pitruj avyava.

9

TYPES OF SNAYU-

xlÉÉrÉѶÉiÉÑÌuÉïkÉÉ ÌuɱɨÉÉxiÉÑ xÉuÉÉïï ÌlÉoÉÉåkÉ qÉå |

mÉëiÉÉlÉuÉirÉÉå uÉÚ¨ÉÉ¶É mÉÚjurÉ¶É xÉÑÍzÉUÉxiÉjÉÉ || xÉÑ.zÉÉ. 5/30

There are four kinds of Snayu-

1) Pratanavati snayu (long tendons)-These snayus are present in shakhas- limbs

and sandhis. Pratanvati means a tendril, a shoot, a low spreading plant, a

spreading creeper and branching out. These are said to be present In Shakha

and all Sandhi. So Pratanavati type of Snayu should be present in all joints

of body and extremities and they should be having branching pattern and

like a creeper. So the structures which resembles Pratanavati Snayu are-

Ligaments- As these are present in all joints.

Nerves- As these are like creepers and have branching pattern.

2) Vrattasnayu–These are circular in shape & are known as kandara. Vrutta

means round or circular.

These are cord like structures present in the body. Acharya Susruta also calls

Vrutta Snayu as Kandara. Kandara is called MahaSnayu or Mahanadi. It is

a cord like structure which is similar to Snayu but large in size. So Kandara

should be large circular or cord like structure. In human the structures

resembling Kandaraor Vrutta Snayu are-

Tendons- As these are cord like

10

Large Nerves cords- These are also cord like and resemble tendon.

3) Pruthusnayu (large &flat tendons)– These are present in chest sides, head

&back region. The word meaning of Pruthula is a broad, large or great. So

these should be structures which are Large, broad and flat resemble Pruthula

Snayu in our body are Aponeurosis Fascia.

4) Susira snayu(ring like tendons) are present in end of stomach & intestine &

urinary bladder. Sushira means porous, hollow, cavity etc. Acharya Susruta

explains that Sushira Snayu is present in the terminal part of regions like

Amashaya, Pakvashaya, Basti etc. So these are structures which are porous

like in nature and also present in the openings of hollow organs and hold

these hollow organs (viscera). So the structures which resemble Sushira

Snayu are sphincters and visceral ligament.

As a ship is constructed & its parts are assembled with different ropes, wires

& bolts, the bones & other parts of the living body also are constructed & bound by

900 different snayus.

Utility of snayu-

According to sushrut just as a boat built by wooden planks placed

side by side, when fastened tightly by ropes in many ways becomes capable of

carrying weight in water steered by a boatman, similarly the human body is able

to carry weight as long as the sandhi(bony joints) are fastened tightly by snayu in

many ways.Ligaments bind the muscle and joints help to keep them in their places

firmly and also strengthen.

11

2) Tvaca

The external covering of the body is called Twak or Twacha. A type

of Indriya which envelops the body is called Twagindriya or Sparshanendriya.

Synonym for Tvaca

1) Tvaca, 2) Asrugdhara

3) Charma, 4) Kruti

5) Parshan, 6) Ajin

7) Chavi, 8) Dehacharma

9) Chadian 10) Shariravaranam

11) Romabhumi 12) Asrugvara

13) Shariravarakam shastram

Twacha: This word is derived as Twacha Samvarane which means covering of the

body.

Charma: This word is derived from Chara which means movement i.e. nature of

moving. According to modern science, cells of epidermis are continuously being

produced, remain for some period and become dead and they are replaced by newly

produced cells. This mechanism can be correlated to Ayurveda Shiryate tat shareeram

law in this way Charma is related to movement so the name has given.

12

Sparshan: To give tactile sensation. Tvaca plays main role in perception of tactile

sensation.

Chhavi: It means to illuminate the complexion, Tvaca enlights colour of a person.

Chhadani: It means to cover Tvaca envelops all organs of the body.

Asrukdhara: It means to hold the blood inside the body. Thus Tvaca prevents

bleeding tendency.

Tvacabhava

Tvaca is a Matruja Bhava.

Tvaca Uttapati

iÉxrÉ ZÉsÉÑ LuÉÇ mÉëuÉÚ¨ÉxrÉ zÉÑ¢üzÉÉåÍhÉiÉxrÉÍpÉmÉcrÉqÉÉlÉxrÉ |

ZzÉÏUxrÉåuÉxÉÇiÉÉÌlÉMüÉ: xÉmiÉiuÉcÉÉåpÉuÉÎliÉ || xÉÑ. zÉÉ. 4/4

Acharya sushruta explained, when life induced by combination of shukra and shonita

in the garbhashaya, at the same time it undergoes rapid transformation and formation.

The seven layers of skin are formed during the embryonic period. The union of sukra

and shonit while being processed by heat gives rise to the formation of seven tvaca

(skin) Just like formation of cream when milk is boiled.

Formation and development of tvaca is took place during the

“Garbhanirmati” i.e. Process of formation and development of Garbha. Sushruta

depicts formation of Tvaca from the metabolization of Shukra & Shonita by Tridosha.

For better understanding of Twacha Uttapati in Brihattrayee the whole process of

13

formation of tvaca is compare with formation of creamy layer over the surface of

milk, when it is boiled and allowed to cooled down, formation of thick layer of skin

take place which is explained as Ksheerat Santaanika.Indu in his commentary

Shashilekha explains theappearance and arrangement of skin layers by giving an

illustration of Kadalidal i.e. Stem of Banana, which has several layers that are

arranged in systematic concentric manner. He states that Twacha is formed from the

Sara bhaaga (Prasaad) of Rakta dhatu, shiny and lustrous appearance of skin is due

to Rakta dhatu. Hemadri in his commentary Ayurved Rasayan depicts that whole

body is Panchmahabhautik and tvaca is formed by metabolization of Rakta dhatu by

its own dhatwagni, several layer of Tvaca are formed over outer surface of embryo.

According to Bhavaprakash tvaca is formed by Pachan that is metabolization of

Shukra and Rasa Dhatu.

Tvaca Uttapati Kala

Acharya describes Bala-Varna-Upachaya in sixth month of intrauterine life, As

Varna complexion is the attribute of skin it is clear that tvaca is formed in sixth

month of intrauterine life. According to Ashtang Sangraha & Hridya Uttapati of

Kesha, Roma, Nakha, Asthi, Snayu, Bala, Varna, Sira and Tvaca develops in sixth

month of intrauterine of life. As per modern all layers of skin is formed in fourth

month of intrauterine life.

14

Layers of tvaca-

iÉxrÉ ZÉsuÉå uÉÇmÉëuÉبÉxrÉ zÉÑ¢üzÉÉåÍhÉiÉxrÉÉÍpÉmÉcrÉqÉÉlÉxrÉ ¤ÉÏUxrÉåuÉ xÉliÉÉÌlÉMüÉ: xÉmiÉiuÉcÉÉåpÉuÉÎliÉ|

iÉÉxÉÉÇ mÉëjÉqÉÉÅuÉpÉÉÍxÉlÉÏ lÉÉqÉ, rÉÉxÉuÉÉïluÉhÉÉïlÉuÉpÉÉxÉrÉÌiÉ mÉÇcÉÌuÉkÉÉÇ cÉ NûÉrÉÉÇ mÉëMüÉzÉrÉÌiÉ,

xÉÉ uÉëÏWåûU¹ÉSzÉpÉÉaÉmÉëqÉÉhÉÉ, ÍxÉkqÉmɱMühOûMüÉÍkɸÉlÉÉ; ̲iÉÏrÉÉsÉÉåÌWûiÉÉlÉÉqÉ, uÉëÏWwÉÉåQûzÉ pÉÉaÉmÉëqÉÉhÉÉ,

ÌiÉsÉMüÉsÉMülrÉcNûurÉQûaÉÉÍkɸÉlÉÉ: iÉ××ÌiÉrÉɵÉåiÉÉlÉÉqÉ, uÉëÏWu¬ÇÉSzÉpÉÉaÉmÉëqÉÉhÉÉ,

cÉqÉïSsÉÉeÉaÉssÉÏqÉwÉMüÉÍkɸÉlÉÉ: cÉiÉÑjÉÏï iÉÉqÉëÉ lÉÉqÉÉ uÉëÏW¹pÉÉaÉmÉëqÉÉhÉÉ, ÌuÉÌuÉkÉÌMüsÉÉxÉMÑü¸ÉÍkɸÉlÉÉ:

mÉçÇcÉqÉÏ uÉåÌSÌlÉ lÉÉqÉ uÉëÏWmÉÇcÉpÉÉaÉmÉëqÉÉhÉÉ, MÑü¸ÌuÉxÉmÉÉÍkɸÉlÉÉ: wÉ¸Ï UÉåÌWûÌlÉ lÉÉqÉ ÌuÉëÌWûmÉëqÉhÉÉ,

aÉëljrÉmÉcrÉoÉÑïSzsÉÏmÉSaÉsÉaÉlQûÉÍkɸÉlÉÉ; xÉmiÉÍqÉ qÉÉÇxÉkÉUÉ lÉÉqÉ ÌuÉëÌWû²rÉmÉëqÉhÉÉ, pÉaÉlkÉUÌuÉSìkrÉzÉÉåïÍkɸÉlÉÉ|

rÉSåiÉimÉëqÉÉhÉçÇ ÌlÉÌSïzÉiÉç ÇiÉlqÉÉÇxÉsÉåµÉuÉMüÉzÉwÉ ãlÉ sÉsÉÉiÉå xÉÑYzqÉÉQèû.aÉÑsrÉÉÌSzÉÑ; rÉiÉÉå uÉYzrÉirÉÑSUåzÉÑ

ÌuÉëÌWûqÉÑZÉålÉÉQèû.aÉÑziÉÉåUSUmÉëqÉhÉçÇqÉuÉaÉÉkÉçÇ ÌuÉbrÉÌSåÌiÉ ||

xÉÑ.zÉÉ. 4/4

1) Avabhasini

2) Lohita

3) Sveta

4) Tamra

5) Vedini

6) Rohini

7) Mansadhara

15

1) Avabhasini- The first layer is avabhasini. It is 1/18 of vrihipramana. It

is adhishtana for sidma, Padma, and kantak diseases. It is whitish black

color and brajakaagni lies in this layer. It reflects the complexion and the

quality of the Rasa dhatu. It also acts as a mirror: it indicates whether the

physiology as a whole is balanced or imbalanced, and whether there is

inner health or disorder. The avabhasini layer also reflects the aura of the

individual — if there is inner bliss, it shows on this layer. It does not have

its own color: it reflects the colors of the inner layers.

2) Lohita- The second layer is lohita. It is 1/16 of vrihipramana. It is

adhishtana for tilakalak, nyacha, vyanga diseases. It indicates the quality of

Rakta Dhatu (blood). If there is ama (impurities) in the blood, it impacts

the aura of the outer layer and accentuates sensitivity to the sun. The color

of this layer resembles molten iron.

3) Sveta-The third layer is sveta. It is 1/12 of vrihipramana. It is adhishtana

for charmadala, ajagalli, mashaqkadiseases. This is a white layer, and it

provides balance to skin color, lightening the darker colors of the inner

layers.

4) Tamra- The fourth layer is tamra. It is 1/8 of vrihipramana. It is

adhishtana for kilas and different varities of leprosy diseases. This layer

nurtures the upper layers of the skin. It supports the immune system. This is

the layer that helps the skin perform its function of being a "barrier." Skin

infections reflect an imbalance in this layer.

16

5) Vedini- The fifth layer is vedini. It is 1/5 of vrihi pramana. It is adhishtana

for visarpa and different varities of leprosy diseases. It is the center for

transformation of sensation like feeling of pain.

6) Rohini- The sixth layer is rohini. It is 1 vrihi pramana. It is adhishtana for

granthi, apachi, arbhuda, shlipada, and galganda diseases. This layer supports

healing and regeneration. Imbalance in this layer retards healing and the

disappearance of scars over time. A balanced diet, rich in nutritional value,

supports the rohini layer.

7) Mansadhara- The seventh layer is mansadhara. It is 2 vrihipramana. It is

adhishtana for bhagandar, vidradhi and arsha diseases. This innermost layer is

the platform for the skin's stability and firmness. When this layer is in balance,

the skin looks young and supple. A skin product that has a vayasthapana effect

nourishes this layer to help retard the aging process.

