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|title=Marma

|title=Marma

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|keywords= Marma chikitsa, marma therapy, carakasamhitaonline, charak samhita, caraka samhita, ayurved, Marma, Marma in ayurveda, Marma meaning, Kasar N.V, Basisht G., Deole Y.S., Classification of marma, Importance of marma in preservation and prevention of health, Common symptoms due to injury to marma, Marma therapy in Siddha medicine, Advantages of marma knowledge in modern surgery

|keywords= Marma chikitsa, marma therapy, carakasamhitaonline, charak samhita, caraka samhita, ayurved, Marma, Marma in ayurveda, Marma meaning, Kasar N.V, Basisht G., Deole Y.S., surface anatomy, ayurveda, indian system of medicine, surgery in ayurveda, Classification of marma, Importance of marma, health, injury to marma, Marma therapy, Siddha medicine, Advantages of marma knowledge in modern surgery

|description=Vital points of the body. These are major seats of prana in the body which are 107 in number according to Ayurveda

|description=Vital points of the body. These are major seats of prana in the body which are 107 in number according to Ayurveda

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

|image=http://www.carakasamhitaonline.com/resources/assets/ogimgs.jpg

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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 Charak mentions the 107 marmas in [[Charak Samhita New Edition|Charak Samhita]] (100 BCE-200 BC). 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  

{{Infobox  

== Definition ==  

== Definition ==  

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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’.  

Marma is defined as the anatomical structure where mamsa (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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=== II. Based on structural components ===  

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

The marma has been classified into five groups according to the structural components.   

The marma has been classified into five groups according to the structural components.   

# Mansa marma (in which the fleshy part is dominant)  

# Mamsa marma (in which the fleshy part is dominant)  

# 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)  

# Sandhi marma (at the area of articulation) [Su. Sa. Sharira Sthana  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.   

Mamsa 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|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.   

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 mamsa 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 ===

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].   

The location, symptoms and, structural anatomy of individual marma is given in table 2.  

The location, symptoms and, structural anatomy of individual marma is given in table 2.  

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

== Importance of marma in preservation of [[health]] and prevention of [[disease]]  ==  

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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. 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]   

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 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]  

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.<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>   

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,<ref name=":0" />  

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

|-

|-

|  

|  

| 1 Mansa marma (dominancy of fleshy structure)

| 1 Mamsa marma (dominancy of fleshy structure)

| 11

| 11

| Talahridaya 4, Indrabasti 4, Guda 1, Stanarohita 2,

| Talahridaya 4, Indrabasti 4, Guda 1, Stanarohita 2,

| 5 Sandhi marma (at the region of articulation)

| 5 Sandhi marma (at the region of articulation)

| 20

| 20

| Janu 2, Kurpar 2, Simanta 5, Adhipati 1, Gulfa 2, Manibandha 2, Kukundar 2, Avarta 2,Krukatika 2.

| Janu 2, Kurpar 2, Simanta 5, Adhipati 1, Gulpha 2, Manibandha 2, Kukundar 2, Avarta 2,Krukatika 2.

|-

|-

|  

|  

|-

|-

|  

|  

| 1 Mansa marma (dominancy of fleshy structure)

| 1 Mamsa marma (dominancy of fleshy structure)

| 10

| 10

| Talahriday 4, Indrabasti 4, Stanarohita 2.

| Talahriday 4, Indrabasti 4, Stanarohita 2.

| 5 Rujakar marma (unbearable pain occurs after infliction)

| 5 Rujakar marma (unbearable pain occurs after infliction)

| 08

| 08

| Gulfa 2, Manibandha 2, Kurchashira 4, Avarta 2.

| Gulpha 2, Manibandha 2, Kurchashira 4, Avarta 2.

|-

|-

| style="text-align:center;" | '''4'''

| style="text-align:center;" | '''4'''

| 2 Dvi angula pramanam (two finger in dimension)

| 2 Dvi angula pramanam (two finger in dimension)

| 6

| 6

| Stanamula 2, Manibandha 2, Gulfa 2.

| Stanamula 2, Manibandha 2, Gulpha 2.

|-

|-

|  

|  

|-

|-

| 5

| 5

| Gulfa

| Gulpha

| Junction of foot & leg

| Junction of foot & leg

| Pain, immobility & disability

| Pain, immobility & disability

== Advantages of marma knowledge in modern surgery ==

== Advantages of marma knowledge in modern surgery ==

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Marma is one of the unique and vital topics discussed in [[Ayurveda|Ayurveda]]. It plays an essential role in surgery. Hence it is called Shalya Vishayardha (half knowledge of surgery). Unless one has not obtained proper knowledge of vital parts of [[Sharira|body]],  he/she will not be a good surgeon. While performing the surgeries on upper and lower limb surgeon should know the Urvi, Bahavi, Aani, Indrabasti Marmas etc. Because major blood vessels pass through these areas, injury to these vessels during surgery can cause severe blood loss. Similarly, injury to Gulfa, Janu, Kurpara, Manibandha, causes trauma to any one or more ligaments of joint leads to severe pain and disability. During the surgeries on cubital or popliteal fossa, the surgeon should know the position of blood vessels and nerves; otherwise the patient will be in severe complications. So to avoid complications and get the desired outcome surgeon should have proper knowledge of marma sharira.   

Marma is one of the unique and vital topics discussed in [[Ayurveda|Ayurveda]]. It plays an essential role in surgery. Hence it is called Shalya Vishayardha (half knowledge of surgery). Unless one has not obtained proper knowledge of vital parts of [[Sharira|body]],  he/she will not be a good surgeon. While performing the surgeries on upper and lower limb surgeon should know the Urvi, Bahavi, Aani, Indrabasti Marmas etc. Because major blood vessels pass through these areas, injury to these vessels during surgery can cause severe blood loss. Similarly, injury to Gulpha, Janu, Kurpara, Manibandha, causes trauma to any one or more ligaments of joint leads to severe pain and disability. During the surgeries on cubital or popliteal fossa, the surgeon should know the position of blood vessels and nerves; otherwise the patient will be in severe complications. So to avoid complications and get the desired outcome surgeon should have proper knowledge of marma sharira.   

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The wide scope of research is seen in ‘Marma Chikitsa' developed in the southern part of India. One can manage or treat certain orthopaedic, muscular or neurological disorders with the help of  gentle movement, clenching the varmam point, mild tapping, gentle stroking,  pressing point with a single finger. By applying this therapy, one may avoid surgery and its further complications.   

The wide scope of research is seen in ‘Marma Chikitsa' developed in the southern part of India. One can manage or treat certain orthopaedic, muscular or neurological disorders with the help of  gentle movement, clenching the varmam point, mild tapping, gentle stroking,  pressing point with a single finger. By applying this therapy, one may avoid surgery and its further complications.   

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== References ==

== References ==