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== Etymology ==

== Etymology ==

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The word ‘Marma’ is derived from the basic Sanskrit word ‘mri’, meaning ‘death’. The vital points of the body causing death after infliction is called ‘Marma’ [Su. Sa. Sharira Sthana Dalhana 6] [Ash. Sa. Sha. 7]. It is also considered to be the vital part of body causing death, unbearable pain, or permanent disability after injury. [Ash. Hri. Sha. Arundatta Tika 4]  

The word ‘Marma’ is derived from the basic Sanskrit word ‘mri’, meaning ‘death’. The vital points of the [[Sharira|body]] causing death after infliction is called ‘Marma’ [Su. Sa. Sharira Sthana Dalhana 6] [Ash. Sa. Sha. 7]. It is also considered to be the vital part of [[Sharira|body]] causing death, unbearable pain, or permanent disability after injury. [Ash. Hri. Sha. Arundatta Tika 4]  

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== Definition ==  

== Definition ==  

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Marma is defined as the anatomical structure where mansa (fleshy part or muscles), sira (vessels), snayu (ligaments), asthi (bones) and sandhi (articulations) are assembled and form a complex structure, which is also the site of prana (vital energy). [Su. Sa. Sharira Sthana 6/15] The body part that shows uncharacteristic pulsation with severe pain after infliction is called marma [Ash. Hri. Sha. 4/37]. Injury to marmas show fatal signs such as hypoxia, hypotension, hypovolemic shock (due to profuse blood lose) and severe pain. It can cause sudden death due to injury to cardiovascular center or respiratory center, as seen in capital punishment. Injury to marma may result in permanent disability as seen in upper or lower motor neuron lesions or injury to peripheral nerves or may be due to avascular necrosis. Or it may produce severe intolerable pain on infliction; such remarkable areas are known as ‘Marma’.  

Marma is defined as the anatomical structure where mansa (fleshy part or muscles), sira (vessels), snayu (ligaments), [[Asthi|asthi (bones)]] and sandhi (articulations) are assembled and form a complex structure, which is also the site of [[Prana|prana (vital energy)]]. [Su. Sa. Sharira Sthana 6/15] The [[Sharira|body]] part that shows uncharacteristic pulsation with severe pain after infliction is called marma [Ash. Hri. Sha. 4/37]. Injury to marmas show fatal signs such as hypoxia, hypotension, hypovolemic shock (due to profuse blood lose) and severe pain. It can cause sudden death due to injury to cardiovascular center or respiratory center, as seen in capital punishment. Injury to marma may result in permanent disability as seen in upper or lower motor neuron lesions or injury to peripheral nerves or may be due to avascular necrosis. Or it may produce severe intolerable pain on infliction; such remarkable areas are known as ‘Marma’.  

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== Classification of marma ==  

== Classification of marma ==  

Marmas are classified based on body part, structure, prognosis, dimension, and its basic constitution.   

Marmas are classified based on [[Sharira|body]] part, structure, prognosis, dimension, and its basic constitution.   

=== I. Based on body parts ===  

=== I. Based on body parts ===  

Marmas are classified into five categories based on their location on body:  

Marmas are classified into five categories based on their location on [[Sharira|body]]:  

# Sakthi marma (located in lower extremities)  

# Sakthi marma (located in lower extremities)  

# Bahu marma (located in the upper extremities)  

# Bahu marma (located in the upper extremities)  

# Sira marma (vascular structures are dominant)  

# Sira marma (vascular structures are dominant)  

# Snayu marma (the predominant structures are ligaments)  

# Snayu marma (the predominant structures are ligaments)  

# 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. Sha. 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.   

In Ashtanga hridaya, additionally, dhamani marma is described as a separate category. Dhamani marma has a dominance of specific tubular or cord-like structures. In Ashtanga Hridaya the mansa marmas are 10 in number, sira marmas are 37, snayu marmas are 23, asthimarmas are 8, sandhi marmas 20 and, dhamani marmas are 9 in number.   