17

Table no.1

Type of skin,modern name,pramana & adhishtana for disease

Sr no Name of skin Modern name Pramana Adhishtana for

Diseases

1 Avabhasini Reflecting layer 1/18vrihi Sidma, Padma, and

Kantak

2 Lohita Reddish layer 1/16vrihi Tilakalak, nyacha,

Vyanga

3 Sveta White layer 1/12vrihi Charmadala, ajagalli,

Mashaqka

4 Tamra Pigment layer 1/8vrihi Kilas & kushta

5 Vedini Sensory layer 1/5vrihi Kushta & visarpa

6 Rohini Proliferating layer

1vrihi Granthi, apachi, arbuda, shlipada, & gandmala

7 Mansadhara Muscle

2 vrihi Bhagandar, vidradhi & arsha

18

Table no.2

Types of tvaca according to different tikakaras-

Sr

no

Sushruta

Samhita

Dr. Ghanekar Acharya

Dalhan

1 Avabhasini Avabhasini Avabhasini

2 Lohita Lohita Lohita

3 Shweta Shweta Shweta

4 Tamra Tamra Tamra

5 Vedini Vedini Vedini

6 Rohini Rohini Rohini

7 Mansdhara Mansdhara Mansdhara

Thickness of Tvaca:

In various Ayurvedic texts, there is a description of tvaca, its layers

and diseases occurring in each layer of tvaca. Sushruta Samhita is unique for

the description of Thickness of tvaca. Here, Sushruta describes thickness of

tvaca in the measurement of Vrihi Pramana. (Vrihi – Rice Grain) So,

Avabhasini tvaca is thick = 1/18th part of 1 Vrihi and likewise about other

19

layers of tvaca. But this measurement of tvaca is not throughout same for all

the body parts. It differs according to various body parts. The measurement of

thickness of tvaca mentioned above is applicable for only thick skin on

muscular parts of the body. It is not applicable for forehead and small fingers.

According to Dalhana, a commentator of Sushruta Samhita twenty parts of 1

rice grain should be done and then thickness of tvaca should be determined

e.g. Avabhasini tvaca is thick = 18/20 parts of 1 Vrihi.

Table no.3

Showing the comparison of thickness of tvaca according to Sushruta and

Dalhana:

Tvaca Sushruta Modern

measurement

Dalhana Modern

measurement

Avabhasini 1/18 0.055 18/20 0.90

Lohita 1/16 0.062 16/20 0.80

Shweta 1/12 0.083 12/20 0.60

Tamra 1/8 0.125 8/20 0.40

Vedini 1/5 0.200 5/20 0.20

Rohini 1 1 1 1

Mamsadhara 2 2 2 2

Total:3.525 Total: 5.9

20

So, according to Sushruta and Dalhana, there is a great controversy

regarding thickness of tvaca- Sushruta: 3.5 Vrihi

Dalhana: Appr 6 Vrihi

If practically observed and thickness of 1 vrihi is measured it becomes average

1mm. So, the thickness of tvaca told by Sushruta and Dalhana expressed in

modern measured will be: Sushruta: 3.5 mm Dalhana: Appr. 6 mm If we want

to compare this measurement with modern measurement (skin thickness = 1.5

to 4 mm), then Sushruta seems to be perfect and more accurate in telling

thickness of skin. Because according to Dalhana, it becomes 6mm which is

highly impossible.

Tvaca as diagnostic tool in clinical examination

WHO defined health as condition of complete physical, mental and social

wellbeing and not merely the absence of disease or infirmity. WHO also agree with

definition of Swastha purusha explained by Ayurveda, Sushruta defined Swastha

purusha as a person having balanced status of Dosha, Dhatu & Mala and all

metabolic activities are carried out by Agni in proper manner, along with having

cheerful status of Atma, Mana & Indriya that is all are performing their function

properly.As tvaca is included in indriya. Normal functioning tvaca is one of the

essential attribute of Swasthapurusha.

In Brittrayee three basic tools are described for clinical examination these are

Darshan (inspection) Sparshan (Palpation & Percussion) &Prashan (Interrogation by

21

history taking).Out of the entire three tools for clinical examination Darshan &

Sparshan parikshan is done by examining the appearance of tvaca and sensory

perception of patient. Tvaca is the reflection of internal body system as only by

examining the skin one can effectively make diagnosis. As earlier mentioned that we

can recognize Dosha, Dhatu and Mala Vriddhi- Kshaya only by Darshan and

Sparshan parikshan. Such as hyper pigmentation of skin in Vata Vriddhi.

Yellowishness of skin in Pitta vriddhi, Shitta sparsha & hypopigmentation of skin in

Kapha Vriddhi, Redness of skin in Rakta Vriddhi, Foul smelling of Tvaca in Sweda

Vriddhi.Similarlyloss in glory of skin &Shita sparsh in Pitta Kshaya. Dryness of skin

in Rasa Kshaya, Shaithilyata (loosness) &Rukshata (dryness) is seen in Rakta

Kshaya. Falling of Kesha and Nakha are observed in Asthi Kshaya. Cracks in tvaca &

loss or Destruction of Roma are noted in Sweda Kshaya. In Ayurveda pathogenesis of

diseases is depends on status of Dosha, Dhatu & Mala, so one can effectively make

diagnosis only by examining status of tvaca.

Modern science also emphasize on importance of skin as diagnostic tool, as many

diagnosis is made by examination of following features of skin:

Color & Pigmentation: following changes in skin color indicates few systemic

conditions.

1. Pallor: Anemia, Hemorrhage & Shock

2. Pale: Hypopitutarism, Hypogonadism

3. Albinism: Congential Absence of Haemosiderin pigment.

4. Cyanosis: Bluish discoloration of skin appears due to lack of oxygen supply to

blood corpuscles such as in Congestive Cardiac Failure & Valvular Septal Defect.

22

5. Jaundice: Yellowish Discoloration of skin, nail, & sclera.

Skin lesions and Eruption: Several skin lesions are observed in various

dermatological disorders such as: Vesicles, plaques, scales, papules, nodules,

papules & patches.

Hair & Nails: Clubbing of nails, oncolysis of nails, yellowish discoloration of nail

are indication of Congenital cardiac disorders, Anemia, Psoriatic nail…etc. Hair

fall and toothed hair roots are observed in Alopecia Aerata, patient on

chemotherapy.

Skin lesions in Sexually Transmitted diseases

Chancres in syphilis,Blisters in Herpes Zoster & Simplex, Candidial Infection in HIV.

Drug Hypersensitivity

Hypersensitivity reactions are notice after administering certain drugs such as:

Penicillin causes Urticaria, Methyl dopa & Phenyl butazone leads to eczema like

rashes, Sulphonyl urea, Indomethacin, Allopurinol causes Exfoliative dermatitis,

Prednisone leads to Acne.

Diagnostic test

Patch test done in Urticaria, Sensitivity test is done to rule out any drug

hypersensitivity before its administration for example penicillin & ASV. Montaux

test for confirming T.B.

23

Tvaca as Rogmarga

In Ayurvediya text three Roga marga are described, these are:

Bahaya Roga marga: Shakha, Raktaadi Sapta dhatu & Tvaca are included under

these Rog marga.

Madhyam Roga marga: Marma, Basti, Hridya, Murdha, Asthi, Snayu, Kandra are

included in these Rog marga.

Abhayantara Roga Marga: Kostha i.e. Mahastrotas, Sharir Madhaya &Pakvashaya

is mentioned in these Rog marga.

Tvaca is included in Bahaya Rog marga, it is one of the mode by means of which

disease exhibits itself.So brief attention should be given towards tvaca while

performing clinical examination.

Tvaca as vrana vastu

Acharya Sushruta mentions eight Vrana Vastu these are tvaca, Mansa, Shira,

Snayu, Asthi, Sandhi, Kostha& Marma. Vrana Vastu means the structure or place

where Vrana (wound) harbor itself. Sushruta state that Vrana limited to Twacha is

fast healing and easy to treat. So we can say that tvaca is an important diagnostic tool

in medicinal and surgical point of view.

24

Tvaca & Panchamahabhoota Relation:

Table no.4

Tvaca is also having Panchabhautik nature.

Sr. no

Element Structure

1 Parthiva Kesha, Loma

2 Aapya Rasa, Lasiak

3 Tejas Kanti, Varna

4 Vayviya Sparsha, Samvedna

5 Akashiya Lomakoopa, Sweda Vahi Nalika

Moolasthana of mansavaha strotas according to sushruta tikakaras-

Tikakaras of the following authors are important ones on the sushruta samhita.

1) Dr.Bhaskar Govind Ghanekar( Ayurvedrahasyadipeeka)

2) Shri.Dalhanacharya( Nibandhsangraha)

1) Dr.Bhaskar Govind Ghanekar( Ayurved Rahasya Dipeeka)

According to Dr.Bhaskar Ghanekar there is snayu and tvaca are moolasthana of

mansavaha strotas.

Snayu-

xlÉÉrÉѶÉiÉÑÌuÉïkÉÉ ÌuɱɨÉÉxiÉÑ xÉuÉÉïï ÌlÉoÉÉåkÉ qÉå |

mÉëiÉÉlÉuÉirÉÉå uÉÚ¨ÉÉ¶É mÉÚjurÉ¶É xÉÑÍzÉUÉxiÉjÉÉ ||

AÉ.U.ÌS. 5/38

25

There are 4 types of snayu

Pratanavati snayu (long tendons)-These snayus are present in

shakhas- limbs and sandhis. Vratta snayu–These are circular in

shape and cord like structure present in body.

Pruthu snayu (large &flat tendons) – Are present in chest sides, head &back region.

Susira snayu(ring like tendons) are present in end of stomach & intestine

& urinary bladder. Snayus are useful in seevan dravyas.

Functions of snayu

LuÉqÉåuÉë zÉUÏUåÅÎxqÉlÉ rÉÉuÉliÉ: xÉlkÉrÉ: xqÉ××iÉÉ:|

AÉrÉÑÍpÉuÉïQèû.aÉÑÍpÉoÉïkSÉxiÉålÉ pÉÉUxÉWûÉ lÉUÉ: ||

AÉ.U.ÌS.5/42

The main function of snayu is binding.

Tvaca-

iÉxrÉ ZÉsuÉå uÉÇmÉëuÉبÉxrÉ zÉÑ¢üzÉÉåÍhÉiÉxrÉÉÍpÉmÉcrÉqÉÉlÉxrÉ ¤ÉÏUxrÉåuÉ xÉliÉÉÌlÉMüÉ: xÉmiÉiuÉcÉÉåpÉuÉÎliÉ|

iÉÉxÉÉÇ mÉëjÉqÉÉÅuÉpÉÉÍxÉlÉÏ lÉÉqÉ, rÉÉxÉuÉÉïluÉhÉÉïlÉuÉpÉÉxÉrÉÌiÉ mÉÇcÉÌuÉkÉÉÇ cÉ NûÉrÉÉÇ mÉëMüÉzÉrÉÌiÉ,

xÉÉ uÉëÏWåûU¹ÉSzÉpÉÉaÉmÉëqÉÉhÉÉ, ÍxÉkqÉmɱMühOûMüÉÍkɸÉlÉÉ; ̲iÉÏrÉÉsÉÉåÌWûiÉÉlÉÉqÉ, uÉëÏWwÉÉåQûzÉ pÉÉaÉmÉëqÉÉhÉÉ,

ÌiÉsÉMüÉsÉMülrÉcNûurÉQûaÉÉÍkɸÉlÉÉ: iÉ× ×ÌiÉrÉɵÉåiÉÉlÉÉqÉ, uÉëÏWu¬ÇÉSzÉpÉÉaÉmÉëqÉÉhÉÉ,

cÉqÉïSsÉÉeÉaÉssÉÏqÉwÉMüÉÍkɸÉlÉÉ: cÉiÉÑjÉÏï iÉÉqÉëÉ lÉÉqÉÉ uÉëÏW¹pÉÉaÉmÉëqÉÉhÉÉ, ÌuÉÌuÉkÉÌMüsÉÉxÉMÑü¸ÉÍkɸÉlÉÉ:

mÉçÇcÉqÉÏ uÉåÌSÌlÉ lÉÉqÉ uÉëÏWmÉÇcÉpÉÉaÉmÉëqÉÉhÉÉ, MÑü¸ÌuÉxÉmÉÉÍkɸÉlÉÉ: wÉ¸Ï UÉåÌWûÌlÉ lÉÉqÉ ÌuÉëÌWûmÉëqÉhÉÉ,

aÉëljrÉmÉcrÉoÉÑïSzsÉÏmÉSaÉsÉaÉlQûÉÍkɸÉlÉÉ; xÉmiÉÍqÉ qÉÉÇxÉkÉUÉ lÉÉqÉ ÌuÉëÌWû²rÉmÉëqÉhÉÉ, pÉaÉlkÉUÌuÉSìkrÉzÉÉåïÍkɸÉlÉÉ|

26

rÉSåiÉimÉëqÉÉhÉçÇ ÌlÉÌSïzÉiÉç ÇiÉlqÉÉÇxÉsÉåµÉuÉMüÉzÉwÉ ãlÉ sÉsÉÉiÉå xÉÑYzqÉÉQèû.aÉÑsrÉÉÌSzÉÑ; rÉiÉÉå uÉYzrÉirÉÑSUåzÉÑ

ÌuÉëÌWûqÉÑZÉålÉÉQèû.

aÉÑziÉÉåUSUmÉëqÉhÉçÇqÉuÉaÉÉkÉçÇ ÌuÉbrÉÌSåÌiÉ ||

AÉ.U.ÌS.4/3

According to Dr. Ghanekar there are 7 layers of tvaca.

