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Marmas are  the sites of [[Prana|prana (soul)]], [[Agni|agni]] (light or heat: a source of eternal energy), soma (water or an eternal source of calmness) and [[Pancha mahabhuta|panchamahabhuta (five fundamental elements)]]. Prognosis after injury, significantly depends on the composition of these vital energies.   

Marmas are  the sites of [[Prana|prana (soul)]], [[Agni|agni]] (light or heat: a source of eternal energy), soma (water or an eternal source of calmness) and [[Pancha mahabhuta|panchamahabhuta (five fundamental elements)]]. Prognosis after injury, significantly depends on the composition of these vital energies.   

The science of Marma was known to mankind from Vedic period, and it has especially been designed to determine the prognosis of injuries at the time of war. Simultaneously, marma knowledge was applied to cause fatal trauma to the enemy leading to victory on the battlefield. Acharya Charaka mentions the 107 Marmas in [[Charak Samhita New Edition|Charak Samhita]] (100BCE-200BC). However, being a physician, Charak has emphasized three major marmas, which are shira (head), [[Hridaya|hridaya (heart)]], and [[Basti|basti (urinary bladder)]]. He gave a vivid description in [[Charak Samhita New Edition|Charak Samhita]] [Cha. Sa. Chikitsa Sthana 26/01].  Acharya Sushruta also identified 107 Marmas in the human [[Sharira|body]]. As a surgeon, he contributed detailed explanations on this topic. Acharya Vagbhata also mentioned 107 marmas in [[Sharira Sthana|Sharira Sthana]] of Ashtanga [[Hridaya|Hridaya]] with slight variation.  The present article describes marma concept, surface anatomy, and practical application.   

The science of Marma was known to mankind from Vedic period, and it has especially been designed to determine the prognosis of injuries at the time of war. Simultaneously, marma knowledge was applied to cause fatal trauma to the enemy leading to victory on the battlefield. Acharya Charaka mentions the 107 Marmas in [[Charak Samhita New Edition|Charak Samhita]] (100BCE-200BC). However, being a physician, Charak has emphasized three major marmas, which are shira (head), [[Hridaya|hridaya (heart)]], and [[Basti|basti (urinary bladder)]]. He gave a vivid description in [[Charak Samhita New Edition|Charak Samhita]] [Cha. Sa. [[Chikitsa Sthana]] 26/01].  Acharya Sushruta also identified 107 Marmas in the human [[Sharira|body]]. As a surgeon, he contributed detailed explanations on this topic. Acharya Vagbhata also mentioned 107 marmas in [[Sharira Sthana|Sharira Sthana]] of Ashtanga [[Hridaya|Hridaya]] with slight variation.  The present article describes marma concept, surface anatomy, and practical application.   

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{{Infobox  

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# Ura and udarastha (in the region of thorax and abdomen)   

# Ura and udarastha (in the region of thorax and abdomen)   

# Prushtha (in the back)   

# Prushtha (in the back)   

# Jatrurdhva (in head and neck) [Su. Sha. Ghanekar Tika 6/4].

# Jatrurdhva (in head and neck) [Su. Sa. Sharira Sthana Ghanekar Tika 6/4].

There are 11 Marmas in each extremity, making the total number 44. 12 marmas are in the trunk. On the back, the number is 14, and 37 marmas are present in the head and neck region.   

There are 11 marmas in each extremity, making the total number 44. The 12 marmas are in the trunk. On the back, the number is 14, and 37 marmas are present in the head and neck region.   

=== II. Based on structural components ===  

=== II. Based on structural components ===  

# Snayu marma (the predominant structures are ligaments)  

# Snayu marma (the predominant structures are ligaments)  

# [[Asthi|Asthi]] marma (osseous tissue is predominant here)   

# [[Asthi|Asthi]] marma (osseous tissue is predominant here)   

# Sandhi marma (at the area of articulation) [Su. Sha. Ghanekar Tika 6/3].

# Sandhi marma (at the area of articulation) [Su. Sa. Sharira Sthana  Ghanekar Tika 6/3].

Mansa marmas are 11 in number, sira marmas are 41, snayu marmas are 27, asthi marmas are 8 and sandhi marmas are 20 in number.   

Mansa marmas are 11 in number, sira marmas are 41, snayu marmas are 27, asthi marmas are 8 and sandhi marmas are 20 in number.   

# Rujakara marma (unbearable pain occurs after injury) [Su. Sa. Sharira Sthana Ghanekar Tika 6/14].

# Rujakara marma (unbearable pain occurs after injury) [Su. Sa. Sharira Sthana Ghanekar Tika 6/14].

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After an injury to sadyapranahara marma the person dies soon after injury or within seven days [Su. Sha. Ghanekar Tika 6/30] as it has a predominance of [[Agni|agni]] (light or heat: a source of eternal energy, deities which empower entire life). Injury to sadyapranahara marma affects [[Agni|agni]] leading to sudden death [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].   

