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Introduction

Marma are vital points located on body at the junction of mansa(muscle), Sira(vein), Snayu(ligaments), Asthi(bones), Sandhi(joints)[1]. It is also called Jeevasthan and Pranayatan . There are numerous scattered references to marma in vedic and epic sources which certifies that early fighters of south-Asia practiced the knowledge of attacking and defending vital points by Kalaripayattu is which oldest form of martial art in South India[2]. The term marma derived from ‘Mru’ dhatu that means which causes death or disability.

According to Ayurveda the points which are very vulnerable to injuries and may lead to complications or death are considered as marma(vital points). Total 107 marmas are accept universally by Ayurveda physicians by enlarge[3]. Sushruta described these 107 marmas in sushruta samhita and same is followed by Ashtanga Sangraha and Ashtanga hridaya. Again Charaka described concept of Trimarma Hruday(Heart), basti(bladder), shira(head) where they have been included in Dashpranaayatanas(Ten resorts of life)[4]

Marma chikitsa can be explained as way of stimulating specific vital points of the body to enhance the ‘Pranic energy’. It can be defined as the technique to stimulate specific vital points of the body in certain way at a critical moment of time for purpose of healing[5] This is method of ‘Pranic Healing’ i.e to heal the body without any medicines They help in removing blockages at mental levels and combat negative emotions. Psychological stress is unavoidable factor in human being caused by several factors and leads to several states of diseases. The term ‘Stress’ may be used in reference to external (way of living, relationship problem, financial problem) internal (way of thinking) affairs triggering negative emotions (worry, fear).[6] Aim of Ayurveda is Swasthasya swasthya rakshanama Aturasya vikar parashamanam  to maintain health of healthy individuals and to treat diseased person. With help of marma therapy we can fulfill the aims of Ayurveda. Marma chikitsa enriches the person with physical, mental, psychological and spiritual level. This ensures the holistic health benefits.

Aim : To study Marma chikitsa (therapy) in management of Psychological Stress : a review

Objective: 1.To study marma science from Ayurveda text and previous research.

                     2. To study marma points and their location useful for stress management.

                      3. To study marma chikitsa (Technique to stimulate marma) to relieve Psychological Stress.

Materials and Method:

Literature of Marma therapy collected from Ayurveda Ancient text, books of Marma chikitsa, previous published articles.

Review Literature:

What is psychological Stress (Anxiety)?

Concepts of stress and anxiety have a significant overlap and closely related. Hence, they are often used interchangeably in the literature. Psychological stress or Anxiety state of mind can be define in terms of intensity of subjective feeling of tension, apprehension, nervousness and worry that are experienced by individual at particular moment and by heightened activity of the autonomic nervous system that accompanies these feeling.

               The multidimensional nature of stress can be divided into 3 main components i.e. Psychological, physiological, behavioural. In practice, it is a general term psychology referring to a wide range of negatively loaded emotional states such as agitation, irritability, anxiety, anger, overstimulation, frustration, unhappiness.[7]

Concept of Stress in Ayurveda:

Acharya Charaka described anxiety by terms of Chittodvega along with Kama(lust), Krodha(anger), Moha(infatuation), Irshya(envy), mana(arrogance), Shoka (grief),Chinta(Worry) etc. Which are types of emotional disturbances of mind.[8] While Chittodvega is more applicable term to illustrate the whole anxious state. Sushruta has mentioned Chittodvega as synonyms with term ‘Shoka’(grief) he has explained similar word like ‘Chittaviparyaya.[9]’ Vagbhata described the term ‘Chittopaplava’ denotes the anxiety.

Ayurveda explained pathogenesis of Stress, emotional response to every negative situation happening in life is common but person having ‘Satva’ predominant mind can resist the ill effect of such emotional disturbances as they are unaffected by such events. But personalities with predominance of ‘Rajas’ and ‘Tamas’ exhibits exaggerated response to emotional disturbance.

What are Marma Points :

In Ayurveda treatise concept of marma has described in Sushruta Samhita. Sushruta defines Marma are junction of Mansa (muscle), Sira(Vessels), Snayu(Ligaments), Asthi(bones), and Sandhi(joints) and ‘Prana’ resides by nature on these places.[10] This concept of marma is on the basis of all martial arts and acupuncture. The word marma comes from ‘Mri’ meaning death. So, any infliction or trauma to the point of their situation cause death or serious damage or severe pain to the body therefore these areas are called marmas. According sushruta there are 107 marmas in human body same is followed by Ashtanga sangraha and Ashtanga hrudaya. while Charaka has given prime importance to three major marmani these tri-marma are Hridaya(heart), Basti(Bladder), and Shira(Head).[11] They are classified according to location Shiro-griva gata marma(head and neck region) 37 in no., Koshthagata (chest + trunk and back) 26,Shakhagata (upper & lower limb)44 in no., According to parinama (effect after trauma to marma) are Sadyopranahara marma(sudden death), Kalantar pranahara(delayed fatal), Vishalyaghna marma((fatal after removal of foreign body), vaikalyakara marma(disabling), Rujakar(painful). The severity of damage caused to marma depends upon the force of injury and type of marma injured.