1) Avabhasini- This is the first layer & having 1/18 of vrihipramana. Sidma,

Padma, and kantak diseases are adhishtana in this layer.it reflects the 5 types

of chhaya.

2) Lohita- This is second layer & having 1/16 of vrihipramana. It is adhishtana

for tilakalak, nyacha, vyanga diseases.

3) Sveta-This is the third layer& having 1/12 of vrihipramana. It is adhishtana for

charmadala, ajagalli, mashaqka diseases.

4) Tamra- This is the fourth layer & having 1/8 of vrihipramana. It is adhishtana

for kilas and different varities of leprosy diseases.

5) Vedini- This is the fifth layer & having 1/5 of vrihipramana. It is adhishtana

for visarpa and different varities of leprosy diseases.

6) Rohini- This is the sixth layer & having 1 vrihipramana. It is adhishtana for

granthi, apachi, arbhuda, shlipada, and galganda diseases.

7) Mansadhara- This is the seventh layer & having 2

vrihipramana. It is adhishtana for bhagandar vidradhi &

arsha diseases.

27

Table no.5

We can correlate Ayurvedokta Tvaca Stara with Modern sciences as per

mentioned by Dr.Ghanekar, which are as follows-

Sr. no Ayurvedokta

Twacha Stara

Correlate with

Modern Skin Layer

Epideris

1 Avabhasini Stratum Corneum

2 Lohita Stratum Lucidium

3 Shweta Stratum Granulosum

4 Tamra Stratum Malphighi

5 Vedini Papillary Layer

6 Rohini Reticular layer Dermis

7 Mansadhara Subcutaneous tissue Hypodermis

2) Shri.Dalhanacharya ( Nibandhsangraha)

qÉÉÇxÉuÉWåû²åiÉrÉÉåqÉÑïsÉxlÉÉrÉÑiuÉcÇÉU£üuÉWûɶÉkÉqÉlrÉÉ:|

iɧÉÌuÉkÉxrɵÉrÉjÉÑqÉÉÇïxÉzÉÉåwÉ : ÍxÉUÉaÉëljÉrÉÉ qÉUhÉçÇcÉç: ||

Q.ÌlÉ.xÇÉ 9/12

Channels of muscle tissue are two, their roots are snayu (ligaments) and

tvaca(skin)and raktavahi dhamani when these are injured, swelling, emaciation/

wasting of muscles and death occurs.

28

Snayu-

xlÉÉrÉѶÉiÉÑÌuÉïkÉÉ ÌuɱɨÉÉxiÉÑ xÉuÉÉïï ÌlÉoÉÉåkÉ qÉå |

mÉëiÉÉlÉuÉirÉÉå uÉÚ¨ÉÉ¶É mÉÚjurÉ¶É xÉÑÍzÉUÉxiÉjÉÉ ||

Q.ÌlÉ.xÇÉ 5/30

There are 4 types of snayu

1) Pratanavati snayu (long tendons)-These snayus are present in shakhas- limbs and

sandhis.

2) Vratta snayu–These are circular in shape and cord like structure present in body.

3) Pruthu snayu (large &flat tendons) – These are present in chest sides, head

&back region.

4) Susira snayu(ring like tendons) are present in end of stomach & intestine &

urinary bladder.

Tvaca-

iÉxrÉ ZÉsuÉå uÉÇmÉëuÉبÉxrÉ zÉÑ¢üzÉÉåÍhÉiÉxrÉÉÍpÉmÉcrÉqÉÉlÉxrÉ ¤ÉÏUxrÉåuÉ xÉliÉÉÌlÉMüÉ: xÉmiÉiuÉcÉÉåpÉuÉÎliÉ|

iÉÉxÉÉÇ mÉëjÉqÉÉÅuÉpÉÉÍxÉlÉÏ lÉÉqÉ, rÉÉxÉuÉÉïluÉhÉÉïlÉuÉpÉÉxÉrÉÌiÉ mÉÇcÉÌuÉkÉÉÇ cÉ NûÉrÉÉÇ mÉëMüÉzÉrÉÌiÉ,

xÉÉ uÉëÏWåûU¹ÉSzÉpÉÉaÉmÉëqÉÉhÉÉ, ÍxÉkqÉmɱMühOûMüÉÍkɸÉlÉÉ; ̲iÉÏrÉÉsÉÉåÌWûiÉÉlÉÉqÉ, uÉëÏWwÉÉåQûzÉ pÉÉaÉmÉëqÉÉhÉÉ,

ÌiÉsÉMüÉsÉMülrÉcNûurÉQûaÉÉÍkɸÉlÉÉ: iÉ××ÌiÉrÉɵÉåiÉÉlÉÉqÉ, uÉëÏWu¬ÇÉSzÉpÉÉaÉmÉëqÉÉhÉÉ,

cÉqÉïSsÉÉeÉaÉssÉÏqÉwÉMüÉÍkɸÉlÉÉ: cÉiÉÑjÉÏï iÉÉqÉëÉ lÉÉqÉÉ uÉëÏW¹pÉÉaÉmÉëqÉÉhÉÉ, ÌuÉÌuÉkÉÌMüsÉÉxÉMÑü¸ÉÍkɸÉlÉÉ:

mÉçÇcÉqÉÏ uÉåÌSÌlÉ lÉÉqÉ uÉëÏWmÉÇcÉpÉÉaÉmÉëqÉÉhÉÉ, MÑü¸ÌuÉxÉmÉÉÍkɸÉlÉÉ: wÉ¸Ï UÉåÌWûÌlÉ lÉÉqÉ ÌuÉëÌWûmÉëqÉhÉÉ,

aÉëljrÉmÉcrÉoÉÑïSzsÉÏmÉSaÉsÉaÉlQûÉÍkɸÉlÉÉ; xÉmiÉÍqÉ qÉÉÇxÉkÉUÉ lÉÉqÉ ÌuÉëÌWû²rÉmÉëqÉhÉÉ, pÉaÉlkÉUÌuÉSìkrÉzÉÉåïÍkɸÉlÉÉ|

29

rÉSåiÉimÉëqÉÉhÉçÇ ÌlÉÌSïzÉiÉç ÇiÉlqÉÉÇxÉsÉåµÉuÉMüÉzÉwÉãlÉ sÉsÉÉiÉå xÉÑYzqÉÉQèû.aÉÑsrÉÉÌSzÉÑ; rÉiÉÉå uÉYzrÉirÉÑSUåzÉÑ

ÌuÉëÌWûqÉÑZÉålÉÉQèû.

aÉÑziÉÉåUSUmÉëqÉhÉçÇqÉuÉaÉÉkÉçÇ ÌuÉbrÉÌSåÌiÉ ||

Q.ÌlÉ.xÇÉ. 4/4

According to the Dalhana tika in nibandhsangraha mentioned that there are 7 layers of

tvaca.

1) Avabhasini- It is the first layer of tvaca & the pramana is 1/18 of

vrihipramana. It is adhishtana for sidma, Padma, and kantak diseases.it reflects

the 5 types of chhaya.

2) Lohita- It is the second layer of tvaca & pramana is 1/16 of vrihipramana. It is

adhishtana for tilakalak, nyacha, vyanga diseases.

3) Sveta-It is the third layer of tvaca & pramana is 1/12 of vrihipramana. It is

adhishtana for charmadala, ajagalli, mashaqka diseases.

4) Tamra- It is the fourth layer of tvaca & pramana is 1/8 of vrihipramana. It is

adhishtana for kilas and different varities of leprosy diseases.

5) Vedini- It is the fifth layer of tvaca & pramana is 1/5 of vrihipramana. It is

adhishtana for visarpa and different varities of leprosy diseases.

6) Rohini- It is the sixth layer of tvaca & pramana is 1 vrihipramana. It is

adhishtana for granthi, apachi, arbhuda, shlipada, and galganda diseases.

7) Mansadhara- It is the seventh layer of tvaca & pramana is 2 vrihipramana. It is

adhishtana for bhagandar, vidradhi and arsha diseases.

30

2.Modern literature

1) ANATOMY OF LIGAMENT

A ligament is the fibrous connect tissue that connects bones to other bones. It is

also known as articular ligament, articular Laura, Fibrous ligament, or true

ligament.

Other ligaments in the body include the

Peritoneal ligament: a fold of peritoneum or other membranes.

Fetal remnant ligament: the remnants of a fetal tubular structure.

Periodontal ligament: a group of fibers that attach the cementum of teeth to the

surrounding alveolar bone.

Figure no 1- Ligament

31

Ligaments are similar to tendons and fasciae as they are all made of

connective tissue. The differences in them are in the connections that they make

ligaments connect one bone to another bone, tendons connect muscle to bone, and

fasciae connect muscles to other muscles. These are all found in the skeletal system of

the human body. Ligaments cannot usually be regenerated naturally; however, there

are periodontal ligament stem cells located near the periodontal ligament which are

involved in the adult regeneration of periodontal ligament.

Articular ligaments

"Ligament" most commonly refers to a band of dense regular connective tissue

bundles made of collagenous fibers, with bundles protected by dense irregular

connective tissue sheaths. Ligaments connect bones to other bones to form joints,

while tendons connect bone to muscle. Some ligaments limit the mobility of

articulations or prevent certain movements together.

32

Figure no 2- articular ligament

Capsular ligaments are part of the articular capsule that surrounds synovial

joints. They act as mechanical reinforcements. Extra-capsular ligaments join together

in harmony with the other ligaments and provide joint stability. Intra-capsular

ligaments, which are much less common, also provide stability but permit a far larger

range of motion. Cruciate ligaments are paired ligaments in the form of a cross.

Ligaments are viscoelastic.

They gradually strain when under tension and return to their original shape

when the tension is removed. However, they cannot retain their original shape when

extended past a certain point or for a prolonged period of time. This is one reason why

dislocated joints must be set as quickly as possible: if the ligaments lengthen too

much, then the joint will be weakened, becoming prone to future dislocations.

Athletes, gymnasts, dancers, and martial artists perform stretching exercises to

lengthen their ligaments, making their joints more supplied.

33

The term hypermobility refers to people with more-elastic ligaments, allowing

their joints to stretch and contort further; this is sometimes still called double-

jointedness.

The consequence of a broken ligament can be instability of the joint. Not all broken

ligaments need surgery, but, if surgery is needed to stabilize the joint, the broken

ligament can be repaired. Scar tissue may prevent this. If it is not possible to fix the

broken ligament, other procedures such as the Brunelli procedure can correct the

instability. Instability of a joint can over time lead to wear of the cartilage and eventually

to osteoarthritis.

Artificial ligaments-

One of the most often torn ligaments in the body is the ACL. The ACL is one

of the ligaments crucial to knee stability and persons who tear their ACL often seek to

undergo reconstructive surgery, which can be done through a variety of techniques

and materials. One of these techniques is the replacement of the ligament with an

artificial material. An artificial ligament is a reinforcing material that is used to

replace a torn ligament, such as the ACL. Artificial ligaments are a synthetic material

composed of a polymer, such as poly acrylonitrile fiber, polypropylene, PET

(polyethylene terephthalate).

