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# Vishalyaghna marma (a person may die if the foreign [[Sharira|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. 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. 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. Sa. Sharira Sthana 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].   

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].   

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.   

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 [[Ayu|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. 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. 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. 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. 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. Sa. Sharira Sthana Ghanekar Tika 6/23].   

Vishalyaghna or vaikalyakara marma sometimes causes death if they get brutally injured. Likewise, although kshipra marma is kalantara pranahara marma, may cause sudden death [Su. Sha. Ghanekar Tika 6/30].   

Vishalyaghna or vaikalyakara marma sometimes causes death if they get brutally injured. Likewise, although kshipra marma is kalantara pranahara marma, may cause sudden death [Su. Sa. Sharira Sthana Ghanekar Tika 6/30].   

The sadyapranahara marma are 19 in number, kalantara pranahara 33, vishalyaghna marma are 03, vaikalyakara marmas are 44 and rujakara marmas are 08 in number.  

The sadyapranahara marma are 19 in number, kalantara pranahara 33, vishalyaghna marma are 03, vaikalyakara marmas are 44 and rujakara marmas are 08 in number.  

==== 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 inflammation. 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, toxicity, 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.  

Sometimes it is seen that injury to hollow organ can cause death if an untrained person tries to remove the foreign [[Sharira|body]] from the site. The content of that organ may come out (it may be blood, urine, body fluids) and may lead to pain shock or severe acute inflammation causing death. This is seen in injury to urinary bladder or liver. Such type of cases are only handled by skilled person or else the symptoms mentioned in vishalyaghna pranahara marma ocours and the life of patient may be in danger.  

Sometimes it is seen that injury to hollow organ can cause death if an untrained person tries to remove the foreign [[Sharira|body]] from the site. The content of that organ may come out (it may be blood, urine, body fluids) and may lead to pain shock or severe acute inflammation causing death. This is seen in injury to urinary bladder or liver. Such type of cases are only handled by skilled person or else the symptoms mentioned in vishalyaghna pranahara marma occurs and the life of patient may be in danger.  

During road traffic accident or surgery the muscles, peripheral nerves, tendons, ligaments, bones or joints may get affected. It can cause long term or permenant disability as seen in Earb’s palsy, Klumpke’s palsy. Injury to axillary nerve causes loss of abduction of shoulder. Injury to radial nerve causes wrist drop. Injury to common peroneal nerve causes foot drop. Injury to ligaments and joints causes mal functioning of joints. Mal-union of fracture causes difficulty in movement. Hamstring tear in soccer player can affect flexion of knee. Tear in tendon of pectoralis major muscle is seen in weight lifters. It can affect adduction and flexion of shoulder. Such type of  permanent disabilities seen in injuries to vaikalyakara marma.  

During road traffic accident or surgery the muscles, peripheral nerves, tendons, ligaments, bones or joints may get affected. It can cause long term or permanent disability as seen in Earb’s palsy, Klumpke’s palsy. Injury to axillary nerve causes loss of abduction of shoulder. Injury to radial nerve causes wrist drop. Injury to common peroneal nerve causes foot drop. Injury to ligaments and joints causes mal functioning of joints. Mal-union of fracture causes difficulty in movement. Hamstring tear in soccer player can affect flexion of knee. Tear in tendon of pectoralis major muscle is seen in weight lifters. It can affect adduction and flexion of shoulder. Such type of  permanent disabilities seen in injuries to vaikalyakara marma.  

Undue movement of any synovial articulation causes severe pain as seen in sprain. It is due to partial injury to ligaments or tendons followed by inflammation. Similarly in fracture unbearable pain occur as seen in rujakara marma.   

Undue movement of any synovial articulation causes severe pain as seen in sprain. It is due to partial injury to ligaments or tendons followed by inflammation. Similarly in fracture unbearable pain occur as seen in rujakara marma.   