In Ashtanga hridaya, additionally, dhamani marma is described as a separate category. Dhamani marma has a dominance of specific tubular or cord-like structures. In Ashtanga [[Hridaya|Hridaya]] the mansa marmas are 10 in number, sira marmas are 37, snayu marmas are 23, asthi marmas are 8, sandhi marmas 20 and, dhamani marmas are 9 in number.   

=== III. Based on prognosis after injury ===

=== III. Based on prognosis after injury ===

# Sadyapranahara marma (leads to immediate death)  

# Sadyapranahara marma (leads to immediate death)  

# Kalantara pranahara marma (death after few days)  

# Kalantara pranahara marma (death after few days)  

# Vishalyaghna marma (a person may die if the foreign body is removed soon after penetration)  

# Vishalyaghna marma (a person may die if the foreign [[Sharira|body]] is removed soon after penetration)  

# Vaikalyakara marma (injury causes permanent disability)   

# Vaikalyakara marma (injury causes permanent disability)   

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

# Rujakara marma (unbearable pain occurs after injury) [Su. Sha. 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 (light or heat: a source of eternal energy, deities which empower entire life). Injury to sadyapranahara marma affects agni leading to sudden death [Su. Sha. Ghanekar Tika 6/23].   

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. Sha. Ghanekar Tika 6/23].   

Injury to kalantara pranhara marma results in death within 15 to 30 days [Su. Sha. Ghanekar Tika 6/30] because it has predominance of agni (light or heat: a source of eternal energy, deities which empower entire 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. Sha. Ghanekar Tika 6/23].   

Injury to kalantara pranhara marma results in death within 15 to 30 days [Su. Sha. 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. Sha. Ghanekar Tika 6/23].   

Vishalyaghna marmas also cause death only when the shalya (foreign body) is removed soon after injury. As the vishalyaghna marma predominates with vayu mahabhuta, the penetrated foreign body obstructs the opening. The vayu can’t escape from it, and a person can survive. Extraction of the foreign body causes the evacuation of vayu from vital sites, and the person dies immediately. But the person can survive if the foreign body comes out automatically after purulence.   

Vishalyaghna marmas also cause death only when the shalya (foreign body) is removed soon after injury. As the vishalyaghna marma predominates with [[Vayu mahabhuta|vayu mahabhuta]], the penetrated foreign body obstructs the opening. The vayu can’t escape from it, and a person can survive. Extraction of the foreign body causes the evacuation of vayu from vital sites, and the person dies immediately. But the person can survive if the foreign body comes out automatically after purulence.   

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 life of a person. [Su. Sha. 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. Sha. Ghanekar Tika 6/23]   

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

==== Clinical aspect ====

==== Clinical aspect ====

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Injury to temporal region, vertex, neck, cervical region, occipital region, brain stem, cardiac area, hypogastric region (rupture of urinary bladder) can cause sudden death or death after few days. The reason may be suppression of some neurological centers, profuse blood loss,cerebral oedema,  pain shock infarction or infection and inflametion. This type of circumstances occur with injury to sadyapranahar marma.  

Injury to temporal region, vertex, neck, cervical region, occipital region, brain stem, cardiac area, hypogastric region (rupture of urinary bladder) can cause sudden death or death after few days. The reason may be suppression of some neurological centers, profuse blood loss, cerebral oedema,  pain shock infarction or infection and inflametion. This type of circumstances occur with injury to sadyapranahar marma.  

In certain cases, the injured person can't die soon after injury. But after 15 days he/she may show severe complications such as infection, septicemia, electrolytes imbalance, toxisity, mal functioning of vital organs or blood loss. This type of condition seen in burn cases or injury to pectoral region (lungs or pleura), hypochondriac region (partial rupture of liver or spleen), extremities (blood vessels) or some part of back. This type of conditions can be due to injury to kalantara pranahara marma.  

In certain cases, the injured person can't die soon after injury. But after 15 days he/she may show severe complications such as infection, septicemia, electrolytes imbalance, toxisity, mal functioning of vital organs or blood loss. This type of condition seen in burn cases or injury to pectoral region (lungs or pleura), hypochondriac region (partial rupture of liver or spleen), extremities (blood vessels) or some part of back. This type of conditions can be due to injury to kalantara pranahara marma.