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Introduction

The concept of Marmas forms a part of Shareera. Modern science hasn't realized the perception of Marma yet, but the science of Marma vignyanam is an essential part mentioned in Ayurvedic samhitas in Sharirsthana of various Samhitas.The earliest talk about of Marma is found in the Rugveda where Indra is said to have defeated Vritra by attacking his Marma with a vajra in between shoulders. References to marma are also found in Atharvaveda, with numerous other scattered references in Vedic and Epic sources. The great Indian Epic Mahabharata and Bhagavata Gita, elephants, horses and soldiers wore varma to protect marma. Arjuna and Karna were only vulnerable to be killed through marma exposure. Ravana and Krishna are said to be have died due to injury on Nabhi and Kshipra marma respectively. Marmas are found by the confluence of 5 important elements or structures of the body namely; Mamsa, Sira, Snayu, Asthi and Sandhi1. Carefully observing this are the main structures which make up the bulk anatomy of the body. The Marmas are 107 in numbers as per Acharya Sushruta. 2 They are composed of all five basics anatomical components3, Sira marma – 41, Mamsa marma – 11, Snayu marma – 27, Asthi marma – 8 & Sandhi marma – 20.

Concept of Marma:

Marma is the part of body, if ajury happens to Marma it results into death or fetal complications hence called as Marma. Marma is a specific anatomical location where five structures of human body viz. Mamsa, (Muscles), Sira (Vessels), Snayu (Ligaments), Asthi (Bones) and Sandhi (Joints) fusion together at one point. Acharya Vagbhata says that those sites which are painful on application of pressure and shows abnormal pulsation should also be considered as Marmas.

Classification of Marma:

1. On the basis of the qualities, Marmas are of 3 types-

1. Agneya
2. Saumya
3. Vayavya

1. On the basis of surgical importance, it is of 5 types4;

1. Sadya Pranahara Marma: 19 in numbers, Agneya and Fatal period within 7 days.
2. Kalanta Pranahara Marma: 33 in numbers, Saumya and Fatal period 15 days to 1 month.
3. Rujakara Marma: 8 in numbers, Agneya & Vayavya. Create intense pain.
4. Vishalyaghna Marma: 3 in numbers, Vayavya, Fatality depends on Specific trauma.
5. Vaikalya kara Marma: 44 in numbers and Saumya.

1. Considering the sites and location of Marma based on Shadangas of the body;

1. Head & neck – 37
2. Ura and Udara pradesha – 12
3. Prushtha – 14
4. 11 in each of the extremities

Physiological basis of Marma:

Marma points are the seats of Dvadasha Prana6 – Soma, Vayu, Teja, Satva, Raja, Tama, Pancha Gyanendriya and Jeevatma. It is also known as ‘Jeevashthana’ or ‘Pranayatna’. Any injury to these vital parts may leads to death, loss of function, intense pain and loss of sensation.This concept of Marma, is conceived martial arts, acupuncture and acupressure.According to Sushruta, due to injury to Mamsa marma, there is loss of sensation of touch. Hence local anesthesia can be produced by irritating the Mamsa Marma.

Scope and indication:

• In traumatic nerve damage; Monoplegia, Paraplegia, Hemiplegia.
• In diseases of Nerves and Brains: Mono-neuropathy, Poly-neuropathy, Brain atrophy, Parkinson’s disease, Dementia.
• In Orthopedic disorders: Vertebral disc prolapsed, Spondylosis, Sciatica, Scoliosis, Osteoarthritis, Osteoporosis.
• To reduce pain of nerves, muscles, bones and joints.
• To produce anesthesia during surgical interventions.
• To improve the function of body by achieving the homeostasis of body humors.
• To improve deformed parts of the body into Healthy state.

Etymological aspect of Marma: 6

• In Buddha period, the science of Marma was transformed in the form of different martial arts.
• In Siddha system – the Marma therapy is a form of treatment of Parna by connecting life forces like Shiva and Shakti.
• Sushruta was the first person who provides conceptual frame work to the practice of the surgery and Marma.
• It is untouched and clinically unopened area of Ayurvedic therapeutics.
• It is the oldest treasure of Ayurvedic medicine or surgery since vedic period.
• Riga veda speaks of using protective coverings to protect these, Marmas.
• The term Marma first time came in Atharvaveda.
• Mahabharta contains many references of Marma therapy.
• In those days it is the important tools for Soldiers and Kings.
• Its therapeutic approach was strictly prohibited to the general public due to its acute effectiveness and due to misuses.
• Acharya Agastya is the first who codifying the 107 nerve centers or Marma points in South India.
• These 107 vital points are used in Indian acupuncture, acupressure and martial in the tradition of Kerala.