=== IV. Based on measurements ===  

=== IV. Based on measurements ===  

In the ancient era, the length, height, width, etc. was measured by ‘fingers’. The finger is the unit for measuring any solid object called ‘Angula’. For the measurement of body structure, one should consider the width of own figures. Based on dimensions, the marmas are classified into five categories:  

In the ancient era, the length, height, width, etc. was measured by ‘fingers’. The finger is the unit for measuring any solid object called ‘Angula’. For the measurement of body structure, one should consider the width of own figures. Based on dimensions, the marma are classified into five categories:  

# Eka angula (one finger in dimension)  

# Eka angula (one finger in dimension)  

# Dvi angula (two fingers in dimension)  

# Dwi angula (two fingers in dimension)

# Traya angula (three fingers in dimension)  

# Traya angula (three fingers in dimension)  

# Chatwari angula (four fingers in dimension)/ panitala (size of own palm)   

# Chatwari angula (four fingers in dimension)/ panitala (size of own palm)   

=== V. Based on predominance of elements ===  

=== V. Based on predominance of elements ===  

As each marma has a predominance of one or two basic elements, it has been divided into five groups:   

As each marma has a predominance of one or two basic elements, it has been divided into five groups:   

# [[Agni|Agni]] dominant

# [[Agni mahabhuta|Agni]] dominant

# Agni-soma dominant

# [[Agni mahabhuta|Agni]]-[[Jala mahabhuta|soma]] dominant

# Vayu dominant

# [[Vayu mahabhuta|Vayu]] dominant

# Soma dominant

# [[Jala mahabhuta|Soma]] dominant

# Agni-vayu dominant.  

# [[Agni mahabhuta|Agni]]-[[Vayu mahabhuta|vayu]] dominant.

The name, number, and classification of marma is given in table 1.  

The name, number, and classification of marma is given in table 1.  

== Importance of marma in preservation and prevention of health ==  

== Importance of marma in preservation and prevention of health ==  

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Understanding the vital areas of our body is essential while treating the patient with yantra (medical equipment), shastra (surgical instruments), kshara (corrosive chemicals like alkali) and agni (cautery) [Su.Sa. Sutra Sthana 1/1].  During these procedures, the surgeon should have complete knowledge of marma (vital parts). Otherwise, instead of benefits, the patient may land in specific complications. Injury to the marma or in the periphery of the marma site can bring patient’s life in danger [Su. Sha. Ghanekar Tika 6/40]. For this reason, knowledge of marma [[Sharira|sharira]] is considered as half part of surgery. [Su. Sha. Ghanekar Tika 6/44] The treatment of certain marmas with their signs and symptoms of infliction is mentioned. Infliction to kshipra and talahridaya marma (located in palms and soles) causes profuse bleeding that aggravates [[Vata dosha|vata]] and may prove fatal for [[Ayu|life]]. In such a condition, a surgeon can amputate the distal part of the extremity from the wrist or ankle to save the patient. [Su. Sha. Ghanekar Tika 6/42-43]   

Understanding the vital areas of our body is essential while treating the patient with yantra (medical equipment), shastra (surgical instruments), kshara (corrosive chemicals like alkali) and agni (cautery) [Su.Sa. Sutra Sthana 1/1].  During these procedures, the surgeon should have complete knowledge of marma (vital parts). Otherwise, instead of benefits, the patient may land in specific complications. Injury to the marma or in the periphery of the marma site can bring patient’s life in danger [Su. Sa. Sharira Sthana Ghanekar Tika 6/40]. For this reason, knowledge of marma [[Sharira|sharira]] is considered as half part of surgery. [Su. Sa. Sharira Sthana Ghanekar Tika 6/44] The treatment of certain marma with their signs and symptoms of infliction is mentioned. Infliction to kshipra and talahridaya marma (located in palms and soles) causes profuse bleeding that aggravates [[Vata dosha|vata]] and may prove fatal for [[Ayu|life]]. In such a condition, a surgeon can amputate the distal part of the extremity from the wrist or ankle to save the patient. [Su. Sa. Sharira Sthana Ghanekar Tika 6/42-43]   

While performing surgery the surgeon should know the vivid structural anatomy and its variation with probabilities of that particular region. In Cholecystectomy, the surgeon should know the variations in biliary apparatus otherwise bile leaks in peritoneum leads to biliary peritonitis and causes death. Similarly during open reduction surgery on elbow joint dislocation with fracture may damage ulnar, radial, or median nerve can cause paralysis.  

While performing surgery the surgeon should know the vivid structural anatomy and its variation with probabilities of that particular region. In Cholecystectomy, the surgeon should know the variations in biliary apparatus otherwise bile leaks in peritoneum leads to biliary peritonitis and causes death. Similarly during open reduction surgery on elbow joint dislocation with fracture may damage ulnar, radial, or median nerve can cause paralysis.  

=== 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 [Ash. Sa. Sha. 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 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]  

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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.[i] 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.[ii]   

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

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