34

Examples

Head and neck

Cricothyroid ligament

Figure no-3- cricothyroid ligament

The median cricothyroid ligament is a flat band of white connective

tissue that connects the front parts of the contiguous margins of the cricoid and

thyroid cartilages. It is a thick and strong ligament, narrow above and broad

below. Each lateral ligament is known as the conus elasticus.

Periodontal ligament-: The periodontal ligament, commonly abbreviated as

the PDL, is a group of specialized connective tissue fibers that essentially

attach a tooth to the alveolar bone within which it sits. It inserts into root

cementum one side and onto alveolar bone on the other.

35

Figure no 4- periodontal ligament

Suspensory ligament of the lens

Suspensory ligament of lens- a series of fibers that connect the ciliary

body of the eye with the lens,holding it in place. Upper eyelid - top,

movable, superior fold of skin that covers the front of the eyeball when closed,

including the cornea.

Figure no 5- suspensory ligament of lens

36

Thorax-

Phrenoesophageal ligament-

Figure no-6-phreno esophageal ligament

The phrenoesophageal ligament (phrenicoesophageal ligament or phrenoesophageal

membrane) is the ligament by which the esophagus is attached to the diaphragm.

The ligament allows independent movement of the diaphragm and esophagus during

respiration and swallowing.

37

Suspensory ligament of breast

Figure no 7- suspensory ligament of breast

Suspensory ligaments are connective tissue in the breast that help maintain

structural integrity.

Pelvis

Anterior sacroiliac ligament-

The anterior sacroiliac ligament consists of numerous thin bands,

which connect the anterior surface of the lateral part of the sacrum to the

margin of the auricular surface of the ilium and to the preauricular sulcus.

38

Figure no 8- Anterior sacroiliac ligament

Posterior sacroiliac ligament-

The posterior sacroiliac ligament is situated in a deep depression

between the sacrum and ilium behind; it is strong and forms the chief bond of

union between the bones.

Figure no 9-posterior sacroiliac ligament

39

Sacrotuberous ligament-

Figure no 10- Sacrotuberous ligament

The sacrotuberous ligament is a slender, fan-shaped ligament of the posterior

(back) pelvis located on either side of the body. This ligament arises midway

down the posterior side of the sacrum, which is located at the spinal base.

Sacrospinous ligament-

Figure no 11-Sacrospinous ligament

40

The sacrospinous ligament (small or anterior sacrosciatic ligament) is a thin,

triangular ligament in the human pelvis. The base of the ligament is attached to the

outer edge of the sacrum and coccyx and the tip of the ligament attaches to the spine

of the ischium, a bony protuberance on the human pelvis.

Inferior pubic ligament-

Figure no 12- Inferior pubic ligament

The inferior pubic ligament (arcuate pubic ligament, arcuate ligament of the pubis, or

subpubic ligament) is a thick, triangular arch of ligamentous fibers, connecting

together the two pubic bones below, and forming the upper boundary of the pubic

arch.

41

Superior pubic ligament-

The superior pubic ligament connects together the two pubic bones superiorly,

extending laterally as far as the pubic tubercles.

Figure no 13- Superior pubic ligament

Suspensory ligament of penis-

Figure no 14- Suspensory ligament of the penis

In males, the suspensory ligament of the penis is attached to the pubic symphysis,

which holds the penis close to the pubic bone and supports it when erect.

42

Knee

Anterior cruciate ligament-

Figure no 15- anterior cruciate ligament

The anterior cruciate ligament (ACL) is one of the key ligaments that help

stabilize our knee joint. The ACL connects our thighbone (femur) to our

shinbone (tibia). It's most commonly torn during sports that involve sudden

stops and changes in direction.

43

Lateral collateral ligament-

Figure no 16- lateral collateral ligament

The lateral collateral ligament is a thin band of tissue running along the

outside of the knee. It connects the thighbone (femur) to the fibula, which is

the small bone of the lower leg that runs down the side of the knee and

connects to the ankle. Like the medial collateral ligament, the lateral collateral

ligament's main function is to keep the knee stable.

44

Posterior cruciate ligament-

Figure no 17- posterior cruciate ligament

The posterior cruciate ligament (PCL) is a ligament within the knee. Ligaments are

tough bands of tissue that connect bones. The PCL similar to the anterior

cruciateligament (ACL) -connects the thigh bone (femur) to your shin bone (tibia).

Although it is larger and stronger than the ACL, the PCL can be torn.

45

Medial collateral ligament-

Figure no 18-medial collateral ligament

The medial collateral ligament is located on the inner aspect, or part, of

your knee, but it's outside the joint itself. Ligaments hold bones together and add

stability and strength to a joint. The MCL connects the top of the tibia, or

shinbone, to the bottom of the femur, or thigh bone.

Patellar ligament-

Figure no 19- patellar ligament

46

The patellar ligament is an extension of the quadriceps tendon. It extends from

the patella, otherwise known as the kneecap. A ligament is a type of fibrous

tissue that usually connects two bones.

Wrist

Palmar radio carpal ligament-

Figure no 20-palmar radio carpal ligament

The palmar radio carpal ligament (anterior ligament, volar radio carpal ligament)

is a broad membranous band, attached above to the distal end of the radius to the

scaphoid, lunate and the triquetrum of the carpal bones in the wrist. Some is

continued to the capitate.

47

Dorsal radio carpal ligament-

Figure no 21-Dorsal radio carpal ligament

The dorsal radio carpal ligament (posterior ligament) less

thick and strong than the volar, is attached, above, to the posterior border of

the lower end of the radius; its fibers are directed obliquely downward and

medialward, and are fixed, below, to the dorsal surfaces of the navicular (now

known as scaphoid), lunate and triquetral being continuous with those of the

dorsal inter carpal ligament.

48

Ulnar collateral ligament-

Figure no 22- ulnar collateral ligament

The ulnar collateral ligament (UCL or internal lateral ligament) is a thick

triangular band at the medial aspect of the elbow uniting the distal aspect of the

humerus to the proximal aspect of the ulna.

49

Radial collateral ligament-

Figure no 23- Radial collateral ligament

The radial collateral ligament (external lateral ligament, radial carpal collateral

ligament) extends from the tip of the styloid process of the radius and attaches to the

radial side of the scaphoid immediately adjacent to its proximal articular surface and

some fibers extend to the lateral side of the trapezium.

Peritoneal ligaments-

Peritoneal ligaments are folds of peritonium that are used to connect viscera to viscera

or the abdominal wall.There are multiple named ligaments that usually are named in

accordance with what they are.

50

Gastrocolic ligament

Gastrosplenic ligament

Gastrophrenic ligament

Phrenicocolic ligament

Splenorenal ligament

Coronary ligament

Hepatoduodenal ligament

Hepatogastric ligament

Figure no 24- peritoneal ligaments

51

Certain folds of peritoneum are referred to as ligaments. Examples include:

The hepato duodenal ligament,that surrounds the hepatic portal vein and other

vessels as they travel from the duodenum to the liver.

The broad ligament of the uterus, also a fold of peritoneum.

Retinaculum

A retinaculum is a band of thickened deep fascia around tendons that holds

them in place. It is not part of any muscle. Its function is mostly to stabilize a tendon.

The term retinaculum is derived from the Latin verb retinere (retain).

A retinaculum refers to any region on the body in which tendon groups

from different muscles pass under one connective tissue band. Specific retinacula

include-

In the wrist:

1) Flexor retinaculum of the hand-

Figure no.25- flexor retinaculum of hand

52

The flexor retinaculum (transverse carpal ligament or anterior annular

ligament) is a fibrous band on the palmar side of the hand near the wrist. It

arches over the carpal bones of the hands, covering them and forming the

carpal tunnel.

2) Extensor retinaculum of the hand-

Figure no 26- extensor retinaculum of hand

The extensor retinaculum (dorsal carpal ligament, or posterior annular

ligament) is an anatomical term for the thickened part of the antebrachial

fascia that holds the tendons of the extensor muscles in place. It is located

on the back of the forearm, just proximal to the hand.

53

In the ankle

1) Flexor retinaculum of foot-

The flexor retinaculum of foot (laciniate ligament, internal

annular ligament) is a strong fibrous band, extending from the bony ankle

prominence (malleolus) above, to the margin of the heelbone (calcaneus)

below, converting a series of bony grooves in this situation into canals for the

passage of the tendons of the flexor muscles and the posterior tibial vessels

and tibial nerve into the sole of the foot.

2) Peroneal retinacula-

The peroneal retinacula (singular: peroneal retinaculum) are

fibrous retaining bands which bind down the tendons of the peroneus longus

and brevis as they run across the side of the ankle. (Retinaculum is Latin for

retainer). These bands consist of superior and inferior fibers.

3) Superior extensor retinaculum of foot-

The superior extensor retinaculum of the foot (transverse

crural ligament) is the upper part of the extensor retinaculum of foot which

extends from the ankle to the heelbone.

54

4) Inferior extensor retinaculum of foot-

The inferior extensor retinaculum of the foot (cruciate crural

ligament, lower partofanterior annular ligament) is a Y-shaped band placed in

front of the ankle-joint, the stem of the Y being attached laterally to the

upper surface of the calcaneus, in front of the depression for the

interosseous talocalcaneal ligament; it is directed medialward as a double

layer, one lamina passing in front of, and the other behind, the tendons of the

peroneu tertius and extensor digitorum longus.

5) Superior fibular retinaculum-

The superior fibular retinaculum is one of two fibrous

bands that bind the peroneus longus and peroneus brevis muscle tendons that

run over the ankle's lateral side. ... Its fibers are connected to the lateral

malleolus (the bony projections at the outside of each ankle) and the

calcaneus's (heel bone) lateral surface.

6) Inferior fibular retinaculum-

A retinaculum refers to any region on the body where

tendon groups from different muscles pass under one connective tissue band.

The inferior retinaculum is responsible for stabilizing the tendons that extend

from the calf muscles as they run down the leg to reach both sides of the

ankle.

55

In the knee:

1) Lateral retinaculum

Figure no 27- Lateral retinaculum

The lateral retinaculum is the fibrous tissue on the lateral (outer) side of the

kneecap (patella). The kneecap has both a medial (on the inner aspect) and a

lateral (on the outer side) retinaculum, and these help to support the kneecap

in its position in relation to the femur bone underneath it.

56

1) Medial patellar retinaculum

Figure no 28-Medial patellar retinaculum

If a retinaculum is injured, it may lead to an impairment of tendon

functionally. If the peroneal retinaculum tears or stretches, it may cause the peroneal

tendons to detach from the fibula. This may cause damage to the tendons and impair

their functionality, leading to a condition known as peroneal tendon dysfunction.

Histology of retinaculum-

Structurally the retinaculum consists of three layers. The deepest layer,

the gliding layer consists of hyaluronic acid secreting cells. The thick middle layer

consists of interspersed elastin fibers, collagen bundles and fibroblasts. The most

superficial layer is made up of loose connective tissue which contains vascular

channels. Combined these three layers create a smooth gliding surface as well as

mechanically strong tissue which prevents tendon bowstringing.

57

2) ANATOMY OF SKIN

The skin is the largest organ of the body, with a total area of about

20 square feet. The skin protects us from microbes and the elements, helps

regulate body temperature, and permits the sensations of touch, heat and cold.

Skin has three layers:

The epidermis, the outermost layer of skin, provides a waterproof barrier and

creates our skin tone.

The dermis, beneath the epidermis, contains tough connective tissue, hair

follicles, and sweat glands.

The deeper subcutaneous tissue (hypodermis) is made of fat and connective

tissue.

The skin‘s color is created by special cells called melanocytes, which

produce the pigment melanin. Melanocytes are located in the epidermis.

The human skin is the outer covering of the body and is the largest organ of the

integumentary The skin has up to seven layers of ectodermal tissue and guards the

underlying muscles, bones, ligaments and internal organs Human skin is similar

to most of the other mammals skin, and it is very similar to pig skin Though

nearly all human skin is covered with hair follicles, it can appear hairless. There

are two general types of skin, hairy and glabrous skin (hairless). The adjective

cutaneous literally means "of the skin" (from Latin cutis, skin).

58

Because it interfaces with the environment, skin plays an important immunity role in

protecting the body against pathogens and excessive water loss. Its other functions

are insulation, temperature regulation, sensation,

synthesis of vitamin D, and the protection of vitamin B floats. Severely damaged skin

will try to heal by forming scar tissue. This is often discolored and depigmented.