Effect of Marma injury: 7

1. Sadya Pranahara Marma –

• When this marma get injured, death occurs in 7 days.
• Other symptoms of injury include – loss of perception of sense organs (Indriyartheshu Asamprapti), perversion in the activities of mind and intellect / cognitive functions (Mano buddhi Viparyaya ), different types of severe pains and quick death.
• These Marmas are predominantly composed of Agni mahabhuta and by the effect of Agni, this marmas cause death in quick time.

1. Kalantara Pranahara Marma –

• When these marmas get injured, there is gradual death. The person may die within 15 days or one month.
• This happens due to the unique composition of this marmas. This marmas are made of Agni and Jala elements. Agni acts and effects quickly and soma acts and effects slowly.
• Due to the association of water element, the death is slow.
• Other associated symptoms are Emaciation or depletion of tissues (Dhatu kshaya) and pain due to Emaciation (Kshayaja Vedana).
• An injury in the surrounding area of Sadya Pranahara Marmas may lead to effect on Kalantara Pranahara marmas also.

1. Vaikalyakara Marma –

• They are predominantly formed by Soma guna. These marmas on getting injured causes deformity.
• Soma or jala dhatu by the virtue of its staility and cold qualities protects the Pranas located in the marmas. Therefore, these marmas do not cause death on injury but surely cause deformities.
• Severe injury may cause death. Proper treatment by an efficient physician will limit the injury to cause deformity but not the death.

Diseases in Marma sites: Among the diseases caused in various directions or places in the body. Marmasthi, Sandhigata are considered to be difficult to handle. They are also considered as ‘Madhyama roga marga’. Among the tissues, Asthi, Majja and Shukra are considered as Marma. The diseases occurring to them are also difficult to treat.8

Urdha Jatrugata Marma (Marma of Head & Neck): -

There are total of 37 Marma scattered over the head & neck.

1. Greeva Marma (Marma of Neck) 14

2. Siragata Marma (Marma of Head) 23

Marma of Neck: -

1. Dhamniyan (Nila-2, Manya-2, located in the neck on each side lateral to Matruka)-4.

2. Matrakayan/Kanta sira (located in the neck, 4 on each side of neck on the side of trachea)8.

3. Krikatika (located at the side of junction of head & neck or base of the skull bone i.e occipital protuberance, on both side)-2.

Marma of Head:

1. Vidhura (located postero-inferior to the ear, 1 on each side)-2.

2. Phana (located in the saddle/roof of nose on the olfactory tract on both side)-2.

3. Apanga (located on the lateral angle of eye on both side i.e outer canthus)-2.

4. Avarta (located just above the lateral part eyebrow, on both side)-2.

5. Utkshepa (located at the level of hair line of scalp, above temporal region, 1 on each side)2.

6. Shankha (located between ear & forehead)-2.

Four Sira that carry Vata, Pitta, Kapha, and Rakta are located in Marma and provide nourishment for the entire body. Damage to these Siras can produce an excessive loss of Rakta Dhatu (blood), which can aggravate Vayu and raise pitta, both of which can result in excruciating agony. Pitta dosha imbalance causes symptoms like thirst, dryness, lack of focus, giddiness, perspiration, and weakness in the body, all of which might ultimately result in death.9

Discussion

In Ayurveda Marma is one the unique and important concept described. It is very important in present era for the Chikitsa and Diagnosis of disease. Marma is the half part of the Shalya tantra in Ayurveda science. Various types of Marmas are explained in Ayurveda. In which if some marma get injured then it causes death, deformity or loss of functions in the body. It is very important aspect as per Shalya tantra. Knowledge of Marma are helpful while performing Surgery or any procedure. In Charaka samhita, Sushruta Samhita, Ashtanga Hrudaya etc all Acharyas explained the total numbers of marma was 107. Acharya Sushruta states that if Aaghata happens anywhere in the body and it leads to death of an individual then it is known as ‘Marma.’10

It is formed by the elements like Asthi, Majja, Sandhi, Snayu. They are correlated with each other. So therefore, any one gets injured from this they cause injury or damage to other parts also. Acharya Vaghbhata mentioned the Marma Viddha lakshanas. They are Guruta, Sammhoha, Murccha, Shwasa etc. The main three Marmas are Shira, Hrudaya and Basti. If Aaghata or injury happens to this marmas then it leads to death. So therefore, study of marmas is very important aspect for physician and it is need of today’s era in Ayurveda.

Conclusion

Marma Science is a crucial component of Ayurveda. There are Marma spots located all over the body. A surgeon must have a thorough understanding of Marma since even the smallest error during surgery might result in serious complications or even patient death., therefore its aspect for clinical practice is more important. Acharya Sushruta states that the Marma is surrounded by the elements like Snayu, asthi, sandhi, Mamsa, sira and its connection connects with the Prana of a person.

Acharya Sushruta described marmas according to body parts, body regions. He mentioned that marmas present all over the body and its injury causes deformity, loss of function or death. Marma points is essential for clinician as these points are control point of body.