A CRITICAL REVIEW OF DHAMANI IN AYURVEDIC LITERATURE: CORRELATING CLASSICAL VASCULAR CONCEPTS WITH MODERN HEMORRHOIDAL PATHOPHYSIOLOGY

Background: The Sushruta Samhita provides a detailed description of Dhamanis as distinct vascular structures, establishing a sophisticated framework for understanding cardiovascular anatomy and pathology. While contemporary scholars debate whether Dhamanis represent mere modifications of Siras (veins), Sushruta explicitly refutes this position, asserting their distinct structural and functional identity. Objective: This review aims to critically examine the classical Ayurvedic concept of Dhamani, particularly in the context of anorectal vascular pathology (Arsha), and establish correlations with modern anatomical and pathophysiological understanding of hemorrhoidal disease. Methods: A comprehensive analysis of Sushruta Samhita (Sharirasthana, Nidanasthana) was undertaken, focusing on descriptions of Dhamani classification, vascular pathways, and pathogenesis of Arsha. Modern anatomical texts and contemporary hemorrhoidal pathophysiology literature were reviewed to establish structural and functional correlations. Results: Sushruta's description of 24 Dhamanis originating from Nabhi, with 10 coursing upward (Urdhwagami), 10 downward (Adhogami), and 4 transversely (Tiryakgami), demonstrates remarkable correlation with the splanchnic vascular anatomy. The Adhogami Dhamanis correspond to mesenteric vascular territories, including the Inferior Mesenteric Artery and its terminal branch, the Superior Rectal Artery—the primary arterial supply to the hemorrhoidal plexus. Sushruta's classification of Raktavahi Dhamanis as specific carriers of blood establishes a direct vascular link to hemorrhoid formation. The pathogenesis model describing vitiated Vata obstructing Dhamanis carrying Rakta and Mamsa in Guda parallels modern understanding of arteriovenous shunting, vascular smooth muscle dysfunction, and hemorrhoidal engorgement. Conclusion: The classical Ayurvedic description of Dhamanis demonstrates a sophisticated understanding of vascular anatomy and pathology that aligns with modern biomedical concepts. This correlation supports the validity of Sushruta's vascular framework and may inform integrative therapeutic approaches, including targeted arterial interventions.