In humans, skin pigmentation varies among populations, and skin type can range from

dry to oily. Such skin variety provides a rich and diverse habitat for bacteria that

number roughly 1000 species from 19 phyla, present on the human skin.

STRUCTURE

Skin has mesodermal cells, pigmentation, such as melanin provided by melanocytes,

which absorb some of the potentially dangerous UV radiation in sunlight. It also

contains DNA repair enzymes that help reverse UV damage, such that people lacking

the genes for these enzymes suffer high rates of skin cancer. One form predominantly

produced by UV light, malignant melanoma, is particularly invasive, causing it to

spread quickly, and can often be deadly. Human skin pigmentation varies among

populations in a striking manner. This has led to the classification of peoples on the

basis of skin color. Terms of surface area, the skin is the second largest organ in the

human body (the inside of the small intestine is 15 to 20 times larger). For the average

adult human, the skin has a surface area of between 1.5-2.0 square meters. The

thickness of the skin varies considerably over all parts of the body, and between men

and women and the young and the old. An example is the skin on the forearm which

59

is on average 1.3 mm in the male and 1.26 mm in the female. His average square inch

of skin holds 650 sweat glands, 20 blood vessels, 60,000 melanocytes, and more than

1,000 nerve endings. The average human skin cell is about 30 micrometers in

diameter, but there are variants. A skin cell usually ranges from 25-40 micrometers

(squared), depending on a variety of factors.

Skin is composed of three primary layers: the epidermis, the dermis and the

hypodermis.

Epidermis-

Epidermis, "epi" coming from the Greek meaning "over" or "upon", is the outermost

layer of the skin. It forms the waterproof, protective wrap over the body's surface

which also serves as a barrier to infection and is made up of stratified squamous

epithelium with an underlying basal lamina.

The epidermis contains no blood vessels, and cells in the deepest layers are nourished

almost exclusively by diffused oxygen from the surrounding air and to a far lesser

degree by blood capillaries extending to the outer layers of the dermis.

The stratified, squamous, cornifying epithelium that is populated by 4 types of cells.

a. Keratinocytes

b. Melanocytes

c. Langerhans cells

d. Merkel cells

60

a) Keratinocytes:

Figure no 29- Keratinocytes

90% of epidermal cells are Keratinocytes they produce a protein called keratin. These

substances helps waterproof and protect the skin and underlying tissues from light,

heat, microbes, many chemicals. Anchoring junctions, desmosomes held

Keratinocytes to one another. Epidermal Keratinocytes undergoes characteristic

changes as they are progressively moved upward from basal of epidermis to the

chornified layer. Four interrelated cellular layer i.e. basal, spinosum, granular,

chornified can be recognized as successive stage of differentiation of germinal

Keratinocytes to chornified keratinocyte. Epidermal chornification is a form of

cellular differentiation that results in the formation of the outermost dead layer of

skin.

61

b) Melanocytes:

Melanocytes are dendritic cells Melanocytes are pigment producing cells of neuro

ectodermal origin. This cell synthesized melanin from tyrosin, a pigment responsible

for skin colour and essential for protection from UV light. Amount of the melanin in

Keratinocytes determines the skin colour. Facial differences in colour are the result

of metabolically active Melanocytes. Melanocytes appear microscopically as clear

cells in and immediately beneath the basal layer of epidermis.

Figure no 30-Melanocyte

The nucleus of a Melanocytes is smaller and more deeply basophilic then that

of Keratinocytes. The ratio of Melanocytes to Keratinocytes in the basal layer of

epidermis varies from 1:4 to 1:10 depending on the region of body example-

Melanocytes are more abundant in the skin of chicks then in that of abdomen. There

are two classes of integumentary melanin. Eumelanin produced in ellipsoidal

melanosomes (Eumelanosomes) account for the brown and black colours of both skin

62

and hair. Pheomelanin, produced in perikal melanosomes (pheomelanosome) account

for the lighter colour of hair, ranging from yellow to reddish brown.It is the amount of

melanin in Keratinocytes that determines the degree of pigmentation of skin and hair.

The principle function of melanin is to protect the skin from the

harmful effect of sunshine by scattering and observing UV.

c) Langerhans cells:-

Figure no 31-Langerhans cell

Are the macros phases like antigen producing cells located above the basal layer of

keratinocyte, which interact with hyper t cells with assisting with the immune

response may be a possible source of prostaglandin. Langerhans cells first described

by Paul Langerhans in 1868.although this cell constitute about 4% of the cell

population of epidermis, regional variation occurs in their distribution their number

varying between 460 and 1000 per (mm)sq of epidermis. The cross sectional

63

appearance of langerhans cell granules has been likened in shape to a tennis racket,

vesicular dilation at one end at a rod like segment. A langerhans cell plays an

important role in various immune process including allergic contact dermatitis,

immune tolerance and surveillance against neoplasio.

d) Merkel cells:

Figure no 32- Merkel cell

Merkel cells are non-pigmented dedrosides cytoplasmic dense core granules, which

function as touch receptors and also interact with separates t cells in assisting with

immune response. Endothelial cells are not found since the epidermis lack blood

vessels. Nutrient delivery and waste transport are by diffusion. There are capillary

networks in the papillary dermis which provide this function. Merkel cells make

contact with the flattened portion of ending of sensory neuron called as tactile

(merkel) disc and are thought to function in the sensation of touch. In 1875 fried rich

64

merkel identified unique cells of the basis of epidermal rate ridges that were in

contact with nerves fibrils. He named cells as ―TOUCH CELLS.

The names of 5 layers of epidermis from deepest to the most superficial are:

1) Stratum basale (basale-base):

Figure no 33- stratum basale

This layer is also called stratum germinativum to indicate its role in

germinating new cells.This single layer of cuboidal to columnar shaped cells contains

stem cells. Which are capable of continued cell division &melanocytes.The stem cells

multiply, producing Keratinocytes which push up towards the surface & become part

of more superficial layers.The nuclei of Keratinocytes degenerate &die. Eventually,

the cell remnants are shed from the surface layer of epidermis. During embryological

development, other stem cells are migrating into the dermis & give rise to sweat& oil

glands & hair follicles.The stratum basale also contain tactile cells (merkel cells) that

65

are sensitive to touch.

Function- The stratum basale also contains melanocytes, cells that produce melanin,

the pigment primarily responsible for giving skin its color. Melanin is transferred to

keranocytes in the stratum spinosum to protect cells from UV rays.

2) Stratum spinosum (spisum-throne like or prickly):

Figure no 34- stratum spinosum

This layer contains of prickle cells, which is composed of several layer of polyhedral

cells. From these plaques numerous fine fibrils radiate into the cell cytoplasm. Some

maintain that the fibrils do not exist as such in living unfixed cells. When the cells are

isolated these desmosomes are broken & surfaces of cells are beset with numerous

short than like processes, named prickle cells. These layers contain of 8-10 closely

fitted rows of polyhedral cells. These cells are able to synthesis protein but cannot

reproduce.

66

Long projections of melanocytes extend among the Keratinocytes, which take in

melanin by phygocytosis of these melanocyte projections.

Function- it is partly responsible for the skins strength and flexibility.

3) Stratum granulosum-

This layer is also known as granular layer. It comprises 2 or 3 layers of fusiform cells.

Which contain numerous granules which stain readily haematoxylin due to

accumulation of readily stainable granules of keratohyline in their cytoplasm.

Figure no 35- stratum granulosum

In this layer, keratin, the water proofing protein is produced. In the stratum

granulosum, the cells appears in various stages of degeneration & as a rule, break down

& cell death occurs.

67

Function- The cells of the stratum granulosum accumulate dense basophilic

keratohyalin granules. These granules contain lipids, which along with the

dermosomal connections help to form a waterproof barrier that functions to prevent

fluid loss from yhe body.

4) Stratum lucidum (lucidus- clear):

Figure no 36- stratum lucidum

This is clear layer appears in section as a homogeneous or deeply

seated layer, composed of closely packed cells in which traces of flattened nuclei may

be found. This layer consists of 3-4 rows of clear, flat dead cells. It is best seen in

regimen where the horizon is thick skin of the palms & soles of the feet.

Function- this is responsible for the capability of the skin to stretch. It also contains a

protein that is responsible for the degeneration of skin cells. This layer also lowers the

effects of friction in skin.

68

5) Stratum corneum(corneum- horny):

Figure no 37- stratum corneum

It is known as horny layer. It consists of several layers of horny,

epithelial cells, in which no nuclei are discernable & their protoplasm has been

converted into a material known as keratin. The outer most cells containing the tough

protein keratin are known as Keratinocytes. They consist of 25-30 rows of dead flat

cells. The cells are continuously shed & replaced by the newly divided cells. The

stratum corneum serves as an effective barrier against light, heat, bacteria & many

chemicals.

Function-The function is to form a barrier to protect underlying tissue from

infection, dehydration, chemicals and mechanical stress.

The daughter cells move up the strata changing shape and composition as they

die due to isolation from their blood source. The cytoplasm is released and the protein

69

keratin is inserted. They eventually reach the corneum and slough off (desquamation).

This process is called "keratinization". This keratinized layer of skin is responsible for

keeping water in the body and keeping other harmful chemicals and pathogens out,

making skin a natural barrier to infection.

Components

The epidermis contains no blood vessels, and is nourished by diffusion from

the dermis. The main type of cells which make up the epidermis are keratinocytes,

melanocytes, Langerhans cells and Merkel cells. The epidermis helps the skin to

regulate body temperature.

Layers

Epidermis is divided into several layers where cells are formed through

mitosis at the innermost layers. They move up the strata changing shape and

composition as they differentiate and become filled with keratin. They eventually

reach the top layer called stratum corneum and are sloughed off, or desquamated.

This process is called keratinization and takes place within weeks. The outermost

layer of the epidermis consists of 25 to 30 layers of dead cells.

Blood capillaries are found beneath the epidermis, and are linked to an

arteriole and a venule. Arterial shunt vessels may bypass the network in ears, the nose

and fingertips.

Genes and proteins expressed in the epidermis

About 70% of all human protein-coding genes are expressed in the skin.

Almost 500 genes have an elevated pattern of expression in the skin. There are less

than 100 genes that are specific for the skin and these are expressed in the epidermis.

An analysis of the corresponding proteins shows that these are mainly expressed in

keratinocytes and have functions related to squamous differentiation and

cornification.

70

Dermis

The dermis is the layer of skin beneath the epidermis that consists of

connective tissue and cushions the body from stress and strain. The dermis is tightly

connected to the epidermis by a basement membrane. It also harbors many nerve

endings that provide the sense of touch and heat. It contains the hair follicles, sweat

glands, sebaceous glands, apocrine glands, lymphatic vessels and blood vessels. The

blood vessels in the dermis provide nourishment and waste removal from its own cells

as well as from the Stratum basale of the epidermis.

The dermis is structurally divided into two areas:

1) A superficial area adjacent to the epidermis, called the papillary layer,

2) A deep thicker area known as the reticular layer.

71

1)Papillary layer:

Figure no 38- Papillary layer

The papillary layer consist of numerous highly sensitive & vascular eminences ,

termed papillae which rise perpendicularly .The papillae are minute conical

projections , having round or blunted extremities ,which may be surfaces of

epidermis. On the general surface of the body & especially in parts endowed with

slight sensibility, they are few in number & exceedingly minute. But upon the palmer

surfaces of hands & fingers & plantar surfaces of feet & toes, they are larger &

closely aggregated together & arranged in parallel curved lines forming elevated

ridges seen on the epidermis. Each ridge contains 2 rows of papillae & between the

rows the ducts of sweat gland pass outwards to open on the summits of the ridges.

Each papillae consist of very small & closely interlacing bundles of finely fibrillated

tissue, with a few elastic fibres, within this tissue there is a capillary loop & in some

72

papillae especially in palms of hands & fingers. There are tactile corpuscles. Papillary

layer has many small, elongated projections called rete peges, also contains loops of

capillaries & these projects into epidermis. Size & arrangement of dermal papillae

from ridge which are external surface of epidermis & provide attachment of epidermis

to dermis & its collagen fibres. In some dermal papillae are present meissner‘s

corpuscles, the nerve ending sensitive to light touch.

2) Reticular layer

Figure no 39- Reticular layer

The reticular region lies deep in the papillary region and is usually much

thicker. It is composed of dense irregular connective tissue, and receives its name

from the dense concentration of collagenous, elastic, and reticular fibers that weave

throughout it. These protein fibers give the dermis its properties of strength,

extensibility, and elasticity.

