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Introduction

In Ayurved, various crucial points are mentioned which are essential to recognize. In Rachana Sharir, many significant concepts related to human body are explained. Predominantly in this view, Acharya Sushrut has explained this topic in his respective samhita in Sharirsthan. Amongst all those points, Marma is one of the key aspects. Marma are the vital points over the body which are vayu and agni predominant in nature.[1]

The science of marma or marmavidya is extraordinary and dynamic therapy that has tremendous value in health, longevity, spiritual practice and diseases. Marma is one of the most widely described at the same time one of the most debated topics in the Bruhatrayees. In dictionaries the word “Marman” means mortal sport, vulnerable point, weak or sensitive part of body, joint or articulation,core of anything, vital structure. Descriptions of 107 marmas[2] given by all Acharyas being classified into five varieties on the basis of structure involved, five on the basis of effect of injury, five on the basis of location on the body. According to dalhanacharya “maryanti iti marmani” this unique line explain the importance of marma this means where there is trauma, death is achived that point is called as marma.(3) Study of Shareera is very important for both the physicians as well as surgeons. Because one who don’t have the basic knowledge of shareera can never achieve his target of Swastasya Swastha Rakshanam and Aaturvikar Prashamanam. The description of Marma is specialty of Ayurveda. All of these marma having their own importance but there is one marma which is very important to study for a physician during his studies and i.e. Kshipra Marma which is located in the upper and lower limb in between base of the thumb and tarjani  in hand and in between the big toe and second toe of the foot. Because it is a place which frequently gets injured in our day to day working.

AIM AND OBJECTIVES

1) To Review the KshipraMarma.

2) To Know the Location of KshipraMarma.

3) To co-relate the Structure comes at the site of KshipraMarma.

MATERIALS AND METHODS

Ayurveda literally means traditional science of life. [4] Marma vigyan is a unique feature of Ayurveda. Susrutha Samhitha gives detailed information of marmas based on the body organs or structures involved, the time bound consequences of the trauma, the area and the sizes, the sites and location over the body and lastly the number of marmas fall in various groups. Aacharya Sushruta defined marma as the vital points of the body which shows various fatal signs and symptoms on traumatic injury. [5]  Depending upon traumatic effects and prognosis, various types of marmas i.e sadhyapranahar (sudden death ),kalantarpranahar (death within short period), vaikalyakar (deformity due to trauma),vishalyaghna ( person lives until removal of foreign body), rujakar (continuous pain due to trauma) mentioned in Ayurveda.[6] Acharya Arunadatta explains, Marmas are such points which produce vishama spandana and ruk. He also opines that Marma on injury causes death or miseries similar to death.[7] Sarghandhara opines Marma as jeevadhara.[8]

Study Of Kshipramarma

Marma is that place which has unusual throbbing’s and pain on touch[9]. The marmas (vital spots) are so called because they cause death; and they are meeting place of mamsa (muscles), asthi (bones), snayu (tendons),  dhamani (arteries), sira (veins) and sandhi (joints) [10] . They are indicated by the predominant structure found in them [11].  There are five types as Sadhyo-pranahara, Kalantarapranahara ,Vishalyaghna, Vaikalyakara and Rujakara. According to Shabdakalpadruma, Kshipra takes it from the root word ‘kship’ and has been assigned with the synonyms ‘Sheeghra’ and ‘Twarita’..[12] It is meant as to throw, cast,send, dispatch etc. in Monier William’s Sanskrit – English dictionary. [13] The Kshipra marma is situated in Urdhva Shakha [14]. It is explained as Snayu (based on the constitution) marma[15] and Kalantarapranhara or Sadhyopranhara marma (based on prognosis of injury) [16] , total four in number. [17] It is located in between Angushtha (1st metacarpal bone) and Anguli (2nd metacarpal bone). Injury to Kshipra marma results in marana (death) due to akshepaka (convulsions) [18] Arunadatta has detailed that the Akshepaka mentioned here is the Vatavyadhi [19].  It is detailed that in akshepaka roga the aggravated vata dosha permeates all dhamanis leading to frequent & repeated convulsions and spasm of muscles.[20][21] Here the terminology of dhamani has been detailed as nadi by Dalhana suggesting the involvement of nervous system in it.[22] Dalhana has also mentioned that in this the whole akshepaka of the body takes place. [23]  Arunadatta has interpreted the word ‘Aakshipati’ as ‘Aakramati’ or attacking. [24] It has also been mentioned that when the limbs get severed, the blood vessels get contracted to allow only little hemorrhage and such persons, though having severe affliction, do not die like tree with several branches cut off survives.[25]

The site of Kshipramarma is given in Sushruta samhita as “Tatrapaadsyaangusthaamanguliyormadhye Kshipra Naam Marma,

TatraVidhasyaakshepaken maran”. [26]

Classification of  Kshipramarma

Kshipramarma Situated in between the root of the thumb and index finger, it better felt when the finger is expanded having the size of Approx.01cm. This Marma is classified

1) According to Rachana – SnayuMarma

2) According to Parinama – KalantaraPranaharaMarma

3) According to Pramana – ½ Anguli

4) According to Panchamahabhota – Agni and Soumya

5) According to Shadanga–Shakhagata

As this marma comes under the classification of Kalantara Pranahara Marma because the predominance of Agni and Jala Mahabhuta is present in this case where the Agni acts faster and Jala acts slowly as a result the person may die within a month of Injury. This marma may leads to Akshepaka (Convulsions) and ultimately leads to death after some time.

