Sandhi Sharir in Ayurveda and Applied Anatomy of Ankle Joint - A Review

Abstract

In Ayurvedic literature, the concept of Sandhi (joints) has been described with varying enumerations by different Aacharyas. Aacharya Sushruta identifies 210 Sandhis, distributed throughout the body, which are essential for facilitating diverse movements. The term Sandhi is traditionally defined as “union,” “to unite,” or “the meeting point of two or more structures,” with emphasis placed on Asthi Sandhi (bony joints) as the primary category for enumeration [1]. Classical texts classify Sandhi broadly into two types—based on Kriya (function) and Rachana (structure)—and consistently describe them as the meeting place of two or more bones (Asthi Samyoga Sthana). While Atreya, Dhanvantari, and Sushruta highlight the importance of anatomical knowledge for understanding the human body, detailed descriptions of joint anatomy are limited in the Ayurvedic Samhitas. In contemporary times, the incidence of joint disorders has markedly increased, posing significant challenges to individuals and society. This underscores the necessity of comprehensive knowledge regarding the structure and function of joints, which is vital for accurate diagnosis and effective management of joint-related diseases.

Introduction

The text provides a comparative review of the concept of Sandhi (joints) in Ayurveda and modern anatomy, with particular emphasis on structure, function, classification, and clinical relevance.

In Ayurveda, Sandhi refers to the junction of two bones and is considered the seat of Kapha, responsible for lubrication and stability, while Vata governs movement. Although the body contains innumerable junctions, only Asthi Sandhis (bony joints) are counted for anatomical purposes. Classical texts differ slightly in their enumeration, with Sushruta Samhita describing 210 joints, distributed across the limbs, trunk, and regions above the neck. Sandhis are supported by structures such as ligaments, synovial components, muscles, vessels, and nerves to enable stability, weight bearing, and motion.

Ayurveda classifies joints in two main ways:

• Kriyanusar (functional classification): movable (Chala/Che??ayukta) and immovable (Achala/Sthira) joints.

• Rachananusar (structural classification): eight types described by Acharya Sushruta, including Kora (hinge), Ulukhala (ball-and-socket), Pratara (plane), and Tunnasevani (sutures), among others.

The Gulpha Sandhi (ankle joint) is reviewed in detail, highlighting its anatomy, movements, Marma significance, and susceptibility to disorders such as Sandhivata, sprains, and fractures.

The modern review explains joints (articulations) through functional (synarthrosis, amphiarthrosis, diarthrosis) and structural (fibrous, cartilaginous, synovial) classifications. Special emphasis is given to synovial joints, their types, synovial fluid, and applied anatomy of the ankle joint, including blood and nerve supply and common injuries.

The discussion concludes that Ayurvedic and modern anatomical concepts of joints closely parallel each other. While Ayurveda offers a holistic, function-oriented understanding, modern anatomy provides detailed structural and clinical insights. Together, these perspectives complement one another and enhance the understanding, diagnosis, and management of joint disorders.

Conclusion

Classical Ayurvedic texts describe Sandhi as the junction where two or more Asthis (bones) meet. Both Ayurveda and modern science classify joints on the basis of their structure and function, showing a close parallel between the two systems. Kora Sandhi corresponds to the hinge joint, allowing movement in a single plane. Ulukhala Sandhi includes joints similar to the ball-and-socket type of synovial joints as well as gomphosis-type fibrous joints. Samudga Sandhi, found in regions such as Ansapeetha, Guda, Bhaga, and Nitamba, can be compared to the acromioclavicular joint, sacrococcygeal joint, pubic symphysis, and sacroiliac joint respectively. Pratara Sandhi, located in the Greeva (neck) and Prushtavansha (vertebral column), corresponds to the intervertebral joints. Sutures like Tunnasevani and Hanu in Vayasatunda can be equated with the temporomandibular joint (TMJ). Sankhavartha Sandhi, which includes Shrota and Shringataka, can be correlated with the cochlea of the inner ear and the nasal conchae region.

References

[1] Vd.Shastri K.A, Sushruta SamhitaPartI, Varanasi: Chaukhambha Sanskrit Sansthan, 2009; Sharir Sthana, page no. 62 [2] Sharma PV, editor. Charaka Samhita of Agnivesha with Chakrapani Datta Commentary. Reprint ed. Varanasi: Chaukhambha Orientalia; 2018. Sutra Sthana, 17/14; Sharira Sthana, 7/32–33; Chikitsa Sthana, 25/6; 28/37–42. [3] Sushruta Samhita, Sharir Sthana hindi commentary Ayurveda Rahasya Deepika by Dr. Bhasakar Govind Ghanekar, 1998, Mehar Chand Lachmandas Publication, New Delhi [4] Sushruta Samhita edited with Ayurveda Tatvasandipika Hindi Commentary by Kaviraja Ambikadutta Shastri. Chaukhambha Sansthan, Varanasi. 12 ed. reprint 2009. [5] Vagbhata; Astanga Hridaya with commentaries of Sarvang Sundari by Arundatta. Chaukhamba Orientalia, Varanasi. Edition, 2012. [6] Charak Samhita with Vidyotini Hindi Commentary by Pt.Kashinath Shastri & Dr. Gorakhnath. Chaukhambha Bharti Academy, Varanasi. 22 edition, 1996. [7] Sushruta Samhita, Sharir Sthana hindi commentary Ayurveda Rahasya Deepika by Dr. Bhasakar Govind Ghanekar, 1998, Mehar Chand Lachmandas Publication, New Delhi [8] Murthy K.R.S., Susruta Samhita, vol-1, Sharir Sthan, Chapter-3, Shlok-41, Edition, Chaukhamba Orientalia, Varanasi, 2012; 98 [9] Prof. Srikanthamurthy K. Sushruta Samhita. Banglore: Chaukhamba Orientalia Publication, 2010; 89 [10] Prof. Srikanthamurthy K. Sushruta Samhita. Banglore: Chaukhamba Orientalia Publication, 2010 [11] Introduction to Joints (2) – Joints – Classification by Movement\". anatomy.med.umich.edu. Archived from the original on 2011-07-18. Retrieved 2012-10 06. [12] Whiting, William Charles; Rugg, Stuart (2006). Dynamic Human Anatomy. Vol. 10. p. 40. [13] Principles of Anatomy & Physiology, 12th Edition, Tortora & Derrickson, Pub: Wiley & Sons [14] Principles of Anatomy & Physiology, 12th Edition, Tortora & Derrickson, Pub: Wiley & Sons [15] Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London: Elsevier; 2021. p. 1349–1362. [16] Drake RL, Vogl W, Mitchell AWM. Gray’s Anatomy for Students. 4th ed. Philadelphia: Elsevier; 2020. p. 14–18. [17] Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London: Elsevier; 2021. p. 137–145 [18] Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London: Elsevier; 2021. p. 137–145. [19] B. D. Chourasiya’s Human Anatomy Regional and Applied, Volume II Lower Limb, Abdomen & Pelvis, Sixth Edition 2008, CBS Publishers & distributors, p.147,148,149,150 [20] Standring S, editor. Gray’s Anatomy: The Anatomical Basis of Clinical Practice. 42nd ed. London: Elsevier; 2021. p. 1485–1490. [21] Chaurasia BD. Human Anatomy: Lower Limb, Abdomen and Pelvis. 6th ed. New Delhi: CBS Publishers & Distributors; 2019. p. 175–180

Copyright

Copyright © 2026 Ganesh G. Surve, Vinod M. Choudhari, Demendrakumar G. Thakre. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.