After an injury to sadyapranahara marma the person dies soon after injury or within seven days [Su. Sa. Sharira Sthana Ghanekar Tika 6/30] as it has a predominance of [[Agni|agni]] (light or heat: a source of eternal energy, deities which empower entire life). Injury to sadyapranahara marma affects [[Agni|agni]] leading to sudden death [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].   

Injury to kalantara pranhara marma results in death within 15 to 30 days [Su. Sa. Sharira Sthana Ghanekar Tika 6/30] because it has predominance of [[Agni|agni]] (light or heat: a source of eternal energy, deities which empower entire [[Ayu|life]]) and Soma (water or an eternal source of calmness). Their injury leads to death after a certain period due to the presence of Soma energy. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].   

Injury to kalantara pranhara marma results in death within 15 to 30 days [Su. Sa. Sharira Sthana Ghanekar Tika 6/30] because it has predominance of [[Agni|agni]] (light or heat: a source of eternal energy, deities which empower entire [[Ayu|life]]) and Soma (water or an eternal source of calmness). Their injury leads to death after a certain period due to the presence of Soma energy. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].   

Injury to vaikalyakara marma causes permanent disability. The chances of death are negligible due to soma energy (water or an eternal source of calmness). It provides stability that protects the [[Ayu|life]] of a person. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23]   

Injury to vaikalyakara marma causes permanent disability. The chances of death are negligible due to soma energy (water or an eternal source of calmness). It provides stability that protects the [[Ayu|life]] of a person. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23]   

Rujakara Marma shows dominance of [[Agni|agni]] and [[Vayu mahabhuta|vayu mahabhuta]]. Due to the dominance of [[Agni|agni]] and [[Vayu mahabhuta|vayu mahabhuta]], infliction to this marma causes severe pain. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].  

Rujakara Marma shows dominance of [[Agni|agni]] and [[Vayu mahabhuta|vayu mahabhuta]]. Due to the dominance of [[Agni|agni]] and [[Vayu mahabhuta|vayu mahabhuta]], infliction to this marma causes severe pain. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23]   

If the injury site is near marma (not exactly on it), then the intensity of the symptoms will be less. The injury nearer to sadyapranahara marma causes death after 15 days as it appears like a kalantara pranahara marma. As the similar condition occurs with kalantara pranahara marma or vishalyaghna marma, it seems like vaikalyakara marma. When the injury is in the periphery of vaikalyakara marma, it causes severe pain, as in rujakara marma. If the latter is injured in the periphery, it gives minimal pain. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].   

If the injury site is near marma (not exactly on it), then the intensity of the symptoms will be less. The injury nearer to sadyapranahara marma causes death after 15 days as it appears like a kalantara pranahara marma. As the similar condition occurs with kalantara pranahara marma or vishalyaghna marma, it seems like vaikalyakara marma. When the injury is in the periphery of vaikalyakara marma, it causes severe pain, as in rujakara marma. If the latter is injured in the periphery, it gives minimal pain. [Su. Sa. Sharira Sthana Ghanekar Tika 6/23].   

During spinal surgeries there may be the chances of trauma to spinal roots that leads to lower motor neuron palsy.   

During spinal surgeries there may be the chances of trauma to spinal roots that leads to lower motor neuron palsy.   

The neck is the most delicate region of our [[Sharira|body]] while performing the surgeries on neck region for example in thyroidectomy severe bleeding may obstruct air way leads to respiratory distress, or sometime injury to recurrent laryngeal nerve cazuses permanent hoares voice.  

The neck is the most delicate region of our [[Sharira|body]] while performing the surgeries on neck region for example in thyroidectomy severe bleeding may obstruct air way leads to respiratory distress, or sometime injury to recurrent laryngeal nerve causes permanent hoarse voice.  

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=== Common symptoms due to injury to marma ===  

=== Common symptoms due to injury to marma ===  

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Heaviness, drowsiness, dizziness, syncope, cold extremity, perspiration, vomiting, and dyspnoea are common symptoms due to Marma's infliction [A. Sa. Sharira Sthana 7]. Giddiness, delirium, falling, confusion, loss of movement, seizures, fever, laxity in body parts, fainting, dyspnoea, severe pain caused by vata, bleeding that appears like meat wash (mamsa dhavana) and loss of sensory perception are the general symptoms of injury to vital part.[Su. Sa. Sutra Sthana 25/34-35]  

Heaviness, drowsiness, dizziness, syncope, cold extremity, perspiration, vomiting, and dyspnea are common symptoms due to Marma's infliction [A. Sa. Sharira Sthana 7]. Giddiness, delirium, falling, confusion, loss of movement, seizures, fever, laxity in body parts, fainting, dyspnea, severe pain caused by vata, bleeding that appears like meat wash (mamsa dhavana) and loss of sensory perception are the general symptoms of injury to vital part.[Su. Sa. Sutra Sthana 25/34-35]  

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== Marma therapy in Siddha medicine ==  

