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Osteocrinology: Insights from the Great Indian Epics

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Dr Sanjay Kalra, Dr Ameya Joshi and Dr Nitin Kapoor     19 February 2023

Indian epics are a storehouse of knowledge and information, which offer an insight into various aspects of health and disease. In this paper, we surmise some of the legendary figures in the great Indian epics, who possibly could have disorders related to osteocrinology. Based on the detailed description provided in Vedic texts, these exemplars from Indian history provide an interesting framework for the study of osteocrinology. These may spark an interest in students and researchers to explore and understand this subject in greater depth.

 

 

The depth and details of description provided in the great Indian epics provides an opportunity to study and reckon one of the earliest descriptions of medical disorders in history. Modern endocrinology also finds echoes of contemporary diagnosis and management in these ancient literary classics.1,2 Numerous characters and events in the Ramayana and Mahabharata have previously been related to endocrine disorders involving the hypothalamic-pituitary axis and the reproductive system in relation to reproductive endocrinology.3 Osteocrinology is a rapidly upcoming subspecialty of endocrinology, which deals with management of metabolic bone disease (MBD). In this paper, we surmise some of the legendary figures in the great Indian epics who have been suspected to have disorders related to osteocrinology. This is based on the detailed description provided in these Vedic texts.

 

 

The earlier descriptions of osteocrinology date back to 1000 years BC. The Egyptian God Bes and Aesop have been depicted to have achondroplasia and an Egyptian mummy dating back to 1000 BC has been described with osteogenesis imperfecta.4 In the first century AD, the Greek physician Soranus described bone deformity in infants.5 Daniel Whistler from England described rickets in 1645, and in 1876, Paget described osteitis deformans, later to be known as Paget’s disease.

 

 

Examples from the Great Indian Epics

Indian literature, which predates these milestones, offers a picture of MBD through the portrayal of its characters. Several examples have been cited below from Ramayana, Mahabharata, Bhagavata Purana, etc.

 

Manthara

Manthara, Kaikeyi’s housemaid in the Ramayana, is described as having a hunchback.6 This is further supported by another less commonly cited story wherein she broke her knee while Rama was playing in the garden and struck a stick on her leg. These examples suggest that she had a probable fragility fracture and a hunchback could be indirect evidence of multiple vertebral fractures. Since she was old when she has been shown to have these features, it is likely these may have been secondary to postmenopausal osteoporosis. Moreover, they were not life-threatening as she has been mentioned to survive the entire period of exile that Rama had spent outside Ayodhya.

 

Kubja

A similar phenotype is ascribed to Kubja, or Trivakra (three bends), a maid servant from Mathura who is healed by Lord Krishna’s touch. She has been believed to be a reincarnation of Surpanakha in Rama’s time and is mentioned in other scriptures as having a hunchback. Given her younger age, reversibility and bony deformities it probably could represent a treatable cause of osteomalacia.7

 

Shakuni

Other example of a possible MBD can be considered as a differential diagnosis of Shakuni’s phenotype. Shakuni, also known as Saubala, walked with a limp, purportedly due to his father striking him on the thigh, to remind him of the pain his brothers had experienced. Moreover, there is also a mention of a prolonged imprisonment with limited food for Shakuni during early days. This may have induced a nutritional osteomalacia in him predisposing to develop a permanent deformity following the traumatic injury by his father. His intelligence and strong political farsightedness is well known.

 

Ashtavakra

MBD is not confined to persons from lower socio­economic strata, or to characters depicted as villains. The saga Ashtavakra (eight bends) was cursed in-utero, and was born with eight physical deformities. A man of wisdom, he wrote the Ashtavakra Gita, which is a seminal work on dualistic philosophy. Osteogenesis imperfecta is one diagnosis which is definitely plausible. Among other causes of juvenile osteoporosis, a genetic defect, including LRP5 mutation, may be possible.

 

 

Conclusion

Indian epics are a storehouse of knowledge and information, which offer insight into various aspects of health and disease. This brief compendium of osteocrinology, as described in Indian epics, creates an interesting framework for the study of the subject. Similar examples from history and mythology can be collated to spark interest in students and practitioners of medicine.

 

Authors

Dr Sanjay Kalra Dept. of Endocrinology, Bharti Hospital, Karnal, Haryana, India; University Center for Research & Development, Chandigarh University, Mohali, Punjab, India

 

Dr Ameya Joshi Dept. of Endocrinology, Bhaktivedanta Hospital, Mumbai, Maharashtra, India

 

Dr Nitin Kapoor Dept. of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India; The Non Communicable Disease & Implementation Science Unit, Baker Heart and Diabetes Institute, Melbourne, Australia

 

References

  1. Lakhani OJ, Lakhani JD. Kumbhakarna: Did he suffer from the disorder of the hypothalamus? Indian J Endocrinol Metab. 2015;19(3):433-4.
  2. Seshadri KG. The curious case of Sudyumna: a tale of sex reversal from the Bhagavata Purana. Indian J Endocrinol Metab. 2013;17(3):451-3.
  3. Kalra B, Baruah MP, Kalra S. The Mahabharata and reproductive endocrinology. Indian J Endocrinol Metab. 2016;20(3):404-7.
  4. Hecht F. Bes, Aesop and Morgante: reflections of achondroplasia. Clin Genet. 1990;37(4):279-82.
  5. Drabkin IE. Soranus and his system of medicine. Bull Hist Med. 1951;25(6):503-18.
  6. Seshadri KG. Hunches on hunchbacks. Indian J Endocrinol Metab. 2012;16(2):292-4.
  7. Kalra S, Baruah MP, Kalra B. Endocrinology in the Ramayana. Indian J Endocrinol Metab. 2016;20(5):716-9.

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