Also located within the reticular region are the roots of the hairs, sebaceous

glands, sweat glands, receptors, nails, and blood vessels.

73

Tattoo ink is held in the dermis. Stretch marks often from pregnancy and obesity, are

also located in the dermis. It consist of strong inter lacing bands, composed cheaply of

white fibrous tissue & containing some yellow elastic fibers, which vary in number in

different parts. In the deeper part the fasciculi are course & large intervals left by their

interlacement are occupied by adipose tissue & sweat glands. Below reticular layer,

there is subcutaneous areolar tissue which except in a few situations contains fat. The

connective tissue bands in reticular layer lie for the main part in parallel bundles so

that if conical object is stabbed through skin & then withdrawn it leaves a linear

wound since the fibers are forced apart with much rupture. The directions taken by the

parallel bundles vary in different part of the body & constitute what are termed the‖

cleavage lines‖, which heal with formation of scar tissue, whereas the incision across

these lines, owing to retraction of the several fibers lead to the formation of the broad

scar. The cleavage lines are arranged longitudinally in the skin of the limbs & more

or less horizontally in the trunk & neck. With increasing age the yellow elastic fibers

atrophy and the skin loses much of its elasticity and become wrinkled. If the skin

becomes much stretched (as by rapidly growing tumors, fat deposition or pregnancy)

the fibers in reticular layer may undergo partial rupture, followed by scar formation;

these areas may show on the surface as white streaks. These are commonly seen in the

anterior wall of abdominal wall after pregnancy and known as linear gravidarum. In

many regions the skin is separated from deep fascia or other structures by loose

areolar tissue and where the skin is freely movable over the deeper structures.

Elsewhere, however, the skin may be firmly anchored to structures like the

periosteum over‖ subcutaneous‖ parts of bones or to the deep fascia in regions related

to movements of underlying joints. In joints there are permanent creases known as

―flexure lines‖; they are particularly evident on the palm of the hand and flexor

surfaces of the digits, where they are arranged in relation to the movements of the

digits. The remaining reticular layer is made of dense irregular, collagenous tissue,

which allows strength & flexibility in every direction. The primary cell of this layer is

fibroblast, which produce the key structure of extra cellular matrix protein namely

collagen & elastin. These cells produce the key adhesive proteins used to attach

epidermal cells to the basement membrane & are used for epidermal cell migration &

74

replication. The fibronectin is a key fibroblast derived signal protein for the

orchestration of the healing ground substance or matrix. This is made of

polysaccharide protein complexes known as GAG or hyaluronic acid, which is semi

fluid that allows cells & connective tissue orientation, provide nutrients diffusion to

the cells & also provides scaffolding for cell migration. The space between interfacing

connective tissue fibers are occupied by adipose tissue, blood vessels, sweat glands,

nerves & hair follicles. It is attached to the underlined structure by the subcutaneous

layer of tissue.

Subcutaneous tissue(hypodermis)-

The subcutaneous tissue (also hypodermis and sub cutis) is not part of the

skin, and lies below the dermis of the cutis. Its purpose is to attach the skin to

underlying bone and muscle as well as supplying it with blood vessels and nerves. It

consists of loose connective tissue, adipose tissue and elastin. The main cell types are

fibroblasts, macrophages and adipocytes (subcutaneous tissue contains 50% of body

fat). Fat serves as padding and insulation for the body.

75

CROSS SECTION

Figure no.40- cross section of skin

76

Figure no 41- cross section of skin( thick and thin skin)

77

Table no.6

Special Features of the Different Layers of Epidermis –

Sr no Epidermis Cells Special feature

1 Stratum corneum (Horny layer)

Corneocytes

Stratified epithelial cells

Fibrous protein

keratin is present

2 Stratum lucidum Flattened epithelial cells Eleidin (Precursor

of keratin) is

present.

3 Stratum granulosum Flattened rhomboid cells

Three cells layered

Keratohyalin is

present in shape

of granules

4 Stratum spinosum (Prickle cell layer)

Several (3–5) cells thick.

Cell possess spine-like

Projection

Some melanocyte.

5 Stratum germinativum Polygonal cells—

Superficially.

Columnar or cuboidal

Epithelial cells— deep

Keratinocytes.

Melanocytes.

78

DEVLOPMENT

Skin color

Human skin shows high skin color variety from the darkest brown to the

lightest pinkish-white hues. Human skin shows higher variation in color than any

other single mammalian species and is the result of natural selection. Skin

pigmentation in humans evolved to primarily regulate the amount of UVR penetrating

the skin, controlling its biochemical effects.

The actual skin color of different humans is affected by many substances, although

the single most important substance determining human skin color is the pigment

melanin. Melanin is produced within the skin in cells called melanocytes and it is the

main determinant of the skin color of darker-skinned humans. The skin color of

people with light skin is determined mainly by the bluish-white connective tissue

under the dermis and by the hemoglobin circulating in the veins of the dermis. The

red color underlying the skin becomes more visible, especially in the face, when, as

consequence of physical exercise or the stimulation of the nervous system (anger,

fear), arterioles dilate.

There are at least five different pigments that determine the color of the skin.These

pigmentsare present at different levels and places

Melanin: It is brown in color and present in the basal layer of the epidermis.

Melanoid: It resembles melanin but is present diffusely throughout the

epidermis.

Carotene: This pigment is yellow to orange in color. It is present in the stratum

79

corneum and fat cells of dermis and superficial fascia.

Hemoglobin: It is found in blood and is not a pigment of the skin but develops a

purple color.

Oxyhemoglobin: It is also found in blood and is not a pigment of the skin. It

develops a red color.

There is a correlation between the geographic distribution of UVR and the

distribution of indigenous skin pigmentation around the world. Areas that

highlight higher amounts of UVR reflect darker-skinned populations,

generally located nearer towards the equator. Areas that are far from the

tropics and closer to the poles have lower concentration of UVR, which is

reflected in lighter-skinned populations there is a correlation between the

geographic distribution of UV radiation (UVR) and the distribution of

indigenous skin pigmentation around the world. Areas that highlight higher

amounts of UVR reflect darker-skinned populations, generally located nearer

towards the equator. Areas that are far from the tropics and closer to the poles

have lower concentration of UVR, which is reflected in lighter-skinned

populations.

In the same population it has been observed that adult human females are

considerably lighter in skin pigmentation than males. Females need more calcium

during pregnancy and lactation, and vitamin D which is synthesized from sunlight

helps in absorbing calcium. For this reason it is thought that females may have

evolved to have lighter skin in order to help their bodies absorb more calcium.

80

The Fitzpatrick scale is a numerical classification schema for human skin color,

developed in 1975 as a way to classify the typical response of different types of skin to

UV light.

Table no 7- cause and color of skin

Sr no Cause Color of skin

1 Always burns, never tans Pale, fair, freckles

2 Usually burns, sometimes tans Fair

3 May burn, usually tans Light brown

4 Rarely burns, always tans Olive brown

5 Moderate constitutional pigmentation Brown

6 Marked constitutional pigmentation Black

In the same population it has been observed that adult human females are

considerably lighter in skin pigmentation than males. Females need more calcium

during pregnancy and lactation, and vitamin D which is synthesized from sunlight

helps in absorbing calcium. For this reason it is thought that females may have

evolved to have lighter skin in order to help their bodies absorb more calcium.

Aging

As skin ages, it becomes thinner and more easily damaged. Intensifying this

effect is the decreasing ability of skin to heal itself as a person ages.

Among other things, skin aging is noted by a decrease in volume and

elasticity. There are many internal and external causes to skin aging. For example,

81

aging skin receives less blood flow and lower glandular activity.

A validated comprehensive grading scale has categorized the clinical findings of skin

aging as laxity (sagging), rhytids (wrinkles), and the various facets of photoaging,

including erythema (redness), and telangiectasia, depigmentation (brown

discoloration), solar elastosis (yellowing), keratoses (abnormal growths) and poor

texture.

Cortisol causes degradation of collagen accelerating skin aging.

Anti-aging supplements are used to treat skin aging.

Photo aging

Photo aging has two main concerns: an increased risk for skin cancer and the

appearance of damaged skin. In younger skin, sun damage will heal faster since the

cells in the epidermis have a faster turnover rate, while in the older population the

skin becomes thinner and the epidermis turnover rate for cell repair is lower which

may result in the dermis layer being damaged.

Functions

Skin performs the following functions:

1. Protection: an anatomical barrier from pathogens and damage between the

internal and external environment in bodily defense; Langerhans cellsin the

skin are part of the adaptive immune system.Perspiration contains lysozyme

that breaks the bonds within the cell walls of bacteria.

2. Sensation: contains a variety of nerve endings that react to heat and cold,

touch, pressure, vibration, and tissue injury.

82

3. Heat regulation: the skin contains a blood supply far greater than its

requirements which allows precise control of energy loss by radiation,

convection and conduction. Dilated blood vessels increase perfusion and heat

loss, while constricted vessels greatly reduce cutaneous blood flow and

conserve heat.

4. Control of evaporation: the skin provides a relatively dry and semi-

impermeable barrier to fluid loss.

Loss of this function contributes to the massive fluid loss in burns.

5. Aesthetics and communication: others see our skin and can assess our mood,

physical state and attractiveness.

6. Storage and synthesis: acts as a storage center for lipids and water, as well as

a means of synthesis of vitamin D by action of UV on certain parts of the skin.

7. Excretion: sweat contains urea, however its concentration is 1/130th that of

urine, hence excretion by sweating is at most a secondary function to

temperature regulation.

8. Absorption: the cells comprising the outermost 0.25–0.40 mm of the skin are

"almost exclusively supplied by external oxygen", although the "contribution

to total respiration is negligible" In addition, medicine can be administered

through the skin, by ointments or by means of adhesive patch, such as the

nicotine patch or iontophoresis. The skin is an important site of transport in

many other organisms.

9. Water resistance: The skin acts as a water-resistant barrier so essential

nutrients are not washed out of the body.

83

Skin flora

The human skin is a rich environment for microbes. Around 1000 species of bacteria

from 19 bacterial phyla have been found. Most come from only four phyla:

Actinobacteria (51.8%), Firmicutes (24.4%), Proteobacteria (16.5%), and

Bacteroidetes (6.3%). Propionibacteria and Staphylococci species were the main

species in sebaceous areas. There are three main ecological areas: moist, dry and

sebaceous. In moist places on the body Corynebacteria together with Staphylo

coccidominate. In dry areas, there is a mixture of species but dominated by b-

Proteobacteria and Flavobacteriales. Ecologically, sebaceous areas had greater species

richness than moist and dry ones. The areas with least similarity between people in

species were the spaces between fingers, the spaces between toes, axillae, and

umbilical cord stump. Most similarly were beside the nostril, nares (inside the nostril),

and on the back.

Reflecting upon the diversity of the human skin researchers on the human skin

observed "hairy, moist underarms lie a short distance from smooth dry forearms, but

these two niches are likely as ecologically dissimilar as rainforests are to deserts."

Microorganisms like Staphylo coccus epidermis‘s colonize the skin surface. The

density of skin flora depends on region of the skin. The disinfected skin surface gets

recolonized from bacteria residing in the deeper areas of the hair follicle, gut and

urogenital openings.

84

Clinical significance

1) Diseases of the skin include skin infections and skin neoplasms (including skin

cancer).

2) Dermatology is the branch of medicine that deals with conditions of the skin.

3) The skin is the body‘s largest organ, and it serves as a protective barrier. Its health

and surface appearance are determined by environmental factors as well as the

function of the components that comprise the layers below.

Hygiene and skin care

The skin supports its own ecosystems of microorganisms including yeasts and

bacteria which cannot be removed by any amount of cleaning. Estimates place the

number of individual bacteria on the surface of one square inch of human skin at 50

million, though this figure varies greatly over the average 20 square feet of human

skin. Oily surfaces such as the face may contain over 500 million bacteria per square

inch. Despite these vast quantities, all of the bacteria found on the skin surface would

fit into a volume the size of pea. In general the microorganisms keep one another in

check and are part of healthy skin. When the balance is disturbed, there may be an

overgrowth and infection, such as when antibiotics kill microbes, resulting in an

overgrowth of yeast. The skin is continuous with the inner epithelial lining of the

body at the orifices, each of which supports its own complement of microbes.