Marma science and marma therapy:

Marma science is very broad term as it encloses number of health and treatment aspects, as it useful to provide the wholesome health benefits. It is denoted with word ‘Chikitsa’ (therapy). Marma science can be explained as method of stimulating the vital points of the body to enhance the ‘Pranic energy’[12]. Marma chikitsa is oldest treasure of Indian surgery from vedic period. During vedic period the knowledge of marma was known to the emperors and warriors. The concept of practical use of marma was famous in those days to achieve the maximum effect when fighting with enemies during war.[13] The knowledge of marma during war can be traced to Saraswati culture or Indus valley civilization, when weapons were used to target vital points on body. Marma therapy includes pressure massage, yogic practices, Aroma therapy etc.[14] In Ayurveda concept of marma has vital role. Diseases affecting these vital parts have bad prognosis.

Guidelines of marma therapy:

To perform marma therapy one has to know the actual location of specific marma. The exact location of the marma varies according to an individual as well as measurement of the body and body parts the site is described in relation to the bony prominence, joints and other body structure. The distance is measured in finger measurement (Anguli Pramana).[15]

Preparation for self marma therapy: Marma therapy is an uncomplicated and easy to learn technique of regaining the vital energy. Prior to start the marma therapy one should follow following steps:

1. Total relaxation of body 2.Deep breathing exercise 3.Perception of psychic centers 4.Perception of marma points .

Different Techniques to stimulate marma therapy includes

1. Deep breathing and holding air in chest. This can stimulate 37 marmas of head and neck and it is helpful to relieve (stress) anxiety.
2. Pressure or massage over marma points, vibrating, pinching, application of lepa, oil massage on marma points. These are different methods to stimulate marma points.

Marma useful to Relieve Stress (Anxiety) in sitting position

Discussion

There are 107 marma points located on surface of body, by using marma points marma chikitsa can carried out. The science of energy points is precious jewel among Ayurveda’s many beneficial gifts. It provides way to combat emotional disturbances by going beyond just alleviating symptoms to support deep and lasting relief. Stimulation of these points can occur through multiple mediums of touch, massage, application of essential oils, vibration, and breath work are methods of stimulation.   

Shankha marma is stimulation with massage by index finger in circular manner can be use to directing energy to the brain and mind. Almond oil or sesame oil applied here is very calming and helps to promote sleep. In Utkshep marma applying pressure on this point helps to calm the mind and aroma controls vata. Sthapani marma is one of the powerful marma of body, it controls the ‘Agya Chakra’. It controls prana, vata dosha, senses, mind and pituitary gland. Its stimulation helps in unfolding the higher perceptual powers of third eye. Bhramari pranayama and OM chanting. Shirodhara with milk, sneha, or Takra(buttermilk) is very efficient for reducing stress quickly. Stimulation of Shringataka marma by OM chanting and meditating upon the top of head both energizes the higher mind and also helps transcend the mind into infinite space of pure consciousness. Meditation here also promotes deep and dreamless sleep, improve concentration and self control. Simant marma is point of intersection of two sutures i.e., bregma and lambda can be used to apply pressure and to give oil massage locally. It opens various srotas (channels) and improves circulation. Adhipati is master marma of all marmas and controls ‘Sahastra chakra’ this is good site to stimulate to calm down nerves and mind to relieve stress and to induced sleep. Krikatika marma stimulation is very effective for improving neck posture, reliving stress in head and neck. Working with all these marma together is an effective way to promote emotional balance, calm the mind, regulate pranic flow, and reduce stress.

Conclusion

From above study it can be conclude that self Marma therapy and marma therapy with the help of yogic practices, meditation, aroma therapy are the safe medicine-less options for conscious relaxation of body and mind. In present era stress is part of life, everyone facing mental stress and physical health of people also affecting because of anxiousness. So, in this fast life for the busy peoples marma therapy is no cost and time effective, non –invasive with immediate relief treatment So, patient as well as clinician also should practice self marma therapy daily to sharpen his senses and intellect and also keep himself healthy and improve ability to increase internal energy for purpose of ‘healing’.