Clinical Significance of Kshipramarma:

According to Sushruta samhita siravedha is the half of the therapeutic measures in Shalyatantra as Basti in Kayachikitsa. Half of the health hazards can be managed by siravedha. Siravedha is a significant therapeutic tool in the emergency management to achieve the better result.       Siravedha is one of the methods of Raktamokshana, Acharya Sushruta had given detail  description regarding the Raktamokshana in his Samhita because rakta is being chief causative factor in the disease manifestation. According to Ayurveda shodhana chikista is the most beneficial treatment in present time. This shodhana chikista is 5 types, among these raktamokshna (siravedha) in one of them. According to shodhana therapy where the doshas are eliminated from its nearest route and in our Samhita we can find no. of diseases treated by siravedha in minimum duration. Like disease Vatashonita (Gout), Padadaha (Burning of Soles), Vatakantaka (Sprain of the Ankle) Padaharsh (tingling in the Soles), Chippa (Whitlow), Visarpa (Erysipelas), Vicharchika (one type of Skin Disease) etc.[27] Diseases are cured by the Siravedha just 02 angula (4cm) above the KshipraMarma by using VrihimukhaShastra. Now-a-days more disease is treated by acupressure on compress of marma points. Pressure area of kshipra is 1st and 2nd metacarpal bone of hands. This are will occupy large web space in hand therefore press this and relief the disease like sickness of shoulder region, anterior triangle of neck, thyroid, dysphonia, dysphagia. Even in patients of excessive eroticism, activate kshipramarma of the feet this will absolutely lessens the libido. If excessive stimulation then damages the kshipramarma so press it according to the need.[28]

Anatomical Structures Involved -

According to modern the structures situated in kshipramarma are.

In Upper Limb – Radial artery, Princepspollicis artery (interval between the 1st dorsal interosseous & adductor muscle), Deep branch of radial artery that proceeds to form deep palmar arch, recurrent branch of median nerve which supplies the thenar muscles. Three proper palmer digital nerves of the lateral branch of the median nerve which supply the skin of both sides of the thumb & radial side of index finger, First lumbrical, 1st palmar interossei, Transverse and oblique head of adductor pollicise, Radial bursa, Superficial terminal branch of radial nerve & its dorsal digital branches.[29]

Discussion

Marmas are the vital points of our body and made from composition of Mamsa, sira, snayu, asthi, and sandhi. Based on the criteria, the Marmas are placed in different groups and given some special names. Based on prognosis of injury at the site of Marma, they are classified under five categories such as Sadhyopranahara, Kalantarapranahara, Vishalyaghna, Vaikalyakara and Rujakara. Kshipramarma is the variety of snayumarma and according to Acharya Susruta location of kshipramarma is situated between the base of thumb and index finger (i.e. angusta and tarjani ). It is a snayumarma, because, there are 20 intrinsic muscles in our hand and Sushruta might have classified most of them as Snayu, due to their small in size which led to the classification of Kshipra as a Snayumarma. Since thumb is the master finger, the first web space was given more importance compared to others.  Acharya Sushruta has also mentioned it is kalantarapranhara in nature. It is also mentioned that sometimes the marma can be sadyopranahara. In the Kshipramarma abhighata causes Akshepaka and maran. Akshepaka, is one of the Vatavyadhi mentioned by Acharya Sushruta and Vaghbhata. In the injury of Kshipramarma there will be severe blood loss which will lead to the Vataprakopa. Then the vayu entering dhamani will cause severe spasm and convulsions. Acharya Dalhana has interpreted that dhamani as nadi which possibly indicates the involvement of nervous system in Vyadhi. The convulsions and spasm caused by due to severe blood loss, is closely similar with the sign found in disease tetanus (lock jaw). The sign of „Opisthotonos? mentioned in tetanus is strikingly similar to the akshepaka. According to modern tetanus is caused by Clostridium tetani. The incubation period of Clostridium tetani is mentioned to be in between 4 to 14 days which strikingly matches with the fact that the person injured, in the Kalantarapranhara marma will die within 15-30 days.

If severe injury occurs to the dorsal metacarpal artery or palmar arch may leads to the excess blood loss or cyanosis. Injury of this marma, the death takes place sadhya (sudden) or within 7 days.

Conclusion

After going through the above discussion we can highlight the following things, the hand and leg are the two main body parts that makes man an efficient being on earth. During Samhita kala, when human life was not mechanized and man had to do all his daily chores like cutting grass, wood etc. with his hand & feet. During this type of work thumb has important role.  So they were more exposed to soil & dirt and hence hand had an easy chance to get wounded. The site of marmas in the hand and feet were more susceptible to injury & infection. The  methodology of management of sepsis might have been different at the time of Sushruta. So this could be one of the reasons why amputation has been indicated in the Kshipra marma abhighata to prevent further spread of infection to upper limb.Therefore to safe our hand and Thumb is the more important.  Therefore, to know about the kshipramarma and it is importance while treating a Patient. Also, we can conclude that the exact location of KshipraMarma is,

1) Kshipramarma location found in between the base Angushtha (thumb) and tarjani (index finger), as per Sushrutasamhita.

2) Space in between root of the thumb and the index finger can be co-related with KshipraMarma.

3) Based on the structural classification, it is of Snayumarma and ½ Angula in dimension.

4) Abhighata of Kshipramarma results in Marana due to Akshepaka.