Sunlight, water and air play important role in keeping the skin healthy.

85

Oily skin

Oily skin is caused by over active sebaceous glands that produce a

substance called sebum, a naturally healthy skin lubricant. A high glycemic index diet

and dairy products consumption increase IGF-1 generation which in turn increases

sebum production. Over washing the skin does not cause sebum over production but

may cause dryness.

When the skin produces excessive sebum, it becomes heavy and

thick in texture. Oily skin is typified by shininess, blemishes and pimples. The oily

skin type is not necessarily bad, since such skin is less prone to wrinkling, or other

signs of aging, because the oil helps to keep needed moisture locked into the

epidermis.

The negative aspect of the oily skin type is that oily complexions are

especially susceptible to clogged pores, black heads and buildup of dead skin cells on

the surface of the skin. Oily skin can be sallow and rough in texture and tends to have

large,clearly visible pores everywhere, except around the eyes and neck.

86

ACTION & FUNCTIONS OF LIGAMENT

Ligaments attach two bones or cartilages, it helps in supporting and keeping the organ

in position, it is made of fibrous tissue.

1) One of the main functions of ligaments is mechanical as they passively stabilize

joints and help in guiding those joints through their normal range of motion when a

tensile load is applied. Ligaments exhibit nonlinear anisotropic mechanical behavior

and under low loading conditions they are relatively compliant, perhaps due to

recruitment of "crimped" collagen fibers as well as to viscoelastic behaviors and

interactions of collagen and other matrix materials. Continued ligament loading

results in increasing stiffness until a stage is reached where they exhibit nearly linear

stiffness and beyond this, ligaments continue to absorb energy until tensile failure.

2) Another ligament function relates to its visco elastic behavior in helping to provide

joint homeostasis. A ligament "load relaxes" which means that loads/stresses decrease

within the ligament if they are pulled to constant deformations. Ligaments

also"creep"which is defined as the deformation (or elongation) under a constant or

cyclically repetitive load. Creep is particularly important when considering joint

injury or reconstructive surgery as excessive creep could result in laxity of the joint

thus predisposing it to further injury.

3) A third function of ligaments is their role in joint proprioception, which is referred

to as the conscious perception of limb position in space. In joints such as the knee,

proprioception is pro-vided principally by joint, muscle and cutaneous receptors.

When ligaments are strained, they invoke neurological feed-back signals that activate

87

muscular contraction and this appears to play a role in joint position sense. Although

progress continues to be made to elucidate the role of proprioception in normal

ligament function.

88

DIFFERENCE BETWEEN TENDON & LIGAMENT & MUSCLES

1) TENDONS

Tendons are dense connective tissues and are dominated by regularly arranged

collagen fibers. They serve primarily to transfer the pull of muscles to bone. They also

play a fundamental role in locomotion, transferring the forces generated by our

muscles to the skeleton, and thus facilitating movement. In addition, they stabilize the

joint, and act as shock absorber to limit muscle damage. Some tendons have an

additional energy storing function which when stretched under load they then recoil.

This lessens the energetic cost of locomotion, as a reduced muscular effort is required

to return the limb to the starting position. Examples of energy storing tendons are the

human Achilles tendon and equine superficial digital flexor tendon. However, tendons

such as the human anterior tibialis tendon and the equine common digital extensor

tendon act purely to position the limb and are relatively inextensible to allow efficient

transfer of force from muscle to bone and precise placement of the limb.

Macroscopically healthy tendons are white in color and have a fibro-elastic

texture. They can vary remarkably in shape and size and in the way they are

attachedto the bone; some tendon can be rounded or cord- like, straplike bands appear

like, or flattened ribbons.The point of unification of tendon to the muscle is referred to

as the myo tendinous junction and the point of unification of tendon with bone as the

osteotendinous junction. The connection of the proximal tendon of a muscle to bone is

called the muscle origin, and the distal tendon connection is known as an

insertion.The myo tendinous is important for force transmission of contracted muscle

89

to tendon. At this region collagen fibers of tendon are inserted into deep recesses

formed by myocyte processes, which allows the tension that has been generated by

contractile proteins of muscle fibers to be transferred to the collagen fibrils. Enthesis

is the interface between tendon and bone and is classified in to four zones: fibrous

tissue, fibrocartilage, mineralised fibrocartilage and bone. The presence of

fibrocartilage in tendon is an adaptation to resist compression and/or shear forces

Connects skeletal muscles to bones.

Tough and elastic.

Proteoglycan content is less.

White in color.

Blood supply is good.

Fibroblasts lie in a continuous row.

The fibers are compact and present in Parallel bundles.

90

2) LIGAMENTS

Ligament is another dense regular connective, which joins bone to bone. Similar to

tendons, ligaments vary in size, form, orientation and location. Grossly, ligament

appears white, firm,homogenous and fibrous.Ligament can be categorized into at least

two major subgroups; those found in the musculoskeletal system and those connecting

other soft tissues, for instance the suspensory ligament in the abdomen. They are

named based on the point of bony attachment, shape, function, their relation to joints

or surfaces and their relationship to each other. Skeletal ligaments play essential roles

for accurate joint function. They passively stabilize the joint and are responsible for

guiding movement of the joint through a normal range of motion. They are

responsible for preventing or blocking abnormal joint movement within set limits.

Another function of articular ligament role in joint is in proprioception, which

provides feedback relating position space of the joint and contributes to the

coordinated movement of the limbs. Ligament contains different regions similar to

what has been previously described in tendon. For instance the anterior cruciate

ligament has a proximal origin from the femur and a distal insertion on the tibia. The

cruciate ligaments of the knee joint are examples of ligaments with direct enthesis at

both the femoral and tibial insertions, whilst medial collateral ligament has an indirect

enthesis at the tibial insertion.The formation of fibro cartilaginous matrix in both

tendon and ligament is thought to occur at sites that are under compression.

Connect bones to bones.

Elastic in nature.

Connects the end of the bones at joints.

91

Each joint contains many ligaments

Proteoglycan content is more.

Yellow in color.

Blood supply is poor

Fibroblasts are scattered.

They are not arranged in Parallel bundles but are compactly packed

3) MUSCLES

Muscles are allowing us to move our body. They enable our internal organs to

function. The human body has over 600 muscles which make up around 40

percent of our bodyweight. There are 3 types of muscles-

a. Skeletal muscle

b. Cardiac muscle

c. Smooth muscle

a) Skeletal muscle

Skeletal muscles move the external parts of the body and the limbs. Skeletal

muscles cover the bones and give our bodies their shape. There are about 320

pairs of identical bilateral muscles, when one muscle contracts the other

expands and this allows movement. Facial expression such as smiles, frowns,

mouth and tongue movements are all controlled by the skeletal muscles.

92

b) Cardiac muscle

Cardiac muscles are responsible for heartbeat. They only exist only in the

heart. The cardiac muscles work without stopping day and night. They work

automatically but they are similar in structure to the skeletal muscle. They

make the heart contract so that the heart can squeeze our blood and release so

that the heart can fill up with blood again.

c) Smooth muscle

Smooth muscles are responsible for movements in the stomach, intestine,

heart, arteries and hollow organs. These muscles are activate automatically.

The smooth muscles in the walls of the intestine contract and push food

forward. During child birth the smooth muscles in a women‘s uterus contract.

Our pupils shrink and expand depending on how much light there. These

movements depend on smooth muscle movements. Smooth muscles are also

present within the walls of the bladder, the bronchi, and the arrestors pill in the

skin which makes the hair stand up.

Muscles are highly vascular organ.

Muscle tissue is soft tissue.

Movement and regulation.

Posture & support

Body temperature regulation

Muscle contains special protein called contractile protein called myofilaments.

Muscles having high rate of metabolic activity.

93

Muscles having ability of contractility, extensibility, and elasticity.

Muscles having abundant supply of blood vessels and nerves.

Muscles transmits electrical impulses.

94

4. Methadology

MATERIALS AND METHODS

MATERIAL

1) Literature present in classical texts,tikakaras and in modern books available in

our institute.

METHODS

1) Study design

A) Literary study

Literary study-

All the information about mansavaha strotas and its moolasthana by sushruta

and its tikakaras was studied. Relation of snayu with other factors like

Dhatus was studied. Also did the study of thickness of tvaca told by Sushruta

and its tikakaras. Also the tvaca utpatti, utpatti kala,thickness of tvaca, tvaca

as diagnostic stool in clinical examination,Vrana vastu, tvaca as a prognostic

stool is also studied. In case of modern aspect of tvaca and snayu,all the

information regarding anatomy of skin and ligament is compiled from

different textbooks of anatomy. Finally the study of mansavaha strotas

moolasthana and its tikakaras is done.

95

METHOD OF SELECTION

1) Inclusion criteria

Literature available in sushrutasamhita and its tikakaras and in modern

texts.

2) Exclusion criteria

- Charaksamhita ,waghbhata And laghutrayee

Sample size of estimation-

It is not applicable for this study.

96

5. RESULTS

1) According to sushruta, there is snayu and tvaca are the moolasthana of

mansavaha strotas.

2) Also according to sushruta sanhita tikakaras, moolasthana of mansavaha strotas

is snayu and tvaca.

3) Acharya sushruta and its tikakaras mentioned that there are four kinds of

snayu viz. pratanvati snayu, vratta snayu, pruthu snayu and sushir snayu.

4) Snayus are the structures which maintain the body posture by joining the

mansa and asthi and provide the strength for the body to perform its activities.

5) These snayus are compared to ligaments.

6) Acharya sushruta and its tikakaras explained that, there are seven layers of

tvaca, these are avabhasini, lohita, sveta, tamra, vedini, rohini, mansadhara.

7) Tvaca is used as diagnostic tool in clinical examination, used as rogamarga and

vrana vastu.

8) Skin is composed of three primary layers: the epidermis, the dermis and the

hypodermis.

9) The epidermis having five layers these are the stratum basale, stratum

spinosum, stratum granulosum, stratum lucidum, stratum corneum. And

dermis having two layers, papillary layer and reticular layer.

10) Ligament is the fibrous connective tissue that connects bones to other bones

and helps in supporting and keeping the organ in position.

11) Tendon plays a fundamental important role in locomotion, transferring the

forces generated by muscles.

12) Muscles are allowing moving our body and also enabling internal organs to

function.

97

6. DISCUSSION

Discussion constitutes a critical stage in the development of thesis. Data observed

during the study are pooled together and on the basis of collected information

discussion will be done through various angles.

1) According to the definition, strotomula is considered as the prabhavsthana i.e. the

place of origin from where the particular commences or gets the nutrition.

2) In the vitiation of mansavaha strotasvarious diseases like arbuda,keela,alaji,etcare

produced which are pertained to skin(tvaca) which is said to be the moolsthana of

mansavaha strotas.

Snayu is another moolsthana of mansavaha strotas. Inmansakshaya

the function of snayu also gets diminished and hence the symptoms like sandhivedna,

sandhisphotana are produced.

3) Tvaca is also explained under eight tool of shadvidha rogi

pareeksha(sparshnendriya ), thus by examining the tvaca we can have a fair idea of

the disease. In this, Rasavaha srotas mainly vitiated because of abnormal functioning

of mana and mana has direct effect on tvaca. This makes mana a leading cause of

tvaca vikara. Descriptions of tvaca in classical texts and modern texts have

tremendous similarity between these two regarding numbers, layers, thickness etc.

4) The organ genesis of tvaca occur during paka of Shukra and Shonita by Agni,

seven types of tvaca gets formed on the surface of Garbha just like while heating milk

cream is formed on its surface. Snayu is a pitruj bhava and Tvaca is a Matruja Bhava

and it having predominance of Vayu mahabhoota and sparsha Vishishta guna.

98

5) Tvaca is the external covering of the body. It is also called ―sparshanendriya or

twagndriya‖ which envelops the body. It plays a great role in perception of sensations

like touch, pain, heat, cold.

6) Thickness of tvaca told by Sushruta and Dalhana is having great difference.

Sushruta seems to be more accurate in telling thickness of tvaca which is more or less

same to the thickness quoted in modern textbooks of Anatomy.

7) Tvaca reflects varna of an individual. Tvaca is one the gnyanendriyas which is

Vayaviya in nature. Its abode is Sparshanendriya which is responsible for the touch

sensation. In all Indriyas, Sparshanendriya is an entity that occupies all other Indriyas

also.