== Marma therapy in Siddha medicine ==  

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According to Siddha medicine, Varmam points (vital points) are the places in the [[Sharira|body]] where the subtle Varmam energy is found.<ref>Shunmugom N: Medical Vermology basic concept kaibagam-seibhagam. Coimbatore Tamil Nadu India: Thirumoolar Varmalogy Institute 2017</ref> There are 108 such vital points in the human [[Sharira|body]] divided into two groups: Padu Marma and Thodu Marma. The Padu Marmas are 12 and Thodu Marmas are 96 in number. Clinically the Padu Marmas are essential. Manipulating or stimulating Marma points in the management of diseases is called ‘marma chikitsa (marma therapy)’ and humans have the inherent power to heal through these points. Through stimulation of marma by various means and methods, the prana (vital energy) existing in it may be directed to remove blockages (even in remotely connected areas) and stimulate energy flow thus resulting in a state of healthy [[Sharira|body]], [[Manas|mind]], and spirit. A judicious application of pressure on appropriate Marma can restore the normal functioning of prana (in affected body parts) where improper manipulation may cause severe pain, disability, deformity and even death.[ii]  

According to Siddha medicine, Varmam points (vital points) are the places in the [[Sharira|body]] where the subtle Varmam energy is found.<ref>Shunmugom N: Medical Vermology basic concept kaibagam-seibhagam. Coimbatore Tamil Nadu India: Thirumoolar Varmalogy Institute 2017</ref> There are 108 such vital points in the human [[Sharira|body]] divided into two groups: Padu Marma and Thodu Marma. The Padu Marmas are 12 and Thodu Marmas are 96 in number. Clinically the Padu Marmas are essential. Manipulating or stimulating Marma points in the management of diseases is called ‘marma chikitsa (marma therapy)’ and humans have the inherent power to heal through these points. Through stimulation of marma by various means and methods, the prana (vital energy) existing in it may be directed to remove blockages (even in remotely connected areas) and stimulate energy flow thus resulting in a state of healthy [[Sharira|body]], [[Manas|mind]], and spirit. A judicious application of pressure on appropriate Marma can restore the normal functioning of prana (in affected body parts) where improper manipulation may cause severe pain, disability, deformity and even death.<ref name=":0">Vineeta Negi: Marma & Marma Therapy: A Review, Article in World Journal of Pharmaceutical Research · August 2018 DOI: 10.20959/wjpr201815-12973 <nowiki>https://www.researchgate.net/publication/326826604_Marma_and_Marma_Therapy_A_Review</nowiki></ref>  

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There are 12 methods of varmam application as follows,[iii]

There are 12 methods of varmam application as follows,<ref name=":0" />

# Gentle movement  

# Gentle movement  

# Mild movements  

# Mild movements  

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=== Importance of marma therapy:[iv] ===  

=== Importance of marma therapy:<ref>National Health Portal: Marma therapy. Available from www.nhp.gov. Accessed on 26/02/18.</ref> ===  

# Removes blocks in energy channels (srotas)  

# Removes blocks in energy channels ([[srotas]])

# Pacifies doshas bringing them to a normal path (especially vyana vayu which controls autonomic nervous system)  

# Pacifies [[Dosha|doshas]] bringing them to a normal path (especially vyana vayu which controls autonomic nervous system)

# Creates physical, mental, and emotional flexibility  

# Creates physical, mental, and emotional flexibility  

# Creates an opportunity to experience powerful and dynamic transformation at physical, mental, emotional, and spiritual levels by building a positive link with the unconscious mind.   

# Creates an opportunity to experience powerful and dynamic transformation at physical, mental, emotional, and spiritual levels by building a positive link with the unconscious mind.   

{| class="wikitable"

{| class="wikitable"

|+ Table 1: The name, number, and classification of Marma.  

|+Table 1: Name, number, and classification of marma.

|-  

|-  

! Sr. no.

! Sr. no.

|-

|-

| 5

| 5

| Gulfa

| Gulpha

| Junction of foot & leg

| Junction of foot & leg

| Pain, immobility & disability

| Pain, immobility & disability

There are 12 methods of varmam application as we have seen earlier. All these methods can be executed on varmam point. The Siddhas had propounded that the application of these 12 techniques on a single point is capable of curing 48 different diseases.   

There are 12 methods of varmam application as we have seen earlier. All these methods can be executed on varmam point. The Siddhas had propounded that the application of these 12 techniques on a single point is capable of curing 48 different diseases.   

This therapy is able to remove blocks in energy channels (srotas), pacify dosha bringing it to the normal path (especially vyana vayu, which controls the autonomic nervous system), creates physical, mental, and emotional flexibility, and create an opportunity to experience powerful and dynamic transformation at a physical, mental, emotional and spiritual level by building a positive link with the subconscious [[Manas|mind]].  

This therapy is able to remove blocks in energy channels ([[srotas]]), pacify dosha bringing it to the normal path (especially vyana vayu, which controls the autonomic nervous system), creates physical, mental, and emotional flexibility, and create an opportunity to experience powerful and dynamic transformation at a physical, mental, emotional and spiritual level by building a positive link with the subconscious [[Manas|mind]].  

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