8)Tvaca is also useful as diagnostic tool in clinical examination.

9) Tvaca is considered as a rogmarga & it is

used as a vrana vastu.

10) Skin is having protective functions helps in general sensation helps in excretion of

waste products of metabolism synthesize Vitamin – D maintains water balance and

stores fats, water and salts.

11) Skin is divided into two layers outer epidermis and inner dermis. Epidermis is

divided into 5 layers and populated by 4 types of cells. Dermis is also divided into 2

layers. Skin is supplied by sebaceous glands which keep the skin surface oily and

sweat glands which excrete waste materials of the body through sweat.

99

12) The definition also proves the concept of Ayurveda that the Snayu which are strong

cord like structure made up of fine fibers, helps in binding the body parts together,

are known as ligaments.

13) Acharya Sushruta has also recommended that the Snayu should be protected along

with other vital structure like Marma, Sira, Sandhi etc., where it becomes necessary

to perform surgery.

14) Snayu are the fiber like material which can be used for suturing purpose in place of

thread.

15) Prathu Snayu which is mentioned by Acharya Sushruta to be present in Parshva, Ura,

Prishtha etc. regions are some special form of fascia or aponeuroses either entirely or

as a part of the muscle.

16) Ligaments are viscoelastic. They gradually strain when under tension and return to

their original shape when the tension is removed.

17) Ligaments play essential roles for accurate joint function.

18) Retinaculum consists of 3 layers i.e. Deepest layer, Gliding layer and superficial

layer. Combined these three layers create a smooth gliding surface as well as

mechanically strong tissue.

19) Tendons play a fundamental role in locomotion, transferring the forces generated by

our muscles to the skeleton, and thus facilitating movements.

20) Some tendons have an additional energy storing function which when stretched under

load they then recoil.

100

21) Ligaments appears white, firm, homogenous and fibrous which joins bone to bone.

22) Muscles are allowing us to move our body also enable our internal organs to function.

23) To understand patho-physiology and anato-physiologic changes, it is necessary to

evaluate and understand Srotas and its moolasthan.

24) The human anatomy (shareera rachana) is an important for allied health sciences. It

is one of the fundamental subject to the health science. The ayurvedic life science is

also based on the human anatomy and physiology (rachana & kriya), without the

knowledge of shareera rachana and kriya, the physician cannot become perfect in the

profession. The study of human anatomy is very much vital for preventive and

curative aspect. Knowledge of snayu & tvaca is very important for physicians as well

as surgeons who are dealing with surgical removal of foreign bodies.

101

7. CONCLUSION

The conclusions which can draw are as follows-

According to acharya sushruta there is moolasthana of mansavaha strotas is

snayu and tvaca. Also sushruta tikakaras Dr.Bhaskar ghanekar and

Dalhanacharya explains there is moolsthana of mansavaha strotas is snayu and

tvaca.

Strotomoola found to be the main functioning centre of particular strotas. Any

kind of vitiation of strotas either directly or through its dhatu leads to the

vitiation of its moola and when strotomoola is affected it leads to the vitiation

of strotas. Hence, it could be said that there is 'samavaya sambadha ' between

strotas and strotamoola. The term used prabhavsthana' used for strotomoola

Should be considered as either the origin place, storage place, controlling site,

conduction place, terminating place or site of manifestation for various strotas.

Acharya Sushruta had given emphasis on the anatomical aspect of the

strotomoola.

According to Acharya Sushruta, Dr.Bhaskar Ghanekar, and Dhalanacharya

there are seven layers of tvaca and in modern science also their number is

same.

The layers of tvaca described by Acharya Sushruta and tikakaras, their names

match with the layers of skin anatomically and physiologically.

It exhibits the image of the physiological and pathological imbalances of the body‘s internal

environment.

102

Acharya Sushruta, Dr.Ghanekar and Dalhanacharya even described thickness

of each layer of tvaca, which is more or less same to the thickness quoted in

modern science.

Dr. Ghanekar, co relates ayurvedic tvaca stara to modern skin layers.

After detailed study of various concepts about tvaca from various ayurvedic

literatures and modern science,we can state that tvaca is well established tool

in clinical examination, diagnostic & prognostic aspect in medical sciences.

Tvaca is considered as a rogamarga and it is used as a vrana vastu.

Indriya pancha panchak and factors causing pratyakasha gyan can be used as a

tool to understand the Gyangrahanprakriya of any sense organ.

The meaning ofSnayu is different in different contexts such as ligament in

binding bone and joints; tendon in binding the muscle and dura matter and

apponeurosis in binding the Meda.

Snayu (ligaments) presents in the human body are closely allied to the

biological air….. vata. Snayu is one of the extra articular or subsidiary tissues,

which plays an important role in the posture of human body.

Snayu is a structure which performs the function of holding and binding the

various structures of human body like bones, muscles and adipose tissue. It

is one among the updhatu which helps the Dharana

(kÉÉUhÉÉiÉ kÉÉiÉuÉÉ)(maintainence) of body.

Snayu is used as bow string owing to its strength. Detailed observation of

these structures reveals them as generally fibrous structures which are strong

103

enough to withstand a certain amount of tension. Observations of Snayu show

it as a white, tough structure. An overall observation of these structures gives

an impression that Snayu is a fibrous structure visible in the body.

Snayu which are better known as vital points in ayurvedic anatomy in specific

locations in the human body which are characterized by the predominance of

the ligaments.

According to acharya sushruta and tikakaras Snayu are of four kinds; we can

consider below mentioned entity.

Pratanavati Snayu –

Ligaments of the limbs and

nerve Vrutta Snayu -

Tendons and large nerve

cord PruthulaSnayu -

Aponeurosis and Fascia

SushiraSnayu -

Sphinctersand ligament of

viscera

Skin is one of the sensory organs and thus helps in knowledge. It is in a way

covering of the whole bodynot only externally but also internally.

Also the skin is useful for the protection, sensation, heat regulation, control of

evaporation, aesthetics and communication, storage & synthesis, excretion,

absorption and water resistance.

104

Modern anatomy explains there is three layers of skin i.e. Epidermis, Dermis

and hypodermis.

To get a proper idea of skin diseases one must know the normal echo texture.

Hence, normal condition of skin is necessary. Hence, the sharir rachana of

tvaca has to be studied in depth.

Ligaments attach two bones or cartilages; it helps in supporting and keeping the

organ in position.

Artificial ligaments possess unique advantages such as no donor site

morbidity, early recovery and no risk of disease transmission.

The periodontal ligament is a fibrous connective tissue, physically small but

functionally important tissue in tooth support.

Retinaculum is not a part of muscle but its function is to stabilize the tendon.

Tendons are elastic and connect skeletal muscles to bone.

Also ligaments are elastic in nature and connect the bone at joints.

In Ayurveda there is 900 muscles are explained but in modern anatomy there

are 600 muscles. Muscle is of 3 type‘s i.e. skeletal muscle, cardiac muscle and

smooth muscle which is useful for movements, proper functioning of body and

maintain the posture and supports the body.

105

8. SUMMARY

This present dissertation entitles ―A literary study of mansavaha strotas

moolsthana as mentioned in sushruta samhita with special reference to modern

anatomy consist of various sections. The sections are in order to achieve the result &

the convenience for review of literature, methodology, results, discussion, summary,

conclusion, bibliography.

Introduction

Introduction gives the information and importance of mansavahastrots and its

moolasthana.

Aim and objectives

Aim

1) To study the mansavaha strotas moolasthana as per classical texts and modern

anatomy.

Objectives

1) To elobrate the moolasthana of mansavaha strotas as per sushruta samhita and

sushruta tikakaras.

2) To determine the action and functions of ligaments and differentiate tendons,

ligaments and muscles.

3) To study the modern anatomy of tvaca(skin) &snayu(ligament) in detail.

106

Review of literature-

Review of literature deals with brief collection of ayurvedic literature on mansavaha

strotas and its moolasthanai. Snayu & tvaca and modern aspect of skin &ligaments.

Result-

Result is an important part of the dissertation described with the literature of the

mansavaha strotas and its moolasthana.

Discussion-

Discussion made on the basis of data obtained on the points of mansavaha

strotas moolasthana, its tikakaras and its modern anatomy.

Conclusion

Conclusion gives the final result of work by various angles and states the output

of the study.

References-

It gives information about books referred with the name of author, publication,

year, & edition are given.

107

9. REFERENCES

Books

1. Sushrutasamhita, k. k. shrikantmurty, 1

st edition, Choukhambaorientalia, 2001.

2. Drushtarthsharirmvol -2, Vd.P.G.Athwale,4th edition,Godavari publishers,nov

2003.

3. Shareerarachanavigyana,Vd. Shivajivavhal, 3rd

edition,Shantanuprakashan,2000.

4. Human anatomy vol-1, B.D.Chaurasia, 4th edition, C b s publishers, 2004.

5. Cunninghams manual of practical anatomy vol-1,G.J.Romanes,15th

edition,Oxford medical publication.

6. Sushrutasamhitavol 1,Kavirajdrambikadattashashtri,14th edition,Choukambha

Sanskrit sansthan.

7. Aayurvedarth anatomy,Dr. vinaymukeshkumarpandey,1 st edition, Aquaris

publication,2012.

8. Sareera rachana –anatomy of Ayurveda,Dr. M Rama sundararao,1 st

edition,2003.

9. A textbook of ayurvedic human anatomy, Dr. Giridharkanthi,1st

edition,Choukhamba orientalia,2008.

10. Susrutha Samhita. Ayurved Tatva Sandeepika hindi commentary Author:

Kaviraj Ambikadatta Shastri published by Chowkhambha Sanskrit Sansthan

Varanasi reprint edition Sushruta Samhita Sutrasthana ch. 2010.

108

11. SuśrutaSaṃhitā, with commentary of Dalhan. Edited by Vaidya Yadav ji

Trikram ji, Chaukahambha Orientalia, Varanasi 8th edition, 2005.

12. Sushruta sanhita, shri dalhanacharya virchatiya nibandhsangraga, edited by

acharya priyavat sharma Chaukahambha Orientalia, Varanasi 8th edition, and

2005.

13. Prof. Srikanth murthy K.R. sushrut samhita (sharer 4/4) chaukambha,

Varanasi,U.P. vol-1,2 edition 2004.

14. Sushruta Samhita: Ayurveda Rahasya Deepika Commentary by Dr. B.G.

Ghanekar, 13 edition, 1998, publication Meherehand Laxmandas, New Delhi.

15. Acharya Y.T. Sushruta Samhita with Nibhandha sangraha commentary of

Dalhanacharya. Varanasi (India): Chaukambha Sankrit Sansthan; 2007.

16. Suhruta Samhita:Dalhana Nibandha Sangraha Commentary, published by

krishnadas Academy.

17. Ghanekar S. commentary on Sushruth Samhita Sharirsthana ―Ayurved

Rahasya Deepika by Dr. Bhaskar Govind Ghanekar, published by

Meherchand prakashan Delhi reprinted edition, Sushruta Sharirsthana ch. 2007.

18. Gupta GK (Ed.). Ayurvediya Kriya Sharir Vigyan. Meerut: Utkarsha

Prakashan; 2016.

19. Acharya Y.T. SushrutaSamhita with Nibhandhasangraha commentary of

Dalhanacharya. Varanasi (India): Chaukambha Sankrit Sansthan; 2010.

109

20. Acharya Y.T. Sushruta Samhita with Nibhandha sangraha commentary of

Dalhanacharya. Varanasi (India): Chaukambha Sankrit Sansthan; 2010.

21. Sushutra, Ambika Dutta Shastri, Sushutra Samhita with Elaborated Ayurveda

Tatva Sandipika Hindi Commentary, Reprint 2009. Varanasi: Choukhambha

Sanskrit Sansthan, Volume 1, Sharir Sthan Chapter 4.

22. Clinical Anatomy – Richard S.Snell 7th edition 2003.

23. Principal of anatomy and physiology by Tortora Grabowski 10th edition 2003.

24. A.P.I. Text book of medicine by G.S. Sainani 1999.

25. Gray‘s Anatomy: By Henry Gray edited by Peter Williams and others.

Published by Churchill Livingstone Edinburgh, London, 37 th edition.

CONSENT FORM-

It is not applicable for this study

PROFORMA-

It is not applicable for this study.

MASTER CHART-

It is not applicable for this study.

ANNEXURES/PHOTOS/IMAGES-

Not